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1.3.20 Hard to Engage Families

SCOPE OF THIS CHAPTER

This chapter was added to the manual in February 2015 and is used with the kind permission of Milton Keynes SCB.


Contents

  1. Introduction
  2. Reasons Why Some Families Find it Difficult to Engage
  3. Definition and Recognising Difficult to Engage Behaviour
  4. Dealing with Hostility and Violence
  5. Managing Transitions between Services
  6. Managing Failure to Attend
  7. Working with Lack of Co-operation
  8. Impact on the Child
  9. When Families will Not Engage at all
  10. Moving the Case Forward
  11. Hard to Engage Professionals Meetings (at times this will be a Strategy Meeting) Multi Agency professionals Meeting to Consider Issues of Non-Engagement
  12. Closure of Case by Any One Agency
  13. Hard to Engage Flowchart

    Further Information


1. Introduction

A feature in Serious Case Reviews across Dorset, Poole and Bournemouth as well as nationally has been the lack of co-operation and/or hostile attitude of parents/carers and some older young people. When there are child welfare/protection issues, a failure to engage with the family may have serious implications and non-intervention is not an option. Accurate information and clear understanding of what is happening to a child is the main focus of all work with families. If families are deliberately preventing professionals from working with them it is important for workers to record and assess what areas of work are difficult to achieve and why.

In brief all workers who work with these families should be mindful of the following:

  • Workers identifying an issue arising from concerns about poor access/engagement should promptly discuss this with their line manager and other agencies working with the family;
  • Workers should ensure all discussions and attempts at engagement are clearly recorded;
  • Workers should assess the impact on the child and consider the speed of the response to non-engagement;
  • Workers should share information across agencies.


2. Reasons Why Some Families Find it Difficult to Engage

Some of the reasons why families find it difficult to engage include the following:

  • Previous negative experience of agencies or hearsay about agencies;
  • Experience of intervention as a young person or as a parent;
  • Not understanding professionals concerns;
  • Cultural differences;
  • Genuine fear- will my children be removed;
  • Anti-authority stance;
  • Lack of / poor communication from professionals;
  • Consider family life to be private and do not want to have their privacy invaded;
  • Having something to hide, which may or not be in relation to safeguarding.


3. Definition and Recognising Difficult to Engage Behaviour

Parents may present in a number of ways on a continuum from hostility, threats and violence through to superficial and ineffective engagement. Behaviours may include:

Ambivalence can be displayed when people are consistently late for planned appointments or they always have an excuse for missing a visit. When discussion an uncomfortable topic such as a worker sharing concerns, the subject will be changed and dismissive body language is used. It may include agreeing to take action and then not doing so. Ambivalence is often evident where there is lack of progress in a plan.

Ambivalence is a common occurrence and does not necessarily mean it will be difficult to engage with the family. It can occur due to the family being unclear about what is expected of them or poor experiences with previous professionals.

Avoidance includes cancelling or missing appointments, not answering the door or cutting short visits due to other apparent important activities.

Avoidance is very common and often indicates that the service user is anxious about the prospect of involvement and wants to escape from the situation.

Refusal includes when families will not meet with workers or refuse for a child to be seen on their own.

Confrontation includes provoking arguments, challenging the professionals in a way that deflects attention from the safeguarding issues.

Confrontation can indicate a deep-seated lack of trust leading to a "fight" not "flight" situation. It is important in these situations that workers are clear about their role and purpose by demonstrating a concern to support the family. However at some point the parent's behaviour will have to be challenged safely so they are able to understand that professionals will not give up working with the family. This may require the professional/having to cope with confrontation until co-operation can be achieved.

Violence may be threatened or actually acted out. It may involve damage to property or physical harm to professionals. Adults and young people may have previous experience of getting their way through violence and intimidation.

Violence from service users may only involve a minority of cases but is the most difficult and challenging of hard to engage behaviours to work with. Risk assessments, information sharing across agencies and support from Police to ensure safety may be needed alongside persistent attempts to understand the situation and reach a point where work can be undertaken safely.


4. Dealing with Hostility and Violence

Some families will respond with threats of violence however the worker approaches the situation. In these instances it is important that Health and Safety procedures are followed; this will include support from the Case Manager. Professionals and the child's safety must be assessed and managed safely.

Threatening behaviour can be covert or implied and consist of :

  • Bombarding workers with emails and phone call;
  • Domineering body language;
  • Intimidating and derogatory language;
  • Swearing;
  • Shouting;
  • Physical violence / damage to property;
  • Racist or homophobic attitudes and  remarks.

Where there are actual threats or incidents of violence the incidents must be reported to the first line manager immediately and agency procedures followed in relation to supervision, support, recording and reporting incidents to the police.

Any response must take account of:

  • Risks to children and other family members;
  • Personal safety issues for staff.

The experience of violence or threats to staff should be used as evidence of the situation of the family and included in assessments of the child's circumstances.

Violence towards staff is a multi-agency problem. If one agency has information a parent/carer is known to be violent, it must alert other agencies of the risks posed. Where an agency is aware of weapons being owned by service users this information will be accessible to inform risk assessments.

Identifying and working with service users, or their families, who are likely to be hostile or violent:

  • Procedures for sharing risk assessments;
  • Making clear statements to service users and their families that violence will not be tolerated;
  • Training for staff to ensure they are confident in de-escalation of difficult interactions;
  • Procedures for arranging joint visits, either with colleagues or with representatives of other agencies;
  • Where appropriate, training for staff in self/defence and/or restraint.


5. Managing Transitions between Services

Often work with non engaging families can be successful if agencies work together. The following are some strategies for supporting families engage across agencies.

When the threshold is met to refer to specialist agencies, the following prompts will assist:

Making an effective, clear referral to another agency is essential and care should be taken to include:

  • A description of the services provided to date and how the service user has engaged with this service;
  • Evidence to support the analysis of the needs of the service user;
  • A description of the specialist service required;
  • Expected outcomes from the specialist service;
  • Clearly setting out expectations with regard to feedback to the receiving agency;
  • A full risk assessment, describing any risks and factors that might aggravate these risks. This assessment might also be shared with other agencies involved with the service user.

Clearly communicating, to the service user, the need for the referral, what the service user might experience in engaging with the service and what the outcomes of the specialist service are likely to be (this might include):

  • A description of how the service is provided, what flexibility there is in terms of venues, times, etc and what sort of professionals they might encounter;
  • The outcomes generally achieved by the specialist service.

Raising the confidence of service users in the specialist service (this might include):

  • Describing the experiences of others that have used the service and what the service user might expect;
  • Engaging other family members/friends who are supportive of the referral;
  • Providing a previous service user as a mentor;
  • Visiting the service with the service user, perhaps identifying a suitable worker to accompany the service user – family support worker, health visitor, social worker, for example:
    • Sharing information about the services;
    • Discussing with the service user any difficulties that might be anticipated and working out shared strategies to manage these.

Communicating to the specialist service any difficulties that might be encountered in engaging with the service user:

  • Any information that leads the referring agency to suspect the service user might be hostile or violent towards the specialist service providers;
  • Any risk assessments that identify triggers and ways of managing conflict that are known to be successful;
  • Any factors that might cause the service user to be mistrustful of the service (social, cultural, religious, ethnic or service user’s personal history;
  • Any reasons the service user might be scared or anxious about the service;
  • Any mobility, financial or geographic issues that may make it difficult for the service user to access the specialist service;
  • Any language or other communication difficulties that the service user has that might make engagement difficult.

Communicating to the specialist service any strategies that have been, or could be, used to overcome difficulties with engagement:

  • Support with communication;
  • Support with transport/mobility;
  • Provision of specialist intermediaries;
  • Times of the day/week when the service users are most accessible for communication;
  • Details of other family members/friends supportive of the referral;
  • The service users’ feelings and expressed wishes.

Making an appropriate and personal invitation to the service user to the first session with the specialist agency:

  • Sending a welcoming letter;
  • Telephoning the service user;
  • Liaising with the service user via a trusted worker from the referring agency;
  • Ensuring that other relevant agencies are informed in writing of any invitation whether verbal or written;
  • Where the referrer intends to support the service user in attending the appointment, liaising with the referrer to ensure a mutually convenient appointment is secured;
  • Copying in the referrer to ensure that where they intend to support the service user, they have the details directly.

Use of language:

  • Reduce the use of technical vocabulary;
  • Check whether written communications can be understood by the service users
  • Consider alternatives with service users for who English is not a comfortable communication medium;
  • Where communication is difficulty, check the understanding of key points before moving on.

On-going communication with the referring agency:

  • Regular and frequent updating communication on the progress of the specialist service towards its agreed objectives;
  • Participating in multi-agency meetings;
  • Alerting the referring service if the service user shows signs of beginning to disengage;
  • Proper notification to the referring service if the referral case is closed through lack of engagement, including engagement/re-engagement strategies tried.


6. Managing Failure to Attend

Any agency that receives a referral should ensure appropriate responses if service users fail to attend or repeatedly cancel and re-book appointments:

  • Repeat communication;
  • Additional communication via different medium – text, e-mail, social networking sites;
  • Seeking support from referring agency worker;
  • Visit from Outreach Worker;
  • Support with transport/mobility.

Appropriate responses to repeated failure to attend:

  • A further repertoire of strategies to reach out to the service user;
  • Calling a multi-agency meeting;
  • A maximum on the number of attempts to engage with the service user before closing the case;
  • Feedback to the referring agency for joint agreement on next steps.


7. Working with Lack of Co-operation

Identifying service users, or their family members, who are disguising their lack of co-operation and compliance:

  • Ensuring clear communication to avoid claims from the service user that they did not understand;
  • Joint working with other agencies to share perspectives/observations and ensure consistency;
  • Ensuring observations correspond with what is being reported by service users;
  • Setting of clear goals with measures to show improvement;
  • Guidance on challenging service users when there is poor co-operation.

Appropriate responses and procedures to be followed when service users or their family members make complaints (informal/formal) about individual service providers as a method of avoiding engaging with the specialist service:

  • Complaints processes which aim to resolve difficulties whilst maintaining professional relationships and the momentum of work to meet the needs of the children is not affected;
  • Risk assessment strategies to identify if/when complaints are being made in an attempt to avoid or disengage;
  • Enhanced management and supervision arrangements to secure highest quality professionalism and service delivery in such situations. (This might involve higher level supervision and management, as frequently team managers become involved in complaints of this type);
  • Openness to considering the risks and benefits, to the service and the service user, of allocating the case to a different worker/team of workers;
  • Strategies to care for and support workers/managers involved in such situations.


8. Impact on the Child

The child may be desensitised to what is going on around then particularly if they live in an atmosphere of hostility and aggression. The child may protect the parent because they love then or are fearful of them. It is important that practitioners attempt to understand the child’s situation and gather as much information as possible from workers who are having contact with the family. It is particularly important to gather and understand any information available from observing the parents and child together to understand if the child is acting compliant or frightened.


9. When Families will Not Engage at all

It is important to assess how far the non engagement is impacting on the assessment process and consider if this is placing a child at increased risk. Practitioners should always consider if the non engagement means that there is serious concern for a child’s welfare. If this is the situation a referral should be made to Child Service’s Social Care. If the child is already know to Social Care the non engagement may mean the case meets the threshold for a strategy discussion. Careful consideration should be given to the implications of poor access for multi-agency work with the family and good inter-agency communication should be maintained.

Legal advice will be sought to establish if there are legal interventions available.


10. Moving the Case Forward

Workers from different agencies need the opportunity to share information and discuss the best way forward when working with families who do not engage, holding a professionals meeting gives agencies the opportunity to share concerns and knowledge of the family and draw up an effective plan of working with the family which shares the decisions made from the meeting.

The most worrying scenario is when every agency cannot engage the family so every one withdraws. When the family only engages with some professionals it is important that information continues to be shared to avoid developing a collusive relationship.


11. Hard to Engage Professionals Meetings (at times this will be a Strategy Meeting) Multi Agency professionals Meeting to Consider Issues of Non-Engagement

There are times when agencies have employed all significant means to address non engagement. At these times, the non engagement should be discussed at a multi agency meeting that is called expressly for this purpose – practitioners can then share information and consult on strategies they have been used in an attempt to engage the child, young person or family.

The purpose of this meeting should not be to solely discuss care planning but to identify the underlying causes for non engagement and put a plan in place to address these. This meeting is also a useful opportunity to acknowledge the risks associated with non-engagement; it should be recognised that at times, non-engagement will increase risks for children and consequently will accelerate action.

Contingency plans should be considered as these meetings.

The importance of good multi agency communication should be maintained. It is also essential that agencies share information when they close cases if the reason is non-engagement as this too may increase the risks to the children in the family.

These meetings can be called by any agency.

The professionals meeting needs to support this not happening. During the meeting:

  • Agencies can share concerns especially if there are Health and Safety implications;
  • Professionals can support each other;
  • A plan of action can be put in place;
  • The reasons for non-engagement can be better understood and plans put in place to address these.

When the meeting is held it is important to ensue that the threat of risk is not exaggerated by group thinking. See flow chart for potential outcomes of the meeting.

  • Step Down Plan – e.g. a CAF where other agencies monitor and refer back if necessary mainly for S17 cases and when families are working with some professionals;
  • Step Up Plan – a referral to Children’s Services Social Care for a full assessment;
  • Continue - review and continue to try and engage with the family, particularly addressing the underlying reasons for non-engagement. Consider whether all options been explored, advocacy, family centre involvement, Family Meeting;
  • Child Protection - is there evidence that the child may be at risk of Significant Harm and that the threshold has been met;
  • Legal Advice – Should Social Care make an application for a Legal Order.


12. Closure of Case by Any One Agency

If an agency intends to close a case, it is essential that there is communication with the Lead Practitioner for the child prior to closure so that the impact on the child can be understood and addressed. The Lead Practitioner can then work with practitioners that remain involved to ensure an effective Care Plan. Where the agency closing the case is the lead practitioner, a transfer of that responsibility will be agreed.


13. Hard to Engage Flowchart

Click here to view the flowchart.


Further Information

Working Harder to Engage with Children, Young People or Their Families More Effectively

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