1. Engaging Families & Working with Resistance Patrick Ayre Department of Applied Social Studies University of Bedfordshire ( Adapted from Calder, M (forthcoming) The carrot or the stick? Towards effective practice with involuntary clients, Lyme Regis: Russell House

2. Why it matters “In many cases parents were hostile to helping agencies and workers were often frightened to visit family homes. These circumstances could have a paralysing effect on practitioners, hampering their ability to reflect, make judgments, act clearly, and to follow through with referrals, assessments or plans. Apparent or disguised cooperation from parents often prevented or delayed understanding of the severity of harm to the child and cases drifted. Where parents made it difficult for professionals to see children or engineered the focus away from allegations of harm, children went unseen and unheard”. “Families tended to be ambivalent or hostile towards helping agencies, and staff were often fearful of violent and hostile men. Although parents tended to avoid agencies, agencies also avoided or rebuffed parents by offering a succession of workers, closing the case, losing files or key information, by re-assessing, referring on, or through initiating and then dropping court proceedings”. Brandon, M, and others (2008) Analysing child deaths and serious injury through abuse and neglect: what can we learn? London: Department for Children, Schools and Families

3. Engagement “Engagement is the basic task of a child and families worker but can never be taken for granted and must always be worked for”

4. Context Often ‘hard core’ families so interactions characterised by guardedness or reluctance to share information avoidance and a desire to leave the relationship strong negative feelings such as anxiety, anger, suspicion, guilt or despair.

5. Context We need to accept that: The best we may be able to achieve is honesty rather than positive feelings and a high degree of mutuality Conflict and disagreement are not something to be avoided, but are realities that must be explored and understood.

6. Some family centred principles Working alongside families rather than disempowering them Raising the self-esteem of parents rather than provoking a defensive or angry response Promoting family relationships enabling parents to safeguard their children whenever possible Focusing on the overall developmental needs of children rather than on an overly narrow concentration on the alleged incident of abuse. (Rose, 1994)

7. What families want To be kept fully informed, To be treated with courtesy To be involved in all stages of the process (Cleaver and Freeman, 1995)

8. What families want Effort towards developing trust Transparency Genuine and even-handed Direct, yet sensitive (Shemmings and Shemmings, 2000)

9. What families want Communication which is open, honest, timely and informative. Time with someone who –listens, –gives feedback, information, reassurance and advice, and –is reliable. Services which are practical, tailored to particular needs and accessible. An approach which reinforces rather than undermines their parenting capacity. (Rose and Aldgate, 2000)

10. Why many interventions fail Failure to consider where families are starting from (probably different from the professionals) Failure to focus on strengths as well as weaknesses

11. Stages of engagement Pre-contemplation Contemplation Action Maintenance Relapse (Calder, forthcoming)

12. Pre-contemplation Not accepting the need for change or considering changing Characterised by blaming others, denial or lack of awareness (eg depression) Need information and feedback to raise awareness and acceptance May need a legal mandate (Calder, forthcoming)

13. 4 categories of pre-contemplator Reluctant: inertia or lack of knowledge Rebellious: heavy investment in the behaviour which needs to change or in making their own decisions Resigned: overwhelmed by problems and has given up hope of changing Rationalising: will explain away the problem and why no change is required (DiClemente, 1991)

14. Contemplation Open to considering the possibility of change but may be ambivalent Open to receiving, feedback, observations, information and even confrontation May respond to ‘consciousness raising’ or to emphasising the gains or giving examples of past successes. (Calder, forthcoming)

15. Six stages of contemplation I accept that there is a problem I have some responsibility for the problem I have some discomfort about the problem and my part in it I believe that things must change I can see that I can be part of the solution I can see the first steps towards change. (Calder, forthcoming)

16. Action Start to work in a structured way on change to which they are committed. Change is stressful and may fail or feel they have failed Worker should focus on success and reaffirming client’s decision to change and look out for signs of relapse (Calder, forthcoming)

17. Maintenance and relapse Change becomes established and internalised, not dependent of presence of workers Relapse is part of the change process, not in conflict with it Most people relapse gradually after a slip brought on by unusual stresses. If not helped they may slide back to pre- contemplation, but they can be helped to get back on track. It can help to emphasise that relapse is common and is not the end. (Calder, forthcoming)

18. Potential parental responses Genuine commitment Compliance / approval seeking Tokenism Dissent / avoidance (Horwath and Morrison, 2000)

19. Strategies for enhancing engagement Before you start, check your mindset (your own biases and assumptions) Have realistic expectations: –It is reasonable that involuntary clients resent being forced to participate –Because they are forced to participate, hostility, silence and non-compliance are common responses that do not reflect my skills as a worker –Due to the barriers created by the practice situation, clients may have little opportunity to discover if they like me –Lack of client co-operation is due to the practice situation, not to my specific actions and activities (Ivanoff et al, 1994 )

20. During initial contacts Adopt a non-defensive stance Be clear, honest and direct and acknowledge the involuntary nature of the relationship Clarify roles and expectations, including what is required of the client Explain consequences of non- compliance and the advantages of compliance (Ivanoff et al, 1994 )

21. Avoid Expressions of over-concern Moralising Criticising the client Making false promises Displaying impatience

22. Avoid Ridiculing the client Blaming the client for his/her failures Being dogmatic Rejecting the client’s right to express different values and preferences (Ivanoff et al, 1994 )

23. Try to Invite participation Understand how the client sees the problem as well as how we see it Understand what the client wants, as well as what we want (Ivanoff et al, 1994 )

24. Identifying resistance, 4 categories Hostile resistance: anger threats, intimidation, shouting Passive aggressive: compliance covers antagonism and anger Passive hopeless: Tearfulness and despair about change Challenging: Cure me if you can!

25. How might resistance show itself? By only being prepared to consider 'safe' or low priority areas for discussion. By not turning up for appointments By being overly co-operative with professionals. By being verbally/and or physically aggressive. By minimising the issues. (Egan, 1994)

26. What might we be doing to make it worse? Becoming impatient and hostile Doing nothing, hoping the resistance will go away Lowering expectations Blaming the family member Absorbing the family member's anger Allowing the family member to control the assessment inappropriately

27. What might we be doing to make it worse? Becoming unrealistic Believing that family members must like and trust us before assessment can proceed. Ignoring the enforcing role of some aspects of child protection work and hence refusing to place any demands on family members. (Egan, 1994)

28. Productive approaches Give practical, emotional support - especially by being available, predictable and consistent See some resistance and reluctance as normal Explore our own resistance to change and by examining the quality of our own interventions and communication style (Egan, 1994)

29. Productive approaches Establish a strong and well-articulated relationship by –clarifying all the rules of sharing records, –inviting people to meetings –sharing with them how and why you have to make decisions –explaining the complaints procedure (Egan, 1994)

30. Productive approaches Helping family members to identify incentives for moving beyond resistance Tapping the potential of other people who are respected as partners by the family member Understanding that reluctance and resistance may be avoidance or a signal that we are not doing our job very well (Egan, 1994)

31. Confrontation In child welfare services, the Children’s Service Worker must be a skilled confronter. Confrontation is, basically, facing the client with the facts in the situation and with the probable consequences of behaviours (Texas Department of Human Resources)

32. Confrontation Client: The doctor is telling lies about me. I didn't hurt Angie, she fell downstairs. She is always having accidents. Worker: I understand that children have accidents. Angie's injuries could not have been the result of a fall down stairs. There are two partially healed fractures in addition to the new head injury. Angie's buttocks and back are marked with bruises in the shape of a hand. (Texas Department of Human Resources)

33. Confrontation Client: I know we haven't been to counselling in three weeks. Get off my back! My husband and I have other things to do. Worker: Going to counselling regularly is a part of your agreement with us to regain custody of your children. If the agreement is not followed, we can't recommend that the children come home. (Texas Department of Human Resources)

34. Effective work involves Logical discussion Focusing Prioritising Summarising Setting realistic limits

35. Effective work involves Universalising Confronting Educating Modelling behaviour

36. Effective work involves Recognising difference Accepting Allowing ventilation Relating to feelings Direct intervention in the environment

37. A scale for assessing motivation 1. Shows concern and has realistic confidence. 2. Shows concern, but lacks confidence. 3. Seems concerned, but impulsive or careless 4. Indifferent or apathetic about problems 5. Rejection of parental role.

38. Shows concern and has realistic confidence. Parent is concerned about children’s welfare; wants to meet their physical, social, and emotional needs to the extent he/she understands them. Parent is determined to act in best interests of children Has realistic confidence that he/she can overcome problems and is willing to ask for help when needed Is prepared to make sacrifices for children.

39. Shows concern, but lacks confidence Parent is concerned about children’s welfare and wants to meet their needs, but lacks confidence that problems can be overcome May be unwilling for some reason to ask for help when needed. Feels unsure of own abilities or is embarrassed But uses good judgement whenever he/she takes some action to solve problems.

40. Seems concerned, but impulsive or careless Parent seems concerned about children’s welfare and claims he/she wants to meet their needs, but has problems with carelessness, mistakes and accidents. Professed concern is often not translated into effective action. May be disorganised, not take enough time, or pays insufficient attention; may misread ‘signals’ from children; may exercise poor judgement. Does not seem to intentionally violate proper parental role; shows remorse.

41. Indifferent or apathetic about problems Parent is not concerned enough about children’s needs to resist ‘temptations’, eg competing demands on time and money. This leads to one or more of the children’s needs not being met. Parent does not have the right ‘priorities’ when it comes to child care; may take a ‘cavalier’ or indifferent attitude. There may be a lack of interest in the children and in their welfare and development. Parent does not actively reject the parental role.

42. Rejection of parental role Parent actively rejects parental role, taking a hostile attitude toward child care responsibilities. Believes that child care is an ‘imposition’, and may ask to be relieved of that responsibility. May take the attitude that it isn’t his or her ‘job’. May seek to give up the responsibility for children (Magura et al,1987)