Engaging Families & Working with Resistance

Patrick AyreDepartment 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

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

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”

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.

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.

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)

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)

What families want

Effort towards developing trust

Transparency

Genuine and even-handed

Direct, yet sensitive

(Shemmings and Shemmings, 2000)

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)

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

Stages of engagement

Pre-contemplation

Contemplation

Action

Maintenance

Relapse

(Calder, forthcoming)

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)

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)

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)

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)

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)

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)

Potential parental responses

Genuine commitment

Compliance / approval seeking

Tokenism

Dissent / avoidance

(Horwath and Morrison, 2000)

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 )

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 )

Avoid

Expressions of over-concern

Moralising

Criticising the client

Making false promises

Displaying impatience

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 )

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 )

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!

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)

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

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)

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)

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)

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)

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)

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)

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)

Effective work involves

Logical discussion

Focusing

Prioritising

Summarising

Setting realistic limits

Effective work involves

Universalising

Confronting

Educating

Modelling behaviour

Effective work involvesRecognising difference

Accepting

Allowing ventilation

Relating to feelings

Direct intervention in the environment

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.

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.

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.

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.

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.

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)