1. Working with families who trouble us. What works and what does not? Honor Rhodes, Director of Development, Family and Parenting Institute. April 2009

2. Why does love matter...to everyone? Neurology Cost Early intervention Every Child Matters Neighbourhoods and communities Wasted potential of any child Child death enquiries

3. Who are the families we’re talking about here? ‘difficult to engage and enable change’ families What do they do to us? Fear, confusion, splitting £££££ down the drain Whole systems work ineffectively and defensively Make workers go off sick and leave jobs We need to be able to call a spade a spade and say what good and poor parenting really is

4. What do we find when we persuade (or make) families open the door to us? Rubbish and smells Dogs Violence especially domestic abuse Too many children Too few parents Teenage pregnancy No sense of possible change Criminality Petitioning neighbours I’m allowed to show you this ‘before’ picture as the family felt it was important; you should see their kitchen now!

5. What do families believe has happened to them? And why might this matter? Bad luck, bad health Victimisation/persecution Lack of tolerance and/or compassion Lack of clear and persistent boundary setting Useful help that was taken away (Health Visitors etc.) OR No help when it was needed OR No help that was acceptable when it was needed perhaps because of the ‘place’ rather than the offeree.

6. What do we know are the underlying problems? Research tells us…(but you know this already.) Severe/enduring adult mental health problems Parents with learning difficulties Long standing physical illness Domestic violence Substance misuse Lack of regulation, time, resources and energy Lack of connection to the world around them Fractured family relationships Early poor parenting across at least two generations, often more

7. So what works with families with this level of disorder, confusion and trouble? Start in the home, don’t summons to an office Solve a problem that the family want help with, this is ‘the test’. Map other agencies involvement (or not), bring them in Use contracts early – they are very effective, and don’t flinch from naming the difficult Protect workers from scabies and violence Review, reward and sanction immediately Underline change and make it very hard to retreat back to how things were

8. Rewards come in many forms and only need thought and dedicated application Do you know how to use a star chart for maximum effect?

9. There are lots of other highly effective tools to use: genograms, pictures, ecomaps… Let’s see who is actually ‘in’ your family…and let’s hear your story

10. 1. What does research tell us works with ‘difficult’ families? Because? Whole family and highly targeted interventions, often concurrent work with family, parent(s) and children Intervention as early as possible, with best sustained outcomes Whole system working Longer periods of intervention + booster sessions Services delivered by trained, skilled professionals Home based working for at least a part of the intervention

11. 2. What does research tell us works with ‘difficult’ families? Because? Parenting programmes that have a strong theory base, clear model of change, specific outcomes focused and ‘manualised’ Interventions that have more than one ‘mode’ of service delivery Focus on behavioural and cognitive interventions working on belief and attitudinal change Moran et al, What works in Parenting Support? A review of the international Evidence. DfES and Home Office 2004

12. e.g: Incredible Years (Webster Stratton) and Strengthening Families 10-14 WeekParent SessionsYouth SessionsFamily Sessions 1 Using Love and Limits Having Goals and Dreams Supporting Goals and Dreams 2 Making House Rules Appreciating Parents Appreciating Family Members 3 Encouraging Good Behaviour Dealing with Stress Using Family Meetings 4 Using Consequences Following Rules Understanding Family Values 5Building Bridges Handling Peer Pressure I Building Family Communication 6 Protecting Against Substance Misuse Handling Peer Pressure II Reaching Our Goals 7 Using Community Resources Reaching Out To Others Putting It All Together & Graduation

13. What does not work? Because? Immediate groupwork for the most difficult: Front line workers need to pace and broker Letters or any written communications : Hidden or manifest illiteracy, letter hoarding, other ways of communicating work better (photobooks, video, pictorial representations of shopping lists, rules, what should go where, rotas for basic cleaning) Short term interventions: complex multi generational problems, families are expert at defeating workers, prepare for the very long haul Loss of energy/enthusiasm for change: family’s purchase on desire to change is very weak, workers need enough energy to sustain the whole system Sanction only interventions: carrots v. sticks

14. The support that others can offer, do you know how to access it and where it happens? Parenting Programmes Whole family support Child and adolescent mental health services (CAMHs) Family Intervention Projects Youth services Health services (often poor users of general health provision) Schools related services Mental Health and Learning difficulties services What is your voluntary sector doing? Who is going to buy the Wilsons an alarm clock so that they can get to school on time?

15. The art of a good referral Know the problem Agree the problem Understand what other agencies are required to do Frame the referral to meet those criteria Understand what they may offer Enable the parents to want this help Support them to use it Support them through and beyond the intervention No hot potatoes or pass the parcel

16. What can we do? A great deal…and you are doing it already Understand the child welfare duty to collaborate placed upon you and others by the Children Act 2004 Know what parents can use locally – voluntarily and under compulsion Be able to know AND articulate what good and poor parenting means Get training for yourself and other staff to equip them to deal with the darn difficult as a good first response Understand the powerful nature of resistance to change…and carry on anyway Have a chocolate or a medal, you deserve both

17. How do you know that you are good at what you do? Are you measuring? What? When? How? Lots of simple (ish) tools to use What about the Goodman Strengths and Difficulties Questionnnaire as a start?

18. Let’s be good enough… For a child to develop a healthy, genuine self DW Winnicott believed that the mother/parent must be a "good-enough mother" (or father or parent) ‘A good-enough mother allows herself to be used by the infant so that he or she may develop a healthy sense of omnipotence which will, naturally, be frustrated as the child matures, this is all to the good.’ We must all, inevitably, be a disappointment…it is just that we must do it knowingly

19. Get help… A place to talk it all through is VITAL This guide was written with people just like you in mind Briefing sheets on referrals, helping parents manage children’s behaviour and more FPI Practitioner Forum and research help All there for you to use so try it and see… and then tell me whether it helped and what more you need www.familyandchildcaretrust.org