Tameside SCB

"Effective practice to protect children living in ‘highly resistant’ families" is a Safeguarding Knowledge Review produced by C4EO. Given several recent high-profile child maltreatment cases in the UK, this knowledge review was commissioned to provide evidence on what works in protecting children living in ‘highly resistant’ families where they may suffer, or are likely to suffer, significant harm because of ill-treatment or the impairment of health or development due to abuse or neglect.  It is based on a rapid review of the research literature involving systematic searching and analysis of key data. It summarises the best available evidence from 2000 to 2009 that will help service providers to improve services and, ultimately, outcomes for children, young people and their families.

Key messages from the C4EO knowledge review

*                    There is no published research focusing specifically on effective services for ‘resistant’ families where children are suffering or are likely to suffer significant harm. Rather, studies have tended to examine case records or practitioners’ and parents’ perceptions of the effectiveness of different aspects of services among families experiencing maltreatment recurrence, families with complex problems and families who kill or seriously injure their children. It is not possible, however, to determine whether these families were actively resisting services or were not receiving the services and support that they needed.

*                     Nevertheless, elements of practice that appear or are perceived to be effective include focused, long-term services rather than episodic interventions; openly dealing with the power dynamic between practitioners and families; practitioners’ conveyance of empathy and acceptance; and services that include practical help for families, families’ involvement in their treatment and social support.

*                    Empathy and established relationship skills remain the necessary, but insufficient conditions when working with resistant families; they need to be balanced with an eyes-wide-open, boundaried, authoritative approach aimed at containing anxiety and ensuring that the child’s needs stay in sharp focus.

*                    The complexities of the adults’ problems often eclipsed children’s immediate needs. All practitioners need to be ever vigilant to children’s needs for protection in the short and long term.

*                    A lack of timely and consistent services was associated with repeated maltreatment or serious injury or death of children, although a recent Ofsted report (2008) concluded that staff capacity and resources were not the main factors leading to serious injury or death (relative to, for example, poor communication across agencies, poor assessment practices and practitioners not recognising signs of maltreatment).

*                    Practitioners were able to describe behaviours and circumstances that posed challenges to their practice, but they lacked confidence when trying to identify families genuinely engaged in treatment as opposed to exhibiting ‘false compliance’.

*                    Families’ lack of engagement or hostility hampered practitioners’ decision-making capabilities and follow-through with assessments and plans. Other research described instances where practitioners became overly optimistic, focusing too much on small improvements made by families rather than keeping families’ full histories in mind.

*                    Gathering information for assessments is not enough – it needs to be organised and analysed – and information from a number of sources and about individuals other than mothers must be included in the analysis.

*                    Direct observation of the parent–child interaction is essential in complex cases. A more concerted effort to ensure children’s voices are captured is also needed.

*                    Good supervision is always important, but is essential when working with the most complex families.

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