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1. Introduction

What do we mean by ‘uncooperative and hard to engage’?

1.1 Uncooperative families are those who will deliberately choose not to engage and / or co-operate with professionals and who will often display one or more of a wide range of uncooperative behaviours towards professionals. From time to time all agencies will come into contact with families whose co-operation is difficult, including those whose compliance is apparent rather than genuine, or who are more obviously reluctant, resistant or sometimes angry or hostile to their approaches. In extreme cases, professionals can experience intimidation, abuse, threats of violence and actual violence.

1.2 The child's welfare should remain paramount at all times and where professionals are too scared to confront the family, they must consider what life is like for a child in the family.

1.3 Certain circumstances for some families mean that they too can be difficult to engage with, for example migration (internal and external due to refugee / asylum seeking processes), culture and language. However for the majority of these families there is not a deliberate act which stops or hinders engagement, and they would be classed at "hard to reach" families. This document does not cover families who are classed as "hard to reach" although it should be recognised that such families can too be uncooperative or dis-engaging and if such behaviours as outlined by this document are displayed then professionals should respond accordingly.

1.4 It is important that practitioners are professionally curious. Professional curiosity is a combination of looking, listening, asking direct questions, checking out and reflecting on information received. It means not taking a single source of information and accepting it at face value. It means testing out your professional assumptions about different types of families. It means triangulating information from different sources to gain a better understanding of family functioning which, in turn, helps to make predictions about what is likely to happen in the future. It means seeing past the obvious. (HEALTH)

 

Reference themes within SCR/LRs - Child K Hampshire 2018; Child D ‘Jamie’ 2018 and Madison 2018; Between January 2016 and January 2017, 12 of the 16 SCRs published on children aged under 10 included issues of hostility and/or disguised compliance. In a 2008 review of 189 SCRs between 2005-2007, three quarters were found to feature lack of parental co-operation with services.

 

 

2. Recognising and Understanding 

2.1.There are a number of resistant behaviours that parents might display:

• Disguised (superficial) compliance: involves a parent or carer giving the appearance of co-operating with agencies to avoid raising suspicions, to allay professional concerns and ultimately diffuse professional intervention.
• Ambivalence is when people are experiencing conflicting beliefs or feelings simultaneously. This can be seen when people are always late for appointments, or repeatedly make excuses for missing them or when they change the conversation away from uncomfortable topics. Ambivalence is having an attitude towards someone or something that contains both positive and negative components, it is the most common reaction and may not amount to non-engagement. No service user is without ambivalence at some stage in the helping process. It may reflect cultural differences, being unclear of what is expected, or poor experiences of previous involvement with professionals.
• Avoidance/Denial is a very common method of non-engagement and includes avoiding appointments, missing meetings, cutting short visits due to other apparent important activity, not allowing easy contact with a child, especially on their own or refusing to acknowledge abuse/problems. They may have something to hide, resent outside interference, not want to accept or discuss concerns about their children.
• Mis-informing: whereby a parent or carer deliberately provides a service with wrong information (for example surname / name of GP etc) to "hide" previous involvement with services.
• Refusal: whereby a parent or career refuses outright to engage with a professional or service. They may not respond to telephone calls or letters, they might not attend appointments or meetings and they might not answer the door.
• Migration: where a parent or carer deliberately moves a family or child to avoid engaging with professionals or services. They may move long distances such as across the country or shorter distances either within an authority or "hopping" across the border into another local authority. The family will avoid telling services of their intent to (and actual) move.
• Confrontation is communication that tends towards anger, creates unnecessary conflict, and damages relationships, it includes challenging professionals, provoking arguments, extreme avoidance and often indicates a deep-seated lack of trust leading to a 'fight' rather than 'flight' response to difficult situations. Parents may fear that their children may be taken away or they may be reacting to them having being taken away. They may have difficulty in consistently seeing the worker's good intent and be suspicious of their motives.
• Violence - threatened or actual violence by a small minority of people is the most difficult of non-engaging behaviours for the worker/agency to respond to. It may reflect a deep and longstanding fear and projected hatred of authority figures. People may have experience of getting their way through intimidation and violent behaviour.
• Aggravated or vexatious complaints – making complaints against workers which are meant to intimidate them or distract attention from the presenting issues
• Pleasing or complimenting – seeming to want to please and go along with plans, falling into grooming of professionals and disguised compliance.

 

If a worker feels intimidated, they must consider what it must be like for a child or young person living in the household. The welfare of the child/young person is paramount at all times. It is important to consider the voice of the child.

 

2.1.2 When parents are resisting professional intervention by using aggression, violence, disguised compliance, deliberate deception, selective engagement, or sporadic or passive compliance, professionals can fail to realise the nature and severity of the abuse that is taking place. This can put children and young people at risk.

 

2.2 What are the reasons for families or family members not engaging?

2.2.1 There are a variety of reasons why some families or family members may be uncooperative with professionals, including:

• Impact of childhood trauma and adversity (Health).
• They do not want their privacy invaded.
• They have something to hide.
• They don’t think they have a problem.
• Their lack of understanding about what is being expected of them.
• A lack of insight into potential harm their behaviours are having on children in their care (Health).
• Their perceived or actual poor previous experience of professional involvement.
• They resent staff changes.
• Their dislike or fear of authority figures.
• They fear their children will be taken away.
• Their fear of being judged to be poor parents because of substance misuse, mental health problems.
• They feel they have nothing to lose, for example where the children have been removed.
• They have cultural differences.
• Shame.
• Self-blame for the difficulties.

In general a parent will try to regain control over their lives, but they may be overwhelmed by pain, depression, anxiety and guilt resulting from the earlier losses in their lives. Paradoxically, the uncooperativeness may be the moment at which the person opens up their feelings, albeit negative ones, at the prospect of help. They are unlikely to be aware of this process going on.

 

3. Impact on Assessment of Children/Families or Family Members

3.1 Assessment

3.1.1 A detailed clear assessment of a child's circumstances and lived experience is essential to ensuring that services and support are provided at the right time, and at the right level for children and their families. Engaging family members, parents and children in the assessment process is the most effective way to reach joint understanding about what needs to happen next.

3.1.2 Engaging a parent who is resistant or even violent/intimidating is more difficult. The behaviour may be purposefully trying to keep professionals away from the home and the children, this needs to be considered within any assessment and linked to the experience for the child in the home.

3.1.3 In the Victoria Climbie inquiry, Lord Laming (2003) highlighted the need for ‘respectful uncertainty’, applying critical evaluation to any information received from parents, as they may be exhibiting resistance or disguised compliance. Workers need to maintain an open mind. Lord Laming highlighted that those who are abusing to the greatest degree are often adept at using disguised compliance and various forms of resistance to keep agencies and workers at bay from protecting the child(ren). Resistant parents can go to great lengths to hide their activities while child protection staff are trying to balance the rights of the parent with the protection of the child.

3.1.4 The ‘rule of optimism’ can affect assessment and decision-making in safeguarding children work. Professionals may wish to see the best in the parents they are working with, and have hope and optimism that their interventions can secure the safety and wellbeing of the children involved. This mindset can, however, leave children open to abuse and neglect if professionals don’t recognise and respond properly to the effects of abusive and manipulative power and control dynamics from parents.

 

Practitioners embarking on an assessment should follow the guidance in The Framework for Assessment of Children and their Families (DoH, 2000) & Working Together To Safeguard Children

 

4. Impact on Multi-agency Working

4.1 Multi-agency Working

4.1.1 Agencies and families or family members need to work in partnership to achieve the agreed outcome and all parties need to understand this partnership may not be equal, depending on whether the involvement is by statutory or voluntary agencies.

4.1.2 Sometimes parents/carers may respond to specific agencies or individuals differently. If this response/refusal to engage is not universal, then agencies should seek to understand why this might be and learn from each other. Where non engagement towards most agencies is experienced, this needs to be managed on an inter-agency basis otherwise the results can be as follows:

• Everyone ‘backs off’, leaving the child unprotected.
• The family is ‘punished’ by withholding of services as everyone ‘sees it as a fight’. This is at the expense of assessing and resolving the situation for the child.
• There is a divide between those who want to appease and those who want to oppose - or everyone colludes.

 

4.1.3 When parents/carers are only hostile to some individuals/agencies or where individuals become targets of intimidation intermittently, the risk to good inter-agency collaboration is probably at its greatest. Any pre-existing tensions between agencies and individuals, or misunderstandings about different roles are likely to surface. The risks are of splitting between the agencies/individuals, with tensions and disagreement taking the focus from the child, e.g.:

• Individuals or agencies blame each other, and collude with the family.
• Those not feeling under threat can find themselves taking sole responsibility which can ultimately increase the risk to themselves.
• Those feeling ‘approved of’ may feel personally gratified as the family ‘ally’ but then be unable to recognise / accept risks or problems.
• Those feeling under threat may feel that it is personal.
• There is no unified and consistent plan.

 

4.2 Ensuring Effective Multi-agency Working

4.2.1 Staff should be aware of the crucial role of making contact with other professionals who know the family and may be aware of potential difficulties and risks. Any agency faced with incidents of threats, hostility or violence should routinely consider the potential implications for any other agency involved with the family as well as for its own staff and should alert them to the nature of the risks.

4.2.2 Regular inter-agency communication, clear mutual expectations and attitudes of mutual respect and trust are the core of inter-agency working. When working with hostile or violent behaviour, the need for very good inter-agency collaboration and trust is paramount and is also likely to be put under greatest pressure. It becomes particularly important that everyone is:

• Aware of the impact of hostility on their own response and that of others.
• Respectful of the concerns of others.
• Alert to the need to share relevant information about safety concerns.
• Actively supportive of each other and aware of the differing problems which different agencies have in working within these sorts of circumstances.
• Open and honest when disagreeing.
• Aware of the risks of collusion and of the targeting of specific professions/agencies.
• Prepared to discuss strategies if one agency (e.g. a health visitor) is unable to work with a family - how will information/monitoring be gained and is it possible to have a truly multi- agency plan?
• PAMIC – multi-agency risk assessment tool should be shared to identify individual risks and needs of families.

4.2.3 Information sharing is pivotal. It should be standard practice for practitioners to be explicit about experiences of confronting hostility / intimidation or violence.

4.2.4 Workers in different settings and tiers may have different thresholds for concern and different based on personal experiences. It is vital that the differing risks and pressures are acknowledged and supported.

 

4.3 Multi-agency Meetings

4.3.1 Avoiding people who display hostile behaviour is a normal human response; however it can be very damaging for effective inter-agency work under child protection plans, which depends on agencies will be reduced by:

• Clear agreements, known to all agencies and to the family, detailing each worker’s role and the tasks to be undertaken by them.
• Full participation at all multi agency meetings with all agencies owning the concerns for the child rather than leaving it to a few or single agency.

4.3.2 Although it is important to remain in a positive relationship with the family as far as possible, this should not be at the expense of being able to share real concerns.

Consider what life is like for the child if professionals are too scared to confront the family. (In the March Triennial Review of Children SCR 30% of cases had parents/carers with criminal convictions including for violence). Remember that although working with hostile families or family members can be particularly challenging, the safety of the child is the first concern

 

5. Responding to Families or Family Members who find it hard to engage

5.1 What Should I do?

5.1.1 A number of different factors come into play from those parents who are unable to engage with professionals because of their own circumstances, for example being unable to read and to tell the time

5.1.2 Maintain a position of ‘respectful uncertainty’, keep an open mind, constantly question all assumptions by playing devil’s advocate, bring in a fresh pair of eyes when you are unsure and use triangulation to verify important information given by parents.

5.1.3 Remember that the relationship between the professional and parents is not a relationship for the benefit of the parents or for the relationship itself, but rather a focused intervention to protect the child and promote their welfare.

5.1.4 Practitioners must confront uncooperativeness when it arises, with understanding, empathy and professionalism.

5.1.5 Where you are going to be involved over a longer period, you will need to help the parent/ carer to work through their underlying feelings as you support them to engage.

5.1.6 Where you think cultural factors are making a family resistant, you could consider asking for advice from local experts, who have links with the culture. In such discussions the confidentiality of the family concerned must be respected.

5.1.7 Clients should be treated with respect and dignity at all times; this includes keeping appointments and also ensuring that families are engaged wherever possible.

5.1.8 If any worker feels uncomfortable or unhappy about working with a family, they must consult immediately with a supervisor for advice and guidance or seek safeguarding supervision.

5.1.9 Regular line management supervision is essential to support staff in identifying cases where the families are uncooperative with the service is impacting on the safety of the child/children.

5.1.10 Were access to the child is denied, this should be regarded as an indicator of significantly increased risk and should be reported immediately to a line manager and depending on agency, legal advice may be sought.

5.1.11 Visiting children and families with a colleague from the same team or another agency can help identify the particular difficulties in communicating with the family as well as provide the worker with another view of the circumstances.

5.1.12 Regular record keeping with chronologies, SMART actions and frequent case summaries should be standard practice and will aid the analysis of information, allow for the recognition of cumulative risk and promote effective case management.

5.1.13 If the parent does not have the ability or motivation to work with the agencies or actively undermines plans or services provided, this must be addressed by the workers and managers with the family in order to maintain the focus on safeguarding the child/children.

 

5.2. What should I not do?

5.2.1 See each situation as a potential threat and develop a "fight" response.

5.2.2 Collude with parents / carers by accommodating and appeasing them in order to avoid provoking a reaction.

5.2.3 "Filter out" negative information or minimising the extent and impact of the child(ren) experiences in order to avoid having to challenge.

5.2.4 Lose focus on the child

 

5.3 Important issues to consider

5.3.1 The parents may be fearful of revealing personal information about such issues as their income, their immigration status or the simple fact that they cannot cope with getting to a meeting on time by themselves.

5.3.2 Some families or family members may be unclear about why they have been asked to attend a meeting or visit them at home due to language difficulties/not understanding English. They may have literacy problems or be unable to tell the time.

5.3.3 Alternatively, communication with parents about concerns and what needs to be changed may not have been clear or understood and expectations may need to be conveyed in a different way.

5.3.4 If workers have a poor understanding of the symptoms of mental ill health, drug/alcohol misuse or Domestic Abuse and the consequent impact on the family, they may operate a lower level of expectation and the impact on the child may not be recognised.

5.3.5 Useful sources of information can be gained by finding out who else is involved, and contacting internal and external colleagues or individuals who have had involvement with the family.

5.3.6 Remember families or family members may develop a resistance or hostility to involvement if they perceive the worker as disrespectful and unreliable or if they believe confidentiality has been breached outside the agreed parameters.

5.3.7 Always assess the lived experience and life through the eyes of the child/children.

Parental participation is not the same as cooperation. Professional involvement is not the same as engagement.

　

5.4 Benefits of conducting joint visits

5.4.1 Enables professionals to consider different perspectives of family needs and how these needs might be met.

5.4.2 Increases the chances of engagement with a range of services – families can have misconceptions about the work of particular agencies which leads to anxiety and a reluctance to engage.

5.4.3 Families that see professionals from different disciplines working together can reduce the frustration of having to repeat information to different professionals, and minimises opportunities for families to manipulate professionals.

5.4.4 Safer working practice specifically with those families that are intimidating or make professionals feel threatened.

5.4.5 It is good use of resources and provides additional support to professionals dealing with hostility.

 

6. Dealing with Violence

6.1 Dealing with Threatening and Violent behaviours

Despite sensitive approaches by professionals, some families or family members may respond with hostility and sometimes this can lead to threats of violence and actual violence. It is therefore important to try and understand the reasons for the hostility and the actual level of risk involved. It is critical both for your personal safety and that of the child that risks are accurately assessed and managed.

6.1.2 Threatening behaviour can consist of:

• Threats of violence to the worker or their family.
• The deliberate use of silence.
• Using written threats.
• Bombarding workers with emails and phone calls.
• Using intimidating or derogatory language.
• Racist attitudes and remarks.
• Using domineering body language.
• Using dogs or other animals as a threat – sometimes veiled.
• Swearing.
• Shouting.
• Throwing things.
• Physical violence.
• Aggravated or vexatious complaints.
• Stalking, including online.

6.1.3 Threats can be covert or implied, e.g. discussion of harming someone else, as well as obvious. In order to make sense of what is going on in any uncomfortable exchange with a parent / carer, it is important that staff members are aware of the skills and strategies that may help in difficult and potentially violent situations and that they consult their own agency guidance.

 

6.2 Impact on Workers of Threatening and Violent Behaviour

6.2.1 Working with potentially threatening and violent families or family members can place workers under a great deal of stress and can have physical, emotional and psychological consequences. It can also limit what you can allow yourself to believe, make you feel responsible for allowing the violence to take place, lead to adaptive behaviour, which is unconsciously "hostage-like", and also result in distressing symptoms.

6.3 Factors that increase the impact on workers include:

• Previous traumatic experiences, both in professional and personal life, can be revived and heighten the fears.
• Regularly working in situations where violence / threat is pervasive: Workers in these situations can develop an adrenalin-led response, which may over- or under-play the threat. Workers putting up with threats may ignore the needs / feelings of other staff and members of the public.
• Hostage-like responses: When faced with significant fears for their own safety, workers may develop a "hostage-like" response. This is characterised by accommodating, appeasing or identifying with the "hostage-taker" to keep safe.
• Threats that extend to the worker’s life outside of work.
• It is often assumed that there is a higher level of risk from men than from women and that male workers are less likely to be intimidated. False assumptions decrease the chances of recognition and support. Male workers may find it more difficult to admit to being afraid; colleagues and managers may not recognise their need for emotional support. This may be particularly so if the perpetrator of the violence is a woman or young person. In addition, male workers may be expected to carry a disproportionate number of threatening service users.
• Lack of appropriate support and a culture of denial or minimising of violent episodes as ‘part of the job’ can lead to the under-reporting of violent or threatening incidents and to more intense symptoms, as the worker feels obliged to deal with it alone.
• Violence and abuse towards workers based on their race, gender, disability or perceived sexual orientation etc. can strike at the very core of a person’s identity and self-image. If the worker already feels isolated in their workplace in terms of these factors, the impact may be particularly acute and it may be more difficult to access appropriate support.

 

7. Keeping Workers Safe

7.1 If necessary, visit in pairs to reduce isolation and the possibility of an individual worker becoming embroiled in the dynamics of the family and failing to see resistance and risk. Remember if visiting in pairs what is the impact on children of living in a home where people are anxious about visiting alone.

7.2 Liaise with the police where the immediate risk is assessed as being very high, in order to protect workers or to respond to parents if their actions are potentially criminal. If there is ongoing harassment of workers, it is possible to use the Protection from Harassment Act 1997.

　

8. Supervision and Support

8.1 To make children and young people safer, managers and staff need to be aware of how parental resistance can lead to a worker who doesn’t have appropriate and effective support within their agency failing to recognise the risks towards a child, or becoming unable to challenge the parent(s) concerning any ongoing abuse of the child.

8.2 Workers and the children they protect can be at risk if workers are not appropriately and effectively supported by managers who understand the stresses arising from working with resistant, threatening and violent parents.

8.3 Effective reflective supervision for staff working with difficult to engage or resistant parents is essential and will consider, amongst other things, the following:

• Power dynamics between the worker and the family.
• Recognise that empathy and relationship skills are unlikely to be sufficient when working with resistant families. Empathy needs to be balanced with an eyes wide open, ‘boundaried’, authoritative approach aimed at containing anxiety and ensuring the child’s needs stay in sharp focus.
• The complexities of adults’ problems eclipsing the child’s immediate needs.
• Distinguish between those who are genuinely engaged and those exhibiting disguised compliance.
• Recognise that family non-engagement or hostility hampers a worker’s decision making capabilities and follow through with assessments and plans.
• Remember to avoid over optimism and focusing too much on small improvements.
• Organise and analyse information for assessments, don’t just gather it.
• Directly observe parent/child interactions.
• Capture the voice of the child.

 

9. Further Information

• Disguised Compliance