Working with Uncooperative Families or Family Members
This guidance aims to help staff whatever their role when working with reluctant and uncooperative families or family members.
What do we mean by ‘uncooperative’?
1.1 There can be a wide range of uncooperative behaviour by families or family members or family members towards workers. From time to time all agencies will come into contact with families or family members who may prove to be apparently (but not genuinely) compliant, reluctant, resistant, or sometimes angry or hostile to their approaches. In extreme cases there can be intimidation, abuse, threats of violence and actual violence.
How will this guidance help?
1.2 This document aims to help staff whatever their role when working with reluctant and uncooperative families or family members. A worker’s purpose in making contact with a family varies depending on their role and their agency; workers need to use this guidance accordingly. Workers need to be clearly aware of the level of authority they represent and therefore how far they are required to engage with the family. The guidance aims to:
Note: In relation to senior staff (i.e. Service Managers, Practice / Team Leaders etc), this guidance aims to help them in supporting their staff and when they need to provide an authoritative response to the resistant family, making it clear non co-operation is not acceptable. Workers in such situations will aim to reach a view about whether a family is displaying understandable ambivalence, or is actually a family where change is much more difficult and a more authoritative approach is needed, in which case a decision may have to be made about whether the child should be allowed to remain in the family.
1.3 All agencies need to be mindful of the need for workers to be trained for the level of work they are undertaking.
1.4 It is helpful if agencies publish a clear statement about unacceptable behaviour by those accessing their services (such as seen in hospitals and on public transport)
1.5 This guidance should be considered alongside the worker’s own profession’s code of conduct and is not intended to replace in-house self defence / safety training in place within organisations.
2. Recognising and making Sense of Lack of Co-operation
How do I recognise uncooperativeness?
2.1 There are four types:
a) Ambivalence can be seen when people are always late for appointments, or repeatedly make excuses for missing them; when they change the conversation away from uncomfortable topics and when they use dismissive body language. Ambivalence is the most common reaction and may not amount to uncooperativeness. No service user is without ambivalence at some stage in the helping process. We are all ambivalent about the dependency involved in being helped by others. It may reflect cultural differences, being unclear what is expected, or poor experiences of previous involvement with professionals. Ambivalence may need to be acknowledged, but it can be readily worked through.
b) Avoidance is a very common method of uncooperativeness and includes avoiding appointments, missing meetings, and cutting short visits due to other apparent important activity (often because the prospect of involvement makes the person anxious and they hope to escape it). They may clearly have a problem, have something to hide, resent outside interference or find staff changes another painful loss. They may face up to the contact as they realise the worker is resolute in their intention, and may become more able to engage as they perceive the worker’s concern for them and their wish to help.
c) Confrontation includes challenging professionals, provoking arguments, extreme avoidance (not answering the door as opposed to not being in) and often indicates a deepseated lack of trust leading to a ‘fight’ rather than ‘flight’ response to difficult situations. Parents may fear, perhaps realistically, 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. It is important for the worker to be clear about their role and purpose, demonstrate a concern to help, but not to expect an open relationship to begin with. However, the parent’s uncooperativeness must be challenged, so that they become aware that the worker / agency will not give up. This may involve the worker in weathering numerous displays of confrontation and aggression until eventual cooperation may be achieved.
d) Violence: threatened or actual violence by a small minority of people is the most difficult of uncooperative behaviours for the worker / agency to engage. 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. The worker / agency will need to be realistic about the capacity for change in the context of an offer of help with the areas that need to be addressed. If necessary the children should be referred for Section 47 enquiries, and this may entail them being removed from the family home for assessment.
Note: 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.
What are the reasons for families or family members not cooperating?
2.2 There are a variety of reasons why some families or family members may be uncooperative with professionals, including:
2.3 It is important to be mindful that a range of social, cultural and psychological factors influence the behaviour of parents / carers and that these can be influenced by previous experiences. 2.2.3 As an adult the parent / carer will try to regain control over their lives, but they may be overwhelmed by pain, depression, anxiety and guilt resulting from the earlier loss. Paradoxically the ‘anti–social tendency (the act of uncooperativeness) may be the moment of hope’ as the adult opens up to their feelings, albeit negative ones, at the prospect of help. They are unlikely to be aware of this process going on.
3: Impact on the Assessment of Children / Families or Family Members
Practitioners embarking on an assessment should follow the guidance in The Framework for Assessment of Children and their Families (DH, 2000) & Working Together To Safeguard Children (DCSF, March 2010)
3.1.1 Accurate information and a clear understanding of what is happening to a child within their family and community are vital to any assessment. The usual and most effective way to achieve this is by engaging parents and children in the process of assessment, reaching a shared view of what needs to change and what support is needed and jointly planning the next steps.
3.1.2 Engaging with a parent / carer who is resistant or even violent and / or intimidating is obviously more difficult. The behaviour may be deliberately used to keep professionals at bay, or can have this effect. There may be practical restrictions to the ordinary tools of assessment, e.g. observing the child in their own home. The usual sources of information / alternative perceptions, e.g. other workers and other family members may also be kept at bay.
3.1.3 It is important to explicitly work out and record what areas of assessment are difficult to achieve and why.
3.1.4 The presence of violence or intimidation needs to be included in any assessment of risk to the child living in such an environment.
3.2 Impact on the child
3.2.1 The worker needs to be mindful of the impact the hostility to outsiders may be having on the day-to-day life of the child and when considering what the child is experiencing, many of the above may be equally relevant. The child may:
3.3 Impact on your assessment
3.3.1 In order to assess to what extent the hostility of the parents / carers is impacting on your assessment of the child it may help to ask yourself:
Practitioner Tips - Written Contract
Consider drawing up a written contract with the family specifying:
4. Impact on Multi-Agency Work
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 be hostile to specific agencies or individuals. If the hostility is not universal, then agencies should seek to understand why this might be and learn from each other. Where hostility towards most agencies is experienced, this needs to be managed on an inter-agency basis otherwise the results can be as follows:
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.
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 parents or carers, 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:
4.2.3 There are reasonable uncertainties and need for care when considering disclosing personal information about an adult. Concerns about the repercussions from someone who can be hostile and intimidating can become an added deterrent to sharing information. However, information sharing is pivotal, and also being explicit about experiences of confronting hostility / intimidation or violence should be standard practice.
4.2.4 If you would answer yes to any of the following questions you should share them with your manager and any other professionals involved with the family:
4.2.5 Workers in different settings and tiers may have different thresholds for concern and different experience of having to confront difficult behaviour. It is vital that the differing risks and pressures are acknowledged and supported.
4.3 Child protection conferences, core groups and multi-agency meetings
4.3.1 Avoiding people who are hostile is a normal human response; however it can be very damaging of effective inter-agency work under child protection plans, which depends on proactive engagement by all professionals with the family. Collusion and splitting between agencies will be reduced by:
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 about intimidation and threat of violence.
4.4 Options to consider are:
a. Discuss with the Child Protection Conference Chair the option of using the exclusion criteria if the quality of information shared is likely to be impaired by the presence of threatening adults.
b. Holding a meeting of the agencies involved to share concerns, information and strategies and to draw up an effective work plan that clearly shares decision-making and responsibilities. If such meetings are held, there must always be an explicit plan made of what, how and when to share what has gone on with the family. Secret discussions are unlikely to remain secret, and the aim should always be to empower the core group to become more able to be direct and assertive with the family without compromising their own safety.
c. Holding a meeting to draw up an explicit risk reduction plan for workers and in extreme situations, instituting repeat meetings explicitly to review the risks to workers and to put strategies in place to reduce these risks.
d. Joint visits with police, colleagues or workers from other agencies.
e. If workers have experienced a frightening event, debriefing with other agencies can be helpful
Remember that although working with hostile families or family members can be particularly challenging, the safety of the child is the first concern. If professionals are too scared to confront the family, consider what life is like for the child
5. Responding to Uncooperative Families or Family Members
What should I do?
5.1 Unfortunately for the worker making the approach, the underlying feelings of the family may be masked by anger or avoidance as these parents do not easily trust and may be fearful of closeness. It is best to be formal, though warm, giving clear indications that the aim of the work is to achieve the best for their child and be helpful if possible.
5.1.2 It is essential that the parent / carer recognises that you are a professional with the authority to be involved with their family and to do this you must clearly state your professional authority. The motivations and capacities of the adults to respond cooperatively in the interests of their children, with the help of the worker and their agency will need to be continuously assessed.
However, both control and care will be needed, and the worker must confront uncooperativeness when it arises, albeit with understanding and empathy.
5.1.3 You should seek supervision from your manager or advice from senior staff to ensure you are progressing appropriately with the family.
5.1.4 Where you as a worker 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 in the tasks of responsible child care.
5.1.5 In some cases, despite making every effort to understand and engage the parents / carers, you may find the family remains completely resistant and will not allow you to become involved.
5.1.6 In such cases you should not hesitate to have discussions with your manager, and together consider if other action might be necessary. It is important for workers in such situations not to feel a sense of personal failure or professional incompetence. Remember: all workers experience such rebuffs at some point during their working life; there are some families or family members who are resistant despite anyone’s efforts.
5.2 What should I not do?
5.2.1 Workers‘ ‘coping’ strategies that may merely obstruct engagement with any other family can be pitfalls when working with hostile families or family members. As a result perceived or actual harm to the child may be minimised or underestimated by the worker. You will need support to understand the family’s behaviour and your own response to it. Workers may unknowingly use the following strategies:
5.3 Important issues to consider
5.3.1 Make every effort to understand why the family may be uncooperative or hostile, and this entails considering all available information. 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.
5.3.2 Some families or family members, including those recently arrived from abroad may be unclear about why they have been asked to attend a meeting, why you want to see them in the office or why you are visiting them at home. They may not be aware of roles that different professionals and agencies play and may not know that the local authority and partner agencies have a statutory role in safeguarding children, which in some circumstances override the role and rights of parents.
5.3.3 Where you think cultural factors are making a family resistant to having professionals involved, you seek expert help and advice in gaining a better understanding and recognising the impact of cultural differences. 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.
5.3.4 Practitioners should ensure that clients are treated with respect and dignity at all times. Being professional not only involves keeping appointments, but also ensuring that families or family members are engaged wherever possible.
5.3.5 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.
5.4 Benefits of conducting joint visits
5.4.1 If you anticipate difficulties in engaging with a family, you may want to consider the possibility of having contact with the family jointly with another person in whom the family has confidence. Any negotiations about such an arrangement must similarly be underpinned by the need for confidentiality in consultation with the family.
5.4.2 Joint visits enable professionals to consider different perspectives of family needs and how these needs might be met. Professionals interpret presenting issues in line with their professional experience and expertise, so professionals from different disciplines that work together can develop a more holistic picture of family needs. Furthermore, having two professionals in a home provides an extra pair of eyes and enables more opportunities for observation, as one professional can observe while the other is talking and vice versa.
5.4.3 This is particularly important for families that are considered to be vulnerable or have complex needs. The home environment is the optimal place for assessing family needs and providing targeted support to address those needs. Evidence suggests that home visiting interventions to address the multiple needs of families are more effective than those that focus on a narrow range of outcomes.
5.4.4 Joint visits can also increase the chances of engagement with a range of services – families can have misconceptions about the work of particular agencies which lead to anxiety and a reluctance to engage. If these workers conduct joint visits with those professionals that already have an established relationship with the family, having a ‘friend’ in a worker can help to break down anxiety for families.
5.4.5 Families that see professionals from different disciplines working together know that those agencies are sharing information and working together to support the family. This can reduce the frustration of having to repeat information to different professionals, and minimises opportunities for families to manipulate professionals.
5.5.6 Joint visits are also good for safer working practices. This is particularly important with those families that are intimidating or make professionals feel threatened. An agency may not have the resources to send two professionals on a joint visit, so conducting a joint visit with a professional from another agency is a good use of resources and provides additional support to professionals dealing with hostility.
Practitioner Tips: Prior to Making Contact
Practitioner Tips: Recognising Diversity
Use of interpreters*
Where you have ascertained that an interpreter is needed, it is important to check out the interpreter is able to communicate in the required language / dialect. Time must be spent prior to making contact to ensure the interpreter understands the purpose of the involvement and feels comfortable about the subject matter of the forthcoming discussions. The interpreter may need to be briefed on technical and legislative matters relating to the contact.
*Note: this applies also where you are aware family members may have impaired hearing; it is important to take steps to ascertain their preferred method of communication and if BSL is to be used, arrange for an appropriate interpreter to assist.
Interpreters can be very helpful in making phone calls to arrange interviews and explaining to the family the purpose of the involvement and the role of the professional.
Family members, relatives and members of their community or friendship group should not be used as interpreters. It is important to clarify this before the visit takes place.
Practitioner Tips: Managing Highly Resistant Behaviour
Practitioner Tips: Professional Practice
Information Sharing & Confidentiality
Practitioner Tips: When Initial Contact Is Established
Remember to: Review the contact or visit, as this can be extremely useful not only for practitioners but also for the family. Try to end each contact with a brief summary of what the purpose has been, what has been done, what is required and by when. Finally, set a review meeting.
Practitioner Tips: Improving Communication with Families or family members
6: Dealing with Hostility and Violence
6.1 Dealing with Hostility and Violence
6.1.1 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:
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.
Practitioner Tips: Making Sense of Hostile Responses
Are you prepared that the response from the family may be angry or hostile towards you? Have you discussed this with your manager and planned the strategies you would use where there is a predictable threat, e.g. an initial visit with police to establish authority?
Might you have aggravated the situation by either getting angry yourself or could you have been construed as being patronising or dismissive? Is the hostility a response to frustration, either related or unrelated to your visit?
7. Impact on Workers of Hostility and Violence
7.1 Impact on Workers of Hostility and Violence
7.1.1 Working with potentially hostile 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.
7.1.2 Staff and Managers should be aware of and respond to any symptoms that may occur.
7.1.3 The impact on workers may be felt and expressed in different ways, for example:
7.2 Factors that increase the impact on workers include:
7.2.1 Previous traumatic experiences, both in professional and personal life, can be revived and heighten the fears.
7.2.2 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.
7.2.3 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.
7.2.4 Threats that extend to the worker’s life outside of work.
7.2.5 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.
7.2.6 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. 7.2.7 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.
8. Keeping Workers Safe
8.1 Worker’s responsibility
8.1.1 You have a responsibility to plan for your own safety just as your agency has the responsibility for trying to ensure your safety. Workers should consult with their line manager to draw up plans and strategies to protect their own safety and that of other colleagues. There should be clear protocols on information sharing (both internal and external). Staff and managers need to be aware where further advice can be found.
8.1.2 Prior to contact with a family consider the following questions:
8.1.3 Finally, a few don’ts:
Practitioners Tips – Keeping Yourself Safe
If an incident occurs:
8.2 Management responsibility
8.2.1 Managers have a statutory duty to provide a safe working environment for their employees under the Health and Safety at Work legislation. This includes:
8.2.2 In practice managers need therefore to ensure that staff are not exposed to unnecessary risks by ensuring:
Tips for Managers
8.3 Supervision and Support
8.3.1 Each agency should have a supervisory system in place that is accessible to the practitioner and reflects practice needs. Supervision discussions should focus on any hostility being experienced by workers or anticipated by them in working with families or family members and should address the impact on the worker and the impact on the work with the family.
8.3.2 Managers must encourage a culture of openness, where their workers are aware of the support available within the team and aware of the welfare services available to them within their agency. Managers must ensure that their staff members feel comfortable in asking for this support when they need it. This includes ensuring a culture that accepts no intimidation or bullying from service users or colleagues. A ‘buddy’ system within teams may be considered as a way of supporting workers.
8.3.3 Workers must feel safe to admit their concerns knowing that these will be taken seriously and acted upon without reflecting negatively on their ability or professionalism.
8.3.4 Discussion in supervision should examine whether the behaviour of the service user is preventing work being effectively carried out. It should focus on the risk factors for the child within a hostile or violent family and on the effects on the child of living in that hostile or aggressive environment.
8.3.5 An agreed action plan should be drawn up detailing how any identified risk can be managed or reduced. This should be clearly recorded in the supervision notes. The action plan should be agreed prior to a visit taking place.
8.3.6 The practitioner should prepare for supervision and should bring case records relating to any violence / threats made. They should also be prepared to explore ‘uneasy’ feelings even where no overt threats have been made. Managers will not know about the concerns unless the practitioner reports them. By the same token, managers should be aware of the high incidence of under reporting of threats of violence and should encourage discussion of this as a potential problem.
8.3.7 Health and Safety should be a regular item on the agenda of team meetings and supervisions. In addition, group supervision or team discussions can be particularly useful to share the problem and debate options and responsibilities.
8.3.8 Files and computer records should clearly indicate the risks to workers and mechanisms to alert other colleagues to potential risks should be clearly visible on case files.