View Working Together View Working Together

4.14 Working with Uncooperative Families

SCOPE OF THIS CHAPTER

A feature in some Serious Case Reviews has been the lack of cooperation and/or hostile attitude of parents/carers. When there are child welfare/protection issues, a failure to engage with the family may have serious implications and non-intervention is not an option. This chapter provides definition and guidance and should be read in full.


Contents

  1. Purpose of this Guidance
  2. Definition
  3. Recognition and Understanding
  4. Impact on Assessment
  5. Impact on Multi-Agency Work
  6. Response to Uncooperative Families
  7. Dealing with Hostility and Violence
  8. Action to be Taken when Non-Compliance or Hostility is Recognised
  9. Management Responsibility
  10. Supervision and Support


1. Purpose of this Guidance

1.1 To assist staff and their managers working with hostile / threatening and non-compliant parents/carers and those who use disguised compliance.
1.2 To help workers and their managers identify where these actions may be impacting on the well-being of the child/children and possible child protection issues.
1.3 To assist with those situations where families are unable or unwilling to engage with workers to effectively promote and safeguard the welfare of children.


2. Definition

2.1

For the purpose of this guidance, 3 types of non-cooperation are identified:

  • Hostile and threatening behaviour; which produces damaging effects, physically or emotionally, in other people.
  • Non-compliant behaviour; involves proactively sabotaging efforts to bring about change or alternatively passively disengaging.
  • Disguised compliance; involves clients not admitting to their lack of commitment to change but working subversively to undermine the process.
2.2 There can be a wide range of uncooperative behaviour by families towards professionals. From time to time all agencies will come into contact with families whose compliance is apparent rather than genuine, or who are more obviously reluctant, resistant or sometimes angry or hostile to their approaches.
2.3 In extreme cases, professionals can experience intimidation, abuse, threats of violence and actual violence. The child’s welfare should remain paramount at all times and where professionals are too scared to confront the family, they must use this to consider what life is like for a child in the family.


3. Recognition and Understanding

3.1

Parents/carers may present in a number of ways on a continuum from hostility, threats and violence through to superficial and disguised compliance. Behaviours include:

  • Ignoring advice/role of the professional
  • Misinterpreting/minimising the child’s needs
  • Non-attendance at medical appointments
  • Effectively preventing the child seeing the professional (blatant or agreeing to appointment then ensuring it does not occur)
  • Controlling discussions
  • Preventing meaningful contact with other parent/carer
  • Moving away
  • Manipulating and splitting professional relationship
  • Subverting change
  • Diverting discussions into arguments over e.g. agenda
  • Use of complaints
  • Aggression and threats
  • Evidence of implements of violence (dogs, knives etc)
  • Known history of actual violence.
3.2

When faced with any of the above behaviours, professionals should ask themselves:

  • What were the reasons for the parents’ behaviour?
  • Are there other possibilities besides the obvious? Could their behaviour have been a reaction to something I did or said rather than to do with the child? (Working Together to Safeguard Children, 2010 - now archived)
  • Have the parents understood the situation and do they understand what they are being asked to do and why is it required of them.
  • Do they need another family member or advocate to support and help them understand?
3.3

Factors associated with hostility and non-compliance include:

  • Isolation;
  • Stress and violent experiences in childhood;
  • Disinhibiting effects of alcohol and certain drugs;
  • Mental Illness;
  • Some psychotic states;
  • Learning disability;
  • Medical or social history indicating a low tolerance of frustration and the potential for violence.
3.4

Situations associated with hostility and non-compliance includes:

  • Child protection enquires;
  • Removal of a child into care;
  • Domestic violence;
  • Previous threats of violence;
  • Presence of weapons; and
  • Potentially dangerous animals(snakes/dogs)
  • Professional interventions e.g. questioning beliefs
  • Siblings can provide an obstruction by taking the focus away from the issue

3.5

Recognition of Disguised Compliance

Factors, which may indicate and evidence, disguised compliance include:

  • No significant change at reviews despite significant input;
  • Parents/carers agreeing with professionals regarding required changes but put little effort into making changes work;
  • Change does occur but as a result of external agencies/resources not the parental/carers efforts;
  • Change in one area of functioning is not matched by change in other areas;
  • Parents/carers will engage with certain aspects of a plan only;
  • Parents/carers align themselves with certain professionals; and
  • Child’s report of matters is in conflict with parents’ report.

3.6

Effects of Disguised Compliance in Child Protection Cases

Workers may believe they have engaged in a positive way with parents/carers in addressing risk and working towards change; however this may not be the case. As a consequence the following may happen:

  • Cases can drift;
  • Risks are not reduced;
  • Risks may actually be increased; and
  • Workers may fail to recognise significant issues of concern, misinterpret vital information and lose inter-agency communication.

The child therefore remains in a high risk, unprotected environment.

3.7

Reasons for Uncooperativeness

3.7.1

There are a variety of reasons why some families may be uncooperative with professionals, including the fact that they:

  • Do not want their privacy invaded;
  • Have something to hide;
  • Refuse to believe they have a problem;
  • Resent outside interference;
  • Have cultural differences;
  • Lack understanding about what is being expected of them;
  • Have poor previous experience of professional involvement;
  • Resent staff changes;
  • Dislike or fear of authority figures;
  • Fear their children will be taken away;
  • Fear being judged to be poor parents because of substance misuse, mental health problems;
  • Feel they have nothing to lose (e.g. where the children have already been removed).
3.7.2 A range of social, cultural and psychological factors influence the behaviour of parents. The more uncooperative the family, the more likely it is that the main influences are psychological.
3.7.3 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.


4. Impact on Assessment

4.1 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.
4.2 Engaging with a parent who is resistant or even violent and / or intimidating is obviously more difficult. The behaviour may be deliberately used to keep professionals from engaging with the parent or child, or can have the effect of keeping professionals at bay. There may be practical restrictions to the ordinary tools of assessment (e.g. seeing the child on their own, observing the child in their own home etc). The usual sources of information / alternative perceptions from other professionals and other family members may not be available because no-one can get close enough to the family.
4.3 Professionals from all agencies should explicitly identify and record what areas of assessment are difficult to achieve and why.
4.4 The presence of violence or intimidation needs to be included in any assessment of risk to the child living in such an environment.

4.5

Impact on Assessment of Child

4.5.1

The professionals need to be mindful of parental attitude towards professional involvement on the day-to-day life of the child. The child may:

  • Be coping with their situation with ‘hostage-like’ behaviour (i.e. accommodating, appeasing or identifying with the ‘hostage-taker’ to keep safe);
  • Have become de-sensitised to violence;
  • Have learnt to appease and minimise (including always smiling in the presence of professionals);
  • Be simply too frightened to tell.
4.5.2

In order to assess to what extent the attitude and behaviour of the parent/s is impacting on the assessment of the child, professionals in all agencies should consider whether they are:

  • Colluding with the parent/s by avoiding conflict, e.g.:
    • Avoiding contact in person (home visits);
    • Using remote contact methods (e.g. telephone and letter contact instead of visits to see the child);
    • Accepting the parent’s version of events unquestioningly in the absence of objective evidence;
    • Focusing on less contentious issues such as benefits / housing;
  • Avoiding asking to look round the house, not looking to see how much food is available, not inspecting the conditions in which the child sleeps, etc;
  • Focusing on the parent’s needs, not the child’s;
  • Not asking to see the child alone;
  • Changing their behaviour to avoid conflict;
  • Filtering out or minimising negative information;
  • Conversely, placing undue weight on positive information (the ‘rule of optimism’) and only looking for positive information;
  • Fear of confronting family members about concerns;
  • Keeping quiet about worries and not sharing information about risks and assessment with others in the inter-agency network or with managers.
4.5.3

Professionals in all agencies should consider:

  • Whether the child is keeping ‘safe’ by not telling professionals things;
  • Whether the child has learned to appease and minimise;
  • The child is blaming themselves;
  • What message the family is getting if the professional / agency does not challenge the parent/s.
4.5.4

Professionals in all agencies should ask themselves whether:

  • They are relieved when there is no answer at the door;
  • They are relieved when they get back out of the door;
  • They say, ask and do what they would usually say, ask and do when making a visit or assessment;
  • They have identified and seen the key people;
  • They have observed evidence of others who could be living in the house;
  • In cases of adults with complex/additional needs (e.g. domestic violence, mental health, etc.) they only work with that adult (rather than both parents even when the other parent is a perpetrator of domestic violence).
4.5.5 Professionals and their supervisors should keep asking themselves the question: what might the children have been feeling as the door closes behind a professional leaving the family home?
4.5.6 Workers may also misinterpret the behaviour of parents/carers. What may appear to be defensive/uncooperative behaviour may be designed to mask hidden issues in the family such as domestic violence, mental ill health, and drug or alcohol misuse. Workers should also be aware of their level of assumption and expectations.


5. Impact on Multi-Agency Work

5.1 Agencies and families need to work in partnership to achieve the agreed outcome and all parties need to understand this partnership may not be equal.
5.2 Sometimes parents may not cooperate or are hostile to specific agencies or individuals. If the behaviour is not universal, then agencies should seek to understand why this might be and learn from each other.
5.3 When parents do not cooperate with some professionals / agencies or where professionals become targets of intimidation intermittently, the risk of a breakdown in inter-agency collaboration is probably at its greatest. Any pre-existing tensions between professionals and agencies or misunderstandings about different roles are likely to surface.
5.4

The risks are of splitting between the professionals / agencies, with tensions and disagreement taking the focus from the child, e.g.:

  • Professionals 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 it is ‘personal’;
  • There is no unified and consistent plan.

5.5

Ensuring Effective Multi-Agency Working

5.5.1 Any professional or agency faced with non compliance or hostility should routinely consider the potential implications for any other professional or agency involved with the family in addition to the implications for themselves and should alert them to the nature of the risks.
5.5.2

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, 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 any targeting of specific professions / agencies;
  • Prepared to discuss strategies if one agency (e.g. a health visitor) is unable to work with a family. In circumstances such as these, professionals in the multi-agency network must to agree whether or not it is possible to gather information or monitor the child’s well-being, and ultimately whether it is possible to have a truly Multi-Agency plan?


6. Response to Uncooperative Families

6.1 When a professional begins to work with a family who is known, or discovered, to be uncooperative, the professional should make every effort to understand why a family may be uncooperative or hostile. This entails considering all available information, including whether a Common Assessment has been completed and whether a Lead Professional has been appointed.
6.2

When working with uncooperative parents, professionals in all agencies can improve the chances of a favourable outcome for the child/ren by:

  • Keeping the relationship formal though warm, giving clear indications that the aim of the work is to achieve the best for their child/ren;
  • Clearly stating their professional and/or legal authority;
  • Continuously assessing the motivations and capacities of the parent/s to respond cooperatively in the interests of their child/ren;
  • Confronting uncooperativeness when it arises, in the context of improving the chances of a favourable outcome for the child/ren;
  • Engaging with regular supervision from their manager to ensure that progress with the family is being made and is appropriate;
  • Seeking advice from experts (e.g. police, mental health specialists) to ensure progress with the family is appropriate;
  • Helping the parent to work through their underlying feelings at the same time as supporting them to engage in the tasks of responsible child care;
  • Being alert to underlying complete resistance (possibly masked by superficial compliance) despite every effort being made to understand and engage the parent/s;
  • Being willing, in such cases, to take appropriate action to protect the child/ren (despite this action giving rise to a feeling of personal failure by the professional in their task of engaging the parent/s).
6.3

With the help of their manager, professionals should be alert to, understand and avoid the following responses:

  • Seeing each situation as a potential threat and developing a ‘fight’ response or becoming over-challenging and increasing the tension between the professional and the family.
  • Colluding with parents by accommodating and appeasing them in order to avoid provoking a reaction;
  • Becoming hyper alert to the personal threat so the professional becomes less able to listen accurately to what the adult is saying, distracted from observing important responses of the child or interactions between the child and adults;
  • ‘Filtering out’ negative information or minimising the extent and impact of the child’s experiences in order to avoid having to challenge. At its most extreme, this can result in professionals avoiding making difficult visits or avoiding meeting with those adults in their home, losing important information about the home environment.
  • Feeling helpless / paralysed by the dilemma of deciding whether to ‘go in heavy’ or ‘back off’. This may be either when faced with escalating concerns about a child or when the hostile barrier between the family and outside means that there is only minimal evidence about the child’s situation.

6.4

Respecting Families

6.4.1 Families may develop or increase resistance or hostility to involvement if they perceive the professional as disrespectful and unreliable or if they believe confidentiality has been breached outside the agreed parameters.
6.4.2 Professionals should minimise resistance or hostility by complying with their agency’s code of conduct, policies and procedures in respect of the appropriate treatment of service users.
6.4.3 Professionals should be aware that some families, including those recently arrived from abroad, may be unclear about why they have been asked to attend a meeting, why the professional wants to see them in the office or to visit them at home. They may not be aware of roles that different professionals and agencies play and may not be aware 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 (e.g. child protection).
6.4.4

Professionals should seek expert help and advice in gaining a better understanding, when there is a possibility that cultural factors are making a family resistant to having professionals involved. Professionals should be:

  • Aware of dates of the key religious events and customs;
  • Aware of the cultural implications of gender;
  • Acknowledge cultural sensitivities and taboos e.g. dress codes.

Professionals may 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.

6.4.5 Professionals who anticipate difficulties in engaging with a family 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.
6.4.6

Professionals need to ensure that parents understand what is required of them and the consequences of not fulfilling these requirements, throughout. Professionals must consider whether:

  • A parent has a low level of literacy, and needs verbal rather than written communication;
  • A parent needs translation and interpretation of all or some communications into their own language;
  • It would be helpful to a parent to end each contact with a brief summary of what the purpose has been, what has been done, what is required by whom and by when;
  • The parent is aware that relevant information / verbal exchange is recorded and that they can access written records about them.


7. Dealing with Hostility and Violence

7.1 Despite sensitive approaches by professionals, some families 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.
7.2

It is critical both for the professional’s personal safety and that of the child that risks are accurately assessed and managed. Threatening behaviour can consist of:

  • The deliberate use of silence;
  • Using written threats;
  • Bombarding professionals with e-mails and phone calls;
  • Using intimidating or derogatory language;
  • Racist attitudes and remarks;
  • Homophobic attitudes and comments;
  • Using domineering body language;
  • Using dogs or other animals as a threat - sometimes veiled;
  • Swearing;
  • Shouting;
  • Throwing things;
  • Physical violence.
7.3 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, it is important that professionals are aware of the skills and strategies that may help in difficult and potentially violent situations.

7.4

Making Sense of Hostile Responses

Professionals should consider whether:   

  • They are prepared that the response from the family may be angry or hostile. They should ensure they have discussed this with their manager and planned strategies to use if there is a predictable threat (e.g. an initial visit with police to establish authority);
  • They might have aggravated the situation by becoming angry or acting in a way that could be construed as being patronising or dismissive.
  • The hostility is a response to frustration, either related or unrelated to the professional visit;
  • The parent needs to complain, possibly with reason;
  • The parent’s behaviour is deliberately threatening/obstructive/ abusive or violent;
  • The parent is aware of the impact they are having on the professional;
  • They are so used to aggression, they do not appreciate the impact of their behaviour;
  • This behaviour is normal for this person (which nevertheless does not make it acceptable);
  • The professional’s discomfort is disproportionate to what has been said or done;
  • The professional is taking this personally in a situation where hostility is aimed at the agency.


8. Action to be Taken when Non-Compliance or Hostility is Recognised

8.1 A manager must be consulted if access is ever denied or appointments repeatedly cancelled and/or ‘forgotten’.
8.2 Professionals should record and report non-compliance and safety issues to their managers and to the Lead Professional.
8.3 If there are child welfare concerns, the Lead Professional’s team manager should convene a meeting. Considering agencies’ involvement in the form of a multi-agency chronology, in accordance with information sharing arrangements, may assist in forming an action plan.
8.4

The multi-agency meeting should address the non-cooperation in the context of the child’s written plan as well as historical information about the child/family. Depending on the circumstances this meeting could be:

8.5

Possible strategies include:

  • Joint visiting with colleagues within or external to the agency, (requesting help from Police if there is a physical risk)
  • Exploring the possibility of engaging other non hostile members of the family, if this does not increase the risk to anyone
  • Children’s Social Work Services holding a legal planning meeting to clarify options e.g. Child Assessment Order, Interim Care Order.
8.6 In cases of non-compliance, an assessment should not be closed down on the basis of parental non-engagement. If the decision is made to close the assessment, explicit consideration must be given to how the original presenting concerns are to be addressed, and this consideration recorded. This is particularly the case when the assessment has been commissioned as a result of previous service provision that has not resulted in the necessary changes so as to improve outcomes for the child.

8.7

When there are threats or incidents of violence

8.7.1 Where there are actual threats or incidents of violence they must be reported to the Lead Professional’s team manager immediately and local ‘Violence at Work’ procedures followed in relation to supervision, support, recording and reporting incidents to the Police.
8.7.2

Any response must take account of:

  • Risks to children and other family members
  • Personal safety issues for staff
8.7.3 The experience of violence or threats to staff should be used as evidence of the situation of the family and included in assessments of the child’s circumstances.
8.7.4 Supervision should be used to explore the dynamics of any hostility or non-compliance and plan how best to address the situation including possible specialist assessments.
8.7.5 Note: Violence towards staff is a multi-agency problem. If one agency has information that a parent/carer is known to be violent, it must alert other agencies of the risk posed. If agencies withdraw their services in isolation due to threats against staff and fail to alert one another to the circumstances a child may be left without being seen by any agency and therefore be at increased risk of Significant Harm.


9. Management Responsibility

9.1

Managers have a statutory duty to provide a safe working environment for their employees under the Health and Safety at Work legislation. This includes:

  • Undertaking assessments to identify and manage the risks inherent in all aspects of the work;
  • Providing a safe working environment;
  • Providing adequate equipment and resources to enable staff to work safely;
  • Providing specific training to equip professionals with the necessary information and skills to undertake the job.


10. Supervision and Support

10.1 Each agency should have a supervisory system in place that is accessible to the professional and reflects practice needs. Supervision discussions should focus on any non-compliance being experienced by professionals or anticipated by them in working with families and should address the impact on the professional and the impact on the work with the family.
10.2 Managers should encourage a culture of openness, where their professionals 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 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 professionals.
10.3 Managers should encourage staff to express feelings of discomfort and promote good reflective practice. Professionals 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.
10.4 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 non-cooperative, hostile or violent family and on the effects on the child of living in that environment.
10.5 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.
10.6 The professional should prepare for supervision and 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 professional 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.
10.7 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.
10.8 Files and computer records should clearly indicate the risks to professionals, and mechanisms to alert other colleagues to potential risks should be clearly visible on case files.

End