Supporting Vulnerable ParentsPam Schultz Spring 2013

Session aims• To review what the term “vulnerability” means to SCPHN’s

and partners• What factors can inhibit this state and enhance resilience &

strengthen capacity?• To explore an asset-based approach to practice

• ………………..Look at some case studies from practice!

Vulnerability• According to Newland & Cowley (2003) the term or

concept is difficult to define, nebulous and hard to measure.• Multifaceted – may be due to disability, health or life

experiences…..or combination of many factors.• Used extensively in contemporary models of health

promotion and social inclusion.• Appleton (1996) described vulnerability as a “continuum”,

which families may move in and out of at various stages of the life cycle depending on ability to cope with internal and external stressors.

What do we mean………?Pic:changemakers.com

Workinghousemedia.com

Firahblogspot.com

Netdoctor.co.uk

Vulnerability

• Spiers (2000) suggests vulnerability defined in terms of deficits. Lack of capability to protect self or others from harm.

• Looking at “vulnerability” purely in terms of risk or deficit is not constructive.

• Vulnerable now used in many contexts (overused….?)

• The “label” can be stigmatising & disempowering

Vulnerability Triad

Resources

Life Experiences

Risk Factors

Salutogenesis: Strengths Based

Barnados.org

Red-nose day

A Health Asset model

• A factor or resource which enhances the ability of individuals, communities and populations to maintain their health and sustain wellbeing.

• The assets can operate….as protective and promoting factors to buffer against life’s stresses.

• Morgan and Ziglio ( 2009) (as quoted by Ros Moore, Chief Nursing Officer• Scotland at CPHVA conference, 2011).

Salutogenesis….

• Pathogenesis:- deficits, “medical-model” approach to health. Emphasis on origins of dis-ease, and Illness. “Down-stream” thinking.

• Salutogenesis: an Assets model. Emphasis on the origins of health- and encourages up-stream & Health Promoting approaches. • http

://www.aahperd.org/aahe/publications/iejhe/upload/10_C_Becker.pdf Antonovsky, 1996

Salutogenesis….

• Highlights factors which create and support human health rather than those which cause disease

• It focuses on resources and capacities which impact positively on health and aims to explore & explain them.

• Explores: why, in adverse circumstances, some stay healthy and others don’t.

What makes some people prosper whilstothers have negative outcomes faced withsimilar conditions?What factors make us more resilient andable to cope in times of stress?

Sense of coherence....• “..... the extent to which one has a feeling of• confidence that the stimuli deriving from one's• internal and external environments in the course• of living are structured, predictable and• explicable, that one has the internal resources• to meet the demands posed by these stimuli• and, finally, that these demands are seen as• challenges, worthy of investment and• engagement."

Antonovsky, 1996)

Enabling sense of coherence• Encourage trust in services• Help prevent unreal expectations• Identify problems clearly & early• Help and support family with resolution of problems• Let them know someone cares• Increase potential of clients to access help & support• Minimise negative impact of events in peoples lives• To give support during times of crisis. (Investigating how health visitors define

vulnerability, Newland & Cowley, 2003)

Collaborative Working• The Positives:-• Less duplication• Understanding & appreciation of others role• Can be more positive experience for family

• HOWEVER: we also need to be aware of some of the problems and work with an “asset-based” approach towards our professional colleagues.

Case Study 1• Summer is a 34 year old ex heroin addict and also a heavy

smoker. 5 years ago she had a professional career in the NHS. Prior to pregnancy she had commenced a methadone programme with the support of a specialist GP. She did not expect to become pregnant, as her health status was poor prior to conception. Once the pregnancy was confirmed (at 17 weeks gestation) she attempted to improve her health. Social care undertook a pre-birth assessment.

• The health visitor and GP have supported her and the baby well, and the 6-8 week check has just been completed. This was undertaken when baby Caleb was 9 and a half weeks due to the extended stay in hospital. She is currently homeless, and lives in shared temporary accommodation.

Case Study 1• Assets:-• Previous career in Health Services• Desire to change• Engaging with professionals who are trying to help

• What are her other strengths? What is her story? How else can the SCPHN work in an empowering way to lessen vulnerability

Case Study 2: The Giles family• The Giles family have 9 children ranging from aged 6 months to 26

years. They have been subject to child protection plans on and off for the last five years, usually due to issues of neglect. There have been numerous accidents, including some fairly serious ones. The school age children attend school erratically, and are regularly fined for non-attendance. However, the children always seem happy and emotionally stable, albeit into “mischief”.

• Mr Giles is long-term unemployed as he has found that the unskilled work that he is able to do does not provide enough income to provide for his family. Mrs Giles has never worked.

• The children are not currently subject to a child protection plan as the family responded well to the previous CP plan whereby they attended the Webster Stratton Behaviour Management Programme, and also a specialist course run by the council re: accident prevention. However, you receive notification from A&E that the six year old child has been knocked off a pushbike and has a fractured humerus

Case Study 2: The Giles family• “Stable” family in the sense that the parents have been

together for 26 plus years• Mr Giles has a strong sense of wanting to provide for his

family• They have tried to work well with professionals in the past.• The children seems to be happy and secure

• What is their history/narrative?• What other strengths do they have?

Case Study 3• The Khan family. This family have fled persecution in

Afghanistan. The asylum status is unknown. The health visitor has undertaken a transfer-in-visit. He has found very few items of food in the house. This has been mainly white bread, milk, and some fruit jams of a poor quality. One day during a follow-up visit he sees the mother spoon feeding the 13 month old baby about 12 5ml spoonful’s of the “jam”. The baby also has multiple bruises to her face and legs.

• The husband has very good English, but the wife speaks no English. The older child aged around 3 years seems happy, but has not English. During this second visit the HV notices some bruising to the wife’s arms. She does not appear fearful or distressed.

Case Study 3• Difficult to assess this without good collaborative working.• Need to be cautious about making judgement, HOWEVER, it

is almost certain that a social services referral will need to be made

• If the family (or the wife) has asylum status then some very specialist services will need to be involved.

• This is based on a true example and had a fairly positive outcome.

Case Study: The Hannay Family• The Hannay family consist of an 18 year old mother, Katya, and her two

daughters Anya & Trinity (aged 3 years and 13 months). Mum had been in foster care since the age of 5, and had got into a relationship with Aaron when she was 15 and he was 25. She did not attend school from the age of twelve, and so did not attain any qualifications. Her own childhood had been abusive and chaotic.

• Aaron was a drug dealer, and had mental health problems. He was a pleasant partner and father when he was not taking drugs or alcohol, but changed very quickly when “under the influence” and became menacing and violent.

• During one episode Aaron became very violent and attempted to throttle Katya. The police were called and took mother and children to a “place of safety”. They then went to a Refuge in a town approximately 100 miles from the violent partner. They found 2 temporary homes in a 6 month period, but then ended up in council homeless accommodation. It took 4 months for them to be housed in council property.

Case Study: The Hannay Family• They now have stable housing• They are at much less risk from domestic violence• Katya has removed herself from an environment of

substance misuse.

• What is Katya’s own story? What sort of a person is she? How does she feel about parenting? Is she confident, would she like support? What else?

Health Promoting…• Building on strengths is a powerful catalyst for change• ----------Important to listen (and really listen) to what

parents and children have to say• Genuinely hearing, and where possible responding to what

they tell us• We can help them to feel confident and build upon their

strengths.

References• Antonovsky, A, (1996). The salutogenic model as a theory to

guide health promotion. Health Promotion International, 11, no.1, pp11-18

• Appleton, J. V, (1996). ‘Working with vulnerable families, a health visiting perspective’ Journal of Advanced Nursing, 23: 912-918.

• Burns, K, (2005). Focus on Solutions: A Health Professionals Guide. Whurr Publishers.

• Cowley, S, & Billings, J.R, (1999). Resources revisited: Salutogenesis from a lay perspective. Journal of Advanced Nursing, 29 (4), 994-1004.

• Cowley, S, (2010). Explaining the principles of health visiting in Brazil. Community Practitioner, 83, no.11

References• Lindstrom, B, & Eriksson, M, (2005). Salutogenesis. Journal

of Epidemiology & Community Health, 59, 440-442• Newland, R, & Cowley, S, (2003). Investigating how health

visitors define vulnerability. Community Practitioner, 76, no.12

• O’Connell, B, (2007). Solution-Focused Therapy. Sage Publications.

• Spiers, J. (2000) ‘New perspectives in vulnerability using emic and etic approaches’, Journal of Advanced Nursing, 31(3): 715-21.