Working with ‘disguised compliance’and resistant families

Sue WoolmoreJune 2010

Resistant or reluctant?

“A problem for social workers and others is that coverage of recent high profile cases in some parts of the media has contributed to an impression of all parents who maltreat their children as conniving, cold-blooded individuals, set on abusing or even killing a child and, in the process, deliberately setting out to deceive the authorities.”

C4EO knowledge review 2010

Resistant or reluctant?

“Irrespective of whether they co-operate, it is worth remembering that most parents involved in the child welfare system are involuntary participants in a process they may resent.”

C4EO knowledge review 2010

Sources of knowledge and thinking

• Biennial SCR studies• Academic commentary• C4EO commissioned knowledge

review• Practice experience• Reflective supervision

‘Disguised compliance’

Identified in Beyond Blame 1993Family provides sufficient evidence to convince workers

that it is co-operating with agencies to protect the child, whilst effectively neutralising professional concern and insight into reality of the child’s life experience.

Colloquially described as, “doing enough to get social services off my back”

Examples of disguised compliance

clean the house week before reviewschool attendance improves for 2 weekswelcome, rather than usual hostility, at

home visitplausible excuses for missed appointmentspresenting for clinic appointment day

before crucial home visit

Identifying disguised compliance• conflicting accounts of family life from family members

• conflicting accounts/evidence from different professionals

• conflicting accounts from neighbours

• persistently unmet needs of children

• presentation and behaviour of children conflicts with adult accounts

• repeat incidents of harm/neglect to children

• analysis of detailed, multi-agency chronology

• observation of parent child interaction (there is convincing evidence that simulated sensitive parenting is very difficult to sustain - C4EO 2010)

Close associates• Dependency

• workers’ belief that helping parents helps the child• potential competition for worker’s attention

• Closure• family tightens boundary around itself to exclude

professionals e.g. closed curtains, missed appointments• the more interest/control shown by professionals, the

more threatened family feels• increased vulnerability for child as family ‘closes’

• Flight• family closes boundaries further by moving elsewhere

Beyond Blame 1993 – Reder et al

Learning from Serious Case Reviews

“Apparent or disguised cooperation from parents often prevented or delayed understanding of the severity of harm to the child and cases drifted. Where parents made it difficult for professionals to see children or engineered the focus away from allegations of harm, children went unseen and unheard.”

Biennial analysis of Serious Case Reviews 2003 - 2005

Collusion with disguised compliance?• Rule of optimism

• workers are required, if possible, to think the best of carers

• ‘Start again syndrome’• attractive to both practitioners and

managers• past is complex, overwhelming, sense of

helplessness• clean slate – ‘intelligence’ from history is

lost

Ingredients for ‘resistance’

Ambivalence

Denial/AvoidanceUnresponsiveness to treatment/

disguised complianceViolence/Hostility

C4EO knowledge review 2010

Learning from Serious Case ReviewsAlmost 75% parents/carers characterised as

uncooperative:– hostility towards workers– actively avoiding contact with workers– missed appointments– disguised compliance– ambivalence

Biennial analysis of Serious Case Reviews 2005 - 2007

Messages for practice with resistance• Children in families without detailed assessment

four times more likely to suffer repeat abuse

• Information for assessments must be organised and analysed

• Sources of information other than just mother must be sought

• Direct observation of parent-child interaction is essential

• Consistent message about effective supervision

C4EO knowledge review 2010

Challenges for practice with resistance• Working with complex families, practitioners focus too much

on small improvements, rather than context of family history

• Parents’ needs eclipse needs of children

• Parents make it difficult to see child alone

• Men, grandparents and siblings often left out of picture

• Practitioners feel pressurised to close cases quickly

• Agency policies encourage workers to create a (false) dichotomy between ‘in need’ and

‘at risk’ of harm

C4EO knowledge review 2010

Effective interventions with resistance• Focused, long term services, rather than episodic

interventions• Accuracy of assessments enhance service, including

attachment behaviours and detailed family history• Child protection system is powerful tool –

practitioners should harness power• Attitudes and behaviour of practitioners have major

effect on families’ engagement• Workers need to show empathy and acceptance, coupled with an authoritative, child focus• Services that include practical help for families C4EO knowledge review 2010

Resistance or poor services?

• What practitioners perceive as resistance may actually be family’s lack of satisfaction with services

• Parents express frustration when not involved in assessments and interventions

• Parents don’t always receive help they ask for

• Negative traits in practitioners cited: cold, insincere, one-sided

C4EO knowledge review 2010

Role of supervision

“Supervision helps practitioners to think, to explain and to understand. It also helps them to cope with the complex emotional demands of work with children and their families.”

Biennial analysis of Serious Case Reviews 2003 – 2005

Reflective practice

• Mature practice should critically review and revise judgements about family functioning and risk:

• admitting you might be wrong is powerful weapon against making crucial errors• there is tendency to form a judgement and

then stick with it, despite contrary evidence• alternative temptation to swap one theory

for another and not reach a coherent conclusion

Reflective practice

“Reflective practice needs to be supported at the individual, team and agency level and requires careful nurturing, time and space in which to thrive.”

Safeguarding : Briefing 3 C4EOSheryl Burton , National Children’s Bureau

Beyond Blame: child abuse tragedies revisited 1993Peter Reder, Sylvia Duncan, Moira Gray

A required mind-set for child protection practice: comments on Munroe (1999) Peter Reder and Sylvia Duncan Letter to the editor Child Abuse and Neglect vol 24, No 4, pp 443-445, 2000

Analysing child deaths and serious injury through abuse and neglect: what can we learn? A biennial analysis of serious case reviews 2003-2005 Brandon et al

Effective practice to protect children living in ‘highly resistant’ families Rebecca Fauth, Helena Jelicic, Diane Hart, Sheryl Burton, David Shemmings Knowledge Review published by C4EO 2010

The oversight and review of cases in the light of changing circumstances and new information: how do people respond to new (and challenging) information? Sheryl Burton , National Children’s Bureau

Avoidable and unavoidable mistakes in child protection work Eileen Munroe British Journal of Social Work (1996) 26, 793 – 808

References