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By Ruth Gardner
John Wiley & SonsISBN: 0-470-02302-3
Chapter OneINTRODUCTION AND SUMMARY OF FINDINGS
This book gives an account of work undertaken with parents and children by the project staff of the National Society for the Prevention of Cruelty to Children (NSPCC). It describes the family support they offer, which we investigated and reported between 1998 and 2001. A second phase of the study, 2002 to 2004, has just ended and this updated edition gives an update on the most recent findings. Why is this work important? and How was it investigated? are some of the issues that this book deals with.
The NSPCC is a national charity offering services from over a hundred and fifty projects across England, Northern Ireland and Wales. Its first aim, according to its Charter, is 'to prevent the public and the private wrongs of children'. The Society pioneered child protection legislation and systems in this country and is today one of the most influential voices in our current debate about their effectiveness. Although many identify it with child rescue, the NSPCC was unusual among the large nineteenth century charities in working with families in their own homes, in using its legal powers to keep them together wherever possible, and in not setting up child care institutions (Malton, 2000).
Its inspectors began to recognise the complexity of the 'evil' of child abuse, including contributory factors such as domestic violence, poverty, ill health and isolation. Their accounts showed that with some assistance most parents could recover from a crisis to 'normal' functioning and could keep their children safe. Their efforts and observations contributed to the foundation of social work. The NSPCC can thus claim to have been one of the earliest testing grounds for family-based preventative action and support.
The projects we looked at for this study were offering services they identified as consistent with S.17 Part III of the Children Act 1989, services intended
to safeguard and promote the welfare of children within their area who are in need; and as far as is consistent with that duty, to promote the upbringing of such children by their families. (The Children Act, 1989)
They thus provide a sample of activities, usually funded in partnership with local authorities, intended to prevent (by early intervention) children coming to harm or unnecessarily having to be accommodated away from home, and to promote the strengths and aspirations of family members.
These two elements, prevention of damage and promotion of strengths, feature in more or less equal balance in most definitions of what 'family support' is intended to achieve. Some definitions centre on the activity itself, and are descriptive:
any activity or facility provided either by statutory agencies or by community groups or individuals, aimed at providing advice and support to parents to help them in bringing up their children. (Audit Commission, 1994)
Other definitions emphasise the ethos of family support, i.e. working with the family's own strengths and in its immediate context-an important theme in this book:
promoting competence and meeting basic developmental needs of children and families in 'normalised' settings; by teaching practical life skills and by providing environmental supports, as opposed to uncovering and treating underlying pathology. (Whittaker, 1991)
More specifically, according to Warren,
family support practice means providing social support networks for children and their families within a range of formal and informal organisations, thus avoiding social exclusion. (Warren, 1997)
This definition is a good summary of what the NSPCC's family support projects say that they are doing. But additionally, when an 'underlying pathology' becomes apparent, staff and volunteers have necessary preparation and training to take this on. They are able to offer more intensive help such as one-to-one counselling, or can support a child or an adult to seek help. The NSPCC's projects thus fall within another definition of family support:
a way of dealing with life crisis and problems, including abuse within families, which takes account of any strengths and positive relationships within those same families which could assist recovery. Formal interventions are minimised and, where necessary, are introduced in a timely, sensitive way with as little damage to the family as possible. (Gardner, 1998)
Working with family violence and harm to children is a high risk area, where mistakes can be serious if not fatal. This study seeks evidence to develop our understanding of early preventative intervention that is capable of protecting children, while remaining accessible to families. The resources are simply not available, even if it were desirable, to apply child protection procedures to investigate every apprehended risk to a child. The referral and assessment processes filter out the majority of reported cases of possible risk to children, without their receiving either child protection or family support (Department of Health, 1995). Many cases of risk are not brought to statutory agencies at all:
the problem confronting child protection professionals is both over-reporting and under-reporting; over-reporting of signs, risks and fears, and underreporting of actual harm and injury. (Wattam, 1997)
This book gives the results of an examination of the NSPCC's family support over a two-year period, commissioned by the charity from Royal Holloway College, University of London. The remainder of the introduction briefly describes the aims of the research and the methods used. Details of the methodology are given in the relevant chapter and the appendices, for readers with a research interest. We summarise the key findings and their immediate implications for policy and practice. Other recent research findings on family support are also set out. An overview of family support, with a broad range of recommendations, is provided in the final chapter.
The original aims of the research were: to identify NSPCC services and activities that can be shown to support families (children, parents or carers) effectively within their communities
to ascertain the extent to which NSPCC services are valued by key stakeholders as delivering a family support service.
By 'effective' and 'valued' we mean being able to offer robust evidence that the services achieve their stated aims in supporting children and families, in ways that conform to or exceed acknowledged practice standards, and at optimal cost.
Relevant objectives or sub-tasks included:
identifying those interested in the NSPCC's family support, i.e. the key stakeholders, and obtaining their views identifying the range of support services and activities and their intended outcomes identifying measures of effectiveness, relating outputs to outcomes, and of efficiency, relating outputs to inputs describing activities that, either singly or in conjunction with other supports, formal or informal, appear to achieve identified outcomes.
Pecora et al. (1995) have identified four types of evaluation questions for family support services, and have suggested appropriate methodologies for addressing them. They are:
questions about family support needs, which can be answered by survey methods; questions about the type and process of service delivery, best answered via case records and other data; questions about outcome, which can be answered by experimental or quasi-experimental studies or by management information data, depending on the size of population; and questions about cost assessment, relying on financial data.
A mix of quantitative and qualitative, more descriptive approaches can be used to address all four types of research questions, and this study has used such a mix, in order to examine each 'layer' of family support-children, their families and the projects within their communities. Well aware of concerns about the quality of research evidence for the effectiveness of services, we do not claim to have proof of family support producing the changes we describe over a six-month period. The changes themselves, however, are evidenced in the words of those directly involved: children, parents, staff of the NSPCC and other agencies working with families, as well as by analysis of questionnaire scores before and after six months of family support intervention, where (with family members' consent) we use tested research schedules.
Tested questionnaires were used to assess child behavioural problems and parental stress, vulnerability and ill health, scoring a series of answers on these subjects and comparing responses six months later. We were particularly interested in families' personal networks of support and use of resources in their neighbourhood. We devised a questionnaire to assess these perceptions, again over a six-month period. These are tentative findings, but they are, we believe, some of the most interesting. These research tools were used consistently by the same researcher in six research projects across England, described in Chapter 8. Finally, using a survey for all the NSPCC's projects, we evaluated components of their family support, in order to ensure that the research sites were reasonably representative, and to see the wider picture of provision.
When we asked what they wanted of family support, most parents sought help in relation to children's behaviour, particularly that of school-age children. Where help is only available for pre-school children, parents were adapting the advice for use with their older children.
Parents we interviewed wanted support (e.g. practical assistance such as day care, advice or other help) for half of the children in their families. Parents saw most (69%) of these children as having positive, or pro-social, characteristics but saw a higher proportion (71%) as having behavioural difficulties. Again, most of these difficulties were 'severe'.
There was a cluster of problems around hyperactivity and conduct, and another around emotional and peer relationships. Bullying and being bullied featured highly.
The degree of difficulty (as assessed by parents) grew with age. Nine was the average age (for both boys and girls) at which children's difficulties were seen as presenting obvious problems and stress to the family and others.
Most problems with children under three had been resolved within six months, and there was also a significant improvement in the behaviour of children over three whom we followed up, although we cannot specify cause and effect.
Parents identified children's behaviour as a major source of stress in the family, increasing their own sense of inadequacy. They often linked severe behavioural problems in children, to family violence and the child's having suffered emotional and/or other harm.
Children, parents and other agencies frequently attributed improvements (at least in part) to the same aspects of family support activity. These were
direct work with children, helping them to improve their social skills and express their wishes and feelings successfully, both within and outside the family (see Chapter 4);
work with parents to identify specific behavioural problems and ways of handling them constructively (see Chapter 4); and
assistance with speedy referrals for specialist help or other advocacy, for example, about behaviour in school or possible exclusion. Projects also offered direct access to the NSPCC's services for dealing with children's or parents' experiences of conflict, assault or abuse (see Chapter 8).
Where parents' existing informal network of friends and family was strong, children achieved or maintained 'positive' behaviour scores over six months. Parents with good informal support also had more positive health and stress scores after six months (see Chapter 6).
Implications for Policy and Practice
Helplines offer one accessible source of advice, but parents need face-to-face support (e.g. counselling and groupwork) to be much more widespread and easy to obtain. Contact with other parents, normalising the most common difficulties and reducing isolation, needs to be made easier.
Expertise in child psychology and psychiatry is seen as remote, and restricted by administrative procedures. These skills need to be more readily available to all family support services so as to identify and seek prompt and suitable support for children with more serious difficulties. This could be in the form of sessions with family support workers in schools or other community bases, and/or joint groupwork.
The most distressed children were exhibiting harmful and self-harming behaviour. Many had not been referred for specialist help, or appointments had not been kept, or parents described what they saw as being blamed for their child's problems. In some areas there were complaints from parents, family support staff and teachers about the inaccessibility of, and lack of partnership with, child mental health services. This study suggests that the variability of child mental health services (Social Services Inspectorate, 1999; Health Advisory Service, 1995) has not markedly improved and continues to pose major problems for families and mainstream services, despite the government's efforts to stimulate new thinking (see p. 44).
COMPONENTS OF PARENTAL STRESS
Nearly half of the parents and carers suffered serious health and stress problems at the first interview. These findings are consistent with other recent studies of family support in Britain (see p. 39). Many of these adults had not been referred for specialist help, or had received what they perceived as a poor response from the health service.
After six months, the majority of parents we followed up summarised their health as 'about the same'. Questionnaire scores indicated that they were optimistic, since nearly half had deteriorated in some aspect of their physical or mental health.
Lower levels of parental stress and ill health at the second interview were significantly associated with parents' assessment of children's behavioural difficulty as having improved to, or maintained at, a level of concern below the threshold score (i.e. the score indicating difficulties that may require specialist help).
A higher proportion of parents who had received a structured service, such as one-to-one counselling, volunteer visiting or parent's groups, had maintained or achieved levels of ill health and stress below the threshold score, compared to parents who had received occasional support. The type and size of the sample means that this finding is not conclusive, but merits further investigation.
A higher level of vulnerability in terms of past life experiences (e.g. early parenthood, multiple moves, violence) was associated with:
greater health and/or stress problems (first interview)
greater behavioural difficulties in a child (first interview) and behaviour maintaining or reaching a level of concern above the threshold score (second interview)
lower levels of informal (friends and family) support.
About a third of the parents interviewed had at some stage sought assistance from the family support project to discuss and deal with their own past experiences of being harmed as children, and/or later experiences of violence. Resolving these experiences was often, in their view, crucial to their own mental health and parenting capacity.
The small number of fathers and other male carers we interviewed had health and vulnerability scores, and needs for support, similar to those of women.
Implications for Policy and Practice
Needs related to parental health and stress appear to be relatively neglected in the development of family support, a finding that has not changed from a previous study of local authority preventative social work. Hitherto, family support providers have not systematically assessed, or sought to address, the physical and mental health of parents unless these obviously impinge on their parenting capacity, and sometimes not even then (Gardner, 1991).
Family support services should have formal links to primary health care, including but not confined to health visiting, and their evaluation should be linked both to health service targets for adults and to developmental targets for children in need. This study endorses the British Medical Association's (BMA) recommendations on health visiting: 'health authorities should initiate health visitor led identification of post-natal depression, and specific training should be offered' (BMA, 1999).
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Table of ContentsForeword by Jane Tunstill.
Foreword by Lord Laming.
Report of the Committee on Local Authority & Allied PersonalSocial Services 1968.
Paul Boateng, Minister of Health, 1997.
1. Introduction and Summary of Findings.
2. About the Families.
3. Components of Parental Stress.
4. Children and Family Support.
5. Typologies of Family Difficulties.
6. Support Networks in the Community.
7. Overview of Family Support Provided by the NSPCC.
8. Examples of Family Support Practice.
9. Children in Need and Local Services.
10. Family Support Now.