The Importance Of Home Visits [email protected]

improving the lives of vulnerable people

developing the staff who work with them

4 transforming how services work together

Statement Does your skills, knowledge and capabilities include A Questioning Culture for Child Protection

Exercise Why do we undertake home visits? What are the reasons/purpose for the home visits? Office based visits vs home visits? What your experience of home visits? How do you plan for your home visits? (be honest?

Maslows Hierarchy of Needs

Assessment Framework Child Safeguarding and promoting Welfare Health Education Emotional and behavioural development CHILDS DEVELOPMENTAL NEEDS PARENTING CAPACITY FAMILY AND ENVIRONMENTAL FACTORS Identity Family and social relationships Social presentation Self-care skills Basic care Ensuring safety Emotional warmth Stimulation Guidance and boundaries Stability Family history & functioning Wider family Hous i ng Employment Income Familys social integr a tion Community resources

Planning and Anticipation Family/Parent Factors What do we know about history? What form does aggression take? Towards whom? Other factors Mental health, substance misuse, DV Triggers caused by us threat of loss, kept waiting, discourteous behaviour, invasion of territory 9

Planning and Anticipation Context Factors Office, home setting, safety, Route, environment Exits Other members of staff Lone working policy Where to sit in room door, objects Contact phone NB where is the child in this? 10

Planning and Anticipation Intimate family space Progress door, hall; living room kitchen, bathroom/toilet. The importance of movement Main stage back stage (not just the front room) A core aim of child protection is to reach an understanding of the childs world, experience and well being and to respond accordingly 11

Planning and Anticipation Worker Factors Always ensure you are safe update your training Is there a risk assessment in place? Alone or co-working? Code/method? Agreed areas - managing the unexpected Anything that could be a trigger factor? If scheduled arrive on time! Use your instincts - is it OK to feel scared? Know the impacts you may experience and manage them? What can I do about it? Can you and have you talked about this in supervision? 12

Planning and Anticipation Personal Factors Personal issues Confidence in self Confidence in process Confidence in co-worker Confidence in organisation Can you acknowledge fear Preparation 13

Getting through the door (and staying there) Know why we are visiting e.g. assessment Making judgements Negotiable and non-negotiable factors What factors may influence the outcome may go wrong and have to go back. Be authoritative not authoritarian Language clarity, role, expectations, consequences (not threats), benefits Empathy and reflection on parents underlying feelings, alongside responsible childcare An assertive, confident, and caring approach 14

Getting through the door (and staying there) Understand why they are uncooperative Keeping relationship formal but warm Clear indications the work is focussed on child(ren) Clearly state your professional and/or legal authority; Continuously assess motivations & capacities of parent/s to respond cooperatively in interests of child/children; Confront uncooperativeness when it arises, bringing it back to the reason for being there Establish written agreement - include areas of resistance/ uncooperativeness, your expectations regarding them. 15

Assertiveness and other skills Pitch between aggressive/passive, formal/warm. Respect yourself and others equally Clear goals and outcomes Say if you dont know or dont understand Listen to and acknowledge other peoples points of view even if you dont understand Empathy not aggression Maintain scepticism and respectful uncertainty Broken record listen to what other says and then if you dont change your mind repeat statement Yes Ill take that on board but can I remind you/come back to Find 3 Yes questions ahead of difficult questions 16

Its not working Stay alert to underlying resistance Be willing to take appropriate action to protect the child/children 17

Prevalence of uncooperativeness & resistance 75% of families in analysis of SCRs characterised as uncooperative. Resisting services or not receiving the services that they needed? What may appear to be resistance may be evidence that the services families are receiving are not fit for purpose (Faith & Shemmings, C4EO) 18

Keeping the Child Central Children cannot wait indefinitely for their needs to be met!! When parents needs are in conflict with their childrens needs, this increases the vulnerability of the child. Parenting Ability vs Parenting Capacity

Focus on the child 20 The failure of all professionals to see the situation from the childs perspective and experience; to see and to speak to children; to listen to what they said, to observe how they were and to take serious account of their views in supporting their needs (is) probably the single most consistent failure in safeguarding work with children Ofsteds evaluation of 50 serious case reviews between April 2007 and March 2008

Purpose/Focus of Consultation Danger/Harm Risk Statements Complicating Factors Current Ranking Safety Strengths/Protective Factors Partnering: Action w/family in their position: willingness, confidence, capacity (Immediate Progress) Safety/Protection Required Enough safety to close 1 2 4 5 7 8 9 10 6 Building Safety & Strengthening Families Practice Framework Next Steps Detail re: incident(s) Bringing the family to the attention of the agency. Pattern/history GENOGRAM/ECOMAP Strengths demonstrated as protection over time Pattern/history of exceptions What is the worker/team looking for in this consult? Risk to child(ren) Context of risk Condition/behaviors that contribute to greater difficulty for the family Presence of research based risk factors Development of next steps relevant to risk context What Who When Etc. Assets, resources, capacities within family, individual/community Presence of research based protective factors Child & Family Services/(Lohrbach) (Gray Area) 3

Why is this approach useful? Helps us to engage with children, young people and their families about their worries/concerns but also what is going well for them (strengths) Organises and structures our thinking in a logical manner from the huge amount of information we gather from various sources Helps us to be proactive not reactive Enables children, young people and their families to problem-solve their own issues/difficulties to make sustainable changes which will lead to better outcomes

Why is this approach useful? Ensures that professionals are honest, fair, objective, inclusive and transparent Professionals have to justify their concerns and be accountable for them Professionals have to use language that makes sense to children, young people and their families Less likely to have families who are resistant or reluctant Ensures not to just concentrate on the deficits/negatives (as you will only just get more of this) Evidenced-informed practice A good tool to use after your visits A good tool to use before, during and after meetings A good tool to use in supervision

Lasting change is more likely to happen when you find out whats working and help people figure out how to do more of it People are more likely to behave/think differently when you work with their goals for change Rapid change or resolution can happen when people hit on ideas that work

Put Simply! What needs to change? How will you/other agencies/child/yp/parents/carers/other people know things have improved enough for us to Exit but only when it is safe to doso Think about children and young people daily experiences

How families avoid? Be welcoming Stage manage visits Avoid home visits and attend office/clinic Restrict or refuse access Failure to attend mtgs Remove children from school/nursery/day clinic Families move

How families avoid? Avoid being in for visits/refuse to answer the door Lie about childs whereabouts Directly threaten professionals Pressure on non-abusing adult not to report or say anything Family tells professionals what they want to hear

How families avoid? Asking for housing move hence professionals becomes distracted Parents/carers discuss their own difficulties and needs Child is scape-goated Parents/cares makes complaints Family questions professionals credibility to undertake their job

How families avoid? Playing agencies against each other Leaving the TV on The presence of animals Allowing their mates to be present

Levels of co-operation a spectrum? 34 Not co-operative Low co-operation Neutral /some co-operation Co-operation V cooperative/persistently seeks help

Analysis and Professional Judgement A Child Developmental Needs must be based on knowledge/research of what would be expected of the childs development. Are their concerns about the childs development in relation to the dimensions? Are we protecting the child from maltreatment? Are we preventing impairment of childrens health or development?

Analysis and Professional Judgement Parenting Capacity should be draw on knowledge about what would be reasonable to expect a parent to give their child which ensures that the child is growing up in circumstances consistent with the provision of safe and effective care Whats missing? Capacity and prognosis for change? Can the parent change within the childs timescale? (Safety over time)

Analysis and Professional Judgement Family and Environmental Factors should be drawing on knowledge about the impact these will have on both parenting capacity and directly on a childs development. Is the accommodation suitable/accessible for a disabled child? Impact of poverty/hardship/isolation? Who else is in the family/extended family that could help/ support? (It takes a village to raise a child-African saying)

Significant Harm Under Section 31 Children Act 1989 as amended by Adoption and Children Act 2002 harm means ill-treatment, impairment of health or development, including seeing or hearing the ill- treatment of another development means physical, intellectual, emotional, social or behavioural development health means physical or mental health ill- treatment includes sexual abuse and forms of ill- treatment which are not physical The question of significant has to be compared to what could reasonably be expected of a similar child

Signs of Safety 1.What are we worried about? (past harm, future danger and complicating factors) 2.Whats working well? (existing strengths and safety) 3.What needs to happen/change? (future safety) 4.Scaling (0-10) 10 means there is enough safety 0 means situation is dangerous

ENGAGING CHILDREN, YOUNG PEOPLE AND THEIR FAMILIES INCLUDE: Working ethically and with consideration for consent and confidentiality Understanding behaviour Interviewing Questioning Observation Listening Summarising Accurate empathy and reflective listening Giving constructive feedback Challenging Working for change and positive outcomes for all

Reflection!! Be respectfully uncertain Do not just be a passive recipient of information Can you critically separate the story given from the actual reality?

Culture & Safeguarding Discrimination is an everyday reality. Our job is to ensure that we do not reinforce that reality and therefore our professional job is to treat people with respect and fairness regardless of non-visible or visible differences (refer to the Culture Map) No culture supports the abuse of children or young people Every child or young person living in the UK is entitled and has the right to be given the protection of the law regardless of his or her background. The basic requirement is that children or young people are kept safe is universal and cuts across cultural boundaries. Never make assumptions about what you see Always question your own prejudices and assumptions. What evidence do you have?

Culture & Safeguarding What is your understanding and experiences of working across different cultures? How do you know if some aspect of a culture is illegal? Always check out with the child/YP and family what their cultural norms are to avoid making any judgements, which are based on stereotypes. Lord Laming said that we should be respectfully uncertain and do not just be a passive recipient of information when working with people.

Culture & Safeguarding All staff working with children and young people should seek advice about what practices are acceptable and which are not within a particular culture to ensure that there are no significant harm concerns and/or a criminal offence has not been committed within UK law. Some individuals will use the word culture or their circumstances (e.g. poverty, relationship breakdown, class) to justify child abuse or neglect. All children and young people have a right to grow up safe from harm and ill-treatment. Child abuse affects all groups to which children belong:- -all social classes -all genders -all ages (including pre-birth) -all abilities -all cultures and ethnic groups (including white children)

Why we lose sight of child/YP Professionals dont believe the childs account Child/YP is fearful of the professionals Professionals like the parents they are a nice family Child/YP has no verbal communication Parents appear nice and plausible Child is fearful of being removed into care Professionals are frighten of the parent (s)

Intervention Who is going to do what, when and how? How are we going to measure progress and ensure life is better for the child/YP?

Exercise Child/YPs Needs Services -how will we know that this will improve or get better for the children(improving their lives)

HELPING CHILDREN TALK

WORKING WITH CHILDREN THE FAIRY AND THE WIZARD

Indicators of poor outcomes Disruptive or anti-social behaviour Overt parental conflict or lack of parental support/boundaries Involvement in or risk of offending Poor attendance or exclusion from school Experiencing bulling or discrimination Special educational needs Disabilities

Indicators of poor outcomes Disengagement from education, training or employment post 16 Poor nutrition/poverty Ill-health Substance misuse Aniexty or depression Housing issues Pregnancy and parenthood

Model of Change Tony Morrison Action Rehearsing new behaviours Maintenance Sustaining and internalising New behaviours Relapse Return to some or all old behaviour. Give up or try again EXIT Contemplation Weighing up pros and cons Start of change process Pre-contemplation Defensive, denial, Projecting blame, depressed, unaware

Six stages of contemplation I accept that there is a problem I have some responsibility for the problem I have some discomfort about the problem and my part in it I believe that things must change I can see that I can be part of the solution I can see the first steps towards change. (Calder, forthcoming)

A scale for assessing motivation 1.Shows concern and has realistic confidence. 2.Shows concern, but lacks confidence. 3.Seems concerned, but impulsive or careless 4.Indifferent about the problems 5.Rejection of parental role

It takes a Village to raise a Child TAC/TAF

T.E.A.M YOT School/College Housing Neighbourhood Police Early YearsHealth Visitor Nursery GP Child/ Young Person Youth CAMHS Parents/Carers/families Midwives CFF Children Centres Voluntary Agencies

Intervention Planning is getting all the different pieces TO FIT TOGETHER

WORKING TOGETHER TO ACHIEVE BEST OUTCOMES AND TO IMPROVE CHILDREN AND FAMILIES LIFE CHANCES

Asking the right questions? What are the needs of this Family? How can WE help and support this Family- stay as a Family? Who needs to be involved and can help make changes with the family?

Possible Roadblocks What are the possible road-blocks to working together? How can the road-blocks be addressed? Solutions?

Put Simply! What needs to change or be improved? How will Families and you know that things have improved or are better for children within their timescale? Who and What will tell us ?

Getting Plans to work It is the plan that is developed where everyone involved knows clearly what needs to remain the same/change, what needs to be achieved, what needs to be different within what timescale, with clear actions that are measurable (SMART) Children and their families are integral to this process. We must think and work differently in how we negotiate with children and their families

Review the Plan Any review needs to consider: Have there been any changes since the last time we all met? What progress has been made? What difference has been made-have you made progress towards, or achieved, the differences you or the family hoped for? Do we need to consider other options?

Scaling and Goal setting What are the child/rens goals? What are the parents/carers goals? What are the agencies goals? 0-No engagement/no progress made 10-engagement/progress made which is real and meaningful to the childs safety and well-being

Karen is a 32 year old mother who has 7 children by 6 different men She is unemployed and living on a council estate Karen had a difficult upbringing, frequently truanting school. She had few aspirations and borderline low intelligence At 14 the relationship with her mother broke down and she spent time in and out of the care system She had a string of failed relationships, based upon heavy drinking, smoking and violence The home was often dirty, dishes piled up in the sink, dirty washing on the floor House was often full of friends who stayed until the early hours drinking and smoking Social Services contacted on numerous occasions by family, neighbours and school staff Services attended the property by appointment, giving Karen chance to clean the property and prepare to adopt the caring parent image Children were placed on the CP Plan, which called for Karen to be constantly supervised because of her inability to successfully place the childrens needs above her own

Just over a year later the children were removed from the Plan as they were deemed no longer at risk and step down to a CAF Children continued to present at school dirty and unkempt with matted hair Karen was manipulative and refused to engage in support services There were no support services engaging with this family How would you support this family?

(Karen Matthews)

Shannon Matthews

A National Framework for Change Following the inquiry into the death of Victoria Climbie, Lord Lamings recommendation made clear that child protection should not be separate from policies to improve childrens lives as a whole

Network of Victorias Services

Information Sharing Almost every child death enquiry since Maria Caldwell has never criticised professionals for sharing relevant information but they have for NOT.in a timely manner!

Who can give consent Children aged 12 and over, consider age, understanding, maturity (consider Lord Fraser judgement)

Information Sharing Whilst the law rightly seeks to preserve individuals privacy and confidentiality, it should not be used (and was never intended) as a barrier to appropriate information sharing between professionals. The safety and welfare of children is of paramount importance, and agencies may lawfully share confidential information about children or the parent, without consent, if doing so is in the public interest. Lord Laming

Information Sharing A public interest can arise in a wide range of circumstances, including the protection of children from harm, and the promotion of child welfare. Even where the sharing of confidential medical information is considered inappropriate, it may be proportionate for a clinician to share the fact that they have concerns about a child. Lord Laming

Information Sharing The Key factors in deciding whether or not to share confidential information are necessity and proportionality, ie whether the proposed sharing is likely to make an effective contribution to preventing the risk and whether the public interest in sharing information overrides the interest in maintaining confidentiality. In making the decision you must weigh up what might happen if the information is shared against what might happen if it is not and make a decision based on professional judgement Lord Laming

Sharing Information Likely outcome if information is shared Data Protection Act 1998 Human Rights Act 1998 Freedom of Information Act 2000 Children Act 1989 and 2004 Likely outcome if information is not shared

Lessons from Haringey SCRs Working together in CP is like being in a relay team- make sure the information you hand over has been received and understood. The rule of optimism means that professionals can even rationalise evidence that contradicts progress

Lessons from Haringey SCRs A child does not have to be hit to be harmed. All neglect indicators stem from a parental choice to prioritise something else above their childs basic needs. Think the Unthinkable: It is crucial to be sceptical of the accounts parents give-they should be tested thoroughly against the facts

Lessons from Haringey SCRs The presence of a child in a household where domestic violence is an issue should immediately alert you to risk. A Seen Child is not necessarily a Safe Child: Almost every child that has died in the last 40 years was seen by professionals within days (or hours) of their death.

Lessons from Haringey SCRs At times professionals failed to act because they thought that another involved professional would take action. The best predictor of future behaviour is past behaviour There is no such thing as a typical family or a typical child, and it is dangerous to think that way.

Lessons from Haringey SCRs Do not confuse an apparent good adult-child interaction with secure attachment....even abusive parents can have good days with their children Risk refers to the probability of a future even; current harm is not a risk but a reality

Messages from Mike Stop and re- group (Critical Thinking) Communication/information sharing Keeping the child/yp central to your conversations/analysis and decisions/plans Dont assess families to death!!!!!!! Child/yp cannot wait for their needs to be met-be confident in your professional judgements to date!

What if this was your child? What would happen if we did nothing? Whats reasonable to expect from parents/carers? When is enough enough? Collective responsibility TEAM When to escalate? Stop trying to fix the unfixable(Children cannot wait!) Messages

Understanding Thresholds across agencies Multi-agency training-do we share/agree with the child/yp welfare concerns? Supporting each other with the workload-its ok and right to ask for help and support!!! We believe in diversity and difference but not at the expense of the child/yp Messages

Being honest and clear about your concerns-being upfront. Its not what you say but how you say it!!!!!!!!!!! We dont have to tolerate abuse/intimidation/

Messages Importance of info sharing-we are all part of the jigsaw puzzle Think of meetings like going to a birthday party-we all bring a present (info) Multi-agency training-roles and responsibilities

Messages Seeking guidance/direction from your peers/supervisor/manager/colleagues We all need to be calm/proactive/critical/reflective thinkers.

PLAN Actions to facilitate outcomes IMPLEMENT Carry out the plan REVIEW What looks different? ASSESS Solution focused Transparent Negotiated OUTCOMES (specific, realistic measurable agree how progress will be measured and scale current situation from 1-10 ) AN OUTCOME FOCUSED PRACTICE MODEL Workers will Family Members will child/parent will What looks different? (scale against outcomes) Have plans been carried out? Impact of the change? (update assessment) Has a good service been provided?

Exercise What have I learnt? What has been confirmed for me? What will I do differently if anything? Messages for the wider audience/colleagues/senior managers/Heads of Services/Councillors/Government and the wider community

Documents

The Importance Of Home Visits [email protected]