Table of Contents
There can be a wide range of uncooperative behaviour by families towards professionals. From time to time agencies will come into contact with families whose compliance is apparent rather than genuine, or who are more obviously reluctant or sometimes angry or hostile to their approaches.
In extreme cases, professionals can experience intimidation, abuse, threats 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 also consider what life is like for a child in the family.
All agencies should support their staff by:
- Ensuring professionals are trained for the level of work they are undertaking;
- Publishing a clear statement about unacceptable behaviour by those accessing their services (such as seen in hospitals and on public transport);
- Providing training to enable staff to respond as safely as possible to risky or hostile behaviour in their target client group;
- Supporting staff to work to their own professional code of conduct or their agency’s code of conduct when responding to risky or hostile behaviour in their client group.
There are four types of uncooperativeness:
- Ambivalence: can be seen when people are always late for appointments, or repeatedly make excuses for missing them; when they change the conversation away from uncomfortable topics and when they use dismissive body language. Ambivalence is the most common reaction and may not amount to uncooperativeness. All service users are ambivalent at some stage in the helping process which is related to the dependence involved in being helped by others. It may reflect cultural differences, being unclear what is expected, or poor experiences of previous involvement with professionals. Ambivalence may need to be acknowledged, but it can be worked through;
- Avoidance: a very common method of uncooperativeness, including avoiding appointments, missing meetings, and cutting visits short due to other apparently important activity (often because the prospect of involvement makes the person anxious and they hope to escape it). They may have difficulty, have something to hide, resent outside interference or find staff changes another painful loss. They may face up to the contact as they realise the professional is resolute in their intention, and may become more able to engage as they perceive the professional’s concern for them and their wish to help;
- Confrontation: includes challenging professionals, provoking arguments, extreme avoidance (e.g. not answering the door as opposed to not being in) and often indicates a deep-seated lack of trust leading to a ‘fight’ rather than ‘flight’ response to difficult situations. Parents may fear, perhaps realistically, that their children may be taken away or may be reacting to them having been taken away. They may have difficulty in consistently seeing the professional’s good intent and be suspicious of their motives. It is important for the professional to be clear about their role and purpose, demonstrate a concern to help, but not to expect an open relationship to begin with. However, the parent’s uncooperativeness must be challenged, so they become aware the professional / agency will not give up. This may require the professionals to cope with numerous displays of confrontation and aggression until eventual co-operation may be achieved;
- Violence: threatened or actual violence by a small minority of people is the most difficult of uncooperative behaviours for the professional / agency to engage with. It may reflect a deep and longstanding fear and projected hatred of authority figures. People may have experience of getting their way through intimidation and violent behaviour. The professional / agency should be realistic about the child or parent’s capacity for change in the context of an offer of help with the areas that need to be addressed.
3. Impact on Assessment
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.
Engaging with a parent who is resistant or even violent and / or intimidating is 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.
Professionals from all agencies should explicitly identify and record what area of assessment are difficult to achieve and why, and record what plan of action is to be taken.
The presence of violence or intimidation needs to be included in any assessment of risk to the child living in such an environment.
3.1 Impact on assessment of the child
The professional needs to be mindful of the impact the hostility to outsiders may be having on the day-to-day life of the child.
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;
- Whether the child is blaming himself or herself;
- What message the family is getting if the professional / agency does not challenge the parent(s).
3.2 Impact on assessment of the adults
In order to assess to what extent the hostility 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;
- Filtering out or minimising negative information;
- Conversely, placing undue weight on positive information (the ‘rule of optimism’) and only looking for positive information;
- Keeping quiet about worries and not sharing information about risk and assessment with others in the inter-agency network or with managers.
- Focusing on the parent’s needs, not the child’s;
- Not asking to see the child alone;
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. Impact on Multi Agency Work
Sometimes parents may be hostile to specific agencies or individuals. If the hostility is not universal, then agencies should seek to understand why this might be and learn from each other. The risks are of splitting between the professionals / agencies, with tensions and disagreement taking the focus from the child.
Where hostility towards most agencies is experienced, this needs to be managed on an inter-agency basis otherwise the results can be as follows:
- Everyone ‘backs off’, leaving the child unprotected;
- The family is ‘punished’ by withholding of services as everyone ‘sees it as a fight’, at the expense of assessing and resolving the situation for the child;
- There is a divide between those who want to appease and those who want to oppose – or everyone colludes.
4.1 Ensuring effective multi-agency working
Any professional or agency faced with incidents of threats, hostility or violence 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 to the nature of the risks. Information sharing is crucial to protect professionals and children
4.2 Sharing information
There are reasonable uncertainties and need for care when considering disclosing personal information about an adult.
Concerns about the repercussions from someone who can be hostile and intimidating can become an added deterrent to sharing information. However, information sharing is pivotal, and also being explicit about experiences of confronting hostility / intimidation or violence should be standard practice.
5. Supervision and support
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 hostility 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.
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.
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.
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 hostile or violent family and on the effects on the child of living in that hostile or aggressive environment.
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.
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.
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.
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.
5.1 Multi-agency meetings
Working with hostile and uncooperative parents is complex and for meetings to be successful the following questions should be considered:
- Discussing with the chair the option of excluding the parents if the quality of information shared is likely to be impaired by the presents of threatening adults;
- Convening a meeting of the agencies involved to share concerns, information and strategies and draw up an effective work plan that clearly shares decision-making and responsibilities. If such meetings are held, there must always be an explicit plan made of what, how and when to share what has gone on with the family. Confidential discussions are to remain secret and there are legal obligations to consider in any event (e.g. Data Protection Act 1998 – see Information Sharing and Confidentiality), and the aim should always be to empower professionals to become more able to be direct and assertive with the family without compromising their own safety;
- Convening a meeting to draw up an explicit risk reduction plan for professionals and in extreme situations, instituting repeat meetings explicitly to review the risks to professionals and to put strategies in place to reduce these risks:
- Joint visits with police, colleagues or professionals from other agencies:
- Debriefing with other agencies when professionals have experienced a frightening event.
Although working with hostile families can be particularly challenging, the safety of the child is the first concern. If professionals are too scared to confront the family, consider what life is like for the child.
6. Response to Uncooperative Families
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.
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 co-operatively 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).
6.1 Respecting families
Families may develop increased 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.
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).
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.
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 be underpinned by the need for confidentiality in consultation with the family.
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 communication 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
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 critical both for the professional’s personal safety and that of the child that risks are accurately assessed and managed.
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 professional are aware of the skills and strategies that may help in difficult and potentially violent situations.
7.1 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.
7.2 Impact on professionals of hostility and violence
Working with potentially hostile and violent families can place professionals under a great deal of stress and can have physical, emotional and psychological consequences, which may impact on their capacity to make effective decisions.
7.3 Keeping professionals safe
Professionals have a responsibility to plan for their own safety, just as the agency has the responsibility for trying to ensure their safety. Professionals should consult with their line manager to draw up plans and strategies to protect their own safety and that of other colleagues. There should be clear protocols for information sharing (both internal and external). Agencies should ensure that staff and managers are aware of where further advice can be found.
If threats and violence have become a significant issue for a professional, the line manager should consider how the work could safely be progressed, document their decision and the reason for it.
Awareness that threat of violence constitute a criminal offence and the agency must take action on behalf of staff (i.e. make a complaint to the police).
Managers have a statutory duty to provide a safe and working environment for their employees under the Health and Safety at Work legislation.