Growing Support
11. Social work and vulnerable families
By its nature, most of social work with children and their families is focused on those who are vulnerable. Quite a few studies have taken place which are relevant and have systematic measures of outcome. In the British context, much of the recent research has been carried out under the broad umbrella of child protection or family support (formerly prevention), so the contents of this section overlap with those in previous chapters. In North America, the term 'family preservation' has been quite common to describe interventions aimed at keeping together families where there is a high risk of the children having to move into public care.
Mainstream practice
Evidence from England and Wales indicated that, in the 1990s, much statutory work with children and families was concerned with investigations of suspected child abuse. Following investigation, many families were found not to have ill-treated their children but needed help which they did not receive (Department of Health 1995; Farmer and Owen 1995; Gibbons et al 1995). There is some evidence that in Scotland families were more likely to gain access to supportive services (Freeman 1996).
More evidence is available about the effects of special programmes than about routine services or indeed innovations within mainstream services. Some studies have pointed to the quality or competence of social workers as factors in success, but the details of what this means are not always spelled out (e.g. Bullock et al 1998). Other work has shown that typically 'packages' of assistance are multiple and differ widely according to the perceived needs of the families, so it is hard to disentangle statistically which parts contribute to success. For instance, in their study of maltreated children, Brandon et al (1999) did not find that features of 'good practice' (e.g. seeking to work collaboratively, frequent supervision) or particular methods were associated with good outcomes. High satisfaction with the service did correlate with good outcomes, however. The earlier work by Farmer and Owen (1995) suggested that children were helped best when direct multi-professional input was accompanied by assistance from within the extended family.
The literature suggests that interventions at two levels are particularly effective: micro-skills work and improving material and/or social supports (Hill 1999). The former requires detailed individual work with parents, while the latter is based on an understanding of formal and informal resources in the local neighbourhood and a capacity to use and enhance these supports. As we shall see below, some projects manage to do both at the same time. A further important quality was revealed in early studies of client feedback on social workers (Rees and Wallace 1982) and has been confirmed in later work. Parents do want direct, practical help, but they also value social workers who give respect and attention to their viewpoints (Cleaver 2000). Also vital is the provision of clear and honest information about social workers' concerns, plans, procedures and powers, as well as parents' rights (Thoburn et al 1995; Cleaver and Freeman 1995).
In order for intervention to be effective, it is necessary for workers to be able to engage well with families. Communication skills are vital for this (Shulman 1992). Many studies have shown that the ability of social workers to gain the trust of parents and include them in decision making is closely associated with good outcomes (e.g. Bullock et al 1993; Thoburn et al 1995), though unfortunately the most 'difficult' and disadvantaged are often the hardest to engage with (Farmer and Owen 1995; Hill 1999).
Skills and social learning approaches
In social work, as in other areas, interventions based on social learning theories have been repeatedly shown to help parents acquire desired skills and to modify behaviour problems in their children (Sheldon 1987; Herbert 1998; Iwaniec and Herbert 1999). Important elements include: use of contracts, precise definitions of targets and application of learning principles (Cigno and Bourn 1998, Gough 1999). Parents with young children are helped to expand their repertoire of techniques for responding to stress or conflict and to avoid angry, negative approaches (Bourn 1998). With respect to children who fail to thrive, careful monitoring is necessary of weight, height and other aspects of development, both to assess progress and provide feedback to the family and professionals (Iwaniec 1996; 1998).
Intensive, multiple interventions
Several careful comparative studies in both Britain and North America have shown that specialist, intensive projects tend to produce better results than routine social work interventions. However, it is not always easy to discern which particular factors have made the difference: indeed it may be that a whole combination of ingredients is needed. They may include better staff resources, higher motivation and a more focused programme, in addition to any particular feature of the different approach. American family preservation programmes have typically sought to produce change at individual, family and community resource levels, using a combination of practical support and skill-based or therapeutic work. They have been found to have low rates of admission to foster and residential care, despite dealing with high risk families (Pecora et al 1992; Rosenburg and Holden 1992; Downs et al 1996). Dutch work also shows that targeting parental skills alongside attention to material needs can be successful. However, it can be difficult to engage the most difficult and mobile families (Little and Mount 1999).
A particular model which has been developed for very disadvantaged families is the 'wraparound' process, which develops individualised programmes tailored to the expressed wishes and identified strengths of families. A vital component is the worker's ability to purchase services in a flexible way. Although primarily used for families with older children, the model is applicable to all family stages and has been shown to be effective in preventing moves into residential or foster care, with financial savings as a result (Brown and Debicki 2000).
In the UK, Iwaniec (2000) has shown that services targeted at infants who fail to thrive for non-organic reasons enable them to progress significantly better than a control group. Key elements are parenting skills training, support with maternal depression and practical help and support. For the cohort followed up over 20 years by Iwaniec herself, the benefits were evident into adulthood for those who received help in the first year of life, whereas the outcomes were much less good for those who received help when they were older.
The British study of Family Support by Gibbons et al (1990) analysed a project where social workers were based in family centres and sought to mobilise informal and voluntary sector supports. The researchers concluded that a combination of network support and day care was essential to the success of the project.
Duration of intervention
Quite often the length of social work involvement is influenced by outside bodies (such as children's hearings) and considerations other than effectiveness, but it is nevertheless important to know whether similar or better results can be achieved from shorter intervention, since that will be cheaper. Unfortunately, the evidence is not consistent. Certainly, some research has shown that brief interventions can achieve as good results as longer-term contacts (Reid and Shyne 1969; Quick 1998). However, other studies have shown that sustained intervention is necessary since otherwise short-term benefits fade. Berrick (1997) concluded that families where abuse or neglect was an issue gained best from services lasting 6-18 months. This supports the view of Guterman (1997) about the need for sustained input, which was cited in section 5.