8.8 Working with families who are uncooperative and/or not engaging with professionals

This guidance is intended to complement existing single agency procedures designed to support and protect staff working with aggressive people. It helps professionals to identify parents and carers who are hostile, aggressive, or using disguised compliance techniques as a mechanism to keep professionals at a distance; or attempting to persuade professionals that sufficient change has occurred or is occurring to reduce the need for further intervention. There can be a wide range of uncooperative and/or reluctant behaviours by families towards professionals who are working with them.  From time to time, agencies will be liaising with families who appear to co-operate, (disguised compliance) or with those families who are more obviously reluctant or sometimes angry or hostile in response to their approaches.

In extreme cases, professionals can experience intimidation, abuse, threats of violence and actual violence.  The child's welfare should always remain paramount. Where professionals feel intimidated by and/or worried about confronting a family, they must also consider what life is like for a child in that 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.

Families may display a wide range of uncooperative behaviour towards professionals, ranging from disguised compliance to reluctant or resistant or sometimes angry or hostile behaviours. In extreme cases, family members may intimidate, abuse or make threats of, or carry out acts of, violence.

This includes a range of uncooperative behaviours

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;

 Avoidance: a prevalent 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). The individual/family 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 maybe 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 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.

Families may be uncooperative with professionals for several reasons:

• Not wanting their privacy invaded
• Having something to hide
• Do not think that there is a problem
• Cultural differences
• Resent outside interference
• Area of concern has not been made clear by the social worker
• Lack of understanding about what is expected of them
• Lack of understanding of jargon used by professionals
• A parent's/care giver's cognitive capability is impaired, and they may be unclear about what is happening
• Professional appears anxious or lacking in confidence, and the family does not have confidence in them
• Previous (negative) experience of professional involvement
• Staff churn – recent change(s) of professionals working with family
• Fear or distrust/dislike of authority figures
• Fear that the children may be removed (from the family's care)
• Fear of being judged to be poor parents/caregivers because of, e.g. substance misuse, alcohol misuse and mental health problems issues
• A feeling that they have nothing to lose, e.g. where the children have been removed.

Accurate information and a clear understanding of what is happening to a child within their family and community are vital to any assessment. It is important that focus on the children is not lost.

Engaging with a parent and/or other caregiver 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 and/or other caregiver and can have the effect of keeping professionals at bay. As a result, 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 areas 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.

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 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?

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 themself;
• What message the family is getting if the professional / agency does not challenge the parent(s).
• Whether the child is too frightened to tell
• Whether the child identifies with the aggressor

The following additional considerations may help when assessing the extent of the hostility of the parent/carers is having on the assessment of the child:

• Has the child learned to minimise or blame themselves?
• Who else is living in the house? Have they been spoken to?
• What might the child have felt when the door close after a professional has visited?
• Is information being minimised by the family and potentially the professional who colludes in order to avoid confrontation?)
• Are meetings focussed on less controversial matters (e.g. where the professional and the family have an agreed approach) which results e.g. in the child not being seen alone.

Impact on assessment of the adults

To assess to what extent, the hostility of the parent(s)/care givers 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;
• 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.

Drawing up a contract of expectation / written undertaking 

A 'Contract of Expectation' or a 'Written Undertaking' is an agreement regarding a specific issue where a practitioner has concerns that require an undertaking from a parent or carer that something will or will not happen.

Such agreements do not constitute an arrangement for partnership working and these are not to be confused with a 'Written agreement'.

They act as a means of outlining an expectation of a parent or carer made by Children's Services in order to inform the parent or carer and other agencies of a specific risk or concern and how to act should the expectations outlined not be met. This leaves the parent/carer in no doubt about the actions they do /don't take, will impact on the plan for the child.  It may be appropriate to use a  'Contract of Expectation' or a 'Written Undertaking'  alongside a wider written agreement to cover a specific concern.

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 divisions opening between the professionals/agencies, with tensions and disagreement taking the focus away 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.

The risk is that relationships between agencies can become fractured and result in taking the focus away from safeguarding the child.

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. Agencies should all work together to share information so that issues such as complaints do not undermine effective interagency working and/or impede child protection processes.

(see Information Sharing and Confidentiality).

Regular-interagency communication and trust is essential to all agencies being aware of the risks of targeting specific professions/agencies. Evaluate the context of the adult's behaviour - consider whether the hostile behaviour was linked to specific circumstances (e.g. mental health problems or substance misuse).

Supervision and support

Supervision and support from managers in working with uncooperative families is essential (see Agency Roles and Responsibilities Procedure and Supervision and Management of Staff Procedure).

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.

When working with families who may be uncooperative or hostile, it is vital that professionals remain child-focused and consider the impact on the child and the child's perspective on what is happening.

Professionals in different settings and tiers of responsibility may have different thresholds for concern and different experience of having to confront difficult behaviour.  It is vital the differing risks and pressures are acknowledged and supported.

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 of the meeting the option of excluding the parents from a meeting if the quality of information shared is likely to be impaired by the presence 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. 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 see Information Sharing and Confidentiality);
• Convening a meeting to draw up a clear risk reduction plan for professionals and in extreme situations, convening 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 paramount. If professionals feel intimidated and/or are worried about having challenging and courageous conversations with the family, consider what life is like for the child.

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 an assessment (e.g. under the common assessment framework) has been completed and whether a Lead Professional has been appointed.

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, e.g. 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. They 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 could result in a family being resistant to having professionals involved.

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/caregiver has a low level of literacy, and needs both verbal and accessible written communication;

• A parent's/care giver's cognitive capability is impaired, and they may not be fully aware of what is happening
• A parent/caregiver needs translation and interpretation of all or some communication into their own language;

It would be helpful to a parent/caregiver to end each contact with a summary of what the purpose has been, what has been done, what is required by whom and by when in a way which is accessible to the individual.

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.  To make sense of what is going on in any uncomfortable exchange with a parent, it is important that professionals are aware of the skills and strategies that may help in difficult and potentially violent situations.

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):
• Their approach and interactions with the family might have aggravated the situation, e.g. 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/carer needs to complain, possibly with reason;
• The parent's/carer’s behaviour is deliberately threatening/obstructive/abusive or violent;
• The parent/carer is aware of the impact they are having on the professional;
• The person/family 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.

Impact on professionals of hostility and violence

Working with potentially hostile and violent families can place professionals under a great deal of stress. It can have physical, emotional and psychological consequences, which may impact on their capability to make effective decisions.

Keeping professionals safe

(Also refer to Violence Towards Staff Procedure)

Professionals have a responsibility to plan for their 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 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.

Managers have a statutory duty to provide a safe and working environment for their employees under Health and Safety at Work legislation.