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Growing Support

3 How well does support meet vulnerable families' needs?

Outcomes for children
Quality of social work practice
Social workers contact with families
Families' expectations
Families' experiences of health services
Social work services
Family centres
Working in partnership with families
Working with families in stressful situations
Working with extended families
Working with men
Keeping purpuseful and effective records

Outcomes for children

1. In more than half of the cases we reviewed where there were concerns about children's safety, development or welfare, local authority social work involvement brought about some immediate improvement. In one in five of the families children had been looked after away from home during the local authority's involvement but most of these children quickly returned to their families of origin. In half of these cases (20) grandparents or relatives had taken over the child's care from parents, with local authority approval and support. In only six of the 147 cases were plans being considered or progressed for children's permanent placement in substitute care. The fears expressed both by families and professionals that social work departments were likely to permanently remove children from their parent's care are not reflected in reality. Social workers worked hard to effect children's speedy return to their families or extended family carers.

2. They also went to great lengths to support parents in looking after their children at home. In almost three-quarters of cases children remained within their families during local authority involvement and in over half of these cases outcomes seemed broadly positive, with a reduction of perceived risk. In one local authority we found creative use of foster care placements for younger pregnant women. For example a young woman in her twenties had had two previous children removed from her care. The foster carer's intensive and consistent support during the pregnancy enabled this young mother to accept her help and advice when the baby was born. This was a creative and effective use of an experienced foster carer to support a young parent through pregnancy.

3. There were 21 cases in which there were continuing concerns for children's welfare in their families but no decisions about whether children's welfare was best promoted within their families had yet been made. In some of these cases intensive support was provided, but there was little evidence that children's circumstances were improving.

4. In a further 20 cases it was not clear whether the eventual outcome had improved the child's welfare or circumstances and in just under a quarter of cases there was no information about the outcome of intervention for the child.

5. We found that agencies relied too much on local policy or guidelines to direct professionals' decision making. These were applied regardless of evidence that indicated alternative options were more likely to safeguard and promote a child's welfare.

6. We found a number of cases in which it was far from clear that the child's welfare was the paramount guiding principle. These were cases in which children had experienced consistently poor standards of parenting despite extensive teaching and support from professionals and other agencies. The severity of parental problems was such that there seemed little likelihood of the child's core needs being consistently and reliably met in the foreseeable future. Parents in these families were often not perceived to be deliberately abusive or neglectful. All professionals found it hard to judge what should be the threshold for removing children in these families from their parents' care. We found examples of health and social work services allowing children's care to drift below adequate standards for unacceptably long periods before taking protective action. Family support plans, inter-agency child protection plans and supervision plans did not describe clear goals with parents and timescales within which improvement in the child's circumstances should be achieved. This compromised the child's right to a secure future in an alternative family.

7. When very young children were looked after away from home the local authority's efforts to reunite the family also meant that insufficient attention was given to planning for the child in the event that parents were unable to fulfil their parental responsibilities until the child was much older. We found examples of children returning to the care of parents whose situation and parenting appeared to the review team to be very unpromising. We were particularly worried by those cases in which children were now securely attached to alternative carers who had provided them with a much higher standard of care than they would now experience. Local authorities advised us that it was important that these children returned 'home'. We query whether the concept of 'home' adequately reflected the child's experience and perception. Care by birth parents, by extended family carers, foster care and adoption are neither exclusive, nor sequential pathways.

Quality of social work practice

8. We looked at the way in which local authority support services met the needs of the children and families in our case sample. The quality of social work practice and intervention was satisfactory or better in almost two-thirds, 94 (64 % ⁵) of the cases we examined. In each of the fieldwork sites we visited we found examples of casework reaching excellent standards. Good practice was characterised by:

• prompt responses to concerns about children's welfare and development;
• social workers' clear and focused assessment with attention to both risk and needs, alongside families' social circumstances;
• clear plans which recorded realistic objectives and timescales;
• patient and persistent direct work with parents and extended families based on regular and reliable contact by social workers and other support staff;
• good communication and collaboration with other professionals and agencies; and
• effective oversight and review by skilled and supportive line managers.

9. In these cases social workers worked closely with support staff and directly with families, some of whom were very anxious and hostile, to bring about change and improvement in parenting and families' circumstances. Staff maintained a clear focus on the child's welfare but also considered parents' circumstances and needs. Social workers displayed evidence of a strong commitment to working in partnership with parents but also took decisive action when standards of care seemed likely to cause immediate harm to a child. In most of these cases the basis for the local authority's intervention was clearly set out and children were at least protected from danger, and at best their welfare was actively promoted.

10. The remaining 53 cases (36 per cent) were less satisfactory and a minority 11 (7 per cent) displayed major weaknesses. These cases were characterised by poor information most commonly focusing on the presenting problem(s) and the families' current circumstances. A lack of information about individuals in the family, particularly young children and fathers, hampered assessment and planning. Social work contact lacked purpose and goals, was ill-directed, and sometimes very infrequent. Many of these social work records lacked clarity about the purpose of social work visits and nature and content of assessment.

11. Where allegations of abuse were made there was a focus on establishing grounds for intervention usually around a particular incident rather than consideration of wider factors in the family. In some instances social workers' focus on progressing child protection enquiries seemed disproportionately punitive towards parents suspected to have harmed their children. This was unhelpful in establishing a relationship within which work to protect children could take place. There was little attention to review of effectiveness of services. Inter-agency collaboration was patchy.

12. Four of the 11 cases displaying major weaknesses concerned children with disabilities or developmental delay, two concerned cases of families from minority ethnic communities and five were unallocated and managed through duty services (a system whereby a 'duty' social worker deals with all referrals or enquiries on a daily basis). Of the 26 cases scored which were managed by duty services, less than a third reached satisfactory standards. Duty systems tended to offer minimal responses and operated as an agency filtering mechanism rather than a helping service in its own right for families in crisis. Most cases were characterised by inconsistency of service and response and, in some cases lengthy delays before decisions were made. The weakest were crisis driven and showed little evidence of improvement in families' circumstances or functioning. Families were not given any idea of when they might be allocated a social worker, if at all.

13. There were examples of services and support offered by the local authority which families found particularly helpful. Child care provided by childminders, nurseries and family centres, and home visiting by home support workers effectively provided respite and support for the most vulnerable families under stress. Their contribution to promoting the index child's welfare was often not adequately evaluated or reflected in the local authorities' records.

Social workers' contact with families

14. Allocated social workers' contact with families for whom they were responsible varied widely ( see table 1). In all authorities social workers tended to maintain regular and frequent contact in the early stages of involvement and during periods of crisis, tailing off as immediate risks to children's safety reduced or crises receded. In over a quarter of cases (28 per cent) social workers visited families at least weekly. Families would often have even higher levels of contact with their social worker during periods of heightened family stress or crisis or at times of review. However, in just under a quarter of cases families had much lower levels of contact with their social workers seeing them less than monthly and less than half saw their social workers more than once a month.

15. Higher levels of contact were associated with more comprehensive assessment and usually, but not always, better outcomes for children. In the best managed cases there was evidence of social workers' skilled engagement with families and family counselling. First line management provided supportive contact for families in their social workers' absence. In some instances social workers' higher level of contact reflected that families in these cases had multiple difficulties and problems and children were exposed to higher levels of risk with a poorer prognosis. In these cases outcomes were not always as good for children. There is a need for activity and contact to be focused. Even where families were visited regularly there were cases in which there was little evidence of assessment of need or risks.

16. Where the level of contact was less frequent than monthly there was less evidence of progress in alleviating risk or promoting the child's health and development. In many cases when a worker was on long-term sick leave cases were not reallocated. Unallocated cases were associated with poorer outcomes. The duty social work service responded to referrals by focusing on investigation of risk to children's safety or welfare rather than exploration of families' needs for support.

17. Low or irregular levels of contact with social workers were associated with weaker case management and poorer outcomes. However, in many of these cases families were receiving consistent and regular support from home care workers or family aides, or were in close touch with family centre staff at the child care centres their children attended. Families valued this support highly and made good use of it. In some cases social workers relied too much on these staff to assess and monitor children's welfare, and to provide information on which to base their own assessment rather than visiting and developing a relationship with the child and family directly.

Table 1: Frequency of contact

18. In those cases in which families were caring for disabled children there was generally very low levels of contact by social workers. Contact was usually to complete an assessment of the needs of the child and their carers rather than to provide support or services.

19. More than one in 10 files did not record the frequency of contact with children and families sufficiently enough to allow analysis. We took this to indicate that contact was infrequent in these cases.

20. We concluded that:

• social work support is of good quality in many cases and can be very effective in bringing about good outcomes for vulnerable children at most risk;
• practice within local authorities is too variable and more needs to be done to bring the standard up to that of the best;
• duty systems do not provide a responsive, helpful or safe service. They build in lengthy delays to decision making;
• child protection enquiries need to be integrated within a framework for assessment of children in need so that responses to referred families focus on risk and needs as required by national guidance; and
• some children's future wellbeing is being significantly compromised by remaining with or returning to their family homes.

Families' expectations

21. We asked a wide range of people who are in touch with social work and health services about the stresses families with young children face and the kinds of support they thought would be helpful. We talked with parents individually and also in small groups in each local authority area. Some had allocated social workers; others were in touch with local family centres or other support services. Some had had extensive involvement with social work services and had complex and stressful personal histories which aroused a lot of professional concern about the safety and welfare of their children. Others used local child care services or had children with disabilities and were using family centres for respite or to assist their child's learning and development. All were families with children in need.

22. Overall the groups were often more critical of statutory services. They gave accounts of conflict with medical staff and were dismissive of available supports from health visitors and social workers. In contrast almost all were very positive about support from staff in family centres or equivalent community-based support services or voluntary agencies whom they felt respected and listened to them. Their comments echoed those of many of the helping professionals.

23. There was a perception in the more rural areas that provision was concentrated in the urban centres and there were strong feelings of isolation, particularly for lone parents. Most people relied heavily on support from extended family for child care and help with transport.

24. A significant proportion of parents described stresses associated with the breakdown of parental relationships and the fear of violence or harassment from ex-partners, usually men. One parent described her fear of her ex-partner taking her child from nursery. Pervasive anxiety about threats from partners, family or neighbouring residents in areas of multiple disadvantage was common.

25. Parents said that what they wanted was:

• time to themselves - a break away from children;
• someone to talk to who could give advice; and
• contact with other parents who were going through the same problems.

26. Few parents referred to difficulties in parenting their children directly as an area with which they needed support. Parenting problems were more likely to emerge in discussion of the supports provided.

27. Parents found support which came to them particularly helpful, and were grateful for visits from professionals such as health visitors and family aides. Increasingly in some areas more sustained home-based support was provided on an outreach basis by family centres, after referral by health visitors and social workers. In some areas parents said that this kind of support was not as readily available as previously or that the extent of help received depended on which area of the local authority they lived in. One local authority was reducing the number of child care places available in family centres in order to provide increased levels of outreach work by staff, and was re-contracting with a specialist family assessment service provided by a voluntary agency to increase home-based work with vulnerable families.

Families' experiences of health services

28. Some parents were critical about their contact with health professionals, particularly GPs and health visitors, with whom they had most contact. Parents were most positive about those professionals who took time to discuss their problems and were honest about the help they could provide even if that was limited. Examples of input from professions allied to medicine were described much more positively. Parents seemed to have clearer information and expectations of specialists and could describe these.

The speech and language therapist was brilliant - she sees my child twice a week; she brings booklets, does activities and explains things. She treated you as an equal and was interested in the child.

29. Although parents appreciated that GPs and medical staff were hard-pressed, many described stressful and difficult contacts with hospital and community-based doctors, and some had painful accounts of professionals' failure to listen to them or to take their concerns seriously.

They just dismissed me as an over-anxious mother.

30. Few parents had a consistent relationship with a named GP and described contacts as hurried. Some medical professionals, particularly in hospital, were seen as remote and patronising. Parents said that they were often not given information that they needed to make confident choices about health care for their children. Some felt that health professionals 'wrote them off' if they came from a disadvantaged area, thinking that they would not be able to understand complex conditions or that they did not provide good care for their children. They felt that too often GPs were too ready to prescribe tablets and unwilling to take time to listen to their problems and worries. The emerging consensus from user focus groups was that doctors provided little technical information and that parents needed more advocacy and support to be empowered to ask questions, find out what they needed to know and to make informed choices for themselves and their families. One parent described having used a patient advocate from a health project with very successful results. Carers (such as relatives or foster carers) of children who were moving around frequently because of family problems reported difficulty in obtaining GP services.

31. Some parents had positive relationships with health professionals.

The biggest help was the health visitor and the GP - they were honest, the GP listens to you - doesn't always have an answer but takes the time and interest.

32. Health visitors were more often seen as a potential source of support. They compensated for deficiencies in information provided by doctors, offered clear and simple explanations of health problems and treatments, ensured that parents understood, and gave practical help on health problems. But here too families described experiences of practitioners who were 'difficult to get a hold of' and occasionally they perceived professionals as critical and judgemental.

33. Some families had had very little contact with their health visitor. Others had had much more and found this a reliable and helpful support. There seemed to be little consistency or understanding of why the differences in frequency of contact came about.

34. Some families felt that health visitors did not take on families with more complex problems where children had special needs or other difficulties and referred on. Others felt the health visitor did not really pay attention to their family's individual needs and were not sure what the purpose of the contact was.

Someone to talk to - mine put me in touch with a mother and toddler group.

She gave me advice on sleeping but it wasn't helpful - they're not listening to what the problem really is.

The health visitor comes in and looks all round about - it feels like an inspection - stressful.

35. Some families described availability of services in smaller suburban or rural areas as poor in comparison with the cities. Large city children's hospitals appeared to offer better facilities for parents when children were admitted. Accommodation allowing them to stay overnight with their child was highly valued.

Social work services

The social work is bad news.

I thought social workers came in and took your child away.

People think you must be battering your kids if you've got a social worker.

I wouldn't own up to having a social worker.

36. We were concerned at the very negative perceptions of many local authority social work services held by parents in the groups. Again and again parents described their fear that if they confided in social workers their children might be taken away. This related mainly to area team social workers who were seen as powerful and threatening by two groups of parents:

• those who had little or no experience of area team social workers; and
• those whose children had been the subject of professionals' concern to the extent that there had been child protection enquiries, their children had been named on the Child Protection Register, or in a small number of cases, the local authority had removed their children from their care.

37. Parents seemed less fearful of other groups of local authority staff who were seen to be providing other services first and foremost and were less associated with the social work department.

38. These parents' views were informed and shaped by a number of sources, including views from relatives or neighbouring families, and the media. Many suggested that involvement with the social work department brings great stigma stemming from an image of social work presented in the media as working only with problem families and failing parents. Some were concerned about what others would think of them if they had a social worker; others reported that extended family were not happy about their contact with the social work department. But few people without an allocated social worker had clear information and ideas about what social workers were for or what they did, other than removing children at risk, or what services and support they might provide.

39. Amongst those who had had extensive contact with area team social workers views were more positive. Many described extensive support and excellent relationships with their social workers. Even those who were less positive acknowledged that field social workers tried hard to help them. Amongst those who had had children removed from their care there was often acceptance that such action had been necessary, despite their anger and fear.

40. Area social work teams were perceived as 'over-worked' and very busy. In some areas parents felt there were far too few social workers. Families described difficulties and frustration in trying to get an allocated social worker and to obtain the services they thought they needed. Some felt that social workers did not have the range of skills and knowledge to help them tackle their personal problems effectively, others that social workers were over qualified to give them the kind of help they wanted. While some parents felt anxious that support would be withdrawn prematurely, others argued that once you had a social worker they were very reluctant to cease contact. One young mother admitted into care at 16 said 'years later they were still in touch'.

They're not a great help - we've been trying to get help for our children and can't get it.

We needed a court order to force the social work department to take our child into care - we have five children, two with disabilities and the older children have problems. We want respite - a break away from the child.

41. There was a strong perception that social workers responsible for monitoring children's welfare exacted very high standards from parents already under stress.

One parent described her situation:

I have three children - two older ones. I was suffering domestic violence, I was isolated and I had a low birth-weight baby. I asked for a psychiatrist or a social worker to help. The social worker lifted [my child] and placed her with my sister. I got her back on Tuesday after one year. I had no back-up. I'd brought up my other older kids without problems. I wanted somebody to be there for me, to back me up. The impact of contact with a violent father on the children wasn't considered. I went to counselling, I had a CPN, I done everything I could do. I couldn't please them. I feared they wanted me to fail.

42. Parents described how difficult it was, in view of their fears, to ask for help from social work services; when they did so this was a momentous decision. The response they receive often colours their relationship with social workers and other staff for a considerable period.

Making the phone call was a big, big decision ... it meant that he would be charged.

I was left high and dry.

43. Reports from many parents echoed our findings about the wide variation in frequency of contact with allocated social workers. Higher levels of consistent contact were associated with better relationships. Parents wanted more choice about the social workers they worked with, and, for example, to be able to ask for a female social worker. Parents said they found it hard to change their social worker if they felt they did not get on, and were anxious about complaining in case services were withdrawn. Complaining to senior social workers was felt to be ineffective as their concerns would not be taken seriously. Too often the social work department did not return their calls.

44. We found that:

• families' strongly negative perception of contact with field social workers hindered them from seeking early help from social work services;
• this perception is not well grounded in fact or families' experience;
• families with experience of support from field social workers were more objective and realistic about the support available and valued contact with social workers; and
• local authorities' referral and allocation procedures do not promote an ethos of partnership with families.

Family centres

45. Almost all of the parents in groups were very positive about the support they received from family centres. This seemed related to the three things they said they valued most highly: respite, good emotional support and advice and social support from peers. Family centres invariably offered some combination of these three things. Parents argued that there was a need for more places, more staff and more support for themselves in child care provision of whatever kind. They wanted staff who could deal with specific special needs and were trained in specific issues such as learning how to play with children, dealing with disability, racism and resultant inequalities, and managing children's difficult and challenging behaviour.

46. Many parents had attended group work programmes in their local family centre or equivalent. The nature of these groups varied: some were parents' support groups with the agenda and activities set by parents themselves with help and practical support provided by a group worker; others were a set series of sessions bringing people with similar problems or stresses together to discuss how to solve these, or for educational programmes. People generally said that they found groupwork very helpful, especially when this included crèche facilities. They offered 'a bit of space' and the chance to meet people in the same situation.

47. Parents described the most helpful characteristics of group work as:

• the knowledge that you are not alone in your predicament;
• hearing others' experience and advice about what works;
• having other adults to talk to;
• knowing that the group will keep your business confidential;
• having interesting and different things to do, and 'getting out of the house'; and
• leaving your responsibilities behind.

48. Some of these characteristics were evident in each of the groups running in the local authority sites we visited. Parents also identified common gaps in group work. They felt that their children could also benefit from groups but that there seemed little available for younger children. Most demanded that parents were also present (such as mother and toddler groups and playgroups). There is little provision for fathers, especially single fathers - most groups are oriented towards women.

49. Some participants commented that the support of the group worker is essential and that groups would not be able to sustain themselves without professional or agency support. The group worker's role was to arrange a venue and other basic facilities, prepare and encourage potential participants to come along, help members to negotiate and agree an agenda for a programme of sessions or activities, and mediate relationships and conflict to ensure the group remains helpful.

50. Parents observed their child acquiring skills and therefore saw the centres as providing measurable support for themselves and their child and were more open to advice from staff whom they perceived as having experience and expertise. Moreover, family centres provided an opportunity to see how centre staff interacted with their children and encouraged learning and development and good behaviour. Parents described their children as being much better behaved at the family centre and this being generalised when they returned home.

51. Parents felt less threatened by the fear of their child's removal in family or child care centres. Most parents knew that staff contributed to assessments and would report any concerns about a child, or a parent's interaction with their child to their social worker. But they saw social workers or senior staff as responsible for decisions about registration, changing plans or removal of a child from their care. They felt that centre staff were more readily available and had more time to listen to them and treated them as an individual in their own right rather than merely a parent of a child.

There's a big difference in [my child] since he's been attending. I come once a week too, to see what he's doing and play with him. I have more patience with him.

The routines they get into in the centre help them get into routines at home too.

52. Both families and professionals found family centres offered great benefit but highlighted gaps in support for example at evenings and weekends.

Working in partnership with families

53. Parents rarely felt that they were equal partners in planning and making decisions with the professionals helping them. In some cases developing partnership working will be very difficult for example, when the parents have severe problems which prevent them from meeting their child(ren)'s core needs, the respective interests of parents and children may diverge. But even when not identical, the interests of children and their parents are inextricably linked. When an equal partnership is not possible and the local authority must act against parents' wishes, it is essential that parents are given the opportunity to contribute their views. Parents acknowledged that social workers could and did provide a great deal of help for families in difficulty and protection for children at risk. They did not always feel that their views were listened to or that they were respected as individuals. They felt that their own needs were dismissed by professionals 'putting children first' when they were sure that if their needs were met they could parent their children better. They felt that agencies did not work together in partnership either and reported very slow assessments and decisions.

54. Parent wanted more choice and control about what services they received and when. They valued sitter services and drop-in services because they could decide when to use them. They wanted more information about what was available in their area and wherever possible wanted to be able to choose which services to make use of.

55. National guidance sets out the requirements for effective working in partnership with parents. These guidelines apply to all professionals who work directly with families in which children may be in need. Achieving partnerships with parents and children in the planning and delivery of services to children requires that:

• they have sufficient information at an early stage both verbally and in writing to make informed choices;
• they should be aware of the various consequences of the decisions they may take;
• they should be actively involved wherever appropriate in assessments, decision- making meetings, care reviews and conferences;
• they should be given help to express their views and wishes and to prepare written reports and statements for meetings where necessary;
• professionals and other workers should listen to, and take account, of parents' and carers' views;
• families should be able to challenge decisions taken by professionals and make a complaint if necessary; and
• families have access to independent advocacy when appropriate.

56. Less than one in five of the case files we looked at contained any form of written agreement with parents or information to families setting out the local authority's assessment and what support and services the local authority would provide. Many of these agreements were partial, focusing on one service or one aspect of support such as day care, arrangements for parents' contact with a child in foster care, or schedules of appointments. The extent to which these were joint agreements seemed limited. Where there were assessments and plans on case records it was often not clear whether these had been copied to parents. Many had not been reviewed or updated recently with some examples of the most recent plans or agreements over a year old.

57. One case record included a contract on file setting out the department's expectations that a parent would improve the cleanliness in her household and work to provide more reliable and consistent routines for her child, including regular attendance at nursery and for health care. Although all parties had signed the contract the wording gave little indication that the terms of the contract were agreed in a way which took account of the parent's views. There was little active support offered by the local authority. The contract noted that social work department staff would visit at an agreed frequency, but without prior arrangement on occasion. The contract was clear but the tone was severe and unsympathetic.

58. We found that little information was given to parents which was tailored to their needs. Where children were looked after or named on local Child Protection Registers families had more access to written information about the local authority's views, proposals and recommendations because they were provided with copies of reports for Children's Hearings, child protection case conferences or reviews. The local authority's assessments were usually contained in the body of these reports.

59. It was clear that social workers tried hard to talk to parents and provide them with full information and many case files contained accounts of discussions with families about the local authority's or professionals' worries about children. But it was also clear from case records and from interviews with parents that such discussions often occurred under stressful circumstances and that families sometimes found it difficult to understand or recall events or information clearly. There were examples of disagreements or disputes about factual information or the basis for professionals' concern. Families felt that social workers reports did not accurately reflect their own perspectives or points of view in their written reports. Although conference, Hearing and review reports should include information about families' and children's views these reports are for a particular purpose and not geared towards communication with families first and foremost, although they should be written with a range of audiences in mind.

60. Poor information and communication with health professionals also stemmed from a lack of attention to how best to communicate information under stressful circumstances. Few health professionals provided information in writing to parents, although this is improving in some areas with the introduction of parent-held records, which were welcomed by parents. Whilst an important development, we found that health visitors using parent-held records did not then retain any separate information or record of their contact or observations of the child. Where there are concerns about a child's welfare and development careful records of observations by all professionals involved with the family are essential.

Working with families in stressful situations

61. Families under stress do not always welcome professional attention especially when this is perceived as critical scrutiny or likely to lead to demands that the family feel unable to comply with. Angry and hostile parents arouse considerable anxiety and fear amongst the people trying to offer help. This may be compounded by knowledge of a history of violence within the family, or experience of threats or even assaults. The often complex and serious problems some families present also arouse anxiety in professionals who worry that they lack the skills or knowledge to really help. They may be very worried about young children's welfare or safety yet there is insufficient evidence to take protective action. Organisations are less likely to maintain contact with hostile and frightening families. They may withdraw services because of unacceptable behaviour and assessments may lack important information because it is so difficult for professionals to engage with families. Children in these families are left unsupported until there is sufficient evidence for child protection enquiries or compulsory measures of supervision.

62. This is not to say that all vulnerable families are threatening or violent. But stress will lead to situations in which families find control of their emotions and behaviour difficult. Misuse of drugs or alcohol will affect parents' behaviour and presentation. These factors pose real risks for both the children living in these families and the people working with them. The difficulty in attempting to develop a supportive and helping relationship with angry, intoxicated or resistant adults cannot be underestimated. Many local authority social workers are clearly very skilled and experienced in working with such people. However, local authorities' concentration on child protection sets the tone for a more confrontational kind of practice and increases the risks for those workers who might be required to challenge parents, perhaps in the presence of unknown strangers.

Whenever I go to visit mum and the baby, there are usually other adults there, her brothers I think. I don't know them. They don't say anything much, they are often stripped to the waist and they are all smoking over the baby who is only 6 weeks old. It's dark with the curtains drawn and the TV is on so it's hard to talk to mum. I feel intimidated and I just want to get out as soon as I can (Health visitor).

63. The majority of frontline professionals working in children's health and social services are women. Women professionals reported that many aspects of their work made them feel unsafe. For example midwives told us they felt vulnerable and sometimes afraid when visiting families in some communities. Few had access to personal alarms or mobile phones. Health visitors and community midwives said they were isolated and heavily reliant on informal support from peers. Off-site management was not readily accessible, clinical supervision was irregular and rarely focused on the relationship between the practitioner and her clients. Male social workers said that they would be asked to visit jointly with women colleagues when there were perceived threats. They felt unsure about their role in such circumstances. Across all agencies frontline staff described working with families who seemed to them to be dangerous with little explicit support from their agency. Line managers were often, though not always, supportive.

64. Staff in family centres and children's centres also experience difficulties and stresses associated with working with families under pressure. However, the combination of direct provision of a valued service, usually childcare, regular and routine, often daily, contact and direct access to a listening ear and some personal support in attractive family friendly surroundings can do much to alleviate the tensions surrounding families' contact with professionals. Even parents who had a long history of conflict with professionals found family centres welcoming and non-threatening places. In contrast the very poor condition of some of the social work offices we visited seemed likely to exacerbate feelings of alienation and poor self-esteem amongst vulnerable families. Reception and interview facilities were dingy, dilapidated and depressing, with grubby, dirty or broken furniture and fittings. There was a lack of toilet facilities, toys and games for children were in a poor condition and public information was often dated, scattered and poorly organised. We found other area offices which were clean, airy, bright and business-like. The atmosphere in these was much calmer. Reception and public areas in health, education and housing services were generally of a much higher standard than those in social work services. We concluded that the stigma attached to contact with social work area teams is intensified by the condition of the places in which they carry out their tasks, and to which families in difficulty have to come for help.

Working with extended families

65. When we asked parents where they obtained most help and support they most often referred to family and friends. Extended family and grandparents in particular provide a great deal of informal support, respite, advice and advocacy and many professionals across support agencies looked to extended family as a source of support for vulnerable children and parents. The presence of a consistent, supportive adult, interested in the child and his or her welfare is a significant protective factor, alleviating the effect of other disadvantage in vulnerable families. Extended family often provided security and compensatory experiences for children whose early experiences were poor. Birth parents reported that accepting help from extended family was more comfortable when there was some degree of reciprocal support and users did not feel too dependent.

66. Where children were not able to be cared for safely by their birth parents we found evidence that all the local authorities made good efforts to explore the possibility of placement with extended family members. Local authorities seldom considered the needs of these family carers separately unless they were perceived as an agency resource, akin to foster carers. In these circumstances the carers' own relationships and attachments, and their role both in the family's problems and in finding solutions, may be overlooked.

67. A significant number of children in our sample were being cared for away from home by extended family, usually grandparents or other immediate relatives such as aunts. Some of these placements were short term, to enable work with parents to resolve other problems, to provide respite, or before decisions about children's futures were reached. Others were clearly long term and in some cases likely to last throughout childhood and adolescence.

68. We found some cases in which the agency's commitment to children being looked after wherever possible in extended family rather than foster or residential care had led to placement without sufficient assessment and exploration of the family's capacity to meet the child's needs. Family carers described social workers placing children with them at times of family crisis, with no preparation for difficulties that emerged, little continuing contact and no apparent review of how this was working. Their commitment to the child in their care was not in doubt. Nevertheless they felt that professionals had left them to deal with often complex problems and difficult behaviours without taking into account the needs of their own families, or the often profound impact on their lifestyle and income. Where parents were opposed to, or contesting, removal of children from their care, this created additional stresses for family carers. Relatives may find it harder than ordinary foster carers to resist their family members' demands to return children. They rarely have the same access to training, advice and support from fostering services or link social workers available to local authority carers.

69. There was little consistency, even within authorities, about the status of, or support for, extended family placements. Some families received the equivalent of fostering allowances for the children they were caring for. Others received intermittent financial grants and some practical or material resources such as child care, clothing, furniture and bedding. Yet others appeared to receive no support at all. In some cases family carers were closely involved in planning for children; in others they were not sufficiently informed or involved in planning or decision making for the child, being consulted as 'carers' only on the child's progress in their care.

70. We found a lack of practical and financial support for family carers, usually grandparents, whom local authorities had made responsible for the permanent care of very young children. In many cases it was clear that a child could not return to their parent's care, that extended family would provide long term or permanent care for a child and that this was in the child's interests. Yet local authorities did not generally support family carers to acquire parental rights and responsibilities through, for example, assistance to the extended family in applying for section 11 orders, or adoption, with continuing financial support where this is necessary.

71. Two of the local authorities were piloting projects in family group conferencing, a method of involving birth parents, children where appropriate, and extended family and other significant adults in finding solutions to family problems, supported by professional mediation, with access to reasonable resources from the local authority and other services. The projects were located outwith mainstream services and relied on referral of suitable families from local area teams. We found little evidence of this approach having an impact on professionals' practice in these areas, with very low numbers of families referred to the projects. Field social workers perceived family group conferencing as inappropriate for families in which children were perceived to be at risk and were more likely to refer families with older children, particularly where their persistent offending could precipitate rejection and family breakdown. Other agencies had little involvement in the pilot projects.

Working with men

... encourage fathers to be more involved; it's harder for us to ask for help - it's not socially acceptable. Social workers should listen and accept a father's role.

72. Throughout the review it was apparent that professionals took insufficient account of the role and contribution of fathers and male partners in the safety and well being of the children and their families. In many case files there was little information about fathers and limited evidence of contact with them to assist assessment and planning even when fathers were perceived to be the main source of risk. In each of the local authority areas there were examples of fathers stepping in to provide support and care for their children, when mothers' difficulties affected the care of their children. These fathers reported that they found family support services almost entirely staffed and attended by women, and however welcoming the service or other users, they felt very isolated. Some of the professionals we interviewed were dismissive of the men they came into contact with, describing them as irresponsible and 'like babies themselves', with little recognition of, or support for, their contribution to parenting. Both male parents and professionals acknowledged that the men present in vulnerable families can shape children's experiences for good or ill, and that services must find better ways to engage with them. But there is little dedicated work with men to support their care of children or enhance their family relationships.

73. Social workers and other professionals held considerable information about the incidence of violence towards or between partners in the families in our case sample. There was often little information about the circumstances in which violence occurred, the frequency or extent of injury and the attitude of the mother or father to this violence. Violent incidents were acknowledged but rarely explored with the families. Professionals seemed to assume that risk would be resolved if the source of the violence (usually although not exclusively the male partner) left the household or if the relationship ended, and apparently waited for this to occur. Sometimes they discussed the impact of domestic abuse on children and exhorted mothers to protect their children from the 'risky' parent. They expected mothers to leave or evict the violent parent without real consideration of the nature and quality of the parental or cohabiting relationship, and the practical and emotional investment which each partner may have in the relationship continuing. There were few examples of discussions with male partners, unless they initiated this themselves.

Keeping purposeful and effective records

74. We found that health visitors and field social workers had very limited access to information technology. This hampered effective record-keeping. The quality and organisation of family case records varied widely within each local authority. We found examples of high and low standards in each. There was no common format across authorities and staff did not follow local formats consistently. In many case files accurate records of contact were not easily retrievable. Records were incomplete or in summary form which did not identify when a family had been seen, who was present or the purpose of the contact. Only in one local authority was there evidence that line managers read case records periodically.

75. In three of the five local authorities there was little evidence of managerial staff using technology to assist information management and retrieval or to modernise professional practice. In these authorities social workers had no direct access to information technology. This hindered their recording practice and made potential contribution to evaluation and research very difficult. Practitioners in the other two local authorities had much better access to IT. Their case records were generally of a significantly higher standard. These records were well presented and usually well-organised, up to date and much more accessible.

76. We were able to review only a small sample of health visiting records in two authorities. The health professionals on our inspection team found that they varied dramatically. There was no standard content other than centile measurement of height and weight and reference to some developmental milestones. These records were selected to match social work records and family interviews and in some cases there had been extensive contact with families both from health and social work services. This was not always reflected in health visiting records. Vulnerability factors and risk were not reliably recorded and there were few examples of health visitors' assessment and plans in writing.

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