CHAPTER FOUR INTERVIEWS WITH PRACTITIONERS
4.1 Interviews were conducted at 21 social work departments, 10 education departments and 14 Community Health Partnerships between October 2006 and August 2007, covering a total of 85 interviewees. As discussed in Chapter 2, two different interview schedules were utilised (see Annexes 3 and 5). Given that the majority of interviews were conducted using the second of these schedules, findings from all interviews are framed in that context.
How Parenting Issues Come to Light
4.2 If all agencies interviewed - health, education and social work - are taken together, the approaches and services operated by all three can be arranged loosely according to the age of the child, and this will be used to illustrate the points at which parenting issues most commonly come to light. Aside from the Hall 4 system for health professionals discussed above, so far as it is known there is no stratification of services in this manner.
Antenatal to birth
4.3 The earliest point at which parenting issues are identified is at the antenatal stage, with midwives being the main referrers, followed by GPs and other health professionals in the majority of cases. Factors such as previous experiences with children from the same family, literacy difficulties, issues that can impact on capacity to parent ( e.g. addiction issues, mental health problems, disabilities, etc.) and the mother's medical history can all point towards potential parenting issues, and can facilitate intervention at this stage. It is also the case that health services will receive referrals from police when domestic violence is affecting an expectant mother.
Birth to 13 months
4.4 During this period, issues around parenting will primarily come to light during scheduled health visitor contacts, though issues can also come to light via GPs, referrals from other services and concerns expressed by relatives or neighbours. There is some consensus among health visitors that problems related to parenting start to become fully apparent at around 9 to 10 months, when the child begins to require more input from the parent. Although many such issues remain manageable at this stage, difficulties tend to increase as the child becomes more mobile. These 'milestones' are supported by the general literature around child development, which will not be discussed here.
Age 13 months to 3 years
4.5 There are no formal health-based checks during this period for all children, although health visitors will have maintained contact with families in particular need during this time. It is therefore likely that families with parenting issues will only come to the attention of professional services in extreme circumstances.
4.6 Before the implementation of Hall 4, there was a standard health check at 2 years, at which it is reported many parenting issues were picked up. This check was removed in the Hall 4 framework as there was not considered to be any evidence to support its' usefulness. However, many health visitors believe that this lack of evidence was a result of both poor record keeping and the sometimes-ephemeral nature of evidencing change ( e.g. at times, simply maintaining a family at home in a stable fashion is an achievement that may have required intensive support, but is not a 'change' that can be measured). All health professionals interviewed expressed concern over the removal of this particular checkpoint.
Age 3 to 5 years
4.7 Along with the professionals mentioned above, and the checks required under the Hall 4 framework, as many children will begin attending some form of nursery or pre-school programme, issues around parenting may now come to the attention of staff in these areas.
4.8 Although true for all ages (as will be discussed further below), for those children aged 3 years and over but not yet at primary school the general impression is that, unless there is some serious concern over the child's welfare then the availability of parenting and/or family support is ad-hoc at best. Provision appears to depend very much on not only the availability of funding but also the enthusiasm of individuals who are willing to take that extra step (either as an extension of their work or as a potential service user) to develop a service. With the health service as the primary contact and source of advice for those with children under school age, while all health-based interviewees emphasised the desire to provide proactive and preventative services to families beyond the checks laid out by Hall 4, the resources are rarely available to do this.
4.9 As such, there is a large variation in the availability of services for this age group, with the more structured services such as Sure Start tending only to be available in cases where there is the greatest need ( e.g. in child protection cases). Sure Start is one of the few services mentioned by the majority of interviewees across all professions as being available in their area, along with health-based services such as that offered by Child and Adolescent Mental Health Teams, addiction services and adult mental health provision. Examples of the services available can be found at Annex 8.
4.10 Doubts around the usefulness of certain services were also raised in some of the health-based interviews as a potential barrier to implementation. For example, although the 'Baby Massage' service offered in many CHPs is proven to assist in the bonding/attachment process along with being good for the health and well-being of the baby, it was reported that some senior managers were reluctant to provide funding for this service as they did not fully appreciate its value.
"..[it] was a bit of a fight to be able to get the funding for...[Baby Massage] because it was kind of seen as massage whereas it is part of the parenting programme. That's one thing you hardly get anybody that won't turn up to, because parents don't see it as a parenting programme" ( CHP20)
4.11 Health professionals were keen to continue providing services such as these, with a high proportion (62%; 22 from 35 interviewees) reporting it was the kind of non-stigmatising, stress-free service that all but the rare few would engage with.
Transition to Primary School
4.12 At this stage, school nurses come into the picture as being a potential source of identifying children who may be subject to the impact of parenting issues. However, school nurses appear to be particularly under-resourced, with one CHP reporting that for 23,000 school-age children, they had 11 school nurses. This same CHP has begun to operate a series of 'transition days', where school nurses and health visitors are brought together. Not only is this considered to promote joint working, but is also believed to increase the potential for picking up problems with children on their transition to school. No other CHP personnel mentioned such a practice.
4.13 On the whole, up to this point it appears to be the health-based services that have the best overall picture of the services available for families when parenting issues are a concern.
4.14 Along with those identified above as playing a role in identifying families with parenting issues, once a child comes into the school system professionals such as teachers, education support workers and classroom assistants are added to this list. There are also Education Home Visiting teams who, technically, can be called in for consultation from birth if organically based developmental issues are identified. In addition, there are Community Skills Workers in at least one third of local authority areas who are well positioned to pick up issues around older children. For the first time, and providing a child attends school regularly, it will be possible for individuals responsible for a child's care to observe indicators related to possible parenting issues such as changes in behaviour. As can be seen in Annex 8, along with the services already available to younger children programmes such as 'Managing Children's Behaviour' now become available. For older children, there is also a 'Managing Teenage Behaviour' programme, as well as more focused interventions such as 'Baby Think It Over' 4, although funding for the later has been mentioned as a particular issue.
4.15 In addition, at least 3 local authority areas have groups that work specifically with fathers, something that is identified in the literature as often being lacking. In these cases interviewees mentioned the importance of adapting parenting support approaches to suit male participants; as they had been found to be less likely to engage with such as group work the use of activity-based tasks, for example, had proved to be very effective. In some areas there are also a range of activities for school-age children that, while not explicitly directed at parenting issues, can be of use in building resilience in children. Examples of this are after-school clubs, sports-based activities and drama clubs. However, it must be stressed that provision of these types of services is patchy and, as with those services detailed in Annex 8, much will depend on the availability of funding and the capacity of individuals to give up free time and/or work extra hours to operate these services.
4.16 Overall, although a number of services have been identified during the interviews conducted with practitioners and the mapping exercises undertaken by various agencies, it has become clear that none, as yet, has a clear idea of all services available in their own particular area. Some are further ahead on this task than others, such as the local authorities discussed in Chapter 2, but there are many factors that have an impact on accurately mapping services that are perhaps not fully appreciated by those external to the task. For example, one difficulty in accurately mapping service provision is the transitory nature of funding for many programmes. This not only makes it difficult to anticipate how long a service will be available, but also can create an instability and uncertainty in the workforce that can lead to significant staffing (and therefore capacity) issues.
4.17 Funding is also a factor in providing consistent provision across an entire local authority or CHP, with different sub-divisions of these larger areas relying on different levels of financial support. These sub-divisions also come into play with regard to availability of specific services, with a particular programme perhaps being available in one locality but not another. Perhaps the best examples of this are CHPs that incorporate parts of two different local authorities within their boundaries, with very different provision available to clients in each LA. For example, in one of these CHPs there is a Family Centre available only to clients in one area because they come under a particular LA.
4.18 One CHP interviewee also raised the concern that, although a range of services was available in her area, she was unaware of any empirical evidence of their effectiveness, or attempts to evaluate their usefulness. Under these conditions, the interviewee felt uncertain about referring clients to these services as she was unclear as to their appropriateness and what the level of benefit to the client would be. Although not explicitly stated in other interviews, this would appear to be a relevant issue as, from the experience of the authors of this report, there are indeed few services of any kind that adequately evaluate the work that they do.
4.19 The majority of CHP interviewees (83%; 29 from 35) also raised the issue of services being targeted at those clients where the level of need is highest, e.g. in child protection cases, therefore limiting the level of work that can be done with lower-level cases. While at least 2 LAs are developing a structured approach that stratifies services by need, in reality this means that those in the greatest need get the services, while there is very little structured provision for those outside of this bracket - work will still be done with all families where need is identified, but programmes such as Triple P will tend only to be available in the most concerning of cases. This is not to say that children and families in this category should receive less support. However, although it is widely acknowledged that early intervention and support, particularly in the first year of life, can be crucial to a child's development, there is very little scope in terms of time or resources for practitioners to be able work preventatively. This is a particular point of frustration for health workers, given their unique early access to almost every child.
First Steps in Addressing Parenting Issues and Working with Other Agencies
4.20 Aside from examples such as those used in the child protection and Children's Hearings context by all practitioners in Scotland, in most areas there is little evidence to suggest a formal approach to providing support to a family is taken in the initial stages of a case. In the health context, some consistence is provided by the 'Solihull Approach', a psychotherapeutic and behavioural model that addresses factors such as sleeping, toileting, feeding and behavioural difficulties in young children that most health visitors appear to be trained in. Originally conceived by health visitors and Child and Adolescent Mental Health teams (' CAMHS') between 1996 and 1999, the Solihull Approach is based on three key concepts:
- Containment: Helping parents manage their own anxieties and emotions so they do not interfere with their parental roles and responsibilities
- Reciprocity: Promotion of positive child/parent communication and the interactions between mother and infant, in order to maximise the attachment process
- Behaviour management: Promoting positive reinforcement of good behaviour and not rewarding negative behaviour with excessive attention.
4.21 Along with one-to-one interaction with a family, the Solihull Approach is supported by a resource pack to assist families with a range of issues, and promotes consistent working practices. Also, the development of a parenting course based on the Approach was completed in 2006.
4.22 A small but apparently robust study by Milford et al (2006) found that outcomes for children and parents were better for those in a group subject to the Solihull Approach than those in a control group. In addition, a study examining health visitors' experiences of the Solihull Approach (Whitehead and Douglas, 2005) reported that health visitors felt it promoted consistency in the way families were worked with, along with improving the referral process and multi-agency working. According to Whitehead and Douglas (2005) through using the Solihull Approach, health visitors were able to:
"..play a crucial role in facilitating the relationship between parent and child, empowering the parent and creating resilience for the child." (Whitehead and Douglas, 2005:23).
4.23 A reliance on professional judgement regarding the particular needs and circumstances of a case, along with the exercise of usual working practices and personal experience, appears to drive the actions taken by a practitioner. The availability of services in an area will also have an impact on the first steps taken with a family, as will a practitioner's experience of training in particular programmes or affiliations with particular services; this later issue was raised in around one third (35%; 16 of 45) of interviews. The issue of training was raised in a number of interviews, as funding is rarely available to train all practitioners in a particular programme. Added to this is an apparent lack of consistency in the approach to training, with the majority of practitioners appearing to be able to 'self-select' the type of off-the-job training they undertake.
4.24 The approach to providing services appears to be based on an assessment of need, although there are few formal statements to this effect either from interviews with personnel or in the strategies produced in relation to service provision. In health, for example:
- The first step in addressing parenting issues will be to offer general support and advice in the home, with information supplied on any appropriate programmes/groups that may be operating in that area, such as a sleep clinic or Baby Massage programme. Of course, as mentioned above, in many cases this later point will be dependent on the individual experiences of the practitioner concern.
- At the next level of need, where possible work will be done in the home utilising programmes such as 'Play at Home' or 'Acorn', again with information on/referrals to other programmes or organisations being made where appropriate. It appears to be at this level where the involvement of other agencies, such as social work, begins to be sought in certain cases.
- Should concern for the welfare of the child increase or the level of need be identified as high, more formal procedures will then begin to take effect in the form of such as child protection protocols. In general, as the level of need increases, the intensity and structure of the support will increase.
4.25 This staged approach obviously follows the structure laid out in Hall 4, although systems prior to this operated in a similar manner.
4.26 At least 2 local authority/ CHP areas have multi-agency teams to which families can be referred for an assessment of their needs, and then be directed towards appropriate interventions. Practitioners from all services can refer to these teams although, as these teams tend to be locality based/driven, again the service provided will not be consistent across an entire area. These multi-agency teams operate in a similar fashion to many child and family centres, though at lower levels of need in most cases.
4.27 In 6 of the 16 interviews conducted at CHPs it was reported that the protocols around child protection procedures would be followed in all cases of high concern, although these will tend to tail off if no actual child protection action is required. One CHP makes use of a 'Family Support Form' in less formal cases, to assist in developing a plan of support for a family. However, it was mentioned that these forms were not always completed fully, particularly when a delay in receiving information from a third party was impeding progress. Other areas have similar forms, while one operates a system of family support 'key workers' through which information is channelled.
4.28 Although no consistent approach has been identified regarding the first step taken with families where parenting is identified as an issue, one interviewee suggested that this was perhaps a good thing as if pathways and protocols were too structured, then this may be detrimental to developing an effective intervention. This position was based on the experience that different families will respond in many different ways to specific interventions, so it was important to be able to tailor response to need.
4.29 With regard to communication between agencies in respect of individual cases, although a few areas are working towards developing practices to systematise this, there would appear to be no formal systems (again, outside of the child protection protocols) to facilitate this. Perhaps the best example of a structured approach to contacts and communication with other agencies is a form of 'service level agreement' that has been developed by one local authority, to which each of its partner agencies (in both the public and private sectors) will ultimately be asked to follow. Also, in one of the small local authorities, formal systems are already in place to facilitate communication with other agencies, although it was openly admitted that these systems were not always perfect. One example of this system was the regular, multi-agency reviews that took place, at which all current cases were discussed. In this particular LA, it was stated that strong communications were viewed as standard good practice and there was a strong ethos of multi-agency working, with one interviewee adding that the LA had:
"…a clear vision [and] actually what happens is that people work much better here than my experience of working with local authorities for the last 15 years." ( ED10)
4.30 In the main, however, communications between agencies are dependent on not only the needs and circumstances of a case, but also the personal relationships developed between individual practitioners and the persistence of these individuals in making follow-up contacts with agencies. In some cases a simple lack of time due to heavy caseloads was identified by interviewees as one reason why contacts with external agencies may be sporadic.
4.31 Particular issues around obtaining feedback from health-based services when a family has been referred to them were identified by CHP interviewees as well as those from local authorities. This would seem to be particularly problematic when dealing with mental health services, with issues of confidentiality being cited as the main reason for lack of even the most basic feedback. A further concern was expressed at 2 LA interviews and 3 CHP interviews around external agencies that may close a case, perhaps through apparent lack of engagement from the family referred, without informing the party that referred the family to them. It was also stated by many interviewees that time, again, was a factor in inter-agency communications, as it was not always possible to attend such as case conferences.
4.32 Overall, those who were not already working on a system of formalising contacts with other agencies felt it would be a useful to develop one, providing there would be enough flexibility to deal with individual cases.
Gaps in Service Provision
4.33 Around one-third of LA interviewees (32%; 16 from 50) raised the issue that, as actual levels of need were unknown on the whole, it was difficult to state accurately what the gaps, if any, in service provision were. In one CHP such a measurement is indeed underway but, although it was possible to have sight of initial figures produced in this exercise, they are not yet in the public domain and so cannot be included here. In all the interviews conducted during this study, this was the only exercise of its type to come to light.
4.34 Although all interviewees identified a general lack of resources as a factor in the provision of services, this was particularly the case with regard to what could be described as the lower-level, more preventative work. Resources tend to be focused on the provision of services to families where the need for intervention is greatest; although understandable, most interviewees felt that a continued emphasis on this was a "fire-fighting" or "elastoplast" approach to problems, while a more proactive stance taken before serious issues arose could have the most benefit in the long term. This issue is further related to the reports from interviewees that structured interventions and services are primarily available for those families where the level of concern is highest. An interviewee at a large city CHP had the following to say regarding such cases:
"Sometimes somebody says why was this not brought up before.. and you've been trying for years to get support for the family... [then] it comes to the stage where that child in need becomes a child protection issue" ( CHP05)
4.35 As mentioned previously, the issue of services perhaps only being available in certain areas (even within the one local authority or CHP), or being limited due to lack of resources, were also raised again as a factor related to gaps in service provision. It was further stated that there could be tensions between what parents and families actually need from services and what that service is willing to provide. One example of this was cited as a multi-agency group, having consulted with local families, working with staff from one particular service provider to run a programme in a specific area with particular need. Although this service provider was initially co-operative, once the families had been recruited the service provider decided unilaterally to operate their standard service instead. As a result, drop out rate was reported as high and ultimately the multi-agency group had to spend additional time and resources to develop their own programme to address local need.
4.36 This difficulty with a service provider highlights another issue raised by interviewees, that of the quality and efficacy of services being provided, as interviewees considered few services to properly evaluate their provision, particularly in the light of the many external pressures (such as poverty) that families are subject to. Some interviewees were concerned that service providers may, in some cases, not fully appreciate the impact that such pressures could have on an individual's capacity to fully engage.
4.37 As may be expected, a range of services were suggested by interviewees as requiring increased provision, with family centres, men's health provision, domestic violence services, intensive support services (particularly those that are residential in nature), support for relatives caring for children, and mental health service being examples of these. The later was identified most often as lacking, with long waiting times cited as particularly problematic. An interviewee at one CHP felt particularly strongly about this issue with regard to child mental health:
"If we are talking about the kids that are really, really damaged or they have got a mental health or emotional problem, it is scandalous. I think it is because the children are not valued; they are not voters either. I know that sounds cynical but that's the bottom line, it's those that shout the loudest that get the money" ( CHP20)
Engaging Families with Services
4.38 Engaging families with services was reported by all interviewees as usually being an issue in all cases at some point. It is not viewed as an overt problem in the sense that practitioners see it as part of their job to work hard at engaging individuals with services, and feel that their persistence and motivational skills will win through in the end.
"..[engagement] is our job; if you cannot [engage a client] there is something really wrong with the service we provide." ( LA04)
4.39 It was further stated that deliberate non-engagement was rare and still something that would eventually be overcome in most instances. In addition, it was consistently reported that a 'multi-agency' approach to achieving engagement was standard working practice, particularly in high-concern cases, where the emphasis was placed on someone from any one of the agencies involved gaining access to the family, rather than one particular agency persisting in isolation. This approach could be particularly useful in situations where, for example, a family may feel stigmatised by previous social work contact, and would therefore be more amenable to contact from the health or education sectors.
4.40 In achieving engagement, it was suggested that best results were obtained when workers were open, honest and non-threatening towards parents, with an emphasis being placed on really listening to families about what their needs and concerns are. The consistency and reliability of contact was also considered to be a key factor in achieving engagement. Further to this, it was also considered important to be able to offer families something concrete and structured in the way of support, a factor that can be badly affected by the availability (or not) of services. Excessive waiting times or delays can also have significant implications, as families may be ready and willing to engage when a problem is first identified, but may have lost enthusiasm if they have to wait a considerable time for assistance. For example, two local authorities ( LA05 and LA12) reported delays of up to 18 months in accessing specialist teams for assessment of autistic spectrum disorders as having a particular impact on some families under their care. However, another local authority reported that a great deal of effort had gone into listening to families over the previous several years, giving full consideration to their concerns. As a result, they reported, new services were being based on identified need and engagement was believed to have improved:
"We don't try and fit square pegs into round holes" ( ED01)
4.41 One interviewee provided a good example of where approaches were being tailored to the needs of families to promote engagement, with a system having been established whereby parents could get in touch with practitioners via text message as this method was preferred over actual telephone conversations.
4.42 It was stated by one interviewee that, sometimes, a lack of engagement could be a result of "circumstances and bad timing" rather than any wilful refusal or lack of capacity on behalf of the parent. This, along with wider issues affecting many families such as poverty and social deprivation can have a significant impact on their ability to engage with services, and these factors should not be ignored "in the rush for progress". One interviewee also highlighted a 'cultural ethos' present in some areas, where factors ranging from unemployment to a lack of interaction between children and parents were viewed as normal, therefore making it difficult to facilitate change in these circumstance. The depth of any problems must also be taken into consideration, as the parent(s) currently given concern may be a product of poor parenting themselves and, aside from not being aware that what they are doing has is having a detrimental impact on the child, as such will not be 'fixed' in a short space of time.
4.43 This latter factor also relates to the capacity of parents to engage with services. Although factors such as substance misuse and mental health issues were cited as a source of capacity issues, the issues most commonly mentioned as having an impact on capacity to engage were denial, self-esteem and self-confidence. With regard to denial, this was primarily related to issue around the parents' own experiences, as to acknowledge their own faults would be to admit they had also been poorly parented. A further factor reported to be increasingly relevant to engagement was a denial by the parent that they had any role in or influence on a child's behaviour, particularly in cases where this behaviour had been given a medical label such as attention-deficit hyperactivity disorder.
4.44 Self-esteem and self-confidence were commonly reported as being barriers to engagement across the spectrum of parents, from single teenage mums to middle-class individuals having their first experience of becoming a parent after many years of independent living. In such cases, it was reported as being vital to tackle these issues before parenting work could commence. As with all cases, taking time to build relationships with the families and individuals being worked with is an important factor in achieving a successful outcome. Identifying barriers such as these mentioned here is an important factor in tailoring interventions to suit individual need.
4.45 Finally here, the issue of resources were highlighted as creating difficulties with engagement at times, as core services in some areas are reported as being badly under-resourced and/or at their limit of capacity, with this often being an issue in cases presenting with a range of complex need. One interviewee stated:
"..core services are badly under-resourced, and they are some of the reasons why there are barriers to engagement for many families." ( LA04)
Parenting Orders and the Use of Compulsion
4.46 Although a range of questions on Parenting Orders were asked during interviews with social work personnel, given the shift in the emphasis of the study in the health and education interviews only basic questions around POs were asked during the interviews where possible, although in two cases time pressures did not allow this. As would be expected given their status as ' PO contacts' for the study, social work interviewees had the best knowledge of POs. All of those education-based personnel interviewed knew details of POs and could remember receiving information on these, many times from social work colleagues. In contrast, the majority of health interviewees (27 from 35) had only basic knowledge of POs and the attendant legislation, with two openly admitting to knowing nothing of the subject. All of these, however, were confident that they could obtain information quickly from a colleague in, for example, social work if required.
4.47 When asked to consider what may be the advantages and disadvantages of Parenting Orders, those who had knowledge of the legislation in the health and education sectors made similar comments to those recorded in the social work-based interviews conducted earlier in this study, with POs being viewed as well intentioned but ultimately misguided. The prime concern expressed was that there is little evidence to suggest that compulsion will have an impact on genuine engagement or facilitate real change:
"You can't legislate [people] to change and that's fundamentally the problem with Parenting Orders." ( CHP10)
4.48 However, one interviewee mentioned that a more formalised system, perhaps support by statutory powers, in which parenting support could be structured would be welcomed, perhaps in the format of an Acceptable Behaviour Contract or similar. That is, something that was less punitive and could be applied earlier on in a contact with a family. However, the resources required to provide intensive intervention, and the format that an intervention would take, are still of concern to some:
"The statutory 'clout' is important and could be constructive in an approach that includes the availability of staff to deliver intensively. The disadvantage is that we have only 50% of that formula available to us" ( ED23)
"[One of my worries] is that unlearning takes longer than learning and focussed interventions of a behaviourist type require quite a skilled and ..intensive input and I am not sure that would be sustained by parents, or would be in fact offered in the first place. So a kind of 12 week, 1 hour, 2 hour a week kind of session dressed up as outcome driven, I am not convinced that ..it is achievable." ( ED23)
4.49 Whether or not a Parenting Order had been given consideration in their area was asked of interviewees, with three responding in the positive. In one LA it was reported that POs had been discussed at a number of case conferences; however, in all cases it was concluded that more work could be done with the family and so the process did not formally initiate. In one other case, resources were again an issue:
"We could not see, given the resource limitation, what we would gain over what we might achieve without it" ( ED05)
4.50 In the final instance, one local authority had passed information to the Scottish Children's Reporter Administration for serious consideration of a Parenting Order in March 2007; at the time of interview (July 2007), no response had been received.
4.51 Where appropriate, interviewees were asked if they felt Parenting Orders would ever be used. Of the 10 that responded, only 1 felt that a PO could be used productively, providing adequate resources were available. The remaining 9 could not envisage a situation where a Parenting Order could be used productively:
"By the time folk get to the sharp end of need maybe a Parenting Order will have no effect what-so-ever." ( ED22)
Additional Comments Made by Interviewees
4.52 Throughout the interviews it became clear that problems around parenting were not the sole province of the deprived or socially disadvantaged, as many interviewees reported difficulties with parenting issues in more middle-class families also. One of the differences between the two would seem to be that problems in the middle-class families can often be more hidden, with parents not only being less likely to seek help from outside parties but also more capable of blocking attempts at intervention, e.g. through use of their superior communication skills. It was also reported by one interviewee that it could be difficult to get agencies to take problems seriously in such families, with an example cited of a child being sexually abused but authorities discounting the concerns of the practitioner due to the families 'good' reputation. It was not until the child became older and came forward in person that action was taken.
4.53 Somewhat allied to this is the impression of over half (54%; 27 from 50) of the LA practitioners interviewed that those external to the service do not always fully appreciate the complex issues affecting many of the families coming to their attention, or the intensity of the service actually provided in these cases. One interviewee stated:
"It's easy to look at these [families] and say 'They should do more, it's their fault and they should control their children' or whatever. But as soon as you get into these cases and you see behind this presenting of the problem, there's usually this huge history that needs addressed, assessed and dealt with… This is beneath the surface of a lot of these families in Scottish society. But it's never revealed… widely acknowledged and understood because it doesn't really fit the confidentiality principles that we have, or doesn't fit the kind of media agenda about, if you like, simplistic notions of blame." ( LA05)
4.54 Three further interviewees mentioned the difficulties that can arise for those better-off families moving into new housing developments, where a lack of an established community and a sense of social isolation can be particularly problematic for stay-at-home mothers. One of these interviewees also mentioned the increase in women having children later in life than has previously been the norm as a source of problems, with the dramatic change to lifestyle that a late baby can bring being overwhelming for some.
4.55 The majority of interviewees (84%) stressed the importance of early intervention for parenting issues with a general view being expressed that, in order to facilitate true change for the future, it would be more constructive to focus resources here than on crisis points. Given the general acknowledgement (and support from the literature) that positive attachment and early care are crucial to a child's development, it seemed incongruous to these interviewees that more effort was not made to channel resources in this direction. One interviewee stated that by neglecting early interventions:
"We are denying these children the opportunity to live and have a normal childhood, and to know what normal life is.... it's not about taking them away from their families but it's about helping their parents to recognise that their issues are impacting on their children" ( CHP11)
4.56 Concern was also expressed about the way new initiatives and legislation were introduced and it was stated that a more "joined-up" approach to this would be welcomed. One example of this was given as the apparent contradiction between the premise put forward by the GIRFEC agenda while provision is being focussed on the "top end" of the spectrum, e.g. antisocial behaviour and persistent offender targets. Another phrased the problem as the separate welfare and youth justice agendas creating difficulties in promoting a co-ordinated approach towards working with young people. The way in which new initiatives are introduced was cited as a concern by two interviewees, with an expectation of immediate implementation within current resources being viewed as:
"..not respecting our value and the staff that are trying to deliver a service. …It's not respecting the children." ( CHP20)
4.57 Aligned to resources issues is a concern expressed throughout the health-based interviews regarding a current review of nursing in the community, where it is being proposed that health visitors, for example, take on more responsibility for such issues as long-term and palliative care. It is felt that such a change would detract even more from their ability to provide proactive and preventative support to families. Resources related to low staffing levels were also highlighted in many of the health interviews, with the ability to provide adequate cover for maternity leave, sick leave etc. being one of these issues. The clearest example of low staffing issues and increased workload came from a CHP with around 23,000 school-age children and only 11 school nurses:
"How hard is it for a school nurse who is so pushed to have a child come over and say to her they want to kill themselves? And she says sorry I've got to go and get round 5 schools and do this immunisation programme. It's terrible." ( CHP20)
4.58 There was also a suggestion from one interviewee that, perhaps, the emphasis placed on keeping a family together can be counterproductive at times, as it could lead to some parents not trying very hard to engage in the confidence that no extreme measures would be taken. The interviewee explained that the attitude of some parents in these circumstances was:
"You can do what you like; you can't take my [child] away." ( CHP16)
4.59 The other side of this coin came through in another interview, where both a lack of resources and an increase in the number of children being removed from their families was a cause for concern. The number of children in foster care was reported to have almost doubled in ten years and the scale of the problem, combined with an increase on other demands on services, was summed up as follows:
"there are between 11,000 and 16,000 adults who have got problematic illnesses, ...9,500 adults on methadone programmes... 100,000 people of working age …who are not economically active, so communities are already stretched. …If we want to have an extra 200 or 400 foster carers, that means we have to generate an extra 2,000 or 4,000 adults to come forward." ( CHP23b)
4.60 Given the many and complex needs often affecting families, one interviewee expressed concern that measures of success in terms of intervention were not always obvious, and this could lead to a lack of understanding regarding progress actually made. An example of this was cited as occasions where an intensive package of support will be put in place to support an extremely vulnerable and chaotic family, and while there might be little evidence of change to an external observer, the fact that the family remains together, in their own home, some months down the line is actually a significant sign of progress.
4.61 One potential solution put forward by many interviewees to reduce problems in the future was the generic provision of parenting information and advice, perhaps something that could be operated in schools and included such as discussions around relationships and basic household management. For example, on interviewee stated:
"…if you're going to look at supporting parents you have to plan it really well. I suppose we've lost a generation in some respects. I think that children and young people should get parenting within the curriculum. It should be aligned to sexual health and relationships... what's the point of teaching folk about having or not having babies when you're not teaching them about how to look after them?" ( CHP20)
4.62 Somewhat aligned to this approach was a suggestion from one interviewee that they would like to see a "national resource that provides support and assistance to families throughout Scotland" that would be funded at the Scottish Executive level rather than locally, in order to provide a consistent and universal approach to parenting education. Another interviewee cited an example from the Scandinavian countries, where expectant mothers are required to attend antenatal classes in order to receive benefits, with similar incentives applied after a child was born. A statement by one interviewee, although lengthy, sums up many of the opinions emerging from the study:
"In our experience things that have made the most positive impact on families have been the things where there's a sense of voluntary engagement, where there's been a sense of being involved from the beginning, where they know each professional involved what they're doing and what their role in the assessment is and what they have identified as being the issues that need addressed and trying as much as possible to have that no blame culture, and the no Order principle. Let's only intervene if we can make a positive difference, let's not do something for the sake of doing something. I think that any future legislation or guidance that comes out from the Scottish Executive, if it keeps in mind those parameters then we would really welcome that and would work with that as positively as we can, that would be really, really helpful because I think that's the way that we are actually going to make progress with some of our families who are in danger of kind of falling off the edge, and what we would consider to be normal society." ( ED12)
4.63 Although not set out in writing by any authority, agency etc. when information from all the interviews is examined together it is possible to present a picture, in terms of the age of the child, of the main times when parenting issues are most likely to come to light. Such potential parenting difficulties can be highlighted as early as pre-birth. It would appear that parenting issues are most difficult to identify in relation to children in the 3 to 5 years age group, unless these issues are serious and very visible ones. The importance of early intervention was emphasised, although lack of resources and demands on time were cited as often being barriers to this.
4.64 The more structured services and interventions were reported as being most likely available only for those cases where the level of need and/or risk was high. Actual availability of services varied widely between each local authority and CHP area, and often within smaller sub-divisions of these areas, with funding and resources in general being cited as a particular problem with regard to service provision. The main gap in services was reported to be provision for early intervention or preventative work to be carried out, with resources tending to be focussed where level of need/risk was considered greatest. Procedures and protocols related to child protection issues are better developed than other formal approaches to interventions identified in the interviews. Although multi-agency work was reported as common in many areas, inter-agency communication regarding individual cases was often reported as being patchy at times.
4.65 Engaging families with services was not viewed as a particular problem for practitioners, with levels of engagement being dependent on many variables and likely to fluctuate throughout the life of a case. Factors considered to impact on engagement include inadequacies in service provision, low levels of self-esteem and confidence in parents, and wider social factors such as social isolation and deprivation. It was further highlighted in many interviews that parenting issues extended across all socio-economic classes, with only the manifestation of these issues tending to vary.
4.66 The majority opinion regarding Parenting Orders themselves was that the legislation was well intentioned but misguided, with the primary concern being that compulsion was unlikely to facilitate genuine engagement or change. Concern was also expressed that current resource levels may be inadequate to provide the intensive service required to support a Parenting Order. Interviewees suggested that a consistent and universal approach should be taken parenting education, perhaps with courses or similar sited in the national curriculum.