Brief summary and learning from:
The process of involvement for families in family support services: A Conceptual Framework
Dr Stella Owens
September 2011
For more information on the research study, please contact Dr Stella Owens
Tel: 01 4160500
Table of Contents
Foreword i
Introduction 1
Research Context 1
Methodology 6
Research aim 6
Research questions 6
Family Centre Service 8
Findings 11
Intake Statistics Sheet (ISS) 11
Parent Expectancies for Therapy Scale (PETS) 15
Attendance Rates and Dropping out 15
Parents Participation in Therapy Scale (PPITS) 16
Discussion and Conclusion 17
Main findings 17
Discussion 17
Conceptual Framework of the Process of Involvement for Families in Family Support Services 27
Recommendations 30
Conclusion 36
What future research needs to be undertaken? 37
Bibliography 38
Foreword
Foreword
i
Introduction
Introduction
Research Context
The United Nations Convention on the Rights of the Child (UNCRC) places particular emphasis on supporting the family in carrying out its caring and protective functions, and prescribes that:
“States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.” (UNCRC, 1989 p. 7)
The Irish Government, which ratified the UNCRC in 1992, aspires to:
“An Ireland ...... where all children are cherished and supported by family and the wider society; where they enjoy a fulfilling childhood and realise their potential”
(Our Children-Their Lives: The National Children’s Strategy 2000, p.10)
These constitute what could be described as highly ambitious targets and aspirations for our children, and as a practice professional working in the field and embarking on research into intervention in child and family services, it raised many questions at the outset; questions relating to policy objectives and drives to achieve these ambitions for children; questions around what progress had been made towards these goals; what research, if any, had been conducted demonstrating advancement in our understanding of children’s lives and improvement in their well being. And ultimately what have been the implications for children and families as a result of the United Nations Convention on the Rights of the Child and other international policy directives?
These ambitions and aspirations for our children have given impetus and a mandate, derived primarily from the UNCRC, to governments world wide to provide such services that promote good outcomes for children, and aim to improve the quality of their lives; but equally services that support parents to bring up their children whilst also ensuring children’s safety and well-being. They are required to balance the two types of need, family support and child protection, and to integrate them in such a way that neither stigmatises support services nor lowers safety thresholds to a level that endangers children (Parton, 1997).
This challenge to support parents in their parenting task whilst also ensuring children are protected if at risk within the family environment has, arguably, had limited success, with prevalence rates for children affected by abuse, neglect and mental health difficulties remaining consistently high (DHHS, 2009; Australian Institute of Health & Welfare, 2009; DCSF, 2009; SONC, 2010; WHO, 2005; America’s Children: Key National Indicators of Wellbeing, 2009). International data indicates that those children identified as ‘in need’ and ‘at risk’ are not receiving the services they need, and those that do access appropriate and available services are dropping out or not completing prevention or intervention programmes as prescribed by the service provider (Girvin, DePanifilis & Daining, 2007; Staudt, 2007; Flischer et al, 1997; Leaf et al, 1996; Wiersbicki & Pekarik, 1993).
Figures for dropping out of child and family support services range from 20% to 50% (Staudt, 2003, 2007; McKay, McCadam & Gonzales, 1996; Kazdin & Mazurick, 1994; Daro & Harding, 1999; Daro & Donnelly, 2002). Research informs us that high attrition and low attendance and participation in services can lead to poor outcomes for children, with children who do not receive any form of intervention or service, being more likely to engage in delinquent activities later in life including involvement in violent crime, school drop-out, drug and alcohol abuse and unemployment, and to have mental health problems (Nock & Photos, 2006; Fergusson & Lynskey, 1998).
In response to this, the last fifteen years has seen an unprecedented increase in the quantity of children and family support services in North America, Europe, Australia and New Zealand, all aimed at intervening effectively and improving the lives of families most marginalised and disadvantaged. International trends have seen a focus on specific higher order outcomes to be achieved for children, through strengthening universal services, that is services to all children and families, and then targeting services at those most vulnerable (Parton, 2006; Hardiker, 2002 & 1991). This ‘outcomes focused’ approach to children’s services aims to encourage service providers and delivery agents to focus their service planning and delivery around how their interventions can improve outcomes for children (Barlow & Scott, 2010; OMCYA, 2007). Policy directives to achieve outcomes have resulted in a focus on prevention and early intervention, concepts that translate in practice as providing services and supports for parents and children aimed at intervening early in children’s lives to prevent situations escalating, and also intervening early in the development of a psychological or social problem (Fernandez, 2004; HM Government, 2004a).
A framework for understanding the different ‘levels of need’ of families and how services can be planned to meet these needs, has been developed by Hardiker and colleagues (Hardiker et al, 1991), and adopted and adapted by governments in Ireland and the UK (OMCYA, 2007; Every Child Matters, 2003). It is a planning framework which assists in understanding different levels of need within a population of children, and facilitates partnership working with statutory, voluntary and community services, by providing clarity about which services are needed for children at each level and how each agency can contribute to providing these services (Hardiker, 2002).
What progress towards providing outcomes focused services and interventions to meet the needs of vulnerable and disadvantaged children and their families has been accomplished? Government policies internationally, including Ireland, have been directed at promoting research which can provide evidence for effective early interventions and prevention programmes to improve child and family well being. Although research and evaluation into effectiveness or ‘what works’ has been hampered and challenged by a number of methodological issues (McAuley, Pecora & Rose, 2006), international efforts to extract what are the constituent elements or active ingredients that contribute to effectiveness in terms of both programme specific and service provision in general has been achieved to good extent. The employment of rigorous evaluation methods is producing evidence for models and programmes that can be easily replicated across different services and settings (McAuley, Pecora & Rose, 2006).
Many of these interventions and models have been directed at supporting parents, and as parents are responsible for initiating contact with services and maintaining child and parent attendance, their experiences of services is perceived as key to improved outcomes and well being for their children (Nock & Photos, 2006; Layzer & Goodson, 2001). An influx of parenting programmes to address behavioural difficulties in children has emerged, with parenting support featuring prominently in most family support services. However a body of evidence for the effectiveness of parenting and behavioural training programmes and other models of intervention for families has been counteracted by research which points to the limits of these programmes with families where individual parental characteristics and external factors, which are essentially beyond the control of parents, are impacting on parenting capacity and family functioning. The effectiveness of these programmes is less certain with families defined as most ‘in need’ and disadvantaged, where parents are socially isolated, living in poverty, experience mental health problems, and as children themselves experienced abuse and neglect (Smith, 2006; McKeown, 2001; Stephenson, 1998). Parents in these circumstances are less likely to engage with services, are more likely to drop out of programmes and to benefit least from them (Reyno & McGrath, 2006; Spencer, 2003; Assemany & McIntosh, 2002).
Factors that may be responsible for the failure of services to engage and retain families, and potential barriers to participation are increasingly becoming the focus of attention for researchers and service providers, but how all of these factors combine or interlink to impact on families and their involvement in services is as yet not well known (Girvan, DePanifilis & Daining, 2007; Staudt, 2007; DePanifilis, 2006; McCurdy & Daro, 2001; Kazdin, Holland & Crowley, 1997; Prinz & Miller, 1996).
Research evaluation of targeted, age defined children’s services, for example, early intervention services like Sure Start in the UK, point to these services struggling to engage with ‘hard to reach’ families and groups, such as, lone parents, families where substance abuse and domestic violence is present, asylum seekers and ethnic minorities and fathers (Anning et al, 2007). Research has emphasised the need for family support services to engage in robust outreach, to provide intensive long term support at both a practical and emotional level to parents, children and the wider family network, with the understanding that families will necessarily attend a service repeatedly throughout the duration of their children’s formative years (Stevenson, 2007). The importance of intervening at all levels within the family system, addressing individual child, parent and family issues, within an ecological model (Bronfenbrenner 1979), has been stressed (Tanner & Turney 2006; Iwaniec, 2004; Thoburn et al, 2000).
Where research has focused on the effectiveness of therapy or therapeutic approaches to address emotional and behavioral difficulties and the impact of abuse for both children, adults and families as a whole, and to improve outcomes for them, robust evidence to support these approaches has been well documented (Westbrook & Kirk, 2005; Lambert & Ogles, 2004; Shadish & Baldwin, 2003; Sprenkle, 2003). However the methodology applied in this research has been the subject of much debate between two opposing research factions; those who advocate for empirical efficacious research conducted in highly controlled environments (Chaffin & Friedrich, 2004; Gelso, 2005), and those who emphasise effectiveness research undertaken in real world settings with people presenting with multiple difficulties. Researchers predominantly engaged in the latter effectiveness research have proposed that there are common factors, the non-specific aspects of therapy, of client/extra therapeutic factors (40%), hope and expectancy (15%), therapeutic models and techniques (15%) and the therapeutic alliance (30%) which are contributing proportionately to variance in outcomes (Luborsky, 2002; Wampold, 2001; Shirk & Karver, 2003; Horvath & Bedi, 2002; Asay & Lambert, 1999).
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Methodology
Methodology
Research aim
Motivated by the apparent shortcomings in research in Ireland of therapeutic intervention with families within family support services, and alarmed at an increasing body of international literature stressing the failure of services to meet the needs of families, the research focused on a particular model of and approach to family support, as provided through the Daughters of Charity Child and Family Services (DOCCFS) family centres.
This study aimed to explore families’ experience of attending the family centres, and to examine the factors impacting and affecting the process of a families’ involvement, factors which may be responsible for them not benefiting from services aimed at enhancing child well-being and family functioning.
The research literature has identified that parents are principally responsible for initiating contact with family support providers (Nock & Photos, 2006: DePanifilis, 2006) and ensuring that their family continues to receive such a service, and their levels of motivation and expectations have been highlighted in the literature as key to engagement. Research further asserts that parents play a key role in bringing about change in their families, and developing an understanding of, and addressing factors that impact on their parenting capacity, is crucial to improving outcomes for their children. The primary research participants were thus drawn from parents, as opposed to children and adolescents, attending family centres.
Research questions
The following research questions were posed:
1. What factors impact on the process of involvement for families with family support services?
· How do these factors impact on a family’s involvement with a therapeutic intervention focused family support service?
· How do these factors affect a family’s experience of the service, and act as enablers or inhibiters to a family’s participation and attendance?
· What aspects of the Service’s approach to the work and models employed, contribute to families remaining in a family support service?
2. What can these factors contribute to our knowledge and understanding of children’s services?
3. How can this knowledge be used to influence policy formation, and the design and delivery of more effective family support services.
The study sought to answer these questions through the use of four instruments:
Intake Statistics Sheet (ISS): The ISS was designed to elicit referral, socio-demographic and personal information from parents at intake, and to assist in developing a profile of the families attending the Service.
Parent Expectancies of Therapy Scale (PETS): A validated questionnaire (adapted) developed to measure parent’s expectancies of their family attending a family centre prior to beginning therapeutic work in the centres (Kazdin & Holland, 1991). Within the scale are three components of:
· Credibility - 13 items relating to the credibility and relevance of the therapeutic work to be undertaken
· Child improvement - 6 items that reflect whether the therapeutic work will be effective and result in improvement in their child’s behaviour
· Parent involvement - 6 items relating to the parent’s expected level of involvement in the therapeutic work
Attendance & Contact Record (ACR): A tick box document designed by the researcher to record and chart families’ attendance and drop out rates at a family centre.
Parents Participation in Therapy Scale (PPITS): A second validated questionnaire (adapted) designed to measure parent’s experience of obstacles or barriers while attending the Service (Kazdin, Holland, Crowley & Breton, 1997). The scale is comprised of 44 items and has been delineated to capture specific domains within the total scale: