Working with Uncooperative Families

1. Introduction

1.1 What do we mean by 'Uncooperative'?

There can be a wide range of uncooperative behaviour by families towards workers - from time to time all agencies will come into contact with families who may prove to be apparently (but not genuinely) compliant, reluctant, resistant, or sometimes angry or hostile to their approaches. In extreme cases there can be intimidation, abuse, threats of violence and actual violence.

1.2 How will the Protocol Help?

The protocol aims to:

• Assist workers in understanding the variety of ways in which non-cooperation can be displayed by families;
• Help workers in understanding the causes of such responses;
• Increase awareness of strategies workers may be able to employ in order to reduce the likelihood of non-cooperation;
• Help workers maintain control of situations and keep themselves safe;
• Help workers to be in a position to effectively assess the risk factors affecting children in the household.

This protocol aims to make clear that non co-operation is not acceptable. Workers in such situations will aim to reach a view about whether a family is displaying understandable ambivalence, or is actually a family where change is much more difficult and a more authoritative approach is needed, in which case a decision may have to be made about whether the child should be allowed to remain in the family.

All agencies need to be mindful of the need for workers to be trained for the level of work they are undertaking.

It is helpful if agencies publish a clear statement about unacceptable behaviour by those accessing their services (such as seen in hospitals and on public transport).

2. Recognising and Understanding Uncooperative Responses by Families

2.1 How do I Recognise Uncooperativeness?

There are four types:

• Ambivalence can be seen when people are always late for appointments, or repeatedly make excuses for missing them; when they change the conversation away from uncomfortable topics and when they use dismissive body language. Ambivalence is the most common reaction and may not amount to uncooperativeness. No service user is without ambivalence at some stage in the helping process. We are all ambivalent about the dependency involved in being helped by others. It may reflect cultural differences, being unclear what is expected, or poor experiences of previous involvement with professionals. Ambivalence may need to be acknowledged, but it can be readily worked through;
• Avoidance is a very common method of non-cooperation and includes avoiding appointments, missing meetings, and cutting short visits. This may be because they have problems, something to hide, or resent outside interference. Cooperation may improve as they come to realise the worker is resolute in their intention, and they may become more able to engage as they perceive the worker's concern for them and their wish to help;
• Confrontation includes challenging professionals, provoking arguments, extreme avoidance (not answering the door as opposed to not being in) and often indicates a deep-seated lack of trust leading to a 'fight' rather than 'flight' response to difficult situations. Parents may fear, perhaps realistically, that their children may be taken away or they may be reacting to them having being taken away. They may have difficulty in consistently seeing the worker's good intent and be suspicious of their motives. It is important for the worker to be clear about their role and purpose, demonstrate a concern to help, but not to expect an open relationship to begin with. However, the parent's uncooperativeness must be challenged, so that they become aware that the worker/agency will not give up. This may involve the worker in weathering numerous displays of confrontation and aggression until eventual cooperation may be achieved;
• Violence: threatened or actual violence by a small minority of people is the most difficult of uncooperative behaviours for the worker/agency to engage with. It may reflect a deep and longstanding fear and projected hatred of authority figures. People may have experience of getting their way through intimidation and violent behaviour. The worker/agency will need to be realistic about the capacity for change in the context of an offer of help with the areas that need to be addressed. If necessary the children should be referred for Section 47 Enquiries, and this may entail them being removed from the family home for assessment.

2.2 What are the Reasons for Families not Cooperating?

There are a variety of reasons why some families may be uncooperative with professionals, including:

• Do not want privacy invaded;
• Have something to hide;
• Do not think they have a problem;
• Resent outside interference;
• Cultural differences;
• Lack of understanding about what is being expected of them;
• Poor previous experience of professional involvement;
• Resent changes in the professionals involved;
• Dislike or fear of authority figures;
• Fear the children will be taken away;
• Fear of being judged to be poor parents because of substance misuse, mental health problems;
• A feeling they have nothing to lose, for example where the children have been removed.

It is important to be mindful that a range of social, cultural and psychological factors influence the behaviour of parents/carers. The more uncooperative the family, the more likely it is that the main influences are psychological, stemming from the parent/carer's adverse experiences in their own childhoods.

3. Impact on the Assessment of Children/Families

3.1 Practitioners Embarking on Assessments

Accurate information and a clear understanding of what is happening to a child within their family and community are vital to any assessment. The usual and most effective way to achieve this is by engaging parents and children in the process of assessment, reaching a shared view of what needs to change and what support is needed, and jointly planning the next steps.

Engaging with a parent/carer who is resistant or even violent and/or intimidating is obviously more difficult. The behaviour may be deliberately used to keep professionals at bay - or can have the effect of keeping professionals at bay. There may be practical restrictions to the ordinary tools of assessment - e.g. observing the child in their own home. The usual sources of information/alternative perceptions - other workers and other family members - may also be kept at bay.

It is important to explicitly work out and record what areas of assessment are difficult to achieve and why.

The presence of violence or intimidation needs to be included in any assessment of risk to the child living in such an environment.

3.2 Impact on the Child

The worker needs to be mindful of the impact the hostility to outsiders may be having on the day-to-day life of the child and when considering what the child is experiencing, many of the above may be equally relevant.

The child may:

• Be coping with their situation with hostage-like behaviour;
• Have become de-sensitised to violence;
• Have learnt to appease and minimise - remember Victoria Climbie always smiled in the presence of professionals;
• Be simply too frightened to tell;
• Identify with the aggressor.

3.3 Impact on your Assessment

In order to assess to what extent the hostility of the parents/carers is impacting on your assessment of the child, it may help to ask yourself:

• Am I colluding with the parents/carers by avoiding conflict, e.g. focussing on less contentious issues such as benefits/housing; avoiding asking to look round the house, not looking to see how much food is available; not inspecting the conditions in which the child sleeps, etc. or, crucially, not asking to see the child alone?
• Am I changing my behaviour to avoid conflict?
• Am I filtering out or minimising negative information?
• Am I afraid to confront family members about my concerns?
• Am I keeping my worries to myself, and not sharing risks and assessment with others in the inter-agency network or manager?
• Is the child keeping 'safe' by not telling me things?
• Has the child learned to appease and minimise?
• Is the child blaming him or herself?
• What message am I giving this family if I do not challenge?
• Am I relieved when there is no answer at the door?
• Am I relieved when I get back out of the door?
• Did I say, ask and do what I would usually say, ask and do when making a visit or assessment?
• Have I identified and seen the key people?
• Have I observed evidence of others who could be living in the house?
• Is this a case of domestic abuse but I am only working with the adult victim?
• What might the children have been feeling as the door closed behind me?

3.4 Written Contract

Consider drawing up a written contract with the family specifying:

• Exactly what behaviour is not acceptable e.g. raising of voice, swearing, threatening etc.;
• Expectations in respect of acceptable behaviour and language;
• Spelling out that this will be taken into account in any risk assessment of the child;
• Clearly explaining the consequences of continued poor behaviour on their part - which could include seeing them only at the office;
• Clearly explain possible further consequences of poor behaviour/non-cooperation, e.g. - seeking a Supervision Order; or seeking legal advice, consultation with the Police.

4. Impact on Multi-Agency Work

4.1 Overview

Agencies and families need to work in partnership to achieve the agreed outcome and all parties need to understand this partnership may not be equal, depending on whether the involvement is by statutory or voluntary agencies.

Sometimes parents/carers may be hostile to specific agencies or individuals. If the hostility is not universal, then agencies should seek to understand why this might be and learn from each other. Where hostility towards most agencies is experienced, this needs to be managed on an inter-agency basis otherwise the results can be as follows:

• Everyone 'backs off', leaving the child unprotected;
• The family is 'punished' by withholding of services as everyone 'sees it as a fight'. This is at the expense of assessing and resolving the situation for the child;
• There is a divide between those who want to appease and those who want to oppose - or everyone colludes.

In situations where parents/carers are only hostile to certain individuals, or where agencies or individuals become targets of intimidation intermittently, the risk to good inter-agency collaboration is probably at its greatest. Any pre-existing tensions between agencies and individuals, or misunderstandings about different roles are likely to surface. There is a risk of splitting between agencies/individuals, with tensions and disagreements taking the focus from the child, e.g.

• Individuals or agencies blame each other, and collude with the family;
• Those not feeling under threat can find themselves taking sole responsibility which can ultimately increase the risk to themselves;
• Those feeling 'approved of' may feel personally gratified as the family 'ally' but then be unable to recognise/accept risks or problems;
• Those feeling under threat may feel that it is personal;
• There is no unified and consistent plan.

4.2 Ensuring Effective Multi-Agency Working

Any agency faced with incidents of threats, hostility or violence should routinely consider the potential implications for any other agency involved with the family as well as for its own staff and should alert them to the nature of the risks.

Regular inter-agency communication, clear mutual expectations and attitudes of mutual respect and trust are the core of inter-agency working. When working with hostile or violent parents or carers, the need for very good inter-agency collaboration and trust is paramount and is also likely to be put under greatest pressure.

It becomes particularly important that everyone is:

• Aware of the impact of hostility on their own response and that of others;
• Respectful of the concerns of others;
• Alert to the need to share relevant information about safety concerns;
• Actively supportive of each other and aware of the differing problems which different agencies have in working within these sorts of circumstances;
• Open and honest when disagreeing;
• Aware of the risks of collusion and of the targeting of specific professions/agencies;
• Prepared to discuss strategies if one agency (e.g. a health visitor) is unable to work with a family - how will information/monitoring be gained and is it possible to have a truly multi- agency plan?

There are reasonable uncertainties and need for care when considering disclosing personal information about an adult. Concerns about the repercussions from someone who can be hostile and intimidating can become an added deterrent to sharing information. However, information sharing is pivotal, and reporting experiences of hostility/ intimidation or violence should be standard practice. See Information Sharing Procedure.

If you would answer yes to any of the following questions you should share them with your manager and any other professionals involved with the family:

• Do you have previous experience of the adult linked to the child being hostile, intimidating, threatening or actually violent?
• Is it general or in specific circumstances? e.g. drink related/ linked to intermittent mental health problems?
• Are you intimidated/ fearful of the adult?
• Do you feel you may have been less than honest with the family to avoid conflict?
• Are you now in a position where you will have to acknowledge concerns for the first time? - and are you fearful how they will respond to you?
• In their position, would you want to be made aware of these concerns?

Workers within a range of settings may have different thresholds for concern, and their experiences of having to confront difficult behaviour may vary. It is vital that any differences in risks and pressures are acknowledged and supported.

4.3 Child Protection Conferences, Core Groups and Multi-Agency Meetings

Avoiding people who are hostile is a normal human response. However, inter agency working and effective child protection planning can be seriously undermined if there is lack of proactive engagement between the professionals involved.

Collusion and splitting between agencies will be reduced by:

• Clear agreements, known to all agencies and to the family, detailing each worker's role and the tasks to be undertaken by them;
• Full participation at regular multi agency meetings, Core Group meetings and at Child Protection Conferences with all agencies owning the concerns for the child rather than leaving it to a few to face the wrath of the family.

Although it is important to remain in a positive relationship with the family as far as possible, this should not be at the expense of being able to share real concerns about intimidation and threat of violence.

Options to consider are:

• Discussing with the Child Protection Conference Chair the option of using the exclusion criteria if the quality of information shared is likely to be impaired by the presence of threatening adults;
• Holding a meeting of the agencies involved to share concerns, information and strategies and to draw up an effective work plan that clearly shares decision-making and responsibilities. If such meetings are held, there must always be an explicit plan made of what/how/when to share what has gone on with the family. Secret discussions are unlikely to remain secret, and the aim should always be to empower the Core Group to become more able to be direct and assertive with the family without compromising their own safety;
• Holding a meeting to draw up an explicit risk reduction plan for workers and in extreme situations, instituting repeat meetings explicitly to review the risks to workers and to put strategies in place to reduce these risks;
• Joint visits with Police, colleagues or workers from other agencies;
• If workers have experienced a frightening event, debriefing with other agencies can be helpful.

Remember that although working with hostile families can be particularly challenging, the safety of the child is the first concern. If professionals are too scared to confront the family, consider what life is like for the child.

5. Responding to Uncooperative Families

5.1 What Should I do?

Unfortunately for the worker making the approach, the underlying feelings may be masked by anger or avoidance as these parents do not easily trust and may be fearful of closeness. It is best to be formal, though warm, giving clear indications that the aim of the work is to achieve the best for their child and be helpful if possible.

It is essential that the parent/carer recognise that you are a professional with the authority to be involved with their family and to do this you must clearly state your professional authority. The motivations and capacities of the adults to respond cooperatively in the interests of their children, with the help of the worker and their agency will need to be continuously assessed. However, both control and care will be needed, and the worker must confront uncooperativeness when it arises, albeit with understanding and empathy.

You should seek supervision from your manager or advice from senior staff to ensure you are progressing appropriately with the family.

Where you as a worker are going to be involved over a longer period, you will need to help the parent/carer to work through their underlying feelings as you support them to engage in the tasks of responsible child care.

In some cases, despite making every effort to understand and engage the parents/carers, you may find the family remains completely resistant and will not allow you to become involved.

In such cases you should not hesitate to have discussions with your manager, and together consider if other action might be necessary. It is important for workers in such situations not to feel a sense of personal failure or professional incompetence.

Remember: all workers experience such rebuffs at some point during their working life; there are some families who are resistant despite anyone's efforts.

5.2 What Should I not do?

Workers' 'coping' strategies that may merely obstruct engagement with any other family can be pitfalls when working with hostile families, and as a result perceived or actual harm to the child may be minimised or underestimated by the worker. You will need support to understand the family's behaviour and your own response to it.

Workers may unknowingly use the following strategies:

• See each situation as a potential threat and developing a "fight" response. Becoming over- challenging, thus increasing the tension between the worker and the family. This may protect the worker physically and emotionally or may put them at further risk. It can lead to that worker becoming desensitised to the child's pain and to the levels of violence within the home;
• Collude with parents/carers by accommodating and appeasing them in order to avoid provoking a reaction;
• Become hyper alert to the personal threat so that you become less able to listen accurately to what the adult is saying, distracted from observing important responses of the child or interactions between the child and adults;
• "Filter out" negative information or minimising the extent and impact of the child's experiences in order to avoid having to challenge. At its extreme, this can result in workers avoiding making difficult visits or avoiding meeting with those adults in their home, losing important information about the home environment;
• Feel helpless or paralysed by the dilemma of deciding whether to "go in heavy" or "back off". This may be either when faced with escalating concerns about a child or when the hostile barrier between the family and outside means that there is only minimal evidence about the child's situation.

It is important:

• That you make every effort to understand why the family may be uncooperative or hostile, and this entails considering all available information, and contacting other agencies and professionals who have had involvement with the family;
• To be aware that some families, including those recently arrived from abroad, may be unclear about why they have been asked to attend a meeting, why you want to see them in the office or why you are visiting them at home. They may not be aware of roles that different professionals and agencies play and may not know that the local authority and partner agencies have a statutory role in safeguarding children, which in some circumstances override the role and rights of parents e.g. child protection;
• That where you think cultural factors are making a family resistant to having professionals involved, you seek expert help and advice in gaining a better understanding of the culture involved. You could consider asking for advice from local experts, who have links with the culture. In such discussions the confidentiality of the family concerned must be respected.

If you anticipate difficulties in engaging with a family, you may want to consider the possibility of having contact with the family jointly with another person in whom the family has confidence. Any negotiations about such an arrangement must similarly be underpinned by the need for confidentiality in consultation with the family.

Practitioners need to ensure that clients are treated with respect and dignity at all times. Being professional not only involves keeping appointments but also ensuring that families are engaged wherever possible and understanding and recognising the impact of cultural differences.

Families may develop a resistance or hostility to involvement if they perceive the worker as disrespectful and unreliable or if they believe confidentiality has been breached outside the agreed parameters.

5.3 Prior to Making Contact

• Have you found out whether a Early Help Assessment has been completed and whether a Lead Professional has been appointed?
• Have you made reasonable attempts to obtain accurate background information on the family and home environment from both your own agency and any others involved? Does this information also include details of any other risk factors e.g. animals and individuals?
• Have you identified and raised issues with the family at the earliest point that you became aware of concerns?
• Do you ensure families are aware of why you want to see them, what you want to achieve and whether this is a one-off or part of a series of contacts?
• Based on the information that you have obtained, do you now feel able to make safe arrangements to have contact with the family?
• If you anticipate difficulties do you and your agency need to contact the Police for further information or for practical support?
• If a series of contacts are planned are you clear about what change you want to help the family achieve and will you do this in a climate of jointly identifying the positive strengths and helping the family to build on these?
• Are the goals and expectations you have of the family realistic?
• Are the proposed timescales of involvement with the family defined?

5.4 Recognising Diversity

• Are you aware of dates of the key religious events and customs?
• Are you aware of the cultural implications of gender?
• Have you acknowledged cultural sensitivities and taboos? E.g. dress.

5.5 Use of Interpreters

This applies also where you are aware family members may have impaired hearing; it is important to take steps to ascertain their preferred method of communication and if British Sign Language is to be used, arrange for an appropriate interpreter to assist.

Where you have ascertained that an interpreter is needed, it is important to check out the interpreter is able to communicate in the required language/dialect. Time must be spent prior to making contact to ensure the interpreter understands the purpose of the involvement and feels comfortable about the subject matter of the forthcoming discussions. The interpreter may need to be briefed on technical and legislative matters relating to the contact.

Interpreters can be very helpful in making phone calls to arrange interviews and explaining to the family the purpose of the involvement and the role of the professional.

Family members, relatives and members of their community or friendship group should not be used as interpreters. It is important to clarify this before the visit takes place.

5.6 Professional Practice

• Do you make every effort to choose a time for appointments that is convenient for the family, and do you arrive on time?
• Do you carry professional identification, which verifies your identity?
• Is your appearance and manner professional when seeing a family and do you take culture and dress code into account?
• If you are unable to attend the appointment or are delayed, do you ensure the family are informed in good time and are offered an explanation or apology?
• Unplanned visits are also essential in safeguarding children and this should be explained clearly to the family in advance
• Consider the seating arrangements and ensure you are seated near the door in case a situation escalates
• In an office setting, ensure reception/admin staff are aware if you think difficulties could arise in the course of an interview.

5.7 Information Sharing & Confidentiality

• Have you familiarised yourself with the information sharing guidance protocol? See Information Sharing Procedure
• Where you intend to share information with others, have you discussed this with the family and sought consent (where appropriate)? Have you explained a refusal may need to be overridden?
• Does the family know how to access written records which are kept about them?

5.8 When Initial Contact is Established

• Do you tell the family what you are required to record, how this information is held and who has access to this information?
• Do you make clear what is expected of the family and what you have undertaken to do?
• Is the family aware of who else is attending any meeting, in what capacity, and what contribution they can make?
• Is the family made aware that they can bring along a friend/family member to be with them at the meeting?
• Are you aware and comfortable with your professional boundaries and able to avoid getting over-friendly with families?
• Does the family perceive you as being firm and fair?
• Do you feel that you have acted in a fair manner? Is there anything that you could or would do differently?
• Remember to review the contact or visit, as this can be extremely useful not only for practitioners but also for the family. Try to end each contact with a brief summary of what the purpose has been, what has been done, what is required and by when. Finally, set a review meeting.

5.9 Practitioner Tips: Improving Communication with Families

Written Communication

• If a letter is sent, is the letter clear about who you are and the purpose of making contact?
• Is the letter written in easy to understand language? i.e. in the family's first language and avoiding complicated words, acronyms and jargon
• Is the letter clear about whether a response is required?
• Have you considered that the recipient may have a low level of literacy? Is written communication appropriate in this situation?
• Where written communication may not be effective have you considered an alternative e.g. audio tape
• Have you made clear how the recipient can contact you to respond?

Spoken communication

• If a phone call is made, are you using plain language to explain who you are; what organisation you are calling from; and who you want to speak to?
• Do you check out with the family their understanding of the content of the phone call? Do you listen to what they say and make sure you check out your understanding with them?
• Do you ask them if they are agreeable to what has been arranged? N.B. only ask if they are agreeable if it is genuinely possible to change this
• Have you thought about the strategies you might use if they were not agreeable?
• Have you ensured a record of the conversation is entered in the case file?

6. Dealing with Hostility and Violence

Despite sensitive approaches by professionals, some families may respond with hostility and sometimes this can lead to threats of violence and actual violence. It is therefore important to try and understand the reasons for the hostility and the actual level of risk involved. It is critical both for your personal safety and that of the child that risks are accurately assessed and managed.

Threatening behaviour can consist of:

• The deliberate use of silence;
• Using written threats;
• Bombarding workers with emails and phone calls;
• Using intimidating or derogatory language;
• Racist attitudes and remarks;
• Using domineering body language;
• Using dogs or other animals as a threat - sometimes veiled;
• Swearing;
• Shouting;
• Throwing things;
• Physical violence.

Threats can be covert or implied, e.g. discussion of harming someone else, as well as obvious. In order to make sense of what is going on in any uncomfortable exchange with a parent/carer, it is important that practitioners are aware of the skills and strategies that may help in difficult and potentially violent situations and that they consult their own agency guidance.

Please note: If you are physically threatened you should consult with your line manager immediately and consider reporting the matter to the Police. Remember to alert other agencies, where threats of violence, implied or direct have been made.

7. Keeping Workers Safe

7.1 Worker's Responsibility

You have a responsibility to plan for your own safety just as your agency has the responsibility for trying to ensure your safety. Workers should consult with their line manager to draw up plans and strategies to protect their own safety and that of other colleagues. There are clear protocols on information sharing. See Information Sharing Procedure.

Prior to contact with a family consider the following questions:

• Why am I doing this visit at the end of the day when it is dark and everyone else has gone home? All visits, but especially potentially difficult/risky visits should be undertaken in daylight whenever possible;
• Should this visit be made jointly with a colleague or manager? Do not be afraid to ask for support;
• Could this visit be arranged at a neutral venue?
• Do I have a mobile phone with me or some other means of summoning help (e.g. personal alarm)?
• Does my manager know my mobile phone number and network, my car registration number and my home address and phone number?
• Are my colleagues/line managers aware of where I am going and when I should be back? Do they know that I may be particularly at risk during this visit?
• Are there clear procedures for what should be done if an officer does not return or report back within the agreed time from a home visit?
• Do my family members know how to contact someone from work if I do not come home when expected?
• Have I taken basic precautions such as being ex-directory at home and having my name removed from the public section of the electoral register?
• Have I accessed personal safety training?
• Is my car likely to be targeted/ followed?
• Have I recorded in writing any overt or implied threats, or any patterns of behaviour, which are concerning and have I discussed these with my line manager?
• Is it possible for me to continue to work effectively with this family?
• Is it safe/ appropriate to visit alone?
• Is the situation safe for any professional - and should the Police be involved? Remember - alert other agencies, where threats of violence, implied or direct have been made.

If threats and violence have become a significant issue for a worker, their line manager should consider how the work could safely be progressed, and document their decision and reasons for this.

Finally, a few don't's:

• Don't take it personally;
• Don't get angry yourself but be firm in your requirements;
• Don't be too accommodating and understanding;
• Don't assume you have to deal with it and then fail to get out;
• Don't think that you don't need strategies or support;
• Don't automatically assume it's your fault and that if you had said or done something differently it wouldn't have happened.

7.2 Tips for Practitioners - Keeping Yourself Safe

• Acquaint yourself with the agreed agency procedures e.g. there may be a requirement to ensure the Police are informed of certain situations;
• Don't go unprepared; be aware of the situation and the likely response;
• Don't make assumptions that previously non-hostile situations will always be so;
• Don't put yourself in a potentially violent situation. Feel safe and in control at all times;
• Get out if it is getting too threatening;
• If an incident occurs:
  • Try to stay calm and in control of your feelings;
  • Make a judgement of whether to stay or leave without delay;
  • Contact your manager or a senior colleague immediately.

Follow agreed post-incident procedures, including any recording required.

7.3 Management Responsibility

Managers, including Senior Managers, have a statutory duty to provide a safe working environment for their employees under the Health and Safety at Work legislation. This includes:

• Undertaking assessments to identify and manage the risks inherent in all aspects of the work;
• Providing a safe working environment;
• Providing adequate equipment and resources to enable staff to work safely;
• Providing specific training to equip workers with the necessary information and skills to undertake the job;
• Ensuring a culture that allows workers to express fears and concerns and in which support is forthcoming without implications of weakness.

In practice, managers need to ensure officers are not exposed to unnecessary risks by ensuring:

• Workers are aware of any home visiting policies employed in their service area and that these policies are implemented;
• Time is allowed for workers to work safely e.g. obtain sufficient background information and plan contact; discuss and agree safety strategies with manager;
• Adequate strategies and support are in place to deal with any situations that may arise;
• In allocating work, managers need to be mindful of the skills and expertise of their team and any factors that may impact on this. They need to seek effective and supportive ways to enable new workers, who may be inexperienced, to identify and develop the necessary skills and expertise to respond to uncooperative families;
• Similarly, more experienced staff may become desensitised and may make assumptions about families and situations;
• Awareness of the impact of incidents on other members of the team
• Where an incident has occurred, managers need to try to investigate the cause e.g. whether this was racially or culturally motivated;
• Pro-actively ask about feelings of intimidation or anxiety so that workers feel that this is an acceptable feeling;
• If threats and violence have become a significant issue for a worker, their line manager should consider how the work could safely be progressed; document their decision and the reasons for this. Remember - alert other agencies, where threats of violence, implied or direct have been made;
• Threats of violence constitute a criminal offence and the agency must take action on behalf of staff i.e. make a complaint to the Police.

7.4 Tips for Managers

• Keep Health and Safety as a regular agenda item at team meetings;
• Ensure that Health and Safety is included in all new employee inductions;
• Ensure that staff members feel comfortable to speak to you about any concerns relating to families;
• Ensure supervision is prioritised and held on a regular basis;
• Ensure that you have a monitoring system for home visits and for informing the office when a visit is completed;
• Analyse team training needs and ensure that everyone knows how to respond in an emergency;
• Ensure training is regularly updated;
• Empower staff to take charge of situations and have confidence in their actions;
• Recognise individual dynamics;
• Pay attention to safe working when allocating workloads and strategic planning;
• Deal with situations sensitively;
• Acknowledge the impact on individuals.

7.5 Supervision and Support

Each agency should have a supervisory system in place that is accessible to the practitioner and reflects practice needs. Supervision discussions should focus on any hostility being experienced by workers or anticipated by them in working with families and should address the impact on the worker and the impact on the work with the family.

Managers must encourage a culture of openness, where their workers are aware of the support available within the team and aware of the welfare services available to them within their agency. Managers must ensure that their staff members feel comfortable in asking for this support when they need it. This includes ensuring a culture that accepts no intimidation or bullying from service users or colleagues. A 'buddy' system within teams may be considered as a way of supporting workers.

Workers must feel safe to admit their concerns knowing that these will be taken seriously and acted upon without reflecting negatively on their ability or professionalism.

Discussion in supervision should examine whether the behaviour of the service user is preventing work being effectively carried out. It should focus on the risk factors for the child within a hostile or violent family and on the effects on the child of living in that hostile or aggressive environment.

An agreed action plan should be drawn up detailing how any identified risk can be managed or reduced. This should be clearly recorded in the supervision notes. The action plan should be agreed prior to a visit taking place.

The practitioner should prepare for supervision and should bring case records relating to any violence/threats made. They should also be prepared to explore 'uneasy' feelings even where no overt threats have been made. Managers will not know about the concerns unless the practitioner reports them. By the same token, managers should be aware of the high incidence of under reporting of threats of violence and should encourage discussion of this as a potential problem.

Health and Safety should be a regular item on the agenda of team meetings and supervisions. In addition, group supervision or team discussions can be particularly useful to share the problem and debate options and responsibilities.

Files and computer records should clearly indicate the risks to workers and mechanisms to alert other colleagues to potential risks should be clearly visible on case files.

8. Impact on Workers of Hostility and Violence

8.1 Overview

Working with potentially hostile and violent families can place workers under a great deal of stress and can have physical, emotional and psychological consequences. It can make you feel responsible for allowing the violence to take place, lead to adaptive behaviour, which is unconsciously "hostage-like", and also result in distressing symptoms.

The impact on workers may be felt and expressed in different ways, for example:

• Surprise;
• Embarrassment;
• Denial;
• Distress;
• Shock;
• Fear;
• Self-doubt;
• Anger;
• Guilt;
• Numbness;
• Loss of self-esteem and of personal and/or professional confidence;
• A sense of helplessness;
• Sleep and dream disturbance;
• Hyper vigilance;
• Preoccupation with the event, or related events;
• Repetitive stressful thoughts, images and emotions;
• Illness;
• Post-traumatic stress.

8.2 Factors that Increase the Impact on Workers Include:

• Previous traumatic experiences, both in professional and personal life, can be revived and heighten the fears;
• Regularly working in situations where violence/threat is pervasive: Workers in these situations can develop an adrenalin-led response, which may over- or under-play the threat. Workers putting up with threats may ignore the needs/feelings of other staff and members of the public;
• Hostage-like responses: When faced with significant fears for their own safety, workers may develop a 'hostage-like' response. This is characterised by accommodating, appeasing or identifying with the 'hostage-taker' to keep safe;
• Threats that extend to the worker's life outside of work;
• It is often assumed that there is a higher level of risk from men than from women and that male workers are less likely to be intimidated. False assumptions decrease the chances of recognition and support. Male workers may find it more difficult to admit to being afraid; colleagues and managers may not recognise their need for emotional support. This may be particularly so if the perpetrator of the violence is a woman or young person. In addition, male workers may be expected to carry a disproportionate number of threatening service users;
• Lack of appropriate support and a culture of denial or minimising of violent episodes as 'part of the job' can lead to the under-reporting of violent or threatening incidents and to more intense symptoms, as the worker feels obliged to deal with it alone;
• Violence and abuse towards workers based on their race, gender, disability or perceived sexual orientation etc. can strike at the very core of a person's identity and self-image. If the worker already feels isolated in their workplace in terms of these factors, the impact may be particularly acute and it may be more difficult to access appropriate support.

8.3 Making Sense of Hostile Responses

• Are you prepared that the response from the family may be angry or hostile towards you? Have you discussed this with your manager and planned the strategies you would use where there is a predictable threat, e.g. an initial visit with Police to establish authority?
• Might you have aggravated the situation by either getting angry yourself or could you have been construed as being patronising or dismissive? Is the hostility a response to frustration, either related or unrelated to your visit?
• Does the person need to complain, possibly with reason?
• Is the behaviour deliberately threatening/obstructive/abusive or violent?
• Is the parent/carer aware of the impact he/she is having on you?
• Is he/she so used to aggression that they don't appreciate the impact of their behaviour?
• Is this behaviour normal for this person?
• Is your discomfort disproportionate to what has been said or done?
• Are you taking this personally in a situation where hostility is aimed at your organisation?