Paper
Whole family approaches: responding to and engaging with complex social lives
- issue: Issue 1 / 2009
- authors: Harriet Clarke, Nathan Hughes, Kate Morris
- keywords: practice, professional, exclusion, family, United Kingdom
- views: 5721
- downloaded: 0
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abstract
Background. In the UK, the Social Exclusion Task Force is currently leading a cross-governmental review on policy and practice in relation to socially excluded families. The stated aims of the review[1] are:
- 'To set out a vision of an effective family support system for families with additional or complex needs'.
- 'To identify barriers and practical solutions to the provision of a coherent whole family approach for these families'.
- 'To agree action to better integrate adult, child and community services around the needs of excluded families in order to tackle the drivers of deep seated exclusion'.
Purpose. This paper draws upon a literature review exploring 'whole family approaches' to work with those vulnerable to social exclusion. As such, it is concerned with how notions of 'family' are understood in research, policy and practice, including theoretical conceptions as well as models and approaches. The review draws on:
- Submissions from expert academic commentators concerned with the specific needs of families experiencing multiple difficulties (mental health, disability, young carers, child welfare, drugs and alcohol, crime and anti-social behaviour, domestic violence).
- A preliminary literature search exploring national and international literature that describes/evaluates/theorises whole family approaches.
Key findings. The dynamic and contested nature of social exclusion means that social policies and social care practices may not capture or reflect the lived experiences and needs of families. Family forms are many and varied, beyond the boundaries of those defined through partner and 'blood' relationships. For family-focussed services to deliver effectively, the complexity of family roles, functions, and compositions need to be examined and understood within the modern context.
Whilst family forms and definitions change, the importance of family for the experience of both interdependence and individual support and well being remains. As such, families who are not engaged by services, or do not engage with or respond positively to inputs, require particular understanding from their own perspective. Extending understandings will ensure that marginalised families who face specific barriers to services are reflected in mainstream policy and provision.
Within the literature reviewed there was repeated evidence of family based services or models in reality being adult or child based provision, with little acknowledgement of the important differences between working with families as opposed to working with members of families. The use of terms such as 'parent' and 'family' as interchangeable descriptions often masks the paucity of whole family service provision and approaches. Three broad categories of models and approaches are identified by the review:
Category 1: Working with the family to support the service user
In the first category, the family is seen as a basis for support for an individual within that family. As such, the extent to which a parent, sibling or spouse may be engaged by policy or services is determined by the ability of that family member to offer support and assistance, with the focus and purpose of provision remaining primarily on the service user within that family.
Such provision can be further classified on the basis of the means of engagement with family members. We are able to differentiate between approaches that recognize and seek to strengthen the presumed, inherent ability of particular family members to offer support to an individual within that family, and those that instead aim to discern particular deficits or weaknesses in particular families, and intervene to address them. The former approach is apparent in relation to therapeutic support involving family members. Such approaches are predicated on the need to solidify supportive family relationships, for example in order to address an individual's substance use. The latter is evidenced in the often coercive approaches to parental engagement within the British youth justice system, which include a compulsion to attend programmes relating to parenting skills.
Category 2: Identifying and addressing the needs of family members
In the second category, family members are recognised as having their own specific needs arising out of their relationship with the primary service user. Whilst their role in offering support to the service user is still prominent, and often the primary basis for intervention, the family member is identified as having needs that are separate, in addition to, and perhaps only indirectly related to those of the service user.
The emergence of this category of provision is most evident in relation to the changing nature of support for parents of disabled children. In relation to this user group, parenting programmes have been developed and advocated both as a universal intervention and as a specialist intervention with parents facing specific difficulties. Within the UK, the provision of services for 'young carers' offers a further distinctive example of an approach focused on supporting family members in order to maintain support to a primary service user.
Category 3: Whole family support
The third category highlights services and policies that seek to work with the family unit as a whole. That is, rather than addressing the needs of the service user or individual family members in isolation, provision recognises and focuses on shared needs and/or the strengths apparent in inter-relationships and collective assets. Whilst aspects of provision within previous categories may have been delivered to the whole family together, this model is distinctive in that the needs to be addressed and the strengths upon which solutions are to be based, are perceived to be held within the collective of the family.
Review evidence indicates that aspects of the whole family approach are apparent in planning and decision-making in a range of areas of provision, including: adult mental health services; child protection; transitions (leaving care, moving families); youth justice; domestic violence; and family conflict. The review has also identified provision of community-based family support services that adopt a whole family approach, including approaches that adopt an ecological stance, considering 'person' and 'family' in a broader social context.
The review has illustrated a momentum towards whole family approaches within policy and provision in relation to a number of service user groups. However it has also illustrated that many such interventions are still in their infancy and require further evaluation. Professional and agency competency in delivering whole family approaches merits review. There is evidence that existing service provision finds 'thinking family' both challenging and controversial and this has implications for professional knowledge and frameworks, training and ultimately the arrival at shared objectives.
There are resonances in the messages about direct practice coming from this review and other, relevant research and reviews. Trust, responsivity, flexibility and sustainability are all core features of positively valued provision. Such components of the working relationship between families and professionals (trust, openness, respect, responsivity) are crucial regardless of the actual service type (e.g. whether 'specialist' or 'mainstream').
Key references
Morris, K., Hughes, N., Clarke, H. et al (2007). Whole Family Approaches: A Review for the Social Exclusion Task Force. London: Cabinet Office.
Social Exclusion Task Force (2007). Reaching Out: Think Family. London: Cabinet Office.
Contacts: Harriet Clarke, University of Birmingham, Institute of Applied Social Studies, University of Birmingham, Edgbaston, Birmingham, B15 2TT, E-mail: H.Clarke@bham.ac.uk Phone 0121 4158479.
[1]. www.cabinetoffice.gov.uk