A solution for vulnerable families?

Written by: HTU | Published:

The coalition’s Education Business Plan sets out its intention to ‘develop a new approach to turning around the lives of chaotic and dysfunctional families’. Headteacher Update looks at what this pledge entails

There must have been a few cynically raised eyebrows at the coalition’s announcement; what could this new approach be? Schools and their partners have struggled for years to work with challenging families in the knowledge that a background of chaos is a poor starting point for a lifetime of achievement. So far, there have been no magic remedies.

Then came the new coalition government’s ambition to turn around the lives of families with multiple problems by the end of this parliament. It is not an initiative only fuelled by the need to do public good, the government’s Families Savings Calculator was used with a sample of 40 families collected from 19 authorities and the average total cost avoidance as a result of a family completing an intervention successfully was calculated at £81,624. A strong incentive when speeches are peppered with the word “austerity”.

As more detail is applied to sweeping statements, intentions and promises, some new themes are emerging. “Family therapy” is one of them.

What is family therapy?

The word therapy can conjure up an alien, American “let’s talk about this” stereotype. Pictures of families sitting cross-legged in circles being frank, argumentative and then embracing. We have seen it all time and time again on Oprah Winfrey and might wonder how such an approach will transfer to the dysfunctional families of Jeremy Kyle. Language and stereotypical perceptions can get in the way. The central principles of family therapy are ones that most people would subscribe to if the cultural associations and jargon were stripped away.

Family therapy, not surprisingly, takes the family as its focus. It believes that key to any solution are the relationships that exist between family members and that to solve problems involving the family is key.

There are different variations of family therapy. However, there tend to be notable similarities between them:

- They are based within the family and are usually located in the home.
- They are intensive and involve a prescribed number of sessions over a period of time.
- Relationships within the family are a central part of any solution.
- They focus more on solving problems than finding causes.
- It involves a no-blame approach.

So, for example, if a child is behaving badly the family therapist might look for ways within the resources of the family to deal with this rather than tracking back to the emotional reasons for why it is occurring. Family and therapist work together to resolve difficulties and find alternative, less-damaging ways of behaving.

These programmes are not as new as you might think. Many of the schools of family therapy emerged during the 1960s and have been around in one form or another since then. So why are they now making such an impact on the intervention horizon?

Why now?

To begin with, we are struggling. Over generations our families have changed into very different entities from those depicted on the earliest television broadcasts. Old styles of working, which assume an authority over the recipient of support, can struggle to make any impact at all.

Models of intervention based on what should happen at home rather than what does have an unworkable foundation. Programmes which require parents to come into school to be told how to manage their child’s behaviour are often dependent upon skills that parents do not have and that may be too late for them to acquire.

However, family therapy acknowledges this and has the advantage of being able to start from whatever foundation is already there. It meets the family more than halfway, in the home, and engages with current practice, highlights existing relationships and develops them to create a solution.

Having a strong American focus, family therapy projects and programmes have the advantage of being both interventions and being well researched. Graham Allen’s report Early Intervention: The Next Steps (2011) is the first of two reports setting out the rationale for early intervention. The main principle is that the earlier you intervene in a child’s life the more chance there is that the cycle of disadvantage and low expectations will be broken. This brings lots of social advantages, not to mention financial savings.

Allen refers to 72 different early intervention programmes altogether with 19 identified as being the most desirable. The majority are from the US, a result of the criteria used by Allen. Programmes had to be able to demonstrate their effectiveness to be mentioned. They had to do much more than collect anecdotal information and provide a RAISEonline analysis.

Evidence was required from randomised controlled trials and a high level of analysis was expected – not something that every early intervention programme has up its sleeve. If there is one thing, however, that US-based programmes are good at, it is justifying their existence. The US models of family therapy come well prepared with evidence to demonstrate their effectiveness.

Of the 19 most promising intervention programmes, Functional Family Therapy (FFT) and Multisystemic Therapy (MST) both focus on family capacity and intervention. MST is an intervention for young people that focuses on addressing delinquency issues. FFT is a family-based intervention that aims at reducing risk factors in families.

Functional Family Therapy

FFT originated in America and is a relationship-based approach that targets youth behaviour problems. It focuses on the strengths of families as well as targeting the issues they have. It acknowledges that behaviour cannot always be eradicated but its negative effects can be reduced and it seeks to address risk and build in protective factors to help achieve this.

FFT is tailored to the family. Each stage in the therapy is informed by the relationships that exist and the needs of the family unit as well as individuals. Although each programme might be unique, there is a very clear structure to it. This is a feature of many family therapy interventions. They must adapt to individual circumstances while applying the same principles and structures across them all.

The therapy lasts for three to four months and involves between eight to 12 sessions. There are six phases in the programme:

- Pre-treatment – relationships are developed, organisational features are agreed.
- Engagement – credibility is gained with the client and a level of high availability and respect is aimed for.
- Motivation – focuses around building self-esteem and being positive about family relationships, issues of blame are addressed.
- Relational – plans are developed for the next stages and there are observations and questioning sessions built in. Activities include switching from the problem to the relationships.
- Behaviour change – building skills, changing habits and finding alternative coping patterns.
- Generalisation – identifying what to do if things go wrong in the future and helping to develop independence away from the programme.

The intention is not to change relational functions but to change the strategies used by individuals to achieve relational functions. So, for example, if a child acts up to get attention, FFT does not aim to eliminate their need for attention but instead changes the means through which they seek to gain it.

Although FFT is still strongly based in the US it has been implemented in the UK in pioneering areas for some time. For example, it was introduced in Brighton in 2007 with support from the US. That this type of approach has just made the headlines does not mean its roots are not already firmly planted. Examples of the emergent focus on families are clearly identifiable in the Family Intervention Projects (FIPs).

Family Intervention Projects

FIPs had already been introduced by the previous government. Targeted at households with extreme anti-social behaviour they provided enhanced support to families. This usually took place in the family home and included the involvement of different agencies. Although it is a multi-agency programme it is coordinated by one key worker who is the main point of contact for the family. Having the same key worker is an important part of the plan.

The average length of an intervention is around 13 months with contact with the family decreasing during the course of the intervention from an average of nine hours a week to 6.8 at the point of the final review and exit. Altogether 150 local authorities took part before March 31 2010. In November 2010 a report was published to evaluate how effective they had been.

Did they work?

Monitoring and evaluation of family interventions by J.Dixon, V. Schneider, C Lloyd, A. Reeves, C.White, W.Tomaszewski, R. Green and E.Ireland, evaluated the results of the interventions. The families who were supported by the projects were categorised according to:

- Family functioning and risk (including those with poor parenting, marriage and relationships issues, experiencing domestic violence or who had child protection issues).
- Crime and anti-social behaviour (having engaged or having a family member arrested, on bail, probation, a tag or a conditional discharge).
- Health (those with mental health, drug/substance misuse or drinking problems).
- Education and employment (where no adult member was in employment, education or training and families with children experiencing problems at school).

Overall, of the families leaving intensive family intervention before March 31 2010:

- 76 per cent left for a successful reason.
- 14 per cent left for an unsuccessful reason.
- 11 per cent left for a reason which could not be counted as a success or a failure.

The greatest number of successful outcomes came from those families with domestic violence, involvement in crime and/or anti-social behaviour and those with issues relating to truancy, exclusion or bad behaviour at school. The least successful were those experiencing mental health problems and worklessness. The evaluation found that the longer families worked with a family intervention programme the greater the chance that it was successful.

The way forward

Working in an intensive way to develop the capacity of families is an approach the government would seem to be committed to. By publishing its Prospectus: delivering intensive interventions for looked after children and those on the edge of care or custody and their families, the government is demonstrating its determination to push this approach forward. Through this prospectus it invites bids from local authorities and their partners to deliver four interventions:

- Multi-dimensional Treatment Foster Care (MTFC)
- Multisystemic Therapy (MST)
- Keeping Foster and Kinship Carers Safe and Supported (KEEP)
- Functional Family Therapy (FFT)

We can expect to see much more from these programmes in the UK in the future. The commitment to them does not mean that it will all happen seamlessly. Thomas Bowerman from the MST programme is a strong advocate for the approach while also recognising that there are issues of transportability between countries. It is not just the US and UK that the programme is being introduced into and maintaining fidelity to its principles while also adapting it for the local context is an important part of any management team’s work.

Transportability between countries is not the only issue. There can be differences in the application of a programme depending upon locality and context within the UK itself. MTFC is currently working in a number of authorities but there are differences in its level of success across rural and inner city areas. For all these programmes this trial and error period is crucial if family therapy is to be the solution it is hoped for.

We are struggling to find solutions to the apparent breakdown of family life and the subsequent problems that result. With the jargon removed, family therapy has many sound principles that do represent a shift in the way that we work with our families. However, translating the message from the American context to inner city and rural Britain requires local knowledge too. The success or failure of this new direction will depend upon the skill the translators are able to apply to their challenging task.

Further information

- Functional Family Therapy: www.fftinc.com/- Multisystemic Therapy: www.mstservices.com/- Multi-dimensional treatment foster care: www.mtfc.com/index.html

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