Family Support in Ireland Definition & Strategic Intent

Family Support in IrelandDefinition & Strategic Intent

A Paper for the Department of Health and Children

BY

DR. JOHN PINKERTON

Queens University of Belfast

and

DR. PAT DOLAN

WHB/NUI, Galway

Child and Family Research and Policy Unit

and

MR. JOHN CANAVAN M.A.WHB/NUI, Galway

Child and Family Research and Policy Unit

December 2004

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Section 1: Introduction … … … … … … … … … … … … … … … … … … 1

Section 2: Emerging Policy Consensus … … … … … … … … … … … … 3

Section 3: From Policy to Practice … … … … … … … … … … … … … … 10

Section 4: Grounding in Social Support Theory … … … … … … … … … 18

Section 5: Definition and Strategic Intent … … … … … … … … … … … 22

Bibliography … … … … … … … … … … … … … … … … … … … … … 26

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Table ofContents

This paper is based on a review of literature relating to the policy and practice offamily support, primarily within Ireland and the United Kingdom but also takingaccount of some international experience. The review was commissioned by theDepartment of Health and Children to inform the work of the Steering Group to theReview of Family Support Services. The aim of the paper is to provide a knowledgebased working definition of family support which will help in the work of the Review.

In preparing this paper a wide range of books, chapters, journal articles, policyreports and legislation, mainly published in the last ten years, was identified.Particular attention was given to identifying material that provided:

• a perspective on children and family needs consistent with the UN Convention onthe Rights of the Child and the National Children’s Strategy;

• an indication of the range of types of existing family support services and the levelsof intervention at which they operate;

• suggestions as to existing best practice principles.

An initial list of written material was generated through considering the contents ofthree key texts covering Irish, UK and international material: Anne Buchanan’schapter “Family Support” in the evidence based practice collection “What Works forChildren” (Buchanan in McNeish et al, 2002), Kieran Mc Keown’s “Guide to WhatWorks in Family Support Services for Vulnerable Families” (2000) which wasproduced as part of the Springboard Family Support Initiative, and Ilan Katz andJohn Pinkerton’s edited book of international material and national case studies“Evaluating Family Support: Thinking Internationally, Thinking Critically” (2002).

The initial list was supplemented by drawing on the authors’ collective knowledge ofthe field. The list was then further added to, and some titles withdrawn from it, asthe review was being carried out. Each source was examined with a view toextracting relevant information in the areas of policy, practice and operationalmanagement. Also efforts were made to characterise the content of the material

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Section 1:Introduction

according to three designations: theory, research findings and policy/practicecommentary. As might be expected, some sources reflected more than just one ofthe categories. In all, one hundred and forty sources were identified, split more orless evenly between the different types of text, although journal papers constitutethe majority. Material was found on policy, practice and operational management butthe latter was noticeably limited. In the main, the texts were concerned withpolicy/practice commentary and descriptive research findings.

Wieler (2000) has suggested that family support can be seen in three ways: as apolitical goal, a method and an organisational form. In this paper all three areconsidered, the first in Section 2: Emerging Policy Consensus, the two others inSection 3: From Policy to Practice. Section 2 also identifies the rights and needs thatshould underpin any consideration of family support. Understanding family supportalso requires theoretical anchoring and this is provided in Section 4: Grounding inSocial Support Theory. Unlike the previous four sections, which describe areascovered in the literature that was found, the final section, Section 5: Definition andStrategic Intent, proposes a definition for family support and a statement of strategicintent, necessary to transpose this definition into an achievable policy goal.

Department of Health and Children

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Reviewing the family support literature shows that it has deep roots in the history ofchild welfare (Ferguson and Kenny 1995, Hill 1995, Murphy 1996). In Ireland and theUK this goes back to the shared Poor Law heritage where ideas of the ‘deserving andundeserving’, ‘less eligibility’ and ‘child rescue’ were first formulated and which stillchime with aspects of the family support debate. This is so, not only in terms of thecounter posing of child protection to family support services but also the blaming ofindividual family members for the perceived failures in family functioning - bothmothers and fathers for lacking the skills and motivation to provide satisfactoryparenting, and children and young people for lack of self discipline and respect forauthority.

At the same time as drawing attention to lessons that might be learned from thepast, an historical perspective emphasises that family support as a coherent,contemporary policy perspective is still at a relatively early stage in its development(Pinkerton et al 2000). It also emphasizes that it is a significant shift from the previousdirection of child care policy. The dominant focus in child care services since the early1990’s has been on the protection and care of children who are at risk. More recently,the policy focus has shifted to a more preventative approach to child welfare,involving support to families and individual children, aimed at avoiding the need forfurther more serious interventions later on (Department of Health and Children2001). The same point, going back a further decade, has been made for the UK (Jackand Jordan 1999, Gardner 2003).

Recognising the extent of the change and the early stage in trying to achieve it goessome way to explaining the considerable confusion and debate that continues overwhat exactly family support means in policy terms. It also suggests that it isappropriate at this stage in the policy process to focus on foundation work arounddeveloping a working definition. Any government or agency that is committed tofamily support needs to develop a conceptual framework and vocabulary that makeexplicit welfare assumptions, areas of need and types of services (Pinkerton 2000).Such secure ground that exists within legislation and documented strategic

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Section 2:EmergingPolicyConsensus

commitments has to be used to provide the basis of a working definition of familysupport on which a policy driven, strategic mission can be built.

At the same time as secure ground needs to be sought, the contingencies of an everchanging national policy climate also have to be acknowledged (Tunstill 2003). Thisneeds to be kept under constant review as to the implications for both developingfamily support as a policy and for evaluating its success or failure (Katz and Pinkerton2003). Over the ten to twenty years that family support has been pursued withinIreland and the UK respectively, managerialism and consumer satisfaction haveemerged as key imperatives within the public sector and in recent years have beenjoined by the commitment to evidence based policy and the pursuit of measurable,costed outcomes. These developments have brought with them a whole range oftechnical challenges around organisational structures, management capacity,including financial controls and communication and information systems.

There is a politics of family support that needs to be recognised and managed bypolicy makers. This includes the micro politics of the relationship within and betweenlevels of government, disciplines, professions, organisations and sectors and acrossthe divides of commissioners, providers and service users (Tunstill 2003, Parton 1997,Katz and Pinkerton, 2003). But it also means the formal world of politics has to betaken into account as both the Irish and UK Governments have struggled to managevery fast changing worlds whilst maintaining electoral support – particularly in Irelandwith the economic boom and rapid social change of the 1990s.

As part of considering this wider canvass, there needs to be recognition that lurkingin the shadows of the debate over family support there is a much more extensivepolitical, social and economic challenge. Pauline Hardiker and her colleagues inLeicester in their influential work on prevention in child care have suggested thereare three types of welfare that inform both the way in which needs are seen and whatservices are provided – residual, institutional, and developmental (see Table 1). Thepolitical choice to pursue one or other of the three has a profound effect on howfamily support is understood and pursued. For example, the Scandinavianexperience of family support may have much to recommend it (Steen Jensen 2000,Andersson 2003) but as one Danish commentator has observed, it has to be seen aspart of “comprehensive well funded interventions in many areas of social life and inparticular in the care and support of children” and that “represents one end of anideological continuum constructed along the dimension of the responsibilities ofindividuals and the state” (Steen Jensen 2000, p.195).

Issues of economic, housing, education and health policy all directly impact on whatis feasible to deliver as family support and whether it is contained within a relativelynarrow children’s services framework or seen as a cross cutting policy imperativeclosely linked to social inclusion (May-Chahal et al 2003). Children and their


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experience within families have become a central concern of policy aimed ataddressing social exclusion such as the Anti Poverty Strategy (Ireland, 1997).“Childhood lays the foundations for adult abilities, interests and motivations andhence is the keystone for assuring equal opportunities for adults” (Ashworth quotedin May-Chahal et al 2003).

Table 1: Framework Linking Types of Welfare to Need and Services(Modified from Hardiker et al 1991)

In addition to concern for the needs of children as adults in the making, there is nowa global consensus around the United Nations Convention on the Rights of the Child(UNCRC) that the needs of children as children demand respect. In line with Ireland’sobligations as a signatory to the UNCRC, the internationally innovative cross cuttingNational Children’s Strategy: Our Children - Their Future (2000) set out a ‘wholechild’ perspective as a means of expressing the holistic needs of children and youngpeople. Nine interwoven developmental dimensions to children’s lives arepresented. For children to realise and express their potential along these dimensions,they require supportive relationships through both the informal social care networks

Section 2 – Emerging Policy Consensus

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Types of Welfare

Residual

Institutional

Developmental

Needs

• individual explanations• pathology model/individual defect• individual requires corrective

treatment

• product of faulty interactionbetween individual andenvironment

• faulty functioning of eitherindividual or social institutions

• individual needs help to adjust todemands of society

• improvements may be needed indelivery of welfare services

• individual difficulties arise from theunequal distribution of power andresources in society

• individuals need to be able toexert more control over their livesincluding increased access toresources

• social systems not people arerequired to change

Services

• individual/family carries burden ofresponsibility to provide for allneeds

• right to choose/duty to provide• state provides basic social

minimum as a last resort/safety net• informal, voluntary and private

sources of care are predominant

• state has a duty to ensure needs ofmost disadvantaged members ofsociety are met

• state discharges its duty by co-ordinating mixed economy ofwelfare in which it plays asignificant role

• state guarantees social rights• state accepts predominant

responsibility for meeting socialneed via universal social servicesand redistributive social policies

• state welfare is a means towards ajust and equal society

of family, friends and neighbours and public and commercial services. The ‘wholechild’ perspective takes an active view of children in which they both affect and areaffected by the world around them. Within the ‘whole child’ perspective there is anunderlying assumption that childrens’ lives can be improved as a result of positiveand supportive interventions. This includes desired outcomes for children andfamilies such as: optimum happiness, realisation of their full intellectual and culturalpotential, the ability to cope with adversity, improved mental health and greatersense of fulfillment in life.

The place of the family in meeting the social care needs of children and youngpeople is generally recognised within Ireland and internationally (UNCRC 1997,Commission on the Family 1998, Gilligan 1999, Katz and Pinkerton 2003). However,the reality of the family’s central role in meeting social care needs is in tension withthe equally apparent reality that the capacity to respond to that need throughcontemporary forms and functions of family life is being eroded. In part that tensionis an expression of the extent of change in family structure and family life that hasgiven rise to a much broader and inclusive view of what constitutes a family and whothe carers are within them (Daly 2004). Family members who have a high degree ofdependence, such as children, elderly people and disabled people, and those whoare depended on, primarily women, are particularly exposed to the pressures ofcontinuing need but reduced capacity.

This need/capacity dilemma has major implications for the form and function of stateservices (Cowie 1999). Given the widespread experience of high cost, low qualitycare where the state has attempted directly substituting its own services for familylife (Conjoint Health Boards 2001, Barnardos 2000), the obvious way forward wouldseem to be to prevent the necessity for invasive and ineffective state interventionthrough the development of family support. Family support appears to be anecessary and appropriate means to achieve a new and effective way of deliveringservices. It uses the power and authority of the state to promote the welfare ofchildren but does so in a manner that enhances parental capacity and responsibilitywithin the context of the family as a key institution of civil society.

It would be wrong, however, to regard the promotion of family support as just apragmatic response by the state to managing social change and family life. It is alsoa principled position in line with the global aspirations of the United Nations’Convention on the Rights of the Child (UNCRC). Although the historic importance ofthe UNCRC is primarily the recognition it gives to children in their own right, it alsoplaces special emphasis on supporting the family in carrying out its caring andprotective functions.

“The family, as the fundamental group of society and the naturalenvironment for the growth and well being of all its members and


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particularly children, should be afforded the necessary protection andassistance so that it can fully assume its responsibilities within thecommunity” (UNCRC)

The mandate for developing family support services is not only found in the UNCRCbut also in legislation in both Ireland and the UK. The promotion of family supportthrough Part IV and Schedule 2 of the Children (NI) Order 1995, along with theassociated guidance and regulations, closely follows the 1989 Children Act in Englandand Wales. While neither legislation defines family support, the recipients of familysupport services are identified in terms of three categories of ‘children in need’.

The literature and research generated in the wake of the UK legislation clearlydemonstrates the difficulty in monitoring and evaluating the working through of thelegislative mandate for family support (Gardner, 2003). Both the attempt to find waysto identify children in need and to develop family support services proved verydifficult. The challenge of refocusing, as it became known (Jack 2001), centeredaround the interface between child protection and family support. Following thepublication of an influential summary and a set of twenty government fundedresearch studies into child protection (Department of Health UK, 1995), the debateshifted from balancing the two types of needs and associated services to finding themeans to integrate family support and child protection in a way that neitherstigmatises support services nor lowers safety thresholds to a level that endangerschildren (Parton, 1997). As the quote below from the most recent review ofGovernment commissioned research, ‘Children Act Now: Messages from Research’,makes clear, the debate has remained stuck in that mode.

“The current system of separating child protection enquiries and familysupport assessment is ineffective and counter-productive to meeting theneeds of children and families. The studies suggest that, by separating thetwo systems, some children have missed the value of early intervention toprevent more intrusive and intensive activity at a later stage. Conversely,some children, who need safeguarding because of neglect are slippingthrough the net of family support services because these services fail toaddress the importance of safeguarding Children’s welfare”. (Aldgate J etal, 1989, P.144)

It remains to be seen whether the very recent green paper prompted by the tragickilling of Victoria Climbie, ‘All Children Matter’ (Laming 2003), with its integrativeadministrative reforms and redesignation of Departmental responsibilities away fromhealth to education will move the debate on.

In Ireland, support for the policy commitment to family support is found in the ChildCare Act 1991 which places a statutory obligation on health boards to identify and


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promote the welfare of children who are not receiving adequate care and attention.Section 3 of Part 2 of the Act specifically states that Health Boards should providefamily support services. While the Child Care Act, 1991 provides a clear context forthe development of family support services at local level, it is fair to say a childprotection focus informed the implementation of the Act due to the findings of theKilkenny Incest Investigation published two years later (McGuinness, 1993) and othersubsequent inquiries. It was only in the report of the Commission on the Family in1998 and the launch of the Springboard Programme in the same year that moresound building blocks of State policy on Family Support emerged. Hazlettcharacterises the overall thrust of the former as focusing “on the need for publicpolicy to focus on preventive and supportive measures to strengthen families incarrying out their functions” (p.131, 2003). Allied to this universal policy orientationwas the approach of the Springboard programme, which focuses on specificcommunities and families and provides integrated, intensive interventions withtargeted families and other families in the targeted communities. In 1999, theGovernment also committed to further expanding the network of family resourcecentres to 100.

A family support orientation is evident in other key policy and legislativedevelopments, for example in the National Children’s Strategy, and its specificobjective in relation to family life, and in the Children Act, 2001, with its significantemphasis on an expanded role for families at different levels in the juvenile justicesystem. At this time also, the Health Strategy published in 2001, proposed anexpanded role for family support services (p.15, 2001). While these measures containsignificant family support elements, the most significant new legislation focusing onfamily support is the Family Support Act, 2001. It established a new Family SupportAgency, which is charged with responsibility for Family Mediation services,counselling services, the Family Resource Centre network and development of aprogramme of family related research. Family support is also consistent with thegeneral trend within social policy towards integrated approaches to policydevelopment and service delivery (Government of Ireland 2001).

Research into how family support has developed in Ireland is limited (Hazlett 2003,Canavan and Dolan 2003). However, providing a backbone for what has been doneis a high quality evaluation of the 21 projects nationwide that now make up theSpringboard family support programme (McKeown et al, 2001). The findings fromthat evaluation are encouraging in that whilst the programme offers no ‘miracle cure’there is evidence “that significant progress has been achieved in promoting the wellbeing of children and parents” (McKeown 2001, p. 123). There are also documentedaccounts of family support policy development at Health Board level (Western HealthBoard 1998, South Eastern Health Board 2003, North Eastern Health Board 2002).The latter makes it clear that what is required from policy is a working definition offamily support, a perspective on children and families’ needs, an indication of range,


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type and level of intervention, and a set of practice principles. All of these elementsneed to be combined in a timetabled development plan that has clear objectives butwhich is also flexible and open to review. Similar work has been undertaken byChildren’s Services Planners in Northern Ireland’s four Health and Social ServicesBoards (WHSSB).

Table 2: Family Support by Levels of Need andTypes of Intervention

As seen in Table 2, they have drawn on the four level model developed by Hardikerand her colleagues, and also used by the major Northern Ireland research on familysupport (Higgins et al 2000), to conceptualise family support as meaning somethingdifferent according to different levels of need and services/interventions. The fourlevel model makes it clear that as the degree of need increases at the higher levels,the number of those in such need declines. What increases with the need is theintensity of support. Need at Level 1, for example as experienced by the majority ofmothers with new born children, can be met by universally available services, such asa home visit by a public health nurse. By contrast at Level 4, a child who has spent aconsiderable period in substitute care placements due to a mother’s mental healthproblems may require a residential worker to put together a complex package ofcare involving a range of interdisciplinary and interagency interventions.


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Level 1All Children and Young People

Universally available services

Level 3Children in Need in theCommunity

Supportive Intervention

Level 2Children who are Vulnerable

Support Services

Level 4Children at Risk / In Needof Rehabilitation

Specialist Intervention

A successful central Government policy must have impact at the level of practice andthat requires effective operational management. In the literature on family supporthowever there is surprisingly little material on organisational structure andmanagement practices (Frost 1997, Thoburn 2000). It is however clear that verydifferent approaches can be taken to organising provision. Service delivery may bedetermined by locality with an emphasis on coverage and accessibility. Services maybe orientated towards need, in a life-cycle context; for example ante natal supportservices, early years services, community based adolescent support projects, andparenting programmes for first time parents. Services can also be delivered on thebasis of types of adversity (Reid 1999, Farrington and Welsh 1999). This involvesproviding targeted services in response to identified specific needs, such as supportservices to women who experience domestic violence. Such targeting is linked toassessment of need rather than provision of service on request (Gilligan 2001).

Little and Mount (1999) and Cowie (1999) suggest that as with any human serviceprogramme, family support practice should start with a focus on the accurateassessment of need. It is important to distinguish between two forms of needsassessment, population needs assessment and individual needs assessment(Pinkerton, Dolan and Percy, 2003). The former refers to attempts to measure theextent and nature of need within a geographical area or subpopulation living withinit. The latter refers to the needs assessment that is conducted by professionals, suchas social workers and health visitors on a daily basis in relation to an individual familyor child and the matching of that need to a specific service designed to alleviateassessed need. There can of course be overlap between the two. Individual needsassessment data can be used to estimate the level of need within a population orarea, likewise, many approaches to the assessment of need at the population levelcollect data from individuals and therefore can be used to provide insights intoindividual variations in need. Martin and Kettner (1996) indicate that this can be donethrough a standardised approach whereby services work together for a child orfamily through two formats, a multi-agency response programme and direct caseplanning, the latter focusing solely on a client completing an individualised case

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Section 3:From Policyto Practice

programme (Farrington and Welsh 1999). Whittaker (1997) and Stevenson (1999)support the view that these methods should not be seen as mutually exclusive.

From their work on family support in cases of child maltreatment and neglect,Thoburn and her colleagues (2000) also suggest that a key task in service delivery isto start with generating information about families’ needs and the different types ofservice responses required. They propose that families can be usefully categorised asrequiring either a long-term service, a short-term focused service or an efficient andknowledgeable advice and referral service. They go on to suggest that multi-agencyplanning groups are needed to identify high need areas from where referrals arecoming and locate family centres within them. They also advocate a multi-agencyapproach for developing strategies to address specific types of problems. It has alsobeen suggested that Children’s Services Plans are the vehicle for this within the UK(Frost 1997, Pinkerton 2000).

As part of the refocusing debate in the 1990s in the UK, the Association of Directorsof Social Services and the charity NCH Action for Children suggested a set of keyelements that could ensure that family support for those in need was combined witheffective child protection.

• service flexibility over level of intervention

• needs led service

• multi-agency integrated planning

• co-ordinated interdisciplinary practice

• comprehensive service

• effective and balanced provision

• well trained professional staff

• capable managers

• partnership with independent sector

Detailed description of five family support settings in Northern Ireland suggested aset of criteria against which family support services and organisations might beassessed comprising: the inclusion of service users in management; effective andflexible working across disciplines, agencies and sectors; close and co-operativerelationship with representatives of the neighbourhood in which families in receipt ofservices live; the capacity to deliver a range of services; and attendance to stafftraining and support needs and the creation of effective and integrated staff teams(Pinkerton et al 2000). Later additions to that list include: creativity andresponsiveness in services; understanding of and respect for issues of race andculture; attention to outreach and engagement; and ensuring clarity about the

Section 3 – From Policy to Practice

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relationship between family support and child protection (Katz and Pinkerton 2003).

Similar ideas can be found in the work of Dunst et al (1988) and Dunst (1997) in theUS context. Writing about what she calls a “family centered approach”, Dunstemphasises that services must provide for family-professional collaboration at alllevels, the honouring of cultural diversity and the need for flexible, accessible andcomprehensive support systems across each of hospital, home and communityservices (1997). She also highlights a further service characteristic also identified inUK studies (Pinkerton et al 2000) – the capacity to provide a range of supports forfamilies: developmental, educational, emotional, environmental and financial. Moreabstract, though possibly most significant for operational managers, is the advice tosee family as the constant in the child’s life and also retain the capacity to see familiesas families and children as children, beyond the narrow confines of their specificneeds. Placing families themselves at the centre of service delivery is alsoemphasised by another US researcher, Whittaker, who, when writing aboutchallenges for intensive family preservation services, advocates the involvement of‘consumers’ in services management and blank-slate analyses (i.e. creative thinkingoutside of what is currently feasible). In this regard, he exhorts services to beambitious and hopeful. Whittaker also recommends developing services from anexplicit family support value base (1997).

In the Irish context, McKeown and his colleagues (2001) reported that beingneighbourhood based and responsive to the local community through presenting asaccessible, informal and comfortable were seen as major strengths of theSpringboard Programme by professionals involved. In addition, the improvementssuggested by parents and children on the programme included more activities andservices and more involvement of local people.

Research from England (Frost 1997) suggests that there are benefits from havingspecialist family support teams as these encourage a shared high commitment to anddefinition of the task. They also provide a secure organisational base whichencourages sharing and developing skills and is open to monitoring and evaluatingthe impact of practice. There is however a disadvantage in specialisation in thatfamily support becomes hived off from mainstream services thereby underminingcapacity for interagency and partnership working.

It is clear from the literature that there are many different types of provision gatheredtogether under the title of family support (Gilligan 1995, Murphy 1996). These canrange from home visiting (Belsky 1997), to programmes delivered in school (Ryan2000, Dryfoos 1993, Mayall and Hood 2001, Boldt 1997, Weiss 2001), in day care, incommunity projects (Teelan et al 1989, Munford and Saunders 2003, Buchanan 2002,Toumbourou and Gregg, 2002, Canavan and Dolan 2003), in health centres(Schofield and Brown 2000), in more formal clinical settings such as therapeutic


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environments (Hoghughi 1999) and even in out of home placements such asresidential care (Sinclair and Gibbs 1998, Stein and Rees 2002).

One of the most obvious representations of family support on the services landscapein the UK are family centres. Colton and Williams (1997) argue that services based onlocality, with family centres as a central resource are ideally suited to family supportand in particular partnership with parents in terms of both decisions about servicesand actual service provision. Thoburn and her colleagues (2000) see family centres asa “particularly appropriate service setting for provision of long term services toidentified families” (p.201). Pithouse and his colleagues (1998) argue for anappropriate combination of open access and specialist referred services, whileArmstrong and Hill (2001) reach the same conclusion. They propose an ideal of “well-coordinated multiple intervention”, recognising that this is the most expensiveapproach and is most often only available in urban areas. In their analysis of the useof family centre budgets in UK Social Services Departments, Batchelor and hercolleagues (1999) suggest that there was a strong case for open access centres withmanagement undertaken by voluntary organisations on the basis of serviceagreements.

In Ireland, Gilligan (2000) suggests that family support practice can be seen asoccurring within three distinct contexts: interventions which focus on developmentalfamily support, for example first time parenting of an adolescent; compensatoryfamily support, such as one to one work with a child with a physical disability; andprotective family support such as working with a group of children who havewitnessed domestic violence at home. Layzer and his colleagues (2001) in their metaanalysis of family support programmes in the USA, identified family support practiceas being orientated around programme goals which include, improved parenting,child development, social support for parents, child and family health care, childabuse prevention, parent self-help and empowerment, parent literacy andemployment training, parent and child community and school involvement and childbehavioural change (2001). They suggest that these goals are met through modes ofservice delivery which include home visits and school and community settingsgroups.

Family support practice also involves working with family members and other peoplefrom the community as central players. Numerous programmes, both nationally andinternationally, place the positive enlistment of support from family and otherinformal sources of help as central tools in family support practice. Such approachesinclude Family Group Conferencing (Marsh and Crow 1998, O’Brien 2000),Mentoring (Tierney et al 1995, Rhodes 2002), Communities that Care (Anderson2000), Strengthening Families (Russell et al 1997), Parent Outcome EvaluationProgramme (Tierney et al 1995), Homebuilders (Pecora et al 1992), Homestart


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(McCauley 1999, McGuffin 2002), PACE (Toumbourou and Gregg, 2002) and TeenParenting Support Programme (Riordan 2002). Much has been written advocatingthe potential of informal supporters in family support in Ireland (National Children’sStrategy 2000, Commission on the Family 1998), in the UK (Belsky 1997, Jack andJordan 2001, Morrow 1999) and in the USA (Gottlieb 1990, 2001, Cutrona and Cole,2001). However it is only in more recent literature that semi- formal help from paidand trained volunteers has become recognised as a model for practice interventionsboth in the UK (Ghate and Hazel 2002) and in Ireland (Mullin et al 1990, McCauley1999, Dolan and Holt, 2002).

Family support practice is usually described as involving activities wherebyprofessionals enable the service user to be supported (Pecora et al 1997, Murphy1996, Audit Commission 1994, Commission on the Family 1998, Pinkerton et al2000). Existing guidelines and practice frameworks in Ireland all follow thisperspective (Western Health Board 1998, North Eastern Health Board 2001, SouthEastern Health Board 2003). Furthermore, family support interventions whichmobilise help from natural sources are now more attuned to the real world needs ofservice users. Recent developments in family support practice encourages socialworkers and other similar professionals targeting and training natural helpers asfamily supporters in both specific contexts, such as specialist foster care (McFadden1998), and for particular populations, for example estranged fathers (Daniel andTaylor 2002) and friendship groups for adolescents with challenging anti-socialbehaviours (Weiss 2001).

The literature suggests a move towards seeing family support practice asconstituting a supportive programme of action by multi-professionals based on usinga range of assessment/intervention tools (Ghate and Hazel 2001, Pecora et al 1997,Belsky 1997, McKeown 2001, Layzer et al 2001). Earlier work (Garbarino 1983, Tracyand Whittaker 1994, Hains 1992 and Compas et al 1993) also suggested that familysupport entails the use of tools to assess need and direct intervention with childrenand families. Some examples of such practice tools are the Social SupportQuestionnaire and Provision Scale, the Adult/Adolescent Perceived Life EventsScales and the Adult and Adolescent Wellbeing Scales. These are particularly usefulin emphasising family social capital building and resiliency enhancement (Howard etal 1999, Clarke and Clarke 2003). The evidence base for the success of practiceinterventions built on the use of such tools by individuals or agency programmes isgrowing, particularly in school settings and in early childhood programmes (Dryfoos1993, Mayall and Hood 2001, Wright et al 2001, Weiss 2001).

The wide-ranging provision that exists can usefully be characterised according to:

• Target group (e.g. parents, toddlers, teenagers, people with disability)

• Professional background of service provider (e.g. social worker, family worker,


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child care worker, youth and community worker, public health nurse, communitymother, psychologist, project worker, family support worker, home help, homesupport worker)

• Orientation of service provider (e.g. therapeutic, child development, communitydevelopment, youth work)

• Programme of activities (e.g. home visits, pre-school facilities, youth clubs,parenting courses)

• Service setting (e.g. home based, clinic based, community based)

Within programmes the practice of family support is often perceived as focusing onone to one work whereas it actually can occur at different levels (Whittaker andGarbarino 1983, Wieler 2000), one to one individual or group work interventions;within and between services at their various levels. Also although much has beenwritten about the preventive nature of family support, it also involves child protectionwork (Thompson 1995, Parton 1997) and reunification work with children and youngpeople looked after in residential and foster care services (Sinclair and Gibbs 1999,Stein 1999, Stein and Rees 2002). Whereas family support requires skills in differentsettings and occurs across a range of sites (from working with individual children tofamilies, groups or in wider community settings) the skills required to work effectivelyin all situations may differ. Whereas some workers operate very effectively insupporting individual children, their capacity to work with community groups may bevery limited. To enhance practice across sites requires skill development for workerswhich Coulshed and Orme (1998) and Davies (1997) both suggest is oftenoverlooked by agency and service managers alike. Skills need to express a strengthsbased approach to families with emphasis on being supportive, holistic and practical,customer-friendly and solution focussed. Workers need to adopt a positive frame ofmind with emphasis on being approachable, available, astute and committedpartners in their dealings with both families and agencies.

For example, providing family support to families at risk requires explicit and delicateskills which workers need to develop (Thompson 1995). Similarly working withparents under stress requires specific aptitudes (O’Connor 1999). Also, interveningwith adolescents, who present as difficult to work with while still in urgent need ofsupport, can be complex and require particular abilities (Herbert 2000). Families whosuffer serious negative life events like suicide need particular help at particular times.Children with disabilities need knowledgeable professionals trained to deal with theparticular challenges they face (Best Health for Children 1999, 2001, 2002). However,the difficulties of matching practice skills to need can be overcome and the burdenof ensuring a sufficiently wide repertoire of skills can be shared between workers.Springboard is a clear example of how differing workers with differing skills can workas a united team to support family members in different ways depending on need(McKeown 2001).


15

However, as family support interventions inevitably imply human interaction, the styleof the worker needs to be recognised as a key ingredient in any model of bestpractice (McKeown 2001, Martin and Kettner 1996, Thompson 1995). McKeown(2000) in his review of what works in family support suggests worker style as one offour clear ingredients. Similarly, other research which explored what parents saw ascrucial in support from professionals also emphasised the social presentation of theworker (Dolan and Holt, 2002). These styles and qualities of the worker which havebeen identified by families globally have been more specifically grouped and namedby Martin and Kettner as including Accessibility, Courtesy, Durability, Empathy andHumaneness (p.42, 1996). These attributes require ongoing reflective practice.

It is becoming clearer what the ‘practice’ tasks involved in delivering family supportentail. In terms of the resources required to deliver assistance to families, having ableand willing staff is more crucial than infrastructure such as buildings. In order toensure that family support staff across all key disciplines are capable of successfullyhelping family members, two key ingredients need to be regularly audited andmaintained: the characteristics of staff themselves and the tools and skill baseavailable to them.

The persona and social presentation of the worker needs to be recognised as a keyingredient in successful engagement of families and subsequent interventions. Theimportance of supervision, self-appraisal programmes, team building and sustenanceprogrammes for staff is critical. However, staff need more than their presentingpersonality and no longer is it adequate just to see family support as giving softemotional support to vulnerable families. It requires staff to learn tools and skills, notjust as a means to engage families in the work but also to be used with them inmeasuring the success of the intervention. There is now a growing bank of familysupport instruments, which cover referral, assessment, and an intervention andevaluation model which staff can learn and use as part of a ‘tool kit’ in their work.


16

1. Working in partnership is an integral part of family support.Partnership includes children, families, professionals and communities.

2. Family Support interventions are needs led and strive for the minimumintervention required.

3. Family support requires a clear focus on the wishes, feelings, safetyand well being of children.

4. Family support services reflect a strengths’ based perspective which ismindful of resilience as a characteristic of many children and familieslives.

5. Family support promotes the view that effective interventions arethose that strengthen informal support networks.

6. Family support is accessible and flexible in respect of location, timing,setting and changing needs and can incorporate both child protectionand out of home care.

7. Families are encouraged to self-refer and multi-access referral pathswill be facilitated.

8. Involvement of service users and providers in the planning, deliveryand evaluation of family support services is promoted on an ongoingbasis.

9. Services aim to promote social inclusion, addressing issues aroundethnicity, disability and rural/urban communities.

10. Measures of success are routinely built into provision so as to facilitateevaluation based on attention to the outcomes for service users andthereby facilitate ongoing support for quality services based on bestpractice.


17

On the basis of what is now known about delivering family support services, it ispossible to identify a set of ten practice principles.

To date there is no shared or dominant theoretical underpinnings apparent in theliterature. One candidate for that role is social support theory (Veiel and Baumann1992, Gottlieb in Eckenrode, 1990). Hill (2002) has suggested that when one mapsout agreed social support concepts including sources, types and qualities of socialnetwork support, there is clarity in describing and measuring these factors, many ofwhich have a resonance in family support.

From research over the last 30 years, there is now overwhelming evidence thatprimarily, people access support from informal sources namely nuclear and extendedfamily and to a lesser extent friendships (Berkman and Syme 1979, Weiss 1974,Cutrona 2000, Aymmens 1995, McKeown 2001). Family and friends are alsocommonly grouped together in the literature and referred to as ‘natural sources’ ofhelp (Duck 1986). In general, it is also known that it is only when natural support isdeemed to be weak, non-existent or incapable of offering the help required that aperson then seeks aid from formal sources. Whereas informal support is preferredbecause it is natural, non-stigmatising, cheap and available outside of ‘nine to five’,there are of course occasions where professional help is required due to the severityof need (Gardner 2003), for example, a home visit from a GP to a child who continuesto be ill, despite the best efforts of parents to help the child get better. Additionally,families are not always supportive and indeed can be the main source of stress, hurtor abuse. In such cases professional interventions from social workers and others issometimes necessary as a substitute for the informal networks or as the means tocontrol them (Thompson 1995, Ghate and Hazel 2002). Nevertheless, the literaturein the social sciences and social psychology since the 1980’s has consistentlyrecommended professionals to optimise natural sources of support for service users,culminating in what Whittaker (1997) describes as the quiet revolution of theeighties.

Apart from providing most support, families also offer a wide variety of help whichWeiss (1974) in his pioneering paper grouped into eight types but which has beenmostly described as occurring in four forms namely: concrete support, emotional

18

Section 4:Groundingin SocialSupportTheory

support, advice support and esteem support (Depanfilis 1996, Coyne et al 1994,Tracy and Whittaker 1990, Cutrona 2000). Concrete support relates to tangible actsof help between people, for example, loaning a friend a lawnmower, or sharing aschool run with a parent who also has children attending the same local school. Interms of offering concrete support, research by Cochran (1993) indicates that veryoften a family’s need for practical help is either missed or underestimated byprofessionals. According to Cutrona (1996), emotional support is a crucial form ofsupport and comprises acts of empathy, listening and generally being there forsomeone when needed. It is an important form of support in that if it is offeredinstead of other forms of support, it is well received and usually perceived as helpful.

Conversely, other forms of help cannot compensate for a lack of emotional supportfrom others. The provision of advice support can be complex and sometimes it is theperceived intention of the donor that may be more important than the advice given(Cutrona 1996). Advice is often sought within families for its comfort and reassurancerather than the advice in itself (Cotterrell 1996). For example, often during theturbulence of adolescence, both parents and young people need reassurance thatthey are each doing well in their respective roles (Herbert 2000). Esteem support,which relates to how one person informs another of his/her worth, has beenmeasured less in research (Veiel and Baumann 1992). However, it is an essential formof support, for within families it is the basis of personal value between members andbetween families and non-kin relationships (Burleson 1990). For helping professionalsinterested in supporting families, particularly those members who are in the higherlevels of need within the Hardiker model (1991), matching the support on offer to thetype needed is a key practice issue (Tracy and Biegel 1994).

The quality of the support on offer to families is also a crucial factor in how help isboth perceived and received. Within social support theory four main qualities havebeen identified and are generally all used in measuring social networks (Veiel andBaumann 1992, Hill 2002). These include closeness, reciprocity, durability andsupport which is non-criticising. In general people only turn to others they feel closeto for support. Even within families it is only to members who are seen as responsiveand towards whom a person feels attached that support is both sought and accessed(Aymanns 1995).

Cutrona and Cole (2001) in the US and Riordan (2002) in Ireland have recently foundthat in respect of teenage parents and lone parents this is particularly the case inrespect of emotional support. Reciprocal support is preferable as it involves actswhereby help is exchanged between people, ensuring that a person does not feelbeholden to another. Within families where members are responsive to each other’sneeds this often occurs automatically and without much thought on the part of thedonor or recipient. Importantly, where support is reciprocated its value lies in the

Section 4 – Grounding in Social Support Theory

19

comfort of knowing that the exchange of support is ready made and available, if andwhen it is needed. In recent times some family support interventions have focusedon building up this reserve of available support for families in what can be commonlycalled social support banking (Pecora et al 1997).

Durability in social support applies to the strength of ties between a person andhis/her network members, the amount of contact between members and length oftime people are known to each other. Durable support is typified by responsivemembers who are known for a long period, are nearby to offer help and who haveregular but not intrusive contact with the central social network member. Tracy andBeigel (1994) have found that where people have mental health problems and aredifficult to support, they often have non-durable networks typified by constantchanges in memberships. Within familial relationships, because one cannot deselectanother family member from the network, they are always potential supportersdespite levels of animosity between family members. Cutrona and Cole (2001) whoadvocate a strength perspective in family support, suggests that this fact alonemakes it all the more worthwhile to work on bolstering social support ties betweenfamily members. However, social support is not always positive and can be bothstressful and harmful, particularly when a person negatively criticises another. Forsome people their networks members, including family, can be highly critical in anon-constructive way which leads to poor self-image, self-efficacy and low self-esteem that ultimately contributes to a person with poorer coping capacity (Compas1993).

In summary, it is being suggested that social network support theory in terms ofsource, type and quality of support can be concisely described and clearlyunderstood. Importantly, consideration of these aspects of support can be directlyapplied in understanding how children and young people achieve their rights andhave their needs met through a series of widening, cupped informal supports -immediate family and carers, other family members and friends, key people withinschool, community, and leisure social networks. Support is then widened out furtherthrough semi formal and formal support practitioners in the community, voluntaryand statutory sectors drawing on agencies, services, organisations, national policyand legislation. Thus social support theory can act as a lynchpin towards an emerging‘definitional frame’ for family support professional practice.


20

Table 3: A Model of the Networks of Social Support

Section 4 – Grounding in Social Support Theory

21

Child / Young PersonACHIEVING RIGHTS / MEETING NEEDS

Nuclear Family

Other Family / Friends

School / Community / Leisure Interests

Semi Formal / Formal Family Support Practitioners

Community / Voluntary / Statutory

Agencies / Services / Organisations

National Policy / Legislation

From the growing literature in the area of family support, it is possible to identifyemerging levels of agreement around characteristics of need, reflecting the pressureand change being experienced by families. It is also possible to identify a serviceresponse to that need which expresses shared features of style and format, reflectingsome confidence that providing support, in certain ways can be demonstrated towork. Collectively, this allows us to define family support as:

“Family support is both a style of work and a set of activities; whichreinforce positive informal social networks through integratedprogrammes; combining statutory, voluntary, community and privateservices, primarily focused on early intervention across a range of levelsand needs with the aim of promoting and protecting the health, wellbeingand rights of all children, young people and their families in their ownhomes and communities, with particular attention to those who arevulnerable or at risk”.

This definition can be presented figuratively as:

Table 4: Elements of a Definition for Family Support

22

Section 5:DefinitionandStrategicIntent

integrated programmescombining statutory,

voluntary, community andprivate sectors

wide range of activities& types of service

positive reinforcement forinformal social networks

Defining FamilySupport

targeting of the hard toreach, vulnerable or at risk

early intervention across arange of levels and needs

style of work based on operational andpractice principles

promotion and protection of health,well-being & rights of all children and

young people, their families andtheir communities.

Whilst it is possible to identify the elements generally agreed as defining familysupport it is vital not to deny the complexity and contested aspects of the purpose,process and outcomes associated with family support which are also clearlyregistered in the literature. This includes acknowledging the absence of an agreedtheoretical base. It is also important to recognise the extent to which family supportas a policy direction for service development is contingent on the specific features ofthe child welfare conditions in which it is being pursued. That in turn will reflect thebroader national and international political, economic, and social context.

In order to transpose the definition which has been arrived at into an achievablepolicy goal, it is imperative to ground it in a statement of strategic intent. On thatbasis it is possible to plan and manage the strategic implementation of the policychoice of family support through planning, service delivery and monitoring andevaluation (see Figure 5 below).

Table 5: Strategic Implementation of Family Supportas a Policy Choice

The statement of strategic intent is an attempt to draw together a number of keythreads running through the literature in a way that grounds them in the Irish context.In considering this statement it is important to note that whereas it obviously has aclear resonance for families, it is aimed primarily at all professional or semi-professional practitioners, community activists, agency managers, services, policymakers and researchers.

Section 5 – Definition and Strategic Intent

23

Family Support as Policy Choice• legislation• policy documents

Planning• mapping need• identifying delivery and training

systems• allocating resources

Service Delivery• types of delivery• levels of intervention• context of delivery• process of delivery• resources for delivery

Monitoring and Evaluation

“Family Support within Ireland is a policy choice based on a legislativemandate to identify need and promote the rights and well being ofchildren and young people. Delivery and training systems within thestatutory, voluntary and community sectors, at all levels of intervention,which enable the practice principles of family support in accordance withthe UNCRC and the National Children’s Strategy will be promoted. Thedevelopment, outcomes and costs of the policy will be monitored andevaluated in order to inform regular policy review.”

The first thing to be noted in this statement of strategic intent is the need to be clearthat a policy choice is being made and that this has certain clear features.

• The welfare assumptions being made lie between the institutional anddevelopmental types of welfare.

• The underlying goal is to strengthen informal social support and promote socialinclusion.

• A ‘Whole Child/Whole System’ rights perspective is being taken to both need andservices.

Secondly, there are a number of key operational principles being applied.

• Working in partnership with children, families, professionals and communities.

• Integrative cross departmental, cross sectoral working at all levels of provision/intervention.

• Attention to organisational culture, particularly management style, staff supportand training.

• Routine timetabled monitoring, evaluation and review.

Thirdly, whilst no specific programme or type of activity is being identified asconstituting family support, the set of ten practice principles noted earlier are beingendorsed which must apply if family support is being undertaken.

• Working in partnership is an integral part of family support. Partnership includeschildren, families, professionals and communities.

• Family support interventions are needs led and strive for the minimumintervention required.

• Family support requires a clear focus on the wishes, feelings, safety and well beingof children.

• Family support services reflect a strengths based perspective which is mindful ofresilience as a characteristic of many children and families lives.


24

• Family support promotes the view that effective interventions are those thatstrengthen informal support networks.

• Family support is accessible and flexible in respect of location, timing, setting andchanging needs and can incorporate both child protection and out of home care.

• Families are encouraged to self-refer and multi-access referral paths will befacilitated.

• Involvement of service users and providers in the planning, delivery and evaluationof family support services is promoted on an ongoing basis.

• Services aim to promote social inclusion, including issues around ethnicity,disability and rural/urban communities.

• Measures of success are routinely built into provision so as to facilitate evaluationbased on attention to the outcomes for service users and thereby facilitateongoing support for quality services based on best practice.

The provisional position represented by the proposed statement of strategic intent,with its policy features and operational and practice principles, allows for knowledgelimitations and political and administrative contingencies, whilst building on suchsolid ground as can be found. It also anticipates the need for the policy commitmentand its outworking in operational management and practice application to be testedand refined as the associated research and information becomes available and isreflected on (Dolan et al forthcoming). Such openness to learning and changing as apolicy is rolled out may appear to be at odds with the certainties that seem to beoffered by evidence based policy. Knowledge however insists on self reflection andso should policy if it is to rise to the challenge of making family support the definingcharacteristic of Irish child welfare.

Section 5 – Definition and Strategic Intent

25

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Family Support in Ireland Definition & Strategic Intent

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