انگیختگی ادراکی ایجاد حافظه های جدید اپیزودیک را بهبود می بخشد

Findings are reported from a process study of an English multi-disciplinary team working with families with long standing and complex problems. The approaches and methods of the team are described and placed in the context of UK policy developments and of UK and USA research on professional practice with families facing multiple difficulties. Basic data are provided on all families referred in the first year and analysed with respect to the first 100 completed cases. A broadly ethnographic research approach is used for the observational study of the team interactions and decision-making on individual cases. For a one-third sub-sample of 33 cases, process and interim outcome data are analysed from information systematically extracted from case records. These are complemented by qualitative data from interviews with managers and caseworkers and by observation of ‘team around the family’ and professionals' meetings. The researchers conclude that the service succeeds in engaging a majority of the referred families who have been hard to reach or hard to change in the past and whose children are either ‘on the edge of care’ or likely to be significantly harmed without the provision of an intensive service. The researchers concluded that improvements were made in the life chances of children in 75% of the families. Aspects of the service identified as associated with more positive outcomes are: the allocation of two key workers (one for the child/ren and one for the parent/s); the centrality of relationship-based practice and flexibility of the approach rather than strict adherence to any particular practice model; the fact that the service is firmly embedded within the statutory children's services department, allowing for continuity of relationships with team around the family members when the intensive service ends; and flexibility about case duration and intensity.

1.1. Continuity and change in the discourse and practice of family social work In England, perhaps to a greater extent than in mainland Europe on the one hand and the USA on the other, child and family social work services have swung over the years between a focus on helping the family as a whole (a child and family welfare approach) and a focus on services to protect children from maltreatment and provide alternative care when protective services fail to make sufficient improvements in the home environment. Thoburn (2010) with respect to out of home care and Gilbert et al. (2009) and Gilbert, Parton, and Skivenes (2011) with respect to child protection services have explored these differences in international context as demonstrated by child level administrative data sets. The emphasis on family support was strongly in evidence in the post-war welfare consensus that established voluntary reception into care as a way of helping hard pressed families at times of stress. In England and Wales, this policy direction culminated in the introduction in 1970 of unified social services departments tasked to assist all vulnerable people ‘from cradle to grave’ (Seebohm Committee, 1968). The England and Wales Children Act 1989 continued this emphasis on family support but placed it alongside clear child protection provisions, but the Children Act 2004 could be regarded as ‘unwinding’ the family services approach by separating the provision of children's social care services from those for vulnerable adults (many of whom are parents). This trend has continued as specialist mental health and addictions social workers have, in many areas, been transferred from local authority adult social services departments to health service mental health trusts. Tunstill, Thoburn, and Aldgate (2010) chart the shifts between a broad family welfare and a more focused child protection orientation since the 1989 Act was implemented in 1991. Over this period, the mixed messages are to be found in a series of government policy documents. Alongside the 2004 Act, cross government working groups spearheaded by the Cabinet Office have argued for early (as in early years) intervention services targeted especially at families with young children living in areas of disadvantage (as exemplified by Sure Start local programmes, Tunstill et al., 2005), and early intervention at the early stages of problem formation to avoid the need for more intrusive and costly intervention, including formal child protection services, entry to care or custody ( Cabinet Office, 2007 and Department for Children Schools and Families, 2007). These have been accompanied by a (at times) bewildering array of government (or part-government) funded ‘pilots’ and ‘pathfinders’. Central to the drive to improve long-term outcomes for children living in ‘problem families’, ‘families with complex problems’ and, most recently, the estimated 120,000 ‘troubled families’ targeted by the Department for Communities and Local Government (DCLG, 2012), have been the development and evaluations of the Family Intervention Projects (FIPs) and the Think Family Pathfinders, one of which – the Westminster Family Recovery Project (FRP) – is described and analysed in this paper. However, it will be argued that the approaches and day to day practice of child and family social workers, especially those working directly with families with complex and long-standing problems whose children are at risk of maltreatment or who may need out-of-home care, owe much to earlier practice approaches. 1.2. Earlier whole family approaches to social work and inter-disciplinary practice with families with multiple problems The long tradition in the UK and USA of whole family approaches to service provision for families with complex problems is documented in the policy, research and social work practice literature. The terminology has changed since Philp (1963) and Philp and Timms (1962) described the philosophy and methods of Family Service Units. From the 1970s onwards, much of the early development of practice approaches and therapeutic interventions, especially in the USA, was more likely to be led by psychologists working in clinical settings than by community-based social workers. In the 1980s and 90s intensive family preservation service agencies set up demonstration projects, mostly based on the ‘Home-builders’ service approach which had many of the characteristics of the intensive outreach model of practice adopted by the FIPs. These model family preservation programmes were more intensive than the earlier family services, some involving a single highly qualified social worker (with case supervision by an experienced social work team leader or family therapist) being available on a 24/7 basis to around four families at any one time, for preferably no longer than four weeks ( Schuerman, Rezepnicki, & Littell, 1994). The approach most frequently used was a combination of cognitive behavioural, problem solving and ecological approaches. When independent evaluations started to appear they questioned the very positive early accounts of the originators. In particular, the short duration and lack of follow up services were considered a weakness in terms of maintaining progress once the service ended. These lessons were taken on board when family preservation models were piloted in the UK (see Brandon and Connolly's (2006) evaluation of the NCH Action for Children Families First project). The move was then towards the development of more structured and less intensive model programmes using a social learning approach (Sanders et al., 2003 and Webster Stratton and Herbert, 1999). Lindsay et al., 2008 and Lindsay et al., 2011 report on their observational evaluation of three model parenting programmes being widely incorporated into family support work in the UK. The evidence for effectiveness of these programmes is strongest for families in the early stages of problem development, or with teenagers with challenging behaviour, but the evidence of effectiveness with families with complex problems where there is a high risk of maltreatment is weak (Barth et al., 2005 and MacMillan et al., 2009). The Family Intervention Pilots (FIPs) incorporated elements of these approaches and model programmes. A particular UK aspect (since a driver for the early FIPs was concern about ‘nuisance neighbours’, anti-social behaviour and criminality by adults as well as children) was the requirement to combine positive approaches to helping the family with clarity about the sanctions that would follow if behaviour did not improve (the ‘care with consequences’ or ‘carrot and stick’ approach). At the point that this evaluation of the Westminster FRP started (in October 2008), in addition to the research and evaluation literature cited above, there was extensive research (mainly using mixed methods rather than experimental research approaches) on UK social work and child protection practice (summarised in the 12 Messages from Research overviews — see especially Department of Health, 1995 and Department of Health, 2001, Quinton (2004), and Stein (2009) and in Hughes (2010), Morris et al. (2008) and Thoburn (2010)). The methodology for the research and analysis of findings in this paper was informed by these and by the more recently published evaluations of UK intensive intervention projects ( Dixon et al., 2010, Flint et al., 2011, National Centre for Social Research, 2011, Nixon et al., 2008 and Pawson et al., 2005) and by the interim reports of the national evaluation of the 15 Think Family pathfinders ( Kendall et al., 2010 and York Consulting, 2011). Alongside published accounts of evaluations, there has been a modest but steady stream of critiques of this ‘carrot and stick’ approach to practice, particularly around the more coercive aspects highlighted by politicians to gain support for government expenditure. As early as 1987, Rojeck and Collins (building on the work of Handler (1773)) queried the use of contracts when power relations between worker and client are so unequal, and concluded that in some circumstances they may more appropriately be seen as ‘con-tricks’. Pawson et al. (2005), Garrett (2007), Spratt (2009) and Gregg (2010) write similarly of some aspects of the contract-based work of the family intervention projects.