The Integrated framework
Smoke and Mirrors: Helping Families Through the Maze of Substance Abuse
Many of the families we work with face a number of challenges including unemployment, housing stress, family violence, substance misuse, mental health issues or socio-economic disadvantage. Families and practitioners can feel overwhelmed by these complex and inter-related problems. The
Integrated Assessment Framework developed by Professor Sharon Dawe and Paul Harnett (2013) provides a systematic approach to assessing family functioning. The framework helps practitioners bring together a range of information to make sense of families with longstanding and complex problems.
The integrated framework helps practitioners move beyond identifying risk and protective factors to assessing how and why specific risk and protective factors impact on and reduce a parent’s capacity to meet the needs of their children. This information is then used to define clear and measurable changes a family will need to make to keep their children feel safe, secure and loved.
The underlying principle of the integrated framework is that a healthy parent- child relationship is essential to promoting a child’s development. There are four main elements to the assessment framework; child developmental outcomes’; the quality of the care-giving; parenting values, expectations and skill; and the different environmental settings within which family members function.
Child development outcomes
The initial focus is an assessment of a child’s developmental functioning including areas of difficulty but importantly areas of strengths across their physical, emotional, behavioural and social domains. It is useful to use standard checklists and well validated measures (such as the Brigance Early Childhood Development Screen or the Strengths and Difficulties Questionnaire) to evaluate a child’s development and behaviour across settings.
Quality of the caregiving relationship
Systematically evaluating the quality of the care-giving relationship between a child and their caregiver is the second component of the integrated framework. The framework encourages practitioners to move away from vague often value laden descriptions such as “she’s a good mother” to a more systematic and scientific assessment of the quality of the caregiving relationship. This is achieved by assessing the three main dimensions that predict the quality of the caregiver-child attachment which are:
- parental sensitivity: the ability of a parent to be warm and emotionally connected to their child
- parental structuring: providing structure to help a child manage their emotions and behaviours and master situations (such as play, learning a new tasks, regulation of emotions)
- child responsiveness: a child’s response or reaction to a parent’s bid for interaction with the child.
Parental vales, expectations and skill
Parental values and expectations of a child play a major influence on the choices parents make about issues such as their style of discipline, the level of child supervision and the establishment and importance of family routines. Their state of mind and their ability to regulate their emotions also influence the way they react, interact with and parent their children.
It is important to understand how the characteristics of each individual within the family, the relationships between family members and the environment in which they live, combine to influence family functioning. The integrated framework suggests there are three levels we need to explore:
- microsystems :the effects of an individual’s personal characteristics on family functioning
- meso-systems: the connections or relationships that exist between different family members (i.e. spousal relationship on parent-child interaction)
- macro-systems: the overarching economic, social, political, and cultural factors that surround and influence a family.
Working with women with complex needs
Women and children with complex problems need to engage in a number of interrelated services. Women-defined advocacy services have proven effective in helping women and children to feel safe and to enjoy a life free from violence (Allen, Bybee & Sullivan 2004; Goodman, Fels, Smyth, Borges & Singer 2009).
Women-defined advocacy interventions include the following:
- needs assessments, services and interventions that are ‘framed’ by survivors. This means we listen and consider what a woman says she needs and the direction she thinks she needs to go to keep herself and her children safe
- partnering with women to navigate the complex network of services. In this way women can access the resources they think they need to keep themselves and their children safe (e.g. housing, legal service, transport, childcare, financial assistance, material goods, services for children, social supports)
- coordinating responses. This means helping erode the organisational cultures, values and attitudes women may be confronted with when accessing various types of services
- taking action. This involves acting on a woman’s life hopes, plans and perceptions of problems and priorities.
There is strong evidence that practitioners working intensely with women and connecting them with multiple services results in women experiencing:
- less violence
- a higher quality of life and social support
- less difficulty accessing community resources and
- for some, being completely free from violence (Allen, Larsen, Trotter & Sullivan 2013).
What does the Integrated Framework mean for Practice?
To help women, children and families with complex needs feel safe and to live free from coercion and control, respectful practice must involve understanding the parent child relationship and working in partnership with women. Here are some practice tips:
- be supportive. Let her know you are there because of her partner’s choice to use violence. Let her know you are there to help keep her and her children safe and to empower her to improve her situation. Be transparent about your agency’s work, including any legal or organisational requirements
- have an open, non-blaming and respectful attitude. Be willing to listen to her lived experience and to explore the history and pattern of abuse. Acknowledge and respond to any safety concerns – she needs to know that she is believed and is not responsible for the violence
- identify risk. Ask her what she sees as the biggest risks to her and her children’s safety. Explore the risks caused by the perpetrator’s pattern of coercion, social factors (e.g. culture, ethnicity, age) and ‘the system’ (e.g. child protection, health, family law)
- assess and share information about a child’s development. This means assessing areas where children are having problems but also areas where they are doing well
- explore the quality of the relationship between the caregiver and child.
Look for how well a child and parent interact and react to one another. Explore how well parents help children master situations, their emotions and behaviour and provide praise and encouragement
- gain an understanding of her choices and decisions. Ask her what supports make sense for her. For example ask her about maintaining her relationship with the perpetrator. Wherever it is safe to do so, our response must be driven by and aligned with her lived experience
- explore and honour her everyday efforts. These are the small acts of resistance she undertakes to keep her and her children safe. Look for and build on ways she has kept her children safe. Help her to see her actions as acts of resistance
- balance choice and safety. Promoting her choices must be done within the overriding aim of keeping her and her children safe. Do not ask her to enact an individualised safety plan that is in isolation to efforts to curtail the perpetrator’s violence – this can be dangerous and disempowering
- help women access services and coordinate responses. Help her access and overcome any barriers (including financial or stigma) she may face in accessing the services they need.
- understand her feelings for her partner. She may have genuine love for her partner and appreciate his role as a father, especially if the violence is sporadic and followed by remorse. Being empathic of the role love plays in her decisions is critical to safety planning and our ongoing work
- ensure there is more than one intervention. Women need agencies to work together and provide a network of protection around them and their children. Consider the likely responses from the various agencies – do they promote or take away her decision-making power? Do they pose any risks? Are there any structural inequalities (e.g. money, housing, schooling) that may prevent her from taking up such services?
- use language carefully. Explore and document her experience of violence and the multiple harms caused by the perpetrator’s violence. Accurate documentation of violence is essential, as required by multiple legal systems. Avoid using language that mutualises violence or suggests consent
- highlight the patterned nature of control and coercion. Be aware of the tactics perpetrators use to undermine a mother’s relationship with her children, such that they may not be attuned to each other’s responses and strengths. Create opportunities to bring women and children together so they can share their lived experiences and efforts at resistance. Help them to see and appreciate what they have to offer and to support one another
To learn more about working with women please watch Sharon Dawe’s presentation at the Research to Practice seminar
Allen, N.E., Bybee, D.I. & Sullivan, C.M. (2004) ‘Battered women’s multitude of needs: Evidence supporting the need for comprehensive advocacy’, Violence Against Women, 10, pp.1015-35.
Allen, N, Larsen, S., Trotter, J. & Sullivan, C. (2013) ‘Exploring the core service delivery processes of an evidence-based community advocacy program for women with abusive partners’, Journal of Community Psychology, 41(91), pp.1–18.
Community Care Division, Victorian Government Department of Human Services. (2004) Women’s journey away from family violence: Framework and summary, Melbourne, Victoria: State of Victoria Department of Human Services, accessed at www.cyf.vic.gov.au/journey.pdfdata/assets/pdf_file/0020/16715/fcs_womens
Dawe, S., & Harnett, P. H. (2013). Working with parents with substance misuse problems: A Parents Under Pressure perspective. In F. Arney & D. Scott (Eds.), Working With Vulnerable Families: A Partnership Approach. Cambridge University Press.
Dutton, M.A. (1996) ‘Battered women’s strategic response to violence: The role of context’, in J.L. Edelson & Z.C. Eiskovits (eds) Future interventions with battered women and their families, Thousand Oaks: Sage.