HOME-START: A VOLUNTARY HOME-VISITING SCHEME

FOR YOUNG FAMILIES

MARGARET HARRISON

Home-Start Consuhancy 22 Princess Road West

Leicester LEI 6TP, England

Abstract-Very often statutory intervention in child abuse cases can prove to be costly, inappropriate or even unwelcome. “Home-Start” began as a voluntary home-visiting scheme in Lcicester. England, 8 years ago with the objectives of offering support, friendship and a practical approach to any young families experiencing difficulties. A recent evaluation by Willem van der Eyken, suggests that Home-Start enjoys a high success rate, particularly with the 25% of families referred to the scheme, who have children on the nonaccidental injury “At Risk” register. This paper outlines details of the objectives. the volunteers, the families visited and the Home-Start approach with child abuse cases. It highlights some elements of the scheme which have proved vital to its success. such as close liaison with the related statutory agencies, the intensive support to families in their own homes, and the meticulous preparation and support of the volunteers themselves. The Home-Start approach is now being used effectively in many other areas of Great Britain and consequently Home-Start Consultancy has been established at 22 Princess Road West, Leicester, England, to provide the opportunity for consultation, liaison and development with existing and new Home-Start schemes.

RCsum6--On constate souvent que darts des cas de maltraitancc d’enfants. I’intervention officielle se revele cotiteuse, maladroite ou franchement ma1 acceptee. “Home-Start” est un programme de volontaires qui a commence & Leicester en Angleterre, il y a 8 ans, avec comme objectif I’appon d’un soutien amical et pratique a des families tres jeunes qui rencontrent des difficult&. Recemment, Willem van der Eyken a Cvalue ce programme et il a trouve que “Home-Start” est un succes en particulier avec le 257~ des familles dont le programme s’occupe, et dont les enfants sont sur la Iiste des enfants a risque de traumatismes non accidentels. Le present rapport d&it en detail Ies objectifs, Ie travail des voiontaires. le genre de families auxquelles ceux-ci rendent visite et l’approche utilisee par “Home-Start” en g&r&al dans le cadre de la maltraitance a enfants. Les parties du plan qui semblent vitales sont: la relation etroite de “Home-Start” avec les agences officielles, Je soutien intensif apporte aux families B leur propre domicile et la preparation minutieuse et le soutien sur lesquels les volontaires peuvent compter. Le plan “Home-Start” a essaime maintenant dam d’autres regions de Crdnde- Bretagne et par la suite un centre de consultation “Home-Start” a ete mis en place au No. 22 de Princess Road West, a L.eicester, en Angleterre. Ce centre est lB pour foumir une certaine guidance et servir de noeud de communication entre les programmes “Home-Start” nouveaux ou anciens.

DURING THE PAST 8 years, around 650 families with nearly 2,000 children between them, have received intensive support, friendship and practical help in their own homes through a

INTRODUCTION

relationship with an individual volunteer in Home-Start. The families are referred mainly through social workers, health visitors or by themselves and sometimes their involvement with a volunteer is for as short a period as 6 weeks, but more often visits last from between 1 and 3 years.

This paper was presented at: The Third International Congress on Child Abuse and Neglect, Amsterdam. The NetherIands. April 1981.

441

432 Margaret Harrison

THE OBJECTIVES

By using volunteers, the objectives of Home-Start are:

1. To offer support, friendship and practical assistance to families with children under five. 2. To be available to families who are experiencing frustrations or difficulties. 3. To visit families in their own homes where the problems exist and the individual’s dignity and

identity can be respected. 4. To develop on a one-to-one basis a relationship in which time, flexibility of approach and

understanding can be shared with the other parent. 5. To encourage the parents’ strengths and emotional wellbeing in order that these may be

transmitted to their children, thus enhancing their development. 6. To reassure parents that difficulties in bringing up children are not unusual and to emphasize

the pleasure of family life. 7. To encourage families to widen their network of relationships and to use community support

and services effectively. 8. To work towards the increased confidence and independence of the family unit.

An important point about a scheme like Home-Start is that, because it is not aimed specifically at “abusing” families, there is no “typical” family and therefore no one associated with the scheme feels labelled in any way. In practice, however, one quarter of the families visited in the past 8 years have had at least one child on a register of children at risk of abuse.

PROFESSIONAL SUPPORT

Although Home-Start is an independent Voluntary Home-Visitin& Scheme, it is, and always has been, supported by a group of high level professionals from related statutory and voluntary agencies, (the Social Services and Education Departments, the Area Health Authority, the De- partment of Health & Social Security, the Leicester Council for Voluntary Service and the Voluntary Workers’ Bureau). Though Home-Start enjoys this support, it remains an autonomous voluntary organisation with a flexible and individual approach which is of paramount importance to the families being visited.

THE HOME-START VOLUNTEERS

This same I~exibility and individuality is also reflected in those who become volunteers. Some are single parents receiving state assistance, some are married and enjoy an adequate income;

some are involved in paid work as well as their voluntary work; some have themselves been families visited through the scheme before eventually becoming volunteers: some have had very little education; some are professionally qualified; some are from the indigenous population; some have only been in this country for a few years. All are parents, all receive out-of-pocket expenses, and all realise that they are fulfilling their own “need to be needed” and the reciprocal nature of their volunteer work, All bring to the families their own experiences of being mothers and wives in the community, and have developed certain skills in their lives, which can be of value in supporting other families. Any success which Home-Start enjoys must be associated with the very careful matching of the volunteers’ skills to the specific needs of the families visited. Only after a true bond has been formed and the volunteer’s genuine care, interest and optimism are recognised and accepted by the family, can any growth or “change” begin.

Home-Start: A voluntary home-visiting scheme for young families 443

COURSE OF PREPARATION AND ONGOING TRAINING FOR VOLUNTEERS

All new volunteers are required to attend a course of preparation which is held 1 day a week for 10 weeks. This aims to help them become well-informed quite apart from being well-inten- tioned. Many say they are attracted to the scheme specifically because of the provision of a course. The sessions, which are practical as well as theoretical, focus on the Home-Start approach, the ethics of visiting other people in their home, some basic child development, an understanding of relationships and a knowledge of resources in the community.

Ongoing training is provided regularly for the volunteers to meet specific problems or queries as these arise. Many volunteers say Home-Start has given them the opportunity to learn more about themselves, their own attitudes, standards and values in life and has helped them to develop and grow with greater awareness of the world. “It helps me get my own problems into perspective.”

Home-Start at its best is a network of mutual care, between the organisers, volunteers and families. It is this aspect of the scheme which is immensely attractive to a wide variety of people in the community.

ADVANTAGES OF VOLUNTEERS

While statutory intervention with young families where there is known or suspected child abuse is generally effective, sometimes it proves inappropriate, costly and unwelcome. There may be a sense of hostility, helplessness, defensiveness or apathy expressed by the parent towards the statutory worker. Indeed, it is well known that in some cases, statutory intervention can induce more stress rather than reducing it, simply because of the family’s perceptions of the “authorities.” Home-Start, however, is not inhibited by departmental procedures. The volunteer’s role can be truly subordinate to the family’s needs, and she can accord to all the family members, the dignity and respect they deserve. Above all, a Home-Start volunteer has TIME. Most volunteers visit only one or two families, and research by Willem van der Eyken has shown that the average length of time spent by each volunteer was 6 hours per week in actual face-to-face contact with the families. Their approach can be flexible: “Let’s go and kick leaves together today!“; nonthreatening (volunteers do not have the power to remove children into care) practical, fun, spontaneous and mutual. One volunteer left her own children with an “abusing parent” while she went to the dentist. This was a vital example of trust for a parent who had virtually lost her self-esteem. Volunteers are able to visit the families as “someone else with young children” rather than as “abusing parents,” thus encouraging the parents to change and gain control over their own lives.

Being available occasionally in the evenings, or on weekends or even at holiday times, can provide a stressed family with vital support which professional staff are often unable to give as they are replaced at such times by “duty” staff.

Another vital element of the Home-Start approach is that visits occur in the parents’ own home at their own invitation and on their own terms, rather than in an office or at a centre. There are no contracts and no time limits. Visiting may last 3 months or 3 years. But there IS a conviction that things can and will change.

The volunteer, through the luxury of being with the family over a considerable period, has the opportunity, at times, of seeing beyond the physical chaos and of knowing when a caring rela- tionship really exists between the parents and their children. Similarly, she has the opportunity to learn whether or not to trust a family’s explanations-not only about child abuse, but about life in general. So often their lives can be so colourless and arduous, that some embellishment and fantasizing is understandable. Where a family is particularly inarticulate, then the volunteer can help verbalize the problem and enable the parents in turn to talk through their difficulties.

443 Margaret Harrkun

PROFILES OF THE FAMILIES

Who then are the families either referred to Home-Start, or who refer themselves, for whom the preventive work of the scheme can hefp minimize abuse?

They tend to be those who for various reasons lack positive support in their lives, and who do not have the confidence to avail themselves of the services which exist for young families. Some are isolated from their own extended family or have no close friends or neighbours. Apart from loneliness and depression, many also have problems coping on their low income or living in inadequate accommodat~on~ Some are of Iow intelligence, tack any routine or have been exposed to physical or emotional battering themseives. A few have been brought up in the care of the Local Authority and have therefore never experienced normal family life (with all its ups and downs). They may live in a fantasy world or be a~or~~phobic. Perhaps they are single parents; perhaps they are bored. Some have unrealistic expectations of their children; some arc exhausted. Some over-protect their children and are over-anxious about them; others are simply filled with FEAR-fear of the inability to cope with their children. their statutory workers and their life in general. Others just need a break away from their children. For some, their problems are induced by the mismatch in temperament between themselves and their children. who may make excessive d~I~ands on them for attenti~?n. affection and stirnul~~~~on.

Many young and inexperienced parents simply cannot say “NO” to their children and thus the vicious circle begins-the whining, the crying, the wettin g, the soifing. the temper tantrums, the anger and the stress.

The experience of the past 8 years of Home-Start has proved condusively that what such families need above all else FIRST, is someone whtr can visit them i~lformally, on ;f one-to-one basis in their own homes. where their problems exist and where their dignity and identity can he respected and protected, and where the focus can be on THEM. This can be provided by a Home- Start vofrtntecr, who, through visiting. cannot only reduce the tensions of a parent who is severefy frustrated or overwheimed, but actually has the time to be with them, to listen and to really care. “You’re the first one who’s taken any notice of ME. AII the others come in here and just concentrate on the bloody kids!” V(~lunte~rs provide nothing but themselves as a rcsource~-no bag of edu- cational toys, no secondhand clothes, no extra food and no furniture (except in rare cases). The families do not look on them as the providers of materin goods. What the volunteers do offer, however. are their unique personalities, their own experiences of life, and attitudes which are fostered by the scheme, rather than a fixed method of in~~oIvenl~nt, Everything is secondary to the relationship developed between the family and the volunteer.

HOME-START AND CHILD ABUSE

It is now known that there are many factors which may be conducive to child abuse and neglect. Home-Start is increasingly being seen by those with responsibility for minimizing child abuse, as a scheme which can help where some of these factors are present.

A common theme is the young mother-to-be referred to Home-Start, in order that support through a relationship with another woman can be established ~&WC the baby is born. Possibly the young mother has been rejected by her own family, or is excessively anxious during her pregnancy. so that Home-Start invtrivement is considered appropriate. Once the baby is born fand it may have been a difficult birth or inadequate bonding taken place) help with coping with the new routine, with problems of feeding or crying or sheer exhaustion can be provided by the votunteer who has already been accepted by the parent. This can also be the pattern for visiting parents whose chitdren have been removed into the care of the Local Authority: a Home-Start volunteer is introduced before the child~ren) is returned home. hopefulty so that problems can bc avoided after the childntn have been reunited with their parents.

Home-Start: A voluntary home-visiting scheme for young families 445

Where a potentially abusive parent does not avail herself of ante-natal care, it may be important to have a volunteer who can ensure that a pregnant woman does attend the ante-natal clinic. Other mothers need help making or keeping appointments, or need help with transport, or simply need a volunteer who can look after their other children, leaving them free to attend the clinic unac- companied and unharrassed.

In a case where a parent is suffering from severe post-natal depression, a group of three or four volunteers can form a rota to give daily support to the mother who simply cannot cope with her new baby or her home. By providing practical help and intensive support of this kind, volunteers can provide positive reinforcement to the parent, and judge the times when she really needs to be totally dependent, and when she can be encouraged to do things for herself or the baby. If this approach is used simultaneously with professional medical attention, then the “bad patch” need not be too protracted. Some parents are desperately in need of some time to themselves, to ease their tensions away from the demands of their young children. Often all that is needed is for a volunteer to take the children off their hands for a few hours, or even a weekend, so that they can “go and have a good rest,” or refresh themselves through an outing without the children. Then there can be joy when they are reunited, instead of constant stress.

In some cases where children are failing to thrive, it can become apparent to the volunteer, that such children are frequently products of their parents’ ignorance, rather than neglect. Perhaps initial advice on feeding, by a statutory worker had been ineffectual, and the decline in the child’s development continued. After the introduction of a volunteer, it soon becomes apparent that the parent who had appeared to be listening to professional advice was actually concerned with what the adviser must be thinking of HER. In subsequent conversation with the volunteer, the parent may ask: “What the hell was all that about. 7” Here the volunteer can act as interpreter and demonstrate in a practical way how to execute the instructions. “Here, let me SHOW you!” Too often apparent child-neglect is. in fact, parental ignorance.

Frequently families are referred to Home-Start for short-term involvement by a volunteer, when there is a particular crisis. Then the volunteer can attempt to defuse a situation, and visit the family regularly until the stress is reduced or the particularly trying state of the child’s development overcome. Thus, frequently, tensions can be prevented from erupting altogether, or reduced to copable amounts so that hopefully many potential cases of child-abuse are avoided.

MOTHERING THE PARENTS

Many of the parents referred to Home-Start are very young, immature and dependent themselves, often displaying erratic and volatile behaviour. Some have never experienced real care and security in their own lives and are starved for attention and affection. In such cases, the role of the volunteer becomes one of mothering the parents with kindness, tolerance, humour, selflessness and occa- sional firmness. Because as volunteers they have the time to offer intensive support as well as genuine care (“Well, she’s not paid, so I know she WANTS to come”) the parents have the opportunity to talk through problems, test their behaviour on the volunteer, learn to order their priorities, regress if necessary, develop trust and replace impulsiveness with clear thinking. It is immensely rewarding for a volunteer ultimately to observe the parents transmitting these same qualities to their own children, thus for the first time breaking family patterns which may well have been reproduced from one generation to another.

Sometimes there is a turning point in the pattern of visiting, where suddenly parents will reject their volunteer (rather like some adolescents test out their own parents). Experience has shown, though, that staying with the family at this stage, (even if visits are lessened and shortened until the parent invites the volunteer back, aware that it is on THEIR terms) can lead to a positive change in the family’s development. Ultimately the volunteer aims to build up contacts within the

446 Margaret Harrison

community with the parents, so that at the time of withdrawal, they can avail themselves of alternative sources of support and services.

Some parents use the volunteer as a model (though most volunteers would not like to be considered such!) for alternative methods of handling a child. Through their volunteer they have the opportunity to observe diverting attention, reasoning, humouring, being firm but kind, and using positive reinforcement. All this can then be echoed in the parents’ own handling of their children.

With families whose lives are chaotically disordered, or over-ordered and tense, or where children are seemingly neglected, the volunteer can introduce a degree of regularity and routine. Where simply the difficulties of coping from day to day are the greatest cause of concern, then the volunteer can help with practical everyday household tasks, like cooking a meal, clearing up, shopping or helping with the budgeting.

CASES WHERE THE INVOLVEMENT OF A HOME-START VOLUNTEER IS INAPPROPRIATE

Experience has shown that Home-Start involvement is inappropriate in the following cases:

1. Where the parents are diagnosed chronically mentally ill. 2. With parents whose personality is so damaged that they cannot themselves develop in time to

nurture their own children. 3. For parents who are intent on their children being admitted into Care. 4. When a parent has a degenerative illness, which affects her physically as well as occasionally,

mentally. 5. Where there is a risk of child abuse by a cohabitee and it becomes apparent to the volunteer

that the mother is so influenced by him, that the child is at risk. 6. Where the parents are known to be “recidivists.”

Nevertheless, Home-Start volunteers can still offer support to such families, often providing the continuity and stimulation for the children, while simultaneously there is considerable statutory and medical involvement with the family.

SUPPORT TO HOME-START VOLUNTEERS FACED WITH CASES OF POTENTIAL CHILD ABUSE

Without adequate support, it would be easy for the role of the volunteers in child abuse cases to reflect the tensions, sense of hopelessness and depression of the neglecting families being visited! They need both adequate preparation to recognise the signs and symptoms of child abuse, and also a knowledge of the resources of other agencies. They must have quite clear instructions about their own responsibilities and each volunteer is issued with a Home-Start leaflet explaining these. Only through intensive support and supervision provided through the organiser, professional workers and each other, can the volunteers’ emotional vulnerability be protected. They need to be infused with positive reinforcement themselves, so that they in turn can sustain the families they befriend. It would be irresponsible to effect positive change in the families they visit to the detriment of their own. The organiser is always available to her group of volunteers for support, more-or-less any time of the day or night.

In Leicester, Home-Start volunteers are invited to attend case conferences concerning the management of child abuse cases at the discretion of the chairman and of the Home-Start organiser. Generally, their opinions and ideas are respected by the other agencies involved because they are seen as intelligent, articulate and practical parents themselves.

Home-Start: A voluntary home-visiting scheme for young families 447

EVALUATION

A recent evaluation of the scheme by Willem van der Eyken, suggests that the Home-Start approach can have a high success rate. He took a random sample of 20% of the 288 families visited during the first 4 years of the scheme, and asked the social workers and health visitors who had referred the families as well as the volunteers, the organiser and the families themselves, whether they thought that at the end of the volunteer’s involvement there had been “considerable

change, ” “some change,” or “no change.” The results are shown in Table 1. Willem van der Eyken writes “Volunteers as one might predict, assess their work more pes-

simistically than do others, including their organiser; families on the other hand, are the most enthusiastic about the effects of Home-Start. But what is perhaps most striking is the assessment made by professional field workers, the initial referrers.”

CONCLUSIONS

Clearly, prevention and rehabilitation are preferable to severing family ties in all but a small minority of cases of actual or suspected child abuse. Volunteers who are independent of statutory agencies but nevertheless organised coherently to liaise with these authorities, can work in a very effective partnership with families to prcvide the best and most appropriate care for them, after considering their very individual needs.

Table 1. Ratings of the Influence of Home-Start Involvement with Families Where Visiting Had Ceased After the First Four Years of the Scheme

Perceived Result

Assessor

Familv Home-Start Home-Start of Involvement Social Worker Health Visitor Themselves Volunteer Organiser

Considerable change Some change

55% 89% 85% 417c 67% 45% 11% II9 40% 23%

No change- 0% 0% 4% 13%

Source: W. van der Eyken [ 1982 in press] “The Young Child in the Community.”

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