Understanding and Supporting “Families with Complex Needs”: An Editorial

Family forms are many and varied, reflecting a myriad of understandings and influencing factors. In any given cultural context, normative notions of family structure, such as the “nuclear family”, may not therefore reflect the reality of family life, experiences and functions, as described and articulated by families themselves; particularly those from minority or marginalized communities [1]. Despite this complexity and perpetual change, the importance of family for the experience of both interdependence and individual support and well-being remains constant. This is particularly the case for “families with complex needs”, who experience both a “breadth” of “interrelated or interconnected” needs and a “depth” of “profound, severe, serious or intense needs” [2], and are therefore most reliant on services and support. This might include families affected by mental health needs, disability, caring responsibilities, migration, asylum seeking, crime, drug and alcohol misuse, and so on.

The increasing complexity of family life, alongside the continued important and complex role played by family in supporting members with particular needs, poses a range of challenges for services seeking to engage with families, particularly those with complex needs. For family-focused services to deliver effectively, the complexity of family roles, functions, and compositions therefore need to be examined and understood. Failure to recognize the structure, role and function of various family relationships may lead to ineffective service provision or a resistance to engage in support by the family. However, in sharp contrast to this complexity and fluidity of experience, Murray and Barnes [3] argue that “family” is a taken-for-granted and narrowly defined concept within policy documentation in the UK, and highlight the importance of “exploring normative assumptions about family” that inform policy discourses, aims and objectives. Similarly Jelin [4] argues welfare policies across Latin America are anchored in an implicit model of family that is far from users’ daily reality.

Clearly the way in which the needs of the family are constructed and responded to by policy and practice may affect relationships with families as “service users”. Of specific concern is the core tension within debates concerning the support of families regarding the right to private family life and the public interest in family intervention. The identification of a small number of families as being in need of intervention provides opportunities to consider how to deliver support; however such an approach is also “demarcating a particular group of families (loosely defined) as having complex needs best met through identification as a public concern”, which may be “a source of resistance” to engagement in services ([5], p. 12).

Given this challenging context it is unsurprising that there is significant evidence that existing policy and service provision finds “thinking family” both challenging and controversial, with clear implications for professional knowledge and frameworks, training, practices, and the design and delivery of interventions. This special issue seeks to support attempts to address this challenging context by providing critical reflections on policy, services and interventions, and professional practices, and by offering accounts of the “lived experience” of families subject to such policies and practices and/or defined as experiencing “complex needs”.

In order to do so effectively, the collection of papers is deliberately broad in its coverage of substantive policy and practice areas and specific family needs, including those related to mental health, child protection, foster care, migration, crime victimisation, and poverty. What’s more, papers on specific topics offer reflections that are readily transferable to other policy areas.

Similarly the collection of papers is deliberately international in its coverage, and comparative in its analysis. Articles draw on research and policy and practice examples from Mexico, Chile, Argentina, Norway, Sweden, Italy and the UK. This reflects the participation of many of the authors in a recent international researcher exchange scheme, funded by the European Commission Seventh Framework Programme. Entitled “Understanding and supporting families with complex needs”, the scheme sought to enhance understandings of family-focused approaches in social care, education, and health by enabling collaboration between eight research groups across Europe and Latin America in a series of case studies. More information can be found on the scheme’s webpage [6].

Previous research has identified a typology of family-focused services that includes: those that work with the family to support the service user; those that address the needs of family members so as to enable them to support a primary service user within the family; and an emerging category of “whole family approaches” that uniquely emphasize shared needs, strengths or risk factors that could not be dealt with through a focus on family members as individuals [7]. It is this latter category that is of greatest interest in supporting “families with complex needs”. Morris et al. [5] suggest some momentum towards “whole family approaches” in relation to a number of service user groups and contexts. However, whilst there is emerging evidence that such approaches may be effective in engaging families with complex needs, they are often tentative and yet to be evaluated [5]. This is echoed by Mauras [8] who argues that, in Latin American countries, there is still a strong tendency of developing diverse policies oriented towards individuals, instead of towards the family as a whole.

Papers in this collection offer some useful reflections on such approaches. Jhadray et al. [9] provide an account of a whole family approach currently being trialled in the UK to support families affected by mental health difficulties. In particular, the paper offers useful reflections on the processes of implementation. Similarly Tsekoura [10] offers a case study of a voluntary sector youth organisation supporting families living in “extreme poverty” in Chile and Mexico. In describing the strengths-based, holistic support provided, the article offers important reflections for policy and practice more generally. In particular approaches to empowerment through the fostering of “family agency” are directly transferable to support for families experiencing a range of complex difficulties.

Other papers offer critical reflections on models of intervention and professional practices that do not readily or effectively engage with the family when meeting the needs of a single primary service provider. Cornejo Torres and Rosales Ubeda [11] explore the difficulties facing immigrant families in Chile in engaging with schools. They describe conflict caused by the school’s inability to address cultural differences, leading to poor social integration. Cabiati [12] is highly critical of the lack of meaningful participation of family members in the child protection system in Mexico. In sharp contrast to the practices described by Tsekoura, Cabiati describes a child-centred approach that denies agency to parents, ensuring “asymmetric power relations” between parents and professionals. The likely limitations of such an approach are presented. Similarly Munoz Guzman and colleagues [13] reflect on approaches to “alternative care” in Chile, Italy and Sweden, including how the potentially competing rights of the child and of the parent might both be guaranteed and assimilated.

The challenges in working with families with complex needs are also reflected in papers examining professional perspectives. Gumuscu and colleagues [14] present the practices and perspectives of social work professionals within five varied sectors of social services in Sweden, highlighting varied constructions of the family as “expert”, “client” or “non-client”, and the implications these constructions have for practices and service user experience. The reflections of service providers are mirrored by those of social work educators in Lyngstad’s [15] analysis of values and understandings in relation to complex and controversial issues related to support of families with complex needs.

There remains insufficient research into the everyday lived experiences of families with multiple difficulties, and particularly more marginalized families. Morris and Featherstone [16] argued that this “absence of conceptual and empirical understandings of family practices, coupled with the contradictory drivers for policy and practice, can only result in confusion for families at the point of engagement with services, and piecemeal underdeveloped outcomes”. This is mirrored in the Latin American context [17]. Of key concern here is the extent to which different family practices (such as extended family support, parenting methods, child rearing within or across households, and so on) are understood and whether (or not) some approaches may be in danger of problematising specific families without engaging with differences as sources of strength or resilience.

Several of the papers in this collection address this theme by considering how “families with complex needs” form and experience contemporary life in the context of the everyday challenges they face. This in turn supports reflections on how such understandings might inform policy and practice responses. For example, Robertson [18] provides an insightful account of the “everyday lives and health” of migrant women in Mexico, detailing the exercise of agency both in the decision to migrate and in the subsequent attempts of mothers to ensure the welfare and well-being of their children.

Indeed, gender is a recurring theme of the special issue. Most notably Hanley and Ruppanner [19] consider the experiences of women in a range of national contexts regarding fear of crime, comparing the influence of various forms of family structure on fear and well-being. Issues of gender also emerge as key themes in other papers, including in relation to child protection services [12] and education [11].

Gender is also a key theme within Gonzalez’s [20] reflections on assumptions regarding the role of women in the nuclear family that are at the heart of social policy construction within a neo-liberal context. Such an analysis demonstrates how normative notions of family, and the influence this has on expectations regarding women, are particularly pertinent to the role of mothers within families with complex needs. Interestingly, however, the role of neo-liberalism is shaping the views of social work educators and professionals is argued by Lyngstad [15] to be limited. The relative roles of policy contexts and professional practices in shaping the experience of families with complex needs in accessing services therefore offers a further theme for reflection.