Talking to Families of Young People with Complex Needs There are many different pathways that can lead a young person to engage in health risk behaviours. Some young people will enter their teenage years with a history of childhood problems or issues, e.g. family violence, abuse, parental mental illness. Other young people reach adolescence and their health declines as they begin to experience mental health issues or engage in substance abuse. Others engage in temporary risk-taking behaviours that are not preceded by nor followed by other risk behaviours¹.
In all these cases, family factors may have played a significant role, or there may have been less influence from family and more from other areas of a young person's life, e.g. individual traits, school, peers, community expectations. Even families that have had a significant influence on adolescent behaviour, may have been doing the best they could under difficult circumstances. Additionally, traumatic experiences may have affected all family members. It is important, therefore, to keep an open mind in regard to the level of influence that a family has had on a young person's needs or problems, and the extent to which they acted in good faith.
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Family factors may or may not have played a significant role in a young person's issues.
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Family members are likely to have strong feelings about what's happening for their young person, and may also be dealing with their own issues.
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Show family members respect, compassion, understanding, information and support in as many appropriate situations as possible.
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Consider how your agency could become more family-friendly.
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General information is helpful to families, as well as involving them where possible.
Feelings Family members of a young person with complex needs may be feeling any or all of the following:
stressed, helpless and overwhelmed about how to help the situation.
worried, anxious, fearful about the young person, self or other family members.
guilt about the young person's difficulties.
shame and embarrassment about the situation.
a sense of failure, low self-worth as a person and/or parent.
frustrated and confused by attempts to get help.
angry and resentful towards the young person or others.
isolated, alone, without understanding or support.
exhausted by crises, financial pressure.
sad, depressed, grief-stricken.
disempowered by services and systems.
Family members may also be dealing with personal difficulties, e.g. drug addiction, mental health difficulties and histories of abuse/trauma. They may be trying to cope with unemployment, poverty, homelessness. All these factors can interact to impact on their level of support and availability for a young person.
It is worth bearing in mind that parents, even those who have played a negative role in earlier years, can repair connections with children, if both parties are receptive. Parents with new skills and increased maturity may, at some stage, be able to make a new start in parenting their child. There is a natural, instinctive desire between parents and children to be reconciled, even when the past cannot be changed and so long as the child is not at risk ².
Your approach with families There are clearly cases where families are abusive and contact with families is harmful, and under such circumstances, the safety of the young person is paramount (see: When Contact with Family is Harmful).
Unless there is evidence to the contrary, however, it is helpful to assume that family members:
have done the best they could with the knowledge and skills they had at the time
are worthy of receiving information and support which is respectfully delivered
are important people and resources in the young person's life
have important knowledge and background information about the young person
are part of the solution for the young person
A good guideline to adopt is to show family members respect, compassion, understanding, information and support in as many situations as possible. The following sections outline some strategies for addressing these needs in your workplace:
It is also possible that while there may be deeper issues which need to be 'worked through' over time, possibly with professional assistance, some direct contact between the young person and the family member may be beneficial. This may enable the young person to begin to rebuild connection in the mean time, while the deeper issues will be dealt with in another forum.
Starting to rebuild the relationship
A family member may be more willing to re-engage in their relationship with the young person if they have some new strategies for doing so. Try to identify an area of tension that impacts on the relationship and consider guidelines or techniques for dealing with the issue. For example:
Help the young person and family develop clear and appropriate boundaries for their relationship, by doing the following:
Make the workplace family-friendly
Parents often report feeling anxious, confused and frustrated after making many calls for help and facing many dead ends. Consider how your agency may provide a more family-friendly service, even where you are unable to provide a direct service to parents/family or when a young person refuses consent to speak to family about them. Some possibilities are:
Have someone who is able to respond to calls from family.
Be clear about the policies and procedures in relation to family involvement in the service.
Offer an information sheet for parents, provide general information to them, or hold parent information sessions.
Familiarise yourself with the most helpful services for families in your area and refer, involve or consult with them as appropriate.
General information is helpful
Families experience relief and empowerment when they receive general information about the service that their young person is accessing. Language should be jargon-free, and information ideally should be provided in a range of formats (e.g. written, verbal).
Provide information about your program, what services are available, the limitations on service-delivery, philosophies behind the approaches (e.g. stages of change, harm minimisation), family inclusive policies and practice, as well as information about specific relevant issues, e.g. drug issues, mental health.
Validating their feelings helps Listen to, understand and, if appropriate, validate the concerns of family members. Help to reduce any guilt they are feeling by letting them know there are often factors contributing to young people's difficulties that are outside parents and families control (individual, peer, school, community, or situational factors). Where appropriate, reassure them they have done the best they could with the knowledge and skills they had at the time, and that even when mistakes are made, things can be done differently next time. Congratulate them for wanting to access information and provide support to their young person.
Support families where you can Doing even a small amount of the "leg-work" to access information for parents helps them feel supported and able to continue their efforts. Provide active referrals for family members where you are able (ie. ensure a service is suitable prior to providing details for family to call, explain the referral process to them and ask them to let you know if they have any difficulties etc.)
Involve families where possible If your role, and the young person, permits you to liaise with and provide support directly to a family member, this may be more beneficial to the young person and their family, than if the family member sees a worker independently. However you should access good supervision in order to ensure that you are not colluding with one family member to the detriment of another.
If it is not part of your role to work intensively with the family, engage another worker for the interested family members. With the young person and the family's permission, liaise with this worker on a regular basis.
Provide parenting support, education and/or counseling
As a youth health professional, you can be an invaluable source of information and knowledge about adolescent health to parents. If you have an opportunity to provide education and support to a parent, consider exploring the following:
Talk to parents about how they may help support their young person (for example, what supports people need to not relapse back into drug use if you have ideas around this).
Talk to parents about how to best communicate with their child to promote a good relationship (e.g. the tone they use, the time they chose to have serious discussions, using appropriate humour). Remind them about the importance of non-verbal communication and the use of constructive letters.
Help parents work out what they can comfortably provide for their young person, physically, emotionally, and mentally, and when they need to say no.
Encourage parents to support their young people and take a strengths-based approach with them, as higher self-esteem empowers change and positive choices.
Discuss age-appropriate boundaries or expectations, and possible consequences with parents (See: Setting Boundaries).
Remind them the young person is still learning how to manage emotions and communicate assertively and parents are their best role models.
Encourage the parent to offer to help the young person to come up with ideas, rather than to tell them what to do.
Remind parents to support the young person when they make decisions and encourage them when they take a positive step.
Explore a conflictual event and try to give the young person's perspective. Discuss alternative approaches and solutions.
Encourage parents to support young people to find their unique passions and strengths.
Talk to parents about trying to give other children in the family time and positive attention.
Encourage parents to prioritise and take responsibility for trying to be happy and healthy themselves amidst the turmoil, e.g. plan their own relaxation and recreational activities and escape from worry.
1. Compas, B., Hinden, B. & Gerhardt, C. (1995) Adolescent development: Pathways of risk and resilience, Annual Review of Psychology, 46, 265-293. 2. Larson, S. & Brendtro, L. (2000) Reclaiming Our Prodigal Sons and Daughters. Indiana, US: National Education Service
