Piloting PERCS: A prevention and early intervention strategy for children living with violence and parental substance use

‘Women and children don’t necessarily go to domestic and family violence services. It is, in fact, the last place they want to go.’ – Meghan Hughes, Executive Manager – Strategic Projects, Women’s Safety Services (South Australia)

‘We often think about the men’s behaviour change as being the only space where work with men happens. I think in reality it’s the minority of where the actual work happens. There’s a huge amount of people working with men using violence in other contexts, or who have had supportive conversations that have nudged the guy in the direction towards maybe thinking about his own behaviour.’ – David Tully, Practice Manager, Specialist Family Violence, Relationships Australia (South Australia)

‘If I had been able to tell my story someone could have seen that my children were my motivating factor for why I wanted to quit.’ – Phoebe, Emerging Minds Child and Family Partner

‘Clients do want to talk about their children, whether they are in their lives or not. They do want to talk about the kind of parent they want to be and be supported in that.’ – Suzie Hudson, Clinical Director, Network of Alcohol and Other Drug Agencies

The PERCS conversation guides have been designed by Emerging Minds to support practitioners to have child-focused conversations with parents affected by FDV – either as perpetrators or victims – and/or substance use. The name incorporates five domains of a child’s life:

• Parent-child relationship;
• Emotions and behaviours;
• Routines;
• Communication and meaning-making; and
• Support networks.

The guides have been adapted from Let’s talk about children (Let’s Talk): a brief, evidence-based method that supports professionals in their work with parents who experience mental illness, focusing on parenting and their child’s needs.

The PERCS-FDV and PERCS-AOD conversation guides were launched as part of the 2019 e-learning courses, Family and domestic violence and child-aware practice and Parental substance use and child-aware practice.

Download a copy of the PERCS-FDV conversation guides
Download a copy of the PERCS-AOD conversation guide

Australian studies show children’s mental health conditions are increasing, while a lack of access to supports is leading to poorer social and economic outcomes for these children (Lawrence et al., 2015; Segal, Guy, & Furber, 2017).

Children who live in a climate of fear, coercion, intimidation or threats, or with one or both parents who are using substances regularly or harmfully, are more likely to experience negative outcomes in social and emotional development and disruption to their relationships, education, routines, consistency and safety (Roberts, Campbell, Ferguson, & Crusto, 2013; Roche et al., 2014; Mohammad, Shapiro, Wainwright, & Carter, 2015;). They are also more likely to experience verbal abuse, inappropriate behaviour, and unsupervised or unsafe situations (Laslett et al., 2015).

These circumstances can have marked effects on children’s mental health, resulting in behavioural, emotional or cognitive problems (Moore, Noble-Carr, & McArthur, 2010). Negative outcomes are more likely to occur if service systems are unable to identify children’s risk early, and do not proactively seek to negate the effects of FDV and parental substance use on children. The ability of all services to identify and respond to circumstances that put children at risk has been at the forefront of contemporary child protection policy development in Australia (Council of Australian Governments [COAG], 2009a, 2009b).

Recent research and adult and family service data has confirmed what many practitioners have long understood: parents (particularly disadvantaged mothers) who attend services often experience co-existing issues including substance use, child protection involvement, mental health difficulties, poverty, family and domestic violence, and a history of trauma (Bromfield, Lamont, Parker, & Horsfall, 2010; Heward-Belle, 2017). Many of these parents have had their first child at a young age, without the social structures or parental relationships to support nurturing relationships with their own children (Early Intervention Research Directorate, 2019).

Practitioners who are attuned to presentations of FDV and the ways in which parental substance use can intersect with other socio-economic disadvantages, are well-placed to provide critical prevention and early intervention support for children’s safety and mental health (McIntosh, Wells, & Lee, 2016; Wells, Lee, Li, Tan, & McIntosh, 2018). The PERCS conversation guides help practitioners to consistently ask questions about the important domains of a child’s life, where they know or suspect the child is living with a parent who is perpetrating or experiencing FDV or using substances at harmful levels.

The PERCS pilot evaluation included interviews with 19 practitioners both before and after their use of the conversation guides. The pilot aimed to understand the contribution the guides made to practitioners’ work with parents; in particular, their ability to consistently ask about the effects of FDV or parental substance use on the child. Practitioners were asked a series of questions about their understanding of FDV or parental substance use; their practice in engaging fathers who were perpetrating violence, mothers who were experiencing violence or parents who were using substances at risky levels; and their strategies for asking child-focused questions.

In 2013, Emerging Minds (then the Australian Infant, Child, Adolescent and Family Mental Health Association) worked intensively with adult mental health services and parents with lived experience of mental illness to develop the Let’s talk about children (Let’s Talk) e-learning course into the Australian context. The course was adapted from the ‘Let’s Talk About Children’ materials originally developed in Finland by Professor Tytti Solantaus for the National Institute for Health and Welfare. ‘Let’s Talk’ is an evidence-based intervention for adult mental health professionals. It supports practitioners to focus on the effects of parental mental health on the child and work with the parent to explore the parent-child relationship.

‘Let’s Talk’ has been implemented intensively in adult mental health and drug and alcohol services in Australia and abroad. However, like other interventions seeking to bring family-focused practice into adult-focused services, ‘Let’s Talk’ has faced a number of barriers to consistent implementation, including time and resource challenges (Allchin, Goodyear, O’Hanlon, & Weimand, 2020).

In 2018, Emerging Minds conducted an intensive needs assessment in adult-focused services, analysing their ability to provide a prevention and early intervention focus for children’s mental health. Practitioners’ responses indicated they were challenged by time restraints, confidence, and a lack of clear guidelines for regularly incorporating child-focused questions into their work with adults.

Time restraints and the adoption of other mechanisms that prompted child-focused questions were commonly reported as barriers to the use of ‘Let’s Talk’ during Emerging Minds’ consultations 2013–2018. At the same time, a co-design process was being undertaken with 12 general practitioners across Australia, to develop a tool that would support child-focused practice with patients who presented to doctors because of adult adversity. General practitioners were also aware of their time restraints and advocated for an intuitive and efficient conversation guide that would prompt them to ask parents about how their experience of adversity was affecting their children.

In 2018, the PERCS conversation guide for general practitioners was launched as part of the e-learning course, Supporting children’s resilience in general practice.

Download a copy of the PERCS-GP conversation guide

Feedback from GPs suggested the guide would be particularly beneficial when working with parents who were affected by both substance use and FDV, and its development became the catalyst for an intensive period of consultation. Emerging Minds worked in partnership with the Flinders University Social Work department, non-government organisations, and parents with lived experience to explore the possibility of adapting the PERCS conversation guide to support generalist and specialist practitioners working with parents affected by FDV or substance use. The aim was to develop a series of questions which supported conversations with fathers whose perpetration of violence was adversely affecting their children, mothers whose ability to parent was being negatively impacted by FDV, and pregnant women and parents whose substance use was taking a toll on their child.

It should be noted that the conversation guides are not intended to teach generalist practitioners to be specialist family violence workers or to become specialists in working with substance use.

The PERCS conversation guides

The PERCS conversation guides explore the five domains of a child’s life:

Parent-child relationship
This domain recognises the importance of a safe, secure, responsive and nurturing relationship between a child and a parent/adult caregiver.

The parent-child relationship is significantly compromised by the father’s use of violence or the parent’s use of substances.

Practitioner’s role
When working with a mother, explore the effects of the violence or substance use on the mother-child relationship, and how she has responded to protect this relationship (despite the violence).

When working with a father, seek to understand what he wants for his relationship with his child, and how the violence/substance use gets in the way of this.

Emotions and behaviours
Children need to feel loved, safe and nurtured. They also need to be able to express emotions and have these emotions listened to, and responded to, in a nurturing way. Strong worries or emotions in a child’s life will often present as behaviours.

Children’s emotions and behaviours are significantly affected by the father’s use of violence/parent’s use of substances.

Practitioner’s role
When working with a mother, explore what they have noticed about their child’s emotions and behaviours – how they have been affected by the violence/substance use, and how she has responded to this (despite the violence).

When working with a father, seek to understand how he interprets his child’s emotions and behaviours, and whether he is able to respond to these safely.

Routines
Routines are daily activities which can support areas of children’s wellbeing – from shared activities such as reading, to expected meal and bedtimes. They provide the child with a stable foundation, especially in times of adversity.

A father’s use of violence/parent’s regular or harmful use of substances is likely to significantly disrupt children’s routines.

Practitioner’s role
When working with a mother, identify the routines that are important to her and her child, and how these have been affected by the violence/substance use.

When working with a father, seek to understand what he is noticing about the effects of his violence/substance use on his child’s routines.

Explore with both parents what they can do to help establish or reconnect the child and family to these routines.

Communication and meaning-making
Respectful and effective communication enables children to express thoughts and emotions and make meaning from any experiences.

Children’s abilities to communicate their thoughts and feelings and make sense of their experiences are significantly affected by the father’s use of violence/parent’s use of substances.

Practitioner’s role
When working with a mother, explore how her child has made sense of the violence/substance use issues, and how she might have supported the child to not blame themselves.

When working with a father, explore how he can understand his responsibility for the violence, and understand that this responsibility should never be directed towards his child.

Support networks
Safe and supportive networks beyond their immediate family can be a key protective factor for children’s social and emotional wellbeing. It is important for children to have many sources of adult support in their lives, through networks which provide them with consistent, positive and strengths-based messages.

The negative side effects of FDV and substance use (e.g. feelings of shame, fear of judgement, mood swings, depression, anxiety) can isolate the mother and child (in the case of FDV) or cause parents to withdraw from their extended family and friends, eroding their child’s support networks.

Practitioner’s role
When working with a mother, explore what support networks exist for her child, despite the violence/substance use, and how these networks might support the child’s social and emotional wellbeing.

When working with a father, seek to understand how important he thinks support networks are for his children, and how his use of violence/substance use might impact these supports.

Recruitment
Eight services in three government and two non-government community service organisations participated in the pilot. All eight work with adults in the context of family violence or problematic substance use and have an understanding of FDV and substance use presentations and their impact on children. Some services work exclusively with parents, while others commonly work with parents and children together and separately. These services show a commitment to employing prevention and early intervention strategies with parents who are affected by FDV or substance use, in ways that could minimise the mental health risks to children.

Nineteen practitioners with a wide range of practice experience in the sector were interviewed (13 from FDV services, six from AOD). Practitioners described their profession as either social worker, counsellor, AOD coordinator, nurse (complex maternity), therapeutic worker or occupational therapist.

It should be acknowledged that all 19 practitioners were supportive of the understandings that are key to the PERCS-FDV and PERCS-AOD conversation guides: an alignment with gendered understandings of FDV, a harm minimisation and strengths-based approach and a commitment to working with parents in ways that increase the social and emotional wellbeing of children.

All 19 practitioners had the explicit support of their service manager to participate in the pilot; and were supported by supervisory processes which assisted them to reflect on the conversations they were having with parents. Further, all participants worked in services that had developed practice positions on working with families where violence or problematic substance use is present.

Initial interviews
Practitioners were divided into two groups according to their sector (FDV or AOD) and initial semi-structured interviews were conducted. Questions were designed to ascertain the practitioners’ understandings of FDV or substance use (depending on their focus) and its impacts on children. Practitioners were invited to share their insights regarding presentations of parents who came to their services, and some of the conversations they currently had about children’s social and emotional wellbeing.

To varying degrees, all 13 FDV practitioners who work with families where FDV is present described the following during the initial conversation:

• They commonly worked with mothers who were or had been subjected to intimidation, control, threats, coercion or violence by a male partner/ex-partner.
• Working with fathers who were practising intimidation, control, threats, coercion or violence was a less familiar area of practice. For some practitioners, this was only occasionally a part of their work.
• A common practice challenge was focusing on the effects of FDV on children, while at the same time not engaging in practices that were inadvertently disrespectful or shaming of parents.
• They had a level of confidence and competence in having child-focused conversations with parents where there was FDV but recognised the potential benefits of using the PERCS-FDV conversation guides in their practice.

All six AOD practitioners felt confident and competent in having child-focused conversations with parents where there was substance use, but recognised the potential benefits of using the PERCS-AOD conversation guide in their practice.

Post-pilot interviews
The post-pilot semi-structured interviews explored the practitioner’s

evaluation of the FDV and substance use e-learning courses – in particular, the usefulness of the PERCS-FDV and PERCS-AOD conversation guides in supporting the consistent application of child-focused practice – as well as their perceived confidence and skill levels in asking parents about their children’s social and emotional wellbeing. Practitioners were interviewed about:

• what they noticed about parents’ willingness to engage in conversations about their children’s wellbeing, and the extent to which (in the practitioner’s view) the effects of stigma or shame were reduced;
• the five PERCS domains: what were the most useful aspects of the questions, and what could be changed to make the conversation guide more useful;
• the extent to which the six practice positions advocated by the PERCS guides were useful in supporting child-focused practice; and
• opportunities that arose from using the conversation guides, and what differences (if any) they noticed in the quality of their engagements with parents when they asked about the domains of the child’s life.

Thematic analysis
Thematic analysis was used to analyse data in the interview transcripts. This analysis seeks to define recurring patterns within data through identifying, analysing and reporting on common themes (Braun & Clarke, 2006). Post-pilot interview transcripts were initially coded for any interesting comments participants made, with a focus on these comments recurring throughout each of the transcripts. Excerpts within each participants’ transcripts were highlighted and labelled with a basic theme. Transcripts were then analysed to determine where these basic themes reoccurred across all interview data.

Nine distinct themes were identified, describing both participants’ familiarity with PERCS, as well as the ways in which it contributed new knowledge and skills to their practice. The highlighted excerpts were collated under their respective theme; then each theme was further analysed and summarised to draw out the details and nuances of participants’ comments. These summaries were compiled into a detailed analysis of the interviews. Finally, specific quotes to summarise each theme were selected.

General comments about the course

Participants were asked to provide general comments about the Family and domestic violence and child-aware practice e-learning course. Although the pilot was more specifically concerned with the PERCS-FDV conversation guides, the understandings and practices within the course were seen to provide an important accompaniment to the guides. Practitioners who were less engaged in the course, it was reasoned, would be less likely to use the conversation guides in their practice.

All 13 participants saw the course as providing practices to respond to parents when FDV is a presenting issue, without expecting them to become FDV specialists. This gave practitioners the confidence to respond to parents in a way that ensured children’s wellbeing was considered, rather than just referring the client to a specialist service.

Alignment with existing practice

Nine participants commented that the PERCS-FDV conversation guides, particularly the practice positions and domains, were closely aligned to their existing practice, and confirmed the guides’ relevance when working with parents where family violence is present.

A holistic framework for practice

Eight participants described the overall structure of the framework as providing a helpful guide for practice. They thought it offered ideas for entry points into difficult conversations with parents about children’s wellbeing, as well as shaped practitioners’ intentions for working with parents.

Three participants commented that the PERCS framework provides a useful tool for reflective practice.

New areas of enquiry

Nine participants reported that although the five PERCS domains were aspects of children’s lives they were already familiar with, the framework supported them to focus on domains they may not otherwise pay significant attention to.

Unsurprisingly, participants varied in regard to which domains extended on their practice.

New practice skills

Participants reported that the suite of questions provided in the guides supported their practice in a number of ways. A couple of the more experienced practitioners suggested the questions could help support new practitioners to conduct difficult conversations with parents in supportive, non-judgemental and curious ways.

Ten participants also said the wide range of questions offered in the guides supported them to work from a position of curiosity and collaboration.

Two practitioners also commented that the questions in the guides helped them to utilise their existing skills to improve enquiries with parents.

Practical usefulness of the guides

Five participants noted that being able to print the guides out and keep them after completing the course was a valuable and highly effective addition to the information and demonstrations presented in the e-learning courses.

Six participants noted that the brief and simple layout of the guide enabled them to use it as an on-the-spot, quick prompt whilst conversations were happening. This helped practitioners to make sure they were covering certain domains, and provided guidance when they needed help forming a question.

Three participants described the usefulness of having a printed guide to refer to in more of a general sense, rather than using it as a reference point during sessions.

One participant thought that having this reference point could support child-focused practice to eventually become a more natural process.

Working with both mothers and fathers

The structure of the PERCS-FDV conversation guides reflects the gendered nature of family violence and, as a result, participants separated their comments on working with fathers and working with mothers. Some participants noted the nuances present in this work and that PERCS supported the different skills needed to address common barriers to engagement in these client groups.

Supporting non-blaming practice with mothers who experience violence

Participants commented that the questions within the guides helped conversations to focus on strengths and to highlight the actions mothers were already taking to ensure the safety and wellbeing of their children. Furthermore, four participants felt that the guides gave them confidence to ask difficult questions that could help mothers to recognise and understand the impact of the violence on their children, framed in a way that did not place any blame on mothers for the violence, nor shame them for not removing their children from the situation.

One participant shared their experience of engaging in one such conversation with a mother who had experienced violence.

Supporting respectful practice with fathers who use violence

Nine participants commented on how valuable it was for them to have a guide that focused specifically on conversations with fathers, for two reasons. Firstly, holding conversations with fathers who use violence was not a common opportunity for many of the practitioners interviewed, who worked more commonly with mothers and/or children. Secondly, working with fathers who use violence was not usually included in professional development on FDV.

Participants found the guides supported respectful engagement with fathers who use violence; and assisted them to understand how this can be achieved without colluding or being perceived as agreeing with fathers’ narratives. The questions provided an opportunity for practitioners to highlight a discrepancy between a father’s actions (use of violence) and their values. This was seen as a catalyst for change for fathers, whilst allowing practitioners to remain respectful and maintain the therapeutic relationship.

Basis for parents’ actions

Five participants commented that the conversations encouraged by the guides formed a solid foundation for parents to take action in supporting their children’s wellbeing. Conversations about the impacts of FDV on children were reported to help parents frame their concerns about their children’s emotions and behaviours differently. Linking their concerns about their children to the children’s experience of violence helped parents to become more open to conversations about change. This was highlighted by practitioners as an entry point into raising difficult topics with parents in a sensitive and collaborative way.

As in respectful practice with fathers, participants spoke more generally about aligning values and actions to support parents to make changes. In highlighting the experience of the child, practitioners were able to support parents to consider their parenting values and how these might misalign with their child’s actual experience due to the violence.

The guide also appeared to support participants in creating a reflective space for parents to consider their children’s experience, and consider (perhaps for the first time) what they might be able to do differently, or more, to support their children’s wellbeing. This was contrasted with an approach of telling parents what their children’s experience might be and what they as parents should be doing differently.

Increased practitioner confidence

Six participants described the PERCS framework as contributing to a sense of increased confidence in engaging parents in difficult conversations about their children’s wellbeing.

Four participants reported that increased confidence supported them to take an earlier intervention stance in relation to children’s wellbeing, rather than only initiating a referral.

Ongoing usefulness of the PERCS guide, including new and unanticipated uses

Seven participants commented they would continue to keep the PERCS guides on hand for use in the future. A further two spoke about reviewing existing questions within their assessments and integrating some of the language used within the guide.

Participants also felt that the guide had much wider applicability and indicated that going forward, they would use it to support parents and children with issues other than FDV.

There were a couple of unanticipated uses for the guides that participants described. One practitioner, who works directly with children, revealed they had used the guide to form questions to ask children.

Another commented on the structure the guide gave to case management and a shared understanding across a team.

The results from the pilot with six AOD practitioners were also very positive. All participants reported that they found the PERCS-AOD framework really helpful in supporting them with child-focused practice with the adults that they work with.

Two participants reported that the resource was very useful for training and supervising other practitioners in child-focused strategies for working with parents with substance use issues.

All of the practitioners interviewed stated that the PERCS structure gave them the tool that was missing in this work. They spoke of the usefulness of the framework in helping them to adopt a child-focused approach.

Providing a simple framework for child-focused practice

Four participants found the PERCS framework simple to use and very helpful in learning how to keep children’s needs in mind when working with parents with substance use issues. They said PERCS provided them with practical strategies and tools that made child-focused practice accessible in their context.

Bringing the child into the room

Three participants reflected on the fact that children’s needs are not always considered in the support provided to their parents, and that there are consequences for this oversight.

All of the practitioners reported that their ability to adopt a child-focused approach was enhanced by the use of the PERCS framework.

Enhancing parents’ engagement and motivation

Two participants, one of whom was a clinical supervisor, reported that team members had often been concerned that asking parents about their children was likely to ‘ruin my relationship’ and cause parents to disengage from AOD treatment. Practitioners who undertook the pilot found the opposite to be true.

Five of the participants reported that parents often named their children as a motivating factor for positive change, while two found the PERCS framework to be helpful in supporting parents to make these changes.

Addressing barriers such as shame and stigma

Five participants stated that the PERCS principles were validating of their current practice.

The framework also brought these practice principles to life for participants. Four interviewees reported an increased understanding of how exactly these principles could be used as part of child-focused practice.

Supporting a collaborative approach

Four participants found that the PERCS framework helped them better position themselves in a way that conveyed support to parents and a team approach. It gave them the skills to respond to risks to children in collaboration with parents, rather than jumping straight to filing a child abuse/neglect report; and to focus on the child’s wellbeing rather than just the risks present.

Three participants found the framework to be useful in developing plans with parents to work on specific areas of their child’s life and to explore and manage any risks that are identified.

Supporting a strengths-based approach to working with parents

All practitioners talked about how they used a strengths-based approach in their core work.

Five stated the PERCS framework helped extend that skill to take a strengths-based approach to parenting with their clients.

Integrating with current practice

All participants found that the PERCS framework fit quite comfortably with their current practice and helped extend it to better incorporate a child-focused approach.

Two practitioners also adapted the framework to suit the needs of their specific client groups and settings.

Enhancing current practice

Four participants found that the framework actually enhanced their current practice and the work they did with parents around their substance use issues. It offered another way of framing the parent’s experience of recovery by bringing their children into every step of their journey, making the work more meaningful for parents.

Guiding child-focused conversations and practical strategies

All six practitioners described feeling like the PERCS framework gave them ‘more scope to poke around in that space’ with regard to child-focused conversations.

Three practitioners also described how these conversations resulted in them working on very practical strategies with parents to minimise the impacts of their substance use on their children.

Supporting challenging conversations with parents

Four participants reported that they often had to have challenging conversations with parents who may not be attending their service voluntarily. They found that the PERCS framework helped them to have supportive but purposeful conversations where potential impacts of substance use on children are not only explored but are also addressed.

Supporting work with parents where child protection is involved

Four practitioners reported that some of the most challenging work they encountered with parents was supporting them when child protection agencies were involved. They found that the PERCS framework was helpful in working through child protection concerns with parents.

Highlighting the importance of integrated care

Three participants reported that the PERCS framework was helpful in facilitating a wrap-around approach to treatment planning with parents that incorporated the needs of children.

Two practitioners also reported using the framework to provide some education to other practitioners around child-focused practice.

Identifying intergenerational factors impacting upon parents and children

Interestingly, three participants found that the framework helped them to uncover the impacts of intergenerational substance use and disadvantage more broadly on parents and the ways in which these intergenerational cycles were being passed on.

Through using the PERCS framework, two of these practitioners talked about working with parents to develop insight and practical strategies to address and potentially disrupt these intergenerational cycles.

Child-focused practice: A lack of time or confidence?

All 19 participants agreed that the targeted approach of the PERCS conversation guides supported parental engagement and child-focused practice where parents experiencing FDV and/or substance use issues presented to services. None of the practitioners interviewed reported time limitations as a barrier to engaging parents in conversations about their children’s wellbeing – a significant contrast to many of the responses received in Emerging Minds’ 2018 needs assessment.

This is most likely because the practitioners and organisations recruited for the pilot described a strong commitment to child-focused practice. While this narrow sample is a limitation of this pilot, many of the insights provided suggest the PERCS guides offer new possibilities for engaging with parents in ways that support children’s safety and wellbeing. The guides were seen to help practitioners support fathers to connect with ethics about safe and respectful behaviour; support mothers to articulate the effects of violence on their most important relationships; and support all parents to consider how their use of substances affects their children, and to take further steps and access additional supports.

Rather than time constraints, some participants described confidence in asking parents about their children as an important challenge to acknowledge. Even those who described long histories of having child-focused conversations with parents mentioned occasions when confidence was an issue. While the authors of this pilot want to avoid general statements about other workforces, time constraints may be more likely to be provided as a reason for avoiding child-focused conversations where practitioners feel unsupported or underconfident in firstly identifying FDV/substance use as an issue, and then asking parents about their children’s wellbeing where it is.

Organisational drivers to support child-focused practice

The overwhelming advice from participants was that consistent use of the PERCS conversation guides aided confidence in talking to parents about how FDV and substance use could be affecting their children. Even those practitioners who were experienced in child-focused practice reported that they don’t always ask child-focused questions, especially when they make assumptions that parents do not want to discuss the social and emotional wellbeing of their children. The PERCS domains provided these practitioners with a physical practice reminder that parents, overwhelmingly, will answer questions about their children if asked.

Limitations and future research

As well as a strong commitment to child-focused practice, participants all enjoyed strong support from their organisation and practice leaders in employing this practice. Further investigation is needed into the organisational support systems that allow a conversation guide such as PERCS to be used effectively with parents affected by FDV and substance use. What is the kind of authorising environment required for a practitioner to effectively utilise the conversation guides in their practice? What organisational drivers can adult-focused services put in place to ensure practitioners are supported to focus on the social and emotional wellbeing of children living in contexts of family violence or parental substance use? These are important questions to be investigated if children’s safety is to authentically become everyone’s business.

This pilot relied heavily on practitioners’ reflections of their own confidence and skills, through the use of semi-structured interviews. An extension of this pilot would include quantitative and qualitative data from clients to assess the outcome on children.

Conclusion

This pilot evaluation engaged a group of 19 practitioners to analyse the contribution of the PERCS conversation guides to their child-focused practice with parents affected by violence or substance use issues. The results of the semi-structured interviews showed that for this cohort, the conversation guides had a positive effect on their child-focused practice with fathers who were perpetrating violence, mothers who were the victims of violence, and parents who were using substances. The pilot actively recruited staff who had strong understandings of FDV and substance use; their interaction with mental health, social isolation and past trauma; and their effects on children. The FDV practitioners were all supported by their organisations to hold child-focused conversations where they suspected, or parents disclosed, violence, abuse, intimidation, threats, coercion or control.

Despite the support and commitment of all the practitioners to child-focused practices, they nonetheless described challenges and dilemmas when faced with options to directly ask parents about their children’s social and emotional wellbeing. Participants cited a range of challenging factors including confidence level, missed opportunities and the lack of practice cues, as well as other complex considerations. The PERCS conversation guides were shown to improve practitioners’ confidence in holding challenging yet respectful, collaborative and curious conversations with parents, providing them with a practical suite of options to weave child-focused conversations into their practice.

This pilot has provided confidence in the PERCS conversation guides, particularly where practitioner understandings and organisational commitment support child-focused practice. The next steps involve work with practitioners and organisations where confidence in child-focused practice is not as high, or where commitment has not been as strong. Findings suggest the conversation guides can be used as part of an overarching framework that supports practitioners to ask child-focused questions of parents who are experiencing FDV and/or substance use issues, as part of a prevention and early intervention strategy. Ultimately, this strategy should be tailored to improve the short- and longer-term outcomes for children’s mental health and social and emotional wellbeing.

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