Research funded by National Institute for Health and Social Care Research (NIHR) 1 Firming up our understanding of Family and Group Conferences (FGC) for adults.

  1. Summary report of Deliberative Forum process Jerry Tew and Sharanya Mahesh, University of Birmingham October 2023

This report comprises of two sections. Section one summarises the key findings from our analysis of the research literature and our national survey of practice. This provided the ‘baseline’ for the Deliberative Forum process. Section two comprises the notes from the group discussions that took place in the Deliberative Forum. These were in response to the unanswered questions that had been identified from our analysis of the literature and national survey results.

We would like to acknowledge the invaluable contributions made by the wider research team and those who took part in the Deliberative Forum.

Family and Group Conferencing for Adults: how it works and what difference can it make in people’s lives
Research funded by National Institute for Health and Social Care Research (NIHR)


A. Characterising model(s) of FGC practice in adult social care and mental health
What we think we know – Who would FGC be suitable for?
FGC can work for:
▪ all adult service user groups
▪ planning for support and care around a person
▪ recovery and enablement
▪ safeguarding

Works most easily when:
▪ Offered as an early response
▪ Potentially supportive network already exists.

Unsuitable where:
▪ No current network exists or the person not comfortable sharing ‘private business’
▪ Preconditions not met for working with domestic abuse (safety, taking responsibility)

Values – Values are important but these tend to be implicit e.g.

▪ People have the right to make their own decisions
▪ Decency, politeness, and respect for each other’s humanity

Preparation – Process is facilitated by an independent co-ordinator who will

▪ Meet all participants to establish concerns, aspirations, preferences
▪ Negotiate inclusion of widest network of family, friends and supporters with whom person feels comfortable
▪ Set the tone for respectful communication and acknowledgement of conflict and differences

Conference – During the Conference

▪ Clear differentiation of roles of coordinator and advocate
▪ Neutral venue chosen to suit preferences of individual and their network
▪ Start with sharing food or other informal ‘doing with’ activity
▪ Practitioners invited to join ‘shared learning platform’ (Conference) – not to dictate agenda
▪ Private time (but to include advocates in some instances)
▪ Individual and their network devise plan for support, recovery, enablement
▪ Individual and their network share plan with relevant practitioners, including agreeing any provision of services

Follow through / follow up
▪ Little consistency in relation to reviews / support for implementation of Plan / option of follow-up conferences

Family and Group Conferencing for Adults: how it works and what difference can it make in people’s lives
Research funded by National Institute for Health and Social Care Research (NIHR)

3 B. What sorts of positive outcomes may be achieved by having FGCs?
What we think we know – Collective decision and implementation
Plan is made and implemented that builds on the preference, strengths and capabilities of the person and their network

Generic outcome – Enhanced capability / wellbeing: people living a meaningful, valued and connected life
Agency / professional agendas
▪ All concerns raised by practitioners are addressed
▪ More efficient and/or better tailored use of resources (services, direct payments, etc)
▪ Positive and considered risk taking

Changes affecting individuals
▪ Recognition, respect, and sense of belonging
▪ Relational agency: empowerment, voice and control through being better connected with, and understood by, others

Changed relationships
▪ Restoration (or development) of open and supportive relationships that maximise possibilities for sharing and reciprocity
▪ Wider and more sustainable circle of support

Lifeworld and service systems – Improved partnership and trust, and more equal power relationships between family/social networks and agencies
C. What are the ingredients that can lead to successful outcomes?
What we think we know – Power – Service system willing and able to share power with people and their networks
▪ Challenge and support NOT ‘doing to’ / ‘doing for’

Power dynamics
▪ Experience of agency – setting the agenda
▪ Co-operative power through reciprocity
▪ Negotiation of protective power

Format and structure
Preparation, structure and practicalities can help to create the ‘scaffolding’ for respectful and purposive ‘courageous conversations’/ ‘good conversations’

  • Inclusion and connection
  • Widening circle of support
  •  Overcoming barriers due to shame and stigma
  • Outward focus – connecting into wider community

Family and Group Conferencing for Adults: how it works and what difference can it make in people’s lives
Research funded by National Institute for Health and Social Care Research (NIHR)
The format for involvement of practitioners at the start of the Conference is important in promoting dialogue and mutual understanding
Recognition – Recognition of 4 Lifeworld and service systems

▪ Personhood of all participants
▪ Culture and identities
▪ Agency and citizenship
Restorative processes

The FGC process can provide a place for

▪ Acknowledging where hurt and harm has occurred
▪ Sharing feelings of shame
▪ Reconnecting where relationships have become distanced or fractured

Discovery – People learning new ways of doing and being together
Risk – Risks are managed collaboratively and collectively
Back-up and follow through

Sustainability of positive outcomes can depend on
(a) mechanisms to support ongoing communication within the network
(b) availability of back-up from service system

D. How acceptable and appropriate are current models of FGC practice to people from different cultural and social backgrounds?
What we think we know – Assumption

There appears to be an assumption that since FGCs worked for Māori children, they are culturally appropriate for all communities.

  • Views about cultural appropriateness
  • Limited exploration about FGCs being culturally appropriate
  • Professionals need to have a nuanced, culturally sensitive view about what ‘family’ means to the person, the dynamics between the network and values of the group.
  • Services need to be open and curious about cultures than attempting to fully understand all cultures

Role of professionals/service
To fully accommodate cultural norms, it may require a significant shift in the role of professionals and processes and mechanisms.

Family and Group Conferencing for Adults: how it works and what difference can it make in people’s lives
Research funded by National Institute for Health and Social Care Research (NIHR)

Questions & Responses
Who should be offered a FGC service? For example, can a FGC be offered
• in a crisis situation
• where there is limited or no network
• where a person has diminished capacity
• where there are significant relationship issues?
▪ In general, FGCs can be offered in all situations.
▪ FGCs are suitable in a crisis situation although, important to make a distinction between an acute and chronic crisis. An acute crisis can involve safeguarding and in a chronic crisis, people may feel stuck between services that are not meeting their needs. In a crisis situation, FGCs can bring network and agencies together and provide a constructive forum that may also be helpful in managing emotions.
▪ Whilst FGCs can be offered in situations where there are significant relationship issues (with or without engagement from network), these need to be handled carefully in the preparation stage.
▪ FGCs can be offered where there is limited and/or disengaged networks. In such situations, coordinators need to be creative and think of ways to build a network.

Do FGCs work for all cultures and social backgrounds?
▪ Where there is a lack of mental capacity, advocates can act on behalf of the person. If the person doesn’t want to be involved, the carer(s) can become the focus of the FGC and not the person.
▪ Offering an FGC as a ‘last resort’ is not very helpful but rather should be provided as a ‘preventative’ and/or ‘early intervention’ tool.

• In engaging with traditionally patriarchal families
• Where there are overriding concerns of social shame
▪ Whilst an FGC can be offered and can work for all cultural groups, there is some reluctance to engage among some Asian communities like- Pakistani and Bangladeshi communities.
▪ This reluctance stems from ‘having respect’ for family members and not wanting to show vulnerability. However, FGCs can also provide a mechanism whereby younger generations can talk in a different and more direct way with their elders
▪ Like in most cultures, those from ethnic minority groups also want to show ‘their best side’ rather than their weaknesses which sometimes affects engagement.
▪ When thinking about shame, it is important to consider both societal and cultural norms that may be leading to shame- it is not always that cultural norms may be leading to shame.
▪ In some Asian cultures, patriarchy exists- the preparation phase and the role of an advocate particularly important to mitigate dominance of a single individual.

To fully embrace cultural differences, the process needs to be flexible, professionals need to demonstrate sensitivity and develop ‘human skills’.
Can the FGC rules and format be too rigid to be culturally appropriate in some instances?
Culture is just one barrier amongst other barriers that may present as challenges in setting up FGCs.

Ethnic / cultural matching
▪ The potential impact of ethnic or cultural matching varies for each family – and may not always be positive.

Family and Group Conferencing for Adults: how it works and what difference can it make in people’s lives
Research funded by National Institute for Health and Social Care Research (NIHR)
6 How far is it helpful to match the background of the co-ordinator with that of the person and their network?

▪ There may be assumptions made around both the ethnic / cultural identity of the coordinator and or the individual and their network that may turn out not to be appropriate.
▪ Where people have had a less positive experience with a professional from a specific cultural background, may not prefer or disengage with other professionals from the same background.
▪ In some instances, especially where families are more traditional, a professional from the same background might be seen to carry the same/similar views which is not always helpful.

How can power imbalances be managed – both within networks and between networks and professional systems?

▪ Advocates can be a useful resource in cases where there may be power imbalances within the family – advocates can step up during private time to ensure that ‘voices’ are heard.
▪ Co-ordinators need to have an awareness of power imbalances within networks and use the preparation stage to mitigate/address it.
▪ Typically, there can be a point at chich the person and their network ‘click’ as they realise that they (and not the professional system) are in charge of the process.
▪ Choosing a venue of importance to the person and enabling their choice of food may help power imbalances and offer a tangible demonstration of who is in charge.
▪ In the case where there is an obvious power imbalance within the network, the conference may be stopped.
▪ In addition to giving people the choice of food and venue, it may be useful to provide some coaching to help people find ways to express themselves.
▪ Organisational support for sharing power – such as allowing professional uncertainty, allowing flexibility to coordinators to support creative working and address power imbalances.

Preparation is important – all information needs to be shared with the person and their network.
▪ Based on previous experiences with professionals, people sometimes do not feel that they can make ‘decisions’ as they have always been told what to do.

Family and Group Conferencing for Adults: how it works and what difference can it make in people’s lives
Research funded by National Institute for Health and Social Care Research (NIHR)
7 What are key things before and during the conference that enable ‘courageous conversations’ to take place?

What is realistic in terms of ‘scaffolding’ for restorative processes? – Enabling courageous conversations

▪ Time during the preparation phase is crucial to build rapport with the person and the network.
▪ Sharing information before the Conference and adapting the Conference rules to accommodate family dynamics.
▪ Having some but not too many ground rules is important.
▪ Recognising and being sensitive to cultural norms and respecting family culture – environment, food, venue, professional language, etc are important factors to be considered.
▪ Active listening, ensuring all voices are heard is essential.

▪ Coordinators play a key role in bringing everyone together and setting a positive and constructive tone in preparing participants for their Conference
▪ Facilitation skills and creative thinking in difficult situations are important.
▪ Offering / arranging mediation prior to the Conference
▪ Flexibility of format
▪ Setting the theme of the meeting so that hurt or trauma can be acknowledged, strong emotions may be expressed, boundaries can be agreed, and it can be seen as the start of a therapeutic process.

How flexible can the overall ‘package’ of FGC be to take account of culture, potential for abuse or exploitation, capacity issues and estranged relational network?
Are there particular ways of setting up the conversation with practitioners that promote an attitude of ‘shared learning’?
▪ FGCs can be flexible to take into account the needs of the person, culture, potential for abuse or exploitation, capacity issues, etc.
▪ The fundamental value of it being person-centred supports co-ordinators to take these sorts of factors into consideration – although it is important to recognise whether other professionals are working with similar principles.
▪ The professional system needs to be willing to be tolerant of uncertainty in order to allow network to be in charge of FGC process and create a space for shared learning.
▪ The venue, location, hybrid options, equipment, having enough time – all these elements can be flexible. Flexibility may also mean- having the perspective ‘to see where it goes’ instead of having ‘a fixed package’ of things to do.
▪ In cases of safeguarding, there may be less flexibility as agency and statutory procedures may take priority and set the main agenda for the FGC in terms of keeping the person safe or addressing potential abuse or exploitation.
▪ FGC navigates diverse circumstances – the individual defines their own needs in conversation with their network. It is about enabling dignity, respect, autonomy, collaboration and having equal power.

What sorts of outcomes should we expect from FGCs over and above making and implementing a Plan?

▪ Wellbeing – in the sense of active flourishing and having a ‘bigger life’ that involves engaging with the people and things that matter (not just having basic support needs met).
▪ Affirming and (re)claiming personal and social identities – through network members listening to who they are, and what matters to them – thereby validating the person’s sense of self.

Family and Group Conferencing for Adults: how it works and what difference can it make in people’s lives
Research funded by National Institute for Health and Social Care Research (NIHR)
8  Learning from and with each other – recognising difference in opinions, recognising conflict but also creating a space to come to a collective understanding that can underpin a shared plan.

▪ Doing with rather than doing to – the person and their network develop their own intended outcomes rather than outcomes being professionally led.
▪ Providing hope to the person, empowering the person in the process.
▪ Acknowledging that outcomes can happen outside the FGC space. The Conference can be a space to celebrate success that occurred outside of the FGC.
▪ In some cases, merely mobilising a network and bringing people together can be an outcome.
▪ Identifying safeguarding issues and developing collective strategies for addressing these.
▪ There have been instances where families have used the ‘FGC process’ within their own families to continue to resolve other situations in their lives.

How can sustainability be best achieved after the Conference?
What should be the minimum and maximum offer in terms of reviews and ongoing back-up support?
Are there particular tools or processes that can be helpful in sustaining an effective network?

▪ There is a need to be a degree of flexibility on how and when reviews are offered.
▪ Reviews may serve different purposes – e.g., sometimes need to revise plans due to changes in circumstances.
▪ As a rule, it is useful to have reviews to check on the progress made with agreed plans and ensure accountability.
▪ Reviews may be set for a certain date, trigger point or any time that the person and their network feel it be appropriate.
▪ In situations where plans are working, there may not be a need for ongoing or regular follow-ups.
▪ In some instances where new issues have risen, a new conference can be called in the place of a review.

▪ Ensure that all network members have a copy of the plan on completion of the Conference.
▪ Provide ‘online’ access to the plan to enable network members to update the plan.