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Your First Phone Call and Visit Can Make the Difference with Multi-Risk Families

	Read this in-depth case study to see how a combination of approaches specifically tailored to this young mother’s circumstances helped her keep her family together

Making your first contact with a high-risk family a home visit rather than expecting them to come to you is your first signal to that family that you respect their circumstances. Sarah Landy and Rosanne Menna, authors of Early Intervention with Multi-Risk Families, say that demonstrating this sort of flexibility and showing a willingness to adapt to a family's needs will make it easier for the family to receive services.

Consider these suggestions for initiating contact with hard-to-reach families:

Making the initial phone call

• In the first telephone call, be clear and direct and tell the parent how you got her name, who you are, and what agency you work with. Let her know what services you can offer.
  
  
• If you are finding it hard for the parent to understand you, offer to have someone who speaks her primary language call her.
  
  
• Ask if there are any immediate services needed. Practical and concrete help—securing housing, food, child care, or other services—offered early on can help establish trust.
  
  
• Ask the parent if she would like to have more information. If she agrees, ask whether now would be a good time to talk or would she prefer you to call back at a more convenient time.
  
  
• If she declines a home visit, ask if you can send information by mail. Suggest that you could call back in the future or at a better time (e.g., "I can give you another call when you are not so busy with the baby").
  
  
• Be open to hearing what individuals want to tell you. Some parents may want to terminate the conversation immediately, whereas others may feel anxious and in need of reassurance.
  
  
• Be brief with the first call—the person you are talking to may be struggling with a baby at the same time! Be friendly and inviting, without being overly familiar.
  
  
• Make it clear that the parents are in control from the beginning; you will not contact them again without their express permission to do so. Be clear, however, that you would like to call again if permitted.
  
  
• Offer alternatives regarding a time for a visit, type of information you can provide, and home or office contact, and let the parents know that the first contact does not necessarily require an ongoing commitment.
  
  
• For families who do not have telephones, leave cards or notes to introduce yourself. It is important to make clear that you are just dropping off the information; you are not assuming they will receive you without prior notice, and you are willing to return at a time that is mutually agreeable.
  
  
• If no one is home, leave the note with an invitation to call you back.

Making the initial home visit

• In the first visit, the information-gathering phase of working with the parent is interwoven with relationship building. Sympathetic listening and collaborating with parents to help them to develop a better understanding of themselves and their children supports a strong working relationship.
  
  
• Continue to let the parents know they are in control: wait to be invited to sit, and ask or watch for any messages about what kind of involvement with their children is acceptable for you to engage in.
  
  
• Ask general questions so that parents can choose what to talk about.
  
  
• Listen to the parents so as to begin to understand their unique interests and capacities. Listen to their stories as they want to tell them, and be aware of what they may have chosen to leave out.
  
  
• Engage in conversation but do not ask a set of questions or fill in an information form in the family's presence.
  
  
• Use active listening techniques: ask questions that naturally follow what the parents have already talked about or that are in tune with what is happening at the time.
  
  
• Acknowledge the presence of other family members and friends, and follow the parents’ lead regarding the extent to which others are to be involved in the discussion. For instance, family elders may need to approve of you before the mother will be permitted to talk with you.
  
  
• Following the parent’s lead about whether to focus on her own needs or those of her infant. For a mother who is able to positively identify with her child, being able to share her sense of joy in the child and her concern about his welfare is a way to establish a connection. For a mother who has difficulty identifying with her child, a visitor’s focus on the child may be experienced by the mother as rejection or neglect of her own needs.
  
  
• Rather than suddenly asking about the parent’s background, reserve these types of personal questions for when you are admiring her baby or child, if appropriate. Then, for example, you may want to ask her how having a baby reminds her of how it was for her growing up. This allows her to respond at a level at which she is comfortable.

Building the relationship After the first contact has been made, you can continue to develop a trusting relationship by respecting that the family is doing the best they can. Enhancing the competence of parents is important: Focus on positive aspects of parent–child interactions and then follow the parents’ lead to move to more problematic areas, which allows the parents to work from a position of strength. Work with the parents as partners, demonstrating they have ultimate control over the direction of the intervention. The experience of mutual respect supports their capacity to engage in a similarly respectful relationship with their children. Support a parent to feel understood and empowered, empathizing with her experience and confirming her reality. This enables her to reflect on her actions and how they might affect her child. (In conditions in which she feels criticized or threatened, she is more likely to become defensive and less able to consider how her child feels.) Taking these initial steps is often the starting point for the parent to feel a real connection with the service provider. When the intervention begins on this footing, the door is opened for much greater strides.