This report describes a new approach to helping highly-challenged parents in disadvantaged communities – those who have been unable to find and engage productively with existing helping agencies: the Integrated Therapy Advocacy (ITA) approach. We will report on a pilot project and describe the impact that the approach has had on the client parents and their families, together with some wider learning.
Background
ITA was conceived in response to our observations that vulnerable, disadvantaged families are highly diverse and often complex (such that one-size-fits all services are unsuitable) and that the parent(s) struggle to find or access other helping agencies. Often attempts to engage fail due to the unsuitability of existing services or other complex factors; this can result in the parent experiencing negative feelings such as shame, despair and a sense of being inadequate. We also observed how engagement and attendance is often disrupted by critical life problems and instability in family life.
The rationale for integrating therapy with advocacy (and other problem-solving help) is based on the observation that a) psychological problems inhibit the parent’s use of organisations which provide practical help while, b) conversely, unresolved practical life challenges inhibit access to counselling services. Tackling both challenges in a near-simultaneous and integrated way was seen as a way of resolving this impasse.
ITA Configuration
Our specification for ITA is that it should be delivered by a qualified counsellor experienced in working with disadvantaged families. In this project, the counsellors were BACP-accredited. Our specification for an advocate is a professional a) with experience of dealing with vulnerable adults and who has completed on-line advocacy training. In this project, half the clients were helped by a counsellor working alongside an advocate and half by a counsellor who also acted as an advocate.
For both configurations, a key feature is a person-centred ethos and delivery flexibility to cater for the unpredictable life challenges which otherwise can disrupt attendance.
The Parents
Parents from two disadvantaged settings who were “stuck” and/or overwhelmed with a combination of life challenges and psychological impairments were identified by partner organisations (collaborating charities and schools). They comprised 7 referrals and 5 self-referrals.
For all clients, it was evident that there was a complex interplay between psychological background and life challenges; and every parent presented with their own individual combination of factors. Nearly all parents bore the burden of multiple Adverse Childhood Experiences (ACEs). Common themes explored in therapy included:
- history of trauma and abuse
- bereavement and loss
- parent-child relationships (intergenerational)
- parents’ neurodivergence
- unhealthy family relationships/dynamics
- challenges of co-parenting
- parenting strategies
- chronic and acute health issues
- negative impacts of barriers to navigating health and education systems
The practical challenges experienced by clients and addressed with advocacy included:
- navigating and completing benefit applications
- educational health care needs assessment (EHCP’s) and complaint process
- psychological assessment request to GP
- the right to choose ADHD assessment
- the challenges of parent-school meetings
- preparation for a school placement tribunal
- school transitions (primary to secondary)
- stressful housing situations
- safeguarding concerns
ITA Delivery
The service was delivered by BACP-accredited counsellors who Our specification for an advocate is a professional a) with experience of dealing with vulnerable adults, b) who has completed advocacy training, and c) can confidently take action on a wide range of practical issues.
Outcomes
Of the 12 parents referred, 10 engaged with the ITA approach. Attendance at sessions was 90% and the drop-out rate was 0%, enabling planned endings to be reached in each case.
Client feedback on their experiences of the ITA model showed that simultaneous access to both practical and therapeutic support was seen as invaluable. They described the cohesive approach between advocacy and therapy as highly beneficial.
There was a consensus that the accessibility, flexibility and continuity of the ITA model provided opportunity to develop trust in the practitioner/s, explore experiences of trauma and life challenges, develop confidence in self/autonomy and enhance their relationships with their children. The knowledge, skills and boundaries developed served to support partner/ex-partner relationships as well relationships in the extended family etc. In addition, learning practical skills around tracking appointments/meetings etc. offered a further sense of resourcefulness.
One client summed this up: “since working with you I have learnt to pause and think before speaking…I have learnt that I am not responsible for what’s happened to me in my traumas nor for how my mum chose to raise me. Most importantly I know I’m a bloody good mum. I know now what I have gained as tools I can show my children and help them in their daily lives.”
The result for all parents was a more stable, controlled family environment with fewer practical emergencies, a greater capacity for self-confidence and self-reliance, and ability to tackle deeper issues mental health issues effectively.
In the Appendix we provide five representative case studies which indicate the diversity of the client situations encountered and how ITA helped.
Other Learning from the Project
Clients’ feedback showed no obvious preference for the single person therapist-advocate approach compared to the two person therapist + advocate approach. Having a support service which spanned both psychological and practical needs was more important than the number of practitioners providing that support.
While the clients’ responses were overwhelmingly positive, we recognise that this approach is not without its challenges. The flexibility that is inherent in the model (at least for optimal results) does make scheduling and time management more difficult – although it is manageable, with communication by text being particularly helpful.
Learning about the situation of highly-challenged parents
The relative ease with which the ITA approach works supports the hypothesis that a key reason why many parents remain unhelped in disadvantaged communities is that counselling and other helping agencies are separated in space and time (travelling difficulties and/or long waiting times); and that this means that the close interplay between the psychological and the practical is not addressable.
However, there are other reasons and, with varying levels of support beyond our observations, we would suggest the following:
- Many family situations are too complex for one-size-fits all services
- Many organisations are too stretched to deal with “difficult” cases
- Some counselling organisations implicitly believe that these parents are not suitable for, or ready for, counselling
- Inconsistencies, confusion, ‘red tape’ and long waiting times
- Levels of trust in many helping organisations is low
- Fear of being judged, criticised or “being reported to social services” if a psychological problem is revealed
- Societal attitudes towards these parents are often negative.
Conclusion
The Integrated Therapy and Advocacy Approach is able to address the complex needs of vulnerable and disadvantaged families, where non-integrated services have been unable to help. Its further development and growing evidence base in other communities could lead to its wider deployment which have a major positive impact on family mental health.
If you would like to know more about the ITA approach, please contact us on info@flourish.org.uk
Della Austin (Clinical Lead and Project Director)
Report updated 24.05.2025
APPENDIX: Case Studies
These case studies are anonymised to avoid identification. Nevertheless, the client’s permission to use them has been obtained.
Elizabeth
Elizabeth lived with her partner and was primary carer to their two children. She had a disabled child and a child waiting for a neurodiversity assessment. Elizabeth described herself as suffering with depression and anxiety for most of her life. She identified multiple ACE’s and an ongoing turbulent relationship with her alcoholic parent. She described the loss of her other parent as highly traumatic and something she could not talk about (despite the loss taking place decades earlier).
Elizabeth had a somewhat tense relationship with school as she felt her disabled child’s needs were not being met. Elizabeth’s anxiety meant she would be in touch with school on a daily basis. This did little to alleviate her anxiety or help to reassure her.
In addition to Elizabeth’s psychological distress, she was angry and confused that an application for her child’s EHCP had ‘been in the system’ for a long time and she felt there wasn’t anything she could so to challenge the situation.
Elizabeth worked with two practitioners, a therapist and an advocate. She explored trust and safety in her own childhood and recognised how this impacted in the present. She worked through issues of grief and loss, developed interpersonal skills and set boundaries within her family including her parent and siblings. She explored options for returning to education. Her work with the advocate enabled her to question the Local Authority position and the legal timescales for her child’s EHCP. With the support of the advocate, she explored options of putting in a complaint and, while this didn’t happen, Elizabeth felt more confident in her discussions with the school.
At the end of the work, Elizabeth felt a massive shift in her self-worth, her contact with school was far less frequent and, when meetings were arranged, Elizabeth felt able to negotiate as an equal partner. She became active in her community, developing group support and activities for families with disabled children. She said:
“I really like your service. It has helped me no end. Working with you has changed my life. Since working with you I have noticed I feel less negative. I am learning ‘re-wording’ so instead of saying things like I can’t, I’m more open to possibility. This experience is helping me heal from my past. I’m gaining in self-confidence and understanding my family in a different, calmer way. I’m more confident talking things through with my children and learning different ways of dealing with behaviour. I’m putting in boundaries without feeling guilty.”
Jenny
Jenny presented as needing help with her autistic son. She reported high anxiety, chronic overwhelm, and feelings of failure – all of which resulted in an inability to take action. Her local education authority (LA) had refused to assess her child’s need for an Education Health Care Plan (EHCP) – despite having a diagnosis – and, due to Jenny’s ADHD, she had not challenged this decision within the timescale allowed.
Working with the therapeutic advocate, Jenny was able to explore her fear of failing her son, which was holding her back. She was able to connect this to her own childhood experience of being an undiagnosed neurodivergent child and her parents’ inability to understand or advocate for her. Alongside the therapeutic support, the therapist-advocate shared research into the statutory requirements of the LA which weren’t being fulfilled, and wrote a supporting letter which Jenny used to successfully access the Needs Assessment that had been previously denied.
Having moved her son’s case forwards, Jenny felt lighter. She was then able to make medical appointments for herself to address the multiple health issues she had been ignoring. She has begun to talk more about the impact her own childhood experiences have on her current parenting challenges, leading to a greater self-acceptance and ability to cope. In her feedback, Jenny said:
“I wholeheartedly believe that without this help my mental health, as a result of the EHCP, would still be awful. Which understandably has a huge impact on my son. And on our family life. It has made such a positive difference to our quality of life, having this support. Things just feel a lot more positive now…Sincerely. Thank you, from me and my family. I have felt truly supported and a lot less on my own.”
Maggie
Maggie and her two children were living in temporary accommodation following her domestic abuse. Maggie’s anxiety had escalated and she had found it difficult to leave their accommodation, other than to take the children to school which was often fraught and resulted in late attendance. She also suffered from a health condition and was undergoing further tests.
Maggie was referred to the service. On initial contact, she was highly anxious about accessing support because of her limited capacity to travel to venues. As a result, a room was secured near her accommodation and Maggie was able to meet with the team in person.
As a consequence of Maggie’s and her children’s circumstances, there was already some professional support in place. Maggie’s heightened anxiety prevented her from ‘keeping track of where things were up to and who was talking to who.’ The advocate was able to liaise with the professionals and update Maggie on how things were progressing. The advocate also supported Maggie in completing an application for additional financial support, which was successful.
Maggie accessed therapy and spoke in depth about her past experience of domestic abuse and current fears for her family. As a result, although Maggie still struggles with her health and her situation, she has greater self-confidence and greater ability to engage with helpers. Her feedback included the following:
“It’s really good having you both working together. There’s lots of people working with me but sometimes it’s like no one’s talking to each other. This service has been very helpful especially because I can’t travel anywhere…well…because of my condition. The advocate has helped me so much. She sorted my applications and made it all work. Also, having someone of my own to talk to has really helped me especially with everything that’s happened. Talking helps me make sense of things and makes me feel better in myself.”
Maxine
Maxine and her two children lived in an unsuitable flat in a neighbourhood which felt unsafe for her and her children. Her daily challenges, combined with childhood trauma, led to a reclusive life-style with multiple anxiety-related symptoms, low self-esteem and bouts of self-harming. She worried that she was not a good mother. Help to find more suitable accommodation was patchy and often increased her anxiety.
An advocate (a retired social worker) was brought in to help; this involved two face-to-face sessions and some text exchanges. She helped Maxine with advice and the form-filling that was required to get her onto on the waiting list for social housing. This provided her with some self-confidence and some hope. This enabled counselling to be more productive; she was able to work through her childhood issues.
After nearly a year her family moved into more suitable and calmer accommodation: her life changed immediately – she felt empowered, got a job and was able to create a safe and nurturing home for the family. Her children stopped worrying about their mum, played with their friends and engaged fully with education.
Isla
Isla was mum to two children. One of her children had additional complex needs and the other was awaiting assessment for ADHD. Isla had a history of depression, anxiety as well as physical ill health at times. She had previously accessed therapy after birth of her first child but had been on the waiting list for six months before her sessions began. The therapy was time limited and Isla felt let down by the level of support.
When Isla was referred to Flourish, she had her first meeting with the team within two weeks. She initially engaged with the therapist and then opted to access the support of the advocate alongside her therapy.
Isla used the therapy to explore past childhood abuse, eating disorder and complex bereavement. She was able to make sense of her depression and anxiety; and how her well-being impacted on the well-being of her children upon her beliefs about her future.
Isla was able to speak to the advocate about her lack of confidence in challenging systems of support for her children. The advocate helped Isla work through her concerns about delays in her child’s EHCP assessment and contact the correct professionals to address this. Isla is now engaging with life. She has enrolled on a Level Two health care training course and plans to enrol on GCSE courses later this year.
“This experience has helped me heal from my past. I’m gaining in self-confidence. I could not have challenged things on my own…my child being let down was so raw. The advocate made it all work. I understand my family in a different, calmer way. I’m more confident talking things through with my children and learning different ways of dealing with behaviour. I’m putting in boundaries without feeling guilty. Working with you has changed my life.”