This Policy Brief explores the evidence regarding improving access to services for marginalised and vulnerable families with young children, and how families can best be engaged and supported.

Why is this issue important?

While most families of young children are well supported socially and make good use of services, some do not (Carbone et al., 2004; Moran &amp; Ghate, 2005; Winkworth et al., 2009, 2010). Children from families who have poor social supports and make limited or no use of community support services are at increased risk of poor health and developmental outcome

Centre for Community Child Health

English

Analysis and Policy Observatory (APO)

 No 18 2010 
 
Initiative of:                       
 
 
 
POLICY BRIEF 
Translating early childhood research evidence to inform policy and practice 
Engaging Marginalised and 
Vulnerable Families 
 
This Policy Brief explores the evidence regarding improving access to services for marginalised 
and vulnerable families with young children, and how families can best be engaged and supported. 
 
 
Why is this issue important? 
While most families of young children are well 
supported socially and make good use of 
services, some do not (Carbone et al., 2004; 
Moran & Ghate, 2005; Winkworth et al., 2009, 
2010). Children from families who have poor 
social supports and make limited or no use of 
community support services are at increased risk 
of poor health and developmental outcomes. 
Those parents most in need tend to be the ones 
who are least likely to access support (Fram, 
2003; Ghate & Hazel, 2002; Offord, 1987). These 
include families with low incomes, young parent 
families, sole parent families, Indigenous 
families, families from culturally and linguistically 
diverse communities, families with a parent who 
has a disability, and families experiencing 
problems with housing, domestic violence, 
substance abuse, mental health or child 
protection (Carbone et al., 2004). Many families 
experience several of these problems 
concurrently.  
The cost of failing to provide timely support to 
these families is considerable – as problems 
worsen, they become more difficult and 
expensive to remedy, and the families become 
more marginalised. Ultimately, this compromises 
national productivity (Hertzman, 2002; Social 
Exclusion Task Force, 2007). Concerns about 
this trend have led to the development – by the 
Australian Social Inclusion Board in 2009 and 
2010 – of a national social inclusion agenda 
(Hayes et al., 2008). One aim of the agenda is to 
increase participation of young children and their 
families in early childhood services (Katz, 2007; 
Social Exclusion Task Force, 2008; Vinson, 
2009). 
 
 
 
 
 
 
 
 
There has also been a significant change in how 
vulnerable parents are viewed and hence in how 
they can best be supported. Such families have 
often been designated as ‘hard to reach’. This 
term is problematic in that it implies that the 
problem exists in the families themselves, rather 
than in the services provided for them (Brackertz, 
2007; Brackertz & Meredyth, 2008; Slee, 2006).  
There is a growing consensus that rather than 
thinking about certain families as being hard to 
reach, it is more useful to think of them as being 
people whom services find difficult to engage and 
retain (Slee, 2006). This changed perspective 
has considerable implications for services and 
service systems. 
 
“There is a growing consensus that 
rather than thinking about certain  
families as being hard to reach, it is  
more useful to think of them as being 
people whom services find difficult to 
engage and retain.” 
Definition: For the purposes of this Policy Brief, marginalised and vulnerable families refer to 
those who are receiving little support in their family and parenting roles either from personal 
support networks or from community-based support services. 
Policy Brief No 18 2010:  Engaging Marginalised and Vulnerable Families  2 
www.rch.org.au/ccch/policybriefs.cfm 
 
 
 
 
 
 
  What does the research tell us? 
The research evidence regarding marginalised 
and vulnerable families and how best to meet 
their needs is limited. This is partly because most 
studies of effective interventions and support 
services have focused only on their effectiveness 
for those who actually used them. There are few 
studies of those who did not make use of 
services or who dropped out of programs, and 
we do not know much about the relative merits of 
different methods of engaging vulnerable families 
(Katz et al. 2007).  
Why parents don’t use services 
While research identifies some issues that stop 
parents from making use of services, the vast 
majority of barriers are not of parents’ making: 
parents generally want to receive help if it is 
appropriate to their needs. In most cases, it 
appears that the key issue is retaining families in 
the services rather than having them access the 
service in the first place. Most parents make 
contact with services, but some then cease 
attendance, attend infrequently, or do not 
become fully engaged (Carbone et al., 2004). 
  
 
 
 
There are three types of barriers to families 
making use of services: service level barriers, 
family level barriers, and interpersonal or 
relational barriers. 
1. Service level (or structural) barriers include: 
• lack of publicity about services 
• cost of services 
• limited availability 
• failure to provide services that meet parents’ 
felt needs 
• inability of services to respond promptly to 
requests for help 
• rigid eligibility criteria 
• inaccessible locations 
• lack of public transport  
• limited hours of operation 
• inflexible appointment systems 
• lack of affordable childcare 
• poor coordination between services 
• the absence of an outreach capacity 
(Anning et al., 2007; Attride-Stirling et al., 2001; 
Barlow et al, 2005; Carbone et al., 2004; Katz et 
al., 2007; Winkworth et al,, 2009, 2010).   
2. Family level barriers include limited income, 
lack of social support, lack of private transport, 
unstable housing or homelessness, low literacy 
levels, large family size, personal preferences 
and beliefs about the necessity and value of 
services, physical or mental health issues or 
disability, and day-to-day stress (Carbone et al, 
2004). Vulnerable parents have to balance 
competing needs, and sometimes ‘survival’ 
needs take priority over attendance at a service. 
3. Relational or interpersonal barriers include 
beliefs, attitudes and skills that can compromise 
the ability of service providers to engage 
families successfully or the ability of parents to 
seek out and make use of support services 
(Attride-Stirling et al., 2001; Carbone et al., 
2004). In the case of service providers, 
relational barriers include: 
• insensitive or judgmental attitudes and 
behavior 
• lack of awareness of cultural sensitivities, 
poor listening and helping skills 
• inability to put parents at ease 
• failure to acknowledge and build on family 
strengths and to engage families as partners 
(Anning et al., 2007; Attride-Stirling et al, 2001; 
Watson, 2005; Winkworth et al., 2009, 2010).  
In the case of parents, relational barriers 
include: 
• lack of trust in services 
• fear of child protection services 
• misperceptions of what services offer 
• lack of the social skills and confidence to 
negotiate with professionals 
• being easily intimidated or put off by 
perceived attitudes of staff or other parents 
(Anning et al., 2007; Attride-Stirling et al, 2001; 
Barlow et al., 2005; Carbone et al., 2004; 
Winkworth et al., 2009, 2010).  
The formal service system has a culture of its 
own, and for parents to make good use of it 
requires them to master the language, roles and 
values of that culture (Sobo et al., 2006). Most 
families learn these skills from their parents, but 
many do not. 
Vulnerable families may also be deterred from 
using services if they perceive a critical mass of 
more affluent, assertive and confident parents to 
be dominating the use of services (Anning et al., 
2007; National Evaluation of Sure Start 
Research Team, 2005; Tunstill et al., 2005). 
Families that move often can find it difficult to 
access the services they need and maintain 
continuity of health care (Healy et al., 2009). 
This has adverse consequences for the 
development and wellbeing of their children 
(Jelleyman & Spencer, 2008).  
 
“…it appears that the main issue is 
retaining families in the services rather 
than having them access the service in 
the first place…” 
Policy Brief No 18 2010: Engaging Marginalised and Vulnerable Families 3 
www.rch.org.au/ccch/policybriefs.cfm 
 
 
 
Ways of engaging vulnerable parents 
 
Primary factors 
There appear to be a limited number of primary 
or ‘threshold’ factors that are essential for 
effective engagement of vulnerable parents 
(Barnes, 2003). These function in an all-or-
nothing manner and are the preconditions for 
successful service delivery. Six such factors have 
been identified (Barnes, 2003):  
• the quality of relationship between the parent 
and the service provider 
• establishing shared decision-making 
• cultural awareness and sensitivity 
• non-stigmatising interventions and settings 
• minimising the practical or structural barriers 
to accessing services 
• providing crisis help prior to other intervention 
aims.  
This means that the success of interventions is 
determined as much by the way in which they are 
delivered as by what is delivered; if services are 
not delivered in ways that engage parents and 
respond to their needs, then they will struggle to 
attract and retain them and their effectiveness 
will be compromised (Barlow et al., 2005; Katz et 
al., 2007; Moran et al., 2004). The relationship 
between service providers and service users is a 
major factor influencing the engagement of 
parents in mainstream services; service 
providers need to be able to establish positive, 
non-judgmental, partnership-based relationships 
with all children and parents (Barlow et al., 2005; 
Carbone et al, 2004; Goodfellow, 2006; Moore, 
2007; Moran et al., 2004; Moran & Ghate, 2005; 
Soriano et al., 2008).  
 
 
 
 
 
 
Formal services can be important sources of 
social support for parents, but only if they are 
respectful, flexible and honest (Winkworth et al., 
2009) and only if parents can learn to trust and 
be trusted by the professionals (Goodfellow, 
2006). 
Services also need to be family-centred – that is 
they need to acknowledge and build on family  
strengths and competencies, respond to family 
needs and priorities, and give families greater 
control over what happens to them and what 
resources they need (Barnes & Freude-
Lagevardi, 2003; Beresford & Hoban, 2005; 
CCCH, 2007; Ghate & Hazel, 2002).  
Vulnerable families are particularly appreciative 
of and more likely to engage with services that 
recognise their basic needs and offer various 
forms of practical help (Ghate & Hazel, 2002; 
Moran et al, 2004; Winkworth et al., 2009). 
Secondary factors 
Besides the primary or threshold factors listed 
above, there are various secondary or direct 
service factors that depend for their effectiveness 
on the preconditions being met, that is, on 
parents being successfully engaged (Barnes, 
2003). These include the provision of a range of 
evidence-based parenting programs and high 
quality early childhood programs, and providing 
multiple opportunities for families to meet and 
build supportive networks with other families who 
have young children.  
There are also a number of factors relating to the 
wider system of services that are important for 
reaching and engaging vulnerable families. 
These include:  
• provision of assertive outreach and support 
to families not yet connected with other 
families or services (Beresford & Hoban, 
2005; Healy et al., 2009; Soriano et al., 2008; 
Winkworth & McArthur, 2007) 
• provision of a mix of ‘soft’ and ‘hard’ entry 
points to the service system (Soriano et al., 
2008) 
• and establishment of strong reciprocal links 
with other relevant services (universal and 
specialist) (Carbone et al., 2004; Soriano et 
al., 2008). 
The type of premises in which a service is 
delivered is also important: a comfortable, non-
stigmatising and conveniently located venue that 
provides refreshments appears to be one 
important factor in keeping vulnerable parents 
attending regularly (Katz et al., 2007; Soriano et 
al., 2008; Weeks, 2004). Such environments are 
the ideal place to begin to build relationships with 
families and link them to other sources of 
assistance. 
 
“…the success of interventions is 
determined as much by the way in 
which they are delivered as by 
what is delivered” 
 
Policy Brief No 18 2010:  Engaging Marginalised and Vulnerable Families 4 
www.rch.org.au/ccch/policybriefs.cfm 
 What are the implications of the research?  
• For a number of reasons, vulnerable and marginalised families often 
find accessing and making good use of services difficult. It is the 
responsibility of service providers to find ways of engaging the families 
and providing them with services that are easy to access and address 
their needs.  
• It is very easy for vulnerable parents to be put off using services; the 
very factors that make them vulnerable (lack of trust, limited 
confidence and personal resources) also act as barriers to their 
seeking and obtaining help and support. 
• The way in which services engage and work with families is critical: 
professionals need to respond to family priorities, build on family 
strengths, and establish partnerships that involve shared decision-
making, thereby giving families greater control over their lives 
• Every service needs to build its capacity to reach and engage 
vulnerable families as it is highly unlikely a service will have no 
vulnerable children and parents among its potential clients. This 
includes helping staff to build their capacity to engage families as well 
as minimising the practical or structural barriers to parents that prevent 
them from easily accessing services. 
• The service system needs to be reconfigured to increase its collective 
capacity to respond promptly to the needs of vulnerable families. This 
means building stronger links between services, developing a 
systematic outreach capacity to reach isolated and transient families, 
and providing a range of ‘soft’ entry points to the service system to suit 
the needs of vulnerable families. 
Considerations for policy and programs 
• Building the capacity of service providers to engage vulnerable 
families (e.g. through training in relationship-based and family-centred 
practices) should be a priority.  
• In planning and developing early childhood and family support 
services and service systems, consideration should be given to 
ensuring that the known barriers to service access for vulnerable 
families are minimised.  
• Ways in which service systems can provide outreach services to 
vulnerable and transient families need to be explored.  
• More research on why families do not use services and on the most 
effective ways of engaging vulnerable families is needed.  
  
 
Policy Briefs 
Policy Briefs aim to stimulate 
informed debate about issues 
that affect children’s health and 
wellbeing. Each issue draws on 
current research and 
international best practice.  
 
A multi-disciplinary team from the 
Centre for Community Child 
Health produces these Policy 
Briefs.   
 
An editorial board of national 
experts, and an advisory group of 
international experts in children's 
policy and service delivery 
provide peer review and advice.  
 
 
References 
A full list of references and 
further reading used in the 
development of this Policy Brief 
is available from: 
www.rch.org.au/ccch/policybriefs.cfm 
 
 
Next Policy Brief 
Policy Brief No.19 will address 
Grandparents. 
 
 
 
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The Centre for Community Child 
Health is at the forefront of 
research into early childhood 
development and behaviour. The 
Centre is committed to translating 
research to inform public policy, 
service delivery and practice.  
 
 
 
Centre for Community Child Health 
The Royal Children’s Hospital 
Melbourne 
Flemington Road 
PARKVILLE  3052 
Victoria  Australia 
 
 
Tel:  +61 3 9345 7085 
Email: enquiries.ccch@rch.org.au 
Web:   www.rch.org.au/ccch 
 
The Integrated Service Development project 
The Centre for Community Child Health is working in partnership with 
the Department of Education and Early Childhood Development 
(DEECD) to build sustainable models for integrated children’s centres 
in Victoria. The project is consistent with the Victorian Government's 
priorities, as outlined in the Blueprint for Education and Early 
Childhood Development (2008), and involves working directly with a 
number of Victorian communities to make access to services simpler 
for children and families and ensure better coordination of services. 
To find out more about the Integrated Services Project, please go to 
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Engaging marginalised and vulnerable families

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Engaging marginalised and vulnerable families

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Analysis and Policy Observatory (APO)