PPC’s family support service is highly valued and received very well by both service users and social workers/referrers. A general all round appreciation of the quality of service provided to families as excellent. PPC continues to offer good consistent services to families; family support women are well informed and trained, their direct work with children is particularly good and parents/careers appear to really benefit from the input (key funding stake holders review 2004).

The two factors in the service

• Qualified staff
• Support around psychological needs

Account for the qualitative difference in service on which commissioner’s comment and for which PPC has such a strong reputation. They also go some way to explaining PPC’s success in addressing a range of needs through our intervention, and with families with whom more traditional services find it hard to work.

• The stability of the relationship with the family
• The support worker is valuable to the children, who typically have experienced upheaval and uncertainty in their care arrangements due to the parent’s ill health (more due to a range of complex needs)
• Although attention to the psychological needs of the parent is not the primary objective of the service, the effect of a consistent and helpful presence in the home also makes an important contribution to the well being of the parent. Family support workers know that they have to give some attention to the needs of the parent in order to be trusted and allowed to work with the children, and working closely with the parent is one of the important principles underpinning the approach
• At the first level of care, the home support enables the parent to continue to look after their child at home, preventing a loss of contract and a need for statutory fostering or care services. The child gains a basic level of care, which might otherwise be lacking; older children are relieved of caring responsibilities for siblings and perhaps for their parent. ‘Older’ in this context can mean aged seven or even younger
• The ability of PPC’s to engage with educational and social needs of the child offers a powerful and cost-effective means of reducing the impact of social exclusion. Child users are typically affected by poverty, with all that implies as well as by parental illness (mental and physical)
• The attention of a qualified worker in the home and on outings supports children in achieving normal development goals and making better use of other resources, such as school and social opportunities. The link here with PPC’s children’s groups, partly staffed by the same personnel is particularly valuable
• The family support workers work with parent users on parenting skills provides a long-term benefit to the children and also to the parents who gain increased confidence and self –esteem from the process
• Children affected by HIV experience a high degree of emotional challenges in childhood, here we refer not only to the (often-repeated) experience of parental ill health and impaired mental well being, but also to the stigma, secrecy and uncertainty which are the rule rather than the exception
• PPC staff are able to offer advice and support around disclosure, before during and after the process
• The work of child psychologists with the family support workers has been a key to developing a model of practice that addresses the child’s psychological needs. Psychologists have supported family support workers in developing practical strategies for dealing with issues as they have arisen. The joint work has led to an understanding and expertise of working with children affected by HIV which is unique to PPC and would be lost if the service were not there