Cumulative jeopardy: the ongoing challenge of working with no fundamental change

I also had a real concern because I was picking up cases where families had had a lot of different interventions tried over several years with no fundamental change in the relationship dynamics between children and their parents and during that time, of course, incidents of abuse or chronic neglect was ongoing, and so I started going, “Well, hang on a sec, what are we using as markers for improvement here?”