This part of the chapter begins with what parents and children have said they want from services for themselves and each other. Then the context in which parental mental health and child welfare work takes place is set out, including: what managers and practitioners have to say about this area of practice; the perceived
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barriers to improving practice; and examples of practice and service developments that have been developed to overcome these. The national policy context and the local context of the two research sites taking part in this study can be found in the chapter 2 – The context of the research.
What do parents and children have to say?
The following (Box 5) is a synthesis of findings that appeared in Falkov (1998) taken from four separate and relatively small scale qualitative studies, which took place in different regions in England, about what parents and children have said they want from services for themselves and each other (Hugman et al., 1993; NSPCC, 1997;
Aldridge & Becker, 1993; Bilsborrow, 1992). Whilst the sample size was small in each study (see below) there was a strong concordance with the findings from each study.
Box 5
BOX 5 WHAT DO PARENTS AND CHILDREN HAVE TO SAY?
STUDY METHODOLOGY
This study involved 24 adults who all were parents and had experience of mental health problems and using professional services. It examined their experiences of parenting and mental health difficulties in relation to professional responses to these two areas of their lives.
Long term problems ...short term solutions – parents in contact with mental health services, NSPCC 1997.
This study involved individual interviews with 20 parents, 10 children/young people and 19 professionals and a workshop where a further 44 professionals and 12 family members took part. Individuals were asked about their perceptions of the problems experienced with mental health and parenting and agency responses to them.
Children who care – inside the world of young carers – Aldridge & Becker, 1993.
This study involved interviews with professionals from health, education, social services and the voluntary sector and 15 young carers ages ranging 3–18 and 4 adult carers who had cared since childhood who at the time of the study were aged between 22–35.
‘You grow up fast as well...’
Young carers on
A total of 11 young carers aged between 9 and 21 years and 46 professionals were interviewed in this study. The
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Merseyside Bilsborrow, S., 1992.
study addressed two principal questions: what knowledge do professionals have of the existence and tasks of young carers: and; what are the experiences of young carers and their perceptions of services which are offered to them?
The findings from the synthesis of these studies are as follows:
For themselves, parents want:
• more understanding and less stigma and discrimination in relation to mental health problems
• support in looking after their children
• practical support and services
• good quality services to meet the needs of their children
• parent support groups
• child-centred provision for children to visit them in hospital
• ongoing support from services beyond periods of crisis
• continuity in key-worker support
• freedom from fear that children will inevitably be removed from them.
For their children, parents want:
• opportunities for children to talk about any fears, confusion and guilt
• opportunities for children to meet adults they can trust, and to participate in activities where they can meet other children
• provision of explanation and discussion about the events and circumstances surrounding the parental mental health problems
• continuity of care and minimal disruption of routines during a crisis (including hospitalisation of parent/carer).
Children and young people want:
• age-appropriate information about the illness and prognosis
• someone to talk to – not necessarily formal counselling
• a chance to make and see friends.
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Children and young people taking on a caring role want:
• practical and domestic help recognition of their role in the family
• a contact person in the event of a crisis regarding a parent.
In general, parents and children want appropriate understanding and support based on the different needs of individual family members. This support needs to be sustained over time, but also varying to reflect any change in circumstances.
Context for parental mental health and child welfare work
Working with families in which an adult carer is mentally ill can be a complex and daunting task for professionals, with some families requiring many different professionals to come together to make an assessment and to provide support for whole families as well as individuals. Despite the importance of the interaction between the mental health of the parent; the safety and welfare of the child, and the impact of parenting on adult mental health, services tend to be structured around either the adult with the mental health problem, or around the needs of children (Stanley & Cox, 2008). Adults’ and children’s services are frequently separated by the organisation within which they are located (e.g. NHS trust versus local authority);
the professional background of staff; policy and legislative imperatives; information and recording systems and organisational cultures. Staff consider themselves locked in a culture of separate services, separate performance indicators and separate skills, all geared to either an adult or child specialist area (SCIE, 2009;
Tunnard, 2004). Practitioners may also be reluctant to work outside what they see as their professional boundaries (Tunnard, 2004; SCIE, 2008). The separation of adult mental health and children’s services along multiple dimensions can make it difficult for professionals to take a holistic view of both individual and family needs.
This can mean that some of the family’s needs may be overlooked, even though they are already in contact with services. Opportunities for preventing problems from arising in the future may also be missed (Diggins, 2009; Falkov, 2012).
Kearney et al., (2003) examined the interfaces within and between services for families where a parent has persistent mental health, alcohol or drug problems.
Using mixed methods, they had discussions with a wide range of stakeholders to
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identify their main concerns about this area of work and their views on the solutions.
A postal survey of adult and children’s social services (109 out of 172 Social Services departments took part), and a follow-up telephone survey and site visits to specific projects were undertaken. The authors of this study point out that workers in all services have far more in common with their colleagues in other specialist services than they might at first think. Staff working in child care are exposed to mental health and drug and alcohol misuse through many of the families with whom they work. Conversely, mental health, drug and alcohol workers are exposed to child care issues. Wherever the worker is based, they may be in contact with parents who have one or more of these difficulties. The researchers argue that this exposure affords then the opportunity to increase professional repertoires. For this to happen, practitioners and their managers need to recognise the characteristics of good practice and derive knowledge from experience. One social worker thought that he had learnt more from his clients than from any professional expert, but this is not a common view. Much professional knowledge is never recognised or systematically recorded and evaluated (Kearney et al., 2003).
SCIE undertook a review of existing practice (2009) in adult mental, child and adolescent mental health and children’s social care services in five multi-agency sites in England. The reviewers in this study were told by managers and practitioners from all five sites that whilst the shift in central policy to include a think family focus (see policy section in Context chapter) was welcome, without the inclusion of a ‘must do’ element (for example specific performance indicators), the policy would remain difficult to implement. Certainly involving the regulators and introducing mandatory performance targets and guidance could help. However, there has been, and still is, nothing stopping agencies introducing their own local performance targets and monitoring activity to ensure that new policy and evidenced-based practice guidance is adhered to and locally evaluated. The difficulties and complexity surrounding this area of practice seem too often to be assigned to the ‘too hard to change’ box and are pulled out periodically; perhaps in response to a serious case review, but then put back again, because the cultural change needed to achieve different outcomes seems insurmountable. So the assertion of many managers and staff is that whilst they understand and appreciate the need for a change in practice culture, achieving this change is proving far harder.
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However, this is somewhat undermined by the parallel assertion of many of the same managers and staff that they have worked with people that do manage to overcome the barriers to successful practice and deliver a service that ‘works’ for families (SCIE, 2009). What is interesting in this scenario is the question – what is it that these professionals do differently that enables them to surmount the barriers that others find too difficult to handle?
In addition to the issues raised above, further examples of what managers and practitioners have had to say about barriers to effective parental mental health and child welfare practice are summarised below. These examples are a synthesis of findings taken from Tunnard, (2004) and Kearney et al. (2003):
• Issues of confidentiality and information sharing continue to hamper inter-agency working for the benefit of families (Tunnard, 2004; Kearney et al., 2003).
• Collaborative working across organisations is often about child protection issues, at the expense of family welfare considerations. Organisational frameworks for collaboration are usually based in child protection work, with few equivalent frameworks for children in need approaches (Tunnard, 2004).
• Administrative divisions, finance systems and separate adult and child care legislation and policy make it difficult to work with families (Tunnard, 2004;
Kearney et al., 2003).
• There is great status in being described as a specialist (Tunnard, 2004).
• There is still too little clarity about professionals’ tasks and boundaries (Tunnard, 2004; Kearney et al., 2003).
• Working with the whole family is skilled and testing work that many staff are unprepared for (Tunnard, 2004; Kearney et al., 2003).
• There is a loss of professional confidence about working with the family as a group and few opportunities to develop the necessary skills (Tunnard, 2004;
Kearney et al., 2003).
• Learning from clients was not often cited as a major source of expertise and knowledge (Kearney et al., 2003).
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