A report published this week by Ofsted and the Care Quality Commission revealed a number of shortfalls in the way in which adult and children’s services work together to handle cases of parental mental health or substance misuse.
The report also contained several examples of ‘good practice’ that social workers and employers might learn from to improve the way these cases are dealt with. Here are some of the key examples of good joint working that were flagged up by inspectors:
1. Test your referrals against the ‘best’
Social workers know the value of a good referral, having received enough of them, but Ofsted and CQC inspectors found that in some cases referrals were not as revealing as they could have been.
So if you’re an adult practitioner referring to a children’s team or vice versa you can help your social care colleagues as far as possible by checking how your referral compares to this set of criteria noted by inspectors:
“The best referrals contained detailed information about how the parent’s or carer’s mental health affected their mood and day-to-day behaviour, and how this impacted children involved. These concerns were often seen to relate to the parent’s instability and volatility and their ability to provide consistency and put their child’s needs first.”
2. Factor in parental mental health in child protection plans
Inspectors noted cases when child protection and children-in-need plans did not make clear what actions were needed to minimise the impact of the parent’s or carer’s ill health on the child, and the role of adult mental health in this. But here’s an example of a case they singled out as good practice:
“In this complex case involving parents with mental health difficulties with young children who were the subjects of child protection plans, an explicit link was drawn in the children’s child protection plans between support for parents and outcomes for children.
“In addition, relevant elements of the child protection plan were also included in the adult mental health care plan, which provided a clear connection between the parents’ and children’s needs.”
3. See the adult as a parent and think about the child
The report highlighted the fact that professionals – on both sides of the adult and children’s divide – too often saw assessing the impact on children as exclusively being the role of children’s services and the impact on adults as exclusively being the job of adult mental health services.
As a result some adult services practitioners didn’t assess the impact a patient’s illness had on children, particularly in cases of severe depression. On the flip side, some children’s teams didn’t consider the impact parenting could have on an adult’s mental health.
So what can you do? Well the CQC/Ofsted review picked up on good examples where mental health professionals had considered the adult as a parent alongside thinking about the child’s needs. Here’s a case study inspectors flagged up as ‘good practice’:
“The mother had a history of low mood, self-harming, violence and aggression towards other adults. The mental health practitioner to whom the mother was referred for assessment had a very clear focus on parenting in her meetings with the mother.
“She was very alert to the impact on the baby of the mother’s difficulties, sharing observations and concerns with the social worker about how the mother interacted with the baby.
“Attachment and bonding were well considered. The assessment was clear that the mother’s long-standing mental health problems, stemming from her childhood, meant that the mother had little insight into how her behaviour, including her violence towards the baby’s father, would impact on the baby.”
4. Work together to promote safe contact between psychiatric patients and their children
The study highlighted the importance of mental health teams working with children’s social workers to arrange contact sessions that are beneficial for both parent and child.
It outlined how reflections and decisions on what actions to take is key to ensuring that contact is well managed and to ensure children’s safety.
For this to happen, relevant information needs to be recorded and shared and the views of both mental health workers and social workers must be heard.
A social worker told inspectors: “Through the security of planned and well-managed contact with their mother, the children had been able to develop a better bond with her.”
5. Develop realistic long-term plans that consider the parent and child’s needs
In terms of joint working on substance misuse, there was a suggestion that some drug and alcohol services too often focused on unrealistic short-term plans that could not be sustained by the parent.
However, joint working was seen to work effectively when the focus was on longer-term change.
Developing realistic plans often meant building in an acceptance that the parent may relapse and services put a safety plan in place to protect both the parent, and the children’s, needs in case this happens.
This meant support for the mother, an awareness of the triggers and, in one example, alerting other family members to signs of a relapse.