Families that have alcohol and mental health problems: a template for partnership working
Devising a protocol
A protocol is the message that the organisation gives to its practitioners about what to do and why to do it, that is, the organisation’s values and policy statements, and how to do it, that is, its practice guidance and implementation processes. A protocol brings together a competent organisation and capable workers.
The previous section has outlined the 'chain’ along which a protocol is brought into practice. This section draws on the material supplied by health and social care agencies. The team noted some common characteristics, usually arrived at by separate, local development, and gives examples. It also noted some individual features that seem to strengthen a protocol or provide solutions to some of the problems that others have encountered. Many of these characteristics are the logical result of discovering and following the processes outlined in the previous section.
A protocol aims to give unambiguous, common instruction and guidance to workers in specific situations. It is most useful when these:
- are outside the everyday experience of the worker;
- involve them in areas of practice or with colleagues who they do not normally work with;
- require swift but careful action;
- challenge a worker’s custom and practice and/or the operational definitions that they are used to.
Workers in these situations may well feel anxious, de-skilled and uncertain of their facts. A protocol should give enough information and reassurance to act, so that professional skills and judgement come back into play.
So far, this approach fits any practice protocol in health and social care. Working with families where parents have mental health or alcohol problems is an area that would particularly benefit from protocols, especially as workers and service users additionally face a complex series of service interfaces. For parents, these complexities may hinder their access to services. For workers, they may cloud the opportunity to offer family support or to involve other professionals. The core of good practice in working across service and agency boundaries is having shared aims, understanding and language. This may mean finding ways to change habits, attitudes, and services. The best protocols in the sample examined by the team have demonstrated these shifts, so a protocol should also help people to think and act differently. These characteristics can be seen in many of the protocols, although arrived at and expressed in different ways, as the examples show.
During the course of this project the team noted a radical shift in thinking which will in itself, have a major, positive effect on the problems that these protocols aim to solve. For example, both Hampshire’s and Bolton’s protocols remind their staff of parents’ rights and duties, and note the importance of understanding the relationships between child care and child protection responses. The catalyst for this change in thinking has come from the service user-led definition of "disabled parents”, which includes parents with mental health, drug and alcohol problems. This approach is the basis of both Oxfordshire’s and Northamptonshire’s policy documents. Oxfordshire’s policy document sets out the importance of service users’ participation in its development: "This policy has been informed by practice development in other local authorities; the Social Services Inspectorate report, A Jigsaw of Services; Department of Health policy and guidelines; research and experience of families that include disabled/ill parents both nationally and in Oxfordshire.”
There are many ways in which involving parents makes a difference. Parents are well placed to identify what might be the attitudinal, structural, financial and other barriers to using a service. They can help to identify characteristics of a nonstigmatising service and with evaluating new practice. Moreover, they can also advise on the need for accessible information and how to provide it.
A good protocol, therefore, should:
- Give instructions and requirements;
- Be authoritative;
- Be linked to legislation, policy and procedure;
- Be easy to use;
- Help people to think and act differently;
- Have a user-led approach.
Some of these features are interdependent, indeed, the examples in the sample often demonstrate more than one feature.