Families that have alcohol and mental health problems: a template for partnership working
This report is about delivering high quality co-ordinated services to families where children live with parents who misuse alcohol or have mental health problems. In line with government policy, it recognises that promoting the well-being of children and keeping them safe should be achieved, wherever possible, by providing support for parents in bringing up their children and by ensuring that children do not take on excessive or inappropriate caring roles in their family.
It promotes the use of collaborative protocols to further good practice and offers a template for agencies to use when developing local initiatives. This report was commissioned by the Department of Health, initially from the National Institute for Social Work (NISW), and then from the Social Care Institute for Excellence (SCIE). It complements the work undertaken by the Joseph Rowntree Foundation in Supporting disabled adults in their parenting role (Wates, 2002).
Balancing the rights and needs of both the children and adults in these families can pose difficult dilemmas. All parents want to do their best and those with alcohol and mental health problems are at times acutely aware of the effect of their illness or alcohol misuse on their children. They may be reluctant to ask for help, as they fear that their children may be removed. Most children in this situation also fear being removed. As a result, they do not readily share their problems with the services that may alleviate them. The legislation relating to services and the rapidly changing organisational arrangements within and across services may exacerbate this difficulty. There are many different routes into services and no single service can currently meet all families'
Why protocols are useful
The team's first report Working with families: alcohol, drug and mental health problems (Kearney, Levin and Rosen, 2000) noted the usefulness of joint protocols that set down the collaborative arrangements between agencies. Feedback from agencies suggests that protocols are doubly useful, as the collaboration required to produce them is also a model for good working practices in applying them. Therefore, a protocol for collaborative working should:
- be the result of agencies working together to produce it while reaching a common understanding of roles, values and actions;
- reinforce and set out the steps to be taken in order to work together in joint assessment, care planning, management of risk, monitoring and reviewing in individual cases.
The team recommends that agencies create a universal protocol that is applicable to all agency settings and to all parents who make contact with services. Supplementary information pertinent to different groups or service agencies can then be included as required. This information could cover glossaries, definitions and further explanation of unfamiliar legislation. One supplement, for example, might be 'Information for Parents'. This format emphasises the commonality of work across agencies and of parental needs. Examples of this format are detailed later in the report.
Protocols and their limitations
These tools are a necessary part of the agency repertoire and a lever towards clear, consistent and competent practice. However, they are not sufficient conditions in themselves to ensure that families get reliable help. Above all, they are not a substitute for expert, confident, well supported practitioners in adult and children's services who are able to reflect on and critically appraise an individual situation and make sound, knowledge-based decisions alongside service users.
Thus, in reviewing practice when things go wrong, it is not acceptable to maintain that, "we followed the procedure", or "we were only following orders", or even that "we had the procedures in place but they were not implemented". This work is complex and demanding and it is important that all the practitioners involved are trained, skilled and have the organisational support and structures in place to facilitate co-ordinated working and good processes and outcomes for families.
The protocols that have been examined are variable in scope, length, content and quality. The team chose examples from a range of protocols to illustrate the examples set out in the template. The team attaches high importance to the processes following the production of the protocol, for example, implementation; dissemination; maintenance; monitoring; review; updating and evaluation. Evaluation of outcomes, particularly from the families' point of view, is crucial.
Why a template is useful
The team's first report noted the value of the template approach within drugs services. This has the advantage of the Standing Conference on Drug Abuse (SCODA) guidelines on which to build local arrangements. This second report looks specifically at how useful this approach might be for mental health and alcohol services.
The definition of a template in this report is a pattern, model or design that can be used as a guide in developing services and that can be adapted and tailored to suit local conditions. It draws on the experiences of those agencies that supplied the team with documents and gave an account of how these were developed. This report focuses on mental health and alcohol services, although many of the key principles and processes would apply to all adult services, including drugs. This report offers a template for developing better, more family-centred approaches to working with families where there are alcohol and mental health problems.
The team has based the template on the policies, protocols and procedures provided by social services and Area Child Protection Committees (ACPCs) following the team's request to all Councils with Social Services Responsibilities (CSSRs) in England. This was followed up by discussions with named contacts and visits to selected social services departments to further explore practice development and implementation issues. These exercises have enabled the team to examine over 70 written policies, protocols and guides and to develop a template that may be useful to the decreasing but nonetheless substantial number of authorities who do not have protocols in place or are in the process of developing them. The template may also be helpful to agencies by providing a benchmark for reviewing their existing procedures and their frontline practices and seeking to improve them.
Using a template to create a local protocol
Some of the agencies that responded had adapted protocols they saw working well in other agencies. The authorities that have developed inter-agency policies and protocols reported that an enormous amount of work and time is involved in producing them, getting them agreed and getting them "owned" and used within and across agencies and teams. Several social services departments and ACPCs that had recently issued joint working protocols had not started from scratch. Instead they had contacted departments that already had written policy and practice guides in place. This approach saves time but it is essential that key stakeholders are fully involved in the local process. This means that the process and the protocols are not simply imported and imposed.
Special mention should be given to two joint service initiatives that have been particularly influential in this way.
- Camden Social Services with Camden and Islington Community Services NHS Trust and the Royal Free Hampstead NHS Trust have produced joint service protocols for families affected by mental illness and with drug and alcohol misusing parents. These documents are formally acknowledged as a source by a number of other protocols.
- In Oxfordshire, the Oxfordshire Interagency Policy for Parents with Disabilities, Sensory Impairment, Illness, Addiction and/or Mental Health Difficulties has been influential in promoting user participation and the inclusive concept of disabled parents as the basis for services.
These experiences suggest that it is important for agencies to each have their own arrangements in place for working with families and with other agencies and professionals. These can then form the basis for collaborative processes in this area of work.