Families that have alcohol and mental health problems: a template for partnership working
Using the protocol
Getting it on the desk
Staff with key responsibility for organisational protocols often told the team that they had not given sufficient attention, time, planning and financial resources to the dissemination of protocols. One social services manager described the production of a protocol as being: "Quite a feat in itself. One draws a deep breath and then realises that there is another stage . . . dissemination and implementation.”
Some departments appeared to measure the success of their protocols by how many hundreds of copies they had distributed. The widespread distribution across and within departments is vital but it does not automatically follow that they will be read, understood and put into practice. Having a sufficient budget for the production of many copies is necessary but there also needs to be a clear strategy for making sure protocols actually get to staff and that they know about them. Having a copy "available” is not going to work on its own.
Training staff about new protocols is important but it is not the only way to ensure that they understand and "own” protocols. Often too high an expectation is placed on training as the main vehicle for the dissemination and implementation processes. Ownership and use by managers is at least as important.
A variety of mechanisms needs to be in place to make sure the dissemination and implementation of a protocol is carried out. The following are crucial: availability; training; public launches and publicity; discussions in team meetings; inclusion in induction for new staff; and regular reference to them in supervision.
If service users have been involved in compiling the protocols, they can be instrumental in implementation. Service user knowledge about agreed protocols can be very powerful in getting them into practice and in making them relevant and practical on a day to day basis. Protocols should be made as available as possible to service users.
The team was struck by the lack of attention paid to the issue of noncompliance with protocols and how this might affect practice. The consequences of non-compliance in terms of the effect on families, and any sanctions on the employee are not spelled out.
Protocols must make sense to busy staff and family members who may be distressed and anxious. Documents and instructions that are long, difficult to read or hard to follow will not be implemented. Protocols must point the way to best practice. Their main purpose is not to act as a defensive protection for staff or the organisation, although effective protocols should guard against poor practice for both service user and service provider.
Getting it right
Protocols, especially those that contain factual information, must be kept up to date. Most organisations still need to upgrade and improve their maintenance activities for protocols. The production and use of protocols is a dynamic process.
However, monitoring and maintenance are generally viewed as less exciting and creative than devising a protocol.
The production of useful and "owned” protocols can be a time consuming and expensive process. Adapting protocols from those who have already carried out much of the basic work can speed up the process, but such protocols have to be made applicable to local circumstances, the efficiencies gained must not be at the expense of local collaborative processes.
Costings need to take into account the continued need for maintenance. Protocols need to be designed so that they can be adapted for the changes that continually occur in practice, policy and the law.
Keeping it relevant
Services are likely to continue to change and gaps in policy, practice and underpinning protocols are continually being identified. It is essential, therefore, that senior managers and practitioners set aside time for the regular review of practice.
At the heart of evaluation there must be a focus on service users. The involvement of service users and front line staff is crucial. This includes evaluating whether individual children, their families and carers get the support they want and need. For everyone involved systems are needed to ensure that service interventions are appropriate. This requires systems that identify users of adult services who are parents as well as the number of families in children’s services that have parents with mental health and alcohol problems. A performance indicator that identifies the number of disabled parents, including those with mental health or alcohol problems known to services, would aid this development
Local service audits and reviews commonly include an appraisal of the information available about the service. This can cover a wide range including: service specific information; operational policies; procedures and practice guidance; service user participation; accessibility assessment; service availability; staffing and strategies for joint staff development; examples of good practice; the quality of care and planning issues. The audit appraisal can ask whether there are written operational policies and practice protocols; who these are for and how and where they are made available. It can ask about how these were compiled, how often and by whom they are reviewed, and how the most current versions are distributed.
None of the examples of protocols in the sample had been produced with information aimed at families, although this should be possible, and should be required. Service user involvement might have ensured this by:
- helping to define the needs, outcomes and tasks for protocol content;
- receiving accessible versions of the protocol detailing what to expect - both as an entitlement to information but also as a lever for accountability, action and compliance;
- participating in monitoring and evaluation.
Evaluation should cover both the processes and outcomes of services, for individual families and all user groups across the spectrum of services. This becomes increasingly complex as services diverge and new interfaces emerge between children and families services and the new care trusts, with multidisciplinary services for adult mental health and alcohol services.
Above all, remember:
- protocols by themselves will not guarantee good practice. They are one tool in the box, not the only one;
- social care is a complex occupation and agencies must provide protocols to help staff and families and must ensure that staff use them. Protocols are not an optional extra but part of good practice;
- agencies must not wait for serious situations, such as the death of a child, to develop protocols;
- protocols can seem like control from elsewhere, written by people who do not have day-to-day responsibility for the work. However, the regular routine use of well designed protocols that staff have helped to develop will give them a better sense of control over their work;
- issues of power and autonomy will be keenly felt by the users of these services, and as with frontline staff, their involvement in standard setting and the development and evaluation of policy and protocol will help resolve some of these issues.