Think child, think parent, think family: a guide to parental mental health and child welfare

Putting it into practice - what the sites did: Northern Ireland

In Northern Ireland, the project managers aimed to work sequentially through the priority recommendations in the guide. We capture some of the work here:

Signposting and improving access to services

There were a number of activities as part of the work on this recommendation.

Communication

Things done to communicate the project and raise awareness internally included:

a letter endorsing the implementation of the guide from the Department of Health, Social Services and Personal Safety (DHSSPS) to senior managers of the Trusts, outlining the importance of the work, and the need for it to be embedded within Trusts
a quarterly newsletter sent to Health and Social Care Trust staff and other key stakeholders
monthly good news stories.

See Practice example 4.

Multi-disciplinary regional agreement

A regional joint agreement was developed, setting out how staff in statutory and non-statutory organisations should respond to families with mental health and/or substance misuse problems. It articulated the actions that should be taken by staff who work primarily with adults and those who work primarily with children.

Consultation with service users and carers

As part of the activities on this work stream, the project managers in Northern Ireland worked with a local consultant to conduct a family experience survey to gain an understanding of families’ and staff’s experiences of the impact of parental mental health.

Screening and assessment

Reviewing multi-agency forms

The project focused on reviewing existing screening and assessment tools to assess the extent to which they supported whole-family working. While SCIE always envisaged that the Think Family model could be applied to a wide range of services, the approach in Northern Ireland has involved an even broader range than originally anticipated, and wider than in the English sites. The Northern Ireland sites frequently included acute medical services and acute mental health services, and with the aim of trying to develop a shared ‘form of words’ across agencies working with families, services shared their screening and assessment forms. Some services were able to provide examples of good practice. For example, in one Project Locality Team area it was found that addiction services had particularly good screening and referral forms. These were then used as the template for other documentation. See Practice example 1.

Changes to Understanding the Needs of Children in Northern Ireland (UNOCINI)

In Northern Ireland, all referrals to statutory children’s services are made using the UNOCINI assessment form. One of the project managers was part of a working group to amend the guidance supporting the form so that it addressed Think Family issues, including mental health and substance misuse. The revised guidance then went out for consultation with staff. See Practice example 6.

Development of outcome/performance measures

The project managers worked with Health and Social Care Board performance staff, to develop a set of outcome/performance measures for the project. Initial scoping work showed that there were very few existing performance indicators that could be used to promote whole-family working. The indicators developed therefore relied on primary data collection using surveys and case file audits. At the time of writing, a set of draft practice measures had been developed, including surveys of:

staff’s awareness of the Think Family model, and ways in which their practice is changing to support it
initial screening, referral and assessment processes to ensure they reflect a family model approach
evidence of shared care planning between mental health and children’s services.

Making links with other initiatives

The project managers worked to link the project to other relevant services and organisations. They met quarterly with directors of children’s services, adult mental health services, acute hospital and nursing services. They also established working links with other relevant organisations, such as:

Safety Improvement Forum – a forum helping health and social care organisations to implement evidence-based interventions known to save lives and reduce harm
Bamford Task Force – the task force implementing the recommendations for modernisation of mental health services developed by the Bamford Review
Regional Maternity Mental Health Forum
Regional Implementation Team – the team leading a comprehensive change agenda for child protection services in Northern Ireland
Hidden Harm Regional Quality Assurance Group
The Regulation and Quality Improvement Authority
Nursing/Allied Health Professionals, Medical and Social Work leads at DHSSPS.

The focus of these links was to prevent duplication of effort and to support relevant areas of work that chimed with the project’s objectives. The link with the Hidden Harm work (which focuses on people with substance misuse problems) was particularly important: both the knowledge and skills framework and regional multidisciplinary agreement cover Hidden Harm client groups as well as parents with mental health problems and their families.

Work with the voluntary sector

From the start, the voluntary sector was involved in the implementation of the Think Family approach in Northern Ireland, and there were voluntary sector representatives on each of the Project Locality Teams. In support of the approach, voluntary sector organisations changed referral and assessment forms to enable the collection of relevant family information, such as:

family composition, for example, name, relationship, age/date of birth, occupation/school/nursery
impact of parents’/carers’ mental health upon children of the family
is there a child/young person undertaking caring?

The project highlighted that the voluntary sector workforce is not always appropriately skilled or qualified to undertake the screening and assessment required to support whole-family working approach, and that extra support and training is therefore needed.

Knowledge and skills framework

The project managers, in consultation with relevant stakeholders, developed a knowledge and skills framework for whole-family working. See Practice example 17. This sets out the skills and competences needed by health and social care professionals working with parents with mental health problems and their families. Its aim is to inform the commissioning and delivery of training for those working across adult mental health and children’s services.

The project managers also made links with education representatives for social services, mental health, nursing and medicine, both at under- and post-graduate level, to raise awareness about the project and to discuss ways of including Think Family in higher and professional education.