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

Planning care

Problems with current practice

Difficulties seem to arise in developing care plans when more than one agency is involved. This is because staff from different disciplines often adopt different views. For example, staff from adult mental health services may not acknowledge that there is a risk of harm to children. At the same time, children's services staff may not accept that change might be possible for the parent. As a result, any joint care plans may not realise the potential to promote the resilience of either the parent or the child. In the absence of any preventative measures and forward planning, families can end up 'drifting' until crisis point is reached.

It also seems that there is little coordination of the care plans for the individuals within a family. For example, young carers' assessments are not routinely fed into adults' care plans. Similarly, the views of young people are often not taken into account when making decisions about the care and support of adult family members.

In a successful service:

• Care planning takes a holistic approach to include appropriate care plans for each individual family member as well as the family as a whole.
• The care plan involves all members of the family in its development and implementation to ensure it is relevant, realistic and achievable.
• The care plan is flexible enough to meet the needs of the individuals and the family as a whole, and to be able to respond to changes in circumstances. Allocating an individual budget could provide this flexibility and give people who use services more choice.
• The care plan includes contingency and crisis preparation for both predictable and unforeseen situations. For example, a parent showing recognised signs and symptoms of becoming unwell, a parent being made redundant, or a young person needing stability at home to study for GCSEs. Respite care, agreeing who the child should contact if their parent becomes unwell and other support services can be planned for such events.

Recommendations for change

When writing, sharing and coordinating adult and child care plans, staff should ensure that:

• The needs of the adult as a parent, and their child, are addressed separately and together.
• The care plan explains the rationale for each recommendation including the preferences of the individual family members.
• The care plan includes realistic and relevant targets and timescales to address the specific difficulties faced by each family member.
• It is clear to all family members what the plan intends to achieve and how progress will be measured, including progress with parents' and children's understanding of the mental health problem.
• There is a clear explanation of what will happen, in what order and why, as well as who will be responsible for each intervention.
• There are clear lines of communication between staff providing services and individual family members.
• Parents and children/young carers can recognise when to ask for help and who to ask.
• There are clear arrangements for child care should the parent not be able to care for their children at any time. For example,during hospital admission. These should be agreeable to parents.
• It is clear how the views of family members will be obtained and recorded during the implementation of the care plan and its review.

Staff need to develop care plans that aim to increase resilience. Research has shown that increasing every family member's understanding of a parent's mental health problem is highly successful in terms of increasing their ability to cope. Therefore, care plans need to provide details of how:

• Parents will be assisted in understanding their own mental health problems
• Children will be helped to understand their parent's mental health difficulties
• Any potential negative impacts of mental health problems on the family will be minimised
• Children will protected from the risk of harm and supported to promote their continued development and wellbeing
• Communication will be improved between family members and relationships maintained
• Family health and wellbeing will be promoted and maintained.

Staff should consider whether using a 'personal budget' will give greater flexibility to the care package to better meet the needs of the individual and the family.

Link: SCIE Report 20: Personalisation: a rough guide

Contingency and crisis plans (may also be relevant to advance directives) should include how many children the parent has, their ages and gender, and the arrangements for their care to be put in place if the parent is not able to care for them at any time e.g. if a parent is admitted to hospital.

Organisations need to:

• Provide training and support to their staff to improve the effectiveness and functioning of interagency working. This will support the development of coordinated care plans.
• Develop interagency policies/protocols in collaboration with parents and children that include a performance management and evaluation framework to ensure their use in everyday practice.

Managers need to:

• 'Manage' and monitor the use of interagency policies/protocols and make them part of mainstream management and practice. They should consider adapting existing electronic case management and management information systems to include a requirement for staff to record that they have followed the protocol and that managers have observed that this has happened.