Think child, think parent, think family: a guide to parental mental health and child welfare
Putting it into practice - lessons about practice: problem areas
The implementation project also provided useful learning about some difficult and intractable practice issues. The sites’ experience demonstrated that, despite considerable effort, there are a number of issues that remain very difficult to surmount.
Forming an accurate picture of the service user population
A number of the implementation sites attempted to find information about the service user population including:
- How many adults using mental health services have children
- How many children of parents using mental health services are on child protection plans or are children in need.
However, the sites usually found that they were unable to obtain this information, for two reasons:
- Features of individual electronic recording systems – for example, recording information about children on adult mental health electronic records is not done in a way that allows the extraction of data on numbers of service users with children.
- Lack of compatibility between electronic recording systems – cross-referencing children and parents across adult mental health and children’s recording systems is challenging as systems typically use different unique reference numbers (NHS number for mental health, other numbering systems for children’s services).
Sharing information about individual cases
The incompatibility of IT systems also has an impact on individual casework as staff are not easily able to check which other services are involved with a particular family. This can mean that relevant information is not shared between professionals.
Quite apart from the IT issues, feedback from the sites - and in particular the practitioner champions groups - suggested that many frontline practitioners are still unsure as to when it is appropriate or inappropriate to share data. It appears that many practitioners tend to err on the side of caution and not share information.
One of the recommendations in the guide is that local services should develop ‘family thresholds’ – thresholds for accessing services that take into account the needs of the whole family. The issue of thresholds remained a challenge throughout the implementation, although one of the sites began exploring options for how to remedy this. However, it was apparent that one of the impacts of funding cuts may be to raise thresholds even higher.
Involving GPs and schools
GPs and schools were not fully engaged in the project, in either the English or the Northern Irish sites. There are practical barriers to both of these professional groups becoming involved, such as being unable to attend meetings during school/surgery hours. However, there was anecdotal evidence that GPs in particular do not see the Think Family approach as part of their role, and that information sharing with GPs is a particular challenge. Nonetheless, schools and GPs are universal, non-stigmatising parts of society, and their engagement in whole-family working would be likely to increase its purchase across all services.