Think child, think parent, think family: a guide to parental mental health and child welfare
Putting it into practice - what helps and hinders
Throughout the implementation process, the sites and their SCIE supporters reflected on factors that helped and hindered progress in their area. Key factors were:
Competing pressures and organisational change
Most people involved in this project had many other work responsibilities. While they found ways to manage this (including the ‘organic’ approach described above) it was a challenge to find the time and space for this project amid the many other demands they faced. Unsurprisingly then, people in the sites reported that competing priorities were a barrier to making progress with this work. This was not a reflection on their commitment or dedication, but rather an acknowledgement of the large portfolio of responsibilities that most professionals in health and social care have.
In addition, a number of sites went through organisational changes, such as restructuring of either local authority or NHS Trust services (or of both), changes to senior management, and proposed mergers of services. Sites were creative in making use of opportunities presented by this, but it also had some negative impact. For example, in some English sites, members of the project steering groups left due to increased work pressures, or because of having to change role or return from secondments.
Sign-up from senior managers
A key factor that repeatedly emerged was the need for senior members of staff (for example, assistant directors and directors) to sign up to this work. See Practice example 18.
Their backing was key to a range of other factors such as:
- awareness of the project across the organisation
- leading the work at a senior level
- facilitating relationships within and across organisations
- ensuring that links were made to other initiatives
- the effectiveness of inter-agency working
- ensuring that staff were released for training, and generally able to prioritise this work.
Need for culture change
Steering group members reported that the progress they had made would be furthered by a fuller change to organisational cultures and people’s perception of what is within their professional remit. There were concerns that people may be even less willing to work outside what they see as their remit at a time of budget cuts and reorganisations.
It was felt that senior members of staff need to lead by example by modelling multi-agency working and flexible approaches.
Time to build relationships
The extent to which true multi-agency working existed in the sites was unsurprisingly an important factor in determining progress. In sites with a history of working across agencies, key relationships were already in place, which helped people move forward. Elsewhere, it was clear that at least some members of project steering groups were meeting for the first time. This meant that in early meetings time was spent getting to know each other, learning about each other’s roles and remits, and building relationships and trust. This is not unusual in multi-agency working. It did, however, reinforce the premise on which this work is built: that adult mental health and children’s services do not always work closely together. It also highlighted the fact that even relatively senior members of staff (many steering group members are heads of service) in different agencies may not know each other.
Some groups of staff remained difficult to engage throughout the implementation project. In particular, engaging with schools and GPs proved challenging, in part due to the difficulties that school staff and GPs have in attending meetings during working hours. Sites also noted that the further services are away from the adult mental health/children’s service interface, the harder they have been, perhaps unsurprisingly, to engage in this work.
While some sites cited a lack of financial resources as a barrier to implementing the work, in others it seemed that the main difficulties could not easily be solved by injecting more cash into the service. This applied particularly to issues such as the lack of knowledge and understanding of other professionals’ roles. This would seem to support our assertion that changing systems need not require substantial expenditure. However, it does mean that other things are required, such as effective collaboration and a conducive set of organisational cultures.
However, the broader financial climate has had an increasingly negative impact as the project has progressed. In Northern Ireland, efficiency savings in local services threatened to impede their ability to implement this agenda. Similarly, in the English sites, cuts to services began to take effect by the end of the first year of the implementation, thus reducing the capacity for putting whole-family approaches into practice. For example, one site built some of their plans on using the PSA 16 grant, and cuts to it were a real impediment to progress.
More fundamentally, reductions to budgets in many sites led to job losses, which meant those remaining in post had even greater workloads to manage. This had a clear impact on their ability to devote time to practice improvement work such as this project.
Administrative and project management support
Having the support of an administrator and/or project manager was a key facilitator of progress in many sites. Administrators helped to provide practical support, such as taking and distributing minutes and agendas for meetings. They also acted as lynchpins for the steering groups, providing a single point of contact and continuity between meetings. In the sites which had project managers, this also helped to drive progress and ensure that tasks were accomplished.
Having service users - or their representatives - on steering groups, tended to add a dynamism to those groups, and a reality check when professionals became too involved in procedural concerns. See Practice example 18 and Practice example 21.
Hearing the experiences of parents and young carers could provide an important reminder to groups about the relevance of what they were trying to achieve. User forums provided a valuable space for parents to meet, and to share their ideas with the wider strategic body. See Practice example 19 and Practice example 21.