Perceptions of Nursing and Midwifery

Safeguarding the the rise of Think Famiy

In recent months I have been positioning the "Think Family" approach to contextual safeguarding - I think it is due to my public health and mental health practitioner backgrounds and my learned believe that all child welfare is impacted by Adverse Childhood Experiences, which will be a future reflection.

 

Since before the Munro Review in 2011 ~ https://www.gov.uk/government/publications/munro-review-of-child-protection-final-report-a-child-centred-system ~ services and practitioners have had conversation about the fact that in families certain issues & hostilities occur and these events can adversely impact on the development and resilience of infants, children, teenagers and young people.

 

The Think Family agenda recognises and promotes the importance of a whole-family approach which is built on the principles of 'Reaching out: think family' -

  • No wrong door – all service should  offer an open door into a system of joined-up support. This is based on more coordination between adult and children's services.
  • Looking at the whole family – services working with both adults and children take into account family      circumstances and responsibilities. For example, an alcohol treatment      service combines treatment with parenting classes while supervised      childcare is provided for the children.
  • Providing support tailored to need –      working with families to agree a package of support best suited to their      particular situation.
  • Building on family strengths –      practitioners work in partnerships with families recognising and promoting      resilience and helping them to build their capabilities. For example,      family group conferencing is used to empower a family to negotiate their      own solution to a problem.

At this juncture we need to reminder ourselves that according to legal definition, all citizens under 18 are referred to as children, despite many of us calling citizens teenagers and young people. 

The family focus alone may not be enough to address the problems faced by some parents with a mental health problem nor will it necessarily prevent a child (or teenager or young person) from suffering harm. Services need to understand the adults' problems so these can be addressed through specific clinical expertise and services, just as children's problems need to be, or those requiring a whole family approach.

Adopting a family focus does not negate the need to providing individual care, but must be considered alongside it. This means thinking about the child, the parent and the family, with adult and children's health and social care services working together to consider the needs of the individual in the context of their relationships and their environment.

The Family Model

The Crossing Bridges Family Model (Falkov 1998) is a useful conceptual framework that can help staff to consider the parent, the child and the family as a whole when assessing the needs of and planning care packages for families with a parent suffering from a mental health problem. The model illustrates how the mental health and wellbeing of the children and adults in a family where a parent is mentally ill are intimately linked in at least three ways (see Figure 1): 

  • parental mental health problems can adversely      affect the development, and in some cases the safety, of children
  • growing up with a mentally ill parent can      have a negative impact on a person's adjustment in adulthood, including      their transition to parenthood
  • children, particularly those with emotional,      behavioural or chronic physical difficulties, can precipitate or      exacerbate mental ill health in their parents/carers.

The Model also identifies that there are risks, stressors and vulnerability factors increasing the likelihood of a poor outcome, as well as strengths, resources and protective factors that enable families to overcome adversity. 

Figure 1: The Family Model

 

Risks, stressors and vulnerability factors

Individual risk or stress factors, on their own, do not necessarily have a serious effect on an adult's parenting capacity or their children's mental health. However, some parents with mental health problems will face multiple adversities. Risk factors are also cumulative – the presence of more than one increases the likelihood that the problems experienced and impact on the child and parent will be more serious.

It is when three or more environmental and/or personal factors occur in combination that a negative impact on child and/or parental mental health is much more likely. For example, the presence of drug or alcohol dependency and domestic violence in addition to mental health problems with little or no family or community support would indicate a increased likelihood of risk of harm to the child, and to parents' mental health and wellbeing.

Risks can also change over time and create acute problems. For example, going into hospital can represent a significant crisis in terms of family life. Everyday routines are disrupted, other adults are overstretched, and both parents and children often feel worried and powerless. An intervention needs to consider the effects on outcomes for the whole family to be effective.

Risks to health and wellbeing will also vary from person to person. For example, people with the same mental health problem can experience very different symptoms and behave in different ways. Therefore relying on a diagnosis is not sufficient to assess levels of risk. This requires an assessment of every individual's level of impairment and the impact on the family.

Strengths, protective factors and resources

The factors which can promote resilience in children – i.e. the factors which determine how well a child copes with their parent's mental health problem – are related to:

  • their physical traits and personality
  • their relationships with other family      members
  • the immediate environment in which they      live
  • life events.

People acquire whatever qualities of resilience they may have in two ways – by what they are born with through their genes, and by the effects of subsequent social experience. The surrounding environment and an individual's biological make-up will continually interact and influence each other in aiding or hindering children's ability to cope with living with a parent who has a mental health problem.

Risk to resilience

It may not be possible to easily change all the adversities which families experience.However, promoting and supporting protective factors can help reduce the negative effects when a parent is mentally ill.

For children, all protective strategies operate through one or more of the following processes:

  • by altering the child's perceptions of, or      exposure to, risk of harm
  • by reducing the cumulative effect of risk      factors compounding each other
  • by helping the child improve her/his      self-esteem and self-efficacy
  • by creating opportunities for change 

Promoting resilience in adults with care needs is challenging and there are many support groups. my own go to resource is Think Local, Act Personal where there is a range of support for physical & mental health or all variations ~ https://www.thinklocalactpersonal.org.uk/ 

Promoting resilience in the most vulnerable has begun to be developed. Fro example for fostered children and young people the Social Care Institute of Excellence is co-ordinating useful examples of how promoting resilience in fostered children benefits ~ https://www.scie.org.uk/publications/guides/guide06/ .

In addition there may be optimum situations or times to target specific interventions to boost resilience – for example, assistance with parental housing or financial problems or offering support at transition points in children's lives.

Promoting resilience does not mean minimising concerns about risk of poor outcomes. If a child is exposed to continuous and extreme stress, then they are very unlikely to develop resilience. It is therefore unrealistic and unhelpful to rely exclusively on a resilience-led approach (Fraser et al. 1999).

Recent research https://www.psychologytoday.com/us/blog/greater-the-sum-its-parts/201703/how-trauma-in-childhood-affects-the-brain) on how teenagers brains process traumatic events is really fascinating and we are only now beginning to understand the physiological damage traumatic events might cause.

Raman, & Carrion (2017) drove home the importance of these findings in their paper: "by better understanding sex difference in the region of the brain involved in emotion processing, clinicians and scientists may be able to develop sex-specific trauma and emotion dysregulation treatments"

But then that will be yet another reflection.

Back to Think Family and Implications for organisations and for practice

An approach based on the Family Model enables staff to:

  • know what to look for
  • take a holistic approach to assessment and      consider the environment, family, cultural and social systems within which      individuals live (e.g. housing, finance, employment, relationships).
  • gain a better understanding of the links      and relationships between risk of poor outcomes and resilience, adult and      child, symptoms and parenting, the changing pattern over time, and what to      do with the information they gather
  • understand the risks to health and      wellbeing that occur across generations and manage these risks to reduce      their impact.

Implications for the frontline practitioner

Adopting this approach requires a change in attitude and practice which includes:

  • switching from a focus on diagnosis or      pathology to concentrate on individual strengths and interventions that      are strongly associated with promoting mental health and recovery,      sustaining families and promoting inclusion
  • raising the expectations of people who use      mental health services who are parents and taking seriously their views of      their resource needs
  • looking at the family as a unit and      focusing on positive interdependency and supportive relationships
  • helping parents to understand their mental      health problems, their treatment plan, and the potential impacts of mental      health problems on their parenting, the parent-child relationship and the      child
  • working with parents and children to enable      the child to have age-appropriate understanding of what is happening to      their parent and information about what services are available for them in      their situation and how they can access these.

Thanks for reading my reflections and everything you do to Think Family. 

What inspired you to write this blog?

Raise the roar of contextual safeguarding

What is your role?

Head of Safeguarding

What are your nursing and/or midwifery qualifications?

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