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Interprofessional responses to the needs of mothers

Health and social care professionals are constantly exhorted to work collaboratively. This book reports on research which examines interprofessional work with families in which mothers have a mental health problem and where there are also concerns about child protection.

Breakdowns in interprofessional collaboration, issues of risk and relevant resources are all addressed. Mothers’ views and experiences are contrasted with professional perspectives.

Child protection and mental health services:

· reports on a survey of 500 practitioners working in health, social services and the voluntary sector;

· presents data from in-depth interviews with mothers with severe mental health problems;

· identifies weaknesses in interprofessional coordination in this area of work;

· suggests a new model for work with families where mental health problems and child protection concerns co-exist.

All those involved in child protection or mental health work with families will find this book a stimulating read. This book will be of interest to practitioners, managers and policy makers as well as students studying health and social care.

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Refuges or shelters have been central to UK domestic violence service provision since the 1970s. In 2013, UK policy transformed teenagers into primary service users of domestic violence refuges. Digital technology is central to teenagers’ lives but moving to a refuge can cause serious disruption in this respect.

The study was undertaken in 20 refuges in England. Repeat qualitative interviews with 20 young people aged 13–18 and single interviews with refuge staff explored teenagers’ experiences of refuge life. Access to digital technology emerged as a central theme for this group of young people.

Teenagers described difficulties in accessing digital technology and the internet in refuges and this impacted on their education, support networks and leisure. Restrictions concerning online access in refuges were attributed to safety concerns and resource shortfalls. This study found that restrictions on internet access lacked consistency across refuges and were underpinned by protectionist attitudes towards teenagers. Refuges need to seek a balance between risk and protectionism and identify opportunities to use digital technologies to increase the safety and support available to teenagers.

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‘Whole family’ interventions for families living with domestic violence and abuse (DVA) are emerging and some international practice examples are available. This study reports a process evaluation of a pilot delivered in Northern England that aimed to work with all members of families experiencing DVA. The evaluation involved analysis of detailed accounts of practice from learning logs and case workbooks as well as interviews with practitioners and family members. The voluntary nature of families’ involvement with the pilot, together with an explicit service philosophy of ‘meeting families where they are at’ appeared successful in engaging families. Pilot staff worked flexibly, seeing family members together and separately, but there was evidence of lower levels of confidence in work with perpetrators. Co-work enabled skills to be transferred to other professionals and social workers increased their use of risk assessment tools in DVA cases. However, there was uncertainty as to whether interagency communication improved across local agencies, and joint protocols and tools were slow to develop. This study is one of the first evaluations of ‘whole family’ interventions in DVA, and it illustrates how, when additional resources and organisational support are made available, a non-blaming approach that families find engaging can be developed.

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This chapter explores theoretical work and research on mothers’ mental health and its impact on children. It examines the ways in which the mental health needs of mothers are conceptualised within health and social care. Mothering is simultaneously identified as a prime site of origin for women’s mental health problems and a key determinant of children’s mental health. While the successful exercise of parenting skills and the intimate relationships that mothers experience with their children can be a source of satisfaction and pride, in the context of mothers with mental health needs, research has tended to focus on adverse outcomes. Positive outcomes for parents with mental health problems and their children are rarely noted.

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This chapter examines the service configurations of the main agencies delivering services to mothers with mental health needs and their children and discusses recent organizational developments in order to establish the extent to which these services are equipped to respond to the needs of such families. It outlines the policy in which mental health professionals and child care workers deliver services. It also examines the role of voluntary organisations in providing services for mothers with mental health needs as this sector has been the source of some innovative projects.

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This chapter considers the research evidence on interprofessional collaboration and communication, in particular that which relates to work in child protection and mental health services. Inquiries into homicide have also contributed to a widespread perception that the effectiveness of both child care and mental health services is impeded by problems in interprofessional communication and coordination. The chapter also looks at the very limited body of work covering coordination and communication between adult mental health and child care services.

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This chapter outlines the methodology used for the research and reports on the pilot study completed in 1997. Funding for the project came from a number of sources, including the University of Hull, a NHS trust and a health authority. The study was fuelled by a desire to understand the response of a range of health and social care agencies to two contrasting sets of needs in families. The study explored the nature of serious mental health problems in mothers whose children were on the child protection register, and examined the extent to which different professionals worked together to meet the family’s needs.

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In this research, focus group discussions with health and social care staff working in an area outside the two research sites were held to assist the development of contextually relevant questions for inclusion in the survey of professionals. Those recruited included representatives of the following professional groups: child care social workers; health visitors; adult psychiatrists; mental health social workers; community psychiatric nurses (CPNs); children’s guardians; practitioners from voluntary organisations serving mental health services users, and from similar organisations for children; and middle managers from both community health and social services. Discussion highlighted several topics, such as the competing demands of individual family members, to which participants were to return in the course of the discussion, and developed, as anticipated, into talk about the possibilities and constraints of service provision in specific geographical areas. The chapter tackles interprofessional communication, the organisation of services and the assessment of risk.

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This chapter discusses interviews undertaken with mothers with mental health problems in the two study sites, A and B. While there has been significantly more readiness in recent years to acknowledge and identify differing professional perspectives in work with families with mental health needs, the consequences of these differences for families have not as yet been fully explored. That research which explores the perspectives of parents with mental health needs has emphasised parents’ experiences of being pathologised by services and of services being targeted on crises rather than delivered in a preventive or aftercare form. The study aimed to interrogate service users’ experience of both mental health and child care services in more depth and to examine need alongside attitudes to services.

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