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Transcript
THE TOXIC TRIO:
Assessing & Responding to the Impact on
Children, Young People and their
Families
David Glover-Wright
Early Help Conference
• The term 'Toxic Trio' has been used to
describe the issues of domestic abuse,
mental ill-health and substance misuse
which have been identified as common
features of families where harm to children
has occurred. They are viewed as
indicators of increased risk of harm to
children and young people.
Early Help Conference
Workshop to include:
• The key aspects of contemporary practice when working
with ‘the toxic trio’
• Assessing and evaluating the impact on children &
young people
• How to work with families where these problems exist,
promoting ‘systemic’, child and family centred
approaches
• Safeguarding children through the application of holistic
risk assessments, ongoing risk management and
positive inter agency practice
Early Help Conference
Social
learning/ peer
group
influences
Psycho
social
factors,
gender roles
PARENTAL
SUBSTANCE
MISUSE
cognitive/
behavioural
impact
PARENTAL
DOMESTIC
VIOLENCE
child/ young
person
increased
vulnerability, self
medication,
negative coping
strategies
)
Interdependency,
emotional stress,
trigger points
established
PARENTAL
MENTAL ILL
HEALTH
Early Help Conference
Personal values/ cultural influences/ factors/
/ religion
Happy families?
Early Help Conference
What are some of the key
concerns?
Take five minutes to talk with your neighbour
and identify three key concerns in your
working practice for families where there is
domestic violence (historic/ present),
alcohol/ drug dependency and mental health
vulnerability.
Early Help Conference
The Family Model ( after Falkov 1998)
Risks: environmental, social, economic, & family stressors =
vulnerability
Child
emotional
health &
development
Parenting &
the parentchild
relationship
Adult
mental/
physical
health
Protective factors and resources: family & social network,
coping strategies, emotional resilience
We have an ongoing responsibility to balance risk factors against protective factors
when working with families. For this to be done effectively, there needs to be a family
centred assessment process which focuses individually on the children and adults’
needs and then considers these in the ongoing parent/ child relationship.
Early Help Conference
Introduction
to Mental
Health
Signs of Safety:
• What’s working well? (strengths and
positive coping strategies)
• What are we worried about? (concerns
impacting directly on the children’s
wellbeing)
• What needs to be done?
• Drawing up a safety plan and working in
partnership
‘The ecological model’
Early Help Conference
•
•
•
•
•
•
•
•
•
Information gathering and analysis is critical:
The behaviours exhibited by children experiencing problems in their home
environment are often similar, e.g. poor attachment to parents due to emotional
unavailability or poor attendance at school or nursery.
While mothers’ parenting appears to be adversely affected by domestic violence,
there is evidence that their parenting can recover once they are no longer living with
domestic violence (Stanley, p54)
Cassell and Coleman (1995) suggest that, when assessing the risks of harm for
children, professionals should consider the following factors:
The warmth of the parent-child relationship
The parent’s responsiveness to the child’s needs
The content of any delusional thinking
The parent’s history of anger management
The availability of another responsible adult (Stanley et al p.334)
Stanley N, Cleaver H, Hart D (2010) “The Impact of Domestic Violence, Parental Mental Health Problems, Substance
Misuse and Learning Disability on Parenting Capacity” The Child’s World. 2nd edition, London: Jessica Kingsley
Publishers
Cassell, D. and Coleman, R. (1995) Parents with psychiatric problems. In: Reder , R. and Lucey, C. (eds.)
Assessment of parenting: psychiatric and psychological contributions. London: Routledge)
Early Help Conference
Reflective practice
Early Help Conference
Reflective practice
• How can you ensure you are reflective in
your practice?
• What do you need in your working life to
ensure this happens?
To be reflective you need to develop your
specialist knowledge and increase your
practice experience.
Early Help Conference
KEY HEALTH CONCERNS &
INDICATORS
• How do we know if children are at risk with
parents where there is evidence of the
toxic trio?
Early Help Conference
HEALTH CONCERNS & INDICATORS:
• Has the baby failed to thrive? Is the baby showing any of these symptoms irritation and high-pitched crying, often for long periods; rapid breathing and heart
rate; disturbed sleep patterns; sweating and fever; vomiting and diarrhoea and
feeding difficulties?
• Babies of women whose use of opiates, cocaine or benzodiazepines during late
pregnancy is heavy are likely to experience withdrawal symptoms.
• Do children have accidental or non-accidental injuries?
• Children are at increased risk of physical injury during an incident [of domestic
violence], either by accident or because they attempt to intervene.
• Poverty and a need to have easy access to drugs may lead families to live in
unsafe communities where children are exposed to harmful anti-social behaviour
and environmental dangers such as dirty needles in parks and other public places
• Neglect involving denial of critical care and lack of supervision was most likely to be
the sole form of maltreatment in those families with the most severe forms of
domestic violence
• When intoxicated, parents may fail to hear their child’s cries or notice he/she is
unwell; they may accidentally smother them when unconscious due to drugs; they
may leave the child unattended when seeking money or drugs
Early Help Conference
•
•
•
•
•
HEALTH CONCERNS & INDICATORS contd
Do young children present with stomach-aches and bed-wetting (psychosomatic
symptomology)?
Hester et al note that pre-school children are more likely to show physical symptoms
such as stomach-aches and bed-wetting [as a result of living with domestic violence].
(Stanley et al, p.331)
Are adolescents involved in problem alcohol or drug use or unsafe sex?
Adolescents may become involved in drugs or early pregnancy [as a result of living
with domestic violence] (Stanley et al, p.331)
(Stanley N, Cleaver H, Hart D (2010) “The Impact of Domestic Violence, Parental Mental Health Problems, Substance
Misuse and Learning Disability on Parenting Capacity” The Child’s World. 2nd edition, London: Jessica Kingsley
Publishers)
Early Help Conference
Education concerns:
•
•
•
•
•
•
•
•
•
Are younger children meeting developmental milestones?
Parents may not have the practical or emotional reserves to engage with their
children in order to provide stimulation to support their development. (Stanley et al,
p.337)
Are appropriate toys available at home?
Finding money for drugs may reduce what is available to meet basic needs
Do children attend school or nursery regularly? If they attend do they arrive on time?
Education can suffer when adolescents stay home to protect their parent or
themselves from an abusive partner.
For a variety of reasons including disorganisation and lack of self-esteem, drug
misusing parents may fail to enable the child to attend pre-school facilities.
Are children alert at school or nursery? Are children failing to achieve their
educational and developmental potential?
Research suggests that children’s education and performance in school may suffer
because parental problems dominate the child’s thoughts and can affect
concentration (young carers)
Early Help Conference
Emotional & behavioural development concerns:
•
•
•
•
•
•
•
•
Is there poor attachment with parents?
For babies and infants post natal depression may hamper the mother’s capacity to
empathise with, and respond appropriately to, her baby’s needs. A consistent lack of
warmth and negative responses increases the likelihood that the infant will become
insecurely attached. Mood swings, a common feature in mental disorders, can result
in inconsistent parenting, emotional unavailability and unexpected and unplanned for
separations.
The all consuming nature of significant substance misuse problems may mean it
becomes the user’s primary attachment, distorting other relationships, including the
ability to show children emotional warmth and make them feel valued. (Stanley et al,
p.337)
Are children expressing anxiety or stress?
Primary age school children may present a wide range of behavioural and emotion
problems [as a result of living with domestic violence] (Stanley et al, p.331)
It is widely accepted that boys are more likely to act out their distress with anti
social and aggressive behaviours while girls tend to respond by internalising their
worries.
Is there evidence of detachment and dissociation in the child/ young person’s
behaviour?
Witnessing domestic violence affects children’s emotions and behaviour and can
lead to temper tantrums and aggression which are directed at family and peers, and
cruelty towards animals
Early Help Conference
Child identity concerns:
• What happens when there is lack of support for adolescents going through puberty?
• Parental problem drug misuse may mean parents are unaware of children’s worries
over their changing body/ personality and fail to provide support and advice
• Is there an acceptance of domestic violence (and what happens as a consequence?)
• Men participating in Stanley et al’s (2009) study of men’s views and experiences of
domestic violence undertaken in northern England described how their perpetration of
domestic violence was interwoven with other forms of community violence
encountered in childhood and with traditional and persistent conceptions of
masculinity (football!)
• Does the child or young person have low self-esteem?
• Studies undertaken from the perspectives of children and young people also draw
attention to the effects of the secrecy and stigma surrounding domestic violence on
young people’s self-confidence, self-esteem and consequent capacity for making
Early Help Conference
Family and social relationships concerns:
• Does the child have irregular meal and bed times?
• Difficulty in organising day to day living [as a result of parental substance misuse]
means that important events such as birthdays or holidays are disrupted and family
rituals and routines such as meal or bed times, which cement family relationships, are
difficult to sustain.
• Adolescents with few friends:
• Many adolescents cope with the stress of domestic violence by distancing
themselves from their family or friends.
• Studies undertaken from the perspectives of children and young people also draw
attention to the effects of the secrecy and stigma surrounding domestic violence
on young people’s self-confidence, self-esteem and consequent capacity for making
relationship with peers. (Stanley, p.31)
Early Help Conference
Social presentation concerns:
• Are children unwashed and wearing dirty
clothes?
• Difficulty in organising day to day living [as a
result of parental substance misuse] means that
important events such as birthdays or holidays
are disrupted and family rituals and routines
such as meal or bed times, which cement family
relationships, are difficult to sustain.
Early Help Conference
Level of self care skills
• Are the older siblings caring for their younger siblings?
• Education may also be interrupted while parental
mental health problems become severe and young
people stay home in order to look after their parent or
younger siblings.
• Do adolescents present as “older than their years?”:
• When parents are unable to look after adolescent
children adequately [as a result of substance misuse],
the normal pace of emotional maturity can be
accelerated and for some the relationship between
parent and child is reversed.
Early Help Conference
Good multi agency practice –
the key to keeping children safe
Partnership working
• Research findings (Ward et al 2010) indicate that social workers rarely consult or
collaborate with services for substance misuse and domestic violence in carrying out
assessments or planning
• Collaboration should be given greater priority because practitioners in domestic
violence units, alcohol and drug services will have a better understanding of how
these issues impact on adult family members and family functioning.
• The expertise of practitioners in these specialist services should be used to inform
the social work assessments, judgements and planning.
How can we promote more effective multi agency practice?
(Ward H, Brown R, Westlake D, Munro ER (2010) Infants suffering, or likely to suffer, significant harm: A prospective
longitudinal study, London: Department for Education)
Early Help Conference
Parental mental health
• Mental health vulnerabilities are going to
be present if there are abusive/ violent
parental relationships and if there is
substance misuse/ alcohol dependency.
Early Help Conference
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
• Organic, including symptomatic, mental disorders (dementias)
• Mental and behavioural disorders due to use of psychoactive
substances (substance misuse)
• Schizophrenia, schizotypal and delusional disorders
• Mood [affective] disorders (bipolar, depression)
• Neurotic, stress-related and somatoform disorders (anxiety/
agoraphobia)
• Behavioural syndromes associated with physiological disturbances
and physical factors (eating disorders, nightmares)
• Disorders of personality and behaviour in adult persons (BDP,
pyromania, transsexualism, paedophilia)
• Mental retardation (mild, moderate, severe)
• Disorders of psychological development (dyslexia, language
disorders)
• Behavioural and emotional disorders with onset usually occurring in
childhood and adolescence (ADHD)
• Unspecified mental disorders (nobody knows…)
Early Help Conference
Diagnostic labels………
•
•
•
•
•
•
•
•
Acute psychotic depression
Schizoaffective disorder
Schizophrenia
Long term depression with psychological problems
Primary depressive disorder
Recurrent psychotic depression
Bi-polar disorder
Personality disorder (s)
Early Help Conference
24
‘Would you go behind
the blinds, take off your
personality and put this
label on …?’
Illustration by Fran Orford
Early Help Conference
25
Impact of Parental Mental Health
Problems on Children
• Children of mentally ill parents are an ‘at risk
group’
• Higher prevalence of emotional and behavioural
difficulties in children with a parent with a
psychiatric disorder- about a third of these
children have a persistent disorder and a further
third have transient psychiatric difficulties
compared to 10% of a community sample.
(Rutter & Quinton,1984, ONS data,
1999, Research in Practice, 2009)
Early Help Conference
Impact of Parental Mental Health
Problems on Children
• Increased rates of disorder in children results
more from greater psychosocial disadvantage
experienced in families affected by parental
mental health problems than from the illness per
se.
• Children’s problems appear to be exacerbated
by factors such as marital discord, family
disruption and the quality of parent-child
interaction.
• Recent studies show a more complex
relationship between specific disorders in
parents and disorders in children.
Early Help Conference
Early Years
• Children develop quickly in their early
years and the impact of parental mental
health problems can be significant if key
developmental stages are affected or
impaired
Early Help Conference
Impact of The Toxic Trio on
Children - Feelings
•
•
•
•
•
Distress
Anger
Worries – fear for themselves
Fear for parents
Confusion about the situation & the parent’s
difficulties. Not understanding the nature of the
parent’s illness.
• Guilt & Blame – blaming themselves or being
blamed
• Experiencing hostility and scape-goating for
parents’ problems
Early Help Conference
Impact of The Toxic Trio on
Children
•
•
•
•
•
Missing school
Missing leisure opportunities
eg outings, having friends home
Young carers
‘Loss of childhood’
Early Help Conference
• But…..How many parents
in the UK actually have
mental health problems?
Early Help Conference
• Approximately one in 10 mothers and one in
20 fathers are thought to have mental health
problems impacting on their children
• At least one in four adults in contact with
mental health services is a parent.
• As many as 25% of children between the ages
of five and 16 have a mother who is at risk of a
common mental health problem such as
depression or anxiety.
• In an average primary school class six or
seven children will be living with a mother with
a mental health problem; many of these will be
lone mothers who are statistically more at risk .
Early Help Conference
How many parents in the UK
have mental health problems?
• Overall more women than men have mental
health problems.
• More younger women and more lone parents
than those in couples have mental health
problems.
• Lone parenthood, particularly among women,
seems to be a risk factor for mental health
problems.
• This is often associated with socio-economic
disadvantage and the interaction of other risk
factors.
Early Help Conference
Working together?
• Once identified, it is clear that in many
cases parents with mental health problems
fall through the net and their needs are not
met. Services often fail to work holistically
with families (despite the ‘Think Family’
approach); poor collaboration and service
coordination, together with confusion over
professional roles and responsibilities,
make the difficulties worse.
Early Help Conference
Introduction
to Mental
Health
Case scenario 1
• Putting the pieces together
Early Help Conference
•
Children's Social Care received a referral from Weavers School due
to concerns for a mother's emotional wellbeing and her problems in
getting one of her children to school on time. This seems due to
current mental health concerns centring on her anxiety and
depression. The family have recently moved to MK from Luton.
•
Gina has become emotionally distressed due to her partner (and
children’s father) Joe leaving the family home a few weeks earlier.
School have assisted Gina in seeking medical support from the GP.
Joe has since returned to the family home but continually comes and
goes leaving for a few weeks at a time. Gina is not willing to accept
support from the local CFP but has a good relationship with her GP.
•
Gina is struggling to sort out her relationship with Joe and has
suffered violence and aggression from him in the past. Both Gina and
Joe have had difficult childhoods. Gina suffered physical and sexual
abuse whilst Joe had a very unhappy childhood with his father dying
from alcohol poisoning when he was 11 years. There was also a
significant level of domestic violence in his family home.
Early Help Conference
Introduction
to Mental
Health
Case scenario 1 contd
•
Joe and Gina confirm relationship problems exist between them. Gina's
anxieties and depression impacts on family life and makes it difficult for her
to prioritise her 3 young children’s needs.
•
Joe finds it difficult to cope with ‘family life’ and struggles particularly to have
any feelings for Justin (6years). He often shouts at him when things are
going wrong in the family. He sometimes loses his temper and will
physically damage things by punching and hitting etc. Gina feels her
depression is not out of control and doesn’t think its affecting her children in
any negative way. She admits she sometimes struggles to get Justin to
school as she often feels low and wants to remain in the safety of her home.
•
The family are isolated and have few contacts in their new area of MK. The
other two children (Joshua, 3ys and Jaidon, 1yr) seem to remain in the
family home for long periods of time and they seem to seldom leave the
family home.
1. What are the key issues and priorities in this case?
2. How can we work with this family?
Early Help Conference
A Family-Centred Approach
• Talk to children & help parents talk to children,
promoting good communication & attachment.
• Use child-centred language. Always consider
the age
• and developmental stage of the child(ren)
• Drawing, toys and play can help children
communicate (signs of safety)
• Check out the child’s understanding of parent’s
illness.
• Provide a child centred explanation of parent’s
illness sufficient to help child (ren) make sense
of the situation but not so much that it
Earlyoverwhelms.
Help Conference
A Family- Centred Approach
Services should plan & work proactively with the
family:
• Children may want to know about prognosis
• Children’s understanding of their parent’s needs can
help to pick up on ‘relapse indicators’
• Contingency plans need to be in place for when parent is
unwell
• There needs to be a positive response to young carer
issues
• Interventions should promote normal opportunities for
children
• Supportive relationships need to be engendered in the
family’s wider networks (FGCs).
Early Help Conference
• Working in partnership with the family
(systemic approaches) – how can we
address the needs of parents and their
children using safe and child centred
approaches?
Early Help Conference
Introduction
to Mental
Health
Think Family
Approach
Early Help Conference
Introduction
to Mental
Health
•And not………….
Early Help Conference
Circled by Agencies!
Early Help Conference
Introduction
to Mental
Health
The ecological model
• Where are the strengths and where are
the weaknesses?
• How do we determine what is ‘safe’ and
what is risk laden?
Early Help Conference
APPLYING SYSTEMIC THEORY TO
SOCIAL CARE SITUATIONS
Social and cultural constraints
GP
Carol
friends
Roger
Alice
Mental
Health
Social
pressures
Grandad
friends
Early Help Conference
Introduction
to Mental
Health
Liam
Craig
school
Case Study 3
Craig 14ys, Alice 12ys and Liam 11ys live together with their mother (Carol) and father (Roger) in a small
mid-terraced house in Bletchley. Roger and Carol have had a stormy relationship for some years. Roger has
begun to spend an increasing amount of time away from the family home staying late at his job as a
mechanic in the local garage.
When he’s not working he is usually down the local pub and often comes home in a drunken state, which
usually sparks off arguments and noisy exchanges. Roger’s behaviour towards his wife has deteriorated and
he has begun punching and shoving her when they argue. Carol has become increasingly stressed by the
situation and has begun to experience incessant headaches and feelings of panic. She has found it difficult
to go to the shops after recently experiencing a panic attack whilst she was waiting in the check out queue.
Roger has got in to a dispute with a neighbour and there are regular angry exchanges after complaints were
made about the noisy late night rows. The two boys have started to target local families and there are regular
incidents of vandalism and criminal damage. The community safety team are already involved with the family
as a consequence. The local Age Concern day centre are concerned about Roger’s father and he has been
attending with bruising evident to his arms and legs. Carol seems to be her father-in-law’s main carer and
she has put this down to his ‘bruising easily’.
Craig is persistently truanting from school. He has been hanging out in the city centre and has a pending
court case for assault and criminal damage. Both boys are heavy smokers and Carol has found evidence of
‘drugs paraphenalia’ in their bedroom. Liam has been suspended from school for swearing at a teacher and
Carol finds it increasingly difficult to discipline the two boys.
Early Help Conference
Introduction
to Mental
Health
Case Study 3 contd.
Carol recently went to her GP and was prescribed tranquillising medication which
makes her feel much worse.
Alice attends school on a regular basis and has made good progress in her new
secondary school. She seems to want to stay on late at school and seldom talks
about life at home. Teachers describe her as a very serious intense child who finds it
hard making friends.
One evening after a particularly violent row with Roger, Carol took a serious over
dose necessitating her admission to a medical ward for a few days. Roger attempts
to keep the family together as best he can but has frequent angry exchanges with
Craig who accuses him of trying to kill their mother.
Things reach crisis point later in the week when Craig has a major row with his dad
and leaves the house. Carol returns home from hospital to find her husband
distraught and upset, Liam has gone out after his brother and Alice is alone in her
bedroom. Roger’s father appears to be oblivious to it all and is sitting in his chair from
which he seldom moves.
1) What plan of action can you put together which encompasses the needs of this
family?
2) What are the key issues you need to address with the family?
Early
Introduction
Help Conference
to Mental
David
Glover-Wright
Health
The container theory
• Rubbish bin or safe container?
Early Help Conference
The container-contained relationship (Bion
1962)
•
“Mother is receptive to the baby’s feelings - feeling the baby’s feelings in herself,.Through
this the baby’s state of mind and feelings can be tolerated and known by the mother and
some sense can be made of them (meaningful attachment). Therefore feelings that were
too powerful for the infant to hold within himself can be thus made tolerable…and can be
contained by the mother who acts as a container” .
•
The mother is open to emotional communication- has space for uncertainty and ambiguity
in communication, and to think about meaning. Workers should develop this capacity
through focused work with parents.
•
Developing reflective practice and countering the ‘fight or flight’ mechanism.
•
“Having a sense of being kept in mind provides an opportunity to reflect on emotional
experiences” – taking the young person’s thoughts and predicament seriously encourages
communication of inner states to take place (Briggs 2002)
•
The absence of containment leads to children experiencing reduced hope or faith in the
possibility of communicating to others about their state of mind; ultimately withdrawal and
an emotional shut down will occur
•
The experiences of being contained in childhood influences the adolescent’s capacity to
make sense of and contain the anxiety, ambiguity and uncertainty of adolescence. Having
a containing relationship helps one to understand and develop one’s individuality.
•
Achieving a secure identity can only take place through and within a
relationship with others.
Early Help Conference
49
Developing a containing relationship
with a child/ young person
This will involve:
• accepting and respecting the child/ young person’s circumstances
• striving to be reliable, attentive, empathic, sympathetically
responsive and encouraging the child/ young person to talk about
their thoughts and feelings
• recognising the importance of emotional communications
• providing psychological space and keeping him/her in mind
• having a ‘psychological space’ to reflect & think
Because:
• Containing relationships has a transformational impact on
adolescent turbulence. Being kept in mind enables the adolescent
to develop and bear the emotional impact of his/her thoughts and
feelings.
• Developing their capacity to make intimate emotional bonds with
others, enables effective personal functioning and stable mental
health
Early Help Conference
50
Developing emotional resilience in
families
• Understanding the cycle of crisis
Early Help Conference
51
• Families where there are multiple
problems and poor coping strategies will
often ‘cycle’ in and out of crisis. This can
have a serious impact on children and
young people’s emotional wellbeing and
their later life experiences.
Early Help Conference
Crisis Theory
• Caplan’s theory of crisis and crisis intervention:
• 4 stages of crisis:
• 1) situation is challenged by trigger events (change/ loss/ threat
to status quo). People cope using their resources; there is
awareness of strained relationships and changing roles but people
‘make do and mend’
• 2) situation becomes ‘normalised’; people adapt to the crisis
sustaining routines and behaviour but emotional and psychological
pressures being to grow
• 3) situation begins to become ‘externalised’ there are
confrontations, angry exchanges and ‘flash points’ which are
patched up but tensions are breaking through and behaviours/ roles
are changing; young people are labelled and formalised in a crisis
role
• 4) situation breaks down; coping strategies are no longer working
and strengths and resources have been exhausted. Caplan called
this stage the ‘disequilibrium of crisis’ and he saw this as the time
when the most positive work could be undertaken.
Early Help Conference
Trigger/ event
Coping strategies not
able to manage
continued exposure to
stress & change and
create disruption in
relationships/
behaviour/ health =
increased vulnerability
to further stress
Physical &
psychological reaction
Adaptation and
normalisation of
reactions and responses:
can lead to resolution if
positive coping
strategies & supports are
in place
resolution
Early Help Conference
SocIal network
Stress/ Performance Curve
Performance
Optimal Stress/ Performance
curve
Optimal level
of output;
mental/
physical
exertion lead
to exhaustion
Stress increases but
performance doesn’t
Crisis
point
Early Help Conference
Stress
Children's messages
Early Help Conference
•
•
•
•
•
Introduce yourself – tell us what your job is
Give us as much information as you can
Tell us what is wrong with our parents
Tell us what is going to happen next
Talk to us and listen to us. Remember it’s not
hard to speak to us; we are not aliens
• Ask us what we know and what we think. We live
with our parents; we know how they have been
behaving
Early Help Conference
• Tell us it’s not our fault. We can feel guilty if our
mum or dad is ill. We need to know we are not
to blame
• Please don’t ignore us. Remember we are part
of the family and we live there too.
• Keep on talking to us and keep us informed. We
need to know what is happening
• Tell us if there is anyone we can talk to. MAYBE
IT COULD BE YOU.
Early Help Conference
Risk management and
safeguarding in families where
there is evidence of the toxic trio
Working in partnership with
families
Early Help Conference
Competent risk management practice with
children and families should:
• 1 – Adopt a holistic, family centred
approach
• 2 – Employ identified risk criteria
thresholds within a framework of
assessment and related intervention
seeking advice and support from senior
staff – assessment needs to be side-byside with intervention
Early Help Conference
• 3 – Involve parents and children in ongoing practice,
validating their perceptions and opinions
• 4 – Avoid gender bias; this is particularly pertinent in a
female dominated work force where the role and opinion
of fathers can be neglected
• 5 – Utilize multi disciplinary processes of assessment
and decision making, validating other profession’s
perspectives and knowledge base
• 6 – Be explicitly shared in supervision and case
discussions and then recorded in ongoing case notes
and decision making processes
• 7 – Compile detailed and family centred risk
assessment and management documentation
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• RISK ASSESSMENT FOR FAMILIES
WHERE THERE ARE MENTAL HEALTH
PROBLEMS:
• Identified Risk Areas:
• Score out of 5: 5 = current; 4= historic/
recent (last 6 months); 3 = historic/ past
(over 6 months); 2 = background
predictors (family history); 1 = background
predictors (current circumstances) 0 = no
risk factors present
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7 most frequently encountered risk factors for
children in families where there are MH problems
Parenting
problems
Environment
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Neglect
Substance
misuse
Family/
Third party
Domestic
violence
Child’s
behaviour/
health
Define behaviours which generate scores noted above:
• Parenting: (Poor attachment/ inconsistent approaches)
• Environment: (Unhygienic living conditions/ hazardous
environment)
• Neglect: (Children left alone unsupervised/ health
appointments missed/ educational problems)
• Substance Misuse: (Alcohol consumption/ substance
misuse leading to intoxication )
• Family/ Third Party: (Ongoing unknown adult visitors to
home)
• Domestic Violence: (Current/ previous partner violent
& abusive)
• Child’s Behaviour/ Health: (Child destructive and
unable to settle/ poor routines)
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Risk assessment contd.
• Outline risk areas which may interact in
a dangerous manner, provide evidence
for this in current family situation and
information source (eg domestic violence
and alcohol consumption/ poor parenting
and leaving child alone/ previous evidence
of risks occurring)
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Risk assessment contd.
• Outline family strengths and resources
which can be consolidated & developed to
address risk factors outlined above:
• 1)
• 2)
• 3)
• 4)
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Define key interventions & resources needed to address
risks outlined above:
•
•
•
•
•
•
•
Parenting:
Environment:
Neglect:
Substance Misuse:
Family/ Third Party:
Domestic Violence:
Child’s Behaviour/ Health:
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Risk Factor
Parenting
Environment
Neglect
Substance misuse
Family/ third party
Domestic violence
Child’s behaviour/ health needs
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Hoped for outcomes
Risk assessment contd.
• Share the risk plan with the family and
encourage their participation and
ownership
• Review the risk plan and evaluate with the
family providing positive reinforcement as
progress is made
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Safeguarding children in families with a
parent with mental health problems
• The responsibility for safeguarding children does
not only lie with children’s services. It is a
requirement of safeguarding children that adult
services, including mental health services, know
whether their service users have children or are
in contact with children.
• It is therefore important to be able to recognise
and understand what contribution adult mental
health problems make to an assessment of
overall risk of harm to children.
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Introduction
to Mental
Health
Signs of Safety Model
Signs of safety Assessment & Planning Form
SAFETY
DANGER/ RISK
List all aspects that demonstrate
likelihood of maltreatment (past,
present & future)
What are we worried about?
Safety & Context
Scale:
List all aspects that
demonstrate safety
(resources, goals,
willingness to change)
What is working well?
Safety scale: Rate the situation 0-10 where 0 means recurrence
of similar or worse abuse/ neglect is certain and 10 means there
is sufficient safety for the child.
Context scale: rate this case on a scale of 0-10, where 10
means no action is taken and 0 means this is the worse case of
child abuse/ neglect the agency has observed
Agency goals: What will the agency need to see occur to be willing to close the case?
Family goals: What does the family want generally and regarding safety?
Immediate progress: What would indicate to the agency that some small progress has
been made?
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What needs
to happen?
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Signs of Safety Model
• Turnell, A. and Edwards, S. (1999). Signs
of Safety: A safety and solution oriented
approach to child protection casework,
New York: WW Norton.
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• Thank you and any feedback would be welcome!
• David Glover-Wright
([email protected])
Independent Trainer
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