Working With Children

Working With Children, Young People And Families 1

WORKING WITH CHILDREN, YOUNG PEOPLE AND FAMILIES

(by Name)

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Introduction

This paper analyzes a serious case review: Child G published in 2014. From the case

review, three key themes have been identified that include: parental mental illness; inter-agency

practice; and working with fathers. The three themes will help in the identification of factors that

can help social work practitioners to effectively work with potentially dangerous families. The

analysis serves to offer practitioners with the capacity to be more attentive to numerous risk

factors, ensures that they are able to do whatever is in their power to reduce risk, and allows

practitioners to remain focused in giving the required support to such families to enable them

reduce their own risks. Where risk factors are evident, practitioners must have the skills and

confidence to initiate the necessary action, at the right time, to protect children without

unnecessary delays. This can only happen when there is a highly skilled staff, good management,

and a transparent and open approach in dealing with children, young people and families.

Summary of Child G Case

From January 2011, Child G`s mother had experienced various instances of depression

that were promptly treated and she felt better. Child G was born in December the same year. In

January 2013, the mother felt psychologically unstable, and she visited a GP. The possibility of

visiting a psychiatrist was deliberated, but the mother felt it was not necessary. In June, the

mother suffered a head injury following an accident at home, and two weeks later she overdosed

herself. On 19th it was found that she required an urgent medical review, instead, three home

visits were done, including on 24. On 25th, Child G aged 18 months received admission to a

hospital after cuts on his tongue and two fractures on his jaw bone. His mother initially reported

that he fell down the stairs; however, she later told the paramedics that the child sustained the

injuries after she intentionally threw him down the stairs (Firth, 2014, p. 4).


Key Theme 1: Parental Mental Illness

Many parents with mental health problems are still able to safeguard and take care of

their unborn child and/or children. However, some parents as in the case of baby G`s mother are

not able to meet the needs and ensure their child is safe. The welfare of any particular child

should be given the utmost priority. There were evident red flags in Child G`s case that could

have been used to anticipate and possible prevent the injury to child G. Firstly, as early as

January 2011 before Child G`s pregnancy, the mother had shown signs of depression prompting

the GP to refer her to Community Mental Health Team (CMHT). Similarly, a month after the

pregnancy with baby G was confirmed, the mother had severe depressive episode and expressed

doubts about the pregnancy for which she was promptly referred to the Urgent Care Team and

she recovered. In autumn of 2011, the mother was under pressure because of the toileting issues

associated with the older sibling. In January 2013, the mother`s psychological state was

deteriorating, and the possibility of seeing a psychiatrist was discussed but never implemented.

The case further indicates that the mother sustained a minor injury on the head following an

accident at home. No further details are provided about this accident, and there is a possibility

that the accident was linked to her psychological state. Two weeks after the home accident, she

overdosed herself (Firth, 2014, p. 3).

As a matter of practice, where a professional suspects that a child is at risk of suffering

severe harm due to the parent`s omission or commission, the referral process must be initiated

immediately. The necessary child protection referral should be done immediately without delays.

This should be done even if diagnosis has not been conducted on the adult (in this case Child G`s

mother). As indicated in the case, the attending crew completed a safeguarding form following

the overdose incident as required. On receipt of the safeguarding referral, the Children's Services


performed welfare checks in relation to the two children, through a telephone call to the mother.

This was a failure because according to the Common Assessment Framework (CAF), ethics

requires that consent has to be obtained from the child, young person and/or the parent, however,

these individuals must tell their own story (Safeguarding Children Board, 2015, p. 1). Therefore,

it was wrong for the Children's Services to only rely on the mother on the mother to perform the

welfare checks. Secondly, such checks can be done best through face to face interaction and not

through telephone assessment (Safeguarding Children Board, 2015, p. 1). In this case, there was

need for immediate action to safeguard the children considering the fact that the mother had a

history of mental illness.

The injuries sustained by baby G were directly linked to the mental health of the mother.

It is evident from the case that the potential risk factors linked to the mother`s mental health were

not comprehensively explored in the ante-natal and post-natal period. Because of this the ability

of the practitioners to accurately judge the mother`s parenting capability was severely

compromised. In baby G`s case, there was a failure to take into account the social and family

history. Injuries to baby G was occasioned by the fact that there was little information relating to

the mother`s mental illness. The CSR report indicates that there was no imminent risk to the

children. However, this is not true considering that the ambulance team had raised concerns and

referred the matter to the Children`s Services (Cordess, 2001, p. 86).

In dealing with parents with mental illnesses, it is important for practitioners to consider

the family context and take into account the safety and wellbeing of the children throughout the

care process beginning from the time when the patient is assessed to the time when he/she is

discharged. This appears not have been the case with child G`s mother. Most of the assessments

conducted before and after pregnancy were more focused on the mother and limited or no


attention was paid to the safety and wellbeing of baby G and his older sibling. The mental health

of the mother and its impact on the two children should have been considered. As at the point

when the mother had an overdose, there were obvious safeguarding issues that the practitioners

ought to have addressed. As indicated in the case review, no information on the mother`s mental

health was shared because of the need to avoid stigmatization (Firth, 2014, p. 7). This was

wrong because in such a situation, information sharing about the mother`s mental state should

have been done considering the fact that the needs of the children are more important and

safeguarding measure have to be undertaken even it risks impairing the therapeutic relationship

with the mother. In addition, whereas the law protects the mother`s confidentially and privacy,

the law cannot be used to prevent information sharing between practitioners (Cordess, 2001, p.

89). Given that the safety and welfare of children is a priority, sharing baby G`s mother mental

health information without consent was a matter of public interest because it could have been

used to protect baby G and his sibling from harm (General Medical Council, 2009, p. 6).

Key Theme 2: Inter-Agency Practice

Inter-agency working is not a new phenomenon. It has been used from the mid-19th

century when social workers and health professionals collaborated in reducing poverty in

England (Cheminais, 2009, p. 1). Many changes have happened in the recent past, which have

emphasized the significance of collaboration between n various agencies working with children,

young people and families. However, despite the immense inter-agency benefits achieved for

clients, patients, and practitioners, many children, young people, and families continue to be

failed by the lack of collaboration by the various agencies in meeting their needs, and this is

evident in the case baby G.


Baby G`s case epitomizes the lack of inter-agency collaboration. Midwives, GP, and

consultant obstetrician are aware of baby G`s mother mental problems. As a result, the midwives

were more effective in assessing and monitoring the mother`s state of mind and making referrals

to the consultant obstetrician when necessary. On the other hand, health visitors who visited the

family regularly did not have any records relating to the mother`s mental health, and were,

therefore, unaware of the degree of the mother`s mental health problems. It is evident from the

case that no records were submitted by the midwives to the health visiting team, as such, there

was no information exchange on the patient. Similarly, there were no communication channels

between health visitors and mental health workers; as such the health visitor was not aware that a

mental health team was also seeing the mother of baby G. When Children's Services came in

after the overdose incident, it became difficult to communicate with the Urgent Care Team

involved because of lack of clear inter-agency communication channels. At this time, the risk to

the children was imminent given that the ambulance services had already referred the issue to the

Children’s Services (Firth, 2014, p. 9).

The various agencies in the case were affected by “start again” syndrome, whereby each

agency had a fresh start when dealing with the client. Whereas starting fresh may be good for

children, young people and families, it poses greater risk of ignoring a parent`s previous history.

Similarly, another problem identified in literature is referred to as the “rule of optimism”,

whereby information that is contrary to the practitioner`s view of the parent is overlooked or

downgraded. All these are evident in the case. The inaction by the concerned agencies,

particularly after the overdose incident was clearly caused by the failure to share information of

concern in relation to the mother`s mental health. It appears that the Children’s Services would

have taken the necessary measures to protect the children, however, because of lack of sufficient


information on the referral they received coupled with the Children’s Services inability to make

contact with the mental health team, made it impossible to make a decision.

The connection between child protection and parent mental health represents one area

where effective inter-agency collaboration is significantly important. Notwithstanding the

predicted benefits of interagency collaboration and despite the existence of legislation and policy

aimed at encouraging or mandating inter-agency collaboration, there are numerous occasions

where these attempts fail to deliver the desired outcomes. In the case of baby G, the failure of

inter-agency collaboration can be linked to the failure by the various agencies to take into

account the mother`s parental responsibilities and roles and integrate them with their respective

perspectives. The failure in baby G`s case happened not because collaboration cannot produce

better services, but because effective collaborations were not developed due to barriers at the

professional and agency levels (Johnson et al., 2003, p. 70). In practice, effective sharing of

information requires each agency to have a positive view toward the role and staff of the other

agencies (Johnson et al., 2003, p. 81). Professionals working in different agencies such as

Children`s services, mental health team, and health visiting teams may be operating with

dissimilar discourses, different autonomy, conceptual frameworks, unequal statuses, and

knowledge bases (Hetherington et al., 2002, p. 45). Such variables may result in different ideas

on a parent`s mental illness and its link to a child`s needs leading to problems in collaborative

decision making and communication. Furthermore, the lack of inter-agency policies and

structures may also explain the problems in collaboration. The case of baby G is an example

where there were no policies and structures to promote inter-agency collaboration, as a result,

individual workers in the different agencies found it difficult to start and maintain inter-agency

relationships (Byrne et al., 2000, p. 21).


In addition, inadequate resources can also dampen inter-agency collaboration because it

leaves the employees without time to create and sustain contact with other people in the different

agencies. As indicated in the case, “Children's Services did try to contact mental health

colleagues and vice versa but the practitioners kept missing one another and had to leave

messages instead” (Firth, 2014 p.9). Most importantly, the friction between a patient`s right to

privacy and the necessity of the personnel to have a comprehensive understanding of the

situation in the family can affect communication between agencies. The problem is even

worsened when agencies have differences practices and policies on confidentiality (Byrne et al.,

2000, p.25).

Key Theme 3: Working With Fathers

As evident in baby G`s case, there is a tendency among practitioners to avoid engaging

fathers. Baby G`s father was viewed by the different professionals simply as a part of the broader

family, but was never proactively engaged to enhance assessment and planning (Firth, 2014, p.

9). In most cases, practitioners do not pass on or pursue information about fathers (Brandon et al.

2009, p. 24). Little information is often known about fathers in the household, their relationship

with mother, and the degree to which they are engaged with the children. Child welfare

personnel have a tendency of focusing more on mothers because mothers are viewed as the

primary caretakers, while fathers are excluded. Even after baby G`s mother overdosed herself,

the Children`s Services still contacted her to conducted welfare checks in relation to the children,

instead of the father (Firth, 2014, p. 4). If the father had been involved in baby G`s case, perhaps

a proper assessment could have been done that would have prevented the unfortunate incident

from happening. In a study by Baynes & Holland (2010), 33% of fathers had never had contact

with a social worker before the initial child protection meeting. In baby G`s case, the father was


seen, but was never contacted despite the fact that he regularly dropped the children to school

and nursery.

Other than the failure of practitioners to engage fathers, fathers are also considered to be

reluctant clients. Some of the reasons given by fathers for evading contact with social workers

include the impact of their previous experiences with family services and their reluctance to

accept help. To some parents, involvement in parenting programs is likely to compel them to

follow particular parenting styles and as such, fathers believe that such programs are more

suitable for mothers (Bayley et al., 2009, p. 43). Furthermore, family support services are viewed

by fathers to be places for mothers, where women sit and talk.

There are various strategies that practitioners can use to promote engagement with fathers

in issues of child welfare. The first strategy is prompt identification and involvement. If fathers

are engaged early and better involved, for example, establishment of paternity at birth is linked

with better father involvement in terms of financial support, contact, and attending sure start

programs (Lloyd et al. 2003, p. 34). For the case of baby G, the father should have been engaged

as early as when the mother developed severe depressive symptoms after the second pregnancy.

For younger parents lacking employment, fatherhood can give them something important that

helps them in feeling worthwhile (Ferguson & Hogan, 2004, p. 32). Younger parents are more

willing to assist with negotiating relationships after a child is born, and are also very supportive

in caring for their children (Ashley, 2011, p. 19).

Secondly, practitioners should proactively engage with fathers. There are numerous

proven strategies that can be used to proactively engage with fathers. They include: no referrals

should be accepted if the child/ children`s father is not included. Secondly, practitioners should

visit fathers at home, and they should be persistent and consult the fathers on the specific support


they require. Similarly, the positive benefits associated with father involvement should be

emphasized. Moreover, practitioners should be more willing to invite fathers and have a positive

attitude toward these fathers.

Thirdly, services should be customized so that they are more relevant to fathers. Research

findings indicate that fathers have a preference for services that are tailor made for them, and

offer opportunity for them to spend more time with their children because this gives them the

opportunity to attract on peer support. Fathers require incentives to attract them and they have

preference for activity-based approaches that permit them to engage with their children and

participate in outdoor activities or skilled-based exercises as opposed to parenting sessions based

on classroom settings (Lloyd et al., 2003, p. 45). It appears that in the context of family support

work, the best interventions embrace a strength based approach that focuses on the significant

contribution that fathers make to the lives of their children. Practitioners should be positive about

the ability of fathers and remain honest about the issues they face. Intervention strategies should

focus on the existing skills that fathers have and make use of solution focused thinking to

improve their skills and build confidence (Gearing et al. 2003, p.43).

Summary/Concluding Section

In conclusion, the case review offers three important themes in terms of working with

children, young people and families. These include parental mental illness, inter-agency practice,

and working with fathers. The case of baby G indicates various shortcomings in handling the

three themes. The UK already has a legal framework that governs practitioners on how to deal

with mental illness and inter-agency collaboration. Children born to mentally ill parents can be

safeguarded using the Children Act 1 989. To be able to tackle the risks posed to children by

their mentally ill parents, the review offers sound recommendations that are evidenced based.


For instance, agencies must work together to protect children. A broad range of stakeholders

have an important role to play in the protection and promotion of children`s welfare. These

practitioners include but not limited to nurses, social workers, midwives, school nurses, adult

mental health, emergency teams, and GP. In dealing with mentally ill parents, these agencies

must work together to perform a comprehensive assessment. For this to be achieved information

has to be shared between the different agencies to promote mental health and implement early

interventions. Understanding a patient`s role as a parent permits the necessary steps to be

undertaken both for the patient and his/her children. Improved collaboration equally enhances

links with primary care where the majority of maternal depression (as was the case with baby

G`s mother) are diagnosed. Most importantly, Children's Services should conduct a

comprehensive assessment of the needs of a child (children) and the capacity of parent in

meeting those needs. Doing so requires the involvement of not just the mother, but also the

father. A father`s role should not be assumed, instead, they should be actively engaged by

involving them as early as when the child is born and customizing the welfare programs to suit

the father`s needs. In addition, social workers have to develop positive attitudes toward the

fathers.

Reference List


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Cheminais, R. (2009). Effective multi-agency partnerships: Putting every child matters into

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