Child Protection and Mental Health

Abstract

In this editorial, we start by celebrating the success of BASPCAN's 8th Congress Keeping Children Safe in an Uncertain World: Learning from Evidence and Practice which took place in April 2012 at Queen's University Belfast, Northern Ireland. This conference brought together practitioners, researchers and policy makers from agencies working in the field of child welfare and protection, to share and debate knowledge and experiences. Conference attendees came from many areas of the globe including Canada, Australia, New Zealand, Poland, Portugal, USA, Republic of Ireland, Denmark, The Netherlands, Switzerland, Norway, Germany, Columbia, Turkey, Pakistan, Israel, Singapore, Finland, Ghana, Gibraltar, South Africa, Nigeria and Russia. There were a wide range of excellent presentations on different aspects of safeguarding research, policy and practice. The papers in this issue reflect some of the diversity of topics discussed during the conference; they also reflect an underlying theme – that of child protection and mental health – which is often discussed as a side issue. Although not well understood, the interplay between parental mental health and wellbeing, safe and effective parenting and children's mental health and wellbeing is a crucial issue for professionals in this field. In a recent review, the Social Care Institute for Excellence (2011) highlighted the complex needs of children and their parents when the latter have mental health problems, including the potential for adverse effects on children's mental health and their subsequent vulnerability to later mental health difficulties. ‘Celebrating the success of BASPCAN's 8th Congress Keeping Children Safe in an Uncertain World ’ ‘The papers in this issue reflect some of the diversity of topics discussed during the conference’ The first paper in this issue by Davidson et al. (2012) draws attention to the evidence from research, inquiry reports and policy which repeatedly stresses the importance of establishing effective inter-agency working between children's services and adult mental health services in order to safeguard children. This informative paper reports on the evaluation of the Champions Initiative implemented in one health and social care trust in Northern Ireland to improve joint working and service provision to children and families. This involved one person in each multidisciplinary community mental health team taking responsibility for championing joint working to improve outcomes and protect children and their parents. The small-scale evaluation comprised a questionnaire completed at baseline and six months later by 24 Champions, 12 working in childcare and 12 in mental health, and members of their teams, to gather data about their experiences and views about the initiative's impact. Problems identified through the baseline questionnaire related mainly to differing priorities and issues of confidentially, communication, continuity and confidence. Findings at the six-month follow-up indicated that the Champions Initiative is making a positive impact on the interface between mental health and childcare services and helping to address some of the difficulties outlined. The authors report that the main problem was getting sufficient time for the Champions ‘to engage in this role, given the pressures of their on-going caseload’ (Davidson et al., 2012, p. 167). Champions were also being asked to take on many complex cases rather than just providing guidance and support to colleagues in their team. Davidson et al. (2012) conclude by making some recommendations to address these issues and to develop the service further. ‘This informative paper reports on the evaluation of the Champions Initiative’ The interface between adult mental health and child welfare services is explored further in the paper by Khadj Rouf and colleagues (Rouf et al., 2012) who report on a small qualitative study examining decision-making around child welfare and protection by adult mental health professionals. These authors highlight the paucity of research in this area and describe how they interviewed 13 mental health workers working in a community mental health team (CMHT) including psychologists, community psychiatric nurses, social workers and psychiatrists. Five Named Nurses for Child Protection also took part and were asked to keep dairies about their decision-making. Study data were analysed using interpretive phenomenological analysis and three superordinate themes were identified: ‘the tensions of working across systems; trying to balance the perceptions and feelings involved in sense-making; and the role that interpersonal dynamics play in the understanding and management of risk’ (Rouf et al., 2012, p. 173). The authors report that all participants demonstrated an awareness of their professional responsibilities, although some were not clear if they should have a role in assessing parenting capacity. Rouf et al. (2012) recommend that CMHT staff could benefit from further training about their professional responsibilities in relation to children. ‘These authors highlight the paucity of research in this area’ ‘CMHT staff could benefit from further training about their professional responsibilities in relation to children’ This point about training is picked up in the paper by Margaret Bruce and Helen Whincup (2012) who discuss the Scottish Executive's introduction in 2006 of Key Capabilities in Child Care and Protection, a set of requirements embedded into undergraduate and postgraduate qualifying social work programmes. Key Capabilities were introduced to ensure that on qualifying as a social worker in Scotland, these professionals are able to evidence their knowledge base and skills in relation to childcare and child protection. Prior to their introduction it was ‘possible to qualify as a social worker without having undertaken an assessment of a child or of parenting capacity. This is no longer possible’ (Bruce and Whincup, 2012, p. 201). Bruce and Whincup's (2012) paper describes the process of developing the Key Capabilities alongside universities providing social work degrees in Scotland and some of the key themes that emerged from the work. Cognisant of the need for the Key Capabilities not to be detrimental to other service user groups, the paper refers to examples of potential difficulties at the interface between adult mental health and children's services. The development work drew on examples from that interface, as well as taking into account relevant policy literature, for example, The Ten Essential Shared Capabilities: A Framework for the Whole of the Mental Health Workforce (Department of Health, 2004). A further paper in this issue by Monica Shiakou (2012) from Cyprus reports on quite a different study which was undertaken to investigate the attachment styles of maltreated and non-maltreated children, using the children's drawings as representations of their experiences. Shiakou (2012, p. 203) explains how family drawings are widely used by mental health professionals as ‘a method of therapeutic communication with children’ to recognise children's emotional distress as part of a wider assessment, but that they cannot be used as an indicator of abuse. This author used the family drawing technique with a small sample of ten maltreated and ten non-maltreated children aged five to 11 years. The findings showed that children who had been maltreated displayed significantly more items in their drawings associated with insecure attachment patterns than the non-maltreated group, while the non-maltreated group displayed more drawing features related to secure attachment patterns. The results also matched scores on the Achenbach (1991) Child Behaviour Checklist, with all maltreated children scoring in the clinical range. While this is a very small study, conducted with a wide age range of children and firm conclusions cannot be drawn, it does provide some tentative suggestions about the representations of attachment patterns in family drawings of abused and non-abused children. ‘Family drawings are widely used by mental health professionals as ‘a method of therapeutic communication with children’’ ‘The non-maltreated group displayed more drawing features related to secure attachment patterns’ The short report in this issue returns to the subject of mental health as Carl Dutton (2012) describes the establishment and work of the Haven Project, an early assessment and intervention project in Liverpool. This school-based project works with asylum-seeking and refugee children and young people in schools to support their mental health and wider needs. The Haven Project is part of the Child and Adolescent Mental Health Services provided by Alder Hey Children's NHS Foundation Trust. The project works in close partnership with schools, children and their parents to assess how the refugee child and their family are settling into life in the school and in Liverpool. An experienced therapist is based in each school for half a day every week and is able to provide mental health advice and specific group interventions for asylum and refugee children, and to signpost to other services. The experiences of individual children and families are recognised as unique by Haven, who seek to use a non-pathologising model ‘to identify protective and resilience factors that can enhance [children's] ability to develop friendships, build a sense of self and manage school in a new place.’(Dutton, 2012, p. 224) Haven recognises the importance of regularly seeking feedback from those using the service to ensure that services remain approachable and relevant to local needs. This project reminds us not just to look at the pathology of poor mental health, but also how we can promote positive mental health and wellbeing, even in very vulnerable children. ‘The project works in close partnership with schools, children and their parents’ ‘This project reminds us not just to look at the pathology of poor mental health’ The issue concludes with two book reviews. Marcus Erooga (2012) looks at Researching Sex and Lies in the Classroom by Pat Sikes and Heather Piper, a challenging read that explores the complex area of false accusations of sexual misconduct against teachers. Martin Gaughan (2012) reviews Children and Adolescents in Trauma: Creative Therapeutic Approaches edited by Chris Nicholson, Michael Irwin and Kadar Nathan Dwivedi. This book provides an extremely useful contribution to understanding the needs of children and young people who are looked after and accommodated because of traumatic childhood experiences.