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1.3.11 Joint Protocol between Mental Health Services and Hillingdon Children and Families Division

Contents

  1. Introduction
  2. Referrals Received by CMHTS/HDAS/HOST
  3. Initial Screening Assessment of Child's Needs by Mental Health Services
  4. Referral by CMHTs to Children and Families Services
  5. Responsibilities of In-patient Staff
  6. Provision of Services by Children and Families Division
  7. Initial Screening Assessment of Adults' Needs by Children and Families Division
  8. Referral by Children's Services to CMHTs/HDAS/HOST
  9. Provision of Services by CMHTs/HDAS/HOST
  10. Consent and Confidentiality
  11. Joint Working
  12. Care Planning
  13. Financial Responsibilities


1. Introduction

1.1 This protocol applies whenever there are concerns about the welfare of children whose parents have assessed mental health difficulties, and there is concern that these difficulties are impacting on the parents' ability to meet the needs of their children.
1.2 A major theme emerging from the Child Protection studies Messages From Research was the high levels of parental mental illness in parents of children who became involved in the Child Protection System.
1.3 The priority for mental health services is to know which of their service users have children. For staff in Children's Services finding out about the mental and physical health of the parents of referred children is a priority.  A broader approach to assessment means that the presence and needs of all family members can be considered.
1.4 This protocol will apply whenever there are concerns about a child's welfare that do not require immediate steps to protect them from Significant Harm. 
1.5 Where it is believed that a child is suffering or likely to suffer Significant Harm, the Referrals and Assessment Procedure of the London Child Protection Procedures must be followed and immediate referral to Children and Families Services made.
1.6 Reference within this protocol to Community Mental Health Teams (CMHTs) should be taken to include all community-based teams within the secondary mental health services run by the Primary Care Trust.  This includes Hillingdon Drug and Alcohol Services (HDAS) and Hillingdon Outreach Support Team (HOST).
1.7 The purpose of this protocol is to improve the identification of Children in Need and provision of services to children and families who have assessed mental health problems.


2. Referrals Received by CMHTS/HDAS/HOST

2.1

For all referrals accepted by the CMHTs/HDAS/HOST, a check should be made whether the person has parenting responsibilities for a child under 18.  If so, and where the indicators listed below point to the need for further assessment, CMHT/HDAS/HOST staff should explore any parenting and child related issues in accordance with the Framework for the Assessment of Children in Need and their Families. Indicators for undertaking an Initial Screening Assessment in relation to parenting and child related issues, and completing an Inter-Agency Referral Form, will include:

  • Chronic and enduring mental illness in a parent, which is likely to impact on the capacity to care for a child
  • Physical or learning disabilities in the parent that are likely to impact on their capacity to care for the child
  • Circumstances where a parent has a mental illness and there is no other adult within the household or extended family or social network whose involvement can compensate or ameliorate the impact of the parent's difficulties and there is likely to be impairment to the child's health or development.
  • Where it is apparent that a young person has taken on a caring role for the adult, which has a serious impact on their health or development.
2.2 When completing or reviewing a Risk Assessment for a service user who is a parent, the Care Coordinator should undertake a screening assessment for children in the household using the headings on the Inter-Agency Referral Form.


3. Initial Screening Assessment of Child's Needs by Mental Health Services

3.1 Whenever the CMHT/HDAS/HOST worker identifies that a service user has parenting responsibilities and the care of a child or young person under the age of 18 years, and indicators for an Initial Screening Assessment of the parenting and child related issues apply (see paragraph 2.1), they will complete the Inter-Agency Referral Form. Where it is felt that the indicators do not apply, the CMHT/HDAS/HOST worker will discuss this with their supervisor/manager, within the supervisory process.
3.2 The CMHT/HDAS/HOST worker for the adult will complete the Inter-Agency Referral Form in partnership with the parent using the Framework for Assessing Children in Need and their Families.  The form will be completed within 7 days from its commencement. On completion of the assessment the CMHT/HDAS/HOST Worker for the adult will pass the completed form to their manager.
3.3 The Inter-Agency Referral Form will be completed by the CMHT/HDAS/HOST worker in accordance with their own professional role and perspective.  It may not be possible for the CMHT/HDAS/HOST worker to complete all sections of the form in detail, for example the section dealing with children's developmental needs may need a more focused assessment by the Children and Families Team where appropriate.  CMHT/HDAS/HOST staff should focus on identifying concerns known to them, and filling in what they can of the form.
3.4 Where the assessment indicates that the parental difficulties are impacting on the parent's capacity to care for the child and the child is a Child in Need whose health or development is being impaired, and the adult service user is agreeable, the CMHT/HDAS/HOST worker will make a referral to the Children and Families Service.


4. Referral by CMHTs to Children and Families Services

4.1 On completion of an Inter-Agency Referral Form, where it is judged that the child is a Child in Need and the parent is agreeable to the referral being made, the CMHT/HDAS/HOST Manager will forward a copy of the completed Inter-Agency Referral Form to the Children and Families Service.
4.2 The Children and Families Service will provide consultation via the Referral and Assessment Team to CMHT/HDAS/HOST staff as appropriate, for example about the appropriateness of referrals or eligibility for service.  
4.3 Immediate referral will be made to the Children and Families Services whenever it is assessed that a child is suffering or likely to suffer Significant Harm in accordance with the Referrals and Assessment Procedure of the London Child Protection Procedures. 
4.4 When a referral has been made by staff within Hillingdon Mental Health Services to the Children and Families Service concerning the welfare of a child, this must always be confirmed in writing by the referring team within 48 hours.  (Climbie Report Recommendation 21)
4.5 Any calls received by staff in Hillingdon Mental Health Services concerning the safety of children must be passed through to the appropriate Children and Families Team (or Emergency Duty Team if out of office hours) without delay, having first recorded the name of the child, the address, and the nature of the concern.  If the call cannot be put through immediately, further details from the referrer must be sought (including their name, address and contact number).  The information must then be passed verbally and in writing to the Children and Families Team within one hour.  (Climbie Report Recommendation 39)


5. Responsibilities of In-patient Staff

5.1 For all in-patient admissions, the admitting nurse will identify any childcare issues and record this on the nursing assessment. This will include:  whether the service user is a parent of a dependant child and whether there are any concerns about the care of the children whilst the patient is on the ward; the issue of children visiting the service user and potential home leave should be considered or flagged up for future consideration and recorded in the nursing assessment. Enquiries should be made with the service user about other involved agencies such as Children and Families.  If there are any concerns at this stage about the welfare of children in the family, the admitting nurse will consult with the ward manager or senior nurse on duty, and liaise with the Care Coordinator in the CMHT/HDAS/HOST.
5.2 Where a service user has an allocated Care Coordinator in the CMHT/HDAS/HOST, the primary nurse will liaise closely with the Care Coordinator to ensure that any concerns about parenting abilities, or the welfare of children, are discussed within the multidisciplinary team. The procedure for referring to the Children and Families Service, contained within this protocol, will be followed where appropriate.  It will normally be the Care Coordinator's responsibility to initiate a referral, although the primary nurse shares responsibility with the Care Coordinator for ensuring that the protocol is followed.  If there are urgent concerns out of office hours, ward staff should telephone the Emergency Duty Social Work Team for advice.
5.3

Where there are concerns about the welfare of a child and a service user does not have a Community Care Coordinator, the primary nurse will consult with the ward manager or senior nurse on duty who will consider action to be taken. This may include:

  • Telephoning the Children and Families Team for advice or to make a referral
  • Telephoning the Emergency Duty Team if out of hours and there are grounds for urgency. 
  • Liaising with the CMHT/HDAS/HOST to request early allocation of a Care Coordinator.
5.4 Where a patient is admitted who is already in contact with the Children and Families Team, consideration will be given to inviting the Children and Families Team social worker to Care Programme Approach care planning meetings, if the patient is agreeable.  Where the patient does not wish the Children and Families social worker to attend, ward staff and Children and Families Team staff are responsible for ensuring that there is effective communication between them where there is a 'need to know' in the interests of the welfare of the child, or of the patient, for example passing on information about discharge or leave, or any concerns about risks to health or safety.
5.5 Safeguards regarding children visiting the in-patient unit are set out in a separate policy: Psychiatric wards and facilities (children visiting) of the London Child Protection Procedures.


6. Provision of Services by Children and Families Division

6.1 On receipt of a completed Inter-Agency Referral Form from the CMHT/HDAS/HOST, the manager of the appropriate Children and Families Team will give consideration as to whether the eligibility criteria is met for services to be provided, an Initial Assessment or Core Assessment undertaken, Section 47 Enquiries commenced or no further action is required.
6.2 Consideration will always be given to the impact of the adult's mental health, physical or learning disabilities on their capacity to care for the child and of the associated level of impairment of the child's health and development. Consideration will always be given to the provision of family support services to support the adult in meeting the identified needs of the child.
6.3 Children and Families managers will ensure that CMHT/HDAS/HOST managers are informed in writing within 24 hours of receipt of the completed Inter-Agency Referral Form, about the decisions made by Children and Families Services regarding future involvement with the family.


7. Initial Screening Assessment of Adults' Needs by Children and Families Division

7.1 In all cases where an Initial Assessment is undertaken, consideration will be given to the impact of the parent's/carer's mental health, learning or physical disabilities on their capacity to care for a child.
7.2 Where an adult appears to have health care needs relating to mental health problems, the normal referral route will be to the G.P., unless the person is already in contact with the specialist psychiatric services.  The GP is responsible for assessing the health care needs and referring for primary care counselling or specialist psychiatric services if appropriate.
7.3 Where an adult appears to have Community Care Needs, which may give rise to a need for services, a referral should be made to the appropriate CMHT/HDAS/HOST (See Levels of Need and Thresholds for Access to Children's Social Care Services in Hillingdon).
7.4 Referral to CMHT/HDAS/HOST or GP should normally be made with the adult's consent, unless the adult is a vulnerable parent in need of protection. Then in exceptional circumstances a referral may be made with the adult's knowledge, in the absence of consent.


8. Referral by Children's Services to CMHTs/HDAS/HOST

8.1 In all cases where it is identified that a parent may have mental difficulties that seriously impact on the adult's capacity to meet the needs of their child, Children's Services will undertake an Initial Assessment using the Framework for Assessment of Children in Need and Their Families.  Where it is assessed that the adult may also have community care needs a referral will be made by the Children and Families Team to the CMHT/HDAS/HOST and a copy of the Initial Assessment Record will be provided with the parent's consent. 
8.2 In exceptional cases where a vulnerable parent is experiencing abuse or exploitation an immediate referral will be made to the CMHT/HDAS/HOST with the adult's knowledge if consent is not achievable.
8.3 CMHTs/HDAS/HOST will provide consultation to Children's Services undertaking Initial Assessments as appropriate.


9. Provision of Services by CMHTs/HDAS/HOS

9.1 On receipt of a referral by Children's Services accompanied by the Initial Assessment Record, the CMHT/HDAS/HOST manager will arrange for a Needs Led Assessment to be carried out.
9.2 On completion of the Needs Led Assessment, the CMHT/HDAS/HOST will consider whether the eligibility criteria is met for the Care Programme Approach and/or the provision of services, and develop a care plan as appropriate.


10. Consent and Confidentiality

10.1 Personal information about children and families held by professionals and agencies is subject to a legal duty of confidence and should not normally be disclosed without the consent of the subject.  Unless it is assessed that the child is suffering or likely to suffer Significant Harm, the consent of a person with Parental Responsibility should normally be obtained before making a referral to the Children and Families Service.  Where the person with Parental Responsibility is judged by the mental health worker to be unable to make a decision in the best interest of their child, information may be shared with the Children and Families Service without their consent if it is judged that good outcomes for the child would not otherwise be achieved.


11. Joint Working

11.1 Following a referral, working together should not be seen as requiring an automatic joint visit by representatives of both services.  Opportunities should be created for consultation, advice, and clarification by both services.  However, where both adults and children are initially assessed as having significant needs, joint or co-working may be required between the Children and Families Service and CMHT/HDAS/HOST staff to ensure that the needs of the family are met.  This may happen at the Initial Assessment, the Care Planning stage, or first or subsequent reviews.
11.2 In some cases it may be appropriate for one team to provide a service and receive consultation from the other.
11.3 In all cases the decisions made about joint co-working should be clearly recorded on the Care Plan on the respective case records and explained to the service user.


12. Care Planning

12.1 Statutory requirements for Care Planning for both children and adults must be observed and within this process the child's needs must be the paramount consideration if there is a conflict between the needs of the adult and the needs of the child.
12.2 Agreement about the respective professional roles must be negotiated, explained to the service user and recorded on the care plan and file.
12.3 Where it is necessary to convene adult or child focused meetings consideration should be given to inviting the relevant CMHT/HDAS/HOST worker from the other service to attend to ensure that any care plans devised are compatible.
12.4 Where there is no statutory requirement to convene meetings, it may be appropriate to jointly convene a planning meeting for the dual aims of care planning to meet the needs of children and their parents.  The chairing of these meetings will need to be negotiated and the aims clarified.


13. Financial Responsibilities

13.1 Where services are to be purchased, it may be appropriate to jointly commission in which case the budget holders within each service must agree the apportionment of costs on a case by case basis in line with eligibility criteria.
13.2 The appropriate financial procedures for each service must be followed.

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