Summary / Abstract

Title: Staff looking after children in local authority residential units: the interface with child mental healthprofessionals

Synopsis: Seventy-two members of staff working in children's residential units in a Local Authority were surveyed,to elicit their experiences and evaluations of working with child mental health professionals. Whilst the majority of staff heldfew or no formal educational qualifications, they emerged as an experienced group, with a level of confidence in their knowledgeand skill base. Support was identified as coming predominantly from within units themselves; relatively few staff had directcontact with child psychiatrists or psychologists, although many children received a service. Staff in general felt that childmental health services were not helpful to them in terms of their work with young people. However, the majority of staff indicateda need for greater direct involvement across a range of child behavioural and emotional problems. The findings are discussed interms of the changing population of “looked after” children and the recommendations of the Warner Report. child mental health, staff, residential units, mental health professionals, support, psychiatry, psychology, qualifications, adolescents, local authority, direct, care, skills, Hatfield, Mohamad, Harrington, social workers, Social Services Department, Warner Report, respondents, Health Professionals Whilst, London HMSO, involvement, intervention, local authorities, Mohamad Seventy, perceptions, children living, helpfulness, questionnaire,

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journal adolescence 1996 19 127 139 staff looking children local authority residential units interface child mental health professionals b hatfield r harrington h mohamad seventy two members staff working children residential units local authority surveyed elicit experiences evaluations working child mental health professionals whilst majority staff held formal educational qualifications emerged experienced group level confidence knowledge skill base support identified coming predominantly units relatively staff direct contact child psychiatrists psychologists children received service staff general felt child mental health services helpful terms work young people majority staff indicated need greater direct involvement range child behavioural emotional problems findings discussed terms changing population looked children recommendations warner report 1996 association professionals services adolescents introduction series recent reports publicized crises residential care children highlighted huge problems organization delivery care levy kahan 1991 department health 1991a department health 1992 whilst nationally numbers children looked markedly declined recent years department health 1992 difficulties organizing residential child care service unprecedented prominence professional debate children looked local authorities identified vulnerable society tend come disproportionately households characterized deprivations poverty lone parenthood bebbington miles 1989 commonly reasons children looked local authorities involve experiences serious abuse conflict families origin inability unwillingness families care residential units continue make significant contribution alternative care children providing care frequently specific groups looked population berridge 1985 notably residential units cater predominantly adolescents authorities identifying foster homes placement choice younger children adolescents remanded reprint requests correspondence addressed b hatfield mental health social work research unit 12th floor mathematics building manchester university oxford road manchester m13 9pl u k 0140 1971 96 02012713 18 00 0 1996 association professionals services adolescents 128 b hatfield r harrington h mohamad care court proceedings offences serious emotional behavioural difficulties department health 1992 levinson minty 1992 kahan 1994 recent comprehensive survey residential care children undertaken wake abuses leicestershire children homes followed conviction frank beck published warner report department health 1992 identifies 64 children living local authority children homes described emotionally behaviourally disturbed third estimated sexually abused high levels recorded private voluntary provider sectors children looked local authorities lengthy care careers moves disruptions going back early childhoods millham et al 1986 thoburn 1988 psychological damage imprints emotional behavioural functioning children unable respond high quality physical emotional care addition disruption lives young children leaves vulnerability longstanding readily repaired environmental improvements wolkind renton 1979 hodges tizard 1989a b provision high quality care proved notoriously difficult residential sector e g colton 1988 vulnerability cease transition adulthood emotional behavioural difficulties childhood adolescence predict greater vulnerability adult life psychiatric disorder criminal conduct rutter 1989 robbins rutter 1990 evidence children spent significant periods time care likely experience difficulties parenting children quinton rutter 1988 caution exercised drawing conclusions impact care experience distinct experience led bullock et al 1993 wolkind rushton 1994 current population children looked local authorities influenced practice children act 1989 act accompanying guidance place emphasis support birth family possible child live outside birth family placement wider family encouraged department health 1991b additional influence population residential units widespread practice looking children foster homes possible taken trends likely mean research findings derived care populations directly applied children currently looked residential units children looked local authority residential units likely characterized high degree vulnerability emotional social terms proportion adolescents long standing problems continue present serious difficulties move adulthood experience particular region confirms generality picture historically staff employed look children local authority units drawn ranks people formal qualifications commonly women remuneration modest parker 1988 continuing debate early 1970s need systematic training qualifications residential workers e g ccetsw 1974 utting report department health 1991a identified training residential staff crucial issue quality care points 70 residential child care staff point hold relevant qualification 20 unit managers terms relevant 129 residential units child mental health professionals qualifications picture unchanged ten years previously warner report department health 1992 confirms lack qualification norm picture see children homes workforce trying cope difficult complex tasks trained plans provide adequate training forseeable future department health 1992 p 116 influential report recommends changes focus predominantly work based training residential social workers acknowledges substantial changes unrealistic resource implications debate entire residential workforce needs training level positive role paraprofessionals diploma social work case appropriate qualification tasks involved residential child care brawley schindler 1991 department health 1992 warner report identifies provision child mental health service support social services department residential units pointing staff units likely need ready access services child psychology psychiatry department health 1992 p 143 high rates emotional behavioural disturbance looked children two levels need identified need support direct work individual children need advice professional support residential staff working children survey shows patchy provision country substantial variation levels child mental health input residential units picture emerges recent survey child mental health services kurtz et al 1994 survey social services departments asked views general adequacy resources available child adolescent mental health half described woefully inadequate quarter describing difficulties access concerns referral priorities kurtz et al 1994 pp 24 25 social services departments priorities therapeutic input identified firstly children experienced abuse 49 respondents followed support children separated families 22 respondents two groups heavily represented residential units areas mentioned intervention child mental health professionals department health circular report warner committee requires social services authorities audit needs children homes specialist mental health support distinguishing needs children needs staff training development support lac 93 15 traditionally child mental health services offered assessment individual children cases treatment outpatient basis involve parents family carers children live child living residential unit dialogue child mental health professionals front line carers severely restricted existence rotating shifts workers complex communication systems warner report appears suggest greater degree integration services child mental health professionals offer direct support advice care staff group individual identified children involving different model service 130 b hatfield r harrington h mohamad delivery multi disciplinary approaches exist see fahlberg 1990 de silveira 1991 developing authorities local region means universally available lengthy history stress disruption lives children live residential units precipitates range emotional behavioural outcomes commonly categorized emotional disorders conduct disorders combination two evidence research practice suggests emotional problems childhood adolescence likely respond therapeutic help likely lasting consequences adult life conduct disorders hand poorer prognosis indicative lasting difficulties rutter 1974 robins rutter 1990 walker 1992 emotional disorders children living residential units need addressed individual work skilled person acting therapist conduct problems major impact daily living daily relationships residential unit staff need skilled help group developing appropriate approaches range examples exists literature see forehand mcmahon 1981 patterson 1982 patterson stouthamerloeber 1984 kazdin et al 1987a b patterson et al 1989 herbert 1991 examples largely developed work parenting skills need careful translation residential context involve conscious management contingencies maintaining undesired behaviours rivertown survey background rivertown social services department agreed take preliminary survey residential child care staff explore experiences perceptions joint working child mental health professionals rivertown large metropolitan area neighborhoods substantial social deprivation 13 children residential units ranging size six 12 places unit functions units varies acting mainly receive children admitted crisis assessment offering longerterm care helping young people leaving care town team child mental health professionals psychiatrists psychologists social workers based local children hospital offering range services local community method residential social workers working social services department units rivertown circulated questionnaire pilot taken 20 minutes complete arrangements made collect complete questionnaires direct units follow visit chase completing late total 72 questionnaires returned potential pool 109 residential social workers response rate 66 1 remaining staff unable complete questionnaire time unavailable due holidays sickness unwilling respond due reservations survey rate return sufficient enable useful comments made responses pre coded computer entry spss generate simple descriptive frequencies 131 residential units child mental health professionals results profile residential staff equal numbers men women 36 responded survey median age staff 38 years little fifth falling 20 29 age group staff emerged experienced group two fifths indicating residential child care experience excess 10 years three people indicating experience 3 years seventy percent current post longer 2 years indicating high level staffing stability staff asked indicate formal educational professional qualifications summarized table 1 third staff indicated formal qualifications likely received substantial service training handful held appropriate social work qualification third staff indicated held position responsible supervising staff unit managers deputies remaining twothirds identified front line residential social workers support residential social work staff survey asked individuals felt staff unit necessary skills knowledge work range difficulties presented children care responses summarized table 2 despite scarcity relevant social work qualifications identified earlier half staff clearly felt reasonably confident skills knowledge unit largely addressed range difficulties presented children looked survey went ask respondents identify sources support available work children emotional behavioural difficulties replies summarized table 3 apparent breakdown support received heavy reliance personnel units approaching emotional behavioural problems children manifest reflect immediacy continuity sort support table 1 qualifications residential staff formal qualifications number dipsw cqsw css 6 8 5 bachelors masters degree professional 4 5 6 level hnc b tech o level 10 14 1 cse gcse city guilds 26 36 6 formal qualifications 25 35 2 recorded 1 table 2 skills knowledge unit staff perceived respondents unit staff skills knowledge work children difficulties number definitely 7 9 7 30 41 7 extent 30 41 7 4 5 6 definitely 1 1 4 132 b hatfield r harrington h mohamad likely available times stress crisis children workers support field social workers fieldwork managers perceived fairly limited possibly reflecting priorities workloads assumption role involved direct care children level support identified child psychiatrists psychologists limited half respondents identifying support received staff necessarily mean child mental health involvement children reflects pattern service operating basis individual child referrals support children workers asked general felt sufficient support residential staff working children emotional behavioural problems figure 1 indicates responses despite support identified earlier coming units majority staff surveyed indicated felt levels support general insufficient experiences involvement child mental health professionals staff asked children unit view serious emotional behavioural problems two staff indicated children describe remainder indicating indicated two six children currently problems staff general caring children assessed psychiatrists psychologists 14 staff indicated current children assessed half staff identify children received ongoing sessions direct work child mental health professional assessment commonly psychiatrist psychologist 19 staff 26 face face contact child mental health professionals respect children currently looked said contact letter telephone staff caring children currently received help child mental health professionals asked rate helpfulness children intervention rating summarized table 4 table 3 levels support received range sources source input level support received lot little unit manager deputy 51 72 9 11 15 7 7 10 0 1 1 4 external line manager 5 7 1 33 47 1 21 30 0 11 15 7 field social workers 2 2 8 18 25 0 35 49 3 16 22 5 fieldwork managers 0 8 11 8 25 36 8 35 51 5 residential workers 43 59 7 16 22 2 7 9 7 6 8 3 training sessions 4 5 6 30 41 7 32 44 4 4 5 6 external consultancy 2 2 9 8 11 4 16 22 9 44 62 9 child psychiatrist 0 9 12 5 21 29 6 41 57 7 psychologist 0 8 11 4 15 21 4 47 67 1 2 2 8 4 5 6 5 6 9 61 78 4 133 residential units child mental health professionals extent 22 00 30 6 7 00 9 7 definitely 23 00 31 9 20 00 27 8 figure 1 feel sufficient support residential staff whilst largest group indicated unsure helpfulness intervention children concerned indicating view majority perceived intervention positive question enquired helpfulness staff child mental health interventions looked children notion feedback advice aspects daily living management children child mental health professionals help residential staff care children emotional behavioural problems responses summarized table 5 proportion 1 5 rated child mental health interventions positively substantial proportion staff rated interventions children helpful residential staff staff currently looking children contact child mental health professionals tables 4 5 help specific behaviours residential social workers completing survey presented checklist child behaviours likely encounter table 4 staff perceptions helpfulness child mental health services children perception helpfulness service helpful 2 3 7 helpful 9 16 7 unsure 36 66 7 helpful 7 13 0 134 b hatfield r harrington h mohamad varying frequency looked children behaviour asked child looked unit exhibited behaviour persistent extreme degree indicate think help sought outside unit think help come range responses indicated table 6 respondents indicate sources help behaviour table 6 unit means response ssd manager fieldworker means response addition unit child mental health professional means psychiatrist psychologist mentioned addition sources category recorded responses two particular behaviours emerged perceived three quarters survey respondents justify referral child mental health professionals deliberate self harm bizarre strange behaviour four respondents case felt behaviours addressed units half respondents felt referral child mental health professional appropriate response depression weeping withdrawal isolation inappropriate sexual behaviour tantrums aggression violence eating insufficient excess third staff responding questionnaire felt referral child mental health professional appropriate case bullying cruelty truancy absconding drug alcohol misuse failure care self truancy absconding drug alcohol misuse commonly seen appropriately referred help sources specifically mentioned police educational welfare agencies schools specialist drugs alcohol helping agencies behaviours likely referred outside units social services department managers fieldworkers 14 child behaviours listed workers responding suggested average six appropriately referred child mental health professional source help average little higher workers 5 years experience compared experienced counterparts 6 1 5 7 problems respectively higher higher educational achievements compared lesser educational achievements 6 3 5 6 problems respectively higher supervisory roles compared front line staff 6 1 5 8 problems respectively marked differences rate suggested problem referral child mental health professionals emerged units individuals table 7 shows average number problems suggested referred child mental health professionals unit staff member three fold difference units highest lowest rates suggested referral child mental health professionals evident table 5 perceptions helpfulness residential staff child mental professionals involvement children perceptions helpfulness service rsws helpful 1 1 9 helpful 9 17 3 unsure 19 36 5 helpful 23 44 2 135 residential units child mental health professionals nature child mental health service delivery final survey sought elicit residential staff nature child mental health services currently access forms service thought ought available order obtain pointers model service residential workers useful responses summarized table 8 percentages sum 100 response possible interestingly third staff completing questionnaire indicated aware current availability services listed table 6 perceptions appropriate sources help specific child problems problem source help ssd manager child mental health unit fieldworkers professional recorded deliberate self harm 4 5 6 5 7 0 52 72 2 11 15 3 depression weeping 15 20 8 10 13 9 37 51 4 10 13 9 withdrawal isolation 15 20 8 15 20 8 36 50 0 6 8 3 tantrums 25 34 7 12 16 7 34 47 3 1 1 4 bizarre strange behaviour 4 5 6 8 11 1 54 75 0 6 8 3 aggression uncooperativeness 16 22 2 19 26 3 33 45 8 4 5 6 violence 16 22 2 19 26 4 29 40 3 8 11 1 bullying cruelty 22 30 6 20 27 7 21 29 2 9 12 5 truancy 8 11 1 23 32 0 20 27 8 21 29 1 absconding 14 19 4 32 44 5 10 13 9 16 22 2 drug alcohol misuse 5 6 9 19 26 4 15 20 8 33 45 9 inappropriate sexual behaviour 6 8 3 17 23 6 38 52 8 11 15 3 eating insufficient excess 20 27 8 7 9 7 31 43 0 14 19 4 failure care self 46 63 9 10 13 9 12 16 7 4 5 6 table 7 average rate person suggested problem referred cmh professionals unit average problems referred cmh professional staff member 4 5 b 6 0 c 4 5 d 6 4 e 6 0 f 5 9 g 7 2 h 3 2 i 6 8 j 2 7 k 8 2 l 7 6 m 8 3 136 b hatfield r harrington h mohamad matter access prioritizing scarce specialist resources n h commonly identified service currently available ongoing sessions appropriate children terms felt available three quarters respondents indicated visits unit advice support residential workers individual children reflects issue identified earlier residential staff relatively little direct contact child mental health professionals discussion rivertown survey residential child care staff reveals picture experienced staff adult age ranges reasonable level confidence service offered units children range difficulty residential child care rivertown described women work men women equally represented sample evidence workforce stable time staff indicated overwhelmingly caring children describe emotionally behaviourally disturbed majority staff lack formal professional qualifications kind mirrors national situation outlined warner report department health 1992 rivertown support work caring children identified coming mainly units reflective positive ethos collective support carries attendent risk attitudes practices consolidate benefit sufficient external expertise practice units mediated involvement external manager development staff knowledge service training programme substantial proportions survey respondents indicated received support sources involve personnel relevant qualifications support child mental health services indicated small proportion staff surprisingly handful respondents found helped direct work children involvement psychologists psychiatrists direct contact child mental health services reflective model service based individual referral children living local table 8 residential staff perceptions child mental services received needed service child mental available available necessary health professionals telephone advice 17 23 6 50 69 4 2 2 8 crisis assessment 13 18 1 50 69 4 2 2 8 visits unit 11 15 3 55 76 4 4 5 6 ongoing sessions appropriate children 21 29 2 46 63 9 0 help getting placement 14 19 4 41 56 9 7 9 7 advice support rsws individual children 17 23 6 54 75 0 0 advice support rsws general management children 14 19 4 48 66 7 4 5 6 137 residential units child mental health professionals authority accommodation effectively passes front line staff takes responsibility passing advice information majority staff surveyed receptive notion child mental health service involvement children young people looked perceived range problems appropriately shared propensity refer child mental health professionals slightly higher staff terms professional development markedly higher units suggestive tentatively ethos external expertise valued units terms model service delivery offered child mental health professionals residential child careworkers indicated frequently need visits unit advice support residential workers individual children reflecting need greater level direct engagement need general support residential workers work children identified certainly echoes warner report recommendations systematic integration child mental health input residential units suggests multidisciplinary approach clearly form approach needs determined strategic level health social services purchasers involve re consideration priorities child mental health services health advisory service 1995 press child psychiatrists psychologists expensive scarce resource current climate efficient effective resources paramount consideration working discipline organizational boundaries present difficulties integrated joint working children young people looked local authority units different levels training qualification recognition pay militate notion equal professional partnerships effective relationship disciplines needs forging skills child mental health professionals impact silveira 1991 differences structure culture different occupational professional groups impede process see huntington 1981 residential social workers largely untrained share social work culture values teamwork improvization negotiated solutions effective involvement child mental health professionals involve culture shift residential workers acknowledgement body knowledge expertise daily living children young people conclusions survey described paper provides support proposals warner committee greater involvement child mental health professionals residential units children young people looked local authorities approach addresses needs staff advice support addition direct services children indicated residential social workers needed references bebbington miles j 1989 background children enter local authority care british journal social work 19 349 368 138 b hatfield r harrington h mohamad berridge d 1985 children homes oxford blackwell brawley e schindler r 1991 strengthening professional paraprofessional 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