Drink problem. Has an acute problem at present. Starts drinking when he is under pressure (trigger) and has recently been arrested for being drunk and disorderly.
Puts his own needs before those of his daughter.
At risk from Mary:
History of mental illness. Bi polar illness and has been involved for a number of years with mental health services. Her condition is medicated and she is taking this on a regular basis. Louise is on the local child protection register because of the family history of mental illness.
D F:
Anxious at the present time because of problems with Louise and Bill. Also worried about her brother who also has a mental illness. This could have a negative effect on her condition (acute).
Hasn’t seen a social worker for 2 ½ months to gain some support. Can be defensive, as she is worried about being seen as an unfit mother. Needs childcare but isn’t accessing any at present.
Financial implications on Louise because of her family situation. Living on benefits. This could affect the resources available to Louise through her parents.
At risk from Uncle:
D F:
History of mental illness. Killed his mother who had cancer. Was in a special hospital, then medium secure, now in hostel at Sheffield. Contact 1 x per week supervised by Mary.
Mary:
History of domestic violence
History of mental illness
Bill bullying Mary for money for drink. (Acute) alcohol becomes an issue when Bill feels pressure, has a problem, which is compounded at times of stress. He has been putting his needs before Mary and the baby. Mary hasn’t been able to give him the attention that he used to get before the baby was born. Bill is resentful of this increasing risk to Mary and Louise.
At risk from Brother:
Mary’s situation is not stable at the present time. People with mental health problems feel comfortable in routines. They can become upset when these are changed and this can make them unstable. Her brother may be affected by the problems in Mary’s life currently.
As well as the other factors Mary could be at risk from herself:
Self harm if the situation becomes intolerable. If Mary finds it hard to cope with the demands of motherhood, relationships and managing her illness as well as involvement with numerous agencies. She may harm herself.
She may stop taking her medication if all the other factors are taking precedence in her life. This coupled with the fact that she hasn’t seen a social worker for a while could have implications for her well-being.
Social Workers/Health Workers:
At risk from Bill because of his history of violence and his drink problem.
Risk that Mary will become detached from the workers and withdraw her cooperation with them as she feels she will be seen as an unfit mother, additionally with Bill harassing her she may be frightened to comply with services. She has seen a solicitor about getting an injunction, but often wants contact with Bill when she calms down.
2.2
Dr Leonard Dalgleish 1989 introduced the RADM (Risk and Decision-Making) model. It provides a basis for assessing risk, which combines professional and clinical judgment. It takes into account actuarial measures but does not rely on them (Hollows 2004). The key principle is intuitive thought and having sufficient information for a judgment to be made (Hollows 2003). The case information needs to be sorted and the worker needs to look at the context of likelihood of future harm, severity of future harm and couple this with the strengths of the family. These are then looked at in the contexts of parenting, the couple’s relationship, child’s relationship, and level of cooperation, social environment and family.
Using the Dalgleish model we need to gather information about current and past problems (historical factors) and use indicators to establish the likelihood and severity of any future harm in this case, then weigh these up against the family strengths which can be drawn on to support the family. Hollows 2004 suggest that the worker needs to make an intuitive assessment and decide their own threshold before making decisions on the risk assessment. Their own willingness to take action, how much harm is too much and in what circumstance is it safer to remove the child. This needs to be recorded on the scale before completion.
The available information in this case is:
Indicators are – Louise low birth weight. Small baby, possibility of visual impairment (health problems). Mary suffering from mental illness and quite high stress levels at the present time. Bill History of mental illness, drinking and violence.
Natures of past/current harms are mental illness, domestic violence, alcohol misuse and financial restrictions (benefits).
These are incorporated into judgments on Family strengths (Brearly 1982 & Bedford 1986): These being Mary cooperating with social services. She continues to take her medication. She is accepting support from professionals in the form of advice from health visitor and the day centre. She ultimately wants what is best for Louise and her aim is to have the baby’s name removed from the Child Protection Register.
The chances of future harm come mainly from Bill although some risks are associated with Mary and the relationship they have. These are in the form of domestic violence, alcohol abuse, possibility of mental health issues impacting on the care of the child (neglect), tenuous relationship between the couple (high stress levels at present).
The magnitude of future harm is high where Bill is concerned.
The key issue is the time frame. The assessment needs to be done with a timeframe of no more than 6-12 months reviewed at regular intervals, with a view to looking at the long term future well being of the child
The Manchester model is often used in assessing the needs of people with mental health problems. It considers 5 areas to be important. History of family, (past harms, issues), ideation (rumination on a particular problem) workers need to know the person’s triggers and significant pieces if information to form a judgment, plan (has the person made a plan to carry something out) the worker needs to know this and intent (do they intend to go through with it) you need to be clear about the questions asked to make sure they are relevant to the situation.
In this case the Manchester model could be used to assess what we know about the person and how we relate it to the situation we are looking at. So we know that there are mental health issues, problems with alcohol, violence and financial problems. Getting an accurate history is vital as it puts the current situation into context. We would need to concentrate on what is going on for all family members and make sure we ask the right questions. We could find out the families’ triggers and what each person is thinking. This helps us to make a judgment on the likelihood of further problems.
2.3
The interventions which I would consider as a worker in this case would be as follows:
Louise to remain on the Child Protection Register. A planning meeting needs to be set up under the 1989 Children Act to discuss current issues and to share information from all professionals involved as well as contributions from the family. An initial assessment needs to be done and a core group needs to be established (or updated if one already exists). Regular reviews. This enables professionals and the family to work together to gain support for the situation and for them to access the correct type of support.
Multi-agency working: Social Workers for Mary, Bill and Louise to enable objectivity and prevent collusion. Health visitor involvement for Louise health needs, help to support Mary to keep appointments for Louise and inform Mary regarding developmental aspects of Louise care. GP involved to help support the whole family and to provide a referral system to access other support systems. Workers from the day centre provide important support for Mary and Bill – Helping Bill with his feelings and encouraging abstinence from drink. Parenting support worker to help Mary with parenting issues and to provide childcare when she needs a break or feels that things are becoming fraught at home.
I would at the present time encourage an anti molestation order against Bill under the Family Law Act 1996 (sec 42). This prevents the person ‘molesting’ Mary (Person associated with respondent) or Louise (relevant child), Family Law Act 1996. The reason for this being that Bill has been violent in the past and at present and has a problem with drinking when stressed; he poses a threat to Mary and Louise as a consequence. Mary needs to concentrate on her relationship with her child and put her needs first at the present time. This would be with a view to him seeking support for his drinking and his anger problems. Possible referral for this through the GP. If he made a concerted effort in this area-supervised contact could be considered.
Parenting support for Mary. Life skills support (budgeting, childcare) and help with Louise. Child care when needed to enable Mary to possibly access some education/training. This may help her to gain self-esteem and skills, which will empower her and give her, the ability to take control of the situation.
Ongoing supervised contact with Mary’s brother. This needs to be monitored by mental health professionals regularly. It will help to keep some continuity in the lives of Mary, Louise and Mary’s brother.
I feel that if we put these interventions into place the risk to the family would be minimized. The welfare of the child is paramount and I feel that by managed more effectively.
2.4
Thompson, N 2001 suggests that oppression is the ‘degrading treatment of individuals or groups, dominance of one group over another, the existence of power and the feelings associated with the power and feelings associated with being on the receiving end of these’
The power imbalance in this case is great and may affect the individuals involved as a consequence. Mary and Bill may feel resentful about professionals coming n to ‘sort out’ perceived problems. They may feel powerlessness. Mary possibly more so if she were assigned a male worker as she has suffered violence at the hands of a man and consequently may not trust males.
Possible ‘overkill’. Lots of people coming in may make Mary want to withdraw. May feel like 1 person against the establishment.
If the family were minority ethnic. There could be cultural issues. They may feel that a white worker could not understand their problems, e.g. values, religion, ideals and beliefs.
2.5
As mentioned in more detail earlier (1) social workers are party to details, which are often traumatic. They can be at risk of violence and threats as part of the job. This can have a negative effect on the worker. Direct and indirect trauma can affect the workers personal vulnerabilities. Numbing, hypervigilence and flooding effects can ensue. These are seen as negative long term coping strategies.
Another risk for the social worker in this situation is becoming over sympathetic to Mary. She appears to want the best for herself and her child. Because of this the worker may become more sympathetic towards her. This could have implications for the practice of that worker. Their personal threshold may be obscured and therefore they may not be able to do an objective assessment in this case. Also possibility of collusion.
Over hostility to Bill. By the same token workers may become over hostile towards Bill. Making their assessment of him subjective and thus disempowering him in the situation.
Strategies to try to minimise the risks include the use of supervision. This is important as you can get an objective overview and input as well as being able to reflect your own feelings.
Workers also need to keep check on their personal threshold to stop them from obscuring perception of how much risk is too much.
Assessing risks posed by parents with mental health problems to their children is a complex task and often depends on an understanding of the nature and meaning of symptoms for the individual as well as an estimation of likely consequences of their behavior and assessment of situational supports to help in times of crisis. Multi agency collaboration is needed to ensure that full contributions are made to the management of risk, (Weir and Douglas1999).
2706
References
Thompson, N (2001)
Anti- Discriminatory Practice
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Basingstoke/Palgrave
Hollows, A
Social Work Violence and Risk
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In Assessment in Childcare
Calder, M and Hackett, S
2003
Russell House Publishing
Http://www. DOH 1999,2000.
Social Policy Documents
Visited 20.04.04
Cooper 2003 (chapter 6)
In Assessment in Childcare
Calder, M and Hackett, S
2003
Russell House Publishing
Horowitz, M (1998)
Social Worker Trauma: Building resilience in child protective workers
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June 1-25
Dr Leonard Dalgleish 1989
In Assessment in Childcare
Calder, M and Hackett, S
2003
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Brearly 1982 & Bedford 1986):
Hollows, A
Social Work Violence and Risk
Unit Handbook 2004
Weir, A and Douglas, A (1999)
Child Protection and Adult Mental Health – Conflict of Interest?
Butterworth Heinemann Publishing
Bibliography
Thompson, N (2001)
Anti- Discriminatory Practice
3rd Ed
Basingstoke/Palgrave
Hollows, A
Social Work Violence and Risk
Unit Handbook
2004
Douglas and Wildavsky (1982).
In Assessment in Childcare
Calder, M and Hackett, S
2003
Russell House Publishing
Http://www. DOH 1999,2000.
Social Policy Documents
Visited 20.04.04
Cooper 2003 (chapter 6)
In Assessment in Childcare
Calder, M and Hackett, S
2003
Russell House Publishing
Horowitz, M (1998)
Social Worker Trauma: Building resilience in child protective workers
Smith College Studies in Social Work
In Hollows 2004
June 1-25
Dr Leonard Dalgleish 1989
In Assessment in Childcare
Calder, M and Hackett, S
2003
Russell House Publishing
Brearly 1982 & Bedford 1986):
Hollows, A
Social Work Violence and Risk
Unit Handbook 2004
Weir, A and Douglas, A (1999)
Child Protection and Adult Mental Health – Conflict of Interest?
Butterworth Heinemann Publishing
Brechin, A, Brown, H and Eby, M
Critical Practice in Health and Social Care
2000
OU press
Lupton, C and Gillespie, T
Working with Violence
1994
Macmillan press
David, T
Protecting Children from Abuse: Multi Professionalism and the children Act 1989
1994
Trentham Books
Visited 21.04.04
Visited 21.04.04
Sunday Herald.com/39646
Visited 21.04.04