Joint protocols

Working across professional boundaries to support children affected by problem drinking parents and promote resilience to long term harm

Working across professional boundaries to support children affected by problem drinking parents and promote resilience to long term harm.

This section of the toolkit looks at the need for joint agreements and arrangements between different groups of professionals that would be helpful in ensuring support to a child affected by a problem drinking parent.

This section does not address the development of child protection procedures, which should already be in place within the different professional groups. However it will shed light on the need for these to be understood and shared across different professional groups, particularly concerning the issue that permeates this toolkit – that of ensuring that child protection procedures are only used when it is appropriate to do so. This issue is dealt with in depth in Addressing child protection .

A process is required in developing joint protocols
As with many issues facing families, identifying children who need extra support and help, and providing it, might require input from a range of professionals working in a coordinated way. Issues of child protection procedures and confidentiality need to be equally considered, but the difficulty most often facing any one professional group is the lack of agreed arrangements between different groups of professionals.

Whilst examples of shared agreements can help professionals in visualising the arrangements that are required, the success of such arrangements – often rather grandly termed ‘joint protocols and care pathways’ - relies on a real dialogue between professional groups. The development of agreements and arrangements must demonstrate a real understanding of each other’s opportunities and constraints in responding to any particular child or family.

Frequently the first question to confront is what might be the role of various professionals in promoting resilience to long term harm in children affected by parental drinking?

Who can help and what is their general role in respect of promoting resilience?
Promoting resilience to long term harm requires an adult to engage with a child whose parent(s) misuse alcohol in enough depth to understand what resilience factors are already present and where it might be possible to encourage the development of others.

Working on the basis that professionals have considered their attitudes to alcohol and developed a ‘normalised’ approach to engaging with a child whose parents might misuse alcohol, and where referral to social services is not required, the professional groups that are perhaps best placed to promote long term resilience and their overall role are set out below.

The overall emphasis of this toolkit is to assist the development of resilience factors in children independent of working with their parents. However, for children under five years old, the opportunities for such work are obviously rare, if not non-existent, in most cases. The role of professionals in relation to under-fives is therefore to be able to identify parental alcohol misuse that is liable to cause distress to a child and to take appropriate action. Information is included within this toolkit to assist professionals faced with this situation, as it is recognised that many feel ill equipped in this respect. However working with the families, which will be the only way to promote resilience to long term harm, requires skills in engaging the families. A family centered approach is one with which most professional groups are familiar.

The first table identifies professionals that may be in a position to identify alcohol misuse in parents with under-fives and sets out their overall role in promoting resilience factors (again where referral to social services is unnecessary).

For children over five it is possible to provide support to help promote resilience against long term harm regardless of the engagement of the parents in this process. The second table then lists the groups of people who are in a position to do this and sets out their overall role. These groups include professionals and non-professionals. It is important that in building resilience to long term harm professionals recognise the vital role that other adults in and around the family can play (see Protecting against long-term harm)

Table one: The role of professionals in promoting resilience in children when the main contact is with children accompanied by parents (most often the under-fives)

Professional in a position to identify parental alcohol misuse liable to cause distress to a child

Role in respect of promoting resilience

To promote resilience factors in under fives it is crucial that professionals are able to identify parents with alcohol problems liable to distress a child.

Taking a family centered approach is the only option for promoting resilience factors for very young children.

Practice Nurse

Midwife

Health visitor

Sure Start Staff

Draw in the support of other professionals and in particular a health visitor and Sure Start staff (if appropriate to the area) to support the family
Encourage parent to use family support
Refer (drinking or non drinking) parent to alcohol service if appropriate*
Keep a watching brief on child welfare

As for GP above especially as the practice nurse is likely to see child and parent more regularly

Draw the family to the attention of the health visitor

Work directly with the family
Access family support resources
Maintain a watching brief on child

Access a range of resources to support parents, family and the individual child directly
Work directly with the family

* Most alcohol services provide support and help to partners of problem drinkers.

Table two: The role of professionals and other adults in promoting resilience factors in children regardless of contact with parents

Group of children by age	Professionals and other adults who can draw alongside children independently of parents to promote resilience
Under five	Professionals: Nursery workers Non Professionals: Non drinking parent Members of the extended family Trusted family friends Home Start volunteers
5 – 11	Professionals: Teachers Class room assistants School nurse After school club workers Summer play scheme workers Non Professionals: Non drinking parent Members of the extended family Trusted family friends Other adults such as church leaders, brownies/clubs etc Home Start volunteers
11-16	Professionals: Teachers Class room assistants School nurse After school club workers Summer play scheme workers Youth workers Community workers Non Professionals: Non drinking parent Members of the extended family Trusted family friends Other adults such as church leaders/youth leaders etc Home Start volunteers

Who needs to work with whom?

Focusing on the professional groups, it might be useful to work out who might need to work with whom and what the likely nature of the contact between any two groups of professionals will be. Undertaking such an exercise will identify exactly what ‘care pathways’ need to be developed and what the joint protocol should address.

The table below makes some suggestions:-

Map of the care pathways required

	Teacher	School Nurse	Practice Nurse	Health Visitor	Social Worker	Alcohol Worker
Teacher	Will discuss a pupil with other teachers who know the child to get a wider picture of the situation, particularly the form teacher	The teacher might ask the school nurse’s advice. School nurse could request that a health visitor visits at home. Could also offer see the child or talk to other professionals	No direct contact	No direct contact	Would only contact social services if concerned that a child might be at risk	Could contact an alcohol service to request information and advice
School Nurse	Would talk to a teacher about a child who she might suspect is having difficulty to check out their impressions. Might inform the teacher and ask the teacher to be aware of a child’s particular needs.	No direct contact with other school nurses needed	Might liaise with a practice nurse but contact with general practice more likely via a health visitor	Could ask a health visitor to check out a child’s home situation and as a means of providing support to the family more generally	Would only contact if concerned that a child might be at risk	Could contact an alcohol service to request information and advice, to make a referral if asked for help by parents or to ask for an alcohol expert to visit the school as part of a lesson or teacher training.
Practice Nurse	Would not normally contact a teacher about a child	Might ask a school nurse to keep an eye out for a child about whom they are concerned	Will wish to discuss children about whom they are concerned with colleagues	Could ask for involvement of a health visitor either to assess the family or to provide additional parenting support for parents	Would only contact if concerned that a child might be at risk	Could contact an alcohol service for advice about an individual parent, a child or about the subject generally.
Health Visitor	Could contact the school as a means of ensuring more support for a child in a family they are supporting	Could contact a school nurse as a means of ensuring more support for a child in a family they are supporting	Would liaise with practice nurses concerning individuals in a family they are supporting		Would only contact if concerned that a child might be at risk	Could refer family members to an alcohol service. Get advice and information
Social Worker	Would contact for information for assessment of a child referred to them. If required to ask a teacher to attend a case conference May contact a teacher as part of plan for ongoing support and monitoring of the child	Might contact for information for assessment of a child referred to them. Might contact as part of plan for ongoing support and monitoring of the child	Would contact for information for assessment of a child referred to them. If required to ask a practice nurse to attend a case conference Might contact a practice nurse as part of plan for ongoing support and monitoring of the child/family	Would contact for information for assessment of a child referred to them. If required to ask a health visitor to attend a case conference Likely to include contact with a health visitor as part of a plan for ongoing support and monitoring of the child/family		Might contact for information for assessment of a child referred to them. If required to ask an alcohol worker to attend a case conference Might contact an alcohol service as part of plan for ongoing support and monitoring of the child/family
Alcohol Worker	With parents permission might contact a teacher as a means of ensuring additional support for child of client	With parents permission might contact a school nurse as a means of ensuring additional support for child of client	With parents permission might contact the practice nurse to arrange further support for parents	With parents permission might contact a health visitor as means of ensuring additional support for the family	Will not be in contact unless concerned about child’s welfare

Requirements for joint protocols
A joint protocol is an articulation, or statement, of the nature of the relationship between parties and the mutual expectations each party has of another in respect of the purposes of that relationship. It needs to include:-

Statement of each party’s role
Statement of the limits of each role
The reason or purpose why parties might wish to/need to work together
The agreed means for contacting each party covered in the protocol
The type of responses that can be expected of each party
How these might be carried out
A statement of the limits of confidentiality
A statement about how the parties wish to keep each other informed of progress
What steps could be taken if the protocol fails to achieve its aims

To information for parents section