Evaluating integrative services in edge-of-care work

Abstract

Children living on 'the edge-of-care' are typically known to local safeguarding authorities and are considered likely to face risks to their safety. Many are subject to a child protection plan and/or involved in 'pre-proceedings' processes. A growing number of their parents face (un)diagnosed mental health difficulties as well as economic and social precarity. This article draws on a mixed methods evaluation of a pilot service in the East of England offering a therapeutically-led attachmentbased intervention for families. The service cross-cuts health and social care, allowing psychologists and psychotherapists to work alongside social workers and other practitioners. The evaluation examined psychological and safeguarding outcomes and explored practitioner perspectives. A key outcome was that 85.4% of families were enabled to remain, or reunite with their child, compared with an estimated 50% of 'edge-of-care' cases nationally. This supports the need for similarly oriented interventions that could help lower the incidence of child removals.

Mental Health Support in the Perinatal Period for Women With a Personality Disorder Diagnosis: A Qualitative Study of Women's Experiences

“…These findings could be made available to general practitioners and other professionals to highlight the potential value in referring women to these specialist services. There is some evidence to suggest that parent-infant psychology may be particularly promising for improving infant attachment security in high-risk families (Barlow, Bennett, Midgley, Larkin, & Wei, 2015), and that a higher proportion of children are able to stay in the family home when mothers receive intense trauma-informed support (McPherson et al, 2018). Further research is needed to explore in more detail experiences and effectiveness of interventions that support parenting and the mother-infant relationship in women with complex and intersecting needs.…”

Reducing Recurrent Care Proceedings: Building a Local Evidence Base in England

“…This is significant because it suggests that women who have had children removed in the past can be supported to parent safely. Studies of 'early' family-based interventions linked to parent-infant mental health interventions and Family Drug and Alcohol Court (FDAC) programmes have similarly found that interdisciplinary work targeting individual needs can enable mothers previously deemed unable to parent, to develop anew their capacity to parent and to keep subsequent babies [7,29,30].…”

“…Between them, these new services engage with hundreds of families each year. Published peer reviewed studies of service effectiveness in this field remain relatively rare, however, with only two available to date [6,7]. This article offers the first combined analysis of independent evaluations of three of these new RCP services in the UK.…”

At the Edge of Care: A Systematic Review and Thematic Synthesis of Parent and Practitioner Views and Experiences of Support for Parents with Mental Health Needs and Children’s Social Service Involvement

“…Furthermore, existing literature outlines steps authors can take to ensure qualitative evidence is synthesized with sufcient rigour, whilst maintaining the context and meaning present in individual studies [46]. Whilst existing reviews focus on parents with mental health needs [47] or those with child protection concerns [29], families with both mental health and children's social services involvement have a distinct set of needs which singlefocus interventions often neglect [48]. Te nature, structure, and names of these services difer between contexts, but for the purpose of this review, we will use "children's social services" to mean services designed to support and protect vulnerable children.…”