Our Time works with young people significantly impacted by parental mental illness, their parents, carers, teachers and peers, to build resilience, reduce morbidity and improve life outcomes.
In response to the ‘Keeping the Family in Mind’ conference, a group of professionals, led by Dr Alan Cooklin, began to develop KidsTime Workshops, an explanation-based, whole-family intervention aimed at building children’s resilience to parental mental illness. The original KidsTime Workshops took place in Camden and Islington in 2000. There are now several KidsTime Workshops running in the UK; with partners in Spain and Germany trained to set up and run KidsTime Workshops. Following this, TeenTalk Workshops have been developed, aimed at older children.
Our Time was registered in 2012 (then The Kidstime Foundation) to formalise this ongoing work. The organisation brings together people affected by parental mental illness in their youth, nurses and psychiatrists, to develop programmes aimed at providing evidence-based, explanation-centred interventions to young people whose parents are currently experiencing severe mental ill health.
The organisation’s overriding aim is to increase understanding of mental illness amongst the general public, in particular, but not exclusively by:
- Educating professionals and the general public about the needs of children and young people who have a parent with a mental illness
- Developing educational tools and interventions to raise awareness of children’s needs to counteract stigma
To this end Our Time:
- Promotes resilience in the children who are affected by parental mental illness
- Promotes positive attitudes to mental health for affected young people
- Works to reduce the stigma associated with mental ill-health in general, and with children of sufferers
- Works to reduce the burden of emotional overload in vulnerable families
The London Child Protection Procedures – Parenting Capacity and Mental Illness (5th Edition, 2017) (5th Edition, 2017) states that:
‘Parental mental illness does not necessarily have an adverse impact on a child’s developmental needs, but it is essential to always assess its implications for each child in the family. Many children whose parents have mental ill health may be seen as children with additional needs requiring professional support, and in these circumstances the need for a common assessment should be considered.’
Mental health and psychological symptoms are common in the adult population affecting up to one in three people. About half of those with symptoms, one in six, will suffer from a recognised mental health problem including depression, phobias, obsessive compulsive disorder, panic disorder, generalised anxiety disorder and mixed anxiety and depressive disorder. Between 30% and 50% of users of secondary mental health services are parents with dependent children. Some of these families are the most disadvantaged and socially excluded people in society (SCIE, DOH, 2008).
Parental mental ill health is only one of a range of inter‐related risk factors which may lead to increased need and risk of significant harm to children and young people. Biennial research and reviews of national Serious Case Reviews has shown that parental mental ill health features alongside substance misuse and domestic abuse in three quarters of the serious case reviews conducted (Brandon et al 2009).
Recommendations include; improving communication, coordination and collaboration between all services and agencies, to ensure that the needs of the children whose parents have mental ill health are addressed.
An initial estimate by Aldridge and Becker identified approximately 65,000 young carers of parents with mental illness in England and Wales, with about one million children significantly affected. In 2010, the Social Care Institute for Excellence (SCIE) updated this estimate to two million children.
The negative impacts of parental mental illness on their children are well documented (Oats, 1997; Nicholson et al, 1999, 2004; Royal College of Psychiatrists, 2011), with 70% of affected young people experiencing one or more of:
- Loss of education through poor attendance and emotional distraction
- High levels of anxiety about the parent/s and their own potential of succumbing to the same illness
- Social isolation resulting from stigma, rejection by peers and self-isolation
- Guilt and an excessive sense of personal responsibility
- High levels of subsequent depression
Fortunately, quite small interventions have been shown to substantially increase a child’s resilience and ability for self-protection. (Quinton and Rutter 1984; Rutter, 1966). Clear information and explanation of the parent’s illness, and of the impact on themselves of the illness and its treatment has been consistently shown to improve resilience (Bostock, 2004; et al.).
A study of 11 to 15-year-olds living with a depressed parent, by Garly et al. (1997) found they wanted information and discussion with a knowledgeable but neutral adult to help them understand four key aspects of their parent’s illness:
- The nature and cause of the illness, including their own feelings of responsibility and vulnerability
- How to recognise the signs of an impending illness
- When a parent should be hospitalised, and what happens when this occurs
- How to manage the illness and its effect on both themselves and their parent
‘It’s the idea that it’s not her [my Mum’s] fault, because it’s not her fault, it’s her illness.’
‘Before, I just didn’t want to speak to my mum, or acknowledge her. [Our Time helped me with] the understanding that she wasn’t in control of it.’
‘It was nobody’s fault really, it just happened to her [my Mum] and it can happen to one in four people too.’
(Juliet, 11 years old, KidsTime Workshop Attendee)
The Finnish Adoption (Tienari et al., 1994, 2004) study and earlier work by Rutter (Rutter et al Rutter M., 1996, 2004) demonstrated that when relationships in the child’s environment are improved, the child’s future resilience to mental illnesses, even when they carry a genetic vulnerability, is enhanced. But major interventions like adoption are rarely required and in fact quite small interventions can make a significant difference. Even such small interventions as an explanation of a parent’s illness have been shown to significantly improve the child’s mental health.
Our Time has connected with MindEd to link up with resources that can help you with a child who is dealing with their own mental illness. MindEd is somewhere you can find out about common signs of mental health problems affecting children and young people.
Important: If you are concerned about someone who is at immediate serious risk you should contact your local support services immediately. To find out more about how to help these children please visit the MindEd website.
3. Purpose of Protocol
The purpose of this protocol is to set out the organisation’s operational and strategic management processes currently in place to safeguard children and to provide procedural guidance and direction for the implementation of robust, high quality safeguarding services for children and young people.
Safeguarding and promoting the welfare of children is defined for the purposes of this guidance as:
- Protecting children from maltreatment
- Preventing impairment of children’s health or development
- Ensuring that children grow up in circumstances consistent with the provision of safe and effective care
- Taking action to enable all children to have the best outcomes
The national guidance, Working Together to Safeguard Children (March 2018), states that:
Effective safeguarding arrangements in every local area should be underpinned by two key principles:
- Safeguarding is everyone’s responsibility: for services to be effective, each professional and organisation should play their full part
- A child-centred approach: for services to be effective, they should be based on a clear understanding of the needs and views of children
Children have said that they need:
- Vigilance: to have adults notice when things are troubling them
- Understanding and Action: to understand what is happening; to be heard and understood; and to have that understanding acted upon
- Stability: to be able to develop an on-going stable relationship of trust with those helping them
- Respect: to be treated with the expectation that they are competent rather than not
- Information and Engagement: to be informed about and involved in procedures, decisions, concerns and plans
- Explanation: to be informed of the outcome of assessments and decisions and reasons when their views have not met with a positive response
- Support: to be provided with support in their own right; as well as a member of their family
- Advocacy: to be provided with advocacy to assist them in putting forward their views
4. Roles and Responsibilities
‘Everyone who works with children – including teachers, GPs, nurses, midwives, health visitors, early years professionals, youth workers, police, accident and emergency staff, paediatricians, voluntary and community workers and social workers – has a responsibility for keeping them safe.’ (Working Together to Safeguard Children, March 2018)
Ultimately, employing organisations are responsible for assuring that their employees have the appropriate level of safeguarding knowledge, skills and competence to undertake their roles. The following is a breakdown of the roles and responsibilities required within the organisation and each of its staff groups:
‘Voluntary organisations and private sector providers play an important role in delivering services to children. They should have safeguarding arrangements in place in the same way as organisations in the public sector and need to work effectively with Local Safeguarding Children Boards. Paid and volunteer staff need to be aware of their responsibilities for safeguarding and promoting the welfare of children, how they should respond to child protection concerns and make a referral to Local Authority Children’s Social Care or the Police if necessary.’ (Working Together to Safeguard Children, March 2018)
- Ensure that the role and responsibilities of the Board in relation to Safeguarding/Child Protection are met
- Promote a positive culture of safeguarding children across the Board through assurance that there are procedures for safer recruitment; whistleblowing; appropriate policies for safeguarding and child protection and that these are being followed; and that staff and patients are aware that the organisation takes child protection seriously and will respond to concern about the welfare of children
- Ensure that there are robust governance processes in place to provide assurance on safeguarding and child protection
- Ensure good information from and between all parts of the organisation in relation to safeguarding and child protection
- Use professional and clinical knowledge, and understanding of what constitutes child maltreatment, to identify any signs of child abuse or neglect
- Identify and refer a child suspected of being a victim of trafficking or sexual exploitation; at risk of FGM or having been a victim of FGM; at risk of exploitation by radicalisers
- Act as an effective advocate for the child or young person
- Recognise the potential impact of a parent’s/carer’s physical and mental health on the wellbeing of a child or young person, including possible speech, language and communication needs
- Clear about own and colleagues’ roles, responsibilities, and professional boundaries, including professional abuse and raising concerns about conduct of colleagues
- As appropriate to role, refer to social care if a safeguarding/child protection concern is identified (aware of how to refer even if role does not encompass referrals)
- Document safeguarding/child protection concerns to be able to inform the relevant staff and agencies as necessary, maintains appropriate record keeping, and differentiates between fact and opinion
- Share appropriate and relevant information with other teams
- Act in accordance with key statutory and non-statutory guidance and legislation including the UN Convention on the Rights of the Child and Human Rights Act
- Recognise potential indicators of child maltreatment – physical abuse including fabricated and induced illness, emotional abuse, sexual abuse, and neglect including child trafficking and female genital mutilation (FGM)
- Understand the potential impact of a parent/carers physical and mental health on the wellbeing and development of a child or young person, including the impact of domestic violence, the risks associated with the internet and online social networking, an understanding of the importance of children’s rights in the safeguarding/child protection context, and the basic knowledge of relevant legislation (Children Acts 1989, 2004 and of Sexual Offences Act 2003)
- Take appropriate action if they have concerns, including appropriately reporting concerns safely and seeking advice
(Intercollegiate Document: Safeguarding Children – Roles and Competences for Healthcare Staff, 3rd Edition, March 2014)
5. Required action in the event of safeguarding children concerns
The abuse of a child, regardless of whether it is physical, sexual, emotional abuse or neglect, is damaging and can have serious and longstanding effects on all aspects of their health, development and wellbeing.
A referral to children’s social care for an initial assessment or pre-birth assessment should always be made if a parent, carer, pregnant woman or her partner is considered to have significant mental ill health as indicated by the triggers given below:
- The pre‐birth assessment of women who have a history of mental ill health, or now are experiencing mental ill health, and where there are concerns about the impact of such a condition on an unborn child, or a woman’s ability to meet the child’s needs once born
- Partners of women who are pregnant who have mental ill health or who are experiencing mental ill health
- Parents or carers (even if not the primary carer) who are exhibiting signs of mental ill health, or who are already the subject of a continued psychiatric assessment, where there are concerns surrounding the impact on a child’s well‐being
- There are concerns about domestic violence/abuse or where a family member or partner is a person identified as presenting a risk to children
- Where there have been two previous referrals concerning carers and their children
- Urgent concerns as a result of parents or carers (even if not the primary carer) being assessed under the Mental Health Act
- Parents or carers (even if not the primary carer) with mental health problems who are caring for a child with a chronic illness, disability, or special educational needs
- Children who are caring for parents or carers with mental health problems (young carers)
- Children with social, education or health needs, e.g. non‐attendance at school or nursery, lack of involvement with other statutory or primary care services
- Where a professional raises concerns about the well‐being of a child
- Children who have been the subject of previous child protection investigations, children who have been or currently are subject to child protection plans, Local Authority care, alternative care arrangements
- Whether either of the parents (particularly if they are young parents) have been previously known to children’s social care (CSC) or have been children looked after (CLA)
Children’s social care has a responsibility to complete a pre‐birth assessment if there are concerns. Some indicators include:
- There has been a previous unexplained death of a child whilst in the care of the parent
- There are concerns about domestic violence or where a family member or partner is a person identified as presenting a risk to children
- The mother’s partner has a mental ill health or is experiencing mental ill health
- A sibling is on or has been subject to a child protection plan
- A sibling has previously been removed from the parent’s care either temporarily or through a court order
- The degree of the parental mental ill health
- If there are concerns regarding the parent’s history of engaging in services and/or compliance with medication
- If there are concerns around the parent’s self‐care skills and/or concern for their ability to care for a child
- Any concern exists that the baby may be at risk of significant harm, including a parent previously suspected of fabricating or inducing illness in a child
Where the need for a referral is unclear, this must be discussed with a line manager or professional adviser and the decision recorded in line with the organisation’s documentation processes.
If there is immediate danger to an individual, including a child, the police must be contacted on 999.
There are currently KidsTime Workshops running in the following areas in the UK; with more workshops being planned to start in different locations around the country:
* KidsTime Barnet * KidsTime Bedfordshire * KidsTime Brent * KidsTime Camden and Islington * KidsTime Hackney * KidsTime Haringey * KidsTime Merton and Sutton * KidsTime Newham * KidsTime Plymouth * KidsTime Portsmouth * KidsTime Tower Hamlets * KidsTime Westminster * KidsTime Wirral
In the event of a concern regarding the safeguarding and welfare of a child, the referral should be made to the relevant borough’s local authority children’s social care service. The referral process will be highlighted on the local authority’s website (accessible below using the hyperlink to each borough’s children’s social care service):
* Barnet Multi-Agency Safeguarding Hub (MASH) * Central Bedfordshire Access and Referral Hub * Brent Family Front Door * Camden Children’s Social Care * Islington Children’s Social Care * Hackney Children’s Social Care * Haringey Multi-Agency Safeguarding Hub (MASH) * Merton Multi-Agency Safeguarding Hub (MASH) * Sutton Multi-Agency Safeguarding Hub (MASH) * Newham Children’s Social Care * Plymouth Gateway * Portsmouth Multi-Agency Safeguarding Hub (MASH) * Tower Hamlets Children’s Social Care * Westminster Social Services and Family Support * Wirral Central Advice and Duty Team
Workshops and services delivered within boroughs situated in London should follow The London Child Protection Procedures – Parenting Capacity and Mental Illness (5th Edition, 2017)
As Our Time also has partners in Spain and Germany the following links are useful for professionals in terms of linking with safeguarding arrangements in other countries:
- Working with Foreign Authorities: Child Protection Cases and Care Orders Departmental advice for local authorities, social workers, service managers and children’s services lawyers July 2014
- Children and Families Across Borders
- Foreign and Commonwealth Office Website
6. Local Safeguarding Children Boards
As a statutory requirement, a Local Safeguarding Children Board (LSCB) must be established for every Local Authority area. The LSCB has a range of roles and statutory functions including developing local safeguarding policy and procedures and scrutinising local arrangements.
The Local Safeguarding Board (LSCB) is the key statutory mechanism for agreeing how the relevant agencies in each local area will co-operate to safeguard and promote the welfare of children in that locality, and for ensuring the effectiveness of what they do. The Children Act 2004 requires each local Children Board authority to establish a Safeguarding Board.
LSCBs do not commission or deliver direct frontline services though they may provide training. While LSCBs do not have the power to direct other organisations they do have a role in making clear where improvement is needed.
To provide effective scrutiny, the LSCB are independent and not subordinate to, nor subsumed within, other local structures. LSCB’s have an Independent Chair who should hold all agencies to account.
As within the above section of this Procedure, Kidstime staff delivering Workshops, Hubs and “Who Cares” Projects within specific boroughs should follow the LSCB multi-agency protocols within the borough they are based and will also have access to LSCB’s programme of multi-agency safeguarding children training.
Statutory Objectives and Functions of LSCBs
Section 14 of the Children Act 2004 sets out the objectives of LSCBs, which are:
- To coordinate what is done by each person or body represented on the Board for the purposes of safeguarding and promoting the welfare of children in the area
- To ensure the effectiveness of what is done by each such person or body for those purposes.
Regulation 5 of the Local Safeguarding Children Boards Regulations 2006 sets out that the functions of the LSCB, in relation to the above objectives under section 14 of the Children Act 2004, are as follows:
Developing policies and procedures for safeguarding and promoting the welfare of children in the area of the authority, including policies and procedures in relation to:
- the action to be taken where there are concerns about a child’s safety or welfare, including thresholds for intervention
- training of persons who work with children or in services affecting the safety and welfare of children
- recruitment and supervision of persons who work with children
- investigation of allegations concerning persons who work with children
- safety and welfare of children who are privately fostered
- cooperation with neighbouring children’s services authorities and their Board partners
- communicating to persons and bodies within the authority the need to safeguard and promote the welfare of children, raising their awareness of how this can best be done and encouraging them to do so
- monitoring and evaluating the effectiveness of what is done by the authority and their Board partners individually and collectively to safeguard and promote the welfare of children and advising them on ways to improve
- participating in the planning of services for children in the area of the authority
- undertaking reviews of serious cases and advising the authority and their Board partners on lessons to be learned
7. Safer Recruitment
Safer recruitment is about the processes we put in place when recruiting anyone (volunteer or paid employee) into a position or agency which works with children, young people or families.
Safer recruitment is about ensuring that only those suitable to work within organisations working with children, young people and families are recruited into such positions. These principles should be adhered to for all positions, whether they are paid or voluntary. Safer recruitment should not be seen merely as the undertaking of Disclosure and Barring Service (DBS) checks on potential new employees or volunteers. An employer may request a criminal record check as part of its recruitment process. These checks are processed by the Disclosure and Barring Service (DBS).
These checks are to assist employers in making safer recruitment and licensing decisions. However, a check is just one part of robust recruitment practice. When a check has been processed by the DBS and completed, the applicant will receive a DBS certificate (DBS check).
The DBS can’t access criminal records held overseas. A DBS check may not provide a complete view of an applicant’s criminal record if they have lived outside the UK.
Employers should make sure they have access to all the information available to them to make a safer recruitment decision. You can read about how to get a criminal record check for overseas applicants, or those who have previously lived outside the UK, on the Home Office website.
Safer recruitment is based on four principles:
- Deter – deter applicants with inappropriate motivations from applying for positions, by making it clear that the organisation is not a ‘soft target’ for abuse (e.g. by referring to safeguarding policies in application processes or job advertisements)
- Reject – identify and reject inappropriate people from the employment process (e.g. through interviews)
- Prevent – ensure that there are no opportunities for abuse in the work context, by managing the environment, assessing risk, and establishing clear standards of behaviour (e.g. through appointment and induction processes)
- Detect – Identify inappropriate behaviour or abuse within the workplace at the earliest opportunity and respond appropriately (safe working culture)
When recruiting, organisations should ensure that their processes reflect these principles, and that they have a safe working culture.
Throughout the employment process, all the way from identifying a vacant post to employing and inducting a new practitioner.
A safe working culture is one where everyone is committed to ensuring that practice is undertaken in the best and most appropriate way to ensure children and young people in their care are safe. In addition, staff should be supported, and know how, to respond to concerns regarding the behaviour or practice of other practitioners.
Key features include:
- An open culture, with no secrets
- A belief that abuse could happen here
- Clear procedures to report concerns about the behaviour of practitioners
- Support for children and adults who raise concerns, and commitment to act on them
- A code of conduct clearly outlining acceptable and unacceptable behaviour
- Policies, procedures and codes of conduct are used, and people made accountable for their use
- Good induction and use of probationary periods
- A commitment from all who work there to safeguard and protect children and to maintain an ongoing culture of vigilance