Moving into a Response Space: A Framework for Health Services working with Vulnerable Families

Moving into a Response Space: A Framework for Health Services working with Vulnerable Families

28 May 2014
Moving into a Response Space: A Framework for Health Services working with Vulnerable Families

Belinda Mawhinney describes how health services can be better supported in their work with children and young people at risk of harm.

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Belinda Mawhinney is Co-ordinator, Child Wellbeing and Clinical Projects at Sydney Local Health District. In this article she describes her experience as a Churchill Fellow, and the outcomes of her project, which examined how health services can be better supported in their work with children and young people at risk of harm.

The opportunity to travel the world and meet with leading experts in child protection was one that I could not overlook. At the beginning of 2013 I started preparing an application for a travelling Fellowship through the Winston Churchill Memorial Trust.

After a competitive application process, I was extremely fortunate and honoured to be awarded a Churchill Fellow for 2013. I scoped my Fellowship project to focus on the role of health services responding to children and young people at risk of harm. A great impetus in my thinking was the implementation of the Keep Them Safe Reform1 which led to significant practice changes for the health workforce in New South Wales.

The Keep Them Safe Reform shifted the landscape of child protection, promoting a strong message of ‘a shared approach to child protection and wellbeing’. The addition of the term “wellbeing” reflected a new threshold of risk.

The premise for mandatory reporting to the Department of Family and Community Services in New South Wales allows suspicions to be reported without solely relying on confirmed abuse, providing the mandatory reporter has reasonable grounds for making such a report. These reports are made where risk of significant harm is suspected.

Where concerns are suspected to be below the threshold, the responsibility to provide a response remains with non-statutory organisations. Alternative reporting provisions are in place for some government agency staff, such as health workers, to refer below the threshold concerns to Child Wellbeing Units (CWU). The establishment of the CWU promotes a greater emphasis on agencies, such as health services, to work with families where there are risk factors for child abuse or where there are “wellbeing” concerns. In these instances, responses are provided in the absence of the statutory child protection agency.

So with this in mind, I designed a six-week travel program including Canada, the United States of America, the United Kingdom and Ireland to meet with an array of practitioners, researchers, academics, consultants and experts in the field of child protection. I wanted to turn a spotlight on the role of health services, and have conversations about how the workforce may enhance existing efforts of working with vulnerable families. I aimed to draw on lessons learned from similar child protection systems and explore opportunities to strengthen practice.

In developing a framework for this project I considered the various levels within the health service that would provide avenues of exploration. In the first instance, I considered the needs at the frontline by asking “What supports health workers engaging with vulnerable families?” From there I examined “What can health services offer once the assessment has identified the concerns or risks?” which uncovered some fantastic models of clinical supervision and consultation models that offer strong opportunities for implementation in the Australian context. A real highlight for me was The Restorative Model for Supervision, developed and implemented across health services in England. This evidence-based model has been developed to assist and support health visitors in their work with vulnerable families.

I then drew “Links between practice and governance” to identify themes such as governance structures and approaches that may strengthen existing arrangements in health organisations.

Key findings:

  • Single solutions are not effective in responding to the complex issues of child abuse and neglect. A “Back to basics” philosophy may offer potential solutions to existing challenges.
  • The workforce should be engaged in discussions that distil process from practice, and frontline workers need to influence systemic improvements.
  • Organisations should apply frameworks that consider all levels of service provision – from the frontline to governance arrangements of accountability.

These recommendations reflect what I consider are the key strategies to support a workforce in fulfilling their child protection responsibilities (both in identifying and responding) from the perspective of a non-statutory child protection service:

  • Practitioners need the ability to talk to families about what child maltreatment is and how it can be prevented;
  • Access to education and training for practitioners which reflects and contributes to evidence-based practice;
  • Provision of quality supervision and consultation; and
  • Robust governance structures.

Ultimately, it was the unexpected conversations and discoveries that offered some of the greatest moments of clarity from The Fellowship. For practitioners, working with families - whether we work in statutory or non-statutory organisations - is inherently emotional. I believe it is fundamental that the broader system acknowledge the emotional foundation of this work and collectively recalibrate to this as a starting position. The opportunities to continue conversations started through the Fellowship are in the early stages and offer me great hope for things to come.

I would encourage anyone to apply for Churchill Fellowship, with applications open from November to February each year.

Click here to access the full Fellowship report.  


The feature image is by Gido, CC BY 2.0.


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