Screening for mental health risks during mediation in separated families

Screening for mental health risks during mediation in separated families

15 October 2014

In this article Jamie Lee describes learnings from a Universal Mental Health Screening project at Relationships Australia (SA).

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It’s no secret that parental separation and conflict is a risk factor for mental health problems in kids (Google "parental separation and child outcomes" if you didn’t already know.)

But nearly all children referred from the Adelaide Family Relationships Centre (FRC) to iKids, the Supporting Children After Separation Program at Relationships Australia (SA), were at much higher risk than typical Aussie kids.1

That’s when we asked: “Are all kids suffering like this when their parents/carers do mediation at the FRC? Short of sending them all to iKids to check, what more can we do to be sure?

As a result, the FRC Universal Mental Health Screening project began in 2013 to assess:

1.   the scale of mental health problems in FRC families; and

2.   whether we could respond within current organisational capacity at Relationships Australia (SA).

We implemented the project as follows:

  • Mediators offered screening to all parents/carers at intake, with parent-report questionnaires for their children and self-reports for themselves.2 Parents and carers were told that they would be contacted if anything significant was found.
  • Mediators passed the forms to a Research Assistant to score the questionnaires. Anything above a no/low risk clinical cut-off3 was passed to a senior practitioner for assessment.
  • The senior practitioner reviewed screening and file information to assess risk level and organisational response (if any).

And the big headline?

There were no floodgates of mental health problems overwhelming the service, despite initial fears. Of the 238 families4 screened so far, over two thirds (68.8%) have no or low risk of mental health problems. By contrast, just 9.2% of children or adults are identified as high risk of a mental health problem with no suitable supports in place. When followed up – usually by phone – about half of these families took up the offer of support from us (e.g. family counselling); the other half said, “Thanks for the call, but I’ll manage it myself.”

This infographic illustrates figures described in the text.

The file review5 by the senior practitioner revealed that another 13.8% had supports in place already, or the mediator had already identified a counselling referral, so no action was needed.  

The final 8.3% of cases – mostly medium level risks – involved supporting the mediator to manage the mental health risks within the mediation context rather than by responding to clients directly. For example, mediators may be prompted to consider child consultation in their mediation if parents’ reports of their children’s wellbeing varied, with the hope the missing ingredient may be strengthening the parenting alliance or hearing their children’s distress at the conflict.

In short, we already had the organisational capacity within our agency to respond to the diverse mental health risks. If not, we had the local knowledge to assist clients to the next place through effective onwards referral outside our agency.

An evaluation of the program6 showed that our universal screening was valued highly by mediators. They saw it as:

  • another set of eyes for families with mental health problems; and
  • a source of ideas for nudging mediations towards agreement.

Client feedback has been overwhelmingly positive. Many clients have thanked us for checking in with them about their families without “checking up on them”.

Finally, an organisational review showed that triaging and responding to all cases was possible within current capacity, with each family taking a maximum of 10-15 minutes to screen and assess for risk.

We identified several factors that made universal screening work smoothly:

  • Agency-wide use of DOORS7;
  • Thorough intake notes by mediators;
  • Co-location of family counselling and FRC services;
  • Good local referral knowledge;
  • Intake Officers’ availability for client follow-up phone calls; and
  • Mediators having little extra administrative burden.

So, to answer the question, we don’t need all children to come to iKids. Universal screening of mental health problems in families is a quick and easy way to begin listening to kids via their parents and carers.

Jamie can be contacted via: adelaidefrc@rasa.org.au.

Footnotes:

  1. Using the Strengths and Difficulties Questionnaire (see sdqinfo.org).
  2. Parents were offered the Kessler K10.
  3. To increase responsiveness, cut offs for assessment were set at lower end of published norms (eg K10 score of 22 or greater based on Crufad norms).
  4. The sample consisted of 402 kids and 455 parents/carers.
  5. This involved reading practitioners’ electronic notes in Penelope and client’s self-reports of risks in a structured intake interview.
  6. The evaluation involved a workshop presenting results to management and to mediators; a discussion group as part of mediator group supervision; and collation of client responses to phonecalls.
  7. DOORS is a post-separation risk elaboration framework (see familylawdoors.com.au).

The feature image is by Travis Swan, CC BY-SA 2.0.

Infographic: C - Relationships Australia (SA)

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Authors

Jamie Lee

Jamie Lee is Principal Researcher at Relationships Australia (SA). He is also a Counselling Psychologist working with children and their families after separation.

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