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Expert's Corner: Dr Anna Preston

Clinical psychologist Dr Anna Preston talks to Clare Jerrom about carrying out parenting assessments in an ethical, timely and multi-disciplinary way.

The benefit of having multi-agency meetings at the beginning of an assessment means families are not subjected to numerous assessments with multiple professionals over a lengthy time period while parenting abilities are established, which means the process feels much more ethical and supportive.

Dr Anna Preston, who has 17 years’ experience in the field, highlights the benefit of having multi-disciplinary assessments right from the start, so it is fairer to children and their families, rather than potentially waiting months while their parenting abilities are assessed by multiple professionals working in isolation before a decision is made on the best way forward for the parents and their children.

She explains: "There is always a reason why parents are not being the best parents they can be at any given time, and we need to understand their needs. We get to identify and understand parents’ and families’ experiences right from the beginning. That is in relation to any case, whether it is around neglect, abuse, risk, or anything else."

It is one of the reasons that Dr Preston works as a clinical psychologist for WillisPalmer and carries out Multi-Disciplinary Family Assessments with a team of various professionals in a model which uses a multi-agency approach to identify problems in the most timely manner.

Presenting cases may include those of neglect, abuse, domestic violence, cognitive or mental health problems including complex situations which present questions relating to an adult's parenting ability.

It is a positive having a tight timescale

The MFA bespoke model is based on highly experienced professionals including social workers, clinical, educational or forensic psychologists, mental health practitioners and family support workers working together as a team with families experiencing difficulties, in the family home, to assess the family and make recommendations within an eight-week time frame.

Initially, all of the professionals involved meet to plan the format of the assessment followed by a meeting with the family to discuss the programme of intervention. Three weeks later, the WillisPalmer multi-disciplinary team and all professionals involved with the family will meet to share progress. A final meeting takes place after six weeks where the findings will be shared with all professionals involved with the family and the findings and recommendations will be presented to the family. The evidence-based final report with clear recommendations and conclusions will be produced after eight weeks. In between times, all professionals involved in the assessment communicate with each other, to establish what is happening, and how to best adapt the approach towards the family, based on the psychological assessment.

"As a team we are coming together bringing different perspectives to come to a consensus about which is the best way forward for the children, parents and others involved, such as carers, in a timely way," said Dr Preston, who also works as a Consultant Clinical Psychologist at Surrey and Borders Partnership NHS Foundation Trust where she is the Trust-wide Lead for Acute Psychological Services.

While the eight-week time scale can be "challenging", Dr Preston says it is vital to have a strict time frame in place; as such it meets the urgent needs of families, including young people.

Changing your communication method can make all the difference

Dr Preston's involvement in the MFA comes at the beginning of the eight-week process when she carries out an initial assessment to determine any cognitive or mental health problems or any risk, be that forensic or as a result of mental ill-health. Her assessment not only identifies any issues right at the beginning of the process which can inform what work needs to be carried out during the assessment, it also determines which professionals should be involved in the process moving forward.

"Social workers, clinical, educational or forensic psychologists, mental health practitioners and family support workers can be drawn on for the process but it does vary as the assessment may not require all of the professionals to be involved. However, this will be determined at the start of the process when I do my assessment, rather than weeks or months down the line”, explains Dr Preston.

She also identifies areas that should be explored during the assessment which is imperative as "if a certain aspect is not assessed during the process, this could have a negative impact on the rest of the proceedings".

Dr Preston's psychological perspective can ascertain why families may not be engaging with services. "When you spend time with families, you can formulate why they are not engaging and work out how you can best engage with them at that time. For example, it could be founded on a bad experience with authority in the past. Based on such an understanding and formulation, we realise that if you change your communication method, it can make all the difference. So directions can be given right from the start, to give the family the best chance of being successful, for the benefit of the children who, of course, are paramount."

Assessments are multi-disciplinary rather than in isolation

The model is based in the family home - familiar surroundings for the parents and children - and if risk is identified, the MFA model means that family support workers can provide 24 hour support thus keeping the family together when safe to do so and preventing the need for a costly residential placement for children and/or families during the assessment process.

Following Dr Preston's assessment and subsequent directions, social workers provide 100 hours of support, and family support workers provide 100 hours of support and intervention including observations of everyday activities to determine where any difficulties may lie.

The model means the assessment is carried out using the perspectives of various professionals rather than different agencies each conducting assessments in isolation. Dr Preston says: "You don't usually get that combination of people working together at the same time in such a timely way."

And because the team works together, it means time spent on report writing is reduced dramatically as professionals do not have to reiterate what has happened for the purpose of keeping other professionals in the loop as they have been involved along the way. This also reduces the cost dramatically - a must for cash-strapped local authority children's services.

Preventing repeated disclosures

As well as saving local authorities money during a climate of cuts, the model reduces delays due to its intensive nature, reduces uncertainty for families, keeps families together at home in natural surroundings and includes input from various professionals working together at the same time which prevents parents having to make repeated disclosures to different professionals over a lengthy period, which can be highly traumatising when having to disclose difficult experiences.

Furthermore, MFA is dynamic and flexible, is bespoke to the needs of the family and is evidence-based.

While some families have been open to the process, others have been more resistant but Dr Preston explains this is down to the nature of the work rather than the model as some families are "resistant to support and change", but the psychological assessment seeks to understand why this is the case, and is empathetic and understanding, and recommendations as to how to address this are able to be identified right from the start. It will be important for us to understand how families who have experienced this model found the process and we will seek to do so.

Keeping families together during the assessment process is a key component of the model, and Dr Preston concludes: "I don't think there is any situation where this model would not be appropriate. We are moving from an isolated assessment to a multi-disciplinary assessment in a drastically reduced time-frame. I don't think it can increase risk, and to the contrary, would mostly reduce it."

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