A multi-disciplinary approach to carrying out parenting assessments ensures the process is both timely and ethical, says Dr Anna Preston, Consultant Clinical Psychologist.
Dr Preston, who carries out Multi-Disciplinary Family Assessments for WillisPalmer alongside a team which is led by an Independent Social Worker and can also comprise psychiatrists, therapists and Family Support Workers, believes a psychologist’s involvement from the outset is fundamental. She also emphasises the importance of the input of all disciplines in the assessment, and coming together as a multidisciplinary team.
“By being involved right at the beginning of the eight-week process I carry out an initial assessment to determine any cognitive, neurodevelopmental or mental health problems or any risk, be that forensic or as a result of mental ill-health. This identifies any issues right from the start and can inform the work that needs to be carried out during the assessment, as well as determining which professionals should be involved in the process moving forward,” said Dr Preston.
“I try and assess someone early on so that if issues are raised, the different disciplines can adapt their approaches especially if I have identified that somebody has ADHD, is on the autistic spectrum, has other developmental issues, learning disabilities or mental health problems. I can make recommendations right at the beginning that the process has to be adapted in a certain way, and then our brilliant multidisciplinary colleagues can adopt the recommended approach. This is not only helpful for the adults involved in the family system, but if the adults are being more effective, it will impact on the children we are assessing too,” she explains.
Dr Preston's psychological perspective can also 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, such as with people who have experienced trauma/abuse and they connect people in authority with their traumatic experiences. Based on such an understanding and formulation, we realise that if you change your communication method, and your general approach, 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.”
“There is always a reason why parents are not being the best parents they can be at any given time, and the reasons behind this and the families’ needs need to be understood”, she adds. “If we can understand this, go a level deeper, we can work out a potential solution and give them the best chance to for their family lives to work.”
Dr Preston has 18 years’ experience working with adults and families in clinical, NHS and private settings, having worked extensively with people who have particularly complex mental health needs and who experience a range of difficulties in combination; for example, personality disorder and mental illness in combination with learning disability and/or autistic spectrum disorders.
Having previously been the Trustwide Lead Psychologist for Acute Psychiatric Care Services and Lead for an outpatient Personality Disorder Service in Surrey, she is currently an Independent Psychologist practitioner providing expert witness assessments and psychological therapies. Dr Preston has been carrying out assessments with WillisPalmer for 11 years, including the MFA when it was introduced.
“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,” said Dr Preston. “Professionals working collaboratively together at the same time prevents parents having to make repeated disclosures about their life stories to different professionals over a lengthy period, which can be highly traumatising when having to disclose difficult experiences.”
A range of professionals can be included in the assessment which is bespoke and tailored to the needs of the family. “The MFA brings together whichever disciplines are needed to bring the pieces of the jigsaw together. This starts at the very beginning of the process, the first meeting, and continues throughout. There are frequent meetings and ongoing communication. It has been evident in cases where, for example, there are safeguarding issues, when all the pieces of the jigsaw are not working together, then problems, risk and harm occur,” said Dr Preston.
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. It can take so long for each discipline’s assessment to take place and precious time passes”
While “challenging”, the eight-week time scale is vital to prevent delays in the assessment and to ensure that families are not subjected to repeated assessments over many months as can be the case, Dr Preston explains.
“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.
The assessment is carried out in the family home and, where there are concerns about risk to the children, a Family Support Worker can be included in the team, providing 24/7 support to the family. This means parents and children are in familiar surroundings, they are more able to do their best, and it avoids the need for a costly residential placement. But it also helps identify risk issues in a timely way. Because the various services are working together over an eight-week period, it allows the family time to explain their experiences and provide their perspective rather than a one-off assessment where they might feel under pressure.
“Families are in their home environment so in a familiar setting and the whole approach is supportive and open. This is vital – especially when adults have trust issues. They need to understand the process and be able to explain their experiences,” said Anna.
Keeping families together during the assessment process is a key component of the model, and Dr Preston says: “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.”
In fact, she highlights that this approach is even more attractive in the current context of COVID where people have lost the human face-to-face contact with people, the services they used to attend, the groups they used to go to, which is significant. In addition, there is the pressure cooker situation where sometimes large families are contained together within four walls, with emotions heightened and worries about physical, mental health or finances are exacerbated.
“The MFA brings back into existence the human contact and support that they have lost and which many people are missing. As the assessment is multi-disciplinary, it enables us professionals to work out what the problems are, whether they are in need of financial assistance, respite, help with mental health problems and work out what the specific solutions are. If a psychological issue is identified sooner, it is easier for us to see that it is not money that is a problem, for example, it’s a mental health problem and now we can recommend support. It makes a difference to the whole system and enables children to stay at home where it is safe to do so,” concludes Dr Preston.