What’s good for the goose is good for the gosling: Providing support services that work for both adults and children
Richard Meier: "Addressing parental conflict requires a grown-up response from policy-makers and commissioners to acknowledge that we will achieve the best outcomes for everyone through approaches which are designed to improve the lot of both children and adults."
EIF’s work on the impact of parental conflict has demonstrated how important it is to think about how we design and provide services that seek to address the parental or couple relationship in order to improve outcomes for children. Here at Tavistock Relationships, an organisation which has its roots in relationally-focused approaches to social work, we have observed the limitations of services which are too narrowly focused on either the children or the parent/couple relationship, and the challenges of providing alternative services that break down these siloes and work for adults and children alike.
A recent survey of clinicians working in an inner-London CAMHS service found that, when reviewing over 300 cases, clinicians believed that parental conflict had contributed significantly to the mental health difficulties of the presenting child or young person in over 40% of cases. Furthermore, clinicians felt that if the conflict was not resolved or improved, the mental health difficulties in the child or young person concerned were likely to continue in 57% of cases.
Tavistock Relationships undertook a number of interviews with CAMHS professionals during 2016. One quote, in particular, stood out:
“I’ve noticed that, over a number of years, not one of the couples that I’ve referred out of our service for relationship support has taken it up. But I do feel comfortable about making that referral, about putting it in black and white, because I then take responsibility, and that blame, from the child. Because I have highlighted it – it’s not that this child has an inherent problem, and they will always be with this problem; I have identified how the dynamics impact on the child’s presentation.”
It is unfortunate that in calling for child mental health services to include interventions which work with the couple, where parental conflict has been identified as a factor in the presenting child’s mental health difficulties, we have met resistance on the grounds that such calls amount to trying to shift resources for children’s mental health to adult services.
Our view is that the interventions offered should be those which have the best chance of effecting positive change. If the quality of the relationship between parents is directly implicated in the mental health of the child or children in question, then it seems uncontroversial to us that an intervention should be available that will help the parents with their difficulties, and thereby improve the quality of the environment for their children.
This is not – as per the quote from the CAMHS clinician above – to suggest that children’s services should simply signpost parents to voluntary sector services. Rather, such services should very much be part and parcel of the overall suite of approaches offered by that service. A lot is made of the multidisciplinary nature of CAMHS teams, but to truly deserve that description, such teams should have dedicated couple therapy provision within them.
Indeed, a number of services used to have precisely this kind of provision, as one of the people we interviewed described:
“We used to have a dedicated parental/couple therapist. That individual had two dedicated days for this work ongoing, providing supportive parental/couple work to support the child. That model held for a long time – and it wasn’t just that that person got the whole of this casework, the rest of us did as well, and we would meet and talk about what we were learning from doing it.”
It isn’t only CAMHS services that we believe need to change. Change is happening, and the evidence-base for interventions to reduce parental conflict is being developed and disseminated, for example through the EIF Guidebook. For example, Schoolchildren and their Families, is a groupwork programme with evidence for improving parental couple relationship satisfaction and improving child mental health. It is one of a number of programmes, which are breaking down the unhelpful divide between services which target adults, with a view to achieving adult outcomes, and those which target children, with a view to achieving child outcomes. Parents as Partners is an intervention we run in the UK based on the same programme model as School Children and their Families (Parents as Partners is not yet on the EIF Guidebook). Addressing parental conflict requires a grown-up response from policy-makers and commissioners to acknowledge that we will achieve the best outcomes for everyone through approaches which are designed to improve the lot of both children and adults.
The NHS offers an example of where such a response could pay dividends. Couple Therapy for Depression has achieved the highest recovery rates for depression and anxiety of any talking therapy delivered in the Improving Access to Psychological Therapies (IAPT) service nationally for the third year in a row. Unfortunately, it only accounts for around one in every 300 sessions delivered within IAPT, and only half of IAPT services offer the therapy at all. This is a very significant lost opportunity.
Furthermore, the fact that there have been no research or evaluation efforts to ascertain whether there are any benefits to the children of those parents who have received this therapy is certainly regrettable. As an intervention which targets adults (whether or not they have children), there are understandable reasons why such work has not been done. Still, given the generally accepted impact of parental depression and relationship issues on children’s mental health and behaviour, it would seem an obvious area for our research efforts to focus on if we are interested in joining up adult services with those of children.