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Use of Structured Clinical Documentation to Identify Patients’ Parental Concerns and Their Childrens’ Wellbeing

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Abstract

Children of parents with mental illness are at high risk of adverse health and functional outcomes, but little is known about how the community mental health staff identify and document these. This file audit examines parents’ case managers’ recording of children’s needs and safety, on relevant components of New South Wales’ Mental Health Structured Clinical Documentation. The audit identified 280 parental files. Study findings indicate that parenting issues form an important load of work on community mental health teams, highlighting the need for systematic identification of parental status in mental health patients.

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Acknowledgments

The authors are grateful for assistance provided by: Donna Gillies (Senior Research Officer), Robyn Bowcock (Quality Systems Manager), and the COPMI coordinators of Western Sydney Local Health Network (prior Sydney West Area Health Service). Neda Dusevic (Former Project Manager MHOAT, InforMH). Participating Service mangers, Team Leaders and Community Mental Health Teams. Financial assistance was provided in the form of a Fellowship for Advanced Training in Child and Adolescent Psychiatry, funded by NSW Health and administered by the NSW Institute of Psychiatry.

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Authors and Affiliations

  1. 1B Grose St, North Parramatta, NSW, 2151, Australia

    Georgios Liangas

  2. Redbank House, Westmead Hospital, Western Sydney Local Health District, PO Box 533, Wentworthville, NSW, 2145, Australia

    Adrian Falkov

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  1. Georgios Liangas
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  2. Adrian Falkov
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Correspondence to Adrian Falkov.

Appendix

Appendix

The FFA is an example of a specific initiative to support clinicians in identifying and supporting Copmi families. It is a two page document which guides the recording of information covering a number of key domains. Page 1 focuses on current identified parent/carer symptoms and behaviours associated with current mental state, insight and judgement, co morbid conditions, and self reported concerns. Each item has a number of prompts to facilitate inquiry and responses can be recorded as present, absent or not known. There a section for the child’s current functioning regarding physical and psychosocial health and development as well as a section for self reported concerns. The final section provides for recording of concerns by others regarding the child’s wellbeing and safety. This includes concerns expressed by relatives, friends or neighbours as well as concerns expressed by staff in other services including teachers.

figure a

Page 2 provides a summary page for recording current and lifetime risk and protective factors relating to the child, parent/carer and family. It covers a number of key domains in which to consider risk as well as protective factors. These include parent/carer mental health history; drug and alcohol history; family medical history; family of origin (childhood) experiences, parental functioning and social support as well as children’s developmental and personal history, impairments and supports.

figure b

Importantly, it provides an overview section to record a summary of impairment relating to parenting, capacity to undertake daily activities and adverse impacts on the child. The intention is for key information to be collated, analysed and recorded as part of the care planning process. Specific actions related to parental support, child safety and wellbeing can be documented. Clinicians therefore have a structured record of information to inform care planning and decision making which takes account of the interplay of risk and protective factors in individuals and the various family interactions.

The FFA is available, along with other MHOAT forms, at http://www.health.nsw.gov.au/policies/ib/2008/pdf/IB2008_047.pdf.

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Liangas, G., Falkov, A. Use of Structured Clinical Documentation to Identify Patients’ Parental Concerns and Their Childrens’ Wellbeing. Community Ment Health J 50, 646–655 (2014). https://doi.org/10.1007/s10597-013-9684-5

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  • DOI: https://doi.org/10.1007/s10597-013-9684-5

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