The Southern Partnership Project evolved partly from a preceding research project,(Children of Parents Experiencing Major Mental Illness, the Department of Psychiatry, The University of Melbourne), and from emerging overseas literature which pointed to the need for inter-sectoral links in providing services for families with dependent children where parents have a mental illness. As the research project developed it became evident that the organisational dimension of cross-sectoral links was basic to responding to this group of children and their parents. With the conclusion of the project and the clear identification of the need to provide resources for and facilitate links between agencies, a submission for a two year project was prepared. Project auspice was sought from and provided by the School of Social Work, The University of Melbourne. Funds made available provided for a 14 month project at four days a week, beginning in mid 1996. The Southern region was chosen because the writer/Project Coordinator had previously worked there for several years, and had more recently formed links with several agencies who were eager to advance this issue, and had relevant expertise to offer.

The primary aim of the Project was to develop four inter-agency networks in the region in order to more effectively meet the needs of families with dependent children where parents have a mental illness.

The Southern Partnership Project was an idea taken to agencies in the Southern Metropolitan region of Melbourne, rather than an initiative from the region. While this is not an ideal process, the need for such a project was understood, and the writer wished to continue the work commenced in the research project. With the evolution of the Project the initiatives became those of the participants who were involved through their belief in the need for active, cross-sectoral collaboration.

• The problem is too complex and the solution too comprehensive for any one agency or organisation to address alone

• The most appropriate place for solving the problem is in the community where it occurs

• The needs and resources already in place should be assessed

• Local ownership should be promoted. (Bogenschneider, 1996.)

While the issue of concern at any time is the wellbeing of the children of parents with mental illness, and their parents, the focus of this project was the professionals who have an impact on their lives through how they manage the family issues and deliver services. Therefore the aims of the project were to facilitate a process of developing collaborative and cooperative links among service providers which would:

• Ensure vulnerable children are identified and receive appropriate support.
• Enable parents to feel they are entitled to ask for help in caring for their children.
• Lead to the development of prevention and early intervention programs for children of parents with mental illness.

From these aims the following objectives were identified for the duration of the Project:

• Establishment of local networks as a forum for ongoing exchange of information and professional development.
• Establishment of formal agreements concerning exchanges of information about both children and parents which will be sensitive to parent rights, child rights and confidentiality.
• Development of agency policies and guidelines which cover family assessment, and the need for flexible and ongoing support for children and parents.
• To increase professional knowledge and understanding of effect of mental illness on parents and on parenting.
• To increase professional knowledge and understanding of effect of mental illness on children, psychologically and socially.
• To increase professional knowledge and understanding of the needs of, and responses to, children of parents with mental illness.

These objectives were written with a two year project in mind, and while obviously having to be modified, are included for information.

A Reference Group was established and comprised senior representatives from adult and child/adolescent mental health, government and non-government family support, education, child protection, psychosocial rehabilitation, and a parent/mental health consumer representative. The terms of reference for this group agreed at the first meeting were:

• To oversee the development of the project.
• To draw on policy and program knowledge and experience.
• To identify planning issues, to scrutinise and make suggestions about material emerging from local networks as the project developed.
• To advocate for and support agency participation in local network process.
• To disseminate information back to agencies and services, to peak bodies and the Victorian Department of Human Services management.

Four local area networks were also established, and meet monthly, in locations which could be described as: Inner South, Middle South, South East, and Peninsula. Members were from both the supervisory and direct service levels and representation was similar to the Reference Group, with the addition of specific services such as foster care, maternal and child health, and others idiosyncratic to a particular network area. Two parent/mental health consumers participated in one network. While the needs of each network varied, their focus was generally the discussion of issues, achievements and impediments at the direct service level.

In keeping with the principle of assessing local resources, which can occur at more than one level, the first Project task was extensive telephone networking in the region, using existing contacts, and developing new ones. From this two important regional professional groups were identified and presentations made at a regular meeting of each one. Development of two of the networks followed with the other two networks following soon after.

The needs of families where parents have a mental illness may fall into both the mental health, and family welfare sectors. Government and non-government agencies from these sectors may be involved such as adult mental health, child and adolescent mental health, family support, family counselling, child protection, foster care. In addition other services may be provided by local government - maternal and child health and early intervention programs, education - school welfare coordinators, and community police

Applying the principle of problem solving belonging in the community meant there should be as wide a representation as possible in each group from the beginning. Also, with the short time-frame for the Project this early inclusion was important.

One parent attended several meetings of the Reference Group, and two other parents attended meetings of one of the networks. With more time, and opportunity for a process of inclusion of parents into each group there may have been greater involvement both in numbers of parents and level of participation. Another parent had contributed to the preparation of the submission.

Adult offspring, and parents, contributed to two workshops, and the Regional Forum described below in Project Initiatives and Outcomes. It is important to involve parents and offspring, both adolescent and adult, in the ongoing development of collaborative practices. Their experience and perspective is essential to educating service providers and informing service development. Area mental health services now routinely seek advice from consumer consultants.

The following three steps overlapped in the early part of the Project.

i) Identification of the types of services to be approached in each locality as described above. Each group suggested further participants as the project developed.

ii) Preparation of a package of materials to be mailed out to each person following telephone contact. The purpose of these materials, other than administrative, was to provide a rationale and framework for the Southern Partnership Project, to provide background briefing material, and to acquaint participants with some principles associated with the process of establishing inter-agency practices. A Questionnaire for Service Providershad been prepared and was also enclosed. See below under Project Initiatives.

iii) Telephoning the identified potential participants to explain the purpose of the project, invite them to the initial meeting, mail out the information package.

During the telephoning process a venue in each locality was offered by an agency having a suitable meeting space, and this information was included in the mailout.

Support in principle for the concept and purpose of the Project was unequivocal. All agencies contacted wished to at least be on the mailing list, and receive Minutes. Some agencies felt they did not have the staffing resource to attend meetings. Other agencies were able to allocate this time.

The setting up of the groups was phased in from May to September. Each group met monthly with progress, and direction, determined by members and differing from group to group. Representatives from 74 services in the Southern region received Minutes. A total of 125 individuals attended at least one meeting during the project. Some agencies had several representatives, or had a change in personnel from one meeting to the next. On occasions students of social work/welfare attended. Involvement of all participants was in addition to routine responsibilities at their agencies.

Common to groups anywhere was the emergence of a core group in each network who were able to attend consistently. This may have been assisted for some by the meeting venue being at their agency, or nearby, and their own commitment combined with a capacity to regularly attend. Continuity for all groups and individuals was affected by competing demands, and events such as holidays, illness, family issues.

One notable characteristic was the arrival into, and departure from, the groups by members throughout the Project. This occurred for the above reasons, as well as staff moving to other employment, or being part of a restructure within their workplace. This was apparent when working with five groups concurrently and poses the question of the capacity of a newly forming group to manage these ongoing changes, continue with the task at hand, and remain a viable group.

With the expectation that ownership would be assumed, over time, there was opportunity for each group to evolve according to their particular interests.

Each group spent some meeting time discussing day-to-day practice issues and frustrations, discussing service requirements, identifying training needs, and exchanging information about their services. These exchanges were important, as set out under Project Outcomes.

The more specific direction and agenda for each group was influenced by expressed concerns and interests of some members, which were supported by the group. In some groups members were asked to present on a relevant topic such as a case study which demonstrated successful agency collaboration. Two groups invited group members from the respective adult mental health service to inform them about the service guidelines of their service, including definitions of 'serious mental illness' and 'crisis'. These terms are sometimes contentious as they have a clinical meaning to adult mental health services, which is not necessarily in accordance with the meaning attributed by, say, a family welfare agency. Discussion of this issue was valuable in its relevance to service eligibility. Two other groups invited outside speakers to address relevant topics. One network decided at their first meeting to provide a workshop on the effects of mental illness on parents, and on parenting and formed a sub-committee to make the arrangements. A second network later provided a similar workshop for colleagues in their locality.

Role of Co-ordinator

The Project Coordinator’s role was conceptualised as coordination and facilitation. In fulfilment of this role, the tasks were primarily administrative. Following the establishment phase this involved both Chairing network meetings, and taking and mailing out of Minutes for each meeting for each group. It also involved arranging for speakers where relevant, organising the Regional Forum, preparing and distributing three issues of a Regional newsletter, and the preparation and distribution of the 'Questionnaire for Service Providers', and subsequently collating, summarising and distributing the responses to all Project participants. It was intended that such roles and tasks would be devolved to the membership over the duration of the project.

The Co-ordinator also prepared the information flyer and project report described below.

With the Project being taken to agencies there was a degree of tension between supporting and resourcing five new groups, formed for a new purpose, with their need to claim ownership, but needing time to assume ownership, having certain objectives to achieve within a specific timeframe, and not imposing direction on to each group. That is, there was a need to balance content, and process, or development of the task, and maintenance of the group.

At a direct practice level some of the lessons learnt included:

• The difficulty for some agencies to committing time and resources.

• The group maintenance role of an outside facilitator provides little motivation to agencies/networks to confront the commitment to resources, until the facilitator withdraws.

• The importance of creating a specific focus, such as network sub-committees arranging workshops and information sessions early in the project.

• That there are different attitudes to sharing information about families, with some agencies seeking information in order to plan family focused services, while agencies providing the required information sometimes do so reluctantly. Effective service responses to the children and their parents require that agencies exchange information.
• That workers have an intense need for understanding, knowledge and development of skills and expertise in this area of their work.

Questionnaire for Service Providers: The Questionnaire was distributed to 74 agencies early in the project, and 55 responses were received (74%). From these responses the majority of participating agencies were welfare oriented (51%), with 33% being mental health/health, and education and community police comprising the balance. Social workers and psychologists comprised 58% of the practitioners completing the questionnaire, with small representations from other helping professions. 63% of agencies routinely recorded information regarding the psychiatric illness of a parent. Where the information was not recorded this was in order to protect privacy, otherwise the information was not recorded/not required/not kept. Respondents were asked to estimate the number of parents with a psychiatric illness having dependent children as a proportion of their client population. 64% of respondents estimated from .5% to 50% of client population, with 35% giving no estimate. The remaining questions asked respondents to identify strengths and limitations of: current knowledge, agency practices and protocols, and the local community network. Responses to these questions informed the Recommendations shown in Appendix I.

Reference Group Initiatives: In line with its Terms of Reference, the Reference Group identified certain shortcomings in the Victorian Department of Human Services Family Support Statistical Data collection forms, relating to service provision to families where parents have a mental illness. As family support agencies increasingly work with these families, this has significance for their funding arrangements. Consequently, a letter was written to the relevant Manager in that Department, proposing changes to these forms.

Early in the second half of the Project a regional forum, Building Partnerships, was arranged and organised by representatives of the Reference Group. The forum was opened by the Victorian Minister for Health, and attended by over 100 project participants and others interested in the issue. Material from the workshop held in the afternoon contributed to informing the recommendations contained in Appendix I.

Three issues of the Southern Partnership Project Newsletter were prepared and distributed, and contained news and information about each group, and associated southern region information.

i) Lobbying: One network wrote to both the State Minister for Health and Minister for Youth and Family Services, seeking a joint meeting in order to table the issues of concern in attempting to develop partnerships. The meeting occurred, and while there was no direct or immediate outcome the achievement was having both Ministers participate in a meeting with community representatives to discuss this issue, which is in fact moving forward in this state.

A second network wrote to several local Members of Parliament expressing concern at the merging of secondary colleges as this would result in longer travel time, and other school expenses, and consequent stresses, for families where young people have a parent with mental illness.

ii) Workshops: Two networks arranged workshops for local co-workers on the subject of understanding the effects of mental illness on parents, and on parenting.

In both cases the tasks of arranging the workshops and inviting speakers from adult mental health services contributed to the partnership process. Both workshops included speakers who were parents experiencing mental illness, and adult offspring of parents with mental illness.

iii) Service Development: In one network area the development of a planned support program for parents with mental illness was able to proceed. Release of funding from the government Department was facilitated by the concurrent development of the Project.

The source of this information was a focus group discussion with each network addressing three topics: outcomes for individual participants, changes noted for individuals in their approach to their work, and changes noted within agencies. This material has been summarised under two headings.

Meeting together for the first time, for the stated purpose, was a significant step for many, with variation in the breadth and depth of experience in working with this group of families. Some may have been regularly involved in case conferences, others may have only spoken on the phone with other agencies. Importantly, there had not previously been any forum in which broad issues relating to this aspect of participants' work could be raised and discussed.

• The opportunity to 'network' was valuable - this process had not previously occurred in relation to these families.

• Meeting with others was affirming of the work people were already doing.
• It was reassuring to share concerns about the needs families have, and about effectively meeting family needs.
• There was a shared recognition that people are trying to be effective, within funding and program constraints.
• People were respectful and accepting of one another for their role and contribution in the network process. This contributed to a change in practice.

Participants reported four main types of impact: increased worker confidence in tackling the issues, increased knowledge of the service network, and consequent improvements in referral and liaison practice, and an increase on motivation to seek innovative solutions. In some agencies participation in the Project by one, or more, staff members contributed to greater awareness among colleagues, and management.

i) Project Report - Building Partnerships. 400 copies of the Report were distributed to all Project participants. The Report was also sent to all of the following services in the State: adult and child/adolescent mental health services, child protection services, local government family and childrens services, and Parent Resource Coordinators. Departments of Health and Community Services in other states, and associates in other states and overseas who are researching or working in this area also received a copy.

ii) Information flyer - Listen to the Children of Parents with Mental Illness.

10,000 copies of the flyer were distributed to the above groups, and widely across the health, mental health and welfare sectors around Australia. The Australian Council for Educational Research contributed to this extensive dissemination. The purpose of the flyer is to serve as a prompt for service providers concerning the needs of children, parents, and family members, and it offers suggestions as to responses they can make.

iii) Recommendations - the Project established its own mandate, and on this basis made recommendations at the levels of service provision, service resourcing, network level, regional level and statewide level, set out in Appendix I.

The end of project funding meant the departure of the Coordinator and the administrative support provided to each network. It could have been expected that this, together with the challenging nature of the project, would see no further work being done. However, it has been very encouraging to find that two networks have amalgamated, continue to meet, and provide occasional community workshops. One network meets regularly and also provides occasional community workshops. The fourth network ceased meeting for a while, but then conducted a survey of local service providers to assess client needs. The tentative nature of network sustainability highlights one of the Recommendations, at a regional level. This Recommendation proposes the establishment of a Regional Community Development position in order to support networks, and initiatives they develop.

The Southern Partnership Project was a community health project funded by the Victorian Health Promotion Foundation from 1996-1997.

Southern Partnership Project - Principal Officer, Dr. Lynda Campbell, Lecturer and Coordinator Children, Young People and Families Research Unit, School of Social Work, The University of Melbourne, Victoria.

Note: The material contained in this presentation will be published in a forthcoming book Children of Parents with Mental Illness (working title), Editor: Vicki Cowling, Publisher: Australian Council for Education Research (ACER) Press, mid-1999.

Please contact the writer for inquiries about the research project Children of Parents Experiencing Major Mental Illness. Maroondah Hospital Child and Adolescent Mental Health Service, Ph: 03-9870 9788, Fax: 03-9870 7973.

Bogenschneider, K. (1996). Family related prevention programs: an ecological risk/protective theory for building prevention programs, policies and community capacity to support youth. Family Relations, 45, 127-138.

Appendix I

Recommendations Arising from the Southern Partnership Project

The recommendations are based on four sources of information:

• Responses to the Questionnaire for Service Providers, completed by 55 project participants.
• Responses to the case study discussions at the Regional Forum held on 11^th February, 1997.
• Feedback from focus group discussions with each network on project outcomes.
• Recommendations from the Regional Reference Group.

Increasingly, we are discovering some core requirements for acceptable worker — family practices when agencies respond to parents who have a mental illness. These include expectations that the worker will demonstrate:

• Awareness of the impact of the illness and its treatment on the children.

• Sensitivity and responsiveness to the needs of these children, the ill parent, partners, and support people to parents with a mental illness.

• Flexibility to provide what is needed when it is needed.

• A capacity to talk directly with children when and as needed.

• Affirmation of the rights and roles of the parent despite temporary or longterm incapacity to fulfil certain parenting roles.

Such practice does not grow without a sympathetic environment, and sustained commitment. The following recommendations address the conditions for nurturing what this project has discovered — the presence of abundant goodwill among workers.

When a parent with a mental illness first enters any agency, their experience is shaped by whether they meet with an informed worker who can offer a family centred and flexible response. It is therefore recommended :

1. That agencies review existing guidelines for service delivery and revise them as necessary to ensure that, with respect to children of parents with mental illness, and their parents:

• parents are received/approached as partners in identifying family needs, making plans, negotiating with other services

• the case assessment made on behalf of the agency routinely includes attention to whether a parent with mental illness has dependent children, and to the needs of all family members

• the case assessment routinely includes attention to the impact of agency practices on the parents, their children, other family members and support people

• the contributions and limitations of the agency’s role will be made explicit to service users and to other agencies involved with the family

2. That agencies collaborate to contribute to respective training needs.

3. That case discussions are established as a routine professional development procedure both within agencies, and between agencies.

4. That agreements for reciprocal secondary consultation be established between agencies.

The informed and family centred response requires both formal authorisation and a supportive agency culture. It is therefore recommended :

1. That managements recognise that secondary consultation is a legitimate and essential component of case management

2. That managements endorse inter-agency case discussions as a group supervision and professional development procedure

3. That managements allocate a portion of worker time to develop skills and be available as resource to other staff concerning:

• specific issues affecting children
• working with children
• avenues for consultation
• specialist agencies
• accessing useful written materials

4. That managements provide for service delivery which acknowledges the fluctuating nature of mental illness, that is

• services may need to be provided over a long period of time
• at the same time, the service provider must have the capacity to be flexible, according to the parent's ability to provide for their children independently of any service

5. That managements recognise that families may require services outside routine office hours, and allocate worker time accordingly

6. That managements endorse agency commitment to work collaboratively with other services to effectively meet the needs of families with dependent children where parent have a mental illness

7. That managements acknowledge that an essential role of case management may require workers to visit other services with whom a family is involved

8. That managements endorse the development of inter-agency training programs concerning issues relevant to work with these families

9. That managements sponsor staff to represent the agency in subregional networks and contribute materially to network maintenance and functions

Agency policy alone cannot ensure that workers will be sufficiently informed about the range of issues and options influencing their practice with parents with mental illness and their families. The subregional inter-agency networks provide a forum for information exchange, mutual education, and innovative ideas. It is therefore recommended that these networks continue, and :

1. That network structures be formally established to facilitate network viability

2. That family members are included in all network planning and implementation -

this could be achieved by approaching mental health consumer groups, or consumer consultants through adult mental health services

3. That networks engage in a systematic process of information exchange concerning the role they may have with these families

4. That networks develop a local resource file for workers

5. That networks develop reliable pathways for consultation processes among agencies

6. That networks plan a program of collaborative training and professional development

7. That networks develop and implement a program of short term job exchange among agencies

8. That networks develop an information booklet about local services for parents

Productive as the networks have been, they require further resourcing and a mechanism for communication with policy makers. It is therefore recommended:

1. That a Regional Community Development position be created to:

• facilitate a channel for consumer contribution to policy and service planning processes

• resource workers and consumers in developing information, developing education programs and developing specific projects, that is provide a consultancy role to network initiatives

• provide a formal link between the field and policy makers

2. That the Mental Health Branch, and Protection and Care Branch liaise with Divisions of General Practice to facilitate the training of General Practitioners concerning the needs of children of parents with mental illness, and their parents

This project has reinforced and built upon messages derived from a related project in the northern region. While service provision must be localised, parenting while living with mental illness is not a regionalised phenomenon. It is therefore recommended :

1. That Mental Health Branch and Youth and Community Services Division examine the compatability of data bases to generate information regarding the current service usage patterns of parents with mental illness and their children, with a view to more advanced study of well met, and unmet, needs

2. That Mental Health Branch and Youth and Community Services Branch collaborate to introduce policy measures through which evaluation at process, impact and outcome levels is a routine mechanism to gather hard data on early intervention/prevention approaches

3. That Mental Branch and Youth and Community Services Branch collaboratively develop a structure of local networks, such as those modelled by the Southern Partnership Project, across Victoria.

4. That the role of primary care workers in early identification and intervention with these families be emphasised. General Practitioners, child care< workers, pre-school workers, school welfare personnel, maternal and child health staff have been identified as those for whom this issue has most relevance among such workers. They should receive high priority for provision of in-service training. Consideration could be given to the use of the planned video/training package funded by Mental Health Branch, currently being prepared for adult mental health workers.

5. As schools are one setting attended by all school age children, it is recommended that primary and secondary schools :

• provide training for Student Welfare Co-ordinators on the effects of mental illness on parents and on parenting

• allocate time to SWC’s to be available to children of parents with mental illness

6. That the Department of Human Services make available to education institutions appropriate current data and service information to assist them to provide tertiary training and in-service of workers in social work, psychology, welfare, maternal and child health, psychiatry, community police. Such material would also include components addressing the developmental issues for children and families where parents have a mental illness.