Templanza y humildad

A small group of social workers in the survey questioned whether foster care is an

appropriate means of looking after children with mental health problems. They questioned whether any level of support could ever be enough:

"In many instances caregivers or foster placements are not in the best interests of the child and young person. They are often best placed in a less intense and more structured

environment e.g. family home type placements," support in itself may not be enough ".

A range of other options was suggested by these respondents, including facilities for those with drug and alcohol disorders and medium and long stay therapeutic residences for adolescents with mental health problems.

Discussion

There is evidence in these results that Child, Youth and Family social workers who work with children with mental health problems understand the importance of informal support and the contribution of caregivers' own strengths in the provision of successful care. Social workers and supervisors rated formal support services including social work support as less effective than informal supports and caregiving factors. The body of research on resi lience, reviewed in chapters two and three, supports their judgement. These studies have established that care-giving and contextual factors are significant in the resilience of families and the life course outcomes of children and young people with mental health problems.

Social workers evidenced familiarity with the principles of strengths based practice, which emphasise the internal strength of caregivers and the importance of support such as that provided by friends and family members in caring for children with high support needs. Factors such as strong family networks, participation in school, recreational activities and building positive social networks were all rated highly by respondents as contributing to positive care outcomes. Caregiver experience and understanding of mental health problems were also highly regarded by social workers. Echoing research describing the importance of management of child behaviour to caregivers (A. Cox & _{Tregeagle, 1 999; Richardson} &

Joughin, 2000), social workers in this study viewed the capacity of carers to manage difficult behaviours as important in achieving good care outcomes.

Formal support services (financial support, home support, training for care givers and family therapy) were rated lower than informal factors but were nevertheless regarded as having value. All formal services were placed above the neutral point on the scale and many were highlighted in the open comments field. Reflecting the growing place of respite care in child

welfare services (1. O'Brien, 200 1 ), respondents to this survey also emphasised this form of

Unexpectedly, despite the high ratings social workers gave to informal factors, the open comments were dominated by concerns for better access to mental health services and improved social work support. Supporting informal carers' own networks and caregivers' internal strengths received comparatively little comment. This may suggest that while family resilience or family strengths is well understood and valued by social workers, there is less knowledge about how to adapt their own social work actions to promote these protective factors.

This study sought to understand the values and perspectives behind the construct of support used by social workers. The survey indicated that this group of social workers understood the difficult nature of care and identified many of the aspects of support which previous research suggests that caregivers value. As chapter five outlined caregivers construct effective social work support as including involvement in decision making, teamwork, practical support and assistance, emotional support, regular contact and provision of information (T. Fisher et aI., 2000; Triseliotis et aI., 1 999). Respondents in this study also described all these matters as part of social work support.

As discussed in chapter three, Twigg ( 1 989) describes three possible models by which social care agencies construct their relationship with caregivers, being caregivers as a resource, care givers as co-workers and caregivers as clients. In this study social workers primarily regarded caregivers as a resource to the organisation. They held concerns in respect of the pressures on this resource. Some suggested that there is an insufficient supply of caregivers to maintain foster care as a viable option for some young people with serious mental health problems. Amongst participants there was also a desire for more teamwork, suggesting some social workers may view caregivers as co-workers or as having this potential.

In the negotiation of a support response, these results indicate that common ground may exist between caregivers and social workers surveyed. While participants understood m any

aspects of social work support, which are documented overseas as valued by caregivers, the results also suggest that social workers may be missing opportunities if their focus remains fixed on gaining access to formal support services. Social workers appeared to disregard their own role in inquiring about informal factors and seemed unfamiliar with ways to enhance and strengthen these networks. Child, Youth and Family may require further consideration of the role of social work support in respect of informal networks. Such thinking is likely to come within the strengths based practice developments planned by Child, Youth and Family (Child, Youth and Family, 2002e).

There was a high level of awareness of the failure of Child, Youth and Family social workers to support caregivers looking after this group of children and young people. The potential effectiveness of social work support in sustaining good outcomes accounts for the frustration experienced by social workers who are unable to provide this support. Compounding this disappointment was their inability to obtain mental health input and sufficient back up services and information to offer care givers. While respite care was rated as the third highest formal support service, social workers noted difficulties experienced by families in finding adequate respite care in the presence of challenging child behaviours.

Social workers saw managing child behaviour as key to developing stable care. There were few suggestions however, about how to ensure care givers were able to do this. Social

workers reported themselves to be poorly informed about mental health problems and unable to answer detailed questions from caregivers.

A sense of powerlessness is perceptible in the comments of social workers. They felt that the provision of effective support to caregivers was largely out of their reach, given the

organisational context and lack of engagement with mental health services. In the light of these deficits some social workers believed the support needed was unobtainable.

Alternatives suggested included sharing this role with mental health services, pursuit of non­ foster care options and the development of specialist support roles within Child, Youth and Family, such as caregiver liaison social workers.

Interestingly, social workers did not comment on those aspects of their support role which were within their power to change or enhance. Social workers in this study demonstrated an understanding of the importance of regular telephone contact and emotional support but did not comment widely about their ability to improve these aspects of their support. Nor was there a sense that the involvement of caregivers in planning and casework was robustly in place in the organisation. These are matters which Child, Youth and Family social workers could attend to without additional resources or the input of others. Overseas research suggests that improving these aspects of support will increase the satisfaction of care givers (Triseliotis et ai., 1 998).

The 'agency of last resort' as described in recent reviews (Brown, 2000; M inistry of Social Development et ai., 2003) is reflected in social work commentary in this study. The child welfare service in New Zealand, as in other jurisdictions, appears to struggle to cope with the mental health problems of those in their care. Child, Youth and Family social workers reported difficulties with interagency relationships, which appear to persist (Ministry of

the access problems and exclusions reported for this group of children and young people

overseas (Nugent & _{Glisson, 1 999; United States General Accounting Office, 2003).}

Interagency agreements and service co-ordination, while valued by social workers, were reported as failing or not in operation. Until a means is found for social workers to receive the support that they require from mental health services, it is unlikely that they will be confident or sufficient in their support to caregivers.

The resulting isolation reported by social workers who are involved with children with mental health problems is of concern. These fmdings concur with those reported by Child, Youth and Family( 1 999b) Calvert (2000), and Cock burn (2002). The majority of

respondents viewed children with mental health problems as the more difficult of their cases. The open comments fields however, indicated that the frustrations relate to inter-and intra­ organisational problems rather than to child symptomology. A picture forms of social workers struggling in isolation from mental health services, bearing what they believe to be an unfair level of case responsibility, constrained by fiscal and time pressures and aware of their inability to support caregivers sufficiently.