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Thanks for your thoughts and feedback. Claire and Chloe, I like the Word document uploads, easier to read than these box's
Cath

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Claire

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Chloe

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Facts in the case:
- Rebecca is a single Mother to Krystal
- Krystal is care of a child protection plan
- Rebecca previously has had 3 children removed from her care 5 years ago due to DV and neglect, she no longer has contact with their father
- Rebecca was in a new relationship (father of Krystal) however Rebecca and  Krystal are protected by a restraining order due to domestic abuse from Aaron
- Rebecca has been diagnosed with Bi-polar and is medicated
Current situation:
- Krystal is 16 weeks and is meeting mild stones however Rebecca has not taken Krystal to her health visitor appointment and the HV could not contact Rebecca to re-arrange this appointment
- At a core meeting Rebecca appeared unkempt, on edge, unsettled and the conversation was jumping from one thing to another did not have a clear pathway
- In the core group Aaron's probation officer informed the group Aaron had been back in contact with Rebecca and Krystal

Issues:
- Rebecca and Krystal should not be having contact with Aaron due to a restraining order in place, domestic abuse and the risk he poses to them.
- Who initiated contact first was it Aaron or Rebecca? What are Rebecca's feelings about being back in touch with Aaron - is she happy and cannot see the risk? Has she got other support so she does not need to rely on Aaron? Or is he threatening her and she is worried about him being in contact?
- Rebecca appears unkempt, on edge and not able to follow a clear pathway in the core group conversation, she has began missing Krystal's health visiting appointments. Is Rebecca looking after herself and Krystal? There was previous neglect with the previous 3 children.
- What is the current state of Rebecca's mental health? What has caused the change in now appearing unkempt and not attend Krystal's appointment? what has triggered this? Is Rebecca taking her medication as prescribed? Does the medication need to be reviewed? Does she need further mental health support is her M/H deteriorating?
- What family support has Rebecca got? What professional support does she have? What coping mechanisms does Rebecca have?
- Rebecca has been in x2 relationships with domestic abuse present making her vulnerable, has she accessed support groups for this and got coping mechanisms in place to support with her new choices in support networks?

Areas I want to know more about and what further information I would want to know:
- I want to learn more about bi-polar, signs and symptoms of when bi-polar might me uncontrolled and needing further intervention
- What support is available for women in the perinatal period with bi-polar and for women who have recently experienced relationship break down related to domestic abuse
- Management/treatment options for women with bi-polar
- Safe guarding protocols when child protection plans are not being followed and families disengage with plans
- I would want to explore Rebecca's current thought processes and mental health? Is she back in touch with Aaron because she is struggling being a single mum? What support has she in place? OR is she missing Aaron and does not understand the risk he poses? Is Aaron threatening her and that is why she is back in touch with her? This would all contribute to what support and referrals could be offered to Rebecca

Thanks
Cath

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Rebecca has previously had 3 children removed from her care.  She has a diagnosis of bipolar and a family history of schizophrenia.  Rebecca has previously been involved in a relationship where domestic violence has taken place and there was also evidence of neglect to her 3 children.  A restraining order has been taken out on Aaron the father of her latest baby due to domestic violence.

Due to Rebecca's history of mental illness and domestic violence she is obviously very vulnerable. Rebecca has the support of Margaret the family support worker and it would appear that a child protection case conference has already been held. She also has the support of her health visitor.

I would try and find out from Rebecca and the health professionals working with her what type of family support she has.  I would be checking with Rebecca and asking her GP if she has been taking her medication as due to her presentation at the core group meeting it sounds like her mental health could be deteriorating again.  I would also want to speak with Aaron's probation officer and try find out more information about Aaron's contact with Rebecca and potentially his mental state.  The fact that Rebecca seemed unsettled when Margaret visited her could be due to the fact her mental health is deteriorating as she may be missing her medication.  It could also be due to the fact that Aaron has been in contact with her which is making her feel on edge.
How easy is it to liaise with Probation etc?

Due to all the circumstances above I would want to hold another core group meeting so all the professionals could get together. I would also want to check with the GP to see if Rebecca had been regularly collecting her medication prescription.  I would also speak to the GP about potentially referring Rebecca to a Community Psychiatric Nurse for assessment.   I would hope that early intervention to support Rebecca would prevent Krystal from potentially being removed from her care.
Thankyou!
Cath

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Amy -

Activity One

Critically reflect and analyse the challenges and potential opportunities of joint working in maternal mental health to seek new insights to the creation and sustainability of integrated approaches to service delivery.

I feel joint working and multidisciplinary working with regards to maternal mental health is critical in order to provide holistic care, as there are so many aspects to maternal mental health. However, I feel it is vitally important to have continuity of carer in each of these areas in order to develop a trusting relationship with the lady and her family to be able to provide individualised care.
I feel there are numerus challenges with joint working in maternal mental health which would include miscommunication between teams and different professions, which in turn could lead to a delay in care, missed information/appointments and individuals unsure of each other’s roles and responsibilities in the provision of care. There may also be numerous referral processes in order to access care by particular teams which may cause delays.

There may also be further potential delays in providing care due to different caregivers/teams working different hours such as shift work, or Monday-Friday office hours, no on call provisions, no weekend work, no Bank Holiday cover.
It would be important to highlight a main care provider within a multidisciplinary team in order to feedback and positive elements or any concerns in order to access further support or to change aspects of care to suit individual needs and for a particular individual to have an overall ‘bird’s eye’ view of the care provided and the effectiveness of this care.
Wouldn't the Perinatal Mental Health team do this?
Cath

On a positive note, if there is good communication between all care providers and good team work, this would provide excellent care for a woman and her family as she would have access to numerous specialised professionals to support her and aid her recovery. It would be an individualised care pathway to meet her needs and all teams would communicate and work together efficiently to provide an effective standard of care.
Different teams/professions may be able to provide support via a variety of different setting including GP surgery, local hospital or the woman’s own home. This would ensure a woman is able to access her care depending on which setting she prefers. For instance, a home visit may enable to the woman to feel more comfortable to discuss how she feels, rather than being in a clinical setting, which in turn, may reduce the incidence of DNA’s.
However, if a woman’s home life is also a cause of her poor mental health, then she may prefer to access care at her GP’s or another unit where she can talk more openly.

Another positive aspect is that the teams can access further information or advice from each other when necessary, for instance a midwife will be able to ask specific questions or gain further information from the Health Visitor or Social Worker in order to provide relevant care and information.

Overall, I feel with respect for each care provider, strong communication skills and a well lead model of care, joint working would be an excellent way to provide care to women and their families.
Thankyou
Cath