Children practitioner responses

This chapter considers practitioner responses to parenting and child welfare in the context of drug problems. The increased vulnerabilities of these children and the statutory framework around child protection merits a closer consideration of the ways in which practitioners think about such cases. The key question that informs this discussion is why had so few of the children described in this study been the subject of investigation The interviews with parents, with their children and with grandparents, all indicated... 

Barnard, M., Barlow, J., McKeganey, N., Hill, M. and Neale, J. (2000) Growing up in drug dependent households parent, child and practitioner responses. Reference no. K/OPR/2/2/D371. Chief Scientist Office of Scottish Executive. 

The search for mitigating reasons that would allow the practitioner to view the adult s incapacity as a temporary problem to be resolved, and therefore not necessarily a decision about child safety, was also a feature of the drug workers response to the situation ... 

What one sees in these responses is a subtle, yet significant, shift away from addressing the immediate child protection issues, to focus on the mother s rationale for increased drug use. The attendant assumption is that given time (next day, next week) the practitioner can address the mother s stress and, in so doing, sort things out for the children. The focus on the mother, however, distracts attention away from the saliency of the child protection concerns. 

A survey on the use of antidepressive agents by an entire country s child and adolescent psychiatric services was recently conducted in Denmark (5 million inhabitants) by sending a questionnaire to all child and adolescent psychiatric departments and specialists with private practices. The response rate from all in- and outpatient clinics as well as from specialists with their own practice was 93.5%. Thirty-two departments and specialists received the survey and 30 were returned. Practitioners were asked to go through their files and report the number of children on medication and the indications for the treatment. Altogether, approximately 5000 children and adolescents were in psychiatric care (out of approximately 1 million children and adolescents in the age group 0-19 years). Of these, 400 (8%) were treated with an antidepressant on the date of the survey (February 8). 

Casey Hooke, advanced practice nurse and creator of the Safety Action Team (SAT) concept, defines SATs as department- or unit-based interdisciplinary work groups that provide a "think tank" for staff to identify safety concerns, process them, and brainstorm new ways to address them (Hooke, 2002). Group membership varies according to individual needs, but SATs strive to include members who represent the continuum of care for the patients they serve. SATs include registered nurses, physicians, pharmacists, respiratory care practitioners, child-life specialists, unit service coordinators, and members of the management team. The group is chaired by a staff leader, or sometimes by two staff leaders who share the responsibility. 

To ensure continuity and appropriate perspective in discussion, the managing practitioner should in most instances handle the disclosure of information and subsequent discussions with the patient or guardian with responsibility for a child s overall care. In some instances, another individual may be designated as the primary person to communicate with the family... 

Your pediatrician, or whatever medical practitioner you are working with, should be regarded as a resource rather than an authority figure. The care of your child is ultimately your responsibility. Write down any questions you might have the night before a medical visit and take notes on your conversation. If the practitioner hasn t answered a question to your satisfaction, ask again, and make sure you understand the answer before you leave. 

---