Experiences of parenting and clinical intervention for mothers affected by personality disorder: a pilot qualitative study combining parent and clinician perspectives

Background: Evidence-based parenting programmes are recommended for the treatment of child mental health difficulties. Families with complex psychosocial needs show poorer retention and outcomes when participating in standard parenting programmes. The Helping Families Programme (HFP) is a 16-week community-based parenting intervention designed to meet the needs of these families, including families with parental personality disorder. This study aimed to explore the help seeking and participatory experiences of parents with a diagnosis of personality disorder. It further aimed to examine the acceptability of referral and intervention processes for the HFP from the perspectives of (i) clinicians referring into the programme; and (ii) referred parents. Method: Semi-structured interviews were conducted with parents recruited to receive HFP (n = 5) as part of a research case series and the referring NHS child and adolescent mental health service (CAMHS) clinicians (n = 5). Transcripts were analysed using Interpretive Phenomenological Analysis. Results: Four themes were identified for parents: (i) the experience of parenthood, (ii) being a parent affected by personality disorder, (iii) experience of the intervention, and (iv) qualities of helping. Three themes emerged for clinicians: (i) challenges of addressing parental need, (ii) experience of engaging parents with personality disorders and (iii) limited involvement during HFP. Comparison of parent and clinician themes led to the identification of two key interlinked themes: (i) concerns prior to receiving the intervention, and (ii) the challenges of working together without a mutual understanding. Conclusions: This pilot study identifies potentially significant challenges of working with parents affected by personality disorder and engaging them in HFP and other similar interventions. Results have important wider clinical implications by highlighting potential barriers to engagement and participation and providing insights on how these barriers might be overcome. Findings have been used to inform the referral and intervention processes of a pilot RCT and further intervention development

Assessment or referral tool: the unintended consequences of a dual purpose common assessment framework form

The Common Assessment Framework (CAF) was designed to facilitate early intervention through multi-agency working and the active involvement of families. The underlying principle was to move away from a risk-focused, needs-led or service-led culture to assess need and match needs to identified services. It was anticipated that services and assessments would become more evidence-based, and a common language between professionals and agencies would evolve. Taking a social constructionist approach this study explored professionals’ experiences of the use of the Common Assessment Framework form. Forty-one professionals from four different local authorities and a variety of agencies took part in semi-structured interviews. Data were analyzed utilizing thematic analysis. Findings suggest the unintended consequences of the use of the CAF were influenced by local authority policy. As the local authorities adopted the policy of utilizing the CAF as a referral mechanism, rather than to assess needs, profes-sionals unintentionally perceived the CAF form as a referral tool, to refer families to existing service provision. Further to this, professionals referred to the CAF form itself, as a ‘means to an end’, implying that this was a step that had to be overcome in order to access services