When a parent is doing it tough, the last thing a practitioner wants is to make them feel worse. Adults who face adversities such as family and domestic violence, substance use issues or mental illness, often present with a history of being judged harshly. The desire to avoid replicating judgment can make practitioners feel reluctant to ask questions about parenting status, or the parent–child relationship. But what is the cost of this reluctance, as well-meaning as it may be? If we never ask the parent about their child, what opportunities might the child miss out on? And in reverse, what can we achieve by taking a curious stance? Can we make a difference by sensitively and proactively talking with parents about their children and their parenting role?
The ability of adult-focused practitioners to provide early intervention and prevention responses for children who are not physically present, is now recognised as a key strategy in improving outcomes for Australian children with mental health concerns (Lawrence et al., 2015). There is a stronger understanding that children’s wellbeing is ‘everybody’s business’, and that practitioners who work in adult-focused services can make a positive difference in children’s lives by adopting child-aware practice, whilst working with parents on their presenting issues.
In the following video (54 seconds), Suzie Hudson – Clinical Director of the Network of Alcohol and Other Drug Agencies – talks about making children visible in practice.
So how can an adult-focused practitioner hear and honour a child’s voice in absentia, and achieve this without replicating the unhelpful judgments that have been part of the parent’s history? As with most skills, the answer lies somewhere in the adage, ‘Practise, practise, practise.’
Emerging Minds has worked with practitioners and partners with lived experience to develop a conversation guide for helping adult-focused professionals develop these skills. This is known as the PERCS Conversation Guide, zeroing-in on the following five domains:
- P – Parent-child relationship
- E – Emotions and behaviours
- R – Routines
- C – Communication and meaning-making
- S – Support networks.
‘I found it incredibly useful as a clinician, as well as a resource to help [parents] work through being more reflective with their parenting while substance use is in their life.’
– PERCS pilot evaluation interviewee (Emerging Minds, 2020)
The PERCS Conversation Guide helps practitioners to promote the visibility of the child in sessions, by focusing on what they are seeing, feeling, and thinking in response to the parent’s experience of adversity. The five domains of a child’s life were developed after an intensive consultation process with practitioners, academics, and parents with lived experience of adversity.
Parent-child relationship – This domain recognises the importance of a safe, secure, responsive, and nurturing relationship between a child and a parent/adult caregiver. The practitioner helps the parent to describe their goals for their relationship with their child, and how their current adversity might be affecting those goals.
Emotions and behaviours – Children need to feel loved, safe and nurtured. They also need to be able to express emotions and have these emotions listened to, and responded to, in a nurturing way. Strong worries or emotions in a child’s life will often present as behaviours. The practitioner uses this domain to help the parent consider what the child’s emotions or behaviours might be communicating.
Routines – From shared activities such as reading, sports and hobbies to expected meal and bedtimes, routines help provide the child with consistency and safety. These routines are often affected by parental adversity, and the practitioner can help parents to consider how routines can continue, even when times are tough.
Communication and meaning-making – Respectful and effective communication enables children to express their thoughts and emotions, and to make meaning from their experiences. Many children blame themselves for the adversity that happens around them, particularly those who have been subjected to trauma (Guy, 2020). A practitioner can work with parents to help them have conversations with children which are open, transparent, and reassure them that they are not responsible for their parents’ experiences of adversity.
Support networks – Safe and supportive networks beyond their immediate family can be a key protective factor for children’s social and emotional wellbeing. It is important for children to have many sources of adult support in their lives, and the practitioner can help parents to access supports that can reinforce children’s safety and wellbeing.
Respectful and effective communication enables children to express their thoughts and emotions, and to make meaning from their experiences.
Looking for – and creating – entry points to making children visible, is a fundamental element of the PERCS Conversation Guide. Practitioners who include questions about parenting as part of their engagement and assessment processes often describe increased confidence in making children visible, in ways that are supportive and non-judgmental (Emerging Minds, 2020).
In the next video (59 seconds), Lisa Hofman – social worker and child-inclusive practitioner at Jarrah House – talks about identifying the positives in parent–child relationships.
Entry points to conversations about children do not need to begin with a description of the problem. Practitioners taking a relational stance, characterised by curiosity and respect, are more likely to listen and enquire about the skills, strengths and know-how that parents have drawn on in responding to the hardships they have been facing. Once these stories and skills are illuminated and made available to parents, they can be replicated, and a blueprint for the safe and nurturing care of children can be developed (Moss & Dolman, 2018).
When parents begin to describe their commitment to their children, they may be more able to fully describe the effects of their experiences of adversity on their children. At this point, the practitioner and parent can work in partnership to build a richer description of the important domains of the child’s life, making the child increasingly visible as the conversations progress.
In the following video (38 seconds), Emerging Minds’ child and family partner Phoebe discusses how supportive it can be when a practitioner identifies a parent’s strengths.
Once a parent becomes confident in talking with you about their relationship with their child, it may be necessary to refer them or their child to a specialist service, or to provide them with resources regarding child development and parenting practices. While a decision to refer-on may ultimately be made, practitioners should resist making hasty or unsupported referrals.
The PERCS Conversation Guide can be used to continue the dialogue with parents, and to connect them with the right supports, even after you have referred them to a specialist service. We know that referrals don’t always result in service delivery, and if a parent feels comfortable disclosing concerns about their children, they may want to continue the conversation with you. Once you have done the hard work in making a child visible in the room, the next challenge is to maintain that focus.
When parents begin to talk about their commitment to their children, it may become easier for them to describe the impact of their struggles on their children.
The following resources can be used to extend your knowledge and practice of keeping children visible in the room. As usual, we are very interested in your experience of using Emerging Minds’ tools and would love to hear from you: get in touch via [email protected].
References
Emerging Minds. (2020). Piloting PERCS: An early intervention and prevention strategy for children living with violence and parental substance use. Adelaide: Emerging Minds.
Guy, S. (2020). Making use of practitioners’ skills to support a child who has been sexually abused. Adelaide: Emerging Minds.
Lawrence, D., Johnson, S., Hafekost, J., Boterhoven De Haan, K., Sawyer, M., Ainley J., & Zubrick, S. R. (2015). The mental health of children and adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing. Canberra: Australian Government Department of Health.
Moss, D., & Dolman, C. (2018). Keeping children visible in practice responses to family and domestic violence. Adelaide: Emerging Minds.
