SETSAF1

The SETSEF1 Form that the mental health nurse raised:

REPORTING A CONCERN FOR A CHILD TO CHILDREN’S SOCIAL CARE – LEVEL 4/SPECIALIST

REFERRERS DETAILS

XXXX XXXXXX SENIOR COMMUNITY MENTAL HEALTH NURSE

What is referrer’s current involvement with the family?

I ASSESSED MUM’S MENTAL STATE 4.3.16 FOLLOWING A GP REFERRAL INTO MENTAL HEALTH SERVICES. THIS WAS AN INITIAL ASSESSMENT. HER CARE WILL NOW BE PROVIDED BY ‘THERAPIES IN-REACH’ TEAM.

INFORMING PARENTS OF YOUR REFERRAL 

Informing Parents Of Your Refferal?

If parent / carer is not aware of the referral, please state why: MUM. HAVE ATTEMPTED TWICE TODAY. HAVE LEFT A VOICEMAIL TO DISCUSS “OUTCOMES” OF ASSESSMENT BUT INTEND TO DISCUSS AND CLARIFY CONCERNS FURTHER re. REFERRAL.

REASON FOR THE REFERRAL

What are you worried about?

IN RESPONSE TO A GP REFERRAL I CARRIED OUT AN INITIAL MENTAL HEALTH ASSESSMENT ON MUM 4.3.16 DUE TO SUICIDAL THOUGHTS AND INTENT, AND DETERIORATION IN MENTAL STATE WITH REGARD TO RECURRENT DEPRESSIVE STATE AND GENERAL EMOTIONAL DYSREGULATION. DURING THE ASSESSMENT, PATENT REPORTED THAT SHE REMOVED HER DAUGHTER FROM SCHOOL IN OCTOBER 2015 AND REMAINS OFF SCHOOL FOR THE PURPOSES OF ‘HOME-SCHOOLING’. IN A PREVIOUS ASSESSMENT WHEREBY PATIENT PRESENTED TO A & E EARLY 2015 IN AN ACUTE SUICIDAL STATE, IT WAS REPORTED THEN ALSO. I UNDERSTAND PARENTS CAN TAKE THEIR CHILDREN OUT OF SCHOOLING FOR HOME-EDUCATION (?) HOWEVER IT WAS THE WAY IN WHICH PATIENT WAS REPORTING THIS, WITH MANY INCONSISTENCIES MAKING IT DIFFICULT TO APPEAR GENUINE. I HAVE COPIED AND PASTED THE RELEVANT PART OF MY CASE NOTE ON THE CONTINUATION SHEET, FOR INFORMATION. MY CONCERNS LAY IN PATIENT’S DAUGHTER’S WELLBEING IF BEING KEPT FROM SCHOOL AGAIN WITH THE RISK OF NOT BEING ALLOWED TO BE IN A SOCIAL LEARNING ENVIRONMENT AND POTENTIALLY MISSING OUT UPON EDUCATIONAL NEEDS.

What are your expectations from this referral / Social Care?

INVESTIGATION INTO CURRENT SITUATION AS DESCRIBED ABOVE DUE TO POTENTIAL RISK OF VULNERABILITY TO CHILD BY NOT FULFILLING EDUCATIONAL AND SOCIAL NEEDS.

REASON FOR REFERRAL (continuation sheet):

* We talked about her daughter for some time. Daughter is still apparently nine years of age despite being recorded in the A & E psych liaison assessment 12 months ago her also being nine. Patient didn’t make any overt reaction when I pondered this aloud. She lives with her Monday to Friday and with her Father at weekends. I asked how is Daughter’s general wellbeing at this time; is she well? Patient reported she was. I asked how did she settle back into school last year following Patient removing her due to apparently a need to make Patient feel safe (recorded in previous assessment/ safeguarding). Patient reported that she has been off school since October 2015 and remains off school to date. I asked her to repeat this, to clarify, to which she said the same again. Her reason apparently for removing Grace from School was so that Patient can ‘home school’ her – but with absolutely no rationale given as to why. Asked if she is due to go back to school – Patient stated as soon as possible, but to a different school instead. Patient states that they do “do learning” together. I asked what her daughter thinks of this, does she miss her friends, ask questions why she’s ‘different’ to her friends. She was unable to fully give any substantial responses saying that she likes it and often sees her friends. “She’s a good girl” Patient added unprompted.

I asked what did Educational services think of this – she reported “nothing”, “they sent a letter home acknowledging me home-schooling her”. I enquired whether Social Care are involved and what they say/ what their plan is. She stated they are not involved/ never have been. Patient’s whole manner felt shifty and ingenuine throughout this conversation. She asked me to return to asking about her own wellbeing. I advised I have a duty of care to the minor when a parent is having a mental health assessment. She acknowledged this.

I asked what does her daughter do during the day when Patient is reportedly sometimes unable to get up from bed due to apparent depressed mood or when Patient reportedly gets angry and smash inanimate objects (she denied hitting her daughter). Patient reported again that she is a “good girl” but will probably soon realise what her Mum is like. I asked if having her daughter at home every day during the week is tiring and exhausting, she said it was not, but comforting. Her daughter plays on her X-box for the most part she then later said. Enquired as to where her daughter is currently whilst Patient is sat with me for the purposes of a mental health assessment, she reported “she’s with a friend”.

It is worthy to note how this was a challenging interview. Patient did not offer anything unless it was asked of her, and nothing was explicitly explained or described further by her. Such a manner was felt not to be in the context of apathy, a flat or blunted affect or in a dissassociative manner. It felt for the most part ingenuine, for whatever motive.

What are the concerns?

-Mums Mental Health
-Mum removing her daughter from education

What is going well?

-Dad regularly see’s daughter
-Daughter is due to start back at school soon

What needs to happen next?

I have discussed the concerns raised with Dad. He has explained that his daughter has been home-schooled since October and an application is being processed for her to attend school soon. Dad has no concerns for mums parenting and is confident that if his daughter had any worries she would tell him. Mum has exercised her right to home school and researched the matter before taking this step. It is positive that she has now decided that it would be better for her daughter to return to school. Mum’s mental health is a concern, however, Mental Health are involved and there is no indication that the child is at any risk of harm. There is no current role for Social Care.

XXXX XXXXXX FOH 11/03/2016

Reviewed 15/03/2016: 

Agreed the concerns have been explored with the father who advises that now he and mother are now agreed that mother will no longer look to home school Daughter, but rather will seek appropriate local educational provision. This will help by reducing Daughter’s educational and social opportunities. Further mother is in receipt of support regarding her mental health, and as such I agree threshold for tier 4 services is not met and therefore considering these factors I agree there is no further role for CSC at this time.
XXXX XXXXXX
Senior Practitioner
FOH

………. ………. ………. ………. ………. ………. ………. ………. ………. ……….

In the last review, notice it says –

“mother will no longer look to home school Daughter, but rather will seek appropriate local educational provision. This will help by reducing Daughter’s educational and social opportunities”

(…perhaps)