Collaboration between mental health and child protection services: Professionals' perceptions of best practice

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Children and Youth Services Review 30 (2008) 187 – 198 www.elsevier.com/locate/childyouth

Collaboration between mental health and child protection services: Professionals' perceptions of best practice Yvonne Darlington a,⁎, Judith A. Feeney b a

School of Social Work and Applied Human Sciences, University of Queensland, St Lucia Qld 4072, Australia b School of Psychology, University of Queensland, St Lucia Qld 4072, Australia Received 25 July 2007; accepted 5 September 2007 Available online 14 September 2007

Abstract This paper provides a qualitative analysis of mental health and child protection professionals' perceptions of best practice when working on cases where there is parental mental illness and there are protection concerns for child(ren). Data were collected as part of a state-wide survey of professionals in both fields. Respondents offered many suggestions for improving interagency relationships, collaborative processes, and outcomes for children and parents. These suggestions encompassed three major content areas: improving communication; enhancing the knowledge base of professionals in both sectors; and providing adequate resources and appropriate service models. Within the three domains of communication, knowledge development and resources, strategies encompassed both formal, organisation-led initiatives as well as more informal initiatives that could be implemented by individuals or small groups. Additionally, strategies were suggested that required implementation at a range of levels of organisational activity, from the front-line workplace to statewide policy changes. Thus, a complex picture emerges of intersectoral collaboration that comprises several key domains and needs to be implemented at all levels of organisational influence. © 2007 Elsevier Ltd. All rights reserved. Keywords: Interagency collaboration; Child protection; Mental health; Best practice

1. Introduction There is a sizable literature describing models of inter-organisational relationships (Gray & Wood, 1991; Walter & Petr, 2000). Although definitions of types of interagency relationships vary, ⁎ Corresponding author. Tel.: +61 7 3365 2512; fax: +61 7 3365 1788. E-mail address: [email protected] (Y. Darlington). 0190-7409/$ - see front matter © 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2007.09.005

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a continuum or hierarchy is typically posed, with loose single-issue coalitions at one end, followed by co-operation, co-ordination, collaboration, and then integration (Hallett, 1995; Walter & Petr, 2000). Research in the area of interagency collaboration between mental health and child protection services has found that effective collaboration can have benefits for workers and clients. Positive outcomes that have been reported include reduced separation of mentally ill mothers and their infants (Seneviratne, Conroy, & Marks, 2003), reduced anxiety for workers (Hetherington, Baistrow, Katz, Mesie, & Trowell, 2002) and faster access to services (Cottrell, Lucey, Porter, & Walker, 2000). In addition to research findings suggesting that collaboration is an effective method of practice, there are policy and system-level pressures advocating, and sometimes forcing, collaborative arrangements. In many parts of Australasia, Europe, the UK, and the USA, some form of collaboration, co-ordination, or joint service provision is mandated for child protection and other health and social services (Bazley, 2000; Blanch, Nicholson, & Purcell, 1994; Department for Education and Skills, 2003, 2006; Hetherington et al., 2002; Queensland Department of Families, 2002b). Nevertheless, many human service workers find effective interagency collaboration difficult to achieve (Darlington, Feeney, & Rixonet, 2004; Stanley, Penhale, Riordan, Barbour, & Holden, 2003). A lack of information on services available, a lack of knowledge about the role of workers in the other agency, a lack of a culture of liaison, and the absence of effective liaison structures and guidelines, have been reported as barriers to initiating and maintaining collaborative relationships (Byrne et al., 2000; Darlington, Feeney, & Rixon, 2005; Johnson, Zorn, Kai Yung Tam, Lamontage, & Johnson, 2003). Where human service organisations are operating at maximum capacity to meet service demands, workers may have limited time to undertake systematic and sustained collaborative work (Darlington et al., 2005; Pietsch & Short, 1998; Sheehan, Paed-Erbrederis, McLoughlin, 2000). Further, ‘gatekeeping’ disputes frequently occur amid pressures on overburdened services to take on new clients (Scott, 1997). Similarly, resource allocation models such as competitive funding arrangements create fears of cost shifting, and provide little motivation to work with other agencies (Gamm & Benson, 1998; Hudson, 2002). Communication is one of the most critical aspects of effective collaboration (Johnson et al., 2003; Pietsch & Short, 1998). However, confidentiality policies and practices vary across agencies, and the inability of workers and their agencies to negotiate these differences can impede communication (Byrne et al., 2000; Cleaver, Unell, & Aldgate, 2000; Hetherington et al., 2002). In addition, professionals from different disciplines operate with different conceptual frameworks, knowledge bases, and discourses (Hetherington et al., 2002; Tye & Precey, 1999), and often differ in status (Stanley et al., 2003). These differences can lead to different understandings of child protection needs and parental mental illness, and difficulties in communication and joint decision-making (Stanley & Penhale, 1999; Stanley et al., 2003). For clients with complex social and health needs to receive comprehensive and efficient services, workers across a range of agencies need to work together effectively (Cleaver et al., 2000; Queensland Department of Families, 2002b). However, interagency work can be challenging for workers in the human services. In this paper, we report research findings pertaining to child protection and mental health professionals' perceptions of ways to achieve effective intersectoral collaboration in cases where there is a parent with a mental illness, and the involvement of statutory child protection services. Taken together, their perceptions reveal the need for a framework for the development and implementation of approaches to interagency collaboration that takes into account formal and informal strategies, operates at a range of levels

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of organisational influence, and involves several key domains of collaborative activity (namely, communication, knowledge and resources). 2. Methodology 2.1. Instrument A self-administered, cross-sectional survey was delivered to statutory child protection professionals and state employed mental health professionals across the state of Queensland, Australia. In addition to demographic data, the survey included sections relating to practices and attitudes in relation to interagency collaboration (see Darlington et al., 2005), barriers to collaboration, brief case reports of cases where a parent has a mental illness and at least one child is the subject of child protection proceedings (see Darlington et al., 2004) and perceptions of best practice in interagency collaboration. A letter of informed consent presenting the study's purpose and assurances of confidentiality and a reply-paid envelope accompanied each questionnaire. The data reported here are drawn from an open-ended question focused on participants' suggestions for ways to achieve best practice in interagency collaboration. 2.2. Participants During June and July 2002, 1105 questionnaires were distributed. In line with our arrangement with the two participating state government departments, the questionnaires were either mailed direct to the work addresses of statutory child protection professionals, or distributed through mental health professionals' supervisors. The final sample of 232 respondents represented a response rate of 21%. (The effective response rate was probably higher, given that the distribution of questionnaires to mental health professionals relied upon managers not necessarily based in the same workplace as the direct care staff.) Similar surveys of health and human services professionals have yielded comparable response rates (Byrne et al., 2000; Delnevo, Abatemarco, & Steinberg, 2004). Further, recent evidence indicates that changes in response rates from below 30% to 65% do not necessarily change results significantly, nor affect data quality (Schoenman, Berk, Feldman, & Singer, 2003). The sample comprised 42% professionals in statutory child protection roles and 55% professionals in mental health roles (3% worked across multiple agencies or did not provide this information). The age range was 21–65 years (M = 37.7), the number of years since graduating ranged from less than 1 year to 38 years (M = 10.4), and the number of years employed with the current agency ranged from less than 1 year to 25 years (M = 5.0). It was possible to establish the representativeness of the sample in terms of gender and geographical location. Forty-five percent of the state population lives in regional, rural, and remote areas (Australian Bureau of Statistics, 2004); our sample had an almost identical distribution, with 43% coming from these areas. Regarding gender, 73% of the sample was female; this figure is comparable to the overall percentage of female staff (69%) within the child protection agency (Queensland Department of Families, 2002a). 3. Analysis and results Respondents provided a rich and diverse range of written responses to the open-ended questions. These were transcribed verbatim from the questionnaire and imported into the NVivo software program to facilitate data coding and analysis. Based on thematic analysis, we identified

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three key content areas in the responses: the role of communication strategies, the importance of professionals having a sound knowledge and skills base, and the importance of having adequate and appropriate resources. Within each content area, we were interested in the specific initiatives and approaches that the professionals considered had enhanced or would enhance the quality of collaborative practice in their work context. This more fine-grained analysis is of particular benefit to practitioners and policy-makers in that it combines the broad target areas of activity, such as communication and knowledge development, with specific ways in which practice in those areas may be enhanced. Table 1 provides a summary of the three key content areas of best practice at the interface of child protection and adult mental health, with further detail of the specific elements identified. 3.1. Effective communication Aspects of effective communication were mentioned 310 times in the respondents' reports. While some responses were simply stated using the terms communication, collaboration, liaison or consultation (54 responses), we were able to identify three major themes from the remaining responses. These were a) strategies that would need to be developed at the organisational level (97 responses), b) strategies that could be implemented by the professionals themselves, on a case-byTable 1 Broad themes and specific elements

Frequency

Communication Collaboration, liaison, consultation, communication (detail not specified) Organisational-level strategies Practice guidelines/formal protocols for interagency involvement Clarity of roles between services Clarity of confidentiality requirements Joint-agency meetings Key interagency liaison person in each service Case-level strategies Joint case plan and management Joint case conferences Sharing information (not otherwise specified) Inter-professional relationships based on respect for persons, different professions and others' knowledge

310 54

Professional knowledge and skills Staff training and supervision Training (detail not specified) Joint-agency training Supervision and support for staff Types of knowledge required Procedural knowledge Substantive knowledge Understanding of the interdependent needs of parents and children

204

Resources More staff/reduced case loads More services for parents with a mental illness and their children Greater emphasis on prevention and early intervention services Total responses

15 32 29 16 5 45 27 33 54

31 27 9 34 38 65 95 59 22 14 609

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case basis (105 responses), and c) an attitude to professional practice based on respect for persons, different professions and others' knowledge (54 responses). Organisational-level strategies included: the development of practice guidelines or protocols for the involvement of both child protection and mental health professionals in certain cases; clarifying confidentiality requirements; clarifying the roles of professionals in the various services; having a key person in each service who could be primarily responsible for interagency liaison; and having regular meetings between service staff that could serve both as a means of clarifying any procedural issues and as a forum for non-case-specific contact. Individual responses in this category included: Development of protocols between child protection and mental health agencies for working with parents with a mental illness where child protection concerns exist (Child protection worker) Establish regular fora to enhance communication and “cultural” understanding. (Child protection worker) The need to clarify and reconcile agency confidentiality requirements encompassed three specific perspectives: reducing organisational and legislative impediments to information exchange due to confidentiality requirements; ensuring that clients' rights to confidentiality were observed; and developing protocols to define the scope and boundaries of confidentiality. As one child protection worker explained: It is very frustrating to contact mental health and not receive information due to confidentiality in the Mental Health Act. This creates a huge gap as I do not consider myself an expert when working with clients with a mental illness. (Child protection worker) Ensuring clients' rights to confidentiality, while simultaneously reducing impediments to information exchange, is a challenge. However, several respondents suggested that the development and implementation of guidelines or protocols could ensure that information is exchanged between agencies while still maintaining client confidentiality. For example: Openness to information sharing and collaboration with awareness of the importance of confidentiality but NOT sacrosanct, as other concerns may take priority. (Mental health worker) Having meetings with all relevant bodies all together and sharing information in a confidential setting where every agency respects each agency's confidentiality requirements. (Child protection worker) At the case level, respondents suggested various types of collaboration. These ranged from simply sharing information about clients or attending case conferences involving all relevant agencies; through to joint case planning and management, where workers from different agencies, and with different nominated clients, would work closely together for the benefit of both parents and children. For example: Collaboration from the beginning to plan the best response to the adult with mental illness and the child with child protection concerns. Case plans to incorporate mental health issues and child protection concerns and how the two agencies will respond to the family concerned to address the needs of both parent and child. (Child protection worker) Shared goal setting, planning and treatment directions. (Child protection worker)

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For cases where such intense collaboration was not occurring, respondents still stressed the importance of sharing pertinent and accurate information about clients. Specific types of information included the resources that could be made available, existing case plans, and updates about clients' progress and treatment compliance. Tensions resulted either when information was not shared, or when an agency expected information to be provided to them, but would not then reciprocate. For example: Coming together of mental health, Department of Families and police and child health where parts of each other's work overlap. Often we find out after the fact that a particular agency has had extensive involvement or know crucial information that could have greatly assisted the Department's work/case plan with a client. (Child protection worker) Many responses highlighted the importance of building and maintaining professional relationships based on mutual respect and trust. This included personal respect as well as respect for different professional perspectives and knowledge. Negotiating, compromising, developing linkages, helping, and being friendly, were all seen as ways of accomplishing this. At its best, this was seen as resulting in a greater quality of practice in this difficult area than could be achieved by workers from one perspective or professional grouping alone. Responses included: Respect and recognition of different agencies' roles. (Child protection worker) Trust in each others' unique skills and insights, without expecting all the answers. (Mental health worker) Be open and respectful. Sharing ideas and respecting each other. Embrace conflict and difference of opinion. (Child protection worker) The following statement clearly highlighted the role of good relationships and communication: I have had many positive interactions with (child protection services). I believe I have a good relationship with the workers there. Clear communication is the key. There is always room for improvement though. (Mental health worker) It is interesting that, given the strong emphasis on barriers to interagency collaboration, both in research (Cleaver et al., 2000; Pietsch & Short, 1998; Tye & Precey, 1999) and anecdotally, so many of the respondents to this survey highlighted close working relationships as a key factor in best practice. This lends weight to previously reported findings from this research that professionals in child protection and mental health services generally have positive attitudes towards each other (Darlington et al., 2005), and suggests that the absence of formal structures to facilitate ongoing collaboration may be a more significant factor in situations of poor collaboration than professional differences or poor communication between professionals. 3.2. Professional knowledge and skills Aspects of professional knowledge and skills were reported as being crucial to effective interagency collaboration on 204 occasions. Within this broad content area, responses were framed in three different ways. Some responses focused on the types of knowledge required by professionals whose client load required them to work cross-sectorally (72 responses). Others focused on the means of acquiring and maintaining knowledge and skills for such work (67 responses). Finally, some responses (65) reflected what practice would be like were a full range of

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professional knowledge and skills demonstrated (i.e. practice based on an understanding of the centrality of the needs of both parent and child). Effective work at the interface of two service systems requires both procedural knowledge (including knowledge of available resources, the referral procedures for different services and the legislation within which they operate), and an understanding of the substantive knowledge that informs practice in the two fields. The respondents did not imply that all professionals need to be experts in all areas; rather, they suggested that they should have sufficient knowledge to be able to make an appropriate referral, to alert the relevant service of any observed change in a parent's functioning or a child's wellbeing, and to understand the basis upon which decisions are made by professionals in either sector. In relation to procedural knowledge, professionals need to know what resources are available for them and their clients, and how to access them. Specific knowledge identified included understanding who to contact, how to notify a child protection concern, how and when to seek a mental health assessment, and the roles, legal frameworks, and practices of each organisation. In addition, it was suggested that workers needed a realistic expectation of what other agencies could achieve. Substantive knowledge was also seen as crucial. Professionals in child protection roles said it was important for them to know how to identify when a client had a mental illness, and then how to best deal with that client. Similarly, mental health workers said that it was important for them to know about indicators of child abuse and neglect, and about child protection processes and orders. Respondents also stated that workers required a solid education and grounding in the theory and knowledge of their own profession. This included a sound understanding of current research, interventions based on models of best practice, and an engagement with evidence-based practice. In addition, mental health workers felt that they required a solid understanding of parenting and attachment issues for clients with mental illness, and of measures that could be taken to enhance these areas of functioning. It was also noted that all workers needed to understand the mental health needs of the children in these families. For example: Educate mental health workers about child abuse and neglect, and in particular, child protection orders. Educate child protection workers about mental illness. (Mental health worker) Up-to-date information about mental illness and how this impacts on children who have parent/s with mental illness/ disorders. (Child protection worker) While some respondents identified the type of knowledge required by professionals, others focused on the means of acquiring that knowledge. The most cited means of acquiring professional knowledge and skills development involved the provision of training. While some respondents did not elaborate further, others noted joint training, ongoing professional development, and in-service education as being beneficial training delivery techniques. Joint training was particularly supported as it combines learning content with the opportunity to build and maintain interagency relationships. It was clear that training topics needed to encompass substantive knowledge in relation to child protection and mental illness, as well as legislative and organisational contexts and collaborative processes. The following is an example of the reported link between agency-level support and the need for knowledge and training: More in-service training/liaison between organisations- this should be organisation driven, rather than left up to individual workers. (Child protection worker)

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Sixty-five responses highlighted the interdependence of parent and child needs. These respondents suggested that, if assessment and intervention are clearly focused on the needs of one's client (be that parent or child), then collaboration with other agencies will necessarily occur. Responses included: Ensuring the child and family receive the support of the services best able to meet their needs. Ensuring the family are in a better position after our involvement than before. (Child protection worker) Quality service provision; continuity of care; consistent care between service providers. (Mental health worker) Overall, respondents argued that practitioners involved in cases requiring cross-sectoral collaboration needed to be highly skilled and focused on meeting clients' needs. Professionals needed to conduct thorough assessments, then plan, monitor, and adapt interventions to ensure the best possible outcome for the client and their family. Throughout this process, they needed to display empathy, respect, and have a positive outlook; maintain a client focus; and engage family, social and community support and resources for clients. In addition, practitioners needed to ensure that their conduct was professional, accountable, and ethical at all times. 3.3. Appropriate allocation of adequate resources There were 95 responses related to the appropriate allocation of adequate resources. These comments encompassed two interrelated themes: the need for more staff and resources, and the need for more services. Respondents reported the need for sufficient funds and facilities for agencies to provide quality services for clients and to work collaboratively. A total of 59 responses related to the need for more staff and/or lower caseloads. Some respondents argued that current funding levels were such that child protection services could only respond to the most urgent of cases, and similarly, that mental health services could only assist the most unwell clients. Attending case conferences, waiting for responses from other agencies, and taking the time to learn what other services were available, were time-consuming aspects of collaboration that were difficult in an understaffed, overloaded agency. One respondent wrote: Management of caseloads to avoid overload and burnout which affects [our] ability to liaise with other agencies and affects [our] ability to engage in principles of best practice. (Mental health worker) Some respondents also identified a need for practical resources such as improved office facilities, access to current information technology, and increased access to vehicles. The other major category of resource-related responses focused on the need for more appropriate services for parents with a mental illness and for their children. Some suggested a greater emphasis on prevention and early intervention, rather than crisis-driven intervention. Rather than proposing more of existing forms of service provision, these respondents suggested a fundamental rethinking of service provision in this complex area. Ongoing parenting support and appropriate mental health treatment could create a safety net for both parents and children, and enable early warnings of either a mental health crisis or potential harm to children. To ensure the active involvement of all relevant services, some respondents proposed that screening parents for mental health problems should be an integral part of a child protection assessment, and,

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conversely, that children's needs should be taken into account by adult mental health services. Individual comments included: Being open to providing support for families where a parent (with a mental illness) is not harming or neglecting the child, but actively seeks assistance in regard to issues such as running away etc. (Child protection worker) More child protection workers, with not just crisis/severe abuse as the focus. More family support workers employed. (Mental health worker) In addition to the resource needs discussed above, respondents from rural and regional communities experienced particular challenges in establishing interagency relationships, due to there being fewer services and to the often substantial geographical distance between services. 4. Discussion Based on a representative sample of direct service workers, this paper has presented a qualitative analysis of mental health and child protection professionals' suggestions for achieving best practice when working with families where there are parental mental illness and protection concerns for their child(ren). Three broad approaches were suggested for improving interagency relationships, collaborative processes, and outcomes for families. These were: effective communication strategies at both the organisational and service-delivery (case) levels; enhancement of professionals' knowledge and skills; and appropriate resource allocation. Communication strategies encompassed formal and informal activities at a range of organisational levels of influence. The development of formal protocols and documents that clarify areas of potential conflict (including confidentiality, roles, boundaries, priorities, and the competing needs of different members of the family) was seen as important to ensuring that collaborative processes are established and are not derailed when difficulties arise. Other strategies that were suggested included the provision of formal and informal opportunities for staff of different agencies to meet and share information on specific cases, on the interagency processes, and on policy. Several respondents suggested developing interagency agreements that clarify confidentiality requirements, and that allow relevant information to be passed between professionals without breaching client confidentiality. Other research has found this to be a valuable process that can reduce conflict and improve interagency relationships (Johnson et al., 2003); in some cases, formal processes have been developed for determining when it is appropriate to reveal information in the absence of client consent (Sheehan et al., 2000). The building and maintaining of relationships based on respect and trust was another important component of effective communication, and is an important aspect of information sharing and confidentiality. According to the disclosure-liking hypothesis, we are more likely to disclose information to people we like, and similarly we are more inclined to like people to whom we have disclosed information and who have disclosed information to us (Collins & Miller, 1994). Hence, relationships built on trust and respect, where each worker feels valued and liked, are more likely to result in the exchange of information. Clarifying organisational boundaries and the services that different organisations can realistically provide is also important to any work at the sectoral interface. This requires negotiation of differing organisational priorities, and working together to ensure that parents' and children's needs are met. Agreeing on the best way to meet these needs is particularly complex, as different understandings of

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mental illness, of risk, and of child protection exist (Cowling, 1997; Hetherington et al., 2002; Hugman, 1995). When the interfaces are not well negotiated, different understandings can lead to communication breakdowns, and create conflict regarding the competing needs of parents and children (Darlington et al., 2004; Hetherington et al., 2002; Wilmot, 1995). All too often, perceptions of service gaps will be real, and require injection of resources in addition to clear communication. We suspect that a great deal of energy that is dissipated in “turf wars” could be better directed towards joint initiatives to secure much needed resources. The issue as to the relative importance of organisational and case-level driven strategies is worth consideration. Previous research concerning the relative importance of informal, professionallevel activities and formal agency-level support structures has produced inconsistent findings. Some research has identified formal organisational initiatives as being more important (e.g., Darlington et al., 2005), and some has found informal professional-level relationships and communication channels more useful (e.g., Hetherington et al., 2002). Although informal collaboration based on individual relationships may provide an open and trusting environment for some professionals from different agencies to work together, the development and maintenance of such collaborations are largely dependent upon the personalities and philosophies of individual workers. Formal organisational structures that embed collaboration as part of both practice and organisational culture provide two key advantages that cannot otherwise be achieved. First, whether a client will have the advantage of interagency collaboration will not be dependent upon the worker to whom they are allocated. Second, protocols and service-level agreements provide clear procedures and boundaries that can facilitate contact and provide clarity around confidentiality requirements. That is, formal structures can facilitate effective communication. Professional knowledge and skills emerged as another essential component of effective service delivery across sectors. In addition to their own professional training, professionals need to have a working knowledge of key substantive content pertinent to other sectors with which they need to collaborate. Such knowledge includes the ways in which services are delivered; for example, referral procedures, services available, and legislative mandate. For professionals to acquire and maintain this level of knowledge, some of which is quite specific to particular work sites, ongoing professional development is imperative. The endorsement of training as an important component of interagency relationships also supports previous research which has found inadequate training of child protection and mental health workers to be a barrier to effective collaboration (Cowling, 1997; Darlington et al., 2005; Stanley & Penhale, 1999). In particular, joint training was a major structural support advocated by many respondents in the present research. Finally, those making resource allocation decisions at the political level need to prioritise the health and welfare of families, and to provide adequate resources for professionals to engage in models of best practice, rather than being overwhelmed by insufficient staff and excessive workloads. It is well established that inadequate resources impede all aspects of social, welfare and health care, and it is not surprising that this includes the capacity for effective intersectoral collaboration (Darlington et al., 2004, 2005; Scott, 1997; Stanley et al., 2003). Ample resources are, however, not necessarily enough to ensure effective collaboration, if other important factors are not in place, and can even mask the existence of other problems (Sheehan et al., 2000). Our findings are strengthened by two aspects of our methodology. Firstly, by asking an openended question we did not pre-empt responses and are thus confident that the three major domains of intersectoral collaboration came from respondents. Secondly, by not constraining the length of responses, respondents were encouraged to write as much as they wanted. Thus, we obtained considerable detail about specific strategies within each of the domains and at different levels of organisational activity (i.e. case level and organisational level).

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Overall, the child protection and mental health professionals surveyed for this research provided varied and detailed suggestions for how to work effectively with other agencies when working on cases with child protection and parental mental health issues. Although some of the avenues advocated can be undertaken by individual professionals, the onus should not rest upon direct service professionals. Substantial structural changes are necessary in order to break down single-focus thinking and organisations, to facilitate seamless collaboration across sectors and, where appropriate, to develop more integrated services. These structural changes require collaboration and commitment at the highest levels of policy development, and in some cases (e.g., sharing client information), legislative change. Acknowledgements This research was funded by a grant from the National Health and Medical Research Council of Australia, grant number 210272, and received the support of the Queensland Department of Families and Queensland Health. This study was cleared by one of the human ethics committees of the University of Queensland in accordance with the National Health and Medical Research Council's guidelines. References Australian Bureau of Statistics (2004). Regional profile: Brisbane. Cat. no. 1379.0.55.001. Canberra: Commonwealth of Australia. Bazley, M. (2000). A collaborative approach to improving outcomes for children and enhancing the quality of government services to families: The strengthening families strategy. Paper presented at the Reducing Criminality: Partnerships and Best Practice Conference, 31 July – 1 August, Perth, Australia. Blanch, A. K., Nicholson, J., & Purcell, J. (1994). Parents with severe mental illness and their children: The need for human services integration. Journal of Mental Health Administration, 21(4), 388−398. Byrne, L., Hearle, J., Plant, K., Barkla, J., Jenner, L., & McGrath, J. (2000). Working with parents with a serious mental illness: What do service providers think? Australian Social Work, 53(4), 21−26. Cleaver, H., Unell, I., & Aldgate, J. (2000). Children's needs—Parenting capacity: The impact of parental mental illness, problem alcohol and drug use, and domestic violence on children's development London: The Stationery Office. Collins, N. L., & Miller, L. C. (1994). Self-disclosure and liking: A meta-analytic review. Psychological Bulletin, 116(3), 457−475. Cottrell, D., Lucey, D., Porter, I., & Walker, D. (2000). Joint working between child and adolescent mental health services and the Department of Social Services: The Leeds model. Clinical Child Psychology and Psychiatry, 5(4), 481−489. Cowling, V. (1997). Building partnerships: Interagency collaboration to effectively meet the needs of families with dependant children where parents have a mental illness. Melbourne: School of Social Work, University of Melbourne. Darlington, Y., Feeney, J. A., & Rixon, K. (2004). Complexity, conflict and uncertainty: Issues in collaboration between child protection and mental health services. Children and Youth Services Review, 26(12), 1175−1192. Darlington, Y., Feeney, J. A., & Rixon, K. (2005). Interagency collaboration between child protection and mental health services: Agency practices and perceived barriers. Child Abuse and Neglect, 29(10), 1085−1098. Delnevo, C. D., Abatemarco, D. J., & Steinberg, M. B. (2004). Physician response rates to a mail survey by speciality and timing of incentive. American Journal of Preventative Medicine, 26(3), 234−236. Department for Education and Skills (2003). Every child matters: Green paper Norwich: The Stationery Office. Department for Education and Skills (2006). Common assessment framework for children and young people: Practitioners' guide. Nottingham: DfES Publications. Gamm, L. D., & Benson, K. J. (1998). The influence of governmental policy on community health partnerships and community care networks: An analysis of three cases. Journal of Health Politics, Policy and Law, 23(5), 771−794. Gray, B., & Wood, D. J. (1991). Collaborative alliances: Moving from practice to theory. The Journal of Applied Behavioral Science, 27(1), 3−24. Hallett, C. (1995). Interagency co-ordination in child protection London: HMSO.

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