The use of Genograms to work safely with Child focussed cases Dr Venetia Young Safeguarding lead GP Jane Hazell HV

Genograms can help. Combine biomedical and psychosocial information

Are an excellent database for future reference Emphasise the clinician’s interest in the context of their patients lives Produce unexpected stories Make connections between people and events Trans-generational patterns of disease and problem behaviours Place presenting problem in a historical context. This can be non blaming and help to relieve shame Arouse curiosity in clinician and patient Diagnostic and therapeutic. They put the patient in the observer role of their own family drama Evidence of time saved: 4 times information from 20 minute interview

Why in safeguarding cases? History of relationships and their quality History of drug and alcohol problems History of mental health problems Toxic trio with domestic violence Which professionals are involved Invisible children Invisible men Look for strengths and protective factors More accurate referrals, with greater chance of appropriate

response. Discussion with colleagues Risk assessment: suicide, self and other harm, domestic abuse

Making the connection

Introducing the genogram , seeking consent and asking some questions Who can you talk about your concerns to? Who are most/least sympathetic? Who do you try to keep how you feel a secret from? What would happen if they found out?

Most families have someone with a drink problem. Who is it in yours? What is the impact of the abuses you have suffered on family

relationships? What are your fears about leaving? What should your fears about leaving be? How do you keep yourself safe? Who helps you to keep yourself safe? What strengths do you have? Who taught you these?

What themes came out in discussing Case 1? Resilience and protective factors Isolation caused by being carer to younger

siblings Isolation caused by bullying at school and lack

of friendship network The impact of the rape The contextual information gathered helps use

the LSCB scaling tool to predict where the referral needs to go to be most effective

Themes of more complex case with a child protection plan Case 2 Child’s voice Gendered view Who is the family? Solution focussed and future oriented Reflection – supposing Early Help had

been offered earlier?

What do you see in genograms of cases subject to SCR? Alcohol – drug use MH problems Domestic Violence Toxic trio over several generations Complex families with multiple adverse events Bereavements and losses Invisible male Isolation Moving frequently

Summing up – some tips

What do you notice about what we have drawn together?

Would you like to hear what I have noticed? Does that make sense to you? Would it be helpful to have a copy of this or talk

about it with a member of your family/friend? Create a plan Breaking ‘bad news’ of referral

Patient views of the process of doing a genogram for safeguarding purposes See their problems more clearly Like having their lives explained in one

go – quicker than some therapists get to in 10 sessions! Young people love them Take their problem more seriously and

look properly at their choices

Practical considerations

Where to store the genogram- scanning Confidentiality of other family members Practice with your own genogram Practice with easy patients – newly

pregnant Find a buddy to share learning

experiences with. Family therapist to support learning

References and links

Ten minutes for the family. Asen, Tomson, Tomson and Young 2004 Routledge http://www.cumbrialscb.com/ Risk and resilience matrix Scaling tool