Without changes in culture and practice within health and social care organizations, there can be little improvement to provision for children and families affected by mental distress. A strategic combination of actions are needed, but the cornerstone of all change must be the participation of children and families themselves. This chapter is an account of how organizations in Liverpool, UK, are working with children and families to implement the recommendations of a recent consultation with service users (Göpfert et al., 1999). A small development project called ‘Keeping the family in mind’ (KFIM) and run by Barnardos Action with Young Carers (see Bilsborough, Chapter 1) has been set up to facilitate and coordinate the change agenda.

Why change is necessary

Adult and child services do not habitually connect and communicate. The following situation illustrates how this separateness can sometimes result in disservice to families. A children's social worker asked the Action with Young Carers project if they would explain to two children why they had been fostered to Liverpool relatives some 100 miles' distance from their home town. One of the children's parents had serious mental health problems, to the extent that the parents were unable to care for their children. The children were already fostered without any of the professionals involved having had this important conversation with the children. Why this omission? The ill parent had a social worker who knew about mental health, but not about children.