Physio or Social Worker?

On my paediatric placement I was treating a child with complex social issues regarding parental custody, and both mother and father had strict, limited visitation rights. I was told that the patient would not comply with/ participate in physiotherapy when either of the parents were present. However on this particular afternoon I had no choice but to treat the patient whilst the parents were there, as the rest of my patients were occupied with other tests/ treatment sessions.

I soon discovered that what I was told was quite far from the truth on this occasion. Mum got very involved in the treatment session (it was a cardio placement so treatment involved bubble PEP and other bubble blowing/ popping games) and provided lots of encouragement for her child to participate. I’d never had a more productive treatment session, or had such good compliance from this patient!

I felt that it was wrong that the parents only had limited visitation rights, when all I had seen was that they were great parents. Other members of staff (including physiotherapists, nursing staff and dieticians) seemed to have only negative things to say about the parents which appeared to be based mostly on “hear-say”.

I knew that previous events were the reason for DCD being involved, and for the limited visitation, but I wanted to tell someone that they’d got it all wrong, but I felt it was beyond my “authority” to question it. Also, I knew that things wouldn’t change based on one good session with the parents present. So I documented in the notes that the parents were present and “compliance +++++” and that the patient appeared to be in extremely good spirits on that particular occasion. I also made a point to try and treat the patient whilst the parents were there so I could see if it was a once off – which it wasn’t. However, when I subtly mentioned how fantastic the child was whilst the parents were visiting, staff seemed to be shocked, as if it wasn’t possible.

The patient was in hospital for almost three weeks and despite what I had seen and documented nothing was changed.

I feel I did everything within my power to communicate what I was seeing without crossing the line, or treading on toes, but do you think I should have taken further action? I know we’re not social workers but at what point does it become our responsibility to cross that line? I can’t comment on the history of this case and I’m sure there were reasons for the rules in place but I am of the understanding that people change and deserve the right for a second chance.

Any thoughts…suggestions?