Transcript 1. Delivering the Think Family Approach

Islington Think Family Service
Islington Think Family
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What is Think Family?
Partners
What we’ve done so far
Challenges and benefits
What next?
What is Think Family?
• Background: Families at Risk Review
Stats – national/local
• A Think Family approach
• What it looks like in Islington
Partners
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Family Action
NHS Islington
Mental Health Foundation Trust
Children’s Social Care
Islington Families/EPIC
Community Service Volunteers (CSV)
All agencies working with children, adults,
families
What we’ve done so far
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Audit- safeguarding and mental health
Staff team/extended Pathfinder
Piloted a model
Developed a WFA tool
Direct work with families
Direct work with Young Carers
Indirect work – consultation/training
DCSF – national conference and consultation
Independent Parent Consultation
Mapped Social networks of our partnering agencies
Challenges
• Different risk thresholds, legislation, separate
guidance on policy and practice.
• Expectation that referrer remains involved
• Anxieties – expertise, professional trust, loss of
autonomy
• Resistance to change
• Team cohesion
• IT/database
• Change in political agenda
Benefits
• Inclusive approach – engaging whole families
and children and young people
• Small case loads
• Intensive outreach
• Enthusiasm and commitment to achieving better
outcomes, joint working etc.
• MDT approach-’multi heads/ideas’
• CSV (Rachel J)
• High Intensity young carer work(YC pathfinder)
CSV Think Family Volunteers
• Based on CSV’s successful Volunteers in Child Protection (ViCP)
projects
• Aim was to integrate volunteer support into TAFs, WFAs and exit
plans for families
• Rigorous recruitment, selection and training procedures and
ongoing monitoring and support
• Now expanded to include referrals from TF partners – CIN, CMHT
and CAMHS teams
• Development of a Think Family plan for each match using key TF
impact areas
CSV Think Family Volunteers
• Benefits:
• High level of interest in volunteering – 308 enquiries and
83 applications from members of the public
• Positive feedback from current matches and strong stats
from pre-existing projects e.g. 0% re-referral rate for
families with CP plans in Bromley
• Fits in well with current government’s national agenda
(Big Society etc) and winner of 2010 Charity Awards
• Capacity to provide more intensive support for longer
than most statutory services (2hrs a week for 6mths)
CSV Think Family Volunteers
• Challenges:
• Establishing the need within a service and clear referral
routes with partner agencies
• Boundaries of the volunteer role and service
• Matching volunteers to families and managing both
parties expectations
• Timescales of the service – making an impact and
evaluating outcomes
Islington Think Family Service
Young Carers Extended
Pathfinder
Young Carers
A child or young person (under 18) who
is caring out significant caring tasks and
assuming a level of responsibility for
another person, which would usually be
taken by an adult”.
Definition provided by Department of
Health (1995)
Qualitative differences in the reasons for caring.
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Mental Health
– Instability in family patterns
– Difficulty understanding about the illness and fantasies about the illness.
– Emotional availability of the parent
– Hyper vigilance
– Stigma
-- Long-term illness
-- Separation due to hospital stay
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Physical Disability
– Physical strain on the young person
– Strain on their health/recreation time due to on going tasks
– Parent may be able to be more available emotionally.
– Stigma
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Substance Misuse
– Impact of parents change in mood and behaviour patterns
– Vigilance
– Stigma – leading to lack of communication within the family and outside the immediate
network.
-- Stigma attached to some illnesses (e.g. HIV)
-- Fear of bereavement
-- Lack of understanding of the illness
Impact on Young Carers
• Emotional burden of caring affects physical and mental
wellbeing
• Lack of positive or consistent role models may affect
choices in regard to healthy eating/physical
activity/sexual activity/use of drugs and alcohol
• Missing school/dropping out early
• Falling behind in school work
• High Instances of Bullying and isolation
• Challenges to parent/school relationship
• Lack of social opportunities
• Lack of consistent boundaries
The young carers service response
to the needs
• Recognition of the role of being a young carer
• Provision of social opportunities and respite via groups
and outings and residential trips.
• Family events and groups
• Child friendly explanation of illness/disability (inc FAB
and KTW)
• Key person to talk to about life experiences and any
worries
• Linking families with services to improve outcomes
• Facilitating families to use their own resources and wider
family to reduce the role of the young person (FGC’s)
Messages from Children an
Young People
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Introduce Yourself
Give as much information as you can
Tell them what is wrong with their parent
Tell them what is going to happen next
Talk and Listen to them
As them what they know and what they think
Tell them it is not their fault
Don’t ignore them
Keep on talking to them and keep them informed
Tell them if there is anyone they can talk to
Barnardo’s (2007)
Genogram
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Referral
The referral for the family was received from Islington
Children’s Social Care who advised that Ms A had a
diagnosis of Depression and is Agoraphobic. Ms A was
being assessed by the Mental Health Crisis Team
following an incident where she drank a bottle of rum
and was having suicidal thoughts.
Family History
• Long history of Depression
• Experience of being in care
• Experience of physical abuse, emotional abuse, neglect
and sexual abuse as a child
• Experience of Forced marriage
• Several past relationships that featured domestic abuse,
most recently with B’s father which she fled to London as
a result of
• History of alcohol misuse
• Family isolation/disownment
• History of minimal engagement with services
• Several past suicide attempts as well as a history of selfharm
Other Professionals working with
the Family
Social Worker
Think Family Key Worker/ Young Carers Worker
Learning Mentor from B’s School
Substance Misuse Support Worker
Family Therapist
Mentor for Child
Young Peoples Drug and Alcohol Service
Adult Psychologist
Identified Need
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B was identified as a young carer as a result of A’s mental illness, substance misuse
and physical ailments
Exploration around the seriousness of A’s Suicidal thoughts
Support around A’s alcohol misuse
A had not discussed any issues around Mental Illness or Substance Misuse with B
therefore he had no age appropriate understanding of his mother’s difficulties
There were concerns regarding the impact of A’s moods and mental health on B
A had no support for herself regarding her mental illness and identified this as a need
Emotional Support for A and support around understanding impact of mental illness,
substance misuse B’s caring role and her relationship with her partner at the time on
B
A had a history of minimal engagement and then disengagement with services
B was very unconfident, experienced bullying and isolated himself with his peers at
school
B’s school attendance was erratic and he was often late
Support Provided
 Regular communication between all professionals to ensure a coordinated approach to provide holistic approach of work with the
family
 Psychological Assessment and referral to Adult Psychology for CBT
 FAB Group and access to other Young Carers Groups
 Weekly home visits to offer emotional support and to discuss other
areas of support with A
• A was met with weekly to offer emotional support and to discuss
some of the practical difficulties that she was having regarding other
professionals and family members throughout the work
• B attended the FAB group to look at and address some issues
around parental substance/alcohol misuse.
• One to one support sessions were provided to B around his
mother’s mental illness and substance misuse, his young caring and
how all these things connected.
• Family Therapy Sessions were attended regularly by A to explore
her feelings around her ex-partner and how they related to her
mental health, emotional well-being and the impact of this on B.
• A and her ex-partner attended several sessions of Family Therapy
together to discuss their relationship and think about how this
impacts on B
• B completed a course in an Art Group at School and Graduated
from the group. He expressed that he liked the group and had fun in
it.
Positive Outcomes for A
• A engaged well with all support provided
• The Crisis Team closed her case
• A has been able to be very honest with Think Family around her
mental health and different aspects of her life that which has allowed
a flexible method of working.
• A visits her GP on a regular basis who monitors her medications,
which she takes as prescribed.
• A has said that she feels that B has calmed down and is now more
manageable in relation to his behaviour.
• Following Family Therapy A began to explore her feelings around
her ex-partner and how they related to her mental health, emotional
well-being and the impact of this on B. This resulted in a decision to
end the relationship consequentially allowing her to move forward in
other aspects of her life
• A reduced her social isolation by becoming more
involved with the school
• As a result of the regular emotional support A informed
of an improvement in her self-confidence
• A felt well supported in Team around the Family
Meetings where she had previously felt attacked by
professionals
• A has advised that she has not drunk alcohol to excess
since May 2010
• A has a future appointment date for her initial sessions of
CBT
Positive Outcomes for B
• B has been able to meet other young carers through the FAB group
and other groups
• B has had the opportunity and openly discuss issues around alcohol
misuse, mental health and young carers
• B now has an age appropriate understanding of mental health and
substance misuse and how it relates to his family/mother.
• B’s school attendance improved and instances of lateness reduced
• Through support from the social worker, school and young carers
worker B is feeling more confident in addressing bullying and has
advised that he is no longer being bullied
• B is reported to be better able to make positive peer relationships
• B is listening more at home and is able to better verbalise his
feelings/emotions
• Awareness that his mother is getting the appropriate support that
she needs
The Final Phase
• Reflection, Monitoring and Evaluation
• Volunteer service- Taking forward the TF
approach
• Taking forward the audit recommendations
• Maintaining corporate and political profile
• Linking with other pathfinders and similar
services-national findings
• Applying the principles of Think Family in times
of austerity
• Taking forward Carers pathway
• Launch of joint protocol/joint training.
Outcomes
• 51% of cases decreased risk level by 1 level, 22% by
two levels, 15% stayed the same (London continuum of
need)
• 23% contained plus DV plus substance use and young
carer.
• 59% of parents where on CPA
• Therefore multi-stressed families in high need- we had
set out to be early intervention/universal