1. Islington Think Family Service

2. Islington Think Family
What is Think Family?
Partners
What we’ve done so far
Challenges and benefits
What next?

3. What is Think Family? Background: Families at Risk Review
Stats – national/local
A Think Family approach
What it looks like in Islington

4. Partners 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

5. What we’ve done so far 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

6. 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

7. 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)

8. 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

9. 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)

10. 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

11. Islington Think Family Service Young Carers Extended Pathfinder

12. 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)

13. Qualitative differences in the reasons for caring.
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
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.
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

14. 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

15. 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)

16. Messages from Children an Young People
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)

17. Genogram 28 10

18. 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. 18

19. 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 self-harm

20. 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

21. Identified Need
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

22. Support Provided
Regular communication between all professionals to ensure a co-ordinated 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.

23. 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.

24. 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

25. 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

26. 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

27. 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.

28. 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