2Islington Think Family What is Think Family?PartnersWhat we’ve done so farChallenges and benefitsWhat next?
3What is Think Family? Background: Families at Risk Review Stats – national/localA Think Family approachWhat it looks like in Islington
4Partners Family Action NHS Islington Mental Health Foundation Trust Children’s Social CareIslington Families/EPICCommunity Service Volunteers (CSV)All agencies working with children, adults, families
5What we’ve done so far Audit- safeguarding and mental health Staff team/extended PathfinderPiloted a modelDeveloped a WFA toolDirect work with familiesDirect work with Young CarersIndirect work – consultation/trainingDCSF – national conference and consultationIndependent Parent ConsultationMapped Social networks of our partnering agencies
6ChallengesDifferent risk thresholds, legislation, separate guidance on policy and practice.Expectation that referrer remains involvedAnxieties – expertise, professional trust, loss of autonomyResistance to changeTeam cohesionIT/databaseChange in political agenda
7BenefitsInclusive approach – engaging whole families and children and young peopleSmall case loadsIntensive outreachEnthusiasm and commitment to achieving better outcomes, joint working etc.MDT approach-’multi heads/ideas’CSV (Rachel J)High Intensity young carer work(YC pathfinder)
8CSV Think Family Volunteers Based on CSV’s successful Volunteers in Child Protection (ViCP) projectsAim was to integrate volunteer support into TAFs, WFAs and exit plans for familiesRigorous recruitment, selection and training procedures and ongoing monitoring and supportNow expanded to include referrals from TF partners – CIN, CMHT and CAMHS teamsDevelopment of a Think Family plan for each match using key TF impact areas
9CSV Think Family Volunteers Benefits:High level of interest in volunteering – 308 enquiries and 83 applications from members of the publicPositive feedback from current matches and strong stats from pre-existing projects e.g. 0% re-referral rate for families with CP plans in BromleyFits in well with current government’s national agenda (Big Society etc) and winner of 2010 Charity AwardsCapacity to provide more intensive support for longer than most statutory services (2hrs a week for 6mths)
10CSV Think Family Volunteers Challenges:Establishing the need within a service and clear referral routes with partner agenciesBoundaries of the volunteer role and serviceMatching volunteers to families and managing both parties expectationsTimescales of the service – making an impact and evaluating outcomes
11Islington Think Family Service Young Carers Extended Pathfinder
12Young CarersA 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)
13Qualitative differences in the reasons for caring. Mental HealthInstability in family patternsDifficulty understanding about the illness and fantasies about the illness.Emotional availability of the parentHyper vigilanceStigma-- Long-term illness-- Separation due to hospital stayPhysical DisabilityPhysical strain on the young personStrain on their health/recreation time due to on going tasksParent may be able to be more available emotionally.Substance MisuseImpact of parents change in mood and behaviour patternsVigilanceStigma – 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
14Impact on Young CarersEmotional burden of caring affects physical and mental wellbeingLack of positive or consistent role models may affect choices in regard to healthy eating/physical activity/sexual activity/use of drugs and alcoholMissing school/dropping out earlyFalling behind in school workHigh Instances of Bullying and isolationChallenges to parent/school relationshipLack of social opportunitiesLack of consistent boundaries
15The young carers service response to the needs Recognition of the role of being a young carerProvision of social opportunities and respite via groups and outings and residential trips.Family events and groupsChild friendly explanation of illness/disability (inc FAB and KTW)Key person to talk to about life experiences and any worriesLinking families with services to improve outcomesFacilitating families to use their own resources and wider family to reduce the role of the young person (FGC’s)
16Messages from Children an Young People Introduce YourselfGive as much information as you canTell them what is wrong with their parentTell them what is going to happen nextTalk and Listen to themAs them what they know and what they thinkTell them it is not their faultDon’t ignore themKeep on talking to them and keep them informedTell them if there is anyone they can talk toBarnardo’s (2007)
18ReferralThe 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
19Family History Long history of Depression Experience of being in care Experience of physical abuse, emotional abuse, neglect and sexual abuse as a childExperience of Forced marriageSeveral past relationships that featured domestic abuse, most recently with B’s father which she fled to London as a result ofHistory of alcohol misuseFamily isolation/disownmentHistory of minimal engagement with servicesSeveral past suicide attempts as well as a history of self-harm
20Other Professionals working with the Family Social WorkerThink Family Key Worker/ Young Carers WorkerLearning Mentor from B’s SchoolSubstance Misuse Support WorkerFamily TherapistMentor for ChildYoung Peoples Drug and Alcohol ServiceAdult Psychologist
21Identified NeedB was identified as a young carer as a result of A’s mental illness, substance misuse and physical ailmentsExploration around the seriousness of A’s Suicidal thoughtsSupport around A’s alcohol misuseA had not discussed any issues around Mental Illness or Substance Misuse with B therefore he had no age appropriate understanding of his mother’s difficultiesThere were concerns regarding the impact of A’s moods and mental health on BA had no support for herself regarding her mental illness and identified this as a needEmotional 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 BA had a history of minimal engagement and then disengagement with servicesB was very unconfident, experienced bullying and isolated himself with his peers at schoolB’s school attendance was erratic and he was often late
22Support ProvidedRegular communication between all professionals to ensure a co-ordinated approach to provide holistic approach of work with the familyPsychological Assessment and referral to Adult Psychology for CBTFAB Group and access to other Young Carers GroupsWeekly home visits to offer emotional support and to discuss other areas of support with AA 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 workB attended the FAB group to look at and address some issues around parental substance/alcohol misuse.
23One 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 BB 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.
24Positive Outcomes for A A engaged well with all support providedThe Crisis Team closed her caseA 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
25A 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-confidenceA felt well supported in Team around the Family Meetings where she had previously felt attacked by professionalsA has advised that she has not drunk alcohol to excess since May 2010A has a future appointment date for her initial sessions of CBT
26Positive Outcomes for B B has been able to meet other young carers through the FAB group and other groupsB has had the opportunity and openly discuss issues around alcohol misuse, mental health and young carersB 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 reducedThrough 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 bulliedB is reported to be better able to make positive peer relationshipsB is listening more at home and is able to better verbalise his feelings/emotionsAwareness that his mother is getting the appropriate support that she needs
27The Final Phase Reflection, Monitoring and Evaluation Volunteer service- Taking forward the TF approachTaking forward the audit recommendationsMaintaining corporate and political profileLinking with other pathfinders and similar services-national findingsApplying the principles of Think Family in times of austerityTaking forward Carers pathwayLaunch of joint protocol/joint training.
28Outcomes51% 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 CPATherefore multi-stressed families in high need- we had set out to be early intervention/universal