Paula Conneely Clinical Specialist, Meriden Family Programme, Birmingham Workshop F: The Meriden Family Programme

The Meriden Family Programme Paula Conneely Clinical Specialist

Aims of the Session To give a background to the work of the Meriden Family Programme To look at how the Programme supports mental health services to develop family sensitive services To look at how the SCIE guidance links with and supports the work of the Programme. To provide an opportunity to discuss implementation; opportunities & dilemmas

The Meriden Programme

What is the Meriden Programme? “The Meriden Family Work Programme is a training and organisational development programme, which has been promoting the development of family-sensitive, evidence-based mental health services since 1998, with a particular emphasis on the implementation of family work. It is an NHS programme with extensive experience of working with organisations to ensure families remain at the heart of quality mental health service delivery” Mission Statement, 2009

The Meriden Family Programme NHS organisation. Programme hosted by Birmingham & Solihull Mental Health Foundation Trust. Operates as a trading arm. Service Level Agreements with a number of West Midlands trusts. Training at a national level.

Aims of the Meriden Programme To provide services that are “family sensitive”. To ensure that evidence-based family approaches are available to families. To support the implementation of government policy and guidance. To ensure that staff have the skills necessary for carrying out this work.

The Meriden Team (9) Director – Dr Grainne Fadden Deputy Director 3 Clinical Specialists Carer Consultant Psychology Research Assistant Business Manager Administration Support Sessional Clinical staff

The Programme Model Cascade training model – we train staff as trainers who train staff from all disciplines on in-service training courses and provide supervision. Close involvement with management on an on-going basis to problem-solve issues relating to implementation.

The Programme Model 5-day course in Behavioural Family Therapy (BFT) – service specific adaptations available. 5-day Train the Trainers course. On-going support and supervision, work with management, special interest groups etc.

The Model of Family Intervention Behavioural Family Therapy (BFT) Falloon model Psychoeducational Information sharing Early warning signs/Relapse prevention strategies Skills based Communication Skills Problem Solving skills

Meriden – Current Numbers Current number of therapists trained – over 2650 across the West Midlands – over 3700 Worldwide Current numbers of trainers – 215 in the UK

Meriden Influence Worldwide Portugal 49 3 Australia UK Ireland 56 Jersey Health & Social Services 10 6 Canada Italy Sweden Finland Sydney Melbourne Ballarat Malaysia 1 Spain 5 Greece 1 Singapore 30 Japan 2 Meriden Influence Worldwide Introductory workshops/Training for managers People trained to deliver BFT BFT Trainers KEY World Total 3726 people trained to deliver BFT 215 Trainers

157 Total in British Isles 3489 people trained to deliver BFT 202 BFT Trainers People trained to deliver BFT BFT Trainers

BFT Therapist Profile – Profession (n = 2455 ) March 2009

Service Specific Adaptations 5-day BFT training for Early Intervention staff/Older Adult services In-patient Awareness training (3 stages) Family Work in Crisis Resolution & Home Treatment teams (3-days) Awareness training for Community staff Therapeutic Skills for Working with Families Team Manager training Bespoke training & Learning Events

Workstreams Parental Mental Health & Child Welfare Early Intervention in Psychosis Transcultural Family Work In-patient & Acute Services Older Adults Services Caring for Carers

Parental Mental Health

Current situation: Meriden - Predominant training of adult mental health workers Longstanding clinical debate re. inclusion of young children Issues cited as lack of confidence, skills, roles, boundaries etc.

Parental Mental Health Steps to date: Awareness raising within core training packages –Keeping the Family in Mind –Being Seen and Heard/Partners in Care resources –Identifying and problem-solving specific issues Introduction to resources/support Interfaces report, 2003 Parental Mental Health SIG

SCIE Guidance Confirmation that change needs to happen. Whole family thinking – not just the responsibility of CAMHS/Child & Family/EI services (Many innovative services – Cams driven?). AMH often just from a risk perspective – acknowledgement of other needs.

SCIE Characteristics A successful service will: Promote resilience and the well-being of all family members now and in the future Offer appropriate support to avoid crises and also manage them appropriately should they arise Secure child safety

A High Quality Service… Respects individual’s wishes and needs and their role and responsibilities in a family. Incorporates a strengths and resilience-led perspective believing that change can be possible – even in unpromising conditions – and that it may start in simple ways. Intervenes early to avoid crises, stops them soon after they start and continues to provide support once the crisis has been resolved. Supports the empowerment of service users through sharing of information and knowledge and ensuring their involvement in all stages of the planning and delivery of their care.

Summary Recommendations Screening Assessment All organisations need to adapt existing assessment and recording processes to take account of the whole family and train staff in their use. Planning care Care planning needs to take a holistic approach to include appropriate care plans for each individual family member as well as the family as a whole and in doing so staff should aim to increase resilience and reduce stressors. Providing care Reviewing care plans Reviews should consider changes in family circumstances over time, include both individual and family goals and involve children and carers in the process. Strategic Approach Workforce development

SCIE “Family Model” Switching from a focus on diagnosis or pathology to instead concentrate on individual strengths and interventions that are strongly associated with promoting mental health and recovery, sustaining families and promoting inclusion. Looking at the family as a unit and focusing on positive interdependency and supportive relationships. Helping parents to understand their mental health problems, their treatment plan, and the potential impacts of mental health problems on parenting, the parent-child relationship and the child. Similarly, working with parents and children to enable the child to have age appropriate understanding of what is happening with their parent and information about what is available for children in their situation and how they can access it.

BFT Model: Assessment Includes every family member Not diagnosis led. Focus on understanding of issues and current behaviours Families/individuals strengths as well as areas for change Goal setting for each participant

BFT Model: Planning Care Inc BFT formulation Individual goals Family goals Early warning signs and relapse planning

BFT Model: Providing Care Sharing of Information Early warning Signs & Relapse planning Communication skills Problem Solving as a family unit

BFT Model: Review Individual goals Family goals Reviewed each session

Meriden Future steps?:

Parental Mental Health Future steps?: Research & evaluation –To what extent are AMH staff using the model with children? –Cross agency working? Workforce Development –Specific skills based training for AMH staff –BFT Trainer training (cascade model) –Learning event PMH SIG Promotion/marketing of training to other areas

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