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Islington Think Family Service. Islington Think Family. 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.

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Islington think family l.jpg
Islington Think Family

  • What is Think Family?

  • Partners

  • What we’ve done so far

  • Challenges and benefits

  • What next?

What is think family l.jpg
What is Think Family?

  • Background: Families at Risk Review

    Stats – national/local

  • A Think Family approach

  • What it looks like in Islington

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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

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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

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  • 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

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  • 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)

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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

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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)

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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

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Islington Think Family ServiceYoung Carers Extended Pathfinder

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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)

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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.

    • Stigma

  • 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

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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

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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)

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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)

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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.

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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

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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

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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

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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.

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  • 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.

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Positive Outcomes for A mother’s mental illness and substance misuse, his young caring and how all these things connected.

  • 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

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  • 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

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Positive Outcomes for B with the school

  • 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

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The Final Phase with the school

  • 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.

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Outcomes with the school

  • 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