Integrated Family Support Team Children In Wales Conference. City - PowerPoint PPT Presentation

Integrated Family Support Team Children In Wales Conference. City Hall, Cardiff, March 2012

Niall Casserly, Consultant Social Worker. Andy Munkley, Intervention Specialist, Health. R.C.T & Merthyr Tydfil IFST

Team Structure Head of Service Intervention Intervention Specialist Specialist Intervention Team Intervention Consultant Consultant Specialist Development Specialist Social Social and Worker Worker Performance Manager and Admin Support Intervention Intervention Specialist Specialist (Health CPN) (Health H/V)

IFST Model of Practice. • Welsh Government Guidance and legislation. • Evidence based Interventions.(MI,SFBT,CBT) • Family Focussed. • “A collaborative, person-centred form of guiding to elicit and strengthen motivation for change.” • Collaboration, evocation, autonomy. • Criteria – children’s services, parental substance misuse and timeliness

Overview of IFST intervention •Consultation with social worker • 72 hour assesment and safety plan •Phase 1 intensive (4 weeks) •Phase 2 maintenance ( 12 month IRO reviewed) •…………..some examples

Case 1 Safety Plan Alcohol.

•The Family •Single Mum, aged 40. •8 year old son •2 Older children who live away from home. One at University, and one with her Father. •Child on CPR for Emotional Harm and Neglect. •Mum chaotic alcohol use, drinks to excess, self harms and has taken overdoses of prescribed medication. •Risk of being removed.

SAFETY PLAN Adult Family Members : Toni Child Family Members : Asif Risks Present Strengths in the family Toni has been intoxicated to excess Toni is a caring mother who wants to and unable to meet Asifs basic care do her best for Asif. needs. (Neglect) Toni has been able to stop drinking for periods of time and has done this Whilst intoxicated Toni has taken an on her own. overdose of paracetamol and has cut Toni is aware that her drinking has herself. Asif has been aware of this affected Asif and her family and and had to care for his mum. wants to make it right. (Emotional Harm) Asif is going to school and doing well. Toni is currently working and has been happy in her job for several years. PLAN When Who and What Toni feels the need to drink. Toni will contact her mother or a professional and ask for support. Toni has drunk. Toni will contact her mother or a professional and ask for support. Asif should go and stay with his grandparents.

Case 2 Intensive Phase. Opiates

The Family •31 year old mother & 37 year old father •1 boy aged 4 and twins aged 9 •Mother Opiate dependant using 3-4 times weekly oral. •Father abstinent but not supportive •Mother historically non-concordant with her treatment programme and disengages. In danger of discharge. •Childrens attendance in school is poor at 65% •Significant history of involvement with children’s services •Children Child in Need and Social Worker considering child protection route.

The 2 Goals that were agreed with this family and social worker were as Follows: 1. Parent to re-engage with substance misuse services in order to tackle her substance misuse issues. 2. For the Children’s attendance/punctuality to improve .

Statement of Problem C has a long history of illicit opiate use. She has been in treatment numerous times but has a history of missing her appointments at CDAT and missing her pick ups at the pharmacy. This often leads to her needing to be re- titrated on her medication or being discharged from services. There is a concern that if C continues in this way her illicit opiate use could increase and her ability to meet the needs of her children deteriorate.

Less than C’s attendance at CDAT and the Expected pharmacy improves initially but then it level of starts to slip. She continues to use illicit success: opiates regularly and starts missing What if pick ups at the pharmacy. things change a little ? (-1) Most C misses 3 pick ups at the pharmacy unfavourable and is discharged from CDAT. Her illicit outcome opiate use increases and her mood is thought affected. Social services concerns likely: increase and child protection What if procedures are started. things don’t change ? (-2)

Best C continues to be abstinent from illicit anticipate opiates and is working with CDAT to d success: reduce on her prescribed medication We keep She continues to attend CDAT and the going ! pharmacy as required. (+2) More than C is stable on her opiate substitute expected medication and is abstinent from illicit level of opiates. She has started to provide success: clean urine samples for CDAT. She We’ve continues to attend her appointments passed regularly at CDAT and there have been no problems with her attendance our target. (+1) at the pharmacy. On Target, C is back in treatment with CDAT and Expected on an opiate substitute medication. level of She attends her appointments at success: CDAT regularly and attends the pharmacy daily to get her This would be good in prescription. She is working towards 4 weeks abstinence from illicit opiates. (0)

Worked with family to: • Remove/reduce barriers to learning (Appointment times and places, psycho education) • Explore family’s preferred futures (family focussed and achievable) • Explore family values and identify discrepancies • Identify and explore family strengths • Identify and learn new skills needed to achieve goals (Relapse prevention: coping with cravings and lapses, CBT, refusal skills and preparing for high risk situations. Routines and boundaries.)

The 2 Goals that were agreed with this family and social worker were as Follows: 1. Parent to re-engage with substance misuse services in order to tackle her substance misuse issues. Scoring at -2 at beginning Scoring at 0 at end 2. For the Children’s attendance/punctuality to improve . Scoring at -2 at beginning Scoring at +1 at end

Maintenance •Continued involvement from CDAT: monitoring (including mood) and relapse prevention. •Social Worker to visit once a fortnight to monitor the families progress and further develop routines/boundaries. •Families First: •Genesis project: self esteem and confidence •Counselling •IFST

CASE STUDY THREE Maintenance Phase Alcohol

Mother Father and Son 12 Father – chronic problem drinker – currently maintaining alcohol free lifestyle since immed pre IFST involvement. Mother – anxiety and stress Son – deteriorating behaviour. Achievements in intensive phase re goals– father’s continued abstinence, decreased conflict with son, parental agreements around parenting reducing anxiety for mother.

Ongoing issues for the Maintenance phase Effect of fathers abstinence on family dynamics (as a couple and as parents) Emergence of fathers mental health problems Son’s refusal to revert to role. I.E Interventions will have effects which themselves need fielding in the maintenance plan through goal setting and involvement of relevant agencies. Statutory involvement of IROs prioritise continuity of approach.

Feedback from Families ‘ It’s a brilliant service ’ ‘ Learning to say ‘No’, self confidence and the Safety Plan- kept it and value it’ ‘Looking back on where I have been and how far I have come’ ‘Straight’ ‘Reliable’ ‘I still go back and look at the family folder’

‘I’m a less negative person’ ‘Finding out that I’m a strong woman’ ‘She made me think what’s important’ ‘Down to earth – could relate to him’

Feedback from Referrers Q: What useful things did the IFST worker do with the family? A1: They were able to see beyond the immediate and look for strengths A2: IFST gave me feedback on what was happening in the family and more precise information on levels of risk

Thanks for listening. We are on 01443 823939