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

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

• 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

IFST Model of Practice.

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

• ne 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 and unable to meet Asifs basic care

• needs. (Neglect)

Whilst intoxicated Toni has taken an

• verdose of paracetamol and has cut
• herself. Asif has been aware of this

and had to care for his mum. (Emotional Harm) Toni is a caring mother who wants to do her best for Asif. Toni has been able to stop drinking for periods of time and has done this

• n her own.

Toni is aware that her drinking has affected Asif and her family and wants to make it right. 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 has drunk. Toni will contact her mother or a professional and ask for support. 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
• n her medication or being discharged from services.

There is a concern that if C continues in this way her illicit

• piate use could increase and her ability to meet the needs
• f her children deteriorate.

Less than Expected level of success: What if things change a little? (-1) C’s attendance at CDAT and the pharmacy improves initially but then it starts to slip. She continues to use illicit

• piates regularly and starts missing

pick ups at the pharmacy. Most unfavourable

• utcome

thought likely: What if things don’t change? (-2) C misses 3 pick ups at the pharmacy and is discharged from CDAT. Her illicit

• piate use increases and her mood is
• affected. Social services concerns

increase and child protection procedures are started.

Best anticipate d success: We keep going! (+2) C continues to be abstinent from illicit

• piates and is working with CDAT to

reduce on her prescribed medication She continues to attend CDAT and the pharmacy as required. More than expected level of success: We’ve passed

• ur target.

(+1) C is stable on her opiate substitute medication and is abstinent from illicit

• piates. She has started to provide

clean urine samples for CDAT. She continues to attend her appointments regularly at CDAT and there have been no problems with her attendance at the pharmacy. On Target, Expected level of success: This would be good in 4 weeks (0) C is back in treatment with CDAT and

• n an opiate substitute medication.

She attends her appointments at CDAT regularly and attends the pharmacy daily to get her

• prescription. She is working towards

abstinence from illicit opiates.

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

• f 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