Our story

Our first office. Thank you to Pat Burton head teacher who believed in us enough to provide our first premises free of charge.

This is Ivy, a much loved lollipop lady who also helped us out volunteering to support a local family when they needed it. Thanks Ivy

Where we are now-The Old Firestation

Read about how Love Barrow families came about in our original vision paper written by Trina. This is how our story began, innovation from the frontline

Integrated Family Services in Barrow

Who I am

This idea has grown over a number of years spent working in services in Barrow and Furness. I was born in Barrow and have lived most of my life here. Over the years I have experience of being a foster parent for teenagers who “were difficult to place”
local authority residential child care, independent residential child care, social work in Barrow Central Children & families team, NSPCC, social work for two other local voluntary agencies. I have now worked part time for CAMHS in Barrow for six years as a Play Therapist/Groupworker. I have an Advanced Award in Social Work and an MA in Play Therapy

I am an approved play therapy supervisor and am a trained trainer in child protection. Along with my colleague Alison Tooby I am a founding member of the International Association for the Study of Attachment (IASA). In 2005 we invited Dr Patricia Crittenden www.pat.crittenden.com to Barrow to train professionals in the Dynamic Maturational Model of Attachment (DMM) which is a highly regarded theoretical evidenced based model advocating an empathic and accepting way of working with whole families who come to the attention of services. The 5 day conference “Attachment & Psychopathology” was attended by 130 professionals across all agencies. Dr Critttenden has returned to Barrow several times to train smaller groups of professionals in her attachment assessments across the life span. For the last four years Alison and I have been working with Dr Pat Crittenden on a research project that has involved the identification of 50 local families who are helping us to validate the School Age assessment of Attachment and learn about family functioning and treatment. I recently presented some preliminary findings from our research at the Tavistock and Portman Clinic as part of a day’s conference to introduce the DMM.

I also work part time along with my colleague Alison Tooby for a well-established charity in Barrow offering individualised joined up packages of support to parents and children using the DMM.

Myself and my colleagues in CAMHS are developing ways of working that use the DMM as a way of understanding and treating both parent and child difficulties. Along with my colleague Annette Wetherell, Family Therapist I have written an article which we are to submit to the Learning Network Journal for publication.

I have also had some recent experience of being involved with both adult and child services as a service user and as a family member and this has been a major influence in my life personally and professionally.

The Idea

To offer a truly integrated service beginning with the families in Barrow who have the most complex needs and who often account for the largest majority of the workload for agencies throughout the tiers of care.

The aim is also to integrate current research and theory into practice in order to develop holistic individualised approaches to working with children and families that reflect the value of systemic working and provide sequences of care that make a difference in the longer term rather than single episodes of care to families who return time and again.

To move from reactive care of families to anticipatory/preventative care resulting in more effective use of current resources.

To work to a philosophy that goes beyond an undertaking not to judge or discriminate, recognising each person’s right to be accepted and treated with respect. Children and vulnerable adults are often in a position of powerlessness and rely upon the professionals working with them to work in partnership and to be able to be genuine and to advocate when this is appropriate.

Why do this?

• Because families in Barrow-in-Furness deserve an excellent service and because continuous improvement of services is beneficial to families and to agencies
• Because in terms of timing there are a wealth of current reports and publications based upon sound research and evidence that point to the fact that integrated working is what families want and need (Foresight report 2009, Field’s Foundation Years 2010, Munro review 2011, Think Family, Centre for Excellence & Outcomes, recommendations from section 8 enquiries). There are a number of professionals across agencies in Barrow who completely support this principle and are able and willing to work together to ensure it can happen through the trust and relationships already available in the community.
• Because feedback from families (and professionals) in Barrow suggests that if anything services are more fragmented and although professionals work hard to follow the good practice guidelines they are often not given the training and support that would enable them to link theory with practice. This means that written policies and procedures often look good but are not followed through in service delivery (The Munro Review of Child Protection 2011)
• Because although integrated working is often talked and written about it is rarely being practiced. Professionals need to be supported to integrate current research into their way of thinking and their practice in the community. Often we are told to do integrated working whilst not having the understanding/experience/skills or support that we need to enable us to do a good job. The Reclaiming social work project in Hackney is an example of a successful integrated service with families which has bucked national trends with a reduction in the number of children coming into care alongside a reduction made in efficiency savings and complaints from families (2010).
• Because professional confidence and morale in Barrow is low and we need to feel inspired and supported to provide a good service to families. We also need to remember that for professionals to give the best of themselves they also need acceptance, compassion, kindness, connection and a welcoming base from which to work
• Because we need to get better at understanding and working collaboratively with those families who need the most resources so that we can offer an individualised package of appropriate services that are efficient, timely and cost effective
• So that we can utilise community resources in Barrow to assist the most socially excluded families to feel included and able to play a part in their community. We need to develop and make use of all of our many assets and strengths but in a way which ensures they are widely known and connected into all services.
• Because we should endeavour to address the needs of families in Barrow in a way that respects and values the prevailing working class culture that remains such a big part of our cohesion as a community
• Because evidence points to the fact that in terms of well-being and mental health people are more likely to be happy if they experience a sense of belonging, feel they have something to give and are connected to one another (www.actionforhappiness.org) This again ties in with utilising resources and viewing assets, not deficits in people/places and neighbourhoods. It also applies equally to professionals working in community (Improvement & Development Agency 2009)
• Because we need to ensure that only the most appropriate families are referred to specialist services e.g. psychotherapy, family therapy, play therapy. That is families who have their primary health and social care needs met so that they can make use of therapy to address underlying psychological difficulties. In order to engage in addressing deeper psychological work families need to feel supported and contained.

What do we want to do?

• Build upon the trusting existing relationships between a small number of professionals in Barrow to bring together a fuller, jointly owned proposal so that the most committed individuals can bring their agency and colleagues along with them. This would include CAMHS, adult services, social care, education, primary care, local charities and voluntary groups. The benefit of this being that the project will be accepted by and embedded in the community. Thus standard services become active participants in shaping this new service as part of a reciprocal process with senior managers and families in the community
• Reflect the values we hold in our work throughout the whole service so that we recognise the importance of trust and long term relationships between professionals
• Identify a focus or user group made up of families from Barrow (using 50 families plus)
• Facilitate user discussion and feedback re ideas for this project and how best to proceed
• Access Dr Patricia Crittenden to support the project and offer some consultation as needed
• Ensure the project is properly established and evaluated
• Raise awareness in Barrow through the immediate small group of multi- agency professionals and begin to think about training needs and cascading learning
• By December 2011 to have a clear proposal or strategy for implementation signed up to by all agencies in Barrow
• To have a day in Barrow in December to share innovative practice and learning in Barrow and launch the project

Who do we want to include?

• See initial stakeholder list
• Further development of stakeholders through small professional group meetings in preparation for proposal/launch

What do we want to achieve?

Short term

• Improved communication between agencies so that professionals begin to think differently and consider the impact upon the family and the community, when problems are treated as individual dysfunction or disorder rather than as seen within a systemic perspective
• Increase/encourage enthusiasm, energy and creative thinking within the professional community in Barrow
• Share learning with colleagues and create shared ownership of our project
• Create a project which is owned by the community and that links into and builds upon the work which is already taking place here in Barrow
• To create a sense of safety for professionals through joined up thinking and sharing of responsibility and risk
• Learn from child deaths and mistakes made
• Start to think about problems being developmental rather than divided into adult and child
• Begin to join with families around their goals, seeking to introduce more effective and satisfying means of reaching them
• Begin to streamline services offered to multi-problem families so that they see fewer providers in a more comprehensive way. Seriously involved families are often the most vulnerable and need an integrated service from the team around them, delivered by a single primary professional where possible. The plan should reflect an understanding of the process of change i.e. that learning is progressive and builds on previous steps and that learning occurs most easily when it is based on strengths. The team working with the family should take responsibility for integrating the services offered rather than leave this responsibility with the family (Crittenden 1992).
• To begin to recognise and utilise the skills of the most trained and experienced practitioners i.e. family therapist, psychotherapist, social workers, children’s therapists, adult psychiatrists and psychologists to support, inform and facilitate praxis for the professionals who work day to day with families so that practitioners feel more able to support families with complex needs and address their difficulties as a network. Specialised resources such as intensive therapy can then be thought about more carefully and the importance of timing, preparation, the right therapy and support to engage can be considered so that only the most appropriate families come to therapy. In this way the package of support from the team of professionals around each family can act as a bridge to efficient timely therapy with appropriately qualified and experienced practitioners
• Apply validated assessments such as the CARE-Index, Adult Attachment Interview to define clearly what the difficulties are and how best to address them. Difficulties should be seen as dyadic/familial rather than individual disorder or dysfunction
• Begin to think about creating a unique participatory service for each family so that their ongoing feedback is sought and affects the structure and process of the service, including genuine links or opportunities for participation in community/neighbourhood life. The recipients of services are therefore seen as equal partners in the ongoing design and service development
• Consider how to engage the families who are the most disadvantaged and least likely to see any value in what we have to offer. The families who are the hardest to reach are often the most in need of services
• Begin to consider professional attitudes and assumptions about problems, moving towards practice which is more accepting, less punitive/judgemental and take into account the impact of poverty, class, culture and language
• Take on the challenge of assessing and understanding the complex difficulties and needs of families so that longer term goals can be reached for families who are not able to engage in or sustain change brought about by shorter term, more straightforward approaches

Longer term

• Interrupt cycle of intergenerational patterns of social/mental health problems
• Raise families expectations of services
• Raise staff morale and encourage sense of ownership and creativity
• Raise parents aspirations for themselves and their children
• Focus on assets rather than deficits – both in the individual/family and wider community/neighbourhood
• Measure outcomes across child mental health, social care, adult mental health, physical health and education in a comprehensive and integrated fashion so that needs can be understood holistically e.g. the link between the psychological and the physical, the impact of deprivation upon educational attainment and life chances.

Katrina Robson
CAMHS
20th June 2011

References

Centre for Excellence and Outcomes in Child and Young Persons Services (2011) Improving the health, safety and wellbeing of children London: C4EO

Crittenden PM (1992) The Social Ecology of Treatment: Case Study of a Service System for maltreated children American Journal of Orthopsychiatry 62 22-34

Crittenden P M, Robson K M, Tooby A J (2007-2011) Longitudinal Validation of the School Age assessment of Attachment.

Crittenden P M (2008) Raising Parents: Attachment, Parenting and Child safety Cullompton UK: Willan Publishing

Department for Children, Schools & Families (2009) Think Family Toolkit improving support for families at risk London: DCSF

Field F (2010) The Foundation Years: preventing poor children becoming poor adults HM Government

Government Office for Science (2008) Mental Capital and Well-being. Making the most of ourselves in the 21st Century London: The Government Office for Science

Gould, M (2010) With reclaim social work Hackney council could find itself leading a revolution The Guardian 4th November 2010.

Improvement & development agency (2009) A glass half-full: how an asset approach can improve community health and well-being Local Government Association

Munroe Eileen (2011) The Munro Review of Child Protection London: Stationary Office