The Triangle of Care: Carers included

Why do we work with carers and families?

Standards and Priorities Quality Priorities: 5. Think! Family – working with the whole family and co-ordinating all aspects of support to address their full needs Core Care Standards: We will work with families and carers Care Act 2014: a duty to meet the eligible needs of carers and promote their wellbeing CQC: the sustained and supported involvement of families and carers in the care of their loved ones Trust Values: we work in partnership with service receivers and stakeholders Triangle of Care, Carers included 2010: gives 6 standards for carers engagement and support It’s the right thing to do

Becoming a Carer https://www.youtube.com/watch?v=K6s4_we_sto

Becoming a Carer “At the time, when my relative joined the service I felt completely lost. Here was a set of new experiences I could not have imagined. I needed to know the ropes, who was there to help and what was going on. I especially needed to believe in the professionals – that they understood my connection to this precious person now in their care. I needed to have confidence they knew how to help him recover and that they saw me as part of that recovery.” Carer speaking about when the person they care for had their first episode

The Triangle of Care is a therapeutic alliance between service user, staff member and carer that promotes safety, supports recovery and sustains wellbeing.

TOC for different groups Carers of adults with mental health problems Carers of people with dementia Young Carers of adults Being extended to other services including services to support people with a learning disability

6 Key Elements Carers and the essential role they play are identified at first contact or as soon as possible thereafter Staff are carer aware and trained in carer engagement strategies Policy and practice protocols re confidentiality and sharing information are in place. Defined posts responsible for carers are in place A carer introduction to the service is available with a relevant range of information across the care pathway A range of carer support services is available

1. Carers and the essential role they play are identified “Nearly a third of care records (30%) did not record whether or not the service user had a carer. ” Healthcare Commission 2008 Carers’ views and knowledge are sought, shared, used and regularly updated as overall care plans and strategies to support treatment and recovery take shape. Record Carers

How do we identify carers?

2. Staff are carer aware and trained in carer engagement strategies “The Healthcare Commission review found that only 32% of front line ward staff had been trained in supporting carers and families, although this ranged from all ward staff having been trained to none.” Triangle of Care 2nd edition Staff need to be aware of and welcome the valuable contribution carers can make and be mindful of carers’ own needs. Staff need knowledge, training and support to become carer aware.

How do we engage with carers? Discuss in pairs

Engaging carers Being listened to feels great Structuring conversations: story, feelings, options Checking meaning Sensitive issues Apologising Body language, voice Praise and compliments Wrapping up Talkwell Star Wards 2009

3. Policy and practice protocols re: confidentiality and sharing information are in place “For me it was hard at the beginning ... they didn’t want to talk to me. They just said: ‘I won’t talk to you without your son being present.’ They didn’t understand my son’s illness, but he used to tell me every single thing ... eventually they came to the understanding that we are partners in this, working together.” Carer (Source: National Audit Office Carer Focus Group) Guidelines on confidentiality and for sharing information Information release forms and protocols. Advance statement forms and protocols.

Carers Experience "Without having friends and family to provide support and enable me to leave hospital within a week I may still be there now, rather than where I am - working, looking after my family and with hope for the future.” Service User https://www.youtube.com/watch?v=3Qw2ZNnkvZU&feature=youtu.be

4. Defined posts responsible for carers are in place “only two fifths of wards (40%) had a dedicated member of staff responsible for leading on carer issues.” Healthcare Commission 2008 Carers lead or champion for all wards and teams irrespective of which service. Carers links delegated for each shift/team.

5. A carer introduction to the service is available with a relevant range of information “One in five wards (21%) did not have an information pack for carers containing any of the information we asked about” Healthcare Commission 2008 An introductory letter from the team or ward explaining the nature of the service provided and who to contact, including out of hours. An appointment with a named member of the team to discuss their views and involvement. Team/Ward orientation/induction procedure and leaflet. Carer information packs. Discharge planning and aftercare support.

6. A range of carer support services is available “Carers want prompt access to help when the person they care for is becoming ill. They want information, practical advice, emotional support and occasional respite. Most of all they want decent care for their loved one.” Professor Louis Appleby, The NSF for Mental Health: Five years On (Department of Health, 2004) Support for carers including: Carer support Carer needs assessment Family interventions

Triangle of Care Self-assessment Self-assessments must: Include carers (and service users where possible) Involve all staff Traffic light system: green=80%+, amber =50%+ Give good evidence for any ‘green’ areas Include an action plan which is implemented and updated Be counter-signed by a senior member of staff

What if? – A carer’s journey through care services When asking for help, what if ... both my relative and I had a phone number to call if an acute situation was to develop as a carer I could call the staff, tell them the need was urgent and I would get a quick response when assessing my relative, the worker(s) talked to me as well, so as to get a clear picture of how to help the worker(s) tried to get a good picture of what my son was like when he was well and aspired to help him to return to this. ... then our caring duties would diminish to a point when we could look towards our own recovery Alan Worthington, Carer