1. Triangle of Care Sustaining Triangle of care: Ideas from Somerset practice

2. The Family Liaison Team Ragni Whitlock Lead for FamTherapy &Family Inclusive Practice 0.5wte Estelle Rapsey Clinical Psychologist 0.1wte Cathy McIver Family Therapist 0.4wte Karen Carter Family Liaison Specialist 0.8wte ©: Whitlock, McIver & Carter (2016)

3. Somerset Aims Not only maintaining but sustaining Not just sustaining but growing Not operational shift but culture change ©: Whitlock, McIver & Carter (2016)

4. HOW? ©: Whitlock, McIver & Carter (2016)

5. The Triangle of Care has helped by: Highlighting the need for inclusion of carers and family Providing a baseline tool for assessing, developing and promoting family and carer inclusive practice ©: Whitlock, McIver & Carter (2016)

6. Create tree Ward F/l Cr/Htt training National ToC CMHT joint working Supervision days Nomination of champions ToC steering group Somerset F/l team Ward training CMHT training ToC embedded in practice Baseline training GROWING ©: Whitlock, McIver & Carter (2016)

7. Sustaining and Growing Training for inpatient and community mental health staff Ensuring continuity of ToC leads roles Supervision days Family Liaison on wards and CMHTs Consultation to wards Family Liaison plus Operational guidelines for recording activity Local auditing Triangle of Care steering group ©: Whitlock, McIver & Carter (2016)

8. Example of one day training - am Carer’s story and discussion – Carer talking or DVD Exercise to illustrate “ Family ‘burden” for carers: small group discussion Carer burden: slides Wider context: Family/Carer views on mental health services Introduce the Triangle of Care ToC element exercise and reflective discussion ©: Whitlock, McIver & Carter (2016)

9. One day training - pm Confidentiality and Information Sharing Quiz and discussion Discuss of confidentiality scenarios and dilemmas raised by group and vignettes Skills Practice exercise and reflective feedback Evaluation of training ©: Whitlock, McIver & Carter (2016)

10. Example of a quiz question 6. Which of the following statements are correct? a)The family/carer’s need to know may take priority over the patient’s confidentiality rights. b)The patient’s confidentiality rights always take priority over the family/ carer’s need to know. c)Family and carers are entitled to their own confidentiality. d)The patient has the right to prohibit a professional from engaging with a carer to provide general information, advice and support. Answers – a) & c) ©: Whitlock, McIver & Carter (2016)

11. A Supervision day plan Introductions & ice breaker Carers assessment team local information update Toc update: National developments/news Induction to ToC lead role exercise Action Plan and Pledges: evaluation of progress and feedback on pledges along with creation of new pledges Team presentation Sustaining Family inclusive practice and the Triangle of Care: Optimistist /pessimist debate Peer Clinical Supervision Exercise Feedback from the day ©: Whitlock, McIver & Carter (2016)

12. Triangle of Care – pro forma Ward/TeamDate: Key achievements to date:  Goals identified at last meeting Goal Completed? 1 – Update: 2 – 2 – Update: Previous Score: New score: Pledges identified today for forthcoming period 1 – 2 – ©: Whitlock, McIver & Carter (2016)

13. Obstacles to maintenance and further development Ever changing workforce: fewer staff, wider roles Lots of chasing. Support from staff managers in agreeing time to fulfil the role of champion. (staffing pressures) ©: Whitlock, McIver & Carter (2016)

14. Culture Change Triangle of Care Range of training Range of provision Range of staff skills Non specialist Specialist ©: Whitlock, McIver & Carter (2016)

15. Culture change Range of specialism from ward staff through champions to specialist clinical staff Range of work from one-off support meeting through brief Family work to full Family Therapy Range of training from Baseline audit through training for all staff to supervision days to skill and equip champions ©: Whitlock, McIver & Carter (2016)