Impact case study database

Having demonstrated efficacy through G1, TFWF was rolled out from September 2013 across local authority multi-agency services in Leicestershire and LPT. The programme was one of three initiatives (from almost 100 submissions) shortlisted in the East Midlands Healthcare Innovation Awards (mental health category) in September 2014. Over the impact period, GBP61,000 in combined authority funding [G2, G3, G4] ensured the initiative engaged 157 multi-agency and education professionals, benefiting an upper bound of 3,107 families and 23,769 school pupils in the region (based on local authority data for services’ case attachment figures and schools’ enrolment numbers). The impact comprises three key strands outlined below.

(1) CHANGING PRACTICE TO STRENGTHEN MENTAL HEALTH PROVISION ACROSS FRONTLINE SERVICES

Research evaluations demonstrated that implementation of TFWF improved the knowledge, skills and confidence of professional staff across Leicestershire in supporting PMI [C1, C4]. This included all workers and managers across the county’s Supporting Leicestershire Families (SLF) teams, all of Leicester City Council’s Early Help Services staff, and teachers and pastoral staff from 42 schools.

Service managers and professionals who engaged with TFWF consistently reported changes to their workplace organisation. A SLF service manager who commissioned TFWF to meet the local authority’s responsibilities under the Troubled Families scheme described it as a ‘unique’ intervention in its consideration of the whole-family approach and facilitation of partnership working across councils, voluntary services, schools and police [C2]. There were changes to staff working and appointment hours to ensure children and young people could be included in the work and increased joint-working between services. Tools (such as symptom-identification and problem-solving toolkits) from the training were embedded in assessment and monitoring processes [C2, C3, C4, C5]. The SLF manager commented [C2]: ‘it allowed us to assess the underlying causes and further notifying the schools in how to work with children from such families. Previously, schools did not usually look beyond the problems being faced by the pupil.’

Evidence also demonstrates that TFWF led professionals to address PMI in families where they previously had not done so; to include more family members in their practice (most significantly making sure that children are part of the process of understanding the illness and setting goals for outcomes); and to work together with whole families to support well-being and recovery [C2, C3, C4]. An occupational therapist described TFWF as ‘a systematic tool to unravel (mental health) issues’ [C6]. She observed: ‘I do not think that I would be the therapist I am without having the training from the Think Family project. It has had significant impact on my learning and added confidence for my work.’

From June 2018, staff from 42 schools in Leicestershire were trained using a programme developed from TFWF research [C4]. Schools now use resources from the training on school premises, in lessons, with parents and at school events to successfully raise awareness among pupils and parents about PMI and the sources of support available to them [C4]. One primary headteacher said: ‘We have had little [information] packs done, a guide to some of the resources you sent out, a guide to depression and a guide to mental health … And I have used that so many times when I am on the phone to parents.’ The success of the programme led to a recommendation from Leicestershire Public Health in July 2020 to recommission TFWF for roll out to up to another 100 schools in 2021 [C4].

(2) EMBEDDING TFWF IN LPT POLICY, OPERATIONAL STRATEGY AND TRAINING

Research evidence from G1 was presented to strategy forums and meetings across LPT and led to changes in operational strategy and staff training. A Think Family steering group was constituted in June 2014 (a cross-departmental group to raise awareness of PMI and ensure support for the needs of families across the Trust’s services) [C7, C8, C9]. Principles underpinning TFWF were incorporated into LPT’s 2014 Families, Young People and Children Divisional Action Plan [C9], and changes were implemented to embed PMI support across the Trust’s services [C10, C11]:

• A Whole Family Lead post was created (managed by the adult and child mental health services) to oversee implementation of the Whole Family Strategy.

• A Whole Family patient and carer experience pathway was developed.

• A Think Family information phoneline was put in place for all Trust employees.

• A Whole Family Newsletter was created for dissemination to all employees.

• Slides from the research are included in the safeguarding training pack for all employees.

• Formal audit processes ensure PMI is monitored effectively.

Crucially, TFWF principles were embedded in mandatory training for LPT’s health visitors and school nurses from September 2013. This was expanded in summer 2014 to include multi-agency training for all LPT staff [C10]. This allowed Trust staff to carry out targeted visiting for families needing support around PMI [C10]. A Practice Educator at LPT said: ‘The training provides a step-by-step package… to provide support using a systematic approach. This has improved [staff’s] ability to identify the root causes behind the mental health of the parent as well as the influence of this on the mental health of the child.’

From 2019, evidence from TFWF was incorporated into mandatory safeguarding training for LPT’s mental health services, GPs, consultants and registrars, and doctors moving into consultant posts [C11]. A former consultant/​designated nurse for safeguarding in the Leicester, Leicestershire and Rutland Clinical Commissioning Group said: ‘we adopted the Think Family principles as part of our education, writing and practice reviews and consider the importance of Think Family as an approach in the wider safeguarding agenda … The Think Family project is, therefore, allowing [us] to bring people into the safeguarding agenda that otherwise could easily have been left out’ [C11].

(3) ACHIEVING IMPROVEMENTS IN FAMILIES’ MENTAL HEALTH AND WELL-BEING

As a result of the changes to services, TFWF has led to parents with mental illnesses and their partners and children experiencing improved mental health and well-being [C2, C3, C4], specifically:

• Family members developed improved mental health literacy and an improved understanding of the illness affecting them.

• Families talked more openly and constructively about PMI and better support one another.

• Parents’ confidence in their parenting and their overall mental health improved.

One service manager [C3] said: ‘Over time, families became less dependent on the services and more self-sufficient. The families’ wellbeing improved massively as they had a sense of control and their self-esteem increased as well. For the families, being part of the project brought a lifelong benefit.’

Interviews with professional staff revealed numerous examples of how families had benefited from the changes introduced through the TFWF approach [C4]. Representative comments included [C4]: ‘Speaking and listening really in that family, it hadn’t happened before in this way and I think that they were starting to listen to each other … because of that, mum could see the boys differently’; ‘(the children) were able to express feelings that they had about their mum’s mental health problems that they’d never been able to vocalise or talk about with their mum’.