Drug and alcohol services - improving holistic family support

Annex D

What we can learn from Whole Family Approaches elsewhere

Local authorities in England have developed a family-focused approach to assessment because of historical perceived gaps in existing individualised approaches to assessing need, developing supports and interventions. Individual support and service impact were found to be undermined where individual issues were not successfully addressed because of problems in the wider family^[44]. "Whole family assessments" have been developed by a range of services, working together to provide the opportunity to provide an overview of family strengths, risks, relationships and needs.

For some local partnerships it also meant "that everyone working with the adult and their family must think about the impact of the care needs of each member of the family, including any children."^[45]

This approach reflects a view that existing approaches did not always assess the needs of the whole family (generally being focused on the individual) and crucially, did not always examine in detail the complex interrelationships between family members.

"...an understanding of the complexity and interrelated nature of the issues faced by families can be developed… it ensures the right services are involved, that they have an accurate picture of the family's needs and that the same questions are not asked more than once….it also provides a coherent and holistic response to families' needs." (p.8)

The development of this model has also led to the concept of a "Team Around The Family" approach, similar to that which underpins the GIRFEC approach in Scotland, albeit with the central focus on the child.

"In the most effective areas, the TAF is a multidisciplinary approach, drawing in support from a range of professionals (from the project team/service and beyond). TAF meetings bring together all relevant staff and agencies currently working with the family, as well as seeking to identify those additional practitioners/services who might need to work with the family."

The Children's Commissioner for Wales has recently described the need for public service co-ordination and delivery of integrated responses for children, experiencing a range of need and vulnerabilities as the 'No Wrong Door'^[46] approach, describing it as:-

"Children and families who seek support for a range of needs often find they have to navigate a very complex system, may fall through gaps where there are no services to meet their needs or be on a waiting list for a long time, only to be told that they are waiting in the wrong queue, or have been knocking at the wrong door all along. The Commissioner and her team believe that services should wrap around families, rather than them having to fit what is out there and that help should be provided as early as possible to prevent more serious problems developing."

The Social Care Institute for Excellence (SCIE)^[47] in describing its work on supporting families affected by parental mental health, describe good family support approaches in the following way:

• enable joined-up support at every point of entry – a "no wrong door" approach
• look at the whole family and coordinate care
• intervene early to avoid crisis
• provide support that is tailored to need
• build on family strengths and promote resilience.

"This means incorporating a whole-family approach at each stage of the care pathway. This may require changing organisational structures and processes, as well as the practice of managers and practitioners."

SCIE's recommendations for how service delivery can be systematically improved included areas which focus on sustained transformation in order to include the whole family highlighting strategic, multi- agency approaches, deeper collaboration between providers, the importance of cultural change and challenging practice that is not focusing on the whole family, embedding WFA's whole-family into performance and quality systems including professional supervision, supporting formal joint training and informal opportunities for professional learning and listening regularly and closely to children, young people and their families about their needs and experiences.