The Meriden Family Programme
The Meriden Family Programme is a training and organisational development programme which seeks train clinical staff, service users, and carers in the skills needed to work with families and to ensure that workers are able to deliver quality, evidence-based family interventions.
Please note that this example was originally submitted to demonstrate implementation of CG82 Schizophrenia (update). CG82 has now been replaced by CG178. The example has been reviewed and continues to align with the new guidance.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
The overall aim of the Meriden Family Programme is to train clinical staff, service users, and carers in the skills needed to work with families and to ensure that, through the training provided by Meriden, workers are able to deliver quality, evidence-based family interventions and develop a family sensitive culture in their host organisation. In addition, Meriden aims to bring about attitudinal and organisational change to ensure that family work becomes embedded within mental health services and that family interventions are routinely considered in individual case/CPA reviews. A further key objective is concerned with implementing government policy and guidelines relating to improving services for carers. The aim has been to link developments for the delivery of evidence-based family work with the involvement of carers across organisations (locally and nationally) in order that work is not duplicated and collaboration is encouraged. Meriden has either been ahead of, or kept pace with, policy guidance over the last 13 years, adapting its work in line with government policies, clinical guidelines (SCIE "Think child, think parent, think family" 2009) and reflecting the challenges put forward by those who commission our training (i.e the Meriden "Sharing Information with Family and Friends" training/workbook).
The main objectives for the Meriden Family Programme are:
1. To train and supervise multi-disciplinary groups of clinicians, along with service users and carers, in evidence-based family interventions and to adapt this training to suit specialist areas within mental health services.
2. To ensure that the structure of family interventions delivered is consistent with the evidence-based model developed by Falloon (Behavioural Family Therapy) which includes all the components defined within the NICE Guideline for Schizophrenia 2009 (188.8.131.52).
3. To maintain contact with managers and key individuals within services to identify barriers to the implementation of family work and develop solutions for overcoming them and to bring about attitudinal and organisational change resulting in family work becoming embedded in services.
Reasons for implementing your project
The programme was one of a number launched in the West Midlands region in 1998 aimed at promoting evidence-based health care and getting research implemented in practice. However, it is the only one that has been sustained. It was clear that there is a robust evidence-base for the effectiveness of family interventions in schizophrenia, but that these are not routinely available. The Meriden Family Programme was ahead of its time in that it had begun to address these issues prior to the publication of the original NICE Schizophrenia Guidelines in 2002, which stipulated that family interventions should be offered to 100% of families where a family member experienced episodes of schizophrenia. The other strand of the programme linked with carers' needs and an awareness that those caring for people with long-term mental health problems have a range of needs that are often unmet and ignored by services. Once again, the programme was highlighting these issues and attempting to develop services for families prior to the publication of the National Service Framework (1999) with its emphasis on carers' rights to an assessment of their needs and a linked care plan (Standard 6).
How did you implement the project
1.In terms of those trained to deliver family work in the West Midlands, the numbers are in excess of 2800 with 137 now trained in the additional skills required to deliver in-house training and supervision. Worldwide, figures exceed 4300 and 262 respectively (see Table 1). Data exists for those who have been trained over the past 10 years, including data on clinical background (Fig.1), demographics and frequency of contact with family/carers. Our figures indicate a conservative estimate of the number of families that have benefitted from the programme over the past 10 years as 10,000 families. This scale of benefit is achieved because of the large scale of the programme.
2. In determining fidelity to the Falloon model (Behavioural Family Therapy), the programme ensures that the training provided is skills based, including extensive role-play with the opportunity to practice skills and receive constructive feedback. Post-training, course participants can then submit both audio taped sessions and written case reports to achieve a certificate of competency from the programme. Family Intervention trainers are further evaluated on their competencies through use of an observational checklist.
3. The training data continues to inform the work that remains to be done to bring about positive change in the culture of mental health services. From the beginning of the programme, we have used a method of process research whereby data collected are fed back to organisations quickly and regularly so that it informs services of progress, areas of deficit and changes needed. As a result, specialist adaptations to the training, awareness building sessions and training for managers has assisted in working towards organisational change. However, the most obvious benefits are for service users and carers who report feeling much more involved in the care process, feeling listened to by professionals and feeling in more control should their family member experience a relapse.
The programme monitors and evaluates its work on an ongoing basis. Data is collected pre- and post-training from all course participants and each training course evaluated. Data exists for all those who have been trained by the programme over the past 13 years. The programme has evaluated the perception of families who have received family work (Campbell, 2004) and has produced numerous evaluations and reports relative to specific pieces of work and intervention (i.e the range of "Caring for Carers" programmes, Recovery for Carers research). Some of these are available on the website, and all are available on request. Much of the work is documented on an ongoing basis in peer reviewed journals and book chapters. (References attached). Qualitative reports are published quarterly in the programmes widely disseminated newsletter which goes out to over 3,000 people. Copies can also be viewed on the programmes website, www.meridenfamilyprogramme.com.
Key learning points
- To ensure that users and carers are at the heart of services. A Carer who has received family work is now employed by Meriden as a Carer Consultant. Carers and service users are actively involved in the delivery of therapy and training, in special interest groups and in raising the profile of the needs of families.
- To train and supervise multi-disciplinary groups of clinicians, service users and carers in evidence-based family intervention. And the ability to design, adapt and deliver training in a variety of specialist areas.
- To ensure key managers review current practice and develop action plans, which positively influence the culture of services. A key feature in bringing about change has been the development of training for managers so that they are clear about their role in ensuring services to families are developed.
- To host and present at local, national and international events to raise the profile of the the programme, and the needs of families in general. And to raise the profile through awards - Meriden won a Health & Social Care "Positive Practice" Award in 2004 and the Health Service Journal "Innovation in Mental Health" award in 2008.
- To actively support initiatives promoting good practice and work in partnership with voluntary and statutory agencies. Examples include the Royal College of Psychiatrists, SCIE, ISPS and Rethink. For example, Meriden developed training for psychiatry tutors nationally to meet the mandatory requirements on the involvement of carers and service users in the training of psychiatrists. During 2011 we have been involved in the Rethink "Carers and Confidentiality" e-learning programme and in developing our own "Sharing Information with Family and Friends" training. Meriden is also listed in the Department of Health's Policy Implementation Guide for Carers (2002) and cited as an example of good practice in the Social Care Institute for Excellence's guide 30 'Think child, think parent, think family' (2009).
The Meriden Family Programme
Is the example industry-sponsored in any way?