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The Families First programme is designed to improve outcomes for children, young people and families. It places an emphasis on early intervention, prevention, and providing support for whole families, rather than individuals.
The programme promotes greater multi-agency working to ensure families receive coordinated support when they need it, and early enough to prevent problems escalating.
Early detection mechanisms are applied locally through such services and organisations as: the school nurse service, CAMHS (Child and Adolescent Mental Health Services), local authority youth services, GP practices and local health boards. Young people are signposted to a wide range of projects and programmes operated at local level, often by voluntary (third) sector organisations or charities with government funding.
The Team Around the Family (TAF) is one of the five key elements of the Families First programme (see ‘Policy framework’ above). It refers to the model of support which oversees and coordinates the interventions received by families through the programme. As the needs of families being supported by Families First are broader than one service can address, a TAF involves the coordination of multiple agencies in delivering services which take account of the needs of individual families and of the whole family.
‘Together for Children and Young People’ (see ‘Improving the mental health of young people’) also focuses on early identification and intervention.
CAMHS (child and adolescent mental health services) adopt a tiered approach to intervention, which aims to prevent problems from escalating. At Tier 1, young people will generally be identified as potentially in need of support by, for example, a teacher, GP, school nurse or health visitor and signposted to CAMHS. Further signposting to more specialised services may follow after assessment. CAMHS teams include a range of professionals, such as specialist child and adolescent psychiatrists, psychologists, psychotherapists and social workers. Team members may also include educational psychologists, art therapists or speech and language therapists. (See the section on ‘Health Care’ in ‘Access to Quality Services’ for more about CAMHS).
School nurses provide and coordinate health intervention and public health programmes on a range of issues. The school nursing service is in a good position to identify potential and actual problems at an early stage and to be proactive in providing early intervention and advice.
The School Nursing Framework includes in the description of the core service for secondary schools to ‘offer appropriate advice and signposting to support a pupil and their parents / carers when health related issues arise’.
The size of a school nursing team depends on the size and needs of individual schools. The school nurse, as team leader, is responsible for coordinating its work with local health and social care teams, teachers, youth workers, parents, etc.
Guidance to stakeholders
‘Learning sets’ are one of the five key elements of the Families First programme (see ‘Policy framework’ above). Learning sets offer a structured format for groups of staff, agencies and local authorities involved in the programme to come together and share learning at a local, regional and national level. Each local authority has a programme of learning sets to share learning about Families First. The team responsible for evaluating the programme has developed a web-based discussion forum for staff.
The Welsh Government issued non-statutory guidance on the Families First programme in 2017.
Public Health Wales has provided information, primarily for the multi-agency programme board which oversees implementation of the Together for Children and Young People programme (see ‘Improving the mental health of young people’) on risk and protective/resilience factors in relation to children and young people’s mental health.
Target groups vary according to the intervention area. As an example, the Families First Programme guidance identifies risk factors which may predispose young people to require support from targeted youth services. These include:
- experience of being bullied
- exposure to adverse experiences such as parental substance misuse, family conflict, parental imprisonment, domestic violence or poor parental mental health
- negative influences from peer groups
- poor family relationships and a lack of family support
- poor support networks outside of the family.
Services to support the early detection, signposting and treatment of young people facing health risks, such as CAMHS and schools nurses, are funded by the Welsh Government, usually through the health budget provided to NHS Wales.