Primary care

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Toolkit

Young Carers Pharmacy project

Pharmacies are visited by about 1.6 million people every day in England so they are ideally positioned to identify carers of all all ages including young carers. They can therefore play a key role in the early initiation of assessment and support which can be life changing.
Area of Care: 
Primary Care
Outcomes: 
PreventionWellbeingIntegrationCarer awarenessIdentifying carers
I work in: 
Health carePrimary carePharmacy ServicesCarers servicesSocial care
I work with: 
Adult carersYoung adult carersParent carersSibling carersFamilies
Caring for: 
AdultsOlder adultsYoung peopleChildren
Location: 
Whole UK
Date Revised: 
Friday, April 27, 2018 - 15:30
Body: 

The Engaging with Pharmacies toolkit was aimed at young carer services to support them to work collaboratively with pharmacies. It drew on the Young Carers Pharmacy Project that took place between 2014 and 2016. This was delivered by Carers Trust Network Partner Salford Carers Centre as one of Carers Trust’s Innovation Generation projects.

Further information

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Research

A Road Less Rocky Supporting Carers of People with Dementia

A Road Less Rocky is a report from Carers Trust that found that carers of people with dementia are not getting the support and advice they often desperately need.
Area of Care: 
Mental HealthDay centreRehab CentreHospitalCare homesPrimary CareSecondary CareAcute CareDementia care
Outcomes: 
PreventionWellbeingCarer awarenessIdentifying carers
I work in: 
Health carePrimary careHospitalsMental health careHealth and wellbeingPharmacy ServicesCarers servicesInformation and adviceCommissioning for carersSocial careCommissioning
I work with: 
Adult carersYoung adult carers
Caring for: 
AdultsOlder adults
Location: 
Whole UK
Date Revised: 
Friday, April 27, 2018 - 14:00
Body: 

The report found that there were a number of critical points along a carer’s journey where they would most value information and support. These critical points include:

  1. When dementia is diagnosed.
  2. When the carer takes on an 'active' caring role.
  3. When the capacity of the person with dementia declines.
  4. When the carer needs emotional support and/or a break from caring.
  5. When the person with dementia loses their mobility.
  6. When the person with dementia has other health problems.
  7. When the carer has to cope with behavioural problems.
  8. When the carer's own circumstances change.
  9. When the person with dementia becomes incontinent.
  10. When decisions about residential care and end of life care have to be made

We have designed a toolkit around these ten points,the issues carers face at these points and what will make a positive difference. It has been produced to sit alongside A Road Less Rocky and gives guidance to professionals who come in contact with carers. The toolkit is useful for anyone who works with or treats patients with dementia and is therefore likely to come into contact with carers. 

A Road Less Rocky – Supporting Carers of People with Dementia complements the Triangle of Care Carers included: A Guide to best Practice for Dementia Care. This document describes how meaningful involvement and inclusion of carers can lead to better care for people with dementia, identifying six key standards required to achieve better collaboration and partnership with carers.

Although the terminology and legislation referred to in this toolkit applies to England the standards and rationale are applicable across the whole of the UK.

Further information

Find further information and download the full report A Road Less Rocky – Supporting Carers of People with Dementia (PDF, 962KB).

Download the toolkit 

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Good Practice

Identification of carers in GP practices

Not enough carers are likely to be receiving the support they need or are entitled to. One of the main obstacles to carers getting the right support is identification – both self-identification and identification by health professionals.
Area of Care: 
Primary Care
Outcomes: 
PreventionWellbeingCarer awarenessIdentifying carers
I work in: 
Health carePrimary care
I work with: 
Adult carersYoung adult carersYoung carersParent carersSibling carersFamilies
Caring for: 
AdultsOlder adultsYoung peopleChildren
Location: 
Whole UK
Date Revised: 
Friday, April 27, 2018 - 12:45
Body: 


There are an estimated seven million unpaid carers in the UK, however not enough carers are likely to be receiving the support they need or are entitled to. One of the main obstacles to carers getting the right support is identification – both self-identification and identification by health professionals.


Self-identification can be problematic as many carers, understandably, see their relationship with the person they care for as one of being a parent, child, neighbour, friend or partner and don’t recognise 'carer' as a term they would use.


This is why identification by health professionals becomes even more important.


Carers Trust’s Raising the voice of carers project works with local Network Partners and aims to give carers the tools and confidence to campaign on issues that matter to them.

Further information

Read our resource –  PDF iconIdentification of Carers in GP Practices (PDF 434 KB).

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Educational

About Time Grant Evaluations

Following the successful delivery of two About Time Grant programmes, Time for Change and Take Action and Support which addressed issues that can lead to young adult carers becoming disengaged from society, independent evaluations of the two programmes have been produced.
Area of Care: 
Mental HealthPhysical illness
Outcomes: 
PreventionWellbeingIntegrationCarer awarenessIdentifying carersCarers in employment
I work in: 
Primary careMental health careHealth and wellbeingCarers involvementCarers breaksInformation and adviceCommissioning for carersEmploymentSocial careEducationCommissioning
I work with: 
Young adult carers
Caring for: 
AdultsOlder adultsYoung peopleChildren
Location: 
Whole UK
Date Revised: 
Monday, February 12, 2018 - 10:00
Body: 

Key points: 

The objectives of the evaluations were to:
  • Provide an overall evaluation of all data to assess the progress of funded projects against the aims and objectives of the About Time grant programmes and of the wider About Time programme.
  • Conduct a qualitative study with funded projects to identify effective strategies and approaches for supporting and enabling young adult carers.
  • Provide a focused evaluation of data derived from outcomes measurement tools designed to measure the extent of care undertaken, the positive and negative impacts of caring for young adult carers and changes in their lives because of taking part in the funded intervention.
  • Evaluate the impacts of programme delivery and Carers Trust grant making processes on funded organisations.

About Time evaluations

The evaluations of the Time for Change and Take Action and Support grant programmes were structured in three phases and each had its own evaluation report with an overview of the whole programme also produced.

Phase one: February–October 2015

 

Phase two: November 2015–November 2016

PDF iconAbout Time Grant Programmes Evaluation Report Phase 2 November 2015 to November 2016 Executive Summary PDF (177 KB)

PDF iconAbout Time Grant Programmes Evaluation Report Phase 2 November 2015  to November 2016 PDF (323 KB)

Phase three: December 2016–October 2017

PDF icon About Time Grant Programme Evaluation Report Phase 3 December 2016 to October 2017 Executive Summary PDF (251 KB)

PDF icon About Time Grant Programme Evaluation Report Phase 3 December 2016 to October 2017 PDF (483 KB)

Overview Report

PDF icon About Time Grant Programme Evaluation Overview Report PDF (519 KB)

Key achievements and learning from the programmes include:

  • Around 7,200 young adult carers have benefited from 114 projects delivered by Carers Trust Network Partners, exceeding the original target of 6,200 young adult carers.
  • Programmes provided support to significant numbers of young adult carers for the first time, with over half of the young people participating being new to Carers Trust Network Partners.
  • Programmes developed a flexible response to the needs of young adult carers, including individual support, group activities and access to small grants for individuals, alongside the development of partnerships.
  • The programme design involved young adult carers and Network Partners, ensuring programmes reflected specific needs across UK.
  • Projects have been successful in reaching a representative group of young adult carers and there was a good geographic spread of projects across the UK.
  • Carers Trust has enabled Network Partners to deliver effective projects by being flexible about delivery approaches and providing good quality support, information and training.
  • The Carers Trust Network has a unique role in supporting the needs of young adult carers.
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Guidance

Young carers and parental substance or alcohol misuse

Children of parents who are addicted to drugs or alcohol may experience chaotic lives which lack routine and may often worry about the safety of their parent.
Area of Care: 
Alcohol MisuseSubstance Misuse
Outcomes: 
PreventionWellbeingIntegrationHealth inequalitiesCarer awarenessIdentifying carers
I work in: 
Health carePrimary careHospitalsCarers servicesSocial careEducation
I work with: 
Young carersFamilies
Caring for: 
AdultsOlder adults
Location: 
Whole UK
Date Revised: 
Tuesday, November 25, 2014 - 10:15
Body: 

The statistics 

  • 22% of young people under 16 in the UK (2.6 million) live with a hazardous drinker.
  • In the UK, 335,000 children live with a drug dependent parent.

How does parental substance or alcohol misuse affect young carers?

Not all young people who live in families where there is drug or alcohol misuse have a caring role or experience difficulties at home. Those who do may undertake physical tasks, such as domestic chores, dealing with bills, or nursing a parent suffering from drug or alcohol withdrawal, but it is often emotional support that is most prevalent in their caring role.

Children of parents who are addicted to drugs or alcohol may also experience very chaotic lives which lack routine and may often worry about the safety of their parent and fear what, or who they will find on returning home from school or college. Young carers from these families may have had to deal with the aftermath of alcohol and substance misuse in their home.

Parents affected by substance misuse may experience impaired patterns of parental care. This in turn may lead to a higher risk of physical neglect or abuse, poor or limited diet, and missed health appointments, such as the dentist or vaccinations.

Research in 2004 found that where children are caring for a relative with drug or alcohol problems, the incidence of missed school and educational difficulties were considerably higher than for other young carers. 34% were missing school (compared to 27% of young carers) and 40% in total were missing school or had other indicators of educational difficulties (source: Dearden C. & Becker S. (2004) - Young Carers in the UK: the 2004 report - Carers UK and The Children’s Society).

Emotions and thoughts

Young carers who care for a parent affected by substance or alcohol misuse may experience a whole range of differing emotions and thoughts: They may become angry, confused and ashamed or even feel guilty. They may feel like their parent loves drugs and/or drink more than them and they may get teased or bullied because of a family member’s addiction. They may feel very isolated and feel unable to invite friends home.

Support

Fear of stigmatisation and fear of intervention by services can act as barriers to identification and young carers receiving support. Services and support must recognise these particular issues faced by these young people and gain the trust of families and young people in order to encourage openness and engagement.

Like many young carers, this group of young carers need someone to talk to and for their needs to be understood. It helps when they realise that there are other young people in similar circumstances. They also need to understand that they are not responsible for their parents’ choices and that it is not their fault. Early intervention is key.

Dual diagnosis

Some parents may be affected by both substance or alcohol misuse and have a mental health condition. It is, therefore, important to maintain effective links between all agencies involved to provide extra support should they need it.

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Guidance

Triangle of Care Membership Scheme

As the number of mental health providers working to embed the Triangle of Care standards in their organisation continues to grow, Carers Trust felt it was important to offer some recognition of this work and developed the Triangle of Care membership scheme.
Area of Care: 
Mental HealthPhysical illnessAlcohol MisuseSubstance MisuseDay centreRehab CentreHospitalPrimary CareSecondary CareAcute CareDementia care
Outcomes: 
PreventionWellbeingIntegrationCarer awarenessIdentifying carers
I work in: 
Health carePrimary careHospitalsMental health careHealth and wellbeingSocial careCommissioning
I work with: 
Adult carersYoung adult carersYoung carersFamilies
Caring for: 
AdultsOlder adultsYoung peopleChildren
Location: 
England
Date Revised: 
Tuesday, November 22, 2016 - 16:15
Body: 

Triangle of Care Membership Scheme (England only)

As the number of mental health providers working to embed the Triangle of Care standards in their organisation continues to grow, Carers Trust felt it was important to offer some recognition of this work and developed the Triangle of Care membership scheme. A three stage recognition process for services who commit to self-assessing their existing services and action planning to ensure the Triangle of Care standards are achieved. The membership scheme is not a "kitemark" scheme that shows work has ended but is to recognise long term commitment from mental health providers who are working towards cultural change.

Carers Trust has developed a simple membership scheme and application process. 

What does being a member mean?

When a Mental Health Trust joins the Triangle of Care membership scheme, they are basically committing to changing the culture of their organisation to one that is carer inclusive and supportive. They do this by completing self-assessment for all their services in partnership with carers and then work on what needs to change to ensure carers are part of the core business of their Trust.

What do the stars mean?

Trusts who join the membership scheme and complete the appropriate stages for their organisation receive an award to recognise their commitment. For Mental Health Trusts this is up to two stars and for Trusts that are integrated there is a third star. They receive the first for completing stage one (self-assessing all inpatient and crisis teams) and then committing to improve. The second star is for completing self-assessments for all of their community services. This is all mental health, learning disability, older people and dementia and substance misuse services. Trusts who are integrated (provide community physical health services), they receive a third star if they complete self-assessment in all of their physical health services.

The stars do not signify that member trusts are fully carer inclusive. They are awarded when the trust has demonstrated a commitment to becoming more carer inclusive, has shown honesty about where they are now and planned where they need to be to ensure carers are better identified and supported.

The documents you will need to join the membership scheme are:

A number of organisations provide services that the existing Triangle of Care self-assessment would not be suitable for. These services fall into two categories: limited contact services (for example Liaison Psychiatry) and Community Health Services (for example district nursing). As such we have developed some additional guidance to help these services implement the Triangle of Care as well as a "universal" self-assessment tool.

Mental health providers are recommended to use the Triangle of Care Implementation Toolkit to ensure all elements required for successful implementation are in place, you can find full information on the toolkit here: Triangle of Care Toolkit - A Resource for Mental Health Service Providers.

As a requirement of membership, mental health providers must have carer partners who will act as critical friends to the process. Carers Trust has developed guidance to support carers and carer organisations to act as critical friends and the process to be as successful and positive as possible. You can download the Carer Toolkit here: PDF iconTriangle of Care Toolkit for Carers & Carer Organisations

You can download the documents here:

PDF iconTriangle of Care Guidance for Limited Contact Services

PDF iconTriangle of Care Guidance for Community Health Services

Microsoft Office document iconTriangle of Care Self -Assessment Tool for Community Health Services

Mental Health Trusts who have joined the Triangle of Care Membership Scheme (updated March 2018) are:

New members undertaking Stage One:

  • Camden and Islington NHS Foundation Trust
  • Central and North West London NHS Foundation Trust
  • Coventry and Warwickshire Partnership NHS Trust
  • Cumbria Partnership NHS Foundation Trust
  • Southern Healthcare

Members who have completed Stage One and are currently undertaking Stage Two:

  • Birmingham & Solihull Mental Health NHS Foundation Trust
  • Bradford District Care Foundation Trust
  • Devon Partnership NHS Trust
  • Dorset Healthcare University NHS Foundation Trust
  • Lancashire Care NHS Foundation Trust
  • Leeds & York Partnership NHS Foundation Trust
  • Livewell South West
  • Pennine Care NHS Foundation Trust
  • South Staffordshire & Shropshire Healthcare NHS Foundation Trust
  • South West London and St George’s Mental Health NHS Trust
  • Sussex Partnership NHS Trust
  • West London Mental Health NHS Trust

Trusts who have completed Stages One and Two:

  • 2gether NHS Foundation Trust
  • Avon & Wiltshire Mental Health Partnership NHS Trust
  • Berkshire Healthcare NHS Foundation Trust
  • Cheshire and Wirral Partnership NHS Foundation Trust
  • Cornwall Partnership NHS Foundation Trust
  • Derbyshire Healthcare NHS Foundation Trust
  • Dudley and Walsall Mental Health Partnership NHS Trust
  • Greater Manchester Mental Health NHS Foundation Trust
  • Hertfordshire Partnership University NHS Foundation Trust
  • Kent and Medway NHS and Social Care Partnership Trust
  • Lincolnshire Partnership NHS Foundation Trust
  • Mersey Care NHS Trust
  • Norfolk & Suffolk NHS Foundation Trust
  • Northumberland, Tyne and Wear NHS Foundation Trust
  • Nottinghamshire Healthcare NHS Foundation Trust
  • Oxford Health NHS Foundation Trust
  • Somerset Partnership NHS Foundation Trust
  • Surrey and Borders Partnership NHS Foundation Trust
  • Tees Esk and Wear Valley NHS Foundation Trust

Trusts who completed Stages One, Two and Three:

  • Cambridgeshire & Peterborough NHS Foundation Trust
  • Rotherham, Doncaster and South Humber Mental Health NHS Foundation Trust
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Guidance

Triangle of Care for Mental Health

The Triangle of Care guide can be used across all mental health services, not only inpatient, and includes a universal self-assessment tool as well as guidance notes.
Area of Care: 
Mental HealthAlcohol MisuseSubstance MisuseSecondary CareAcute Care
Outcomes: 
PreventionWellbeingCarer awarenessIdentifying carers
I work in: 
Health carePrimary careHospitalsMental health careHealth and wellbeingCarers servicesCarers involvementCommissioning for carersCommissioning for young carers
I work with: 
Adult carersYoung adult carersYoung carers
Caring for: 
AdultsOlder adultsYoung peopleChildren
Location: 
England
Date Revised: 
Thursday, January 28, 2016 - 13:15
Body: 

The Triangle of Care, Carers Included: A Guide to Best Practice in Mental Health Care in England

Triangle of Care logoThe The Triangle of Care, Carers Included: A Guide to Best Practice in Mental Health Care in England (PDF, 241KB) can be used across all mental health services, not only inpatient, and includes a universal self-assessment tool as well as guidance notes. In addition the guide now includes good practice examples from across the mental health care pathway. Although the Triangle of Care uses the language of mental health with a little imagination it can easily be used in children's, older people's, learning disability and substance misuse services.

The Triangle of Care guide was launched in July 2010 as a joint piece of work between Carers Trust and the National Mental Health Development Unit, emphasizing the need for better local strategic involvement of carers and families in the care planning and treatment of people with mental ill-health.

The Triangle of Care approach was developed by carers and staff to improve carer engagement in acute inpatient and home treatment services. The guide outlines key elements to achieving this as well as examples of good practice. It recommends better partnership working between service users and their carers, and organisations.

There are a wealth of good practice examples cited in the Triangle of Care guide, these are held on the RCN Virtual Ward (with even more not listed).

Our new guide for mental health professionals working in children and young people’s mental health services in England

See our latest guide, published on 10 October 2019 – The Triangle of Care for Children and Young People’s Mental Health Services (CYP MHS).

The Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in Scotland

The Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in Scotland has been produced in partnership with agencies throughout Scotland including Scottish Government, NHS Scotland, NHS health boards, local authorities throughout Scotland, Mental Welfare Commission Scotland, Support in Mind Scotland, Scottish Recovery Network and many dedicated Network Partners, carers and professionals. 

PDF iconThe Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in Scotland

The Triangle of Care for Young Carers and Young Adult Carers, A Guide for Mental Health Professionals

The Triangle of Care programme has identifed that many frontline staff are unaware of who young carers are and what their needs are. Thanks to the support of NHS England, Carers Trust has produced a supplementary resource to support staff to understand the needs of young and young adult carers, what the challenges are to identifying them and how to overcome them. The resource supports the wider implementation of the Triangle of Care and works to ensure that all carers are included and supported by mental health services.

You can download a copy of the resource here: PDF iconTriangle of Care for Young and Young Adult Carers

Carers Strategy refresh

The guide received further validation when it was included in the Carers Strategy refresh in November 2010 and No Health without Mental Health in February 2011. The Triangle of Care was included as a clear action in Closing the Gap 2014, the government’s mental health action plan. In addition we have had enquiries from as far away as New Zealand about how to go about adopting the Triangle of Care standards in their services.

England Regional Groups

Regional groups have been established in all parts of England; the majority of NHS mental health providers and over 30 third sector carers’ organisations are involved. The group works in partnership to share good practice and problem solve to work towards implementing the Triangle of Care standards in mental health services. A number of group members have taken the next step to formally embed Triangle of Care in their services by joining the membership scheme.

Find out if your local NHS mental health provider has joined the membership scheme.

If your organisation is interested in joining your regional group please email policy@carers.org.

Downloads: 
Microsoft Office document icon Triangle of Care self-assessment tool PDF icon The Triangle of Care, Carers Included: A Guide to Best Practice in Mental Health Care in England (PDF, 241KB)
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