Young Carers and Young Adult Carers

Executive Summary

Children and young people are at risk of becoming young carers (under 18 years old) and young adult carers (18-25 years old) if they are relied upon in maintaining the health, safety or day to day caring of the person who:

  • needs medication
  • has a physical or sensory disability
  • has a mental illness or suffers drug and/or alcohol misuse
  • has life threatening and life limiting conditions.

Children and young people who are living in single parent homes, families in poverty, black and minority ethnic (BME) communities, military families, families with prisoners/ex-prisoners are also more likely to be young carers and young adult carers.

The Children and Families Act 2014 and the Care Act 2014 require all local authorities in England to identify and assess young carers under 18 on the appearance of need. This has highlighted the importance of an integrated approach by local authorities, health, education and carers organisations to identify, assess and support young carers and young adult carers. Surrey has adopted this approach through the memoranda of understanding, ‘Together for Carers and No Wrong Doors’, with partner organisations which is supported by the Surrey Carers Commissioning and Development Strategy. As a result, the number of young carers known to the services and supported by Surrey Young Carers is continuing to rise, although awareness raising amongst professionals and public as well as information sharing across agencies are key to further increase identification and improve assessment and support to this vulnerable group.

Further identification and understanding of young carers who are caring for someone suffering substance misuse; under the age of 8; military young carers, children of prisoners/ex-prisoners and those young carers who have special educational needs and disabilities is needed. Further support is required during transition to ensure that young carers are given appropriate advice and support when they move into adult services. This should include those young carers who do not currently receive any children’s service.

Professionals and services that young cares come into contact with should be more flexible and adaptive to the young carer’s life. Support services such as Child and Adolescent Mental Health (CAMHS) should be located at places that young carers find accessible. Young carers supported by Surrey Young Carers regard the respite activities and the subsidised cost of leisure services as important to their wellbeing. Mental health and wellbeing services should aim to help building young carers’ resilience and finding strength to carry on through managing stress/frustrations. A bereavement service which helps young carers and young adult carers to cope with the death of a loved one is also needed.

Introduction

The Children and Families Act 2014 and the Care Act 2014 require all local authorities in England to identify and assess young carers under 18 on the appearance of need. The Children and Families Act 2014 amended Section 17 of the Children Act and gives young carers a right to an assessment of their own needs, no matter how much caring they do (1). The Care Act 2014 introduces a ‘whole family approach’ which means that the assessment of adults in need of care should trigger a young carer assessment of children in the household. The Care Act requires that transition assessments are offered to young carers before they turn 18, so that they can plan for the future with their families (2).

These legislative changes and the national research have highlighted the importance of an integrated approach by local authorities, health, education and carers organisations to identify, assess and support young carers and young adult carers (3). This chapter aims to provide a deeper understanding of the profile, needs and experience of young carers and young adult carers in Surrey so as to inform the planning, commissioning and delivering of services for better outcomes of young carers and young adult carers.

A young carer is a child or young person under 18 who provides care and emotional support to a family member who is physically or mentally ill, disabled or misuses substances. The term young carer does not apply to everyday or occasional help that may occur in all families. It is specific to care that is relied upon in maintaining the health, safety or day to day wellbeing of the person receiving support or care (4).

A young adult carer in Surrey is someone who is aged between 18 – 24 years old.

Who’s at risk and why?

Children and young people with parents or siblings who have a mental illness or suffer drug and/or alcohol misuse

Research identified that there are challenges in the self identification of children and young people who support a parent with mental illness or drug and/or alcohol misuse (5). Children and young people can become isolated due to the stigma of a parent with mental illness (6).

Children and young people with parents or siblings who have a physical or sensory disability

Young carers and young adult carers may be at risk of injury providing physical support to the person they care for. They are also more likely to provide intimate care (7).

Children and young people caring for someone who needs medication

Young carers and young adult carers may be relied upon to administer medication to the person they care for. This can be a worrying task for a child or young person who may feel responsible that one mistake could be fatal (8).

Children and young people caring for someone with life threatening and life limiting conditions

The strategy for Public Health in England recognises that if the person being cared for reaches a critical point unprepared, carers are at risk of experiencing a traumatic bereavement with associated mental and physical health issues (9).

Children and young people who are heavily involved in caring

“Heavily involved” means a young carer is taking on “adult like responsibilities and where caring roles impact on their own psycho-social development, health, education and wellbeing” (10). Research in Surrey identified that no young adult carers report being “at ease” with their caring role and that most carers in this role felt restrained by this relationship as they got older (11). Statutory guidance for both the Care Act and Children’s legislation make clear that young carers should be protected from inappropriate care.

Children under 8 with caring responsibilities

A report by the Children Commissioner indicates that 22 out of 102 local authorities have assessed and provided support for young carers under 5 (12). The 2011 census shows nearly 10,000 young carers aged 5-7 in England and Wales. The report highlights that many services for young carers only start working with children once they reach eight years old and hence services are often not tailored to meet the needs of this particular group (13).
Children and young people in military families

A military young carer is a military or veteran dependent child or young person between the ages of 5 -18 years of age, who helps look after a relative who has a condition, such as a disability, illness, mental health condition, or a drug or alcohol problem. They may be caring for a member of their military family (parent or sibling) and extended family (grandparents or relatives) (14).

Children of prisoners/ex-prisoners with a disability, mental health or substance misuse

It is estimated that 200,000 children are affected by parental imprisonment across England and Wales. Children with a parent in prison feel isolated and unable to talk about their situation because they are scared of being bullied and judged. These children are twice as likely to experience conduct and mental health problems, and less likely to do well at school. They are three times more likely to be involved in offending. Sixty five per cent of boys with a convicted father will go on to offend themselves (15).

Special Educational Needs and Disabilities (SEND)

Young carers are 1.5 times more likely to have a disability, long term illness or special need (16).

Black and minority ethnic (BME) groups

Research in Hidden from View found young carers are 1.5 times more likely to be from BME communities and are twice as likely not to speak English as their first language than peers. However previous data shows that children and young people from BME communities are often less likely to self identify (17). Children and young people in the Gypsy Roma Traveller community are at risk of becoming young carers and young adult carers as the adults from the GRT community are more likely to suffer chronic ill health or suffer more than one health condition (18).

Families in poverty

The average annual income for a family with a young carer is £5,000 less than those who don’t have a young carer (19). Families with less disposable income may have less choice and become reliant on informal care where they are unable to fund other care options (20).

Children and young people in single parent homes

Children and young people from lone parent families are more likely to take on caring responsibilities if there is no other responsible adult available to provide care. Results of three national surveys of young carers showed over half of the young carers were from lone parent families and most were caring for ill or disabled mothers (21).

Education, Employment or Training

Caring responsibilities can impact attendance and engagement with education services and this continues to affect young carers as they get older. Young adult carers under 20 years old are more likely to be not in education, employment or training (NEET) (22). The concern for young adult carers is that a caring role at this stage in life can affect future life opportunities (23).

The level of need in the population

Overview

The estimated number of young carers aged 0 -18 years old in Surrey, based on findings from a BBC and University of Nottingham survey in 2010, is 14,030 (24). The 2011 census indicates that there are 6,021 children and young people age 0 – 24 years old providing unpaid care in Surrey. The highest density is in South East of Surrey (2% of the population), followed by North West (1.9%), North East (1.8%) and South West (1.7%) (25). The number of young carers identified in the 2011 census is far below the number estimated by the survey therefore there are likely to be young carers who have not been identified by the parent/carer completing the questionnaire.

Child and Family Assessment

In the period of April 2014 and February 2017, there were 1,518 Child and Family Assessments where ‘Young Carer’ was selected as a factor in the assessments. The proportions of male and female young carers were roughly the same. The majority of these young carers were aged 5 to 9 (30%) and 10 to 15 (43%). 75% of the young carers were white British. There were 210 (14%) young carers recorded as having some form of disabilities.

Around 55% of the assessments came from Reigate and Banstead, Spelthorne, Guildford, Elmbridge and Waverley. The majority of the Child and Family Assessments led to a Child in Need Plan (33%), other actions including Initial Child Protection Conferences (25%) and putting a team around the family (15%). However, 355 (23%) of the assessments were recorded as no further action and this includes 27 young carers who had some form of disabilities. Further work will be needed to establish what other help or support have been offered to these young carers.

Source: Children’s Services, Surrey County Council

Adult Social Care Services

Adult Social Care Services identify young carers and seek to ensure that services they provided to the adult service user reflect the needs of the young carer.

The number of young carers recorded as known to Adult Social Care Services is continuing to rise although there still is thought to be under recording. The figures below are tracking progress during 2015/16. By March 2016 the number had risen to 304.

Surrey Young Carers

25% of the referrals to Surrey Young Carers came from Children’s and Adult Social Care Services of Surrey County Council. 20% were self-referrals and 10% were from carers support organisations. There was 35% from other non-specified sources.

Source: Surrey County Council Adult Social Care (4 August 2017)

The total number of young carers supported by Surrey Young Carers has increased from 1,392 in 2012/13 to 2,212 in 2015/16 (26). As at 6 February 2017, Surrey Young Carers and Action for Carers were supporting a total of 1,812 young carers and young adult carers aged 4 to 24 in Surrey. About 14% of the total were under 8 years old, 73% aged 9 to 17 and 13% were between 18 and 24 years old. Overall, there were more males than females particularly in the age group of 9 to 17. Around 75% of the young carers and young adult carers were White British. Ther current system does not record if any young carers and young adult carers have any form of disabilities.

Source: Surrey Young Carers

Ethnicity Percentage
Indian 0.6%
Bangladeshi 0.1%
African 0.5%
Caribbean 0.3%
Other black 0.6%
Other ethnic 1.9%
Other mixed background 5.1%
Other white 2.7%
Pakistani 1.9%
White British 74.8%
Not known 11.6%

Source: Surrey Young Carers (6 February 2017)

Guildford not only had the highest total number of young cares and young adult carers but it also had the highest numbers across all age bands. Waverley and Reigate and Banstead had the second and third highest total numbers respectively. In comparison, Surrey Health and Epsom and Ewell had the lowest numbers of young carers and young adult carers. This reflects a similar picture of the Child and Family Assessment.

Source: Surrey Young Carers

Overall, 44% of young carers and young adult carers were caring for someone under 18, whereas 48% were caring for an adult up to the age of 64. It is particularly concerning that 32% of the young carers under the age of 8 were caring for an adult.

Source: Surrey Young Carers

The highest percentage of cared for people have physical/sensory difficulties as a main health condition followed closely by Autism Spectrum Disorder and Mental Health. About 1% of those being cared for have a main health condition of substance misuse. This low percentage may be due to the stigma and barriers to seeking support where the person being cared for is suffering drug or alcohol abuse (27). There were 26 young carers under the age of 8 caring for someone with mental health issue and one caring with someone with substance misuse. Appropriate help and support will be needed for these very young carers.

Main health condition of the person cared for Young Carers and Young Adult Carers Percentage
Under 8 Aged 9 to 17 Aged 18 to 24
Physical / sensory difficulties 35 374 50 25%
Autism Spectrum Disorder 45 339 23 22%
Mental health (excluding Dementia) 26 275 64 20%
Multiple / other health condition 12 85 63 9%
Learning difficulties 7 120 22 8%
Substance misuse 1 19 5 1%
Dementia 1 6 3 1%
Not known 120 109 8 13%

Source: Surrey Young Carers (6 February 2017)

The majority (56%) of the young carers and young adult carers spent an average of 10-19 hours or 20-34 hours per week in caring for someone. About 9% cared for someone between 35 and 49 hours per week. There were, however, 2% spent an average of 49 hours or over per week. The remaining 24% were unknown. It is concerning that around 4% (9) of young carers under the age of 8 spent an average of 35 to 49 hours per week caring for someone. In order to support the effectiveness of service provision, it would be useful to have data with regard to the types of care being provided by the young carers and young adult carers.

Amount of care provided – hours per week

Source: Surrey Young Carers (6 February 2017)

Surrey Young Carers provide four levels of support depending on the assessed needs of the young carers and young adult carers. They can move between the different levels of support due to a change in their caring role and level of impact. The majority of the young carers and young adult carers (78%) were achieving life opportunities and experiences a low level of impact from their caring role. 14% of them were affected by their caring role but with early help and intervention their life opportunities can be achieved. Around 3% (56) of the young carers and young adult carers were at risk and vulnerable and their caring situation were seriously impacting on their life opportunities. 14% (8) of those who were at risk were young carers under the age of 8.

Source: Surrey Young Carers (6 February 2017)

Surrey Young Carers Forum

Early this year, two representatives from Surrey County Council attended one of the Surrey Young Carers Forum in order to gain a deeper understanding of the needs of young carers. There were nine young carers in attendance at the forum. The key themes arising from the meeting are:

  • Registering for support should be quicker and easier so that young carers are not left without support. Young carer should not have to bring proof of their young carer status every time they try to access some services.
  • Professionals and services that young carers come into contact with should be more flexible and adaptive to the young carer’s life. Child and Adolescent Mental Health (CAMHS) service was mentioned as too formal and appointments were set at inconvenient times and locations.
  • Support services should be located at places that young carers find accessible. Many of the young carers said that support services should be located within schools/colleges.
  • Many of the young carers wanted to remain and succeed in their education but bullying had caused some young carers to remove themselves from mainstream education.
  • The council should provide appropriate support to home-schooled young carers for example in purchasing learning materials such as books and online packages.
  • The PSHE education should include a module about young carers to raise awareness and understanding of the challenges faced by young carers amongst teachers and pupils.
  • The council should continue the respite activities and the subsidised cost of leisure services as they are important to the wellbeing of the young carers.
  • Transitions from children’s services to adult services should be smoother. There should not be periods of time where young carers are left without an adequate support system when they move into adult services.
  • The council should do more to make young carers aware of support services such as the Surrey Young Carers forum.

Health Related Behaviour Questionnaire for schools

In 2016, Surrey County Council conducted a Health Related Behaviour Questionnaire with schools and 168 children in the secondary schools self-identified themselves as young carers. The key findings are:

  • 33% of the young carers responded that they had been bullied at or near their schools and 43% had experienced online abuse by other pupils.
  • 38% of the young carers were afraid of going to schools and 11% had stopped going to school because of worries about bullying.
  • 29% of the young carers said that they had cut or hurt themselves when feeling stressed or worrying about problems, whereas 35% were worrying about their mental health.
  • 13% of the young carers had drunk alcohol in the 7 days before completing the survey whilst 6% had taken drugs to get high.
  • 83% had never heard of CATCH 22. 26% said that they had never learned about contraception from anywhere and 71% had never heard of Contraception And Sexual Health (CASH) clinics.
  • An average of 11% of the young carers had not found the lessons at school about bullying, emotional health and wellbeing, drug, sex and relationships education useful (28).

Surrey Young Carers Health Survey

The Surrey Young Carers Health Survey 2013 found that 35% of respondents recognised they experienced the symptoms of an eating disorder with 10% relating this specifically to their caring role. Harmful coping mechanisms such as self-harm, alcohol misuse or smoking may exacerbate health problems for young carers. When asked how caring affected their health there was a high response for factors that affect emotional health and wellbeing. 65% of respondents had felt stressed, 50% had felt anger, 28% had experienced depression, 28% had felt anxious and 9% had self harmed (29).

Military young carers

The Royal British Legion Household Survey in 2014 estimated that there are
6,200 service personnel and 680 military families in Surrey. It indicated that there are around 1,375 military young carers in Surrey (30). The 2016 school census showed a slightly lower figure of 1,265 pupils in maintained, academies and free schools in Surrey who are receiving the Service Pupil Premium. The highest proportion of all service pupils in Surrey live in Surrey Heath (35% or 444) and Guildford (15% or 185) (31). Service families are located close to major military establishments in Surrey which are The Royal Military Academy Sandhurst, The Army Training Centre Pirbright and Princess Royal Barracks Deepcut, and the Defence Medical Rehabilitation Centre, Headley Court.

Military young carers can face extra caring responsibilities than their non-military family peers. Research demonstrates that young carers in military families may be caring for a parent/sibling who has returned from combat injured, both physically or emotionally, or they may be caring for the parent who has health problems while their other parent is away with the military. Additionally, a child or young carer may have to provide emotional support to a parent who has begun the transition from the Armed Forces back in to civilian life (32). Furthermore, many military families do not live within close proximity to their extended family, which has the increased potential to limit extra support. Military families may also have to endure bereavement or physical or mental injuries as a consequence of the job (33). Service children are more likely to change school than non-service children in both Primary and Secondary school which may have an impact on their education (34).

Family Support Programme (FSP)

During 2016/17, there were 40 families in the Family Support Programme identified with young carers. A family which has met at least 2 of the 6 criteria below is eligible to be supported by the Family Support Programme. The following breakdown indicates that the majority of the 40 families had members with poor health and mental health issues. These families were identified or assessed as needing Early Help and they were in receipt of out of work benefits. Some families also had children with special educational needs and safeguarding issues. Persistent absence from education was also prevalent (35).

Family Support Programme
Criteria
Number of families*
Worklessness Significant/Unmanaged Debt 11
In receipt of Out of Work Benefits 19
Children Needing Help Identified/Assessed as needing Early Help 33
Child in Need/subject to an enquiry/Child Protection Plan 5
Education Persistent absence (+10% last 3 consecutive school terms) 15
Child with Social Emotional Mental Health (SEMH) impacting on education 13
Health Mental Health issue 30
Poor health impacting on whole family, e.g. obesity 19
Domestic Abuse Child to parent violence reported 5
Police call out for one or more incidents in last 12 months 4
Crime 3

*A family can meet two or more of the criteria and it can be counted more than once.

Source: Performance and Knowledge Management, Surrey County Council

Services in relation to need.

There are various levels of services and support to young carers based on their needs.

Universal Services

Early Help

Early help means providing support as soon as a problem emerges, at any point in a child’s life, from the foundation years, through to the teenage years. Young carer is included in the Surrey Levels of need document which enables agencies to decide the most appropriate support to the young carers and their families, for example, through an Early Help Assessment and Team around the Family (36).

Surrey Emotional Wellbeing and Mental Health (EWMH) offer

Surrey’s EWMH offer delivers preventative services and treatment to children and young people to help build their resilience, wellbeing and support a wide range of mental health issues. Services are commissioned from universal to acute provision with a key focus on early intervention and identification. These services may become involved with a young carer who needs support or they may be working with the person the young carer is caring for.

Children’s Community Health Services

The service brings together physical and emotional wellbeing services for children and families and it provides a better system of working across the following services:

  • Health visiting – supporting parents and carers with younger children to give them the best start in life through proactive health and parenting advice and support, from before birth to five years of age.
  • School nursing -routine health checks, as well as advice and support, for children and young people of school-age and their families. This also includes nursing for, and within, special schools.
  • School-age immunisations – vaccinations given as part of the national immunisation programme for school age children and young people.
  • Specialist nursing and therapies for children with additional needs – paediatric medical, nursing and therapy services for children with additional physical, medical and learning disability needs.
  • Emotional wellbeing services – supporting the emotional wellbeing of school age children and young people, and for parents with a child under one year.

Targeted Mental Health in Schools (TaMHS)

The promotion of positive emotional wellbeing and mental health in schools is recognised as being key to building resilience and giving children and young people a greater understanding of mental health. TaMHS promotes positive mental health and enables schools to access training and support in order to help meet the emotional and mental health needs of local communities.

‘Everybody’s Business’ Training is a multi-agency / multi-disciplinary training offer that provides awareness level training for Universal staff. The training equips staff to recognise the early signs of emerging mental illness and emotional distress in children and young people and by increasing their confidence to know how to support them. Staff also have a greater understanding of when and how to appropriately refer to more specialist services as required. A representative from Child and Adolescent Mental Health Youth Advisors (CYA) attend to provide a young person’s perspective about receiving services and how best they can be supported with their mental health issues.

Child and Adolescent Mental Health Youth Advisors (CYA)

CYA is a network of around 250 young people who all access or have accessed mental health services in Surrey. CYA works to ensure that children and young people who use CAMHS have a voice in what goes on in CAMHS through being involved in recruitment, staff training, service development and lots more. CYA present at schools and colleges to raise awareness and reduce stigma around mental health, by sharing young people’s experiences and provide information and training to the Police and GP’s from a young person’s perspective of mental health.

Healthy Schools Programme

The programme offers guidance to schools regarding young carers. Education Advisors who are employed by Surrey Young Carers can assist schools in identifying and supporting young carers (37). The service is free and includes training, briefings, consultations for teachers, assembly talks to pupils, a listening support service for pupils and Personal Social and Health Education resources for Key Stages 2, 3 and 4. The Education Advisors can provide guidance on implementing tools such as the education support plan.

Children and Young People’s Haven (10-18 years old)

The Children and Young People’s Haven is another option for CYP to go to seek support for their EWMH needs. It provides a safe place for young people aged 10-18 to go to and talk about their emotional and mental health in a confidential, friendly and supportive environment. Based in Guildford, the Haven provides a drop-in service by a number of professionals including a Mental Health Nurse, a Youth Worker and a Peer Mentor. Plans are in place to develop a further 2 Haven’s across the county over the next year.

Safe Havens (18-64 years old)

Safe Havens provide out of hours expert help and advice from professionals to people and their carers who are experiencing a mental health crisis or emotional distress. There are five Safe Havens in total across Surrey and North East Hampshire which provide a safe, relaxed and friendly environment. They are open evenings, weekends and bank holidays and are designed to give adults a safe alternative to Accident and Emergency when in crisis. They are staffed by a Surrey and Borders mental health practitioner and 2 trained Safe Haven workers.

For more information of emotional wellbeing and mental health, please see JSNA Chapter: Emotional Wellbeing and Mental Health.

Targeted Services

Surrey Young Carers is part of registered charity Action for Carers and supports carers who are under 18 years old. The service provides online information, one to one support, advice and advocacy, workshops, residential breaks, activities, support with school/college and training for professionals (38).

Action for Carers support young adult carers aged 18 – 24 and carers who are over 18 years old. It has created ‘Be informed’ an interactive booklet aimed at young adult (39). There is a Work 16 – 24 Development Officer who provides specialist support for young adult carers in regards to learning and work. They also have a role in assisting older young carers in preparation for further education and work.

Surrey Military Young Carers – Action for Carers has appointed a staff member to lead on this and it has created a new website for military young carers (40). The lead person works with a community integrated task group, set up by the Surrey Military Partnership Board, to support and advocate on behalf of the Armed Forces community including serving personnel and their families. The Army Welfare Service is a professional and confidential welfare support service for Army personnel families.

Carers Support

There is a countywide Carers Support service covering all parts of Surrey also delivered by Action for Carers Surrey. Although this service provides support to adult carers it is important in helping identify where there are young carers in the families they support and making appropriate referrals for support.

Surrey Family Support Programme offers a whole family approach co-ordinating a team of people and agencies with specialist skills to help families. Family with a young carer is included in one of the eligibility criteria. The programme has enabled young carers to be identified and supported.

Services for Young People recognise that young carers are at greater risk of being not in education or employment (NEET). The Young People’s Employability Plan 2012 -17 shows a commitment to working with vulnerable groups such as young carers to promote the benefits of participation (41).

Crossroads Care Surrey provide flexible respite care service for carers who are looking after family or friends, helping to avoid admission to hospital or residential care of the person being cared for. Services are provided in both home and community settings. Crossroads also provide an End of Life Carer Support Service, for carers who are looking after someone with an end of life diagnosis. Regular short breaks can be offered to carers through a fast-track service to reduce the stress and fatigue that they may experience as a result of their caring role.

Emotional Wellbeing

As well as counselling services that can be accessed through the GP there are free confidential services available to young people in Surrey:

  • Heads Together (East Surrey) – Up to 12 weeks free counselling to young people aged 14 – 24 years old.
  • Youth Counselling Service (West Surrey) – Free counselling service for young people aged 12 – 24 years old.
  • Further services can be found through Youngminds, a charity committed to improving the emotional wellbeing and mental health of children and young people. See www.youngminds.org.uk

Emotional Wellbeing and Mental Health Targeted Services

These services help children and young people with more specific needs. The key services that are commissioned in Surrey are listed below. For more information on emotional wellbeing and mental health services, please see JSNA Chapter: Emotional Wellbeing and Mental Health.

  • Primary Mental Health Service
  • CAMHS Extended Hours Service
  • Looked After Children (CAMHS Children in Care Service)
  • Adopted Children and Special Guardianship Order (Post Order Service)
  • Care Leavers Service
  • HOPE Services (Epsom & Guildford)
  • Extended HOPE Service
  • STARS (Sexual Trauma and Recovery Service)
  • Parent Infant Mental Health Service
  • Behavioural, emotional neurodevelopmental (BEN) Pathway

Specialist Services

Surrey Children with Disabilities Teams

The Children with Disabilities team may identify young carers who are siblings of a child or young person receiving a service. Currently the Social Worker in the Children with Disabilities Team will consider the needs of the young carer as part of the sibling’s assessment. Services can be accessed for the young carer by the Social Worker in the Children with Disabilities Team.

Surrey Children’s Social Services

A young carer may be supported through a Child and Family Assessment if there is a concern they are a child in need (CiN) under the Children Act 1989. If a young carer is the main carer or providing an inappropriate level of care and is at risk of harm they may become subject to a child protection plan or become a looked after child.

Emotional Wellbeing and Mental Health Specialist Services

Specialist level services can help support children and young people with their complex emotional wellbeing and behaviour needs. Specialist services can also help to prevent children and young people from having an unnecessary admissions to an adolescent psychiatric bed. The key services that are commissioned in Surrey are listed below. For more information of emotional wellbeing and mental health, please see JSNA Chapter: Emotional Wellbeing and Mental Health.

  • Community Child and Adolescent Mental Health Services
  • Children and young people Learning Disability Service
  • Eating Disorder Service
  • Hard to engage 16-25 year old service– known locally as the Mindful Service

Surrey Adult Social Care support young carers as part of the whole family approach. In 2015, the Children and Adult Social Care Services of Surrey County Council and Surrey and Borders Partnership NHS Trust agreed a Memorandum of Understanding, ‘No Wrong Doors’, to ensure effective joint working to support young carers and their families regardless of which service is contacted in the first place. A young carers can request a Young Carer Needs Assessment (42). The assessment is an opportunity to discuss with social care practitioner what support or services a young carer needs. The assessment will look at how caring affects the carers life and whether they are able or willing to carry on caring.

Mental Health services for adults have a similar role to Adult Social Care Service in identifying young carers and seeking to ensure that services they provided to the adult with mental health reflect the needs of the young carer as well as the person they look after.

Unmet needs and service gaps

Early identification and tailored support to young carers under the age of 8 years is needed. More attention should be directed at identifying and supporting children younger than 8 who may not be aware that they are a young carer themselves. Schools, health and universal services play a key role in their early identification.

Early identification and tailored support to military young carers is needed. Identification and understanding of the needs of young carers from military families is needed in order to provide tailored support to their needs. Specialist support may include helping young carers understand the role of rehabilitation, or providing extra support for a parent when the other parent is on tour.

Further identification of young carers caring for someone suffering substance misuse is needed in Surrey. Those caring for someone with substance misuse face barriers in being identified as young carer (43). It is important that all services contribute to the multi-agency strategy group for young carers and agree an updated joint protocol.

Young carers who are female and/or from BME groups may be missing out on early help services.

Children, young people and their families are less likely to contact Surrey Young Carers directly than be referred by another agency. In 2016/17, 25% of the referrals to Surrey Young Carers came from Children’s and Adult Social Care Services whereas 20% were self-referrals. This could mean that further awareness raising is needed to give families the confidence to self-refer. However other agencies often refer at the request of the young carer and their family so it may show families feel more confident being referred to the service rather than approaching on their own. This raises the importance of all agencies having the knowledge to identify young carers and make a referral to Surrey Young Carers.

Clarification of help provision is needed to those young carers with an outcome of no further action after the Child and Family Assessment.

No young carers should be left without any form of support after being identified through the system. A tracking system is needed to ensure that they have been given appropriate advice, support and information.

Clarification is needed for who will be responsible for the assessment of young carers if the person being cared for is not receiving a statutory service. This requires discussion between Children’s Social Care, Early Help and Adult Social Care. Whilst this is for the local authority to resolve, the multi-agency strategy group are interested stakeholders.

Early identification of young carers for transition assessment even though they do not currently receive any children’s service

This includes young carers whose parents have needs below the local authority’s eligibility threshold but who may nevertheless require advice or support to fulfil their potential as well as young people and young carers receiving child and adolescent mental health services (CAMHS) who may also require care and support.

Further support is needed during transition to adulthood. The strategy, ‘Making it Real for Young Carers’, states that “We shouldn’t go from loads of support to nothing when we are 18. It is almost impossible to think about having a life and caring at the same time with nothing” (44). To help address this it is essential that this group of carers are offered a transition assessment in line with requirements of the Care Act.

There are no current services for young carers aimed at children and young people in the Gypsy Roma Traveller (GRT) communities. There is an action in Surrey’s Strategy for Gypsy Roma and Traveller Children and Young People 2014-17 to improve identification and support for GRT young carers (45).

Bereavement of young carers and young adult carers

Coping with the death of a loved one is hard for everyone, but especially for young carers. Children have an overwhelming sense of confusion, fear and anxiety, alongside their grief, which must be cared for in order for them to move on to adulthood.

What works

An integrated whole family approach

NHS England, Directors of Adult Social Services, Carers Trust, Carers UK and The Children’s Society have jointly developed an integrated whole family approach for the identifying, assessment and meeting of carers’ health and wellbeing needs (46). This approach focuses on the independence of the carer and the wellbeing of the carer and their families. The Children’s Society has also produced a resource for practitioners to support the implementation of this approach (47).

Surrey has adopted this approach by agreeing a Memorandum of Understanding (MoU) recently, ‘Together for Carers’, between social care, health and carers organisations in Surrey (48). The MoU covers young carers under 18 years of age, adults looking after other adults and parents carers looking after disabled children. The MoU is supported by the Surrey Carers Commissioning and Development Strategy 2016/17- 2018/19 which includes actions such as the identification of carers through Surrey NHS Carers Prescription, NHS Carers Passports, GP Carers registration, Hospital Carers Support, Pharmacies and Military Carers Support (49).

The co-designed Surrey NHS Carers Prescription (50) website enables health practitioners to make referrals online or signpost carers to support. The website also includes the Carers Care Pathway for young carers and young adult carers to ensure that they receive the appropriate type of support (51). The Surrey Young Carers Strategy 2015 -2018 is another mechanism to support the MoU (52).

Service for children under 8 with caring responsibilities

The Carers Trust and Carers Lewisham Service has produced a resource for professionals who are supporting young carers aged 5-8 (53). It has built on a successful project started in 2013 which aimed to provide early intervention support and help to reduce in appropriate caring carried out by these young carers (54). The resource provides an overview of the service provided, case studies and tips for setting up similar service.

Identification and support of young carers in schools

Jointly run by the Carers Trust and The Children’s Society, the Young Carers in Schools programme is an England-wide initiative that equips schools to increase identification of and improve outcomes for young carers in schools (55). It also awards good practice. This programme has been designed with teachers and schools staff and it includes free resources such as A Step-by-step Guide for Leaders, Teachers and Non-teaching Staff (56). Surrey Young Carers has been promoting this programme in Surrey schools.

Pastoral needs of service children and community support to military families. Schools can use the Service Pupil Premium (SPP) to support the pastoral needs of service children, for example, through ‘Skype time’ clubs to improve the level of and means of communication between the pupils and their deployed parents. In addition, Mobility Co-ordinators, Forces Liaison Officers or Parent Support Advisors can be appointed to work closely with the pupils and families when they move into the area or are due to leave. They can also support pupils and families where a parent is deployed . Wiltshire Young Carers Strategic Partnership’s project for young carers in military families has led to a reduction in negative outcomes and a rise in positive outcomes for young carers as measured by the tools in the Manual for Measures of Caring Activities and Outcomes for Children and Young People . Both parents and young carers from military families have consistently reported that they really appreciate the specialist provision for them
(59).

Support services for 16 – 24 year olds
(60)

Research into Young Adult Carers 16 – 24 in Surrey gives examples of UK projects. Project representatives were interviewed in order to research what works and what doesn’t work for 16 – 24 year olds. Key themes throughout the projects reviewed in the paper are:

  • It is important to build relationships with colleges and employers in the local area.
  • Building young adult carers support into existing services for young people (e.g. NEET services) can be a way of supporting young carers to gain skills for independence.
  • Personalised support for each young person is important.
  • Young people should be involved in developing the service in order to offer the best support for the area e.g. some areas focused on individual support, some on education and employment with others organising social events.
  • It can be difficult to engage 16 – 24 year olds particularly once they have lost touch with under 18 projects.
  • It takes time to raise awareness and many of the groups started with small numbers.

Schools counselling to support emotional wellbeing of young carers

The National Children’s Bureau and the Children’s Law Centre in Northern Ireland have carried out a survey in 13 schools that use the Independent Counselling Service in Schools (ICSS)[1]. A total of 955 Year 11 students completed the survey. Most students who had used school counselling found it helpful (72%).

A high proportion of students (67%) want counselling to be run in school by counsellors who come into the school. One third of students stated that a student should be able to meet with a counsellor as often as required and 90% stated they wanted a “drop in” counselling service that they could use when needed. Overall, attitudes towards school counselling were positive, with many agreeing that it is a good thing to have in school and can prevent small problems getting bigger (61).

Torbay Care Trust – Carers Support Worker Substance Misuse

One example of good practice of joint working cited by The Children’s Society is the implementation of a Carers Support Worker Substance Misuse. The position is employed by the Torbay Care Trust but based in the substance misuse service, COOL recovery. The role increases awareness within substance misuse teams and could provide support for the whole family. The position was part of a new service commissioned for carers and families following a consultation process with carers, users and staff. The worker is able to support all family members including young carers and young adult carers. The service is also available when the cared for person is not in treatment (62).

Family Mental Health Empowerment Project (63)

Gloucestershire Young Carers and 2gether NHS foundation trust have worked in partnership implementing the project to ensure that no child or young person takes on the majority of the care when an adult is discharged from mental health services.

  • A member of staff from 2gether NHS foundation works as a project worker for the programme splitting time between Gloucestershire Young Carers and the trust’s hospitals, clinics and community mental health teams.
  • Young carers champions and link workers have been identified in all the mental health teams in Gloucestershire.
  • A Web resource has been developed for any professionals working with families impacted by mental health.

Tailored help to build resilience

Avon and Wiltshire Mental Health Partnership NHS Trust and charity Second Step provides a range of psychological therapies (IAPT) for carers including anxiety or panic, trauma, obsessions and depression. Group workshops are organised around specific themes aimed at building carers’ resilience and finding strength to carry on through managing stress /frustrations. Those who need intensive help receive one-to-one support, by phone or face-to-face. Carers can self-refer by contacting Positive Step directly, or referrals can be made through a GP, primary or secondary care, but most people are guided by charities. More than 500 carers have received therapy and support since its launch in 2014/15 (64).

Young carers and bereavement

The death of the person being cared for can often lead to a double bereavement – the loss of a loved one and the loss of the caring role. A number of national and local charities or groups support bereaved children, young people and their families. These include Child Bereavement UK, Hope Again and Winston’s Wish and Childhood Bereavement Network. A bereavement counsellor explains what bereavement is, how to cope, and where to go for help and support. A local charity in Dorset called ‘Mosaic’ provides individual or group work with bereaved children and their families as well as childhood bereavement training for professionals (65).

Commissioning Services

The Carers trust 2012 guidance, Commissioning Services for Young Carers and their Families, outlines 10 headings for good practice in supporting young carers and their families.

  • Whole family approach.
  • Targeted support for young carers and families.
  • Early intervention and prevention.
  • Supporting access to education, employment and training.
  • Improving access to transport for young carers.
  • Improving and maintaining the health and wellbeing of young carers.
  • Transition support: seamless support from young to adult carer.
  • Personalisation: individual budgets and direct payments.
  • Workforce development and raising public awareness.
  • Giving young carers a voice (66)

Value of being a young carer

Young carers are often proud of their role in the family and value their role as carer (67). Although a young carer should not be relied upon for an inappropriate level of care it is important that young carers feel valued and are listened to. Young carer and young adult carer’s views should always be considered in any care package for the person they care for (68).

Surrey Young Carers

In 2016, Ecorys has been commissioned to conduct a cost and benefit analysis of the service provided by Surrey Young Carers in 2015/16. It is estimated that Surrey Young Carers has potentially avoided the taxpayer spending just under £3 million over the course of one year by avoiding young carers becoming Child in Need status (69).

Surrey Minority Ethnic Forum (70)

Raising awareness of young cares in the Surrey Minority Ethnic forum which is a collective of community and voluntary groups from Black, Asian and Minority Ethnic (BAME) backgrounds. Through the Forum, members can access information and resources to support their work in Surrey.

[1] Young People’s Views on Accessing Counselling in Schools (June 2013)

http://www.ncb.org.uk/media/1111029/schools_counselling_summary_report_final_june_13.pdf

Recommendations for Commissioning

  • Implement the agreed Together for Carers Memorandum of Understanding between social care, health and carer organisations with the action plan.
  • Adult Social Care and Children’s and Safeguarding Service to publish a clear pathways of referral and assessment of young carers and young adult carers that can be assessed and used by any referring agency.
  • Set up information sharing between health, social care and carer organisations to increase identification and improve assessment and support to young carers and young adult carers. This is particularly important to track those young carers who have been in contact/assessed by the services but who have been deemed not to be in need of support. It is also important to gather data on the types of help provided by the young carers and young adult carers to the person being cared for to ensure that services are tailored to their needs.
  • Support professionals to recognise when a child or young person is a carer through training, guidance and resources.
  • Expand on this with guidance for supporting a young carer through the Early Help programme. The Early Help Assessment is a way of all agencies accessing support and recording the work they are doing with the young carer.
  • Promote the Young Carers in Schools Programme and empower schools to identify and support young carers. Consider the use of young carers ID cards and a young carer charter in schools. Use the Index for Inclusion to raise the awareness and understanding of young carers. Encourage schools to implement the key principles from the Together for Carers and refresh their PHSE curriculum, young carer policy, anti-bullying policy. Appoint a designated teacher to lead on the welfare of young carers. Further raise awareness by using the play called ‘People Like Us’ developed by Surrey Young Carers in schools.
  • Raise public awareness so that children, young people and their families recognise when they are a young carer and know where to seek support. This should include participation in activities for national young carers rights day on 25 January 2018.
  • The action plan from the Surrey Young Carers Health Survey Report 2013 (71) should be considered by commissioners. The six priorities are:
  • Carers Breaks.
  • Health and Wellbeing.
  • Emotional Support.
  • Training.
  • Carers “care” Pathway – Identifying, Recognising and Supporting Young Carers.
  • Employment Support.
  • Work closely with Early Years services to improve identification of infant young carers.
  • Military young carers
    Work with Military Carers Adviser employed by Action for Carers Surrey in order to promote better identification and awareness of the needs of military young carers.
  • Review existing services to ensure support is available and accessible to all young carers and young adult carers in Surrey.
  • Young carer champions or specialists are needed, particularly in drug and alcohol services.
  • Consider if specific services need to be commissioned to ensure young carers emotional wellbeing. This can include a service to help young carers and young adult carers to cope with bereavement.
  • There is a need to consider services specifically aimed at 18 – 24 year olds to meet needs in regards to independence, education, employment and transition to adulthood.
  • Carer support payments have been shown as an effective way of supporting young carers and young adult carers and there is scope to further increase the availability of this kind of support.
  • Black, Minority and Ethnic (BME) Groups

    Further information is needed regarding the needs of young carers from BME groups in Surrey. Currently we are only able to see the data from Surrey Young Carers which shows that there may be a gap in children from BME groups receiving support.

Key contacts

Chapter References

  1. HM Government (2014) Children and Families Act Part 5. Available at: http://www.legislation.gov.uk/ukpga/2014/6/section/96/enacted Accessed on 26 /7/2017
  2. HM Government (2014) Care Act Part 1. Available at:
    http://www.legislation.gov.uk/ukpga/2014/23/section/64/enacted Accessed on 26/7/2017
  3. ADASS, The Children’s Society, Carers Trust and Carers UK (2016), An integrated approach to identifying and assessing Carer health and wellbeing. Available at:
    https://www.england.nhs.uk/wp-content/uploads/2016/05/identifying-assessing-carer-hlth-wellbeing.pdf Accessed on 27/7/2017
  4. ADASS, ADCS and The Children’s Society (2012) Working Together to Support Young Carers and their Families. Available at:
    http://www.youngcarer.com/sites/default/files/imce_user_files/PTP/mou_young_carers_2012.pdf Accessed on 3/2/2014
  5. ADASS and ADCS (2011) Signposts: Working together to improve outcomes for young carers in families affected by enduring parental mental illness or substance misuse. Available at:
    http://www.adcs.org.uk/download/news/signposts.pdf Accessed on 12/2/2014
  6. The Children’s Society (2011) Supporting children who have a parent with a mental illness Available at: http://www.youngcarer.com/sites/default/files/mental_illness_booklet_2011_2nd.pdf Accessed on 16/05/2014
  7. Social Care Institute for Excellence (2005) The Health and Wellbeing of Young Carers Available at: http://www.scie.org.uk/publications/briefings/files/briefing11.pdf Accessed on: 19/05/2014
  8. Royal College of General Practitioners (2014) Commissioning for Carers 2013 Available at: http://www.rcgp.org.uk/clinical-and-research/clinical-resources/~/media/Files/CIRC/Carers/RCGP-Commissioning-for-Carers-2013.ashx Accessed on 13/05/2014
  9. HM Government (2014) Healthy lives Healthy People Available at:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216096/dh_127424.pdf Accessed on 19/05/2014
  10. University of Nottingham and Commission for Rural Communities (2008) Service needs and delivery following the onset of caring amongst children and young adults: evidence based review Available at: http://saulbecker.co.uk/v1/downloads/young_carers/Evidence%20review%20on%20young%20carers%20and%20young%20adult%20carers%202008.pdf
    Accessed on 07/04/2014
  11. Action for Carers Surrey (2012) Research into Young Adult Carers Aged 16­24 in Surrey. Surrey: Action for Carers. Available at:
    https://www.actionforcarers.org.uk/files/7613/6329/2930/Full_Report-into-Young_Adult_Carers_in_Surrey_16-24_1.pdf
    Accessed on 03/02/2014
  12. The Children’s Commissioner (2016) The support provided to young carers in England. Available at: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2017/06/Young-Carers-report-December-2016.pdf Accessed 28/7/2017
  13. Ibid
  14. Action for Carers Surrey: Surrey Military Young Carers website. Available at:
    http://critcher.wixsite.com/surreymilitarycarers/copy-of-home
    Accessed on 28/7/2017
  15. Barnardos: Children affected by parental imprisonment. Available at: http://www.barnardos.org.uk/what_we_do/our_work/children_of_prisoners.htm
  16. The Children’s Society (2013) Hidden from view: The experiences of young carers in England Available at:
    http://www.childrenssociety.org.uk/sites/default/files/tcs/report_hidden-from-view_young-carers_final.pdf Accessed on 13/02/2014
  17. Ibid
  18. Race Equality Foundation and Communities and Local Government (2008) The Health of Gypsies and Travellers in the UK Available at: http://www.better-health.org.uk/sites/default/files/briefings/downloads/health-brief12.pdf
    Accessed on 23/04/2014
  19. The Children’s Society (2013) Hidden from view: The experiences of young carers in England Available at:
    http://www.childrenssociety.org.uk/sites/default/files/tcs/report_hidden-from-view_young-carers_final.pdf Accessed on 13/02/2014
  20. Becker, University of Nottingham (2007) Global Perspectives on Children’s Unpaid Caregiving in the Family Available at:
    http://saulbecker.co.uk/v1/downloads/young_carers/S%20Becker%20Global%20perspectives%20on%20young%20carers.pdf Accessed on: 09/04/2014
  21. University of Nottingham and Commission for Rural Communities (2008) Service needs and delivery following the onset of caring amongst children and young adults: evidence based review Available at: http://saulbecker.co.uk/v1/downloads/young_carers/Evidence%20review%20on%20young%20carers%20and%20young%20adult%20carers%202008.pdf
    Accessed on: 07/04/2014
  22. The Children’s Society (2013) Hidden from view: The experiences of young carers in England Available at:
    http://www.childrenssociety.org.uk/sites/default/files/tcs/report_hidden-from-view_young-carers_final.pdf Accessed on 13/02/2014
  23. Carers Trust and The University of Nottingham (2014) Young Adult Carers and Employment Available at: http://www.carers.org/sites/default/files/young_adult_carers_and_employmentlo_final_2.pdf Accessed on 19/05/2014
  24. NHS Guildford and Waverley Commissioning Group and Surrey Young Carers (2013) Surrey Young Carers Health Survey Report 2013 Available at: http://carersworldradio.ihoststudio.com/carersnet/surrey%20young%20carers2.pdf Accessed on 07/02/2014
  25. Surrey County Council (2013) JSNA Chapter: Carers Available at: http://www.surreyi.gov.uk/jsna Accessed on 29/04/2014
  26. Ecorys (2017) The Economic Case for Supporting Young carers for Surrey Young Carers
  27. ADASS and ADCS (2011) Working Together to Support Young Carers and their Families: A Template for a Local Memorandum of Understanding [MoU] between Statutory Directors for Children’s Services and Adult Social Services Available at: http://www.youngcarer.com/sites/default/files/imce_user_files/PTP/mou_young_carers_2012.pdf Accessed on 17/04/2014
  28. Surrey County Council Public Health
  29. NHS Guildford and Waverley Commissioning Group and Surrey Young Carers (2013) Surrey Young Carers Health Survey Report 2013 Available at: http://carersworldradio.ihoststudio.com/carersnet/surrey%20young%20carers2.pdf Accessed on 07/02/2014
  30. The Royal British Legion (2014) A Household Survey of the Ex-Service Community. Available at:
    http://media.britishlegion.org.uk/Media/2275/2014householdsurveyreport.pdf
    Accessed 28/7/2017
  31. Action for Carers Surrey: Surrey Military Young Carers (Military and Veteran Data Link). Available at:
    http://critcher.wixsite.com/surreymilitarycarers/copy-of-home
    Accessed 28/7/2017
  32. Forces Online: Military Young Carers website. Available at
    https://www.forcesonline.org.uk/veterans-directory/military-young-carers/
    Accessed 28/7/2017
  33. Surrey Health Needs Assessment of the Armed Forces Community (2013). Available at Surreyi https://www.surreyi.gov.uk/dataset/health-needs-assessment-of-the-armed-forces-community-the-armed-forces-their-families-and-veterans Accessed on 29/7/2017
  34. Department for Education (2010) The Educational Performance of Children of Service Personnel. Department for Education: London.
  35. Surrey County Council Performance and Knowledge Management Team
  36. Surrey Safeguarding Children Board (2016) Levels of Need. Available at
    http://www.surreyscb.org.uk/wp-content/uploads/2017/07/Levels-of-Need-Final-4-October16.pdf
    Accessed on 29/7/2017
  37. Action for Carers Surrey: Supporting young carers in school (a manual for school leaders, teachers and support staff. Available at http://www.actionforcarers.org.uk/files/2314/2555/1083/SYC_SCHOOL_MANUAL_09.2014.pdf Accessed on 29/7/2017
  38. A website by Surrey County Council, Surrey Health and Joint Training Partnership and Action for Carers Surrey. Available at:
    http://carersworldradio.ihoststudio.com/youngcarersresdocs.html
    Accessed on 29/7/2017
  39. Action for Carers (2013) Be Informed Available at: http://www.actionforcarers.org.uk/files/5613/7024/8647/PRINT_DOWNLOAD_BE_INFORMED.pdf Accessed on 23/04/2014
  40. Action for Carers Surrey: Military Young Carers website. Available at:
    http://critcher.wixsite.com/surreymilitarycarers/copy-of-home Accessed on 27/7/2017
  41. Services for Young People (2012) The Young People’s Employability Plan 2012 – 2017 Available at: http://www.surreycc.gov.uk/__data/assets/pdf_file/0006/395655/Employability-plan-summary-FINAL.pdf Accessed on 03/06/2014
  42. Surrey County Council: Care and Support for Adults website. Available at: https://www.surreycc.gov.uk/social-care-and-health/care-and-support-for-adults/looking-after-someone/your-role-as-a-carer#assessment
    Accessed on 27/7/2017
  43. The Children’s Commissioner (2016) The support provided to young carers in England. Available at: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2017/06/Young-Carers-report-December-2016.pdf Accessed 28/7/2017
  44. Think Local Act Personal (2012) Making it Real for Young Carers Available at: http://www.thinklocalactpersonal.org.uk/_library/MIRyoungcarersFINAL.pdf Accessed on 03/02/2014
  45. Surrey County Council (2014) Surrey’s Strategy for Gypsy Roma and Traveller Children and Young People 2014-17 Surrey: Surrey County Council
  46. NHS England, Directors of Adult Social Services, Carers Trust, Carers UK and The Children’s Society (2016) An integrated approach to identifying and assessing Carer health and wellbeing. Available at: https://www.england.nhs.uk/wp-content/uploads/2016/05/identifying-assessing-carer-hlth-wellbeing.pdf Accessed on 29 July 2017
  47. The Children’s Society, The Whole Family Pathway – a resource for practitioners. Available at: https://www.childrenssociety.org.uk/sites/default/files/whole-family-pathway_0.pdf. Accessed on 28 July 2017
  48. Surrey County Council, NHS, Actions for Carers Surrey (2017),Together for Carers Memorandum of Understanding. Available at: http://carersworldradio.ihoststudio.com/carersnet/Together%20for%20Carers%20final.pdf. Accessed on 29 July 2017
  49. Surrey Carers Commissioning Group, A Life Outside of Caring Surrey Carers Commissioning and Development Strategy 2016-17 to 2018-19. Available at:
    http://carersworldradio.ihoststudio.com/carersnet/Carers%20commissioning%20and%20development%20strategy%20-%20InDesign%20publication-1.pdfAccessed on 29 July 2017
  50. The Surrey NHS Carers Prescription website. Available at: http://carersworldradio.ihoststudio.com/centralsurrey.html. Accessed on 29 July 2017
  51. The Surrey NHS Carers Prescription: Carers Care Pathway. Available at: http://carersworldradio.ihoststudio.com/centralsurreypath.html. Accessed on 29 July 2017
  52. Surrey Young Carers Strategy 2015-18, Making it Real for Young Carers. Available at: http://carersworldradio.ihoststudio.com/carersnet/young%20carer%20strat.pdfAccessed on 29 July 2017
  53. The Carers Trust and Carers Lewisham Service (2015) Supporting Young Carers Aged 5-8: a resource for professionals working with young carers. Available at: https://professionals.carers.org/sites/default/files/final_master_young_carers_toolkit_version_4.pdf. Accessed on 29 July 2017
  54. Carers Lewisham Service: Supporting infant young carers (aged 5-8 years) in Lewisham. Available at: https://makingastepchangeprevention.files.wordpress.com/2014/07/lewisham_proof4.pdf. Accessed on 29 July 2017
  55. The Children’s Society and the Carers Trust: Young Carers in Schools programme. Available at: https://www.childrenssociety.org.uk/youngcarer/schools/award. Accessed on 29 July 2017
  56. The Carers Trust: Supporting young carers in schools – a guide for leaders, teachers and non-teaching staff. Available at: https://professionals.carers.org/stepbystep. Accessed on 29 July 2017
  57. Ministry of Defence (2016) Service Pupil Premium-examples of best practice. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/579866/20161221-DCYP_SPP_booklet_final_V3.pdf Accessed on 29 July 2017
  58. Joseph S, Becker F, Becker S (2012), ‘Manual for Measures of Caring
    Activities and Outcomes for Children and Young People’. Carers Trust.
  59. Carers Trust: Partnership working for young carers in military families. Available at: https://professionals.carers.org/sites/default/files/wiltshire-military-proof2-6711.pdf Accessed on 29 July 2017
  60. Action for Carers (2012) Research into Young Adult Carers Aged 16­24 in Surrey. Available at:
    https://www.actionforcarers.org.uk/files/7613/6329/2930/Full_Report-into-Young_Adult_Carers_in_Surrey_16-24_1.pdf Accessed on 03/02/2014
  61. Young People’s Views on Accessing Counselling in Schools (June 2013)
    http://www.ncb.org.uk/media/1111029/schools_counselling_summary_report_final_june_13.pdf Accessed on 29 July 2017
  62. The Children’s Society (2014) Prevention through Partnership Practice Examples Available at: http://www.youngcarer.com/sites/default/files/imce_user_files/PTP/Resource_Bank/Good_Examples/carers_support_worker_substance_misuse.pdf
    Accessed on 01/04/2014
  63. Carers Trust (2013) Practice example Whole-family support for young carers affected by parental ill health Available at:
    http://static.carers.org/files/whole-family-support-for-young-carers-affected-by-parental-mental-ill-health-6661.pdf Accessed on 16/05/2014
  64. NHS England, Positive Steps for Carers in North Somerset. Available at: https://www.england.nhs.uk/mental-health/case-studies/positive-step/. Accessed on 29 July 2017
  65. Mosaic website. Available at: http://www.mosaicfamilysupport.org.uk/What-we-Offer.asp Accessed on 29 July 2017.
  66. Carers Trust (2012) Commissioning Services for Young Carers and their Families Available at: http://www.waterloofoundation.org.uk/Files/commissioning_services_for_young_carers_and_their_familes_final_copy_for_web.pdf Accessed on 22/04/2014
  67. ADASS and ADCS (2011) Working Together to Support Young Carers and their Families: A Template for a Local Memorandum of Understanding [MoU] between Statutory Directors for Children’s Services and Adult Social Services Available at: http://www.youngcarer.com/sites/default/files/imce_user_files/PTP/mou_young_carers_2012.pdf Accessed on 17/04/2014
  68. Surrey Young Carers Strategy 2015-18, Making it Real for Young Carers. Available at: http://carersworldradio.ihoststudio.com/carersnet/young%20carer%20strat.pdfAccessed on 29 July 2017
  69. Ecorys (2017) The Economic Case for Supporting Young Carers for Surrey Young Carers
  70. Surrey Minority Ethnic Forum website: http://www.smef.org.uk
  71. NHS Guildford and Waverley Commissioning Group and Surrey Young Carers (2013) Surrey Young Carers Health Survey Report 2013 Available at: http://carersworldradio.ihoststudio.com/carersnet/surrey%20young%20carers2.pdf Accessed on 07/02/2014

Signed off by

John Bangs, Surrey County Council

Sheila Jones, Surrey County Council

Debbie Hustings, NHS Guildford and Waverley, East Surrey and Surrey Downs Clinical Commissioning Groups

Jamie Gault, Action for Carers, Surrey