Working in partnership with specialist services

Pete BurkinshawSkills and Development Manager

Overview

The NTA and specialist services The current policy context Recovery, rebalancing and the skills agenda Why social workers Social work specialisms + what can you do & expect

Special health authority within the NHS Established by Government in 2001 to improve the availability, capacity

and effectiveness of treatment for drug misuse in England Achieved targets to:

Double the number of people in treatment between 1998 and 2008 Increase the percentage of those successfully completing or

appropriately continuing treatment year on year. Functions transferring to public health in 2012 Business plan priorities now on rebalancing the system to emphasise

recovery while maintaining crime and health related gains

How specialist services are organised

Central funding (for now) Local partnerships – assess needs, plan treatment Joint commissioning group commissions NTA managed performance or assured delivery Range of services and providers:

NHS and voluntary sector (and private) community and residential criminal justice in the community and prisons

What specialist services provide to drug misusers

Pharmacology Psychosocial Harm reduction Reintegration

RECOVERY

The current landscape

Early and cross departmental involvement Health- treatment Home Office- the drug strategy DWP- recovery and reintegration Cabinet Office- PBR Number 10

NTA functions move into the new public Health service in 2012 Treatment funding to jointly appointed Directors of Public Health Broad consensus on rebalancing the system Emphasis on Recovery whilst maintain crime and health related gains Localism Lighter touch from the centre (whilst strengthening CQC) More market determination (yet emphasis on evidence and NICE) Fewer/no process targets- emphasis on outcomes.

The current landscape continued

Payment by Results The Coalition’s ‘defining’ agenda Distinct from Labour’s initiative Ministers have clear ideas which are currently being worked through Cross department working group Moving quickly and will determine how services are commissioned Full implementation- in life of Parliament but may be phased

The New Drug strategy Consultation now open To be published in December

The NTA Business Plan

NTA Business plan (18 Month plan)Signed-off by MinistersClear mandate to deliver until move into Public Health Service in 2012Aims to:‘Position the treatment system to focus on safe and sustained recovery, and demonstrate transparent outcomes, while consistently providing more for less.’

Key initiatives include:

The NTA Business Plan

-Opioid substitution therapy-Patient Placement Criteria-Skills consortium-Recovery orientated service framework

Recovery, Rebalancing and Skills

Recovery orientated systems

‘One of the key principles of a recovery-orientated model is it's integrated. That is, all of the constituent parts, all the various elements of a local system are co-coordinated, speak the same language, communicate with each other and have a congruous set of values and principles that orbit around the affirmative and empowering possibilities of recovery…. Every part of the system is involved in a collaborative effort to increase positive outcomes …….. allow greater flexibility and non-linear movement between system elements.’ NSPs in a recovery-orientated system, Stephen Bamber

HR, MI, ITEP, CM….. recovery communities………

From this…….to this……..

Recovery Capital

Recovery capital consists of three broad domains:1. Personal and life skills; esteem; efficacy2. Beliefs and desires around recovery3. Support and engagement in family and

community

The Challenge- a critique that ……

Bio - Psycho - Social

became

Bio - Bio - Bio

Or is it this………but it may need to be……..as a step to….

Bio - Psycho - Social

To this.

Bio - Psycho - Social

Social-Vital for recovery

Play with three balls of play-doh for long enough…

Recovery- implications for services

Greater focus on what happens before and after primary treatment From solely professional-directed treatment plans to incorporate client

developed recovery plans Greater emphasis on the physical, social and cultural environment in which

recovery happens e.g. shift from clinic based aftercare to community-based continuing care

Integration of professional treatment and indigenous recovery support groups- recovery communities

Increased use of peer-based recovery coaches (guides, mentors, assistants, support specialists)

Integration of paid recovery coaches and recovery support volunteers within multidisciplinary teams

Searching out skills, strengths and uniqueness

3 priorities in relation to Skills

• Case management and system navigation• Organisational competence/implementation• Psychosocial Interventions

Why social workers?

Frequent professional contact with substance misusers Treatment placing greater emphasis on families and community reintegration –

social workers' 'bread and butter'. (Think Family) Social work's role is, by definition, social, holistic and involves client advocacy,

rather than being medical. It may therefore be increasingly relevant to the future direction of drug treatment.

Social workers may also have some of the psychosocial skills with which we want the drug treatment workforce's competence to improve.

Social workers specialise in working with other client groups that are (or may increasingly be) important in drug treatment: mental health, children and older people.

Social workers also deal with domestic violence issues, something which overlaps heavily with drug and alcohol misuse

Need for increased partnership on Safeguarding

Research shows the impact of parental drug/alcohol misuse on children is significant

Working Together 2010 places increased emphasis on consideration of substance misuse in cases involving children

In 2008-9, 37,900 children became subject to child protection plan, but only around 1000 referrals to drug treatment were recorded as being from social services

However, substance misuse is cited a factor in up to 70% of serious case reviews.

Drug & alcohol treatment is likely to be a protective factor for children Estimated 120,000 children have a drug using parent in treatment

However

Shortage of social work staff generally (and rare in substance misuse teams)

Pressured by child protection demands Little if any substance misuse in social work qualifying training (despite

the SIG’s best efforts)

What specialist services/partnerships can provide At partnership level:

A joint local protocol setting out the working arrangements between social work teams and drug partnership, with clear referral thresholds and pathways.

At operational level: Screening tools Clear & developed referral pathways Joint attendance at review meetings Shared care plans for the individual & better range of services to

meet individual need. Information, advice and training

Social work specialisms and substance misuse

Mental health Dual diagnosis common Mental health lead if severe and enduring mental illness SM lead if common MH problem (anxiety and depression)

Children and families Parental drug misuse Move away from risk based assessments, towards risk & resilience

model Parenting ability is key, not SM per se, as stated in Working Together Links with alcohol & DV common, so shared approach essential

Safeguarding. From this....

…to this

Using this

Information sharing is key

Arrangements should be agreed locally and support joint care planning

Guidance, training and organisational support are vital In line with guidance (HM Government Information sharing:

Guidance for Practitioners and Manager, 2008) and Caldicott Clear on information sharing in relation to safeguarding Treatment services should look at family needs in a wider sense

than just statutory referrals & make use of wider services such as parenting support & children's centres.

PROGRESS TOWARDS PROTOCOLS

TREATMENT PLAN ANALYSIS

Social work specialisms and substance misuse 2

YP drug misuse Treatment different Specialist less often relevant/needed and not SM-focused

Older people Increasing focus/interest Past drug users (especially the 1980s H users) getting older – risk of OD,

ill health New drug users (over 40s coming into treatment for the first time) Older people drinking too much or misusing, e.g. pain meds

Community care funded residential care Coalition priority?

What you can do

Screen Assess risks (as if you don’t already!) Use pathways Give information and advice Provide brief interventions

What’s the NTA doing

Working with social work reps and relevant the Government departments to "promote sustained improvement in education and training on alcohol and other drug issues for social work practitioners and managers".

Working with SCIE on e-learning modules on Parental Substance Misuse for Social Workers

Developing supplementary guidance on the Safeguarding/treatment protocols, including and an example protocol and examples of good practice

Recently supported the publication of:

NTA BUSINESS PLAN• Signed off by Coalition for 2010/11• Priorities as follows:

• Embed whole family approach in drug treatment• Submission to Munro Review • Work with DfE to provide strategic leadership• Support drug partnerships to work effectively with

substance misusing parents• Work with partnerships to support local delivery

Final thought

Has partnership working reached the tipping-point required to make it safe?