Annual Report 2014

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Our Vision A world free of the harms associated with substance misuse.

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Management Committee and Other Information Management Committee Fr. Pat Carolan (Director, Chairperson) Dr. Tom O’Brien (Director, Treasurer) Miriam Kane (Director) Catherine Gorman (Secretary) Celine Martin Frances Ward Desmond Balmer Project Coordinator Trevor Keogh Assistant Project Coordinator Doreen Davis Company Registration Number 341613 Registered Charity Number CHY 15488 Company Address Unit C & C1 Bluebell Business Park Old Naas Road Bluebell Dublin 12 Auditor Donal Ryan & Associates 34 Manor Street Dublin 7

T 01 450 5396 F 01 450 5069 E cctpturas@eircom.net W www.turastraining.ie

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Overview Founded in 1999 Canal Communities Training Programme, TURAS, is a rehabilitative education and training programme specifically designed as a response to the needs of stabilised drug users. TURAS is a Special Community Employment Scheme funded and supported by the Department of Social Protection (DSP), the Health Service Executive (HSE), and the Canal Communities Local Drug & Alcohol Task Force (CCLDATF). Since 2011 we have been a FETAC/QQI Primary Provider of nationally recognised awards in our own right. As a rehabilitation and education programme, we have close ties with the CCLDATF and the CDETB. This interagency cooperation has been of enormous

benefit to providing expert facilitation and tuition to service users. We are also the host and management organisation for the CCLDATF Interim funded initiative CC2-30/R which funds one full post with two elements: to run a 16-week stabilisation programme and function as a regional rehab resource worker. We provide a range of integrated psycho-social intervention and education programmes grouped under four pillars/headings: Rehabilitation, Education & Training, Experiential Learning, and Holistic Practice.

Mission Statement Our mission is to provide a holistic rehabilitative education and training programme for people living with addiction in the Canal Communities area.

Values Values are the guiding principles and beliefs that members of an organisation consider important in how people work together. Our values are the standards by which we conduct and manage our relationships in order to carry out our mission.

Safety Safe Welcoming Environment Psychological and Physical Safety

Respect, Equality and Fairness For Ourselves, Others, and Property Everyone Treated and Valued Equally

Confidentiality Recognise the Need for Privacy Deal with Information Sensitive & Appropriately Acknowledge Boundaries

Transparency Openness & Honesty Clear Communication Accountability

Commitment Attendance, Punctuality and Participation Work Towards Goals Take Responsibility

Peer Support and Teamwork Provide & Accept Support Share Relevant Experiences & Knowledge Cooperation & Support

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Table of Contents

Overview, Mission, Values 4 Summary 5 Chairperson’s Welcome 6 Project Coordinator’s Foreword 7 Summary 8 Governance 9 Therapeutic Approach to Addiction & Rehabilitation 9 Quality Standards 12 Service Outputs 13 Four Service Pillars 14 Logic Model 15 Individual Components Chart 16 Summer Programme, Awards Ceremony, Memorial Service 17 Attendance Overview 18 Sessions in Hours 19 Multidisciplinary Team 19 Keyworking 20 Satisfaction Ratings 21

Outcomes 23 Outcomes Stars 24 Care Plan Outcomes 25 Case Studies 26

CONNECT/CC2-30/R 28 Programme Overview 30 Outcomes 34 Rehab Resource Worker 35

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Accounts Summary 36

Chairperson’s Welcome

I am delighted to report another successful year of hard work and dedication on behalf of everyone associated with TURAS.

This year we have been joined on the board and the staff by new personnel who have brought new ideas and plenty of talent and energy with them. The organisation is well placed to build on its strengths and work towards its goal of being recognised for standards of excellence. TURAS runs two distinct services: a Drug & Alcohol Rehabilitation Day-Programme in Bluebell, and a Stabilisation Programme called CONNECT along with our partners in the Canal Communities Local Drug & Alcohol Task Force. We were very pleased to see CONNECT move to a bigger and better premises which has enhanced the service in many ways. In a similar vein, I am looking forward to expanding the space available to our clients in our Bluebell Centre as just one of a number of targets we have set ourselves in the Strategic Plan 2012-2016. A special welcome this year goes out to our new group of young adults with whom we have the pleasure of working with in response to changing

needs. I am looking forward to seeing the developments and innovations that will no doubt arise from the inputs of this new group. The wide range of services that the team are able to provide to so many people every day would not be possible without the support of our funders: The Health Service Executive, and the Department of Social Protection. I would like to thank them for their continued support. I would also like to thank the members of the management committee for their hard work and support, all of whom give their time and expertise voluntarily. Many thanks are also due to the staff, tutors and volunteers who deliver to the highest standards under the management team led by the Project Coordinator Trevor Keogh. Finally, I would like to congratulate all the participants of TURAS and CONNECT for their considerable achievements this year. The management committee and staff look forward to working you all into the future and continuing our journey of positive change.

Pat Carolan Chairperson

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Project Coordinator’s Foreword

Welcome to our Annual Report for the year 2014. This document offers an account of the services, standards and outcomes for the entire organisation for the year.

________________________________________________________________________________________

This report provides an overview of the four areas of the Day-Programme: Rehabilitation; Education & Training; Experiential Learning; and Holistic Practice. The four-pillar structure is the hallmark of our organisation. The rationale for this approach is to ensure that we continue to offer a balanced, varied and ultimately effective suite of rehabilitation and employability services with each component complementing and enhancing the other. You will see below that each area contains a range of FETAC/QQI component awards such as Career Preparation, Information Technology, and Health & Fitness, as well as specially developed psycho-social intervention components such as Reduce the Use 2 (Sao Project), Cannabis & Weed, and Bereavement & Loss. You will also find similar information on the work of the Stabilisation Programme CONNECT, for whom we are the hosting organisation, working in close partnership with the CCLDATF.

This year has been marked by a renewed focus on Governance development, improved Information & Communications Technology, and a substantial change in client profile. Change is the prevailing theme of our work, and this year has seen significant change indeed – both positive and negative. One of the many insidious effects of the economic downturn has been the barriers created in recent years to accessing some rehabilitation services for female and long-term unemployed drug users. TURAS is determined to reach out to this group through its work with the CCLDATF and the ongoing campaign by CityWide as detailed in its publication ‘Barriers or Bridges’? I would like to pay tribute to the courage and bravery of our clients who inspire us to be the best we can be. And to the staff and management committee for their motivation and fortitude as we all face change and our future journey together.

Trevor Keogh Project Coordinator

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Summary TURAS as a single organisation has two parts since the adoption of the Stabilisation Programme and its Rehab Resource Worker in 2007 (iniative CC2-30/R). The first part of this report will deal with the Rehabilitation Day-Programme in Bluebell supported by Section 39 HSE funding and Special Community Employment Scheme funding from the Department of Social Protection. All services provides and outputs will be detailed. The second part of the document will deal with the Interim Funded initiative CC2-30/R. While ‘CONNECT’ properly refers to the Stabilisation Programme, it may be used in this document to refer also to the Rehab Resource Worker functions which also forms its remit.

________________________________________________________________________ The structures and services within the CCLDATF permit the delivery of specialist interventions and programmes at all points on the continuum of care. TURAS and CONNECT occupy adjacent but different spaces on the continuum of care. CONNECT works with low-threshold/stabilising individuals referred predominatly from the Drug Teams. It provides a stepping stone and pre-induction for progression on to further treatment and education including Drug Rehabilitation Projects. CONNECT, like TURAS and other organisations in the area has its own identity. It can therefore be viewed alongside TURAS as a complementary structure

working with different service users with a complementary but slightly different focus and pace. This delineation has been very sucessful as the outcomes sections below will illustrate

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During 2014 TURAS Ltd. had contact with 120 clients and engaged with 85 across two services (TURAS and CONNECT). TURAS Drug Rehab Project (DRP) Our day programme has a maximum capacity of 37 places at any one time. The day programme engaged with a total of 53 service users throughout 2014 including the introduction of a dedicated Young Adult Group (group of 10) as a response to the increasing demand for rehabilitation services from this cohort. The decline in the up-take of rehab places by the 30-50 year old cohort (not only in TURAS but among most other similar projects) is cause for concern and documented in the CityWide research Barrier or Bridges. TURAS was included on the research advisory group for this research and our service users made important inputs. The success of 2014 can be summarised by the fact that service users achieved over 50 individual components leading to 75 accredited (FETAC) awards and 145 non-accredited component awards. Furthermore, many significant Care Plan outcomes were achieved across all domains.

TURAS Centre in Bluebell

Studying the ‘Johari’ Window

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CONNECT The Stabilisation Programme has been expanded on a trial basis from one 16 week programme at a time to two 16 week programmes running morning and afternoon. This required additional resources from TURAS and our colleagues in the CCLDTF Ltd, who have been very supportive and serve as a model of cooperation. The sharing of resources across the TF area was also evident in the onging work of the Rehab Resource Worker which is also funded by this initiative (CC2-30/R). Along with Treatment & Rehabiliation (T&R) Subgroup the Rehab Resource working play an important role in supporting the local T&R stragegy. CONNECT worked with 32 individuals who engaged in over 40 sessions each covering the core areas of Drug & Alcohol, Personal Development, and Progression.

CONNECT achieved success as drug use levels were shown to decline significantly for those who completed the programme. Furthermore, Service User progression to CE reached 25% and 10 % to further treatment.

CONNECT Offices & Group Room

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Governance In 2014 we welcomed new management committee members joined the organisation and it was an appropriate time to review our Governance practice. Guided by the standards set out in the Quality in Alcohol and Drug Service (QuADS) framework, and with the assistance of Aoife Dermody and the team in Quality Matters, two special management committee meetings took place in 2014 to look the Governance

Code and identify areas in which we needed to improve and importantly set ourselves goals for the year. The review process led to a new Governance Handbook which is founded on a commitment to best practice standards at all levels in the organisation.

Principles guiding the Board of Management

i. Provide vision and leadership for our organisation. ii. Be accountable to all stakeholders including service users and funders. iii. Monitor all financial activity and ensure all resources are used prudently, effectively, transparently, and are accounted for. Iv Monitor and review all elements of activity to ensure TURAS complies with all legal obligations and good practice. v. Have clear and effective working practices and clearly defined roles for our Board members. vi. Behave with integrity in the execution of our duties and as representatives of the organization. vii. Respect and support the capacity and leadership skills of our CEO and staff.

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Therapeutic Approach

A statement on our approach to Addiction along with

a definition of Rehabilitation will be given here to

contextualise the approach and content of our service

provision. It is important to note that our programme

is structured, client/learner-centred and non-

directive. Service Users are supported through

motivational strategies to participate as much as

possible in a choice of programmes and services

appropriate to their individual needs over a 19.5-hour

week.

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Addiction

Approaches to treatment and rehabilitation range

from abstinence to harm reduction, both of which are

considered valid and effective (NDS Rehab Report

2007). Services also vary in terms of the model of

addiction that underpins their ethos.

The Biopsychosocial Model, developed by the World

Health Organisation (WHO, 1981), in our view best

accounts for the many factors that influence

substance use and how they interact. It identifies

biological, personal and social factors and learning

experiences, and shows how they may have

immediate or more distant influences on a person’s

disposition to use drugs and/or alcohol. It also shows

that social and individual factors can be influenced by

the consequences of use.

Our service addresses more the psycho-social aspects

of service users’ needs along with, for example, tier 3

interventions such as methadone maintenance and

community detoxification which service users receive

in primary care settings.

Rehabilitation

Rehabilitation is a comprehensive developmental

process designed to address the complex needs of

drug users. In line with The Working Group on Drugs

Rehabilitation, rehabilitation has four aspects (1) a

structured developmental process fully involving the

individual to regain their capacity for daily life from

the impact of drug use, (2) providing a ‘continuum of

care’ to address holistic needs, (3) aimed at

maximising their quality of life and that of their

families and community, and (4) enable social

reintegration (National Drugs Strategy 2001-2008

Rehabilitation, page 7).

Drug Rehabilitation in TURAS is founded on this

understanding and encompasses interventions aimed

at stopping, stabilising and/or reducing the harm

associated with substance use as well as addressing a

person’s broader health and social needs.

Continuum of Care

The National Drugs Strategy envisaged that treatment

services would be based on a continuum of care

model and a key worker approach. The aim of this

approach is to provide coordination of services and

smooth transition between the different phases of

treatment.

TURAS operates within the Continuum of Care Model,

both at a local level within the CCLDATF and the wider

structures of the state.

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Quality Standards & Performance Indicators Below is a chart outlining the quality standards, best practice frameworks and evaluation tools used in TURAS. For example, our organisational standards are founded on QuADS, education and training standards are based on FETAC/QQI, and bespoke components are based on the principles set out in Quality Standards in Substance Use Education. Service user

assessments and education needs are identified using the National Rehabilitation Framework protocols and the DSP’s Individual Learning Plan (ILP) systems respectively. These systems provide quality control, promote progress, help to establish realistic performance indicators and facilitate quantifiable outcome measures.

Quality Standards Framework in TURAS Evaluation/Performance Indicator Tool Name Best Practice Standards or

Recommended Frameworks Sources

Drug & Alcohol Outcomes Star System

NDRIC QUADS

www.outcomesstar.org.uk www.drugs.ie/policies

Individual Learning Plan National Framework DSP QQI/FETAC

https://csmilp.fas.ie www.welfare.ie

Comprehensive Assessment National Framework QUADS

www.outcomesstar.org.uk www.encludeit.org www.canalcommunitiesldtf.ie www.drugs.ie/policies

TURAS Service User Satisfaction Questionnaire QUADS

www.turastraining.ie

Care Plans

National Framework QUADS CCLDTF

www.canalcommunitiesldtf.ie www.drugs.ie/policies www.turastraining.ie

Service User Involvement Policy National Framework QUADS

www.drugs.ie/policies www.turastraining.ie

Human Resource and Professional Development National Framework DSP QQI/FETAC

https://csmilp.fas.ie www.welfare.ie www.drugs.ie/policies www.turastraining.ie

Nationally Accredited Awards and Non-Accredited Component Awards

QQI/FETAC Quality Standards in Substance Education

www.qqi.ie

PERFORMANCE INDICATORS 1. Attendance records 2. Increased engagement with services 3. Service User able to identify risk and harm reduction

techniques 4. Improved knowledge in Drug & Alcohol misuse 5. Establishing Care Plans for Each Service User 6. Weekly meeting with Service User and Keyworker 7. Care Plan Progression 8. Records of meeting, Care Team Meeting, Case Meetings 9. Records of Issues and Actions 10. Positive Case closure 11. Outcome Star Measures 12. Improved literacy 13. Improved employability 14. FETAC/QQI Certification 15. Records of attendance 16. Increased skills attainment 17. Portfolio of work

18. Positive satisfaction reviews from client survey 19. Improved physical and mental well-being 20. Enhance team-work & problems solving skills 21. Understanding of the workings of the human body 22. Understand and apply the principles necessary to plan

and carry out a safe exercise program to improve personal fitness

23. Healthier lifestyle 24. Understand stress and its effects and the human

response to stress 25. Recognise the causes and symptoms of stress 26. Discuss different lifestyle changes 27. Explore the relationship between exercise and relaxation 28. Identify and engage in different techniques for reducing

stress 29. Evaluate ways of managing stress in the home 30. Understand and engage in the process of relaxation using

a number of techniques 31. Engage in and evaluate the process of mediations and

visualisation

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Service Outputs In 2014 the day programme delivered 65 individual components along with one-to-one keyworking and employability services to service users. A component is an individual unit, programme or course that fits into a bigger major award or pillar. For example, under the Education & Training Pillar a major FETAC award at level 3 comprises four core components: Maths, Communications, Personal Effectiveness and Computer Applications and four elective components such as Crafts, Drama, and Art & Design. Similarly, and in accordance with QuADS standards, our Rehabilitation Pillar includes Drug & Alcohol information, Harm Reduction and Relapse Prevention components on regular and reflexive basis. Reduce the Use 2, Introduction to Addiction & Dependency and Cannabis & Weed are all components under the Rehabilitation Pillar that were delivered in 2014. Each pillar has its own repertoire of components and in a number of instances the components are integrated across pillars. For example, Health & Fitness and Stress Management are components that see parts of the course delivered under Rehabilitation, Experiential Learning and Holistic Practice Pillars combining different delivery styles and mixed methodologies. Variety and seasonality are very much part of what we do. The Summer Timetable, Annual Awards Ceremony and Winter Memorial Service are feature in the section below.

In this section on Outputs looking at the measureable units of service delivered to service users, you will find the logic model and tables illustrating all the components and the number of attendances at each session.

A Logic Model is also included which is a description of the logical relationships between the resources, activities, outputs and outcomes of a programme.

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Four Service Pillars The day-programme services in 2014 were delivered in accordance with our holistic strategy of four interrelated pillars of areas: Rehabilitation, Education & Training, Experiential Learning, and Holistic Practice. A structured programme is provided is for each service user for 19.5 hours per week. Service users were assisted in selecting the most appropriate

schedule for them using a combination of Care Planning, Individual Learning Plans and assessment/consultation with his/her keyworker and CDETB education officer. The chart below describes each pillar in detail along with the number of hours the individual components and services under those headings totalled for the year.

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Service Area, Service Description and No of Hours Delivered in 2014

Pillar/Service Area Name

Description of Area No of hours Delivered in 2014

Rehabilitation

Structured developmental process whereby individuals are facilitated to become fully involved in the process of regaining their capacity for daily life from the impact of problem substance use. This programme area includes a number of interventions and approaches including Assessment, Keyworking, Care Planning, Case Management and Drug Information & Education Programmes.

63.5 hours

Education & Training

The aim of Education & Training is to provide appropriate education and training services and enhance employment and progression opportunities. QQI/FETAC accredited courses range from foundational literacy programme to QQI/FETAC Minor and Major Awards up to Level 6.

514.5 hours

Experiential Learning

The aim of Experiential Learning is to improve physical and mental well-being, enhance team-work and problems solving skills through a variety of group-based outdoor activities. Specific services/components include Health & Fitness, and Experiential Learning & Team Building.

712.5 hours

Holistic Practice

The aim of Holistic Practice is to provide remedial responses to the harm causes by drug use and develop healthy ways to cope with stress. Holistic treatments and practices include: auricular acupuncture, hypnotherapy and mediation, and activities like Art & Design and Crafts.

206.5 hours

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TURAS Programmes/Logic Model

Programme Areas

Addiction Specific Programmes/Services Rehabilitative Education & Training Services

Rehabilitation Holistic Practice Education & Training Experiential Learning

Aims Structured developmental process whereby individuals are facilitated to become fully involved in the process of regaining their capacity for daily life from the impact of problem substance use.

The aim of Treatments is to provide remedial responses to the harms caused by drug use and to promote healthy ways to cope with stress.

The aim of Education & Training is to provide appropriate education and training services and enhance employment and progression opportunities.

The aim of Experiential is to improve physical and mental well-being, and enhance team-work & problems solving skills through a variety of group-based outdoor activities.

Objectives 1. Access Continuum of Care 2. Comprehensive Needs identification Through

National Assessment 3. Integrated Care Planning 4. Structured Holistic Rehab Programme

1. Understand the causes of stress and anxiety 2. Develop coping skills 3. Apply stress management techniques to

mind & body 4. Achieve relevant QQI/FETAC Accreditation

1. Develop Employment skills 2. Attain QQI/FETAC Accreditation 3. Progression to further education and/or

employment

1. Engage in outdoor pursuits one full day per week

2. Participate a variety of activities in various locations

3. Achieve QQI/FETAC Accreditation

Inputs Agencies/Members of Local Drug & Alcohol Task Forces City of Dublin Education & Training Board Dept. Of Social Protection Health Service Executive: Local Doctors, Clinics, Pharmacies Local Community & Voluntary Agencies

Outputs Outputs are measurable units of delivered services to service users and are listed in details in section 3 – Service Deliver Specification.

Outcomes (measures)

Programme Attendance & Participation

Care Plan Goal Progress

Changes in Outcomes Star Scores

Positive Service User Feedback Questionnaires

Participation in and Completion of Holistic Programmes

QQI/FETAC Certification

Physical and Mental well-being

Stress Management Skills

Positive Service User Feedback Questionnaires

Participation in and Completion of Relevant QQI/FETAC Programmes

Awards Achieved

Increased Employability Levels

ILP goal attainment

Employability Measures

Participation in and Completion of Experiential Learning Programmes

Positive Service User Feedback Questionnaires

Outdoor Education Individual Learning PLan

QQI/FETAC Certification

Quality Assurance

QuDAS and NDRIC Protocols

QQI/FETAC Quality Assurance System

Quality Standards in Substance Use Education

Performance Management and Development System

QQI/FETAC Quality Assurance System

Holistic Best Practice

Performance Management and Development System

QQI/FETAC Quality Assurance System

DSP Sponsor Manual Guidelines

QQI/FETAC Quality Assurance System

Performance Management and Development System

Results Reduction/Abstinence from Substance Misuse Improved Quality of Life Personal Development Empowerment

Vocational Education & Training Attainment Increased Employability and Life Skills Progression to Further Education/Employment

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Individual Components Chart 2014

List of All Components Delivered Under Each Pillar

Rehabilitation Education and Training Holistic Practice Experiential Learning

Alcohol & Polydrug Awareness Application of Numbers 3N0928

Anger Management Experiential Learning & Team Building 1

Alcohol Intervention Art and Design 3N0608 Art and Design 3N0608 Gardening/Horticulture

AM Check-in Back to Education Initiative

Bereavement and Loss Health and Fitness 3N0531

Anger Management Computers Literacy Craft Sewing 3N1035 Hillwalking

Annual Awards Ceremony Career Preparation 3N0896

Drama 3N0922 Orienteering

Assessments Rehab Pillar Co-facilitation: Roles & Responsibilities

Drama Group Autumn 2014

Stepping Stones Induction

Bereavement and Loss Computer Applications 4N1112

Group Work Trip (Educational)

Boundaries & Confidentiality Ecass Training Health Group Autumn 2014

Cannabis and Weed E-Learning & Cloud Computer Solutions

Health Promotion

Experiential Learning & Team Building 1

Functional Maths 3N0930

Holistic Treatments

Group Work Individual Learning Plans Hypnotherapy

Health and Fitness 3N0531 Internet Skills 3N0931 Intro to Stress Management & Relaxation Techniques

Health Matters 1 Mathematics C10139 Meditation

Holistic Treatments Peer Support Personal Development & Stress Management

Hypnotherapy Personal Effectiveness 3N0565

Tapestry

Introduction to Addiction & Dependence

Lunch Progression Workshop

MABS Budget Plan QA Reviews

Personal Development & Stress Management

Reception & IT Skills

PM check-in Support Workers Group

PM Orientation Trip (Educational)

Reduce The Use 2 Word Processing 3N0588

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Summer Programme, Awards Ceremony, and Winter Memorial Service Summer Programme The daily timetable structure is maintained for each participant throughout the year. During the CDETB break in the summer, we run a summer programme that places more emphasis on Experiential Learning, Holistic Practice and creativity. It is also an opportunity to bring in new facilitators to deliver innovative and challenging programmes. Drama, Health Promotion and Horticulture featured in this year’s summer programme.

Summer Activities

Annual Awards Ceremony The annual awards ceremony is a highlight of the year where we celebrate the achievements of every participant and service user in TURAS. In the preceding 12 months 41 participants have achieved a total of 50 FETAC minor awards and 199 component awards covering core subjects like communications, maths and personal effectiveness along with new awards like Health & Fitness, Career Preparation and Health Awareness. We are very proud to note this success and held a special lunch in the Family Resource Centre in Inchicore where all the catering and entertainment was done in-house by own team include CE workers.

Niall speaking at the Awards Ceremony

Annual Memorial Service High levels of mortality and morbidity are tragic realities among our service users. Many people are not alone in their family or their community in dealing with effects of addiction. In light of this we hold a humanistic memorial service each year to remember and celebrate loved ones who have passed away. This year the service was facilitated by our generous friends in Sofia Housing, Cork Street to whom we owe sincere thanks.

Sofia Housing, Cork Street

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Attendance Overview for 2014 The recording of attendances at each session is just one of the many data points that the new Client Management System has allowed us to do more easily. For example, all arrival and exist times for staff and service users are easily recorded and charted on the system as well more complex functions such as electronic based Care Plans, Individual Learning Plans and HR management.

Ecass CRM system donated to TURAS by salesforce

No. of Service User Attendances for Each Component

Alcohol & Polydrug Awareness 53 Health Matters 1 106

Alcohol Intervention 16 Health Promotion 22

AM Check-in 1,443 Hillwalking 203

Anger Management 141 Holistic Treatments 212

Annual Awards Ceremony 19 Hypnotherapy 28

Application of Numbers 3N0928 11 ILP Work 37

Art and Design 3N0608 44 Internet Skills 3N0931 92

Assessments Rehab Pillar 38 Introduction to Addiction & Dependence

60

Bereavement and Loss 134 Introduction to Stress Management & Relaxation Techniques

21

Boundaries & Confidentiality 4 Lunch 1,138

Breakfast/Orientation 1,685 MABS Budget Plan 48

Back to Education Initiative 386 Mathematics C10139 4

Computers Literacy 249 Meditation 70

Cannabis and Weed 7 Orienteering 272

Career Preparation 3N0896 260 Personal Development & Stress Management

74

Co-facilitation: Roles & Responsibilities 4 Personal Effectiveness 3N0565 63

Computer Applications 4N1112 112 Personal Effectiveness GF0033 6

Craft Sewing 3N1035 134 PM Check-in 291

Drama 3N0922 150 PM Orientation 273

Ecass Training 2 Progression Workshop 6

E-Learning & Cloud Computer Solutions 3 QA Reviews 13

Experiential Learning & Team Building 1 181 Reduce The Use 2 166

Functional Maths 3N0930 125 Support Workers Group 4

Gardening/Horticulture 16 Tapestry 88

Group Work 201 Trip (Educational) 27

Health and Fitness 3N0531 212 Word Processing 3N0588 95

Grand Total 9049

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Sessions in Hours Sessions vary in length from check-ins of 15minutes in the morning or afternoon to orientate and grounds participants for the work ahead, to full-day outdoor sessions such as orienteering in Wicklow lasting up to 6.5 hours. The schedule and duration of sessions are regularly reviewed to ensure the correct pace and delivery style is achieved to maximise beneficial effects for service users.

Multidisciplinary Team The variety of skills, knowledge and abilities that each staff member in TURAS possess creates the cornerstone of our multidisciplinary team. Each team

member brings unique qualities that are needed to provide the broad range of services we have on offer.

Staff Member Roles Doreen Davis Assistant Project Coordinator, Trainer, Keyworker, Holistic Therapist Anthony Moyles Associate Project Coordinator, FETAC QQI Coordinator, Trainer Mandy Moore CE Supervisor, Keyworker, Trainer, Holistic Therapist Melissa Buckley CE Supervisor, Keyworker, Trainer, Holistic Therapist Amanda Whelan CE Supervisor, Recruitment Officer, Trainer Colin Walshe CE Supervisor, Senior Outdoor Instructor, Keyworker Elizabeth Doherty CE Supervisor, Outdoor Instructor, Keyworker, Trainer Aisling Holland CONNECT Coordinator, CCLDATF Rehab Resource Worker

Total Number of Sessions and Total Hours by Pillar in 2014

Sessions in Hours Total

Sessions Total Hours Pillar

0.25 Hour Sessions

0.5 Hour Sessions

1 Hour Sessions

2.5 Hour Sessions

6 Hour Sessions

Rehabilitation 336 385 20 126 4 871 635.5

Experiential Learning

0 0 0 33 105 138 712.5

Education and Training

0 0 46 185 1 232 514.5

Holistic Practice 0 11 36 66 0 113 206.5

Total 336 396 102 410 110 1,354 2069

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Keyworking

This rehabilitation pathway is based upon shared care planning and the development of an integrated care pathway model. This means that if a service user has a range of needs that cannot be met by one service alone, a number of key workers from different services (collectively known as the care team) will need to work together to provide a more holistic package of support for the service user.

A Keyworker is named person who is assigned to work closely with the service user and provide a range of psycho-social interventions and advocacy. Keyworking is a process undertaken by the key worker to ensure the delivery and on-going review of the care plan. This usually involves regular meetings between the key worker and the service user where progress against the care plan would be discussed and goals revised as appropriate. The key worker is usually a member of the multidisciplinary team responsible for delivering most of the service user’s care.

Keyworking, Care Planning, Case Management 2014

The services provide by Keyworker in 2014 include:

Values & Policies Referral & Intake Assessment & Orientation Relationship Building Individual Care Planning Link to external services Documentation & Review Advocacy & Self-advocacy Crisis Prevention & Intervention Direct Service Provision Transition Planning Tracking Progress Case Management

Some of the team in TURAS

Area of Work Number of Sessions

Keyworking Sessions 674

Care Planning Sessions 295

Case Management Meetings 90

Care Team Meetings 31

Total 1090

No. of Keyworking and Related Sessions

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Service Satisfaction Ratings Service users are invited to take part in feedback opportunities throughout the year. Every component is evaluated individually and the programme pillars in general are also evaluated in a separate questionnaire. Each pillar heading lists six questions or statements to which service express their satisfaction /dissatisfaction or agreement /disagreement. The questions designed to elicit feedback on the Rehabilitation Pillar are shown below with the response to question 1 illustrated in the chart (right). The information is based on collated feedback from 35 participants in 2014.

Rehabilitation Services Satisfaction Rating

Rehabilitation Services

1. I am satisfied with my Rehabilitation and substance use progress over the past 12 months

Very Satisfied Satisfied Don’t Know Dissatisfied Very Dissatisfied

42% 68% 0% 0% 0%

2. My confidence and self-esteem have improved over the past 12 months Strongly Agree Agree Don’t Know Disagree Strongly Disagree

41% 50% 8% 0% 0%

3. My Care Plan is comprehensive and contains clear goals for me Strongly Agree Agree Don’t Know Disagree Strongly Disagree

33% 58% 0% 8% 0%

4. I am satisfied that my needs have been assessed compressively Very Satisfied Satisfied Don’t Know Dissatisfied Very Dissatisfied

25% 75% 0% 0% 0%

5. I meet my keyworker on a regular basis Strongly Agree Agree Don’t Know Disagree Strongly Disagree

25% 75% 0% 0% 0%

6. Group work and keywork has assisted me in my Rehabilitation and maintaining my stability Strongly Agree Agree Don’t Know Disagree Strongly Disagree

41% 58% 0% 0% 0%

Responses to the satisfaction ratings questions for the remaining three pillars are illustrated below.

0%

20%

40%

60%

80%42%

68%

0% 0% 0%

Rehabilitation Services Satisfaction Rating

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Experiential Learning Services Satisfaction Ratings

Education & Training Services Satisfaction Ratings

Holistic Practice Services Satisfaction Ratings

0%10%20%30%40%50%60%

34%

58%

8% 0% 0%

Experiential Learning Satisfaction Rating

0%10%20%30%40%50%60%

52% 48%

0% 0% 0%

Education & Training Satisfaction Rating

0%10%20%30%40%50%

30%

50%

20%

0% 0%

Holistic Practice Satisfaction Rating

23

Outcomes Put most simply, outcomes describe the changes that have occurred in a service user that can be attributed to the intervientions that he or she been involved in within the service. The outcomes success of 2014 can be summarised in the fact that service users achieved over 50 individual

components leading to 75 accredited (FETAC) awards and 145 non-accredited component awards. Moreover, many significant Care Plan outcomes were achieved across all domains. The latter will be outlined in the following sections concluding with some case studies form the year.

Outcomes Framework and Targets Achieved 2014

Service Area Name

Outcome Targets 2014 Outcomes

Rehabilitation 1. For each Service User to complete a Comprehensive Needs Assessment (National Framework) within the first two week of the programme

2. For each Service User to create an Outcomes Star within the first week of the programme and every three/four months thereafter

3. For each Service User to attend Key work meetings no less than one per fortnight. It may be appropriate for Service User to meet two or more times a week with their key worker.

4. For each Service User to make progress on their care plan and Outcomes Star domains in accordance with their goals (i.e. drug use, alcohol use, housing, legal offending) and establish a progression pathway.

5. For each Service User to participate in one relapse prevention focused component and one drug education and information component per year.

6. For each participant to engage in therapeutic group support sessions as appropriate to their individual needs (i.e. group work and group support).

7. For each Service User to have a breakfast and/or lunch of their choice each programme day.

Achieved 38 Achieved 38 Achieved 674 See next section Achieved Achieved Total 2400

Education & Training

1. For each Service User to complete a comprehensive Learner Profile (LP-2 Form) within two week of starting on the programme

2. For each Service User to meet with an CDETB education and career advisor within four weeks of starting their programme.

3. For each Service User to identify and engage in relevant QQI/FETAC component awards and achieve 2-4 component awards within 12 months or as appropriate.

4. For each Service User to complete learning review of all components.

Achieved Achieved 38 Achieved See section above Needs Improvement

Experiential Learning

1. For each Service User to participate in one Experiential Learning (Outdoor Education) day per week appropriate to his/her needs and abilities.

2. Complete one QQI/FETAC award within 12 months. 3. Complete weekly reflection exercises.

Achieved (with the exception on health ability) Needs Improvement

Holistic Treatments & Activities

1. For each Service User to engage in two Holistic therapies of their choice per month (i.e. mediation, acupuncture, relaxation).

2. For each Service User to participate in two Holistic components per year and achieve one QQI/FETAC accreditation (as appropriate).

3. For each Service User to acquire the skills, knowledge and competencies to apply stress management techniques in own lives.

Achieved Partially Achieved Achieved

24

Outcomes Star

Service users routinely talk about the benefits of

having structure in their day-to-day living, the setting

of short, medium and long-term goals and interacting

with peer groups in a safe and positive environment.

In attempting to measure these benefits and the

results of service users’ participation in every Output

activity, a recognised and agreed measurement

system is needed. The difficulty of quantifying

outcomes depends on the service being discussed.

For example, Outcomes and Results from

participation in accredited FETAC modules (or courses

certified by other awarding bodies) are determined by

the National Framework of Qualifications and

therefore relatively straightforward.

In 2014 a typical service user participated in eight

certified programmes accumulating four awards.

Programmes often take longer than one term or

calendar year to complete. Participation in certified

core-skills vocational training through the Back to

Education Initiative (BTEI) and Progression Training

addresses service users’ needs in terms of

progression, improved employability and aspects of

self-esteem and social-reintegration. However, these

outcomes do not capture aspects of personal growth

or improved confidence. These and other outcomes

from all programmes and services are quantified by

using the Outcomes Star System.

Outcomes Star System

The Outcomes Star System (or Star for short) is an IT

and paper-based tool for supporting and evidencing

change when working with at-risk groups such as

recovering drug users.

The Star System is designed to increase service user

involvement, identify and reinforce service user

progress, assist in goal-setting and by increasing the

focus of keywork create a more holistic, systematic

and consistent approach to responding to service user

needs (The Outcome Star: Organisation Guide, p 14).

The Star measures and summarises changes across a

range of areas. It is also a keywork tool that supports

the service user in making changes by providing him

or her with a map of the journey of change and a way

to plot progress and plan actions.

The Star focuses on core areas that have been found

to be critical to supporting people in the move away

from causes and consequences of addiction. They also

mirror the domains in the Comprehensive

Assessment to provide a coherent and systematic

approach to identifying service user needs, motivating

change and monitoring progress.

Domains1. Drug Use 2. Alcohol Use 3. Emotional and Mental Health 4. Physical Health 5. Meaningful Use of Time 6. Managing Tenancy/Accommodation

7. Offending 8. Motivation and Taking Responsibility 9. Social Networks/Relationships 10. Self-care, Living Skills 11. Managing Money

Outcomes 2014

The tables below provide the Outcomes Star results

report for end of 2014. The first shows the average

level of need of the service users as recorded on the

Star during their first recording of data in November

2012 (column one) and their most recent reading

(column two) in December 2014.

Column three shows the difference between the two

scores – the outcome of the project for those service

users at this point in time.

The average level of need of the service user in

column one does not represent the need on entering

the project because their time with the project

precedes the introduction of the Star system.

The second table shows the percentage of service

users who have made a positive or negative change

or stayed the same.

Table 1 Average Change in Scores

Scale Average at assessment Average for last

Star Chart in chosen period

Average Change (outcomes)

1 Motivation 5.8 7.1 1.3

2 Living skills 6.8 6.8 0.0

3 Managing money 6.0 6.8 0.8

4 Social networks 5.6 6.4 0.8

5 Substance use 5.9 6.7 0.8

6 Physical health 6.1 6.6 0.5

7 Mental health 5.5 6.4 0.9

8 Use of time 5.4 6.6 1.2

9 Managing tenancy 6.5 7.2 0.7

10 Offending 8.1 9.1 1.0

Overall 6.2 7.0 0.8

Table 2 Percentage Positive, Negative Scores

Scale Positive outcome Negative outcome No change in score

1 Motivation 55% 29% 16%

2 Living skills 35% 48% 17%

3 Managing money 48% 32% 20%

4 Social networks 39% 42% 19%

5 Substance use 39% 39% 22%

6 Physical health 42% 26% 32%

7 Mental health 52% 32% 16%

8 Use of time 58% 23% 19%

9 Managing tenancy 58% 19% 23%

10 Offending 35% 6% 59%

Overall 46% 30% 24%

26

What does the data show? Data from Table 1 shows that the majority of service

users are at the ‘Believing’ Stage. The Believing Stage

is comparable to the ‘Determination Stage’ on the

Wheel of Change Model (Prochaska, 1977) as service

users rate themselves at 5 or 6 on the 1-to-10 point

scale. Scores have increase to slightly higher in some

areas and up to 7 or 8 in others which corresponds to

the ‘Learning’ Stage (or ‘Action’ on the Wheel of

Change).

At this point service users believe that positive

change is possible, and that they can do things

themselves to address their issues. This would be

expected and appropriate stage for services users

engaging in a rehabilitation programme; that is

beyond ‘low threshold’ but yet to achieve ‘self-

reliance’.

By the end of the period reviewed the overall results

show 46% experienced positive outcomes across

domains, 30% negative outcomes and 24% no

change. The general trend indicates progression in

the right direction in addition to relapses and

retrograde steps along the way

---------------------

Care Plan Outcomes

A care plan is a documented agreement of a plan of

action between the service user and service provide

based on SMART objectives.

Care plans should document and enable review of

service user needs, goals and progress across all

relevant domains which may include: Drug Use,

Alcohol Use, Independent Living, Income & Finance,

Physical Health, Mental Health, Family &

Relationships, Education & Training, Work &

Employment, Legal Issues/Offending, Social

Recreation, and Accommodation.

These twelve care plan domains may be summarised

under four general key domain headings to provide a

concise summary of the some indicative outcomes for

2014: Substance Use; Health (Physical/Psychological);

Legal/Offending; and Social Functioning.

Care Plan Objectives Set Across All Service User by year end 2014

No. Care Plan Outcomes by Domain by Year End 2014 Objective Status

Grand Total Care Plan Domain Draft In Progress Blocked Closed

1 Drug Use 35 15 5 10 65

2 Alcohol Use 10 4 0 4 18

3 Independent Living 0 2 0 0 2

5 Physical Health 3 9 1 1 14

6 Mental Health 8 9 1 0 18

8 Education and Training 3 20 0 1 24

9 Work and Employment 5 6 0 3 14

10 Legal Issues/Offending 5 10 0 0 15

11 Social Recreation 7 2 0 1 10

12 Accommodation 2 3 4 8 17

Grand Total 78 80 11 28 197

27

Case Studies Rob

Rob joined TURAS in the last quarter of 2014. Rob

presented with drug use as his main area of concern

and was in significant debt to drug dealer. Rob

engaged extremely well with the programme, and

regained his confidence by becoming part of group

and structured timetable. His main care plan

objective was to reduce his weed consumption from

an average of seven joints a day to three or fewer. He

achieved this within three months.

Understanding the effects of substance abuse on

mental health and learning harm reduction

techniques were important steps for Rob. With

money advice and budgeting Rob was able begin to

address his financial issues. He also joined a sport

club and took part in healthy past time activities for

the first time in many years.

------------------------ Leon

Leon joined TURAS in January 2014. Leon presented well yet was still actively smoking heroin on a daily basis. Due to Leon’s drug use family relationships were strained and a court case with the possibility existed of a custodial for 10 years. Leon was very open and honest about his recovery and engages extremely well with all aspects of the programme. Heroin use was reduced from two bags a day to zero. By the end of the year Leon moved from daily clinic attendances to receiving weekly scripts. Arriving into TURAS each morning for breakfast and then having a hot cooked lunch every day onsite

improved Leon nutritional intake and improved mood. Leon engaged fully with courts, probation, and prison-links worker as part of the case-management process coordinated by his keyworker in TURAS. Leon made sure to sign on in the local Garda station weekly as requested by the courts without exception. Leon fully participated with the day rehabilitation programme resulting in a very favourable probation report in the autumn of 2014. Leon avoided a custodial sentence in 2014 and continues with addressing education and employment goals.

-------------------

Tom

Tom joined TURAS in March of 2014 and presented

with chaotic polydrug use mainly cannabis/weed.

Tom’s main area of priority was to address his

cannabis/weed use and secondly address his benzo

use. Due to his polydrug addiction Tom had very

low self-esteem, low confidence and presented

with anxiety issues.

Housing was also major concern for Tom as he was

living in unstable accommodation and also had

outstanding court issues. Tom did not finish the

programme as he did not feel he was ready to

address changes in his life. Tom discussed his drug

use openly with his doctor for the first time and

started a controlled detox.

As he stabilised and found better accommodation

he was able to regain his focus and engage

successfully with courses to address his low literacy

levels. By the end of 2014 Tom has completed two

FETAC awards, four other components awards and

demonstrate good attendance and time-keeping.

CC2-30/R

29

Overview: What is CONNECT?

The initiative CC2-30/R funds one full-time post with two elements: to Run a 16-Structured Stabilisation Programme and to act as a Rehab Resource Worker.

Aims of Stabilisation Programme

The aim is to provide a structured 16-week stabilisation programme for participants aged 18 and over, living within the CC’s with a view to progressing on to further education, employment, training or treatment.

The emphasis is placed on addressing addiction and current drug use, personal development, relapse prevention, goal setting and identifying progression pathways. The stabilisation programme run Mon-Wed inclusive, with one-to-one support on Thursday mornings.

------------------------------------------------------------------------

Rehab Resource Worker

The Rehab Resource worker takes place in the time remaining to the worker outside the running and one-to-one support of the service users. There are three general areas to which this work is directed:

Assist in the development and coordination of the local Rehab Strategy

A CCLDTF liaison with the Regional Rehabilitation Coordinators

Work with Treatment & Rehabilitation Subgroup

Structure of Programme

The Stabilisation Programme is designed to empower participants to make informed choices about their drug use, personal development and progression options.

These three areas provide the structure for the sessions and interventions that form the content of the programme. Individual sessions run for two to two-and-a-half hours per day. Sessions are grouped into units, and units are organised under main areas heading as illustrated below

Stabilisation Programme Content 2014 Areas

Drug & Alcohol Interventions

Personal Development

Progression

Units

1. Drug awareness Denis 2. Drug & Alcohol Information 3. Addiction Studies 4. Behaviours and Attitudes 5. Relapse Prevention 6. Drug Free options 7. Wheel of change 8. Detox Options 9. Harm Reduction 10. History of drugs in Ireland 11. Health awareness 12. Hepatitis and HIV

1. Personal development 2. Art/craft 3. Domestic Violence 4. Communication Skills 5. Stress Management 6. Relaxation 7. Nutrition 8. Anger management 9. Health awareness 10. Self-esteem Workshop 11. Orientation/Induction 12. Parenting

1. VEC education progression 2. LES info registration 3. Information sessions from

Community Employment Projects: Links and TURAS

4. Housing and Entitlements 5. Goal Setting 6. Interview Skills

Individual Sessions

1. Benzodiazepines Information 2. Depressants Information 3. Alcohol 1 4. Alcohol 2 5. Polydrug use 6. Methadone 7. AS PT 1 Drugs & Effects & Categories 8. AS PT 2- Stimulant Substances

PT1&2 9. AS PT 3- Process of addiction 10. AS PT 4- Head shops & Black- market 11. AS PT 5 Foetal Alcohol Syndrome. 12. Behaviours & Attitudes 13. Coping with Cravings 14. Anxiety Management 15. Stress Management 16. Anger Management 17. Drug free Options 18. Wheel of Change 19. Detox Options 20. Harm Reduction 21. Outcome Star 22. How the body works 23. Hep A&B 24. Hep C 25. HIV 26. Parenting PT1- Young people Signs

& Symptoms of drug use 27. Domestic Violence session 28. Relaxation

1. History of Drugs 1 2. History of Drug 2 3. SE 1 Introduction to SE 4. SE 2 Contributing factors to high & low

SE 5. SE 3 Total Behaviour 6. SE 4 Johari Window 7. SE 5 Review & RECAP 8. Behaviours & Attitudes- passive assertive aggressive 9. Anxiety Management 10. Stress Management 11. Anger Management 12. Community Development 13. Empowerment 14. Wheel of change 15. Outcome Star 16. Parenting PT1- Young people Signs & Symptoms of drug use 17. Parenting PT 2 18. Parenting PT3 19. Art & Crafts 20. Listening skills 21. Communication Skills 22. Guidelines 23. Relaxation

1. Preparing Applications & Interview Skills 2. Drug Free Options 3. Community Development 4. Outcome Star 5. Crumlin College

Information 6. Les Registration 7. LES group Mediation 8. Links Presentation 9. Turas Presentation 10. Housing 11. Entitlements 12. Outcome Star

Drug Free Worker Harm Reduction & Needle Exchange RCDT and Kavanagh House/Bluebell CDVEC TURAS and Community Lynks Alcohol & Polydrug Worker Community Resposne Education Coordinators LES

1. Paul Holdaway 2. Trish O’Neill 3. Norah Byrne 4. Denis O’Driscol 5. Ciara Faughnan 6. Irene/Cathy 7. Gerry Fitzgearald 8. Graham Ryle 9. Anne Dunne 10. Amanda Whelan 11. Deidre 12. Cathy M 13. Olivia Carr 14. Frances Ward 15. Aisling Holland 16. June Dunne

Outcomes Start and End evaluations forms are given to

participants to measure the impact of the content

of the programme and provide outcomes.

Outcomes are measured in terms of the change

from Start Evaluation to the End Evaluation, and

the numbers who progress on to further treatment,

education and training including Drug Rehab

Projects.

In 2014, eight of the thirty-two participants

progressed on to DRPs and three stabilised

sufficiently in their drug use to meet the eligibility

criteria to enter into residential treatment.

The Evaluation Forms assess stabilisation and

progression outcomes under four headings:

1. Levels of Drug Use

2. Knowledge/Plans for Progression

3. Knowledge and Application of Harm

Reduction Techniques

4. Levels of Structure in you Day-to-Day life

---------------------------

Ratings of drug use have moved significantly from high/chaotic to stable.

32

The average score for Levels of Day to Day structure move from Poor to Excellent.

Knowledge and Plans for progression moved from an average of fair to very good.

33

Knowledge of treatment options moved from an average of Poor/Fair to Very Good.

Knowledge/Application of Harm Reduction Techniques move from Good to Excellent.

34

Rehab Resource Worker

The second element of CC2-30/R is to deliver Rehab Resource supports to the TF region. It was originally envisaged that this work would take place under the supervision and guidance of a dedicated Rehab Coordinator as discussed in the Rehab Report 2007.

In the absence of a Rehab Coordinator for each TF area, the Rehab Resource Worker has worked closely with the Treatment & Rehabilitation (T&R) Subgroup with significant support from its members and the Task Force Coordinator Mary Ryder.

This year has seen a high level of involvement in the rolling out of NDRIC protocols following on from the Pilot project started in 2012.

The Resource Worker along with the T&R chairperson and reps from other community and voluntary drugs services developed policies, assessment forms, and information booklets that are now available on the CCLDATF website.

This was significant piece of work successfully completed by all involved and driven by CC2-30/R funding.

The Rehab Resource worker is the CCLDATF representative on the NDRIC subcommittee and its liaison person through the T&R Subgroup.

The Resource Worker supports the running and administration of the T&R Subgroup (along with others) and liaises directly with other keyworkers and project workers in the course of client work with CONNECT and the functions of the local treatment & rehabilitation strategy.

CONNECT Group Room and T&R Subgroup Meeting Room

35

Income and Expenditure Account

for the year ended 31/12/14

Continuing operations

2014 2013

€ €

Income 1,095,584 1,036,683

Expenditure (1,090,577) (1,037,572) _______ _______

Deficit on ordinary

activities before taxation 5,007 (889)

Tax on deficit on ordinary activities - - _______ _______

Deficit on ordinary

activities after taxation 5,007 (889) _______ _______

Balance sheet

as at 31/12/14

2014 2013

€ € € €

Fixed assets

Tangible assets - 6,250

Current assets

Debtors 31,136 16,471

Cash at bank and in hand 81,102 38,065 _______ _______

112,238 54,536

Creditors: amounts falling

due within one year (112,181) (65,285) _______ _______

Net current (liabilities)/assets 57 (10,749) _______ _______

Total assets less current

liabilities 57 (4,189)

Net assets 57 (4,189) _______ _______

Capital and reserves

Capital reserves 5,797 6,559

Revenue reserves account (5,740) (10,748) _______ _______

Members' funds 57 (4,189) _______ _______

36

Annual Report 2014