Mannix MageeActivating Rural Communities

(ARC)

Network Event Creggan Healthy Living Centre

5th March 2009

Historical context

Challenges

Community Response

ARC HLC Ltd. SOLACE:A Befriending and Advocacy Programme

Using Harm Reduction

Funded by WDACT:Initiated in December 2002:

Delivering Services at present in North Fermanagh 2006 – 2009Won the tender for delivery 2009 – 2011 with 3 one year options

Priorities for Action• Government Policy

Framework

• Addressing Community Safety issues

• Targeting those at risk and vulnerable

• Reducing illicit drug use• Harm reduction approaches• Addressing Binge

Drinking

• Local Community Needs Analysis

• Sallyswood Report – ““Community group Community group

involvement”involvement”– ““There are presently no There are presently no

facilities at times of facilities at times of abstinence”abstinence”

– ““Local services to engage Local services to engage while on the street”while on the street”– ““Alternatives in the Alternatives in the

community” community” – ““Service availability when in Service availability when in

relapse”relapse”

ARC HLC Ltd SOLACE

ADVOCACY

BE

FR

IE

ND

IN

G

Harm Reduction

In Crisis

(Level 4)IMT 1/2

Coming out of or going into crisis

(Level 3)IMT 3/4

Involved in worthwhile daily activities /Reasonably stable emotionally

(Level 1) IMT 7/8

In need of emotional/practical help(Level 2)IMT 5/6

Phone: 02868628737Mob: 07990796778Fax: 05601158685E-mail: Mannix.magee@archlc.comwww.irvinestowndevelopment.com

The Rock44, Mill StIrvinestownBT94 1HP

Better to Light a Candle than Curse the Dark

Harm Reduction

The International Harm Reduction Association defines Harm Reduction as “policies and programs which attempt primarily to reduce the adverse health, social and economic consequences of mood altering substances to individuals, drug users, their families and their communities.”It does not condone or encourage drug/alcohol use because it recognizes that there are risks involved andproblems may follow. Secondly, harm reduction, as defined above, does not reject abstinence. In fact, some claim the most effective means to reduce harm is not to engage in drug/alcohol use in the first place.

•Harm reduction is a complementary strategy that sits beside supply control and demand reduction.•Its key focus is on outcomes rather than actual behaviours per se.•It is realistic and recognises that alcohol will continue to be used extensively in many communities and will continue to create problems for some individuals and some communities.•Harm reduction is non-judgemental about the use of alcohol but is focused on reducing the problems that arise.•It is pragmatic – it does not seek to pursue policies or strategies that are unachievable or likely to create more harm than good.

Harm reduction recognizes individual human rights – it is rooted in an acceptance of individual integrity and responsibility.

Harm Reduction

Befriending

“Befriending - is a process whereby two or more people come together with the aim of establishing and developing an informal and social relationship… Ideally the relationship •is non-judgemental, •mutual, •purposeful •and there is commitment over time.”

(Home Office & Joseph Rowntree Foundation))

YOUR ADVOCATE SHOULD:

Give you power so that:•Your views and feelings are heard and you feel fully involved in decisions that are being made about your life•Your rights are met by people who make decisions about you.

Speak up for you by:•Helping you to speak up for yourself,

OR•Putting your views across for you.

Support you by:•Giving you information and advice about your rights and any worries you have •Helping you make choices about what you feel is best for you.

Help you by:Sorting out problems and issues with the people who are• involved in your life • Making a complaint if you are not happy about something or •Finding you a solicitor if your legal rights aren’t met;

•Referral – open – basic referral form completed•Client information completed•Individual hard copy folder opened and secured•No contact in 3 months, an exit letter is generated •The service continues to remain available

Pathway

AUDITAlcohol Use Disorder Identification Test

ZONE 1 ZONE 2 ZONE 3 ZONE 4

Low Risk Hazardous Harmful Dependence0 – 7 8 – 15 16 – 19 20 - 40

HAZARDOUS DRINKING refers to a pattern of drinking that is associated with high risk of psychological or physical problems in the future.

HARMFUL DRINKERS are already suffering or experiencing these problems

DEPENDENCE DRINKERS are experiencing symptoms of dependence including impaired control or a subjective experience of compulsion to drink

BINGE DRINKINGFive or more drinks (men) four or more (women) in one session equates to binge drinking. (Guideline)

“The culture within which our attitudes have been formed mitigate against people behaving in a rational manner when out socialising.”

Levels of Support

Level of Support Total Hours/week Level of Need

Level 4 –Daily Contact 3 -7 Resettlement/crisis (IMT:1,2) Intervention

Level 3 -2/3 visits per week 2-3 At risk of falling (IMT: 3,4) into crisis

Level 2 -1 visit per week 1-2 Need for practical & (IMT:5,6) & a phone call Emotional support

Level 1 -1 visit per month > 1 Occasional emotional & (IMT;7,8) & a phone call Practical help

FSW; _______________________ Dev. Officer; ____________________

The Alcohol Outcomes Wheel: Summary of Points This summary version of the scale is for

(1A) PERSONAL RESPONSIBILITY

1 Not acknowledging a problem with alcohol/other substances/issues 2 Acknowledge need for support without awareness around addiction 3 Acknowledge problem but not accepting own addiction. 4 Explore issues within treatment but not fully behind changes needed for recovery 5 Increased self-awareness/understanding around alcohol/substance misuse 6 Accepting responsibility for recovery/significant change or turning point. 7 Taking responsibility for maintaining progress 8 Abstinent over period of time/accessing on-going support/ independent of service.

(2) SOCIAL CONTACT / NETWORKS 1 Isolated or only social contact within drinking/substance culture 2 Initial contact with alcohol workers, limited communication 3 One or more initial relationships or on-going contacts with alcohol/drug workers 4 Open up and more contact with others (not drinking friends) 5 Aware of need for positive relationships and need to distance oneself from situations 6 Behaviour changes to help build social contact or networks 7 Contact with people activities outside the alcohol/substance service 8 Satisfied with the level of contact with other people

(3) MANAGING PHYSICAL HEALTH 1 Not taking account of own personal health or safety-exposure to high risk situations. 2 Some avoidance of high risk situations/drinking at harmful levels. 3 Receive some medical treatment for physical problems. 4 Taking responsibility for attending health appointments-trying to reduce risk to health 5 Improved physical self-care-change behaviour harmful to health 6 Taking positive responsibility for own health. May feel healthier 7 Feeling healthier-reduction in health problems. Using health services wisely 8 Health improved-responsible self-care-use medical service well appropriately

(4) MENTAL AND EMOTIONAL HEALTH 1 Frequent crisis and/or severe problems e.g. self harm, suicidal thoughts 2 Some avoidance of high risk situations/reduction in crisis but not accepting help 3 Symptoms persist but accept help and use sources of support 4 More involved in exploring issues-improved communication with workers 5 Greater self-awareness-explore causes of emotional health issues 6 Overall improved satisfaction/ take responsibility for health, medication and behaviour 7 Improved self-esteem and confidence. Comfortable with self/making better choices 8 Reasonably stable emotionally over period of weeks or months

(5) DAILY LIFESTYLE 1 Drinking/using lifestyle, no motivation in positive use of time 2 Some structure in day-to-day life 3 Dissatisfaction with situation, but reluctant to change 4 Ideas around areas of interests/ activities-increased motivation to move forwards 5 Identify what is needed in order to move towards activities, interests, occupation 6 Planning ahead and taking action towards these plans-has sense of focus/purpose 7 In training, education, voluntary work or work placement 8 Involved in worthwhile daily activities paid or unpaid and reasonably satisfied

INTERVENTION Apr '08 May June July Aug Sept Oct Nov Dec Jan'09 Feb'09 Mar-09 Total

BEFRIENDING                          

Catering 126 101 119 112 116 108 142 109 96 102 0 0 1130

Centre Contact 229 183 216 204 210 197 258 199 174 185 0 0 2055Family 5 6 22 11 14 15 12 10 20 29 0 0 144

Home Visits 51 34 36 28 37 34 36 24 37 26 0 0 343Listening 131 165 120 137 138 131 137 138 125 139 0 0 1361

Phone Visits 187 236 172 198 190 187 195 190 178 198 0 0 1931Shopping 5 4 4 7 9 5 6 5 5 0 0 0 50

Street Contact 12 8 48 23 24 23 23 21 24 29 0 0 235

                           ADVOCACY                          

CAB 14 12 6 14 16 10 12 23 6 3 0 0 116CMT 1 2 3 0 2 2 2 5 4 0 0 0 21DHS 19 16 15 18 19 17 17 16 14 12 0 0 163Legal 3 2 10 8 4 5 0 4 4 6 0 0 46

Medical 12 11 19 12 14 14 10 8 4 5 0 0 109NIHE 11 12 17 18 21 16 22 25 7 8 0 0 157P2W 1 2 5 1 3 4 6 8 1 8 0 0 39PBNI 0 0 4 2 2 2 6 5 3 0 0 0 24PSNI 2 4 3 5 8 4 0 7 5 0 0 0 38

Round Table 1 0 0 1 0 0 1 0 0 0 0 0 3Social Worker 0 1 2 3 2 2 1 3 0 1 0 0 15

SVP                 65 3     68Counselling 0 0 0 0 0 0 0 8 9 4 0 0 21

                                                      

Harm Reduction                          Cook-It 4 0 0 0 0 0 0 0 0 0 0 0 4

Complimentary Therapies 12 8 4 9 12 0 0 6 4 3 0 0 58Detox 0 1 2 0 0 0 0 0 1 3 0 0 7

Education 46 42 51 36 25 40 38 36 26 37 0 0 377Health 11 12 16 13 10 12 0 34 21 27 0 0 156

ICT 0 0 16 8 0 0 0 5 4 12 0 0 45Industrial Therapy 38 36 41 39 38 38 36 36 23 0 0 0 325

Information 47 38 58 40 46 45 40 42 25 38 0 0 419  0 0 0 0 0 0 0 0 0 0 0 0 0  0 0 0 0 0 0 0 0 0 0 0 0 0  0 0 0 0 0 0 0 0 0 0 0 0 0 

0 0 0 0 0 0 0 0 0 0 0 0 0

10 Step Outcome Wheel (one copy per client)

Agency: ______________________________ Date: ____________________________Review date: ___________________________ Client name/ID number: ________________________________ Completed by: Worker & client jointly Client only Worker only

Accommodation Internal

Social

Drug use/ Dependency

Alcohol Consumption Physical

Health

Relationships Emotional Health

Daily Lifestyle

Crime & Community Safety

IMT USE

(a) Agency – 1.shows success: 2. Informs training needs: 3 supports care planning(b) Client/FSW – 1. Shows complex needs: 2. Motivator in change process: 3. Can and does identify areas of ongoing need(c) Commissioners – 1. Delivers message that BOI do lead to change: 2. Links well to best value: 3. Variety on the wheel leaves it possible to communicate with several target groups Health Board : 1. Decisions can be evidence based: 2. Provide data for future planning: 3. Opportunity for data collection for agency comparisonPartnerships: 1. Offers evidence of Community/Voluntary services are professional: 2. Useful report back mechanism to referral agencies: 3. Useful for report back to funding agencies

(BOI – brief and opportunistic interventions)

Better to light a candle than curse the dark!

Its good to know we haven’t been forgotten about

Don’t worry we won’t abuse this place