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Working in partnership with specialist services. Pete Burkinshaw Skills 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. - PowerPoint PPT Presentation
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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?