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Helping Clients Engage with Mutual Aid – PHE’s Approach

CSARS Group · Conference 2014 Recovery from Addiction: Bridging the gap between policy and practice University of Chester · April 29th & 30th 2014. Helping Clients Engage with Mutual Aid – PHE’s Approach

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Helping Clients Engage with Mutual Aid – PHE’s Approach

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  1. CSARS Group · Conference 2014Recovery from Addiction: Bridging the gap between policy and practiceUniversity of Chester · April 29th & 30th 2014 • Helping Clients Engage with Mutual Aid – PHE’s Approach • Megan Jones, Senior Programme Manager and Luke Mitcheson, Clinical PsychologistAlcohol & Drugs Team, Public Health England

  2. What is Mutual Aid? • Mutual Aid refers to the social, emotional and informational support provided by, and to, members of a formal group at every stage of recovery. • Twelve-step fellowships (AA, NA, CA, Al-anon…) • SMART Recovery • Other locally-developed groups

  3. Improving Mutual Aid Engagement • PHE key priority: improve recovery rates from drug dependency • Commitment to increase effective links between treatment and mutual aid • Increase awareness of positive benefits of mutual aid for those in treatment • Facilitate access to groups of their choice • 5th wave of public health (community-based assets)

  4. Why promote it? • Evidence : MA likely to improve an individual’s chance of recovery • Extra effect when combined with structured treatment • Continuing support structure reduces rates of post-treatment relapse • NICE recommendation: staff should routinely provide people with information about MA groups and facilitate access and engagement

  5. Mutual Aid Toolkit • PHE is working with a group of commissioners, service managers and representatives from the major mutual aid organisations • Objectives • Support & improve local understanding of the availability, gaps and barriers to MA • Encourage more people in treatment to access MA and monitor uptake • Support commissioners and service managers to develop effective local networks • Support early adopters

  6. NICE Guidance • CG51 Psychosocial Interventions (2007) • Routinely provide info • Consider facilitating initial contact if SU expresses an interest • CG52 Opioid Detoxification (2007) • SUs considering detox should be provided • with info re self-help support groups • Staff should consider facilitating engagement • with such services • QS23 Drug Use Disorder Quality Standards (2012) • People in drug treatment are offered support to access services that promote recovery and reintegration including housing, education, employment, personal finance, healthcare and mutual aid. (QS7)

  7. Orange Book • Drug Misuse and Dependence: UK Guidelines on clinical management (2007) Self-help and mutual aid approaches, especially 12-Step, have been found to be highly effective for some individuals and patients seeking abstinence should be signposted to them. Self-help and mutual aid groups (such as Narcotics Anonymous) should be recommended for all drug misusers seeking to achieve and maintain abstinence. Patients then have a clear choice as to whether they participate in these groups outside formal treatment settings.

  8. Medications in Recovery • Recovery Oriented Drug Treatment Expert Group (2012) • “ how to meet the ambition of the Drug Strategy 2010 to help more heroin users to recover and break free of dependence…” • Four phases of treatment: Engagement and stabilisation Preparation for change Completion Active change Proactive and supported engagement with mutual aid should be a priority Facilitated referral to mutual aid

  9. Advisory Council on the Misuse of Drugs (2013) The role of mutual aid, including Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery, are to be welcomed and supported as evidence indicates they play a valuable role in recovery. Involvement with mutual aid can significantly improve recovery outcomes. Some factors including more active or frequent involvement with mutual aid and becoming a sponsor are associated with greater improvement in drug and alcohol outcomes. There is evidence that active encouragement to engage with mutual aid enables better drug and alcohol outcomes, although coerced involvement is not beneficial.

  10. Objective 1: Support & improve local understanding of the availability, gaps and barriers to MA • Brings together existing findings and recommendations from • NICE Quality Standards and Clinical Guidelines • RODT: Medications in Recovery • ACMD: Recovery Committee’s 2nd report on recovery outcomes

  11. Objective 1: Support & improve local understanding of the availability, gaps and barriers to MA

  12. Objective 2: Encourage more people in treatment to access MA and monitor uptake • Evidence base: MA can significantly improve recovery outcomes but simply giving info is not enough • All the guidance tells us we should be helping SUs to make contact and engage with MA • More active approach required: • Treatment services can host meetings • Peer supporters can accompany SUs to their first meeting • Hold explicit/structured conversations with SUs • Facilitating Access to Mutual Aid (FAMA) • pragmatic intervention for key workers • Adapted from evidence-based 12-step facilitation

  13. Sets out how key workers can help SUs to access appropriate mutual aid support • Uses existing skills in regular one-to-one sessions • Sets out a structured 3-stage care-planned approach • Discuss choices available problems and solutions • Role of peer mentors • Mapping tools and hand-outs FAMA

  14. Objective 3: Support commissioners and service managers to develop effective local networks Coming soon: • Commissioners guide… • Service managers guide… • … to developing effective relationships with local mutual aid groups, building sustainable networks and promoting access • Professional development resource

  15. Objective 4: Support early adopters of a structured approach to developing MA locally • 6-8 Early Adopter partnerships • Supported to develop a structured approach to developing and promoting MA locally • Understanding what works • Development of good practice • Importance of recording – NDTMS CDS-J • Lessons learnt

  16. Implementation • .. incorporation and use over time of a new treatment in routine clinical practice (Manuel 2011) • .. is the least researched component of translating evidence-based approaches into practice (Gotham, 2004) • Requires synergy between: • Leadership • Culture of innovation • Training • Supervision

  17. Implementation more likely to be successful if .... Organisational rather than individual staff focus: • System and service user needs assessment • Engage the entire organisation • Consistent with external expectations • Local adaption of the intervention • Staff involvement in implementation processes • Training enhanced with supervision, feedback on directly observed practice, coaching • Manuals and competence frameworks • Discussion of implementation barriers • Objective evaluation of change • Evidence based practices – vs – Evidence based treatments

  18. Barriers to Implementation– General • Organisational commitment to current treatment (e.g.. Medication, CBT, 12-step) • Low organisational readiness for change • High staff turnover • Low staff engagement in learning tasks • Antipathy to change per se or the specifics of the new approach • Lack of resources for training and supervision in the new approach • Heavy caseloads • Limited translational research and limited evidence from this research • Few appropriately qualified practitioners in the field

  19. Barriers to Implementation: Specific • Availability of local meetings and capacity issues (e.g. female sponsors) • Lack of staff experience of mutual aid and or negative views of it • Antipathy from mutual aid attendees towards treatment agencies and OST • Lack of contacts with attendees / organisers of local meetings • What else? • Barriers to specific types of mutual aid? (SMART / NA / AA)

  20. To discuss • Is this an appropriate area for PHE to take an interest in? • Barriers to implementation – are there some common issues for us all to be aware of? • How might these be overcome? • Invitation to share some experiences that might be useful for all…… • How staff can get this on the agenda – top tips?

  21. Resources • Recovery Resources page of the NTA legacy website www.nta.nhs.uk • www.nta.nhs.uk/uploads/mutualaid-briefing.pdf • www.nta.nhs.uk/uploads/self-assessment-tool-final-pdf-version.pdf • www.nta.nhs.uk/uploads/mutualaid-fama.pdf

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