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Richard McVey & Claire Hampson

Increasing family-focused practice across an Organisation: Helping services become more family-focused. Richard McVey & Claire Hampson. Introduction.

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Richard McVey & Claire Hampson

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  1. Increasing family-focused practice across an Organisation:Helping services become more family-focused Richard McVey & Claire Hampson

  2. Introduction Substance misuse is associated with a range of social and health problems affecting the individual as well as the family within which the individual lives (Orford et al., 2005) E.g. about 4 million people in the UK suffering as a result of problem alcohol user in their family (Copello, et al., 2000) important to develop strategies to meet their needs Growing research evidence to support the view that families and social networks can be influential when involved in treatment On the whole, routine addiction services remains focused on the individual drinker or drug user (Copello & Orford, 2002)

  3. Background • Project part of a long programme of work aiming to understand the impact of alcohol and drug problems on the family and develop strategies in addiction practice to help reduce family strain • Earlier work focused on: • understanding the impact of alcohol and drug use on family members (FMs)(Orford et al., 1998a) • natural family ways of coping (Orford et al., 1998b) • development and testing evidence-based family-focused intervention in primary care (Copello, et al., 2000) and specialist teams (Orford et al., 2009)

  4. Aims Whole Organisation approach Provided a non-statutory addiction treatment Organisation an opportunity to receive training and on-going supervision in two family-oriented interventions: The ‘5-Step approach’ Social Behaviour and Network Therapy (SBNT) To promote a shift towards family-focused practice and to further advance implementation of family work into routine addiction services Allowed comparisons between teams at different time periods in order to evaluate the impact on the implementation of family-focused practice

  5. Methods Mixed-methods quasi-experiment integrating action research Made up of 2 phases over a 3-year period Phase one = pilot study: trained 2 teams (n=19) Phase two = random assignment to training 2 teams received immediate training (n=24) 2 teams received delayed training (n=19) (+1 team previously trained in IFM study) The Involving Family Members across the Organisation (IFMO) training and supervision package Two-day initial training event Eight monthly follow-up consultancy meetings One-day follow-up training event

  6. Project timeline Training & supervision period Follow-up period Baseline IMMEDIATE TRAINING 2 teams Pilot study (2 teams) Random assignment 4 teams Training & supervision period Baseline period 2 teams DELAYED TRAINING

  7. Evaluating the impact of the project • Two questionnaires measuring professionals’ attitudes towards family-focused practice (pre, post, and follow-up) • Attitudes to Addiction Related Family Problems Questionnaire (AAFPQ) • Attitudes to Involving Family Members in Treatment Questionnaire(AIFMTQ) • ‘Diary-snapshot’ – to assess changes over time in staffs’ weekly activity • Qualitative analysis of professionals’ comments during consultancy supervision meetings

  8. Phase two results: Staff attitudes (AAFPQ) Training & supervision period Follow-up period * Baseline period * FU IMMEDIATE TRAINING PI B1 Mean total AAFPQ Score * Baseline period Training & Supervision period * PI DELAYED TRAINING B1 B2 *Significantly greater than baseline B1=Baseline 1 B2=Baseline 2 PI=Post-intervention FU=Follow-up

  9. Diary-snapshot results: phase two IMMEDIATE TRAINING Training & supervision period Follow-up period Proportion (%) of family-focused practice Training & supervision period Baseline period DELAYED TRAINING

  10. Overall proportion of family-focused practice *^ * *Significantly greater than baseline. ^Significantly greater than training period.

  11. Qualitative analysis: Main themes Policy and procedures impeding family-focused practice “It doesn’t just fit into the cycle we’re funded for” A need to improve outcomes for all “I had a session where a Mother and Daughter let some stuff out [in the session]. At the end of it they got up and hugged each other, apparently for the first time in 5 years” Recognising changes needed in practice and policy ‘Admin will be amending the wording of the invitation letter to show clients that their FMs are welcome in the sessions’ Perceiving and experiencing challenges and difficulties “We’ve had it rammed down our throats careful of the confidentiality, careful not to give anything away” Efficacious impact of the project “Nothing comes of a one-off model workshop. It needs a follow-up intervention.’ ‘The meetings are a useful as a constant reminder. It’s good having the contact” Working creatively and flexibly ‘The confidentiality form is a useful tool rather than a formality…I ask them [focal client] if your brother called me, could I talk to him? I’m proactive in searching around” EXTERNAL Individualistic practices remain “A one-to-one can be quite precious and that’s my preference to working” INTERNAL Limited family-focused practice within outside organisations “GPs only refer drinkers, they don’t think about the affected family members”

  12. Drivers for family work integration • Permission to work in family focussed way • Open flexible attitude vs ‘opening a can of worms’ • Management ‘buy in’ • Family work protagonists / ‘champions’ • Follow up in supervision / team meetings • Addressing issues between consultancy sessions eg first appointment letter

  13. Training needs • 1-1 work vs 2+ clients in the room • Working with FM’s in own right vs seeing FC and FM’s together • Openness to looking for opportunities for family work • Complex family therapy vs quick wins • Family work = more work vs same/less work • Selling family work to service users • Confidentiality • Conflict and communication issues • How to deal with unsupportive network members • No support network

  14. Conclusions Study supports the use of an Organisational platform to promote the inclusion of affected family members within addiction treatment Significant improvement in staff’s attitudes towards family-focused practice Significant increase in % of family-focused practice across the Organisation (19% at baseline to 34% post-intervention) Number of family workers increased from 9 – 14 during the project Increases in positive attitudes and family-focused practice cannot be fully attributed to the training element of the project Culture change permeating the whole Organisation?

  15. Some final thoughts….. Teams and Organisations or the wider health system or both?

  16. Thank you for listeningFor more information, please contact:Richard McVey: richard.mcvey@aquarius.org.ukClaire Hampson: c.hampson@derby.ac.uk

  17. References Copello A, Templeton L, Krishnan M, Orford J, Velleman R. (2000a). A treatment package to improve primary care services for the relatives of people with alcohol and drug problems. Addiction Research, 8, 471 – 84. Copello, A. & Orford, J. (2002). Addiction and the family: is it time for services to take notice of the evidence? Addiction, 97, 361–1363. Copello, A., Orford, J., Velleman, R., Templeton, L., & Krishnan, M. (2000b). Methods for reducing alcohol and drug related family harm in non-specialist settings. Journal of Mental Health, 9, 319-333. Copello, A., Velleman, R., Templeton, L. (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review 24, (4), 369-85. Orford J., Natera, G., Copello, A., Atkinson, C., Mora, J., Velleman, R., el al. (2005a). Coping with alcohol and drug problems: The experiences of family members in three contrasting cultures. London: Brunner-Routledge. Orford J., Natera, G., Davies, J., Nava, A., Mora, J., Rigby, K., Bradbury, C., Copello A. & Velleman, R. (1998a). Stresses and strains for family members living with drinking or drug problems in England and Mexico. Salud Mental V, 21, No. 1. Orford, J., Natera, G., Davies, J., Nava, A., Mora. J.. Rigby, K.,Bradbury, C., Bowie, N., Copello, A. & Velleman, R.(1998b) Social support in coping with alcohol and drug problems at home: findings from Mexican and English families. Addiction Research, 6, 395-420. Orford, J., Templeton, L., Velleman, R. & Copello, A. (2005b). Family members of relatives with alcohol, drug and gambling problems: a set of standardised questionnaires for assessing stress, coping and strain. Addiction, 100, 1611-1624. Roberts, M., Klein., A. & Trace, M. (2004). Towards a Review of Global Policies on Illegal Drugs. Drugscope – Report 1, 1 – 8. UKATT Research Team (2005). Effectiveness of treatment for alcohol problems: findings of the randomised UK Alcohol Treatment Trial. British Medical Journal; 331, 541–544. Velleman, R., Templeton, L., Group, U. K. A. D. a. t. F. R., (2003). Alcohol, Drugs and the Family: Results from a long-running research programme within the U.K. European Addiction Research, 9 (3), 103-112.

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