Working in partnership with specialist services

1. Working in partnership with specialist services Pete Burkinshaw Skills and Development Manager

2. 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

3. 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

4. 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

5. What specialist services provide to drug misusers • Pharmacology • Psychosocial • Harm reduction • Reintegration • RECOVERY

6. 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.

7. 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

8. The NTA Business Plan NTA Business plan (18 Month plan) • Signed-off by Ministers • Clear mandate to deliver until move into Public Health Service in 2012 • Aims 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:

9. The NTA Business Plan -Opioid substitution therapy -Patient Placement Criteria -Skills consortium -Recovery orientated service framework

10. Recovery, Rebalancing and Skills

11. 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

12. HR, MI, ITEP, CM….. recovery communities………

13. From this…….to this……..

14. Recovery Capital Recovery capital consists of three broad domains: 1. Personal and life skills; esteem; efficacy 2. Beliefs and desires around recovery 3. Support and engagement in family and community

15. - Psycho - Social The Challenge- a critique that …… Bio

16. - Bio - Bio became Bio

17. - Psycho - Social Or is it this………but it may need to be……..as a step to…. Bio

18. - Psycho - Social To this. Bio

19. Social- Vital for recovery

20. Play with three balls of play-doh for long enough…

21. 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

22. 3 priorities in relation to Skills • Case management and system navigation • Organisational competence/implementation • Psychosocial Interventions

23. 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

24. 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

25. 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)

26. 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

27. 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

28. Safeguarding. From this....

29. …to this

30. Using this

31. 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.

32. PROGRESS TOWARDS PROTOCOLS

33. TREATMENT PLAN ANALYSIS

34. 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?

35. What you can do • Screen • Assess risks (as if you don’t already!) • Use pathways • Give information and advice • Provide brief interventions

36. 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:

37. 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

38. Final thought Has partnership working reached the tipping-point required to make it safe?