The Skills Consortium The proposed ‘skills framework’

1. The Skills Consortium The proposed ‘skills framework’ East of England Recovery & Reintegration Conference 20th July 2010

2. A brief history of the consortium Convened to develop a sector led consensus on good practice and lead workforce development For the sector, by the sector Two large sector-wide stakeholder workshops in 2009 These tasked a smaller working group (the Core Group) to develop the ideas and the constitution ‘Build it and they will come’

3. Aims of the consortium To support the drug treatment sector to: Identify workforce needs required to promote and sustain beneficial treatment outcomes for service users and their communities Review, consolidate and develop existing workforce initiatives with a view to retaining the existing and future workforce Support employers and commissioners to equip practitioners and managers with the requisite skills, knowledge and attitudes.

4. The Core Group’s approach Core Group: royal colleges; trusts; third sector; users; carers; membership organisations; educators Develop a constitution and establish a fully constituted consortium in June/July 2010 An elected executive Criteria for a representative membership (40-60) All stakeholders can access resources; tools etc. Launch a skills framework very shortly after the consortium becomes constituted Framework will be the ‘wire-frame’ of the on-going work of the consortium

5. The roots of the framework Based on: Previous guidance (Care Planning Practice Guide in particular) NICE drug misuse guidance 2007 Clinical Guidelines Informed by emerging thinking on recovery and personalisation. It is also informed by ITEP, BTEI and ‘Recovery, Engagement and Life Skills’ model developed by TCU. As interventions, approaches and technologies emerge it is anticipated that they can be absorbed by the framework.

6. The aims of the framework Aims to be an … integrated (coordinating elements of local systems) dynamic (responsive to need, moving service users forward) coherent (focussed on the service user’s journey) congruent (based on values of recovery and reducing harm) … model The intention is to give all evidence-based interventions and those from the ‘Orange Book’ based on expert consensus a proportionate and integrated position in a conceptual model. Treatment adaptation/optimisation is key component of the model.

7. Segmenting delivery:the phases of treatment (columns) • Based on current phases of treatment (CPPG and MoC). • Informed by current thinking on recovery and TCU (ITEP/BTEI/RELS) • Engagement: Establishing the process components of key working; developing the therapeutic relationship; build motivation for change and set initial treatment goals. • Preparation: Refine treatment goals and actively prepare for change. • Change: Initiate and maintain changes in substance use, behaviors and cognitions and build recovery capital. • Reintegration: Strengthen community integration, develop recovery capital and exit formal treatment. • (Reintegration starts at the beginning of treatment and runs throughout. Its focus may shift from safety initially and progress through social, and self-esteem related needs)

8. Segmenting delivery:the types of intervention (rows) • Keyworking – process/support: elements of keyworking/case management which are offered to all clients and which form the bedrock of treatment • Keyworking – low intensity psychosocial interventions: including psycho-educational interventions, manualised and mapping interventions • “Keyworking+”: interventions requiring additional competencies, training and supervision structures • High intensity or specialist interventions / Specialist/external services

9. Underpinning values • The core group have explored a range of issue and concepts which have formed the underpinning values of the model. These will be developed as part of the Consortium’s work programme. • They include: • A supported and facilitated transition from being clinically managed to taking personal responsibility through self-management. • The vital role of harm reduction in recovery-orientated treatment. • An increased focus on the service user’s strengths, focussing on the development of a positive identity outside of their drug use. • An increased use of peer-based recovery mentors and the integration of structured treatment and indigenous recovery support groups. • A greater emphasis on the physical, social and cultural environment in which recovery happens, i.e. a shift from clinic-based aftercare to community-based continuing care • Manners Matter: factors that encourage clients to return and stay the course.

10. Comprehensive assessment inc • Child protection • Risk • Assessment/reassessment of recovery capital • Cataloguing strengths • Recovery/care planning • Care coordination (if applicable) • Risk management • Crisis management • Health monitoring • Advocacy • Coaching • Pro-active engagement/re-engagement • Building social networks • Harm reduction • Multi-agency work, including • Child protection • Mental health • Appropriate supported/facilitated referrals to: • Medical monitoring and healthcare • Mutual aid • Financial and legal advice • Housing, employment, education and training Engagement Preparation Change Re/integration The care plan should specify the detail of the case management interventions, as agreed with the service user. Case management and key working interventions may utilise mapping techniques and manuals to support their delivery. Keyworking

11. Comprehensive assessment inc • Child protection • Risk • Assessment/reassessment of recovery capital • Cataloguing strengths • Recovery/care planning • Care coordination (if applicable) • Risk management • Crisis management • Health monitoring • Advocacy • Coaching • Pro-active engagement/re-engagement • Building social networks • Harm reduction • Multi-agency work, including • Child protection • Mental health • Appropriate supported/facilitated referrals to: • Medical monitoring and healthcare • Mutual aid • Financial and legal advice • Housing, employment, education and training Adaptation Adaptation Adaptation Adaptation Engagement Preparation Change Re/integration The care plan should specify the detail of the case management interventions, as agreed with the service user. Case management and key working interventions may utilise mapping techniques and manuals to support their delivery. Keyworking Review /Optimise/Plan (Care Plan Review, TOP, other) Care/recovery plan Review /Optimise/Plan (Care Plan Review, TOP, other) Review /Optimise/Plan (Care Plan Review, TOP, other)

12. Limitations and focus of the framework • It focuses on interventions and practice rather than service design or components • Change will happen in several areas of someone’s life and at different rates. The service user is located in the phase relating to the key change identified in the recovery plan • Integration with mainstream services is key but not directly addressed • Pre and post treatment interventions/services are not yet included • The model has informed the early development of the NTA’s proposed recovery-orientated service framework. This framework will cover some of the broader issues relating to system & service design and commissioning.

13. The ambition for the framework • The aim is that the framework becomes the front end or wire frame of an interactive web-based resource hub. • The proposed work programme of the consortium is to populate the framework with: • supporting detail (manuals, guidance, etc) • emerging interventions • shared learning • training networks • relevant occupational standards • And to sponsor early adopters to developinterventions and test implementation.