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Workforce development in the new...... Annette Dale-Perera Strategic Director of Addiction and Offender Care. Wider range of service users. POLICY. RECOVERY. PUBLIC HEALTH. Reduce Blood borne viruses Reduce drug and alcohol related deaths Reduce health inequalities
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Workforce development in the new...... Annette Dale-Perera Strategic Director of Addiction and Offender Care
POLICY RECOVERY PUBLIC HEALTH Reduce Blood borne viruses Reduce drug and alcohol related deaths Reduce health inequalities Increase life expectancy Increase health & wellbeing Smoking cessation Prevention • Voluntary self control over substance use plus health and wellbeing plus re-integration • Push for abstinence – planned discharges substance free • Training & employment • Housing • Friends/relationships
Evidence WHAT RECOVERY OUTCOMES • White( 2012) 407 studies: around 50% with substance dependency achieve remission: 20% do so through abstinence. • Cannot tell until someone is in stable remission until after 5 years • Different people have different recovery capital/ potential • Some substances are more difficult to achieve remission from
Evidence RECOVERY OUTCOMES Heroin is sticky • First 6 mths to a yr in treatment – most potential for change (NTA) • Drug outcomes improving in England since mid 1990’s 75-65% heroin users stopped using 3-5 yrs (NTORS etc). 30 yr follow-up study: Grella and Lovinger (2011) Of survivers 40% in stable remission but normally after 5-8yrs in opioid substitution, 25% did not reduce use at all.
Evidence HEALTH OUTCOMES Substance dependence causes significant collateral health damage, directly or through associated lifestyle – smoking, diet, hygiene etc 33 yr follow-up study: 50% heroin users dead (Hser 2007) • Alcohol - mental health, cognitive damage, liver disease & and `system damage’ – cancers • Injecting drugs – infections, vein damage & DVT, heroin overdose risk & death • Smoking tobacco, cannabis, crack lung & heart disease • Teeth !!!
Evidence EMPLOYMENT OUTCOMES CRIME OUTCOMES International evidence suggests this is the most difficult to achieve Those employed on starting treatment likely be employed at follow -up and visa versa UK worst rate of unemployment in drug users compared to EU & USA BUT Education, training & voluntary work helps recovery & happiness Substance - driven crime outcomes good if people achieve remission
Evidence SOCIAL OUTCOMES • Having supportive friendship/family networks is paramount • NICE: Mutual Aid, Family Therapy and Behaviour Couples Therapy • Wellbeing research: friendship group of more than 3 = happiness
Some great guidance and tools Drug Matrix: Evidence for effective treatment: FINDINGS....
Overcoming dependence takes time Manager competence • clear pathways - staff and service users know • Track progress of clients particularly heroin users eg using `MAR’ data • Review clients every 3 months • If treatment not working – optimise • Data/reviews to track clients progress and key workers caseload & complexity
Workforce competency improvements • Health screening, assessment, treatment • better harm reduction & health treatment when using • better treatment for health issues when in treatment • Evidence-based behaviour change interventions • Empowering service users rebuild lives • Helping (re) establish constructive relationships • Education, training and meaningful activities • Longer term health & wellbeing strategies
Reality check • EXTENSIVE APPROACH needed ie longer term support but can we afford to do this • PbR EXPECTATIONS................failing • More health improvement & treatment • More competence in behaviour change techniques –with fidelity & supervision • Re-commissioning risks: TUPE, Disruption • Smaller financial envelop risks of `Dumbing down’ loss of `expensive workers’
EG Well-being amongst staff and clients `Five Ways to Wellbeing’ framework. Staff & service users have 5 ways plans Teams have 5 ways activities & funding