Supervision and the Recovery Agenda: bridging the gap between theory and practice

1. Supervision and the Recovery Agenda: bridging the gap between theory and practice Jan Hernen Clinical Psychologist Tom Atton Project Worker Turning Point Somerset (Substance Misuse)

2. Overview of the session • Key messages of the Recovery Agenda which apply to the supervision process • The theory-practice gap • Group supervision – Somerset model • Example: using TOP at review (non-MI and MI-consistent) • Reflections and plans for future supervision practice

3. 2010 Drug Strategy • “..for too many people currently on a substitute prescription, what should be the first step on the journey to recovery risks ending there” • An expectation that “all those on a substitute prescription engage in recovery activities”

4. Recovery-orientated Drug Treatment Task Group 2010-present • Evidence from drug users and colleagues around the country that people with addiction problems could be better supported in their recovery and that there could be greater ambition for and focus on their potential to make further progress

5. Recovery-orientated Drug Treatment Task Group 2010-present • Staff working in treatment services may need additional training and support to gain the competences to improve the quality of regular review and restructuring of personalised care to support recovery • Treatment services need to re-orientate to achieve the best balance between reduction of negatives (harm reduction) and accrual of positives (recovery)

6. How do we obtain the positives? • By attending to efforts to identify ‘recovery capital’ in clients and staff • By encouraging a more proactive and aspirational approach for clients and staff • By identifying strengths and increasing ambition to make important behavioural changes

7. Which treatment approach could help us to make teams more recovery-focussed?

8. In an organisational context.. We need to:

9. BPS Toolkit guidelines on supervision • Supervision as an essential element of effective delivery of all psycho-social interventions • It is common to all well conducted trials of effective interventions • It therefore cannot be seen as an optional extra (Roth and Pilling, 2008)

10. What gets in the way of effective clinical supervision? • Tight agency budgets leading to staffing problems • High demand for supervisors to provide more direct services • More emphasis on managerial than on clinical supervision • Lack of training and awareness of supervisory models and skills

11. Turning Point Somerset supervision Model • Group supervision Example; Mindfulness Skills Program • For facilitators of Mindfulness skills programme (which has emphasis on relapse prevention and preparation for referral-on to Community Access Project or other community-based, service user led groups/programs) • Supervisor meets group facilitators (approx 12 maximum), in informal group setting for 1.5-2hr monthly.

12. Content of Supervision Sessions: • Set agenda: • Process of group, attendance, facilitators experiences (problems or solutions with ideas for development). • Ongoing review of program materials both reference and those given to clients. • Session specific activities reviewed and developed based on client and facilitator feedback. • Specific client related issues, i.e., special needs in terms of content, i.e. language barriers, or logistics of enabling all clients to attend.

13. Style of supervision sessions • Supervisees use the therapeutic approach from the skills programme (mindfulness) to reflect on experience in supervision • Personal challenges in working with certain clients are discussed within an MI-consistent conversation. • Space is made for wider-ranging discussions triggered by clinical practice, e.g. 'squaring' old beliefs and practices with new recovery agenda.

14. In this supervision model how is treatment made more effective? Facilitators fed back following: • Facilitators are able to discuss 'journeys' of clients from the various referral pathways – pathways become clearer and more consistent • Similarities and differences between team processes can be recognised and best practice shared • This helps to put recovery clearly in the minds of the facilitators and allows understanding of how others are adapting their work practices to suit newer recovery-based practices with acceptance of difficulties therein.

15. How does this model support staff? • Emotional support through shared experience • Sharing difficulties and being able to offer solutions and alternative perspectives to each other is widely recognised as being of great value. • Lack of 'own-team' management present encourages openness and a chance to test consensus or accept that issue is not mutually held, before making a ‘group contact’ to management for guidance. • Encourages protection/defence of facilitators time allocated to the proper running of the group programme

16. Planning for supervision in the recovery model – example: use of clinical tools at client review • Identification of key clinical tools used at review (e.g. TOP and care plan) • Identification of a clinical scenario that will trigger some discussion over recovery and harm reduction • Role played example of non recovery-consistent use of clinical tools • Supervisees generate ways of using clinical tools in a more recovery-consistent way • Supervisees role play using tools in ways identified • Supervisees reflect on the process (identifying therapeutic approach most effective) and plan ways in which they can change practice • Discussion is generated on recovery context – what might recovery mean for the individual concerned?

17. Clinical case scenario • 56 year old heroin user who has been in core treatment services for 8 years (GP does not prescribe methadone) • Prescribed 65mgs methadone daily dispensed twice a week • Smokes heroin now and again • Does a bit of casual work, sees his daughter now and then, has some friends who live locally • Invited to appointments every 6 weeks but attends generally every 3 months and does a TOP and care plan

18. Use of a therapeutic model at different levels of the treatment process • Empathy • Avoiding • argumentation • Roll with • resistance • Deploy • discrepancy • Increase • self-efficacy

19. Implications for future supervision in your workplace Becoming more recovery focussed: • Supervision type: individual and/or group? • Supervision function: managerial and/or clinical? • Supervision content: specific client issues and/or treatment processes? • Overlaps between training and supervision?

20. References • HM Government (2010) Drug Strategy 2010: ‘Reducing Demand, Restricting Supply, Building Recovery, Supporting People to Lead a Drug-free Life’. London. HM Government • Recovery-orientated Drug Treatment: An Interim Report, (2011) Professor John Strang • ‘Routes to Recovery: Psychosocial interventions for Drug Misuse: A Framework and Toolkit for implementing NICE-recommended Treatment Interventions’ (2010) Pilling, S. Hesketh, K & Mitcheson, L. National Treatment Agency for Substance Misuse & British Psychological Society. • ‘Principles of drug addiction treatment: A research based guide’ (1999) National Institute on Drug Abuse • Bradley, E.H et. Al (2004) ‘Translating research into practice: Speeding the adoption of innovative health care programs’, Issue Brief (Commonwealth Fund) July (724), 1-12 • Miller, W .R & Rollnick, S. (2002) ‘Motivational Interviewing: Preparing People for Change’. Guilford Press