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

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Working in partnership with specialist services

Working in partnership with specialist services

Pete Burkinshaw

Skills and Development Manager


Overview

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


Working in partnership with specialist services

  • 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


How specialist services are organised

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


What specialist services provide to drug misusers

What specialist services provide to drug misusers

  • Pharmacology

  • Psychosocial

  • Harm reduction

  • Reintegration

  • RECOVERY


The current landscape

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.


The current landscape continued

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


The nta business plan

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:


The nta business plan1

The NTA Business Plan

-Opioid substitution therapy

-Patient Placement Criteria

-Skills consortium

-Recovery orientated service framework


Working in partnership with specialist services

Recovery, Rebalancing and Skills


Recovery orientated systems

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


Hr mi itep cm recovery communities

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


Working in partnership with specialist services

From this…….to this……..


Recovery capital

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


The challenge a critique that

-

Psycho

-

Social

The Challenge- a critique that ……

Bio


Became

-

Bio

-

Bio

became

Bio


Or is it this but it may need to be as a step to

-

Psycho

-

Social

Or is it this………but it may need to be……..as a step to….

Bio


To this

-

Psycho

-

Social

To this.

Bio


Working in partnership with specialist services

Social-

Vital for recovery


Play with three balls of play doh for long enough

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


Recovery implications for services

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


3 priorities in relation to skills

3 priorities in relation to Skills

  • Case management and system navigation

  • Organisational competence/implementation

  • Psychosocial Interventions


Why social workers

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


Need for increased partnership on safeguarding

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


However

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)


What specialist services partnerships can provide

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


Social work specialisms and substance misuse

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


Safeguarding from this

Safeguarding. From this....


To this1

…to this


Using this

Using this


Information sharing is key

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.


Progress towards protocols

PROGRESS TOWARDS PROTOCOLS


Working in partnership with specialist services

TREATMENT PLAN ANALYSIS


Social work specialisms and substance misuse 2

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?


What you can do

What you can do

  • Screen

  • Assess risks (as if you don’t already!)

  • Use pathways

  • Give information and advice

  • Provide brief interventions


What s the nta doing

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:


Nta business plan

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


Final thought

Final thought

Has partnership working reached the tipping-point required to make it safe?


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