Commissioning mutual aid facilitation obstacles and opportunities
This presentation is the property of its rightful owner.
Sponsored Links
1 / 32

Commissioning Mutual Aid Facilitation: Obstacles and Opportunities PowerPoint PPT Presentation


  • 73 Views
  • Uploaded on
  • Presentation posted in: General

Commissioning Mutual Aid Facilitation: Obstacles and Opportunities. Tony Mercer Public Health England 29 th April 2014. Mutual aid groups in West Midlands. Mutual aid groups in East Midlands. Obstacles Organisational change Structural obstacles Ideological obstacles. Opportunities

Download Presentation

Commissioning Mutual Aid Facilitation: Obstacles and Opportunities

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Commissioning mutual aid facilitation obstacles and opportunities

Commissioning Mutual Aid Facilitation:Obstacles and Opportunities

Tony Mercer

Public Health England

29th April 2014


Mutual aid groups in west midlands

Mutual aid groups in West Midlands


Mutual aid groups in east midlands

Mutual aid groups in East Midlands


Commissioning mutual aid facilitation obstacles and opportunities

  • Obstacles

  • Organisational change

  • Structural obstacles

  • Ideological obstacles

  • Opportunities

  • Public health perspective

  • PHE toolkit

  • Evidence base


O rganisational change

Organisational change

  • Duties and responsibilities

  • People

  • Money


S tructural obstacles

Structural obstacles

  • Definitions – mutual aid, peer support and recovery community organisations

  • Inter-agency joint working

  • Key-working - how long and how often?


Ideological obstacles

Ideological obstacles

  • Its “religious”


Acmd recovery standing committee what recovery outcomes does the evidence tell us we can expect

ACMD Recovery Standing Committee“What recovery outcomes does the evidence tell us we can expect?”

  • “There is emerging evidence from a meta-analysis that a close match between personal beliefs and the choice of mutual aid group actually attended improves outcomes and that non-12-step groups are probably as effective as 12-step groups.”

  • Atkins & Hawdon (2007) Religiosity and participation in mutual-aid support groups for addiction


Acmd recovery standing committee what recovery outcomes does the evidence tell us we can expect1

ACMD Recovery Standing Committee“What recovery outcomes does the evidence tell us we can expect?”

  • Atkins & Hawdon (2007) Religiosity and participation in mutual-aid support groups for addiction

  • the effect of different recruitment strategies

  • interclass correlations per primary recovery groups found that they were not homogeneous

  • no direct measurement of the degree of the “religiosity” or “spirituality” of different groups was made despite their being substantial heterogeneity among groups


Acmd recovery standing committee what recovery outcomes does the evidence tell us we can expect2

ACMD Recovery Standing Committee“What recovery outcomes does the evidence tell us we can expect?”

  • The association between 12-step mutual aid affiliation and good outcomes is strongest among people who are younger, white, less educated, unstably employed, less religious, and less interpersonally skilled

  • Timko, DeBenedetti & Billow (2006) Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes


Kelly white 2012 broadening the base of addiction recovery mutual aid

Kelly & White (2012) Broadening the base of addiction recovery mutual aid

  • In the most recent SMART participant survey (N=513)

  • 60.7% of members reported believing in some kind of God or Higher Power

  • 85.2% reported attending AA or other 12-step organizations in addition to SMART


Public health perspective

Public health perspective

Social relationships: Overall findings from this meta-analysis

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Social relationships: High vs. low social support contrasted

Social relationships: Complex measures of social integration

Smoking <15 cigarettes daily

Smoking cessation: Cease vs. continue in patients with CHD

Alcohol consumption: Abstinence vs. excessive drinking

Flu vaccine: Pneumococcal vaccination in adults

Cardiac rehabilitation (exercise) for patients with CHD

Physical activity (controlling for adiposty)

BMI: Lean vs. obese

Drug treatment for hypertension in populations > 59 years

Social relationships have as great an impact on health outcomes as smoking cessation, and more than physical activity and issues to address obesity (Holt-Lunstad et al 2010)

Air pollution: low vs. high


Public health perspective1

Public health perspective


Public health perspective2

Public health perspective


Public health perspective3

Public health perspective

  • Asset Based Commissioning –

  • look what's in the fridge before going to the supermarket


Phe toolkit

PHE toolkit

  • A briefing on the evidence-based drug and alcohol treatment guidance recommendations on mutual aid

  • Brings together existing findings and recommendations from:

  • •NICE Quality Standards and Clinical Guidelines

  • •RODT: Medications in Recovery

  • •ACMD: Recovery Standing Committee’s 2nd report on recovery outcomes


Phe toolkit1

PHE toolkit

  • Mutual aid self-assessment tool

    • Availability

    • Promoting mutual aid

    • Leadership and workforce

    • Facilitation

    • Local strategic planning and monitoring


Phe toolkit2

PHE toolkit

  • Facilitating access to mutual aid: three essential stages for helping clients access appropriate mutual aid support


Phe toolkit3

PHE toolkit

  • Improving access to mutual aid: a brief guide for commissioners

  • Local vision

  • Self-assessment

  • Local action plan/steering group

  • Service specifications

  • NDTMS

Engaging with Mutual Aid Oct 2013


Phe toolkit4

PHE toolkit

  • Improving access to mutual aid: abrief guide

  • for alcohol and drug treatment service managers

  • Develop links with local groups/reps

  • Workforce knowledge and skills

  • Literature and promotion

  • FAMA/key-working/supervision

  • Care-planning documentation

Engaging with Mutual Aid Oct 2013


Evidence base

Evidence base

  • If mutual aid works……….

  • it will improve performance (more successful completions/less representations)

  • there's an ethical case for doing it


Qs23 quality standard for drug use disorders 2012 quality statement 7 recovery and reintegration

QS23 Quality standard for drug use disorders (2012)Quality statement 7: Recovery and reintegration

  • People in drug treatment are offered support to access services that promote recovery and reintegration including housing, education, employment, personal finance, healthcare and mutual aid.


Nice clinical guidelines cg51 2007 psychosocial interventions for drug misuse

NICE Clinical Guidelines CG51 (2007)psychosocial interventions for drug misuse

  • 23 studies identified

  • 16 studies excluded

  • 6/7 studies included focussed on 12 step mutual aid groups

  • 2 x RCTs - McAuliffe (1990) and Timkoet al.(2006)

  • 1 x RCT sub-analysis - Weiss et al. (2005)

  • 2 x cohort studies - Moos et al. (1999) and Ethridge et al. (1999)

  • 1 x prospective longitudinal study - Fiorentine & Hillhouse (2000)

  • 1 x case series - Toumbourou et al. (2002)


  • Nice clinical guidelines cg51 2007 psychosocial interventions for drug misuse1

    NICE Clinical Guidelines CG51 (2007)psychosocial interventions for drug misuse

    • Clinical summary

    • There is limited but consistent evidence from these studies that 12-step attendance is associated with abstinence from illicit drugs and alcohol, and fewer drug and alcohol problems.

    • Furthermore, involvement in such programmes can be improved by interventions from healthcare professionals to encourage regular attendance and active participation in such groups.


    Nice clinical guidelines cg51 2007 psychosocial interventions for drug misuse2

    NICE Clinical Guidelines CG51 (2007)psychosocial interventions for drug misuse

    • Clinical practice recommendations

    • Staff should routinely provide people who misuse drugs with information about self-help groups. These groups should normally be based on 12-step principles; for example, Narcotics Anonymous and Cocaine Anonymous.

    • If a person who misuses drugs has expressed an interest in attending a 12-step self-help group, staff should consider facilitating the person’s initial contact with the group, for example by making the appointment, arranging transport, accompanying him or her to the first session and dealing with any concerns.


    Commissioning mutual aid facilitation obstacles and opportunities

    NICE Clinical Guidelines CG115 (2011)Diagnosing, assessing and managing harmfuldrinking and alcohol dependence

    • For all people seeking help for alcohol misuse:

    • •give information on the value and availability of community support networks and self-help groups (eg, AA or SMART Recovery)

    • •help them to participate in community support networks and self-help groups by encouraging them to go to meetings and arranging support so that they can attend


    Commissioning mutual aid facilitation obstacles and opportunities

    NICE Clinical Guidelines CG115 (2011)Diagnosing, assessing and managing harmfuldrinking and alcohol dependence

    • TSF v CBT - Easton (2007)

    • TSF v MET and CBT - MATCH (1997)

    • TSF v coping skills - Walitzer (2009)

    • TSF v couples therapy and psycho-educational intervention - Falsstewart (2005), Falsstewart (2006)

    • Standard TSF v intensive TSF – Timko (2007)

    • Directive TSF v motivational TSF and coping skills – Walitzer (2009)


    Commissioning mutual aid facilitation obstacles and opportunities

    NICE Clinical Guidelines CG115 (2011)Diagnosing, assessing and managing harmfuldrinking and alcohol dependence

    • TSF was significantly better than other active interventions in reducing the amount of alcohol consumed when assessed at 6-month follow-up

    • Those receiving TSF were more likely to be retained at 9-month follow-up

    • Intensive TSF was significantly more effective than standard TSF in maintaining abstinence at 12-month follow-up

    • Directive TSF was more effective at maintaining abstinence than motivational TSF up to 12-month follow-up


    Acmd recovery standing committee what recovery outcomes does the evidence tell us we can expect3

    ACMD Recovery Standing Committee“What recovery outcomes does the evidence tell us we can expect?”

    • 9. The roles of recovery community organisations and mutual aid, including Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery, are to be welcomed and supported as evidence indicates they play a valuable role in recovery.


    Acmd recovery standing committee what recovery outcomes does the evidence tell us we can expect4

    ACMD Recovery Standing Committee“What recovery outcomes does the evidence tell us we can expect?”

    • A range of recovery outcomes and sustained recovery are more likely to be achieved if people engage in mutual aid (AA) Fiorentine(1999), Kelly, Hoeppner, Stout & Pagano (2012)

    • Mutual aid (AA) participants who become actively involved in helping others, for example as a sponsor, are more likely to do well Fiorentine, (1999), Pagano, Friend, Tonigan, & Stout, (2004)

    • Having a sponsor early (AA) was beneficial and predicted increased abstinence from alcohol, cannabis and cocaine Tonigan& Rice (2010)


    Acmd recovery standing committee what recovery outcomes does the evidence tell us we can expect5

    ACMD Recovery Standing Committee“What recovery outcomes does the evidence tell us we can expect?”

    • Being a sponsor (NA/AA) over a one-year period, was strongly associated with substantial improvements in sustained abstinence rates for injecting drug users Crape, Latkin, Laris & Knowlton (2002)

    • “There is emerging evidence on other forms of mutual aid, for example, SMART Recovery”


    Commissioning mutual aid facilitation obstacles and opportunities

    • Obstacles

    • Organisational change

    • Structural obstacles

    • Ideological obstacles

    • Opportunities

    • Public health perspective

    • PHE toolkit

    • Evidence base


  • Login