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The Drug Treatment System and its key transitions. Three Current Approaches and how to Integrate Them. UKDWF Conference 2009 Ian Wardle October 2009. Introduction. Joining up the individual and the social. The Individual AND the Social .
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UKDWF Conference 2009
Joining up the individual and the social
“Medical training can be faulted by social science for its centering on the care of individuals, for individualizing the issues which are properly social and should be taken at the population level.
Along both those tracks, Robin Room was a friend who would check me if I ever lapsed too much into a narrowly patient-centred view. The richest insights come and the best policies evolve when one sees and honours the realities of the individual, but at the same time grasps the realities of the population”
Griffith Edwards, Interview in Addiction, 1990
Outline of Government Targets
One of the difficulties of establishing national outcomes measures arises from the fact that each government department has its own aims and objectives, for example:
Ministry of Justice – To protect the public and reduce re-offending
Department of Health – Improve the health and well-being of people in England
Home Office – Reduce the harm that drugs cause to society, to communities, individuals and their families.Outcomes Paper PDTSRG, September 2009
The Language of Care
The Language of Integration and Complexity
The Language of the Mainstream
Therapeutic Change Approaches
William White is a thinker stressing therapeutic paradigm change. In his paper, Addiction recovery: Its definition and conceptual boundaries (2007), he describes us as being "on the brink of shifting from long-standing pathology and intervention paradigms to a solution-focused recovery paradigm"
In Fragmented Intimacy, Peter Adams describes how the medical profession, and more latterly, the profession of psychology have, over the course of the past century, defined and dominated orthodox drug treatment. …
For Adams, we need to move beyond what he calls the particle paradigm, with its biopsychosocial underpinnings, towards a social paradigm"which shifts the focus of attention away from people as discrete individuals and towards people in terms of their relationships.”
Systems Thinking and LSPs
Systems Thinking in Organisations
Systems Thinking in National Policy
Complexity stares you in the face when confronting wicked issues with multiple stakeholders, which is what Local Strategic Partnerships do.
The growing complexity involved in this governed interdependence is challenging the performance management systems that have become such an established feature of public policy in the UK and worldwide.
Making performance management work in these circumstances is a current frontier of policy development.
Places matter because they are open, dynamic and adaptive systems that do not have a simple cause-effect relationship with national or global drivers of economic, social or policy
They are a setting for intervention, but with outcomes more likely to arise from complex causal combinations than linear cause and effect.
Tim Blackman--Placing Health: Neighbourhood renewal, health improvement and complexity, 2006,
“The fact is that public-service workers have been 'cheating' their systems to meet their targets, a practice which has become known in the NHS as 'gaming' -- a new word for the management lexicon, a word of our time.
It is a consequence of the quasi-market. The regime administering this madness is called 'payment by results'. It is a misnomer; it should be called 'payment for activity'.
What was supposed to be a system for liberating public-sector organisations has turned into a burgeoning and dysfunctional stranglehold of bureaucratic control.”
John Seddon, Systems Thinking in the Public Sector, 2008
Key questions for the drug treatment field in 2010.
(A) CENTRALISED, EXPERT, MODEL
(B) LOCALLY LED, RECOVERY MODEL
The current, silo-based, centralised, target-driven expert –led, evidence-based therapeutics sit within a strategic framework of population-level risk management
The new local, systems-based ‘Recovery’ therapeutics aim to enable a more accessible, person-centred, community-embedded and qualitative social therapeutics of need