Glasgow ARBD Supported Living Service

Transcription

1 Glasgow ARBD Supported Living Service penumbra.org.uk

2 01 About Penumbra Penumbra is one of Scotland s largest mental health charities. We support around 1600 adults and young people every week. Founded in 1985, we provide a variety of innovative services in communities across Scotland: 1 st Response and Crisis Support - Short term support for people experiencing a mental health crisis. ARBD - Recovery focused support for people with Alcohol Related Brain Damage (ARBD). Carers Support - Support for people who are caring for someone with a mental health challenge. Nova Projects - Services that promote recovery, social inclusion and selfmanagement. Peer Support Services where staff use their own experience of mental ill-health to help other people recover. Self Harm Projects - Services for both adults and young people who self-harm. Short Breaks - Supportive breaks for people to focus on their recovery. Supported Accommodation - Supported housing and tenancy projects. Supported Living - Practical and emotional support provided in people s own homes. Wellness Centre - Access a range of services in the community which promote positive mental health and support people to recover from mental ill health. Our vision for Scotland We envisage a society where people with mental health problems expect recovery and are accepted, supported and have the resources to fulfil their potential. To achieve this vision our Strategic Plan sets out five aims (RPIII): Recovery - To ensure that all mental health services and activities are hopeful, personalised and recovery focused. People - To ensure a highly valued, skilled and involved workforce. Innovation - To develop, support and provide innovative responses that promote recovery, social inclusion and citizenship for people with mental health problems. Influence - To promote mental health and wellbeing in communities by influencing; policy makers, funders and others. Improvement - To ensure quality and continuous improvement in all business processes to achieve our mission. RPIII is supported by objectives and a results and monitoring framework. As part of this framework, Penumbra services compile an Annual Review which summarises the work undertaken to meet the five key aims, to achieve our mission, and to realise our vision for society. This Annual Review is based around the RPIII structure, with sections for Recovery, People, Innovation, Influence, and Improvement.

3 02 Service overview Contact details West Area Office Standard Building Floor 6 94 Hope Street Glasgow G2 6PH e alison.garrow@penumbra.org.uk t About the service Glasgow ARBD Supported Living Service offers support to people across the city of Glasgow. Staff are based from a centrally located office space in the heart of the city and our support is delivered seven days a week usually between 9am and 5pm, although alternative arrangements can be made upon request. Currently, our supported people are located in the Drygate, Possilpark, Yoker and Knightswood areas of the city with pending referrals in Govan and Hillhead. The service evolved around 2006 when a need became apparent for people who left the Penumbra ARBD Supported Accommodation to relocate into their own tenancies. We work closely with Glasgow City Council Health and Social Care Partnership Mental Health and Addiction commissioning teams to identify and assess the suitability of potential referrals, before working alongside the person and significant others to devise a person centred and recovery focused support plan. The service has developed an excellent reputation for effective partnership working with other agencies, having an in-depth knowledge of local resources, involving family members where appropriate in the supported persons support planning as well as effective input and signposting to ensure the maximisation of a person's income. Types of support provided The service offers a keyworker system to ensure effective relationship building through a small team of staff including a support manager, recovery practitioner and a recovery worker. Support is informed by a person's identified goal setting and can include support with healthcare appointments, tenancy maintenance, housework or accessing local resources. Although the service actively promotes the benefits of abstinence to aid recovery from ARBD, the service approaches all supports from a harm reduction perspective.

4 Number of people Number of people Number of people Annual Review 03 People who use our services Referrals are received directly from Glasgow City Counselling Commissioning team. These will be generated largely from local social work care managers or from the NHSGGC ARBD team specifically. Referrals Referred Exited / /18 Referrals for this small service remain steady. Referrals by gender Male Female Not disclosed / /18 People referred to the service are still predominantly male but as numbers are so small it is difficult to generalise about current or future trends. Referrals by age Ages (years) 2016/ /18 People referred during this time frame ranged between This is in line with current trend which is seeing an increase in the number of younger people being referred to ARBD services city wide.

5 04 Recovery I.ROC The Individual Recovery Outcomes Counter (I.ROC) is an outcome measurement tool Penumbra created to measure recovery journeys. People who use our services complete an I.ROC by scoring 12 wellbeing indicators every three months. These scores allow us to build up a picture of their wellbeing over time, and assess and measure their personal recovery journey. Scores for everyone using a service can be averaged to show general trends. Traditionally Social and Personal Network score low for people with ARBD as it is not uncommon for people experiencing alcohol dependency/misuse to be alienated from family and friends. Through the Step Up programme people can identify resources and activities they may wish to join or try and we see an increase in their social circle or engagement in the community. Using other tools in the programme, for example looking at Being a Good Neighbour helps people work through concerns they have about maintaining tenancies or living as part of a community.

6 05 Recovery story When minimum unit pricing was introduced in Scotland, I was drinking up to twelve cans of super strength lager every day...washed down with a three litre bottle of strong cider! I ve has spells in specialist supported accommodation and detox services over the last few years and I ve been able to achieve abstinence for a few months here and there says Nick. But I ve always returned to the bottle eventually, I used to say I just liked the taste of it, but to be honest I just wasn t ready to give it up. Nick spent Christmas and New Year in Eriskay House detox unit at Stobhill hospital in Glasgow earlier this year and returned home in the middle of January. I thought it might have been the push I needed to stop once and for all, but I went in with the mind-set that I was just having a few weeks off it (alcohol) to give my body a wee break. Within an hour of returning to my flat I d already been to the off-licence to get stocked up again. By the middle of May, Nick had been hospitalised after experiencing, heart palpitations, breathlessness, complaining of feeling like his head was going to explode and not being able to walk properly. That was the scariest thing I ve ever experienced in my life says Nick. My mind was gone; I couldn t remember anything and thought I was going to die. After a week in hospital I discharged myself, I wanted to get back to the safe and familiar surroundings of my flat. Nick considers this period his rock bottom and the closest to death you can get to whilst still alive. Once home, Nick vowed never to touch alcohol ever again and hasn t touched a drop since the 26th May. Something s different this time, it s still early days but I can say with total confidence that I m not drinking that muck ever again. "The cider I was drinking increased from around 3 a bottle to around 11 so I couldn t afford it anymore" I ve had a diagnosis of ARBD for a few years now and I know that the only way to recover is to stop drinking. For those few weeks in May when I was buying vodka and whisky as well as cider, I could barely stand up and I was bouncing off all the walls in my flat, I wasn t eating and I didn t want to go to sleep because I thought I wouldn t wake up. I suppose you could say that the minimum unit pricing has saved my life, I needed to go through what I did in order to reach rock bottom. Believe me, once your there it s a sad and lonely place and it s not a place you want to stay for too long. I feel like a new person and even though I m only a few weeks off the booze, I feel like I ve got my life back. Those blurry days are in the past, and I m moving forward. I was the closest to death you can get to whilst still alive, being 'rock bottom' is a scary place to be

7 06 Recovery story Now retired, Eric s entire employment history was as a painter and decorator and he worked in a variety of unusual settings. I used to paint the exterior of battleships and frigates when they were in the dry dock as well as painting the cranes that were used to build the actual ships says Eric. Married with kids, Eric says he drank alcohol every day, usually lager, but he never saw it as a problem, it was other people who had the problem he jokes. After a while, my marriage broke down and I ve not seen my girls since. It was around the mid 90 s I think that things must have gone downhill because that s when my memories fade away. Eric has lived with a diagnosis of ARBD for around a decade now and has achieved some periods of abstinence when residing in a residential setting. Returning to the community to live independently however has coincided with a return to old routines involving alcohol use. It would be clear to ascertain that Eric is currently at the pre-contemplation stage of the cycle as he doesn t feel that any problem exists. To those around him however, the negative consequences of his sustained alcohol use are clearly apparent with self-neglect evident. Historically however, Eric has used his autonomous decision making abilities to decide to move into residential care home settings or to receive in-patient detoxification. This suggests that during some periods of his recovery he has successfully navigated the contemplation stage of the cycle and acknowledged alcohol use was negatively impacting his life. Also, whilst on waiting lists for vacancies in supported accommodation and detox wards, Eric has clearly made plans for the preparation stage and showed his intention to address problems that were detrimentally impacting on his health and overall wellbeing. Eric has spent several years in supported accommodation enjoying lengthy periods of abstinence and engaging with rehabilitation and recovery programmes. This action stage is where the real change is witnessed and although it can be stressful, it can also be exciting with opportunities for a new future becoming a real prospect. For Eric, he has overcome the physical and mental addiction to alcohol several times by living in a structured residential environment with staff and peers on hand to offer support and guidance, as and when necessary. Eric has returned to live alone on several occasions after remaining abstinent for sustained periods. Succumbing to temptation and returning to old behaviours can happen within minutes, as has been the case for Eric, and so the cycle continues. I used to paint battleships and frigates, but when the working day was done, pubs were on every street corner in those days

8 07 People Staff As the Supported Living Service was devised as a follow-through service from the Supported Accommodation Service, the support manager is responsible for managing both the SA and SLS ARBD services in Glasgow. This allows for some excellent joint working and sharing of knowledge. Supported by an Assistant Support Manager, the SLS also has a designated Recovery Practitioner and Recovery Worker who deliver the vast majority of the scheduled support. Periods of absence is covered by Penumbra employees from the SA and occasionally from the pool of relief staff. Training All staff are supported to meet the training requirements specific to their role, this includes introductory and core training that is completed within the first 6 months of someone's employment. Core training includes specialist ARBD training delivered by the local authority ARBD team and I.ROC training provided by Penumbra's L&D (learning and development) department. Beyond this staff are encouraged to continually develop professionally through additional training that is relevant to their role. Training is accessed in a range of ways, including online platforms (RBS Mentor, Penumbra's enetlearn and SSSC Learning Zone), Penumbra's L&D department and through other external agencies or organisational bodies. SSSC registration All employees are either fully registered or in the application process of registering with the SSSC on the following three register parts depending on supervisory responsibility Adults in a care home setting Care at home Housing support This ensures effective relationships are maintained between both the SA and SL services. All staff are encouraged to make use of associated SSSC materials such as Step into Leadership and medication resources, the open badges and the PRTL learning logs.

9 08 Innovation Staff from the service have contributed many articles to publications as a way of promoting supported peoples recovery stories as well as some best practice reflections. Another area which is currently being explored by the service is the idea that the terminology of 'alcohol related brain damage' may be considered to be discriminatory and stigmatising on certain levels. For example, to have 'alcohol related' in the medical diagnosis highlights the 'self-inflicting' nature of the condition - we don t refer to smoking related lung cancer after all. Also, the term 'brain damage; isn t a term favoured by brain organisations such as Headway, with brain injury being preferred. Countries such as Ireland and Australia actually use the term alcohol related brain injury. With these things in mind, we are currently (July 2018) liaising with partner agencies and other stakeholders including supported people to seek their views on the term ARBD. Feedback will dictate if this issue may or may not be explored further. The use of whiteboards as a memory aid is well publicised in the field of ARBD and dementia related illnesses. Over the last year we have encouraged and supported our supported people to try digital memory clocks which can be programmed with alarms to act as medication prompts for example. Four people have been in a position to purchase them so far with feedback in all cases being favourable regarding the person's ability to be more independent and manage daily living tasks better. As we recognise that supported people have pasts and often employment history, we have also promoted and supported people to research and explore the option of applying for charitable benevolence to charities based on their previous occupations. Success rates have been high with people securing finances for an oven, dining room table and chairs, heaters, televisions, energy costs as well as regular payments. Currently, we are supporting someone to seek funding from a charity relating to his previous job as a fork lift truck driver, this would allow him top buy a new digital memory clock to better manage his daily routines and promote further independence. POWWOWs and outreach Staff within the service have a sound knowledge of local resources available to people in their communities and support them to access opportunities as and when appropriate. With support from the research stage to referral and actually attending the service, staff have formed good working relationships with various agencies such as Gatehouse day centre in Knightswood, Marie Trust, Fred Paton day service and Cordia to name a few.

10 09 Influence Over the last year, the service Recovery Practitioner has contributed four blog posts to the Third Force News website. The articles have all been on different subjects and were discussed and shared at team meetings as a way of sharing best practice. One article was about the effectiveness of implementing the Penumbra smoke free policy within supported living services and the risk of second hand smoke. Another article related to the moral dilemma of supporting people to maximise their income when there is a high risk of any disposable income being used to purchase alcohol. A third contribution related to the introduction of the Scottish Government s minimum unit alcohol pricing which was implemented in May and the possible increase in illicit alcohol use within society. A final article was contributed on the subjects of nature deficit disorder and eco-therapy and how they can be used an intervention to aid recovery from ARBD. This article also touched upon the fit150 initiative. Three further articles have also been submitted and appeared on the community care website. An article on the subject of the benefits and use of narrative theory to help people with memory problems document their recovery story was well received. A comparison article relating to the ways the service promotes recovery at every opportunity compared to some other agencies was also published by community care which was well received and got favourable feedback also. A final article titled 'the pool table assessment' was also published recently. This was written by the recovery practitioner and describes how the humble game of pool can be used to gauge a range or alcohol related brain damage presentations such as memory, mobility, reasoning and attention skills. Over the last year, the service has updated its unique tool with the intention to provide a structure and framework when working alongside supported people. Called the 'Step Up' programme, it contains a range of tools, some from the HOPE toolkit and some designed inhouse to better inform support sessions and to keep them underpinned by best practice of ARBD and recovery. Following on from previous years, we continue to utilise the services of our Peer Volunteer and offer his input to supported people who may benefit from peer support. Feedback has always been favourable and the Peer Volunteer's own recovery journey has also been documented in the media as he featured on BBC Radio Scotland last year as well as a feature in the Evening Times.

11 10 Improvement Care Inspectorate An announced (short notice) inspection was held in June 2017 by the care inspectorate. Quality of Care and Support received a grading of 5 which is consistent from the previous year. Quality of Management and Leadership increased to a 5 from a 4 in Quality of staffing was not assessed on this occasion although a grade of 5 was achieved in 2016.The inspection recognised that the service promoted recovery but also recognised that harm reduction was also a relevant need. They confirmed that staff worked hard to promote positive health and wellbeing outcomes for people and feedback from professionals reinforced a very positive view of the service, staffing and management. It is expected that an unannounced or short notice inspection may take place over the coming weeks. The team feel that they can evidence a consistent approach to support planning and the ability to help deliver good outcomes for the supported people. This gives us every confidence that our grades could be improved upon from Quality Assessment Framework (QAF) Feedback The service has received positive feedback questionnaires from the people supported, family and carers and from partners we work with through Survey Monkey. The people we support wholeheartedly confirm how much they appreciate the support they receive and praise the workers in the team. Family members also confirm that find the support their family member receives as excellent/very good. They comment on how genuine the team are, how well we keep people informed and involved and how much of an impact it makes.

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13 Contact Penumbra Penumbra Norton Park 57 Albion Road Edinburgh EH7 5QY FB.com/PenumbraScotland Instagram.com/penumbrascotland Service Penumbra is a charity (SC ) and a company limited by guarantee (SC ) registered in Scotland.