Renfrewshire ADP Commissioning Strategy Introduction/Background This is the first three year Commissioning Strategy developed in Renfrewshire for individuals who are affected by drugs and/or alcohol. The Strategy will describe Renfrewshire Alcohol and Drug Partnership s (ADP) commissioning intentions over the next three years. The ADP will aim to update this year on year through local processes to acknowledge personal and service delivery achievements and to agree the following year s priorities. The ADP Alcohol and Drug Strategy and ADP Delivery Plan should also be referred to. The ADP aims to articulate their vision through the development of this Commissioning Strategy to ensure the best possible outcomes for their service users and carers. This will enable the ADP to set out a planned response to prevention, treatment and rehabilitation with the intention of informing future investment and service configuration across the public and third sector providers. Our Vision Our vision in Renfrewshire is to ensure that individuals will achieve and sustain recovery from their problem alcohol and drug use and become contributing members of society. To achieve this, the ADP aims to:- Support people to live in a positive, health promoting environment where alcohol and drugs are less readily available. Ensure that communities and individuals will be safe from alcohol and drug related offending and anti-social behaviour. Support children and family members of people misusing alcohol and drugs to improve their life chances. Ensure individuals are improving their health, well-being and life chances by recovering from problematic drug and alcohol use. Reduce the number of adults and children who are drinking or using drugs at levels or patterns that are damaging to themselves or others. Ensure people are healthier and experience fewer risks as a result of alcohol and drug use. Provide services which are high-quality, continually improving, efficient, evidence-based and responsive, ensuring people move through treatment into sustained recovery. The core functions of the ADP are to: Develop and take forward the ADP Strategy ensuring that all service provision is recovery and outcome focussed. 1
Implementing and managing an overall performance framework including monitoring HEAT Targets and SOAs. To ensure that intended outcomes for service delivery are being achieved. Developing good practice. Commissioning and contract management of all mainstream and purchased services. Current service delivery involves frontline staff from a range of disciplines dealing with individuals affected by drug and alcohol issues. Services have staff specially qualified to deal with health issues, social care issues, mental health, criminal justice and the needs of young people. These services account to the ADP for their performance and attainment of the ADP s Strategic Priority Outcome Areas. However, this process will be further enhanced by the development/monitoring of service performance agreements for all mainstream drug and alcohol services and service specifications for ADP purchased services. Commissioning Intentions Commissioning is a process of planning, buying, delivering and monitoring services. Commissioning is about improving people s lives and providing high-quality services that are designed around the individual (source). Our commissioning approach will be centred on improving outcomes for individuals. It will provide a framework for partners to work together and aspire to achieve ambitious improvement. A number of reviews have taken place over the last few years which have shown that services are achieving positive outcomes but acknowledging further work is required. Using our needs assessment as our foundation we will set out our priorities for action in specific areas of prevention, recovery, children affected by parental substance misuse and enforcement. This Plan will also provide information on where funding is currently invested and what our future intentions will be to ensure we continue to strive to achieve our Vision. Policy Drivers The Strategy is underpinned by national frameworks for both drugs (Road to Recovery, 2008) and alcohol (Changing Scotland s Relationship with Alcohol: A Framework for Action, 2009) and will continuously strive towards achieving positive outcomes for individuals affected by drugs and alcohol. There has been a significant amount of work been undertaken to provide a clearer understanding of the needs of our target population. Information on population trends, deprivation levels, employment as well as levels of crime and morbidity and mortality levels. Over the last number of years there have been a number reviews undertaken around the following areas:- Review of Alcohol Services (insert date) Review of Drug Services (insert date) Review of Renfrewshire Drug Service (2011) Impact Analysis of Getting Our Priorities Right Guidance (2010) Training Needs Analysis (2011) ADP Needs Assessment (2011) Drug Deaths Report (annually) Review of Low Threshold Clinic (2012) Mapping of Current Service Provision Against a Recovery Orientated Schema (2012) Strategic Overview of Alcohol and Drugs Services (2012) EQIA for Renfrewshire Drug Service (2012) EQIA for Alcohol Problems Clinic & Integrated Alcohol Team (2012) EQIA for Renfrewshire ADP Alcohol and Drug Strategy (2012) 2
(The ADP Needs Assessment is detailed in Appendix One) All other documents are available on request). The Scottish Government has developed a suite of national core outcomes which the ADP will be responsible for reporting on. These outcomes and indicators are reported via the ADP Delivery Plan on an annual basis. HEALTH: People are healthier and experience fewer risks as a result of alcohol and drug use: a range of improvements to physical and mental health, as well wider well-being, should be experienced by individuals and communities where harmful drug and alcohol use is being reduced, including fewer acute and long-term risks to physical and mental health, and a reduced risk of drug or alcohol-related mortality. PREVALENCE: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others: a reduction in the prevalence of harmful levels of drug and alcohol use as a result of prevention, changing social attitudes, and recovery is a vital intermediate outcome in delivering improved long-term health, social and economic outcomes. Reducing the number of young people misusing alcohol and drugs will also reduce health risks, improve life-chances and may reduce the likelihood of individuals developing problematic use in the future. RECOVERY: Individuals are improving their health, well-being and life-chances by recovering from problematic drug and alcohol use: a range of health, psychological, social and economic improvements in well-being should be experienced by individuals who are recovering from problematic drug and alcohol use, including reduced consumption, fewer co-occurring health issues, improved family relationships and parenting skills, stable housing; participation in education and employment, and involvement in social and community activities. CAPSM: Children and family members of people misusing alcohol and drugs are safe, wellsupported and have improved life-chances: this will include reducing the risks and impact of drug and alcohol misuse on users children and other family members; supporting the social, educational and economic potential of children and other family members; and helping family members support the recovery of their parents, children and significant others. COMMUNITY SAFETY: Communities and individuals are safe from alcohol and drug related offending and anti-social behaviour: reducing alcohol and drug-related offending, re-offending and anti-social behaviour, including violence, acquisitive crime, drug-dealing and driving while intoxicated, will make a positive contribution in ensuring safer, stronger, happier and more resilient communities. LOCAL ENVIRONMENT: People live in positive, health-promoting local environments where alcohol and drugs are less readily available: alcohol and drug misuse is less likely to develop and recovery from problematic use is more likely to be successful in strong, resilient communities where healthy lifestyles and wider well-being are promoted, where there are opportunities to participate in meaningful activities, and where alcohol and drugs are less readily available. Recovery will not be stigmatised, but supported and championed in the community. SERVICES: Alcohol and drugs services are high quality, continually improving, efficient, evidence-based and responsive, ensuring people move through treatment into sustained 3
recovery: services should offer timely, sensitive and appropriate support, which meets the needs of different local groups (including those with particular needs according to their age, gender, disability, health, race, ethnicity and sexual orientation) and facilitates their recovery. 4
ADP Financial Framework Funding within the Financial Framework derives from two main sources Scottish Government funding which is allocated the ADP via NHS Greater Glasgow and Clyde processes and Renfrewshire Council. It should be mentioned that the Financial Framework does not reflect total investment by all partners. For example that work which is undertaken within the prevention element of the Strategy is under-reflected because a lot of the work is carried out by Education Department and Strathclyde Police. Similarly there are also significant costs of treatment and support for recovery which are NHS Greater Glasgow and Clyde and Social Work which come from core budgets and is difficult to quantify. Alcohol and Drug Partnership Financial Framework 2011-12 Alcohol 000 Drugs 000 Total 000 Resources ADP Allocations 938,000 942,000 1,880,000 ADP Support 48,000 48,000 96,000 Core NHS Funding Allocation 145,000 145,000 290,000 Core Social Work Funding Allocation 953,000 954,000 1,907,000 Strathclyde Fire and Rescue 2,500 2,500 5,000 Lloyds TSB Partnership Drugs Initiative 20,000 20,000 40,000 Barnardos 9,847.00 9,847.00 19,694.00 North Strathclyde Community Justice Authority 400 400 800.00 Total Resources 2,116,747 2,121,747 4,238,494 Profile of Renfrewshire Renfrewshire is the ninth largest council area in Scotland with a population of 170,250. It is relatively densely populated, with most of the population concentrated in urban centres and only 4% living in rural areas. The area has a very small ethnic minority population, with only 1.2% of residents having a minority ethnic background. According to the Scottish Index of Multiple Deprivation (SIMD), 17% of Renfrewshire s population were classed as income-deprived in 2011. There were 44 datazones in Renfrewshire (out of a total of 214) identified as being in the most deprived 15% in Scotland; these areas have a combined population of 31,160 (18% of the population according to the 2009 estimates used). There has been an increase in income deprivation with 16.5% (28,070 individuals) of Renfrewshire s population considered income deprived, compared to 15.9% (27,050 individuals) in 5
SIMD 2009. (Source Renfrewshire Community Planning Partnership, Joint Strategic Needs Assessment, 2012) With an increase of 0.6% in income deprivation, Renfrewshire is within the top 10 Local Authorities with the largest increase in income deprivation. (Source Renfrewshire Community Planning Partnership, Joint Strategic Needs Assessment, 2012) Renfrewshire s Economy Renfrewshire s economy has a higher than average proportion of the manufacturing sector and public sector employment is above average at 20.9%, compared with 17.7% in the UK as a whole. The recession and the UK s continuing economic problems have resulted in an increase in unemployment across the country. In Renfrewshire 2.1% of the working age population were claiming Employment Support Allowance and the end of 2010 the seventh highest claimant rate in Scotland. The percentage of the population claiming Incapacity Benefit or Severe Disablement Allowance was 5.7%, the ninth highest in Scotland. Estimates suggest that 3% of the working age population in Renfrewshire are unlikely to participate fully in the economy as a result of substance misuse. Source Renfrewshire Community Planning Partnership, Joint Strategic Needs Assessment, 2012) Approximately 15-20% of people residing in the Renfrewshire area who are referred to the Work Programme via JobCentre Plus presents with alcohol and/ or drug issues. Many people referred lack basic skills such as literacy. (Source Renfrewshire Community Planning Partnership, Joint Strategic Needs Assessment, 2012) There has been an increase in employment deprivation with 14.7% (15,570 individuals) of Renfrewshire s working age population experiencing employment deprivation, compared to 12.6% (13,410 individuals) in SIMD 2009. (Source Renfrewshire Community Planning Partnership, Joint Strategic Needs Assessment, 2012) Youth Unemployment 18-24(JSA Claimant count) in Renfrewshire and Scotland 2008-2012 (Source: Renfrewshire Community Planning Partnership, Joint Strategic Needs Assessment, 2012) Renfrewshire Renfrewshire Rate Year Claimant Scotland Rate Count 2012 1605 10.4% 8.5% 2011 1555 10.10% 8% 2010 1490 9.60% 8.2% 2009 1125 7.40% 6.3% 2008 760 5% 4.3% The table illustrates the very substantial rise in youth unemployment from January 2008, just prior to the start of the financial crisis and January 2012. Understanding Current Local Needs The large increase in drugs clients at the end of 2008/09 is largely due to the inclusion, from this point, of clients using the GP Enhanced Care service. The spike in alcohol clients in Q4 2010/11 was due to the inclusion of the Integrated Alcohol Team. However, it then emerged that these were already being included in figures from the APC. As such, the apparent fall in 2011/12 is not actually a drop but reflects more accurate figures. However, the figure of 1070 was reported hence inclusion. Figures for 2011/12 are consistently higher than previous years). 6
Number of clients in contact with drug and alcohol services 1800 1600 1400 1200 1000 800 600 400 200 0 Q1 2007/08 Q2 2007/08 (Source: SUMS) Q3 2007/08 Q4 2007/08 Q1 2008/09 Q2 2008/09 Q3 2008/09 Q4 2008/09 Q1 2009/10 Q2 2009/10 Q3 2009/10 Q4 2009/10 Q1 2010/11 Q2 2010/11 Q3 2010/11 Q4 2010/11 Q1 2011/12 Q2 2011/12 Q3 2011/12 Q4 2011/12 Alcohol Alcohol The rate of alcohol related hospital discharges has shown an increase from 789 in 2004/07 to 823 in 2007/10 and is significantly higher than the national picture (734). In 2011, there were 46 alcohol related deaths in Renfrewshire (underlying cause). Within NHS Greater Glasgow and Clyde, 28% of males (aged 16 years or more) usually consume more than the recommended weekly alcohol limit for males whilst 18% of females (aged 16 years of more) usually exceeded the recommended weekly alcohol limit for females (Scottish Health Survey, 2008/2009 combined dataset). With the assumption that these prevalence estimates are transferable to the population of Renfrewshire, this would mean that there are approximately 18, 331 males (over the age of 16 years) in Renfrewshire that usually consume more than the weekly recommended limit of alcohol for males and 13, 256 females (over the age of 16 years) in Renfrewshire that usually exceed the recommended weekly alcohol limits for females (2008/09). In 2011, there were a total of 450 licensed premises in Renfrewshire 138 off sales and 312 on sales. Of the 817 Renfrewshire pupils that indicated that they had had an alcoholic drink (Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS), 2010), 15% of males and 14% of females indicated that they had participated in binge drinking (defined as consuming 5 or more drinks on a single occasion) on four or more occasions in the past 30 days Evidence from SALSUS 2010 showed that in Renfrewshire, 42% of 13 year olds and 78% of 15 year olds reported ever having had an alcoholic drink. Compared with 2006, there has been a notable decrease in the proportion of 13 year olds who have ever had an alcoholic drink (from 53% in 2006 to 42% in 2010). There has been no statistically significant change in the proportion of 15 year olds who have ever had an alcoholic drink. The proportion of pupils in Renfrewshire who had ever had an alcoholic drink is similar to national average. Drugs 7
Age and gender breakdown of alcohol misuse clients 100% 80% 60% 40% 20% 65+ 40-64 19-39 0% 2008/09 2009/10 2010/11 2011/12 2008/09 2009/10 2010/11 2011/12 0-18 Male Female The Cost of Alcohol in Renfrewshire In 2010 the Scottish Government produced The Societal Cost of Alcohol Misuse in Scotland for 2007 which estimated a central cost of 3.6bm. This national methodology has been applied to local data to provide estimates of the cost of alcohol-related harm at a local authority area level Health Service: 10.97m Social Care: 9.93m Crime: 27.23m Productive Capacity: 24.11m TOTAL COST: 72.23m (These costs do not include wider social costs that estimate the value of non-paid work and intangible social costs associated with people who experience premature mortality from alcohol related diseases. As these costs are hard to estimate accurately they have been excluded from the overall cost, but are believed to be somewhat in the range of 41.62m- 76.43m for Renfrewshire)? Cost of Alcohol Harm per Person in Renfrewshire NHS 64.00 Social Care: 58.00 Crime: 160.00 Productive Capacity: 142.00 Overall cost per head: 424.00 Drugs Estimated prevalence rate of problem drug use amongst 15-64 year olds in Renfrewshire (percentage of total population age 15-64) is 1.84% compared to 1.71% for Scotland. In 2009/10, 474 new individuals were reported to the Scottish Drugs Misuse Database (SDMD) from Renfrewshire. This represents an increase of more than 40% since 2006/07. One in six Renfrewshire secondary school pupils (17%, 896) said that they had taken illegal drugs at some time with cannabis being the drug most commonly used (13.3%, n = 699). However, 0.6% indicated that they had taken heroin (n = 33) and crack cocaine (n = 30) - see table 16. 8
Males were more likely than females to have taken drugs ever. Upper school pupils were more likely to have ever misused drugs (27% n=336). SALSUS responses showed that 8% of 13 year olds (n=57) and 26% of 15 year olds (n=167) had used or taken drugs on one or more occasion. Drug Related Deaths in Renfrewshire has shown an increase of 26.3% (n=24) on the deaths recorded in 2010 (n=19), the third highest ever recorded for the Renfrewshire area. It also represents a return to the underlying trend identified in the graph below. Age and gender breakdown of drug misuse clients 100% 80% 60% 40% 20% 65+ 40-64 19-39 0% 2008/09 2009/10 2010/11 2011/12 2008/09 2009/10 2010/11 2011/12 0-18 Male Female Points to Note: Alcohol clients tend to be older (majority in 40-64 age group) compared with drug clients (majority aged 19-39). Higher number of under 18s involved with drug services than with alcohol services. 9
Relatively small number of over 65s involved with alcohol services but number of males aged 65+ has trebled (BUT from very small number) in four years. Males make up greater proportion of alcohol clients - 71% in 2011/12 compared with 69% in 2008/09. Number of men attending alcohol services increased by 65% between 2008/09 and 2011/12; number of women increased by 51%. Number of drugs clients aged over 40 is increasing quickly - number of men in this age group increased by 155% between 2008/09 and 2011/12 whilst number of women 40-64 increased by 106% in same period. Implications for other services as numbers of older substance misuse clients increase - increased likelihood of health problems = increased need for health and social care services = services for older people may have to adapt to accommodate needs of clients with substance misuse issues. Number of men involved with drugs services increased by 53% between 2008/09 and 2011/12; number of women increased by 22% in same period. Children Affected by Parental Substance Misuse Thirty nine per cent of individuals reported to the Scottish Drugs Misuse Database from Renfrewshire had dependent children. There were 5618 contacts to Renfrewshire Council Social Work Department relating to child care concerns in 2010/11. The rate 1.8 of maternities recording drug use has been maintained from 2005/08 and 2006/09. In contrast, in 2007/10 there has been a sharp increase rising to 7.3. For the same period Scotland has seen a slight increase from 9.6 to 11.9 (further analysis is planned to understand this figure). 70% Percentage of children on the Child Protection Register affected by parental substance misuse 60% 50% 40% 30% 20% 10% 0% Apr-08 Jun-08 Aug-08 Oct-08 Dec-08 Feb-09 Apr-09 Jun-09 Aug-09 Oct-09 Dec-09 Feb-10 Apr-10 Jun-10 Aug-10 Oct-10 Dec-10 Feb-11 Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12 (NB: Proportion of children on the register affected by parental substance misuse in Renfrewshire has increased since the introduction of new national CP guidance on 1 August 2011. Instead of children being registered under one of four categories, all areas of concern are now recorded for each child, and this includes parental substance misuse. The new guidance also allows children to be registered prior to birth, leading to an increase in the registration of unborn babies with substance-misusing mothers). 10
Future Problem Drug Use Predicted numbers of problem drug users 2500 2000 1500 1070 1051 1028 997 951 910 Female 1000 Male 500 1009 996 978 954 921 899 0 2010 2015 2020 2025 2030 2035 Estimated population projections from 2008 to 2033 for Renfrewshire show decreases of 10.8% (male 9.8%, female 11.8%) and 18.2% (male 16.7%, female 19.6%) in the 0-15 and 16-64 age groups respectively but an increase of 52.6% (male 60.1%, female 47.2%) in the pensionable years age group. (Source: GROS). Prevalence rates (from ISD Scotland, 2009/10 figures) only apply to the population aged 15-64, so projections are only based on the future population in that age group. As such, projections suggest that the number of problem drug users will fall, since there is expected to be a significant decline in the size of the adult population. However, prevalence rates increased between 2006 and 2009/10 and if this trend continues, the number of problem drug users will obviously be higher. Due to differences in the methodology used, it is not possible to compare prevalence with earlier studies). Service Provision in Renfrewshire Mainstream alcohol and drug services are delivered by the NHS and Renfrewshire Council. The ADP also commissions a number of third sector organisations whose work ranges from working with young people to those involved in the criminal justice system. There is also funding available for individuals who wish to access Residential Rehabilitation Facilities via an Assessment process. These services are available out with Renfrewshire. 11
Prevention and Early Intervention The ADP recognises that reducing future demand for alcohol and drugs can only be achieved by addressing the root causes of the problem. Evidence shows that problem alcohol and drug use occurs in both urban and rural areas, but there are strong and clear links with deprivation. Renfrewshire has concentrated pockets of intense deprivation with multiple social problems, where problems are more likely to become worse. Evidence clearly shows that real long-term success will only come by increasing economic growth; enhancing children's experience in their early years; promoting mental health and wellbeing; and improving universal services for young people. This approach is complemented by the role that the reform of our education system through Curriculum for Excellence will play in promoting resilience, confidence, independent thinking and positive attitudes and specific action on substance misuse education and information. More emphasis is also being placed on the role of parents or carers in educating their own family about drug misuse and alcohol problems. Renfrewshire ADP will work to prevent harm in Renfrewshire caused by alcohol and drugs by adopting a holistic approach to prevention and education work which will be underpinned by the Greater Glasgow and Clyde Prevention and Education Model. This will ensure all work undertaken has a robust evidence base. All activity within this area is co-ordinated by the prevention and education sub group SPEAR. Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change Fewer individuals drink above the recommended limits Reduced per capita consumption The Adult Health and Wellbeing Survey 2011 showed that 18.6% of individuals exceeded the weekly alcohol limit and 33.5% binge drank in the last week. Within NHS Greater Glasgow and Clyde, 28% of males (aged 16 years or more) usually consume more than the recommended weekly alcohol limit for males whilst 18% of females (aged 16 years of more) usually exceeded the recommended weekly alcohol limit for females (Scottish Health Survey, 2008/2009 combined dataset). With the assumption that these prevalence estimates are transferable to the population of Renfrewshire, this would mean that there Continue to support partners in primary care to increase the delivery of Alcohol Brief Interventions by providing training to key staff and supplying additional resources. 12
are approximately 18, 331 males (over the age of 16 years) in Renfrewshire that usually consume more than the weekly recommended limit of alcohol for males and 13, 256 females (over the age of 16 years) in Renfrewshire that usually exceed the recommended weekly alcohol limits for females (2008/09). Reduced alcohol consumption by young people Increased knowledge and changed attitudes to alcohol, drinking and drugs Reduced drug taking Evidence from SALSUS 2010 showed that in Renfrewshire, 42% of 13 year olds and 78% of 15 year olds reported ever having had an alcoholic drink. Of the 817 Renfrewshire pupils that indicated that they had had an alcoholic drink (Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS), 2010), 15% of males and 14% of females indicated that they had participated in binge drinking (defined as consuming 5 or more drinks on a single occasion) on four or more occasions in the past 30 days 1. Explore the piloting of life skills training in Renfrewshire secondary schools and as part of the achieving stepped change initiative. 2. Along with Community Planning partners review relevant evidence based approaches 3. Provide diversionary activities for young people to prevent harmful drinking by supporting the delivery of the Streets Stuff programme. It should also be noted that Curriculum for Excellence is being implemented in all schools and recent educational inputs are unable to demonstrate improvements in young people s drinking. Work in this area should be a priority to ensure work within this area is part of an evidence based approach. Reduced substance misuse in communities at risk Paisley West and Central Community Council carried out a consultation to seek views and opinions of local residents about how drinking alcohol could be made more positive and less harmful and to get them involved in the process. Continue to support community-led, community based, multi-faceted approaches to tackling alcohol issues in the West-End of Paisley using all resources and networks. Deleted: 13
Recovery The central concept of the Government's strategy is recovery. 'Recovery' is the principle that people suffering from problem drug use should receive interventions which do more than just reduce the immediate risks and harms of addiction. Instead, the clear goal should be to move on from addiction, towards a drug-free life as active and contributing members of society. Furthermore, it incorporates the principle that recovery is most effective when service users needs and aspirations are placed at the centre of their care and treatment. In short, an aspirational, person-centred process (Road to Recovery, Scottish Government, 2008) Recovery Principles Research supporting the Principles of Recovery Many pathways highly personal generally involve a redefinition of identity in the face of crisis or a process of progressive change There is a process of natural recovery which involves neither treatment nor involvement with mutual aid groups Some people will require treatment and/or the assistance of mutual aid self help groups The success of natural recovery may be the individual s social capital Methadone, combined with psychosocial support, leads to improved outcomes e.g. decreased death rates, reduced transmission of STDs; elimination or reduced illicit opiate use; reduced criminal activity; enhanced protective behaviour; improved global health and social functioning. Recovery is self-directed and empowering: The person in recovery is the agent of recovery, leading to higher levels of autonomy. Through self-empowerment individuals become optimistic about life goals Self-efficacy is critical to self-management Motivational interviewing has been shown to decrease substance use and improve outcomes. Recovery involves a personal recognition of the need for change and transformation: The process of change can involve physical, emotional, intellectual and spirited aspects of a person s life Motivation to change is vital for recovery The best predictor of engagement and retention The person must accept she/he has a problem, make a conscious choice to change and be working and motivated to take action to change her/his behaviour. Recovery is holistic: Some literature demonstrates that the integration of the physical, emotional and spiritual realms of an individual is influential in the quest for recovery 14
Fundamental aspects of attitudes and values for recovery: Structural changes in life Spiritual functions e.g. gratitude; humility; helpfulness; eager to change and learn; self care and valuing of self. Recovery has cultural dimensions: Need to understand the role of culture in a person s life Traditional theory of counselling and treatment are reflective of western cultures Language is vital Culturally competent services improve recovery and remission rates for all, including minority populations Gender is crucial. Recovery exists on a continuum of improved health and wellness: Recovery is not a linear process. It is based on continual growth and improved functioning Relapse may be a part of the continuum, but not an inevitable outcome There is a chronicity about substance use recovery is a developmental and continuous process that varies from person to person Individuals should learn from the experiences of the process of recovery not be made to feel a failure in the process. Recovery emerges from hope and gratitude: Greater hope and increased goal orientated thinking, positive correlation to lengths of abstinent, quality of life and self-efficacy Sharing of experiences with people AA concept of gratitude recovering alcohol misusers often report seeing their problem be as a gift that brought a greater sense of wholeness and fulfilment, then they feel they would have achieved without trying to confront the addiction Importance of hope and belief in the possibility of a renewed sense of self and purpose essential component of recovery. Recovery involves a process of healing and self redefinition: Process of discovery and fostering self-empowerment, returning to basic functions and improving quality of life Recovery involves addressing discrimination and transcending shame and stigma Recovery is supported by peers and allies Recovery involves (re) joining and (re) building a life in the community the importance of recovery capital Recovery is a reality. It can, will and does happen Many studies agree that recovery is a continuous, life-long process. (USA Department of Health & Humanities 2009) 15
A recovery orientated system of treatment, care and support should utilise: Family and social network involvement in treatment, which, where supportive and functional, leads to improving more sustainable outcomes Increasing the extent to which the person seeking recovery has access to recovery orientated norms and values and a social network who are recovery supporters for that individual Help the individual, conceptually, emotionally, and practicality to overcome barriers to recovery, deal with life stresses, specific high risk situations and incidents and build self-efficacy through increased confidence and self-belief Improved social participation and integration into non-substance using activity provide group solidarity in tackling and developing the individual s stigmatisation, a key barrier to recovery Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change The delivery of care will be an aspirational, person-centred process Data captured indicates a good basis for the development of further service user involvement. It is clear that links with the ADP are robust and should be continually built upon. The women service user group should be further supported and encouraged. From other areas of work in recovery it can be seen that personalised approaches to the delivery of care are one of the most profound changes required. In the absence of personalised budgets for service users it should still be possible to develop more self directed care within core services. As a result of this service users will have greater expectations of themselves and treatment services. This should mean that they progress through treatment more quickly and at less cost. Although services indicate that person-centred care is at the heart of their treatment programmes this should be further explored to find out if everyone has the same view, experience and knowledge of person-centred care. 1. Further develop the recruitment and training of voluntary treatment mentors i.e. people who have already been through treatment programmes that can support new entrants to treatment. 2. Develop Network for Service User Involvement in Renfrewshire. Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change The recovery model is implemented in all drug and alcohol services There is a range of services both statutory and third sector within the ADP area. It is clear that services have been developed in line with the QATS Model and reflect a tiered approach. Whilst this is consistent with Government policy and Quality Standards for Drug and Alcohol Services, this approach should now have recovery embedded within service delivery. Person-centred, recovery-focussed approaches should be 1. The production of an anti-stigma campaign by use of print, broadcast and social marketing media. (The ADP will consider the feasibility study currently being undertaken by UK Drug Policy Commission and the work on antistigma). 16
present at all levels in the system to promote a culture of ambition and a belief in recovery. 2. The ADP will review all service contracts (carried out in-house and commissioned by ADP) on the basis of a recovery focussed approach. This will include: Programme content Modalities provided Staff learning and development Service user involvement Volunteer support Partnership working Links to recovery/community support Develop clear outcomes based on the recovery principles and ensure services are signed up Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change The public s perception of individuals affected by alcohol and/or drugs will improve If recovering drug and alcohol users are to achieve social integration the local community and employers must be welcoming or at the very best tolerant of those seeking rehabilitation. Problem drug and alcohol use are chronic relapsing conditions. Thus there is an acknowledgment that many individuals will not succeed in overcoming their problem drug and alcohol use at the first attempt. The recovery ethos should extend beyond the treatment system into local communities. It is evident from some comments that the media in the ADP area could be more helpful in the accurate reporting and language used in such reporting. 1. The ADP will employ social marketing techniques to help communities understand the benefits that would accrue if they were prepared to support the attempts of problem drug/alcohol users to reduce their dependence on substances by the development of a Communications Strategy. 2. Formal links will be made with the local media to engage with recovery stories and positive examples of recovery, and re-engagement in community life as per Communication Strategy. 3. The setting up of a community reference group (local residents) or enhance links with Local Area Committees to advise the ADP on all issues of re-integration of those in recovery 17
into the community. Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change Recovery communities will be developed to engage and support mutual aid and peer support groups AA has a range of meetings in Renfrewshire but it is not clear how effectively mainstream services link to them. There are no NA groups available locally. There are also a number of service user groups e.g. SURF, Alcohol Service User Group, Women s Service User Group, Route 66 (Befriending Service) and Family Support Groups. 1. Continue to promote and support recovery and encourage the development of self-supporting meetings. 2. Invite and support innovation in developing Recovery Cafes. 3. Consider SMART recovery in Renfrewshire. Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change Individuals in recovery have access to meaningful activity and are encouraged and enabled to develop skills and achieve training, education and employment Engagement in education, training and employment is an essential component of full-stage recovery and social re-integration. A Move-on service should help to challenge preconceived ideas of unemployability by offering very personalised approaches to training and education, thereby increasing the potential of employability. Whilst a number of services within the ADP area indicate they are engaged in Move-on activities, it may be more efficacious to devise a substantive Move-on service. Development an evidence based Mental Health and Addictions Meaningful Day and Employability Service in Renfrewshire. The service will concentrate on:- promoting understanding of and engagement in the concept of recovery i.e recovery is a process and is achievable encouraging structure and purpose in peoples daily lives increasing access to a range of employability opportunities, including training, education, volunteering and paid employment Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change Data recording systems will be enhanced There are a variety of data collection systems in place within the NHS, Council and Third Sector. In order to measure the achievement of outcomes it is vital to have the appropriate infrastructure in place to support an integrated treatment system, based on recovery. The workforce should be fully conversant with the importance of data 1. Scoping underway to investigate data recording methods within local services. 2. Consider the implementation of the electronic SSA. 3. Further develop the implementation of the 18
collection, how it is used, what it is used for in terms of a number of goals/outcomes for services and the ADP. Understanding from by the treatment population of data collection and how ultimately it can benefit not only their individual journey but how it can influence the design and change for an improved recovery system STAR Outcome Tool. Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change The drug and alcohol workforce will be competent and have the necessary skills to support the recovery agenda Significant training has taken place over the last few years. The training has been skill based in the areas of problem drug use and alcohol use. To ensure all services are recovery focussed the mind set of workers may need to change. Analysis of data shows that the treatment system is too static and may not provide enough progress through the system. Research evidence for recovery indicates the importance of the workforce having ambition for its service users. 1. A learning and development sub-group will be established to define workforce outcomes. This group will lead on a Workforce Development Strategy for Renfrewshire. 2. Members of the group should be team leaders, service user and carers assisted by ADP Support staff. 3. Staff should be further trained on personcentred care and planning within a recovery focus and multi-agency basis. 4. Specific training should take place, on a multiagency basis on the role of trauma in personcentred care, and the promotion of recovery. Further consideration of (Comments please) ARBD 19
Children Affected by Parental Substance Misuse Children who live with parents who have drug and alcohol problems are among the most vulnerable in society. The UK Hidden Harm report 2003, the Getting Our Priorities Right guide in Scotland (2001 and 2003) and the Scottish Executive response to Hidden Harm (2004) have been key drivers in improving support for children affected by parental substance misuse at national and local level. Building on the success of these two documents, the National Drugs Strategy, emphasises that we must do more at a local level to achieve the following key strategic priority outcomes:- The best possible start for every child will be achieved through effective prevention and early interventions. The capacity of universal and targeted services to improve the identification, assessment, recording and planning for children at risk will be strengthened. The capacity, availability and quality of support services for children and families affected by parental substance misuse will be strengthened. The consistency and effectiveness of the management of those children known to be at immediate risk will be enhanced. Communities will be supported to protect children by encouraging the public to report concerns Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change Support for children and vulnerable families will be further enhanced Social work services in Renfrewshire work with over 1500 children and their families. At the beginning 2012 there were 794 children and young people looked after within Renfrewshire, 329 of whom are in foster or residential care placements with the remainder looked after in their own home or with relatives. 89 children were on the child protection register. Over the past five years the number of children and young people coming into contact with social work has increased, as has the number of children on the child protection register and the number of children accommodated. The ADP has committed a significant amount of resources both fiscal and service led for this specific client group. For example - 1. Services to support the earlier identification and intervention for children with parents whose use of alcohol and drugs is problematic. 2. Clearer pathways for referral from adult treatment services. tbc 3. A multi-disciplinary response to the clear focus on vulnerable families. 4. Further services to support young people (Commissioning of a specific Young Carers Project)? 5. Consideration of the recommendations of the 20
Findings of an Impact Analysis carried out by STRADA clearly show GOPR protocol is now largely embedded in practice. The ADP provided funding for activities with kinship carers and children to reduce the impact of parental substance use on children and families. Full delivery of protocol briefings and training by multi-agency staff in Renfrewshire to ensure continued rollout and core to induction in organisations. Mainstream alcohol and drug services now have Family Support posts in place to further enhance work in relation to families and support to children. Alcohol Family Support Group established. Barnardo s Paisley Threads Partnership funded by ADP and Lloyds TSB PDI to develop a specific targeted intervention for young parents (under 21) and their children who are affected by problematic drug and alcohol use in Renfrewshire. recent Significant Case Review COMMENTS PLEASE Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change Enhanced Family Support The Carers Focus Group gives true testament to the problems associated with caring for an individual with a drug and/or alcohol problem. Family members, and close friends, can experience significant stress and health problems. The impact can also spread more widely, for example affecting family members employment, their social lives and relationships and family finances. There is the basis within Renfrewshire for both support of families, and the mobilisation of their support for problem drug and alcohol users in recovery. 1. Improving the needs assessment of those caring for people with drug and alcohol problems by the integration of specialist and generic services to increase the identification and assessment of adult family members and provide access to services through clear pathways and linkages. tbc 2. Advising the ADP on anti-stigma campaigns and service re-design to support the individual and family recovery (Circles of Care?). 3. Raising awareness in both generic and specialist services of the needs of adult family members, and the provision of training for the workforce in evidence based interventions to 21
increase provision (link into workforce development) Other Priority Outcome Areas Comments Please Enforcement and Communtiy Saftety Issues of violence, disorder and antisocial behaviour have a significant negative impact on communities, damaging levels of social trust and destroying civic pride and participation. There is a clear expectation from the public that the police should play a leading role in tackling these issues. The 2010 Force Public Consultation survey revealed that the public listed drunk and disorderly behaviour, drug misuse and violent crime in their top three public priorities for local policing. The key strategic priority outcomes we aim to deliver are:- 1. A reduction in levels of alcohol related violence and disorder. 2. An enhanced approach to target those involved in the illegal supply of controlled drugs. Priority Outcome Area Existing Provision and Gaps Identified Priority Actions for Change Insert info Commission on Women Offenders 22
Implementation of Our Commissioning Strategy The ADP will carry out a robust review of its existing contractual arrangements taking account of value for money, performance and outcome focus. A number of these contracts, originally awarded in compliance with the Standard Financial Instructions of NHS Greater Glasgow and Clyde and Renfrewshire Council, will also be reviewed. On the assumption that monies will be allocated to the ADP via NHS Greater Glasgow and Clyde beyond 2012 it is the intention that all existing contracts will be reviewed and where appropriate will enter into a service specification or service performance agreements(for current mainstream providers) based on strategic outcome areas. The Commissioning and Performance Sub-Group will lead in this area by monitoring performance based on agreed outcomes and indicators which will be reflected in Service Specifications/Service Performance Agreements. Implementing the Commissioning Strategy will also involve the continual development of the ADP Delivery Plan (ADP Delivery Plan 2012 Appendix Two). The Delivery Plan will support and guide the implementation of the Commissioning Strategy and will aim to show that service users and carers attain the desired outcomes and will provide detail around:- Targets Milestones ADP Governance arrangements Monitoring and reviewing linking with analysis of risks, and contingencies to deal with significant risks. Equalities Impact Assessment In line with statutory requirements all service specifications/service performance agreements required to be accompanied by an equalities impact assessment (EQIA):- Each service specification/service performance agreement will require an EQIA outlining anticipated impact across each equalities category. Data recording systems will require to capture this information. Commissioning Timescale Comments please Monitoring, Evaluation and Review The quality of mainstream and purchased services, the effectiveness of their contribution to the ADP Strategy and the extent to which they meet the needs of service users require to be regularly reviewed. Reporting is a key part of performance management activity. To enable the ADP to effectively plan, commission and manage mainstream and purchased services we will further develop existing reporting arrangements to provide the key information we need. We will do so in a manner that minimises the bureaucratic burden across the system, using existing data wherever possible. Activity in support of this will include:- The identification of key business areas where systematic performance reporting on outcome based commissioned services should be developed via the implementation of service specifications for ADP commissioned services and Service Performance Agreements from NHS/Renfrewshire Council. Consulting with service users, families and local communities. 23
Ensuring that the performance of commissioned services is appropriately reflected in annual performance arrangements i.e ADP Delivery Plan and Annual Report and Service Level Annual Reports. The development of the ADP Workforce Development Sub-Group which will collect information on key indicators of service quality, including number of service users, absence monitoring, staff turnover and development and dealing with complaints and incidents. Development of mechanisms to gather and use service user feedback. The use of information detailed above to inform the development of audit and service review programmes. Exploring the potential of training and awareness sessions for Team Leaders on their role in this process The ADP Commissioning and Performance Sub-Group will lead in this area (Terms of Reference Appendix three) 24