Increasing family-focused practice across an Organisation:

Helping services become more family-focused

Richard McVey & Claire Hampson

Introduction

• Substance misuse is associated with a range of social and health problems affecting the individual as well as the family within which the individual lives (Orford et al., 2005) • E.g. about 4 million people in the UK suffering as a result of problem alcohol user in their family (Copello, et al., 2000) – important to develop strategies to meet their needs • Growing research evidence to support the view that families and social networks can be influential when involved in treatment – On the whole, routine addiction services remains focused on the individual drinker or drug user (Copello &

Orford, 2002)

Background

• Project part of a long programme of work aiming to understand the impact of alcohol and drug problems on the family and develop strategies in addiction practice to help reduce family strain • Earlier work focused on: – understanding the impact of alcohol and drug use on family members (FMs)(Orford et al., 1998a) – natural family ways of coping (Orford et al., 1998b) – development and testing evidence-based family focused intervention in primary care (Copello, et al., 2000) and specialist teams (Orford et al., 2009)

Aims

• Whole Organisation approach • Provided a non-statutory addiction treatment Organisation an opportunity to receive training and on going supervision in two family-oriented interventions: –

The

‘

5-Step approach

’ –

Social Behaviour and Network Therapy (SBNT)

• To promote a shift towards family-focused practice and to further advance implementation of family work into routine addiction services • Allowed comparisons between teams at different time periods in order to

evaluate the impact on the implementation of family-focused practice

Methods

• Mixed-methods quasi-experiment integrating action research • Made up of

2 phases

over a 3-year period – Phase one = pilot study: trained 2 teams (n=19) – Phase two = random assignment to training – 2 teams received immediate training (n=24) – 2 teams received delayed training (n=19) – (+1 team previously trained in IFM study) • The Involving Family Members across the Organisation (IFMO) training and supervision package • Two-day initial training event • Eight monthly follow-up consultancy meetings • One-day follow-up training event

Project timeline

Training & supervision period Follow-up period Pilot study (2 teams)

4 teams

Random assignment Baseline period Training & supervision period

Evaluating the impact of the project

 Two questionnaires measuring professionals’ attitudes towards family-focused practice (pre, post, and follow-up) 

Attitudes to Addiction Related Family Problems Questionnaire (AAFPQ)



Attitudes to Involving Family Members in Treatment Questionnaire (AIFMTQ)

 ‘ Diary-snapshot in staffs ’ ’ – to assess changes over time weekly activity  Qualitative analysis of professionals’ comments during consultancy supervision meetings

155 150 145 140 135 130 125 120 115 110

Phase two results: Staff attitudes (AAFPQ)

155 150 145 140

Training & supervision period

*

Follow-up period

* FU 135 130 125 120 B1 PI 115 110 B1

Baseline period

B2 *

Training & Supervision period

* PI * Significantly greater than baseline B1=Baseline 1 B2=Baseline 2 PI=Post-intervention FU=Follow-up

50% 40% 30% 20% 10% 0%

Diary-snapshot results: phase two

50% 40% 30% 20% 10% 0%

Training & supervision period Follow-up period Baseline period Training & supervision period

19

Overall proportion of family-focused practice

% family-focused practice *^

34 * 26 Baseline (117/611) Training & Supervision period (108/410) Post-intervention (257/765) * Significantly greater than baseline. ^Significantly greater than training period.

Qualitative analysis: Main themes

Policy and procedures impeding family-focused practice

“It doesn’t just fit into the cycle we’re funded for”

A need to improve outcomes for all

“I had a session where a Mother and Daughter let some stuff out [in the session]. At the end of it they got up and hugged each other, apparently for the first time in 5 years”

Efficacious impact of the project

“Nothing comes of a one-off model workshop. It needs a follow-up intervention.’ ‘The meetings are a useful as a constant reminder. It’s good having the contact”

Recognising changes needed in practice and policy

‘Admin will be amending the wording of the invitation letter to show clients that their FMs are welcome in the sessions’

Working creatively and flexibly

‘The confidentiality form is a useful tool rather than a formality…I ask them [focal client] if your brother called me, could I talk to him? I’m proactive in searching around”

Perceiving and experiencing challenges and difficulties

“We’ve had it rammed down our throats careful of the confidentiality, careful not to give anything away”

Individualistic practices remain

“A one-to-one can be quite precious and that’s my preference to working”

Limited family-focused practice within outside organisations

“GPs only refer drinkers, they don’t think about the affected family members”

Drivers for family work integration

• Permission to work in family focussed way • Open flexible attitude vs

‘

opening a can of worms

’

• Management

‘

buy in

’

• Family work protagonists /

‘

champions

’

• Follow up in supervision / team meetings • Addressing issues between consultancy sessions eg first appointment letter

Training needs

• 1-1 work vs 2+ clients in the room • Working with FM ’ s in own right vs seeing FC and FM ’ s together • Openness to looking for opportunities for family work • Complex family therapy vs quick wins • Family work = more work vs same/less work • Selling family work to service users • Confidentiality • Conflict and communication issues • How to deal with unsupportive network members • No support network

Conclusions

• Study supports the use of an Organisational platform to promote the inclusion of affected family members within addiction treatment – Significant improvement in staff’s attitudes towards family-focused practice – Significant increase in % of family-focused practice across the Organisation (19% at baseline to 34% post-intervention) – Number of family workers increased from 9 – 14 during the project • Increases in positive attitudes and family-focused practice cannot be fully attributed to the training element of the project – Culture change permeating the whole Organisation?

Some final thoughts…..

Teams and Organisations or the wider health system or both?

Thank you for listening

For more information, please contact:

Richard McVey: [email protected]

Claire Hampson: [email protected]

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References

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