Transcript Peer & Aftercare Support Service

Peer & Aftercare Support
Service
An enhancement of the Torbay
treatment system to improve the
effectiveness & capacity of specialist
treatment
Consultation Event – How do we
reduce hospital-related admissions?
Service Users
Carers
Primary Care
Stakeholder
Representation
Mental Health
Providers
Safer
Communities
Torbay (CDRP)
Hospital Staff
Alcohol
Treatment
Providers
Overview of Priorities areas
identified
Why Peer & Aftercare Support
• Provision of structured aftercare and peer
support was identified as being a top 3
priority by:
– All service user delegates.
– All carer delegates.
– The majority of alcohol treatment provider
delegates.
How would this help (service user
perspective)?
• Service Users & Carers feedback:
– The worst thing is moving from support to nothing
because I’ve achieved my goals.
– We don’t just need treatment, we need support to
keep on track afterwards.
– A peer support system could stop me relapsing and
having to go through treatment again.
– Evenings and weekends are often the most difficult
times for someone who has completed treatment. An
out of hours buddy system would help during these
times.
– Peer support groups need help to be set-up and keep
going. They can be very draining to run.
How would this help (treatment
provider perspective)?
• Treatment Provider feedback:
– Peer and aftercare support groups can help
individuals self-manage their ‘recovery’ after
formal treatment is completed
– Peer support system may help sustain
people’s recovery and minimise relapse and
further referrals back into treatment.
Historic Alcohol Treatment model
for Adults in Torbay
Level of alcohol use
Very
severe
dependence
Severe dependence
Moderate dependence
Harmful
Hazardous
Residential Rehabilitation
Specialist structured
community treatment (DPT)
Community detox (TCT)
Specialist structured
community treatment (DPT
or TCT)
Brief interventions (TCT)
Information & Advice
Information & Advice (TCT)
Developing Alcohol Treatment
Model for Adults in Torbay.
Peer & Aftercare selfmanagement support
Level of alcohol use
Very
severe
dependence
Severe dependence
Moderate dependence
Inpatient detox (DPT)
Residential Rehabilitation
Specialist structured
community treatment (DPT)
Community detox (TCT)
Specialist structured
community treatment (DPT
or TCT)
Harmful
Brief interventions
Information & Advice
Hazardous
Information & Advice
Conclusions
• Those that were closest to the treatment
system identified continuity of support as
being an integral part of treatment.
• Service users wanted to take control over
their own well-being and longer-term
recovery.
• Service user empowerment needs to be
supported.
Service Procurement
–
–
Aftercare and Peer Support Service for those
individuals that successfully complete their
structured community or residential rehabilitation
alcohol programmes and who would benefit from
structured aftercare support from peers to sustain
their treatment goals through self-management
strategies such as ‘recovery plans’.
This service forms part of an integrated alcohol
treatment system for Torbay that delivers a range of
interventions to meet the assessed needs of people
who experience alcohol-related harm.
Actuall
y my
name is
Carl
This is a
user..uhhh! patient..
Ah!.. User of
services….
One Individual’s Perception
“My journey is real
–your pathway is made up”
Facilitation of
Recovery/Aftercare
“tell me and I’ll forget
show me and I’ll remember
involve me and I’ll understand”
Chinese Proverb
Facilitation of
Recovery/Aftercare
•
•
•
•
GROUPS
Join the group, it supports you.
Take part
Be a part
You support others joining the group.
SAFETY
• An Individuals wellbeing is more important than the
group.
Facilitation of
Recovery/Aftercare
• Everyone has something to offer.
• The balance of getting support and giving
support will change over time.
• Opportunity for members to co facilitate
and then to facilitate their own groups.
• Training opportunities to be developed.
• Mentoring and supervision to make “it”
safe.
Scientific Conclusions
• Professionally-directed, post-discharge
continuing care can enhance recovery
outcomes, but only 1 in 5 clients actually
receives such care.
Dennis, M.L., Scott, C.S., & Funk, R. (2003). An Experimental Evaluation of Recovery Management Checkups
(RMC) for People with Chronic Substance Use Disorders. Evaluation and Program Planning, 26(3), 339-352.
Godley, S.H., Godley, M.D., & Dennis, M.L. (2001). The Assertive Aftercare Protocol for Adolescent Substance
Abusers. In E. Wagner and H. Waldron (Eds.), Innovations in Adolescent Substance Abuse Interventions
(pp. 311-329). New York: Elsevier Science Ltd.
Ito, J. & Donovan, D.M. (1986). Aftercare in Alcoholism Treatment: A Review. In W.R. Miller & N. Heather
(Eds.), Treating Addictive Behaviors (2nd ed., pp. 317-336). New York: Plenum Press.
Johnson, E. & Herringer, L. (1993). A Note on the Utilization of Common Support Activities and Relapse
Following Substance Abuse Treatment. Journal of Psychology, 127(1), 73-78.
McKay, J.R. (2001). Effectiveness of Continuing Care Interventions for Substance Abusers: Implications for the
Study of Long-Term Treatment Effects. Evaluation Review, 25(2), 211-232.
Outcomes of Peer Recovery
Support
• Completion of addiction treatment AND
participation in recovery mutual aid groups
is more predictive of long-term recovery
than either alone.
Fiorentine, R., & Hillhouse, M. (2000)
Potential developments?
•
•
•
•
•
SMART Groups
Other Mutual Aid groups.
Mentoring
Peer based telephone support system.
Web based support networks
Contact
• Judith Ward – Alcohol Team Lead, Torbay
Care Trust . [email protected]
• Bruce Bell – Treatment Effectiveness
Manager in Public Health, Torbay Care
Trust . [email protected]
Service User Involvement
• Self-Help Groups, Support Groups, Expert
Patient Groups.
• Consultation, Partnership/collaboration,
user Control.
Social Movement Theory
“The social movements perspective fundamentally
challenges the ways that we have learnt to organise and
lead change in the NHS. It advocates that healthcare
improvement strategies need to extend beyond the top
down programme by programme approach to embrace a
concept of citizen led (healthcare staff and/or user)
change that draws upon unstructured and largely selforganising autocatalytic (self-fuelling) factors.”
Helen Bevan, Institute for innovation & Improvement.
Baseline
Audit
Charter for
Service User
Involvement
Lead
On Torbay
Service User
Forum
Lead on
Mutual aid/
Self help
Groups
Review
Job
Description
Steering
Group/
Partnership
Recovery
Action Plan
Model
Identify
Training
Needs
Pool of
Mentors &
Facilitators
Facilitate
Aftercare
Recovery
Group
Focus for
Service
Briefings
Progress so far!
• Service User Involvement.
• Briefing of staff at multi agency away day.
• “Soft sell” to current people within or
leaving the system.
• Recruitment – getting the right person for
the post!