workforce development in the new...... annette dale- perera strategic director of addiction and...

Workforce development in

the new......

Annette Dale-Perera

Strategic Director of Addiction and

Offender Care

Wider range of service users

POLICYRECOVERY• Voluntary self control over

substance use plus health and wellbeing plus re-integration

• Push for abstinence – planned discharges substance free

• Training & employment• Housing• Friends/relationships

PUBLIC HEALTH• Reduce Blood borne viruses• Reduce drug and alcohol

related deaths• Reduce health inequalities• Increase life expectancy• Increase health & wellbeing• Smoking cessation • Prevention

EvidenceWHAT RECOVERY OUTCOMES

• White( 2012) 407 studies: around 50% with substance dependency

achieve remission: 20% do so through abstinence.• Cannot tell until someone is in stable remission until after 5 years• Different people have different recovery capital/ potential• Some substances are more difficult to achieve remission from

EvidenceRECOVERY OUTCOMESHeroin is sticky• First 6 mths to a yr in treatment

– most potential for change (NTA)• Drug outcomes improving in England

since mid 1990’s 75-65% heroin users stopped using 3-5 yrs (NTORS etc).

30 yr follow-up study: Grella and Lovinger (2011)Of survivers 40% in stable remission but normally after 5-8yrs in opioid substitution, 25% did not reduce use at all.

EvidenceHEALTH OUTCOMESSubstance dependence causes significant collateral health damage,directly or through associated lifestyle – smoking, diet, hygiene etc33 yr follow-up study: 50% heroin users dead (Hser 2007)• Alcohol - mental health, cognitive damage,

liver disease & and `system damage’ – cancers• Injecting drugs – infections, vein damage & DVT,

heroin overdose risk & death• Smoking tobacco, cannabis,

crack lung & heart disease • Teeth !!!

EvidenceEMPLOYMENT OUTCOMESInternational evidence suggests this is the most difficult to achieveThose employed on starting treatment likely be employed at follow-up and visa versa UK worst rate of unemployment in drug users compared to EU & USABUTEducation, training & voluntary workhelps recovery & happiness

CRIME OUTCOMESSubstance - driven crime outcomes good if people achieve remission

EvidenceSOCIAL OUTCOMES• Having supportive friendship/family networks is paramount • NICE: Mutual Aid, Family Therapy and Behaviour Couples Therapy• Wellbeing research: friendship group of more than 3 = happiness

Some great guidanceand tools

Drug Matrix: Evidence for effective treatment: FINDINGS....

Overcoming dependence takes timeManager competence• clear pathways - staff and service users know• Track progress of clients particularly heroin users

eg using `MAR’ data• Review clients every 3 months • If treatment not working – optimise• Data/reviews to track clients progress and key

workers caseload & complexity

Workforce competency improvementsHealth screening, assessment, treatment better harm reduction & health treatment when using better treatment for health issues when in treatment

Evidence-based behaviour change interventions

Empowering service users rebuild lives• Helping (re) establish constructive relationships• Education, training and meaningful activities • Longer term health & wellbeing strategies

Competencyrequired to treat Drug families

Reality check• EXTENSIVE APPROACH needed ie longer term

support but can we afford to do this• PbR EXPECTATIONS................failing• More health improvement & treatment• More competence in behaviour change

techniques –with fidelity & supervision • Re-commissioning risks: TUPE, Disruption• Smaller financial envelop risks of `Dumbing

down’ loss of `expensive workers’

EG Well-being amongst staff and clients`Five Ways to Wellbeing’ framework.

Staff & service users have 5 ways plans

Teams have 5 ways activities & funding