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Workforce development in
the new......
Annette Dale-Perera
Strategic Director of Addiction and
Offender Care
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Wider range of service users
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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
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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
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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.
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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 !!!
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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
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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
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Some great guidanceand tools
Drug Matrix: Evidence for effective treatment: FINDINGS....
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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
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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
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Competencyrequired to treat Drug families
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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’
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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