Transcript Annette Dale-Perera - Workforce development

Workforce
development in
the new......
Annette DalePerera
Strategic Director
of Addiction and
Offender Care
Wider
range of
service
users
POLICY
RECOVERY
PUBLIC HEALTH
• Voluntary self control over
substance use plus health
and wellbeing plus reintegration
• Push for abstinence –
planned discharges
substance free
• Training & employment
• Housing
• Friends/relationships
• Reduce Blood borne viruses
• Reduce drug and alcohol
related deaths
• Reduce health inequalities
• Increase life expectancy
• Increase health & wellbeing
• Smoking cessation
• Prevention
Evidence
WHAT 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
Evidence
RECOVERY OUTCOMES
Heroin 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.
Evidence
HEALTH OUTCOMES
Substance dependence causes significant collateral health damage,
directly or through associated lifestyle – smoking, diet, hygiene etc
33 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 !!!
Evidence
EMPLOYMENT OUTCOMES
International evidence suggests this is the most difficult to achieve
Those employed on starting treatment likely be employed at follow
-up and visa versa
UK worst rate of unemployment
in drug users compared to EU & USA
BUT
Education, training & voluntary work
helps recovery & happiness
CRIME OUTCOMES
Substance - driven crime outcomes good if people achieve remission
Evidence
SOCIAL 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
guidance
and tools
Drug Matrix: Evidence for effective treatment: FINDINGS....
Overcoming
dependence takes time
Manager 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 improvements
Health 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
Competency
required 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