Transcript Stoner WRAPP Preliminary Results

WREXHAM RECOVERY FROM
ADDICTION PILOT PROJECT
(WRAPP)
Prof John Stoner
CSARS Group
University of Chester
WREXHAM RECOVERY FROM ADDICTION
PILOT PROJECT (WRAPP)
WRAPP:
 a partnership Twelve Step Facilitation (TSF) pilot project
 funded by Welsh Government
 delivered on behalf of the North Wales Area Planning Board
PARTNERS:
 Wrexham County Borough Council, Substance Misuse Advisory
Team (WCBC SMAT),
 AVOW - Association of Voluntary Organisations in Wrexham
 CSARS Group, University of Chester.
SERVICE USERS’ REQUIREMENTS AND
SERVICE PROVIDERS’ RESPONSE
“ Perfect
Engagement” Consultation Event
14 th February, 2013, Wrexham
Hosted by WASUP (Wrexham Alliance Service User
Partnership) on behalf of AVOW
SERVICE USERS’ REQUIREMENTS
 Recognition of users’ low Recovery Capital and self - esteem,
they feel unsupported
 Accommodation – housing, hostels
 Education, training and employment
 Inadequate and unaf fordable transport
 Poor communication between individual service providers and
users
 Current services are seen as bureaucratic and unresponsive to
users’ needs
 Lack of treatment (rehab, detox), out -of-hours and aftercare
services
 Strong preference for support workers in recovery themselves
– they “understand”
SERVICE PROVIDERS PRIORIT Y
RECOMMENDATIONS
 Aftercare support and services to be developed (Resources?)
 ‘Out of hours’ support to be developed (Resources?)
 Review need for paperwork and engage more with service
users (Progress?)
 Monthly Service Provider Delivery meetings.
 To work towards a consensus of what Service User
involvement means to Providers and Service Users
LIKELY SHORTFALL IN SERVICE PROVISION
 Recovery services (rehab, detox, aftercare)
 Support for individual service users
 Linking to mutual-aid groups
Adapted from the Perfect Engagement Report, 2013
Progress review in June 2014
ADDRESSING THE SHORTFALL: COOPERATION
AND T WELVE STEP FACILITATION
“More rigorous evidence in support of AA emerging in the past
20 years, in particular, has moved AA from a peripheral status
to playing a more central role in a recovery -oriented system of
care …. Stemming from these findings on AA’s broad reach,
ef fectiveness, and cost -ef fectiveness, professional interventions
have been developed and tested, designed specifically to
engage patients with these community mutual -help resources
during and af ter treatment. These “Twelve -Step Facilitation”
(TSF) interventions have been found to enhance patient
outcomes in randomized controlled investigations.”
(John F. Kelly & William L. White, 2012 )
TSF: MAAEZ MANUAL
Making Alcoholics Anonymous (& NA) Easier
developed by
Lee Ann Kaskutas and Edward Oberste
Alcohol Research Group
Berkeley, CA 94709
MAAEZ OUTCOMES & OBJECTIVES
Facilitating participation in AA/NA
Preparing clients for transition into AA/NA
culture
Addressing some of the myths about AA/NA
Explaining how AA/NA helps and operates
Providing a safe group for individual’s to
exchange experiences
WRAPP: PROJECT AIMS
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
Supporting a group of 20 people with
substance-misuse problems and wanting to
achieve abstinence-based recovery.
Introducing the participants to the principles
of 12-Step recovery programmes and local
mutual-aid groups such as AA and NA.
Providing support for participants in early
recovery
Providing training to improve staff awareness
& understanding of 12-Step recovery
programmes & groups (40 staff)
WRAPP: PROJECT TEAM
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
 Tony Ormond –
 Tim Roberts -
 Jim B –
 John Stoner -
Service User Involvement Coordinator, AVOW
Project Officer, CSARS Group, University of
Chester & AVOW Volunteer. Formerly
Rhoserchan & Park View Treatment Centres
AVOW Volunteer & AA liaison
Visiting Professor & Co-Director of CSARS
Group, University of Chester, Professorial
Research Fellow, Centre for Research into
Environment and Health, University of
Aberystwyth,
Formerly Rhoserchan Treatment Centre
We gratefully acknowledge the suppor t of key staff and the
cooperation of AA & NA
WRAPP DELIVERY
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
 A four-month project December 2013 – March 2014,
compressed due to delays in funding approval.
 Recruitment took place in December/January and
the programme ran from January – March 2014.
 Staff training events held in late January & March
 Participants were supported through a weekly
programme of WRAPP activities comprising
workshops, group sessions and facilitated
attendance at local AA and NA meetings.
)
WRAPP: STAFF TRAINING EVENTS
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
 Twelve-Step Approaches to Recovery and
Engagement with Mutual – Aid Groups
 Government Policy, Service User Requirements and
Resources Available
 Twelve Step spirituality (Higher Power Project)
 AA/NA Members’ Shares on their experience,
strength and hope of recovery
 WRAPP Preliminary Outcomes
 Delegates were also offered the opportunity of
accompanied attendance at local AA/NA meetings.
60 attendees, 36 feedback questionnaires
WRAPP OUTCOMES: STAFF ATTITUDES
W R E X H AM RE C OVE RY F ROM A D D I C T ION P I LOT P ROJ E C T
Some Perceptions of AA/NA Before Training
 Support for people. Don’t know anything about them .
 Religion based (structured) groups. America, Christian based
ethos.
 Advantages - Holistic approach, the persons responsibility, it’s
cheap. Disadvantages - its image may be off putting.
 Mixed, (Advantages) I realise that all of the above have helped
people turn their lives around who would not have sur vived ,
(Disadvantages) but I worr y that the dependency on the group
simply replaces the dependency on the drug / alcohol
 My Straight Head – acceptance, recover y: My Cynical Side –
stigma, god, higher power, forced down your throat:
 Advantages – fellowship, sense of belonging/ community
support. Disadvantages – Abstinence is not for ever yone, can
become over dependant and Evangelical.
How informed have referrals to AA/NA been?
WRAPP OUTCOMES: STAFF ATTITUDES
W R E X H AM RE C OVE RY F ROM A D D I C T ION P I LOT P ROJ E C T
Some Perceptions of AA/NA Af ter Training
 … spiritual / religion and dif ferent under standing.
 … only disadvantages are the religious image and the life long fight. BUT
loads of pluses, ef fective increased wellbeing and health, abstinence and
wellbeing.
 Changed a lot, you have shown me a lot and I have a lot more feelings and
opinions about AA and NA .. I under stand the 1 2 steps more now
 Hearing per sonal stories and how people have tac kled their problems, as
well as beating some myths through the day have helped me (apprec iate)
the benefits of these groups
 Good suppor t network for people, more awareness and better
under standing , the stories helped
 Suppor t system for life - af ter detox and rehab centres and treatment units.
Has politics as all inter ventions do, but works well with open door policy
 Radical c hanges are needed to c hange the concept of AA and NA , I
under stand better what is needed to improve the profile
 I just wish that judges where able to order people to go and that there was
less stigma attac hed to admitting you are an addict or alcoholic.
WRAPP OUTCOMES: STAFF ATTITUDES
W R E X H AM RE C OVE RY F ROM A D D I C T ION P I LOT P ROJ E C T
Attendance at AA/NA Meetings
Before Training:
 83% (30) had never attended a meeting
After Training:
 78% (28) said that they intended to attend a meeting
 14% (5) have subsequently attended meetings
accompanied by AA/NA members
Follow-up required to encourage/facilitate attendance
WRAPP OUTCOMES: STAFF ATTITUDES
W R E X H AM RE C OVE RY F ROM A D D I C T ION P I LOT P ROJ E C T
Client Referrals to Mutual - Aid Groups AA/NA
Before training:
 22% (8) Never
 11% (4) Rarely
 17% (6) NA
 25% (9) Sometimes, when appropriate
 25% (9) Regularly/routinely
Af ter training:
 94% (34) intend referring clients, many with enthusiasm
Follow -up required if this intention is to be translated into
positive referrals
WRAPP OUTCOMES: STAFF ATTITUDES
W R E X H AM RE C OVE RY F ROM A D D I C T ION P I LOT P ROJ E C T
Following accompanied attendance at an AA/NA Meeting:
 I did enjoy the meeting last night, it gave me a huge insight into
people's experiences and the dif ficulties alcoholics have to
overcome ever yday which we would take for granted.
I will tr y and per suade people who I come across that there is hope
and spread the word of AA and the other fellowships out there . I
was impressed by the suppor t you all give each other and "got it" If
you know what I mean!
Susan Carrington ASB Of ficer Nor th Wales Police
 I found it hugely uplif ting and the experience was one of warmth,
acceptance and suppor t that is unrivalled by anything that I have
been involved with before. I truly feel honoured to have seen a
fellowship in action, so thank you.
Vicky Jones, Per formance Improvement and Par tnerships Manager,
Wrexham CBC
WRAPP OUTCOMES: STAFF ATTITUDES
W R E X H AM RE C OVE RY F ROM A D D I C T ION P I LOT P ROJ E C T
Following accompanied attendance at an AA/NA Meeting:
 I could not believe how welcomed and relaxed I felt. The
people were so open, honest and accepting of everybody.
From a commissioning perspective it made me realise that we
need to think carefully about how and by who services are
best delivered. It also made me think about how we get more
people to engage with groups like this, we would welcome any
advice you can give.
Shirley Jones, Suppor ting People Manager
 Thank you for supporting me to attend last night’s meeting, I
found it very insightful.
Dawn Lewis, Community Diversity Officer, Wrexham CBC
WRAPP OUTCOMES: RECRUITMENT
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
 Experience to date suggests that there have been significant
awareness and resistance issues towards 12-Step recovery
amongst local staf f involved with substance misuse issues .
 Low referral rates to WRAPP from other agencies – 11 people
referred, only 5 attended for assessment.
 The remaining participants found WRAPP through word of
mouth, publicity, a service -user event and personal contact
with service users by WRAPP staf f.
WRAPP OUTCOMES: ASSESSMENT
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
 Assessment criteria used at inter view :
- Duration of active addiction
- Engagement history with drug & alcohol services
- Willingness to change, attitude & behaviour
- Perceptions/previous engagement with AA/NA
- Physical / Social / Psychological mitigators
- Emotional responses to structured recovery options
- TOPPS and ARC assessment tools were used to augment
weekly assessments of individual progress and change
 Candidates assessed: 19
 Participants selected: 16 displayed some willingness to change,
but several had significant health, other or motivational issues
making completion of the course problematic.
WRAPP WEEKLY PROGRAMME
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
WORKSHOP SESSIONS
 Registration and Introduction
 Accepting Help and Twelve-Step Spirituality
 Changing: Characteristics of Addiction and Recovery
 Changing and Living in the Day
 Living Clean and Sober
 Managing Emotions and Living with Others
 Relapse Process and Prevention
 Developing Individual Recovery Plans
 Review Session: Living Sober and Relapse Prevention
Workshops supported by group and individual sessions
WRAPP SUPPORT
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
 Participants were supported to develop their own
individual recoveries by trying to remain abstinent,
undertaking homework, and integrating with local
recovery groups and communities.
 They were encouraged to independently attend
additional AA/NA meetings and get involved with
other local recovery activities.
 AVOW provided support for participants generally
and referred individuals to other services when
appropriate.
WRAPP OUTCOMES: RETENTION 1
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
16 initial participants assessed weekly:
 7 (44%) completed the programme and are making
good progress. They have attended most of the
WRAPP sessions, attend between 1 and 4 AA/NA
meetings weekly and have engaged with local AA/NA
members & groups, several have a sponsor.
 9 (56%) attended between 1 and 3 WRAPP sessions
and dropped out of the programme for a variety of
reasons
Follow-up studies planned after 1 & 2 years
WRAPP OUTCOMES: RETENTION 2
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
Of the 9 par ticipants who dropped out of the WRAPP
Programme:
 3 have since been in touch with us to let us know that they
are pursuing their own path of action within their fellowships
 2 were able to get into detox during the running of the course
 2 left because they felt they didn’t need it anymore
 2 left and have not been contactable since
Positive outcomes for 75% of par ticipants
WRAPP OUTCOMES: FEEDBACK 1
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
Feedback from par ticipants on the WRAPP Group:
 WRAPP is a great support group that also gives you a foot into
AA and after-support, which I feel I lacked the last time I
attempted to stay sober.
 I love the talking, sharing and debating in the group, it helps you
to understand your own feelings .
 IT’S NOT JUST YOU!
 WRAPP is good and I have seen a difference in myself. Going to
AA as part of WRAPP is good .
 I have been sober for a while now and being in group has done
me good – I think it would help other people too.
WRAPP OUTCOMES: FEEDBACK 2
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
Feedback from par ticipants on their recoveries:
 It gave me a massive head-start. I got things quickly in the
rooms once I found them. I probably wouldn’t have found the
rooms by myself anyway
 I realise that I can have a happy, honest and good life without
alcohol.
 Two choices exist (for me):
- A life of carnage, no family, no business, no friends, no
future
- A fulfilling life with people I love and the possibility of a
good future
 AA and other support will help me keep sober
WRAPP OUTCOMES: LESSONS LEARNT
W RE X H AM RE C OVE RY F ROM A DDI C T ION P I LOT P ROJ E C T
 The low WRAPP referral rates from most Wrexham agencies
was disappointing but understandable.
 Feedback suggests that staf f training was ef fective in
improving staf f understanding of and future commitment to
12-Step recovery through mutual -aid engagement.
 Despite recruitment problems, WRAPP has confirmed TSF as a
cost-ef fective intervention:
7 of 16 (44%)participants still engaged with the programme,
a further 5 (31%) pursuing recovery through dif ferent routes
 There is considerable support amongst graduate participants,
partner organisations and local staf f to build upon the
success of the pilot project and develop a sustainable mutual aid engagement project in Wrexham.
WRAPP OUTCOMES: WHAT NEXT? WRAP?
W R E X H AM RE C OVE RY F ROM A D D I C T ION P I LOT P ROJ E C T
 There is a requirement from government and service users for
provision of a recovery option through mutual -aid engagement
and recovery communities.
 Despite time constraints and recruitment issues, the pilot project
has confirmed that TSF is a cost -effective option for those
wishing to achieve abstinence -based recovery.




WRAP Proposal Benefits
builds on what has been achieved by the pilot project –
individuals and organisations
establish sustainable and cost -effective abstinence-based
recovery options
provide a safe recovery group for those in early recovery
involving trained volunteers
contribute towards improved “joining-up” of service provision