Mainstreaming Recovery:
Practitioners, Organisations and Systems.
1. Workforce Transformation – beyond training.
2. Localism, and the key integrations for alcohol
and drugs treatment.
Ian Wardle, CEO Lifeline
14th February
Skills Consortium
ian.wardle@gmail.com
Mainstreaming Recovery
The successful implementation of personalised,
recovery-oriented practice goes:
• beyond the confines of the current drug treatment system
and its disconnected forms of working;
• beyond retraining the existing workforce
and involves serious consideration of:
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front-line practice;
organisational learning and development and
system wide commissioning and partnership activity
a sustained focus on integrating services for the multiply
excluded and earlier intervention for many drink and drug
problems
Skills Consortium:
the workforce transformation matrix
Allows us to look in more detail at these:
– Practitioner Led elements
– Organisational elements
– System elements
Mainstreaming Recovery
• Practitioner Elements: Developing a Recovery Oriented Workforce
– Beyond training
– Efficacy and evidence-based interventions
– Learning embedded into practice
• Organisational Elements:
– Cultural and transformational factors in mainstream recovery
– Business and Operational Factors
– Structural Factors in Service Delivery
• System Elements
– Efficiency driven top down integration
– End of Ring Fence may result in Drug Treatment Shortfalls
– Cross-Sector coalitions will augmenting commissioned systems
– Financial innovation driving more sophisticated inter-sectoral
outcome measures
Skills Consortium: the workforce transformation matrix
a)
Practitioner Intervention Level: competencies appropriate to post.
•
Working with drug users –establishing which therapeutic techniques,
interpersonal styles or attributes work best with whom and in what situations.
b)
Worker Level: staff selection, training supervision and support
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Plus requirements to develop and improve practice based on research and user
feedback
c)
Organisational Level: creating and maintaining ‘learning organisations’
•
Organisations’ which seek and incorporate knowledge and promote staff
development in outcome-promoting directions
d)
System Level: integration and empowerment driven from above and below
•
Fostering a), b) and c) through commissioning decisions in a local area,
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The establishment of inter-agency practice sharing and development networks,
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Contractual requirements to demonstrate evidence-based practice, etc.
Organisations commonly fall short of efficacy
• Relevant studies examined by Thomas D’Aunno
• “…many treatment programs across the nation
use treatment practices that do not meet
empirically established standards for effective
care.
• “…a relatively large body of evidence on the
effectiveness of particular treatment practices for
drug abuse clients.”
• “…organisations deliver very unevenly in respect
of evidenced practice and the skills upon which it
is based.”
Practitioner Elements:
Developing a Recovery Oriented Workforce
Workforce Development: well beyond the narrow
traditional notion of “training”
1) “The strategies required to develop an adequate
workforce response to alcohol and drug problems
extend well beyond the narrow traditional notion of
“training”.
2) Systemic and sustainable changes within key
organisations and agencies are also essential.
3) A major paradigm shift is required to refocus our
thinking away from an exclusive orientation on training
to one which encapsulates factors such as organisational
development, change management, evidence-based
knowledge transfer and skill development.”
Organisational Elements:
• New Cultural and Transformational factors in Mainstream Recovery
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Focus on Empowerment and the Co design of Recovery
Peer-led working in custody and community
More Powerful and Personal Service-user Voice
New partnerships, greater continuity of care
Financial innovation around evidence and outcomes
• Business and Operational Factors
• Clearer demarcation of key management and practitioner functions
• New job roles reflecting recovery orientation
• Levels of competency and efficacy consistent with evidenced standards
• Structural Factors in Service Delivery
• Service models with clear recovery direction
• Engagement Phase with seamless assessment and co-designed recovery
planning
• Co-ordination as a key function
• Re-integration and recovery available from initial engagement
. New cultural and transformational
elements in Mainstream Recovery
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A new more optimistic anthropology
Better systems of recognition, representation and
voice
Recovery as a personalised, ‘owned’ journey
The therapeutic role of peer communities
Recovery options founded on meaningful choice,
closer partnership and greater continuity.
Provider coalitions driven by financial innovation
around outcomes and evidence
Business and Operational Factors:
Clearer demarcation of key management and practitioner functions
Top
Managers Team
Front-line
Managers
Leaders workers
Performance Management
Business Development
Strategic Awareness
Stakeholder Engagement
Equality & Diversity
Core Skills
• Recovery Coordination Team Leader JOB PURPOSE
1) To lead one of four integrated components that comprise Lifeline’s
recovery-orientated treatment system.
2) To ensure that the service’s key elements (recovery coordination and
psychosocial support, at standard enhanced and targeted levels) are
integrated, effective and delivered to a high standard.
3) To work in close collaboration with services, internally and externally, to
develop effective pathways, approaches and interventions to support and
motivate service users through all stages of their individual recovery
journey.
4) To work within a strengths-based, recovery-orientated, change and
outcomes focused approach which promotes service users and
communities as responsible co-producers of health, well-being and
recovery
Structural Factors in Service Delivery:
Assessment
• Underpinned by the following principles assessment is:
• A process, not an event
• Helps services users begin to reflect, or self-assess, and
gain insight into their circumstances
• Focuses on strengths and weaknesses, risks and
resilience.
• Enables the worker to develop a rapport with the
service user
• Enables us to gather information and data
• A phased process, with the duration of each phase
varying depending on service user needs.
Structural Factors in Service Delivery:
Assessment focuses on strengths and
weaknesses, risks and resilience.
Health
Improvement
Build
Strengths
Assessment
Recovery
Planning
•Harm reduction interventions to ensure service user safety and infection control
•Health improvement interventions to address general health needs and develop personal responsibility for change
•Identify service user strengths, skills and abilities
•Complete 'strengths mapping' exercise with the service user
•Support the above work with motivational enhancement interventions
•Gather required data (core data set), where possible by self completion by service user
•Complete risk assessment/risk management plan and start TOP
•Service user completes recovery capital scale to develop insight into strengths
•Based on assessment work to date, identify key treatment needs & recovery capital
•Develop a recovery plan based on the 4 domains of recovery capital
•Develop a weekly planner of activities with the service user to structure time
System Elements: the challenges that come
with the end of the ring fence
1. Commissioning may only address non-ring fence
public health priorities;
2. Potential Alcohol and Drug Treatment Resource
shortfalls across commissioned systems
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will occasion uncommissioned innovation including
financial and organisational innovation;
will encourage cross-sector provider coalitions seeking
fresh forms of investment;
will promote those cross sector partnerships that deliver
more and better primary and secondary and secondary
outcomes;
will in turn encourage better top-down modeling.
Overlap between experiences of homelessness
and other social issues
The key practice integrations:
Drugs and Alcohol
1. Integration and the challenge of multiple exclusions;
2. Reducing offending by a closer integration of our
criminal justice work: custody and community;
3. Bridging the transitional gap of young adults and
incorporating prevention, brief interventions and
treatment in targeted work and recovery pathways
4. Integrating clinical, risk-based approaches with asset
based forms of assessment and co-working to
produce and inspirational recovery-oriented
workforce