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 Consortiumian.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:• 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

• 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

Mainstreaming Recovery

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• 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, • The establishment of inter-agency practice sharing and development

networks, • 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.”

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.”

Practitioner Elements: Developing a Recovery Oriented Workforce

Organisational Elements:

• New Cultural and Transformational factors in Mainstream Recovery• 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• 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

Top Managers

Managers Team Leaders

Front-line workers

Performance Management

Business Development

Strategic Awareness

Stakeholder Engagement

Equality & Diversity

Core Skills

Business and Operational Factors:Clearer demarcation of key management and practitioner functions

Business

and

Operational

Factors:

New job roles reflecting recovery

orientation

• Recovery Coordination Team Leader JOB PURPOSE1) 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.

Structural

Factors in

Service

Delivery:

Recovery

Oriented

Assessments

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– 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