Sources of support and referring to specialist services

Joint working and shared care

• You may find that you are involved in working with other services or agencies with a service user with substance use problems, or their family/carer.

• Joint working will help you with the aspect of substance use, but will present other challenges.

• Let’s look at the advantages to you and the challenges...

Joint working & shared care (cont.)

Front line social care staff have identified a number of tensions/ frustrations (Galvani 2011):

• ‘Too many cooks spoiling the broth’ – potential confusion, repetitive history taking and information sharing issues.

• Service users who are ambivalent or not ready to engage with specialist services.

• High thresholds for specialist intervention mean a service is not offered.

• When specialists cannot provide a service for particular clients (e.g. older people, those with a disability).

• Different expectations, e.g. individual vs family focus.• Conflicting policy – e.g. around consent for information sharing.

Joint working & shared care (cont.) (Galvani 2011)

They have also identified a number of benefits:

• On a personal/professional level:– A problem shared – a sense of relief.– Freed up to focus on own specialism!

(working with substance use is everyone’s job).– Increased confidence in working with the issue.

• For the service user:– A perception that specialist workers are able to develop more

open communication with service users.– An independent worker who can advocate for the service user.

Joint working & shared care (cont.) (Galvani 2011)

What might your role be?

• Assessing need and initiating the referral for specialist care.

• Following up referral and liaising with specialist case workers.

• Supporting the person in your own role during specialist substance use interventions.

• Monitoring risk for the service user and relevant others (carer, family members, the public, depending on your role).

Case study: PhilPhil is 34, a heavy cannabis and alcohol user diagnosed with schizophrenia 3 years ago. He lives with his frail parents. His cannabis use reduces his anxiety but also triggers his psychosis.

The drug and alcohol team are monitoring his substance use while attempting to engage him in a dual diagnosis mutual aid group.

His drug and alcohol case worker reports to you that he has had a family upset and is using heavily again.

Case study: Phil

Within a multi-disciplinary team, what would you do if:

• You were his mental health nurse?

• You were his social worker?

• You were his primary care worker?

Case study: PhilThere is very little difference between these roles!

• Mental health nurse. MH services should take the lead for clients with a serious mental illness. It is likely that an early visit or appointment would be sensible to assess Phil’s state of mind (clinical assessment). Concerns should be passed on to other members of the shared care team. Family support would be given.

• Social worker. This role may prioritise support for Phil in other areas of his life as well as identify support needs of his parents as carers. May take the lead in supporting Phil and his family.

• Primary care practitioner. Practitioners in this role would need to be informed of any change in Phil’s condition. They should initiate enquiries if no information is forthcoming from other services following concerns from the drug team. They may co-ordinate referral to secondary care.

Referring to specialist services(Galvani 2012)

In referring people to services you need to consider:

• What information will the agency need? – If you don’t know this, call the agency and ask them first.

• What information will the service user need? – You need to know what services are available and how they differ,

e.g. will they have to do groups or is it individual work? Do they insist on abstinence or will they work with the individual to agree their own goals around their substance use?

• An inappropriate referral is likely to fail and will not encourage the service user to have a) confidence in you and b) seek further help with their substance problem

5 steps to good referral practice (Galvani 2012)

1. Has the person agreed to a referral?2. Do you have all the information you need to make a successful

referral first time? 3. Does the person know what to expect? - For example, do they

know where the agency is and how they can get there? Have you explained the agency’s expectations of the person attending (some people don’t want to be in groups)?

4. Does the person want some support to get there? – can you take them to the appointment? If not, is there someone else the person can ask? This may need some exploration.

5. Have you followed up after the referral? – this is important. You need to check how it went, what it was like, and what the next steps are. If it didn’t go well, why not? Do you need to make another referral elsewhere?

Caveats in referring people on...

• You are the human safety net at this stage. • Don’t make the mistake of assuming that when the referral is

made, the job is done.

• Follow up and provide encouragement – sometimes this includes to the specialist service!

• Do not give up on the person at the first attempt if it hasn’t worked. Very often, a person needs several attempts to change their use of substances.

Whole systems support• Supporting someone in changing their relationship with substances

requires a ‘whole systems’ network of support, not just, say, substitute prescribing (Daddow & Broome, 2010).

• It may be a key role for you to facilitate access or provide some of that support. This may be housing, supporting carers, skills training or enhancing self esteem and efficacy.

• Some of this is now recognised to come from user-led support approaches – mutual aid.

Using mutual aid • If you have seen the resource Pathways to recovery you will have

learned about mutual aid. This is becoming a highly effective route for recovery and should not be underestimated.

• Your service user is likely to benefit if linked to a mutual aid group or community.

• You cannot ‘refer’ your service user to mutual aid. It is up to them to link up with them. However, you can facilitate access to mutual aid support where appropriate.

• Mutual aid is not just a support group which helps someone while they are having treatment. For many people, mutual aid makes the difference between getting into recovery or not (Daddow & Broome, 2010).

Finding your local resources

• Services involved in substance misuse support are commissioned locally and geared to local needs.

• Some of these will be statutory but many are community-led or commissioned voluntary sector agencies.

• Finding local resources will depend on local knowledge. However, national websites provide information for your area.

Finding your local resources: statutory & commissioned• Frank website – Government sponsored online drug information

and service finder http://www.talktofrank.com/support-near-you

• NHS drug and alcohol support service finder– http://www.nhs.uk/Service-Search/Information-and-support-for-dr

ug-misuse/LocationSearch/339– http://www.nhs.uk/LiveWell/Alcohol/Pages/Alcoholhome.aspx

Finding your local resources: recovery & mutual aid resources*

• UK recovery Federation: http://www.ukrf.org.uk/

• Faces and voices of recovery: http://www.facesandvoicesofrecoveryuk.org/

• Association of recovery organisations (currently developing in the UK). Currently hosted at: http://www.facesandvoicesofrecoveryuk.org/association-of-community-recovery-organisations-a-r-c-o/

• SMART recovery UK – find a meeting: http://www.smartrecovery.org.uk/meetings

*local mutual aid and recovery groups are developing rapidly at time of writing. Check your locale for newly developed groups and communities.

Useful linkTurning Point has a useful video on their website discussing their resources in providing for both detoxification and rehabilitation for service users.

http://www.turning-point.co.uk/smithfield-residential-detoxification-service.aspx

References• Daddow, R. & Broome, S. (2010) Whole person recovery: A user-centred systems

approach to problem drug use. London, RSA projects. • Galvani, S., Dance, C. & Hutchinson, A. (2011) From the front line: alcohol, drugs

and social care practice. A national study. Available at: http://www.beds.ac.uk/__data/assets/pdf_file/0003/218343/LA-Survey-final-report-3-Oct-2011.pdf