1. Peer & Aftercare Support Service An enhancement of the Torbay treatment system to improve the effectiveness & capacity of specialist treatment

2. Consultation Event – How do we reduce hospital-related admissions? Stakeholder Representation Service UsersCarers Alcohol Treatment Providers Hospital Staff Safer Communities Torbay (CDRP) Mental Health Providers Primary Care

3. Overview of Priorities areas identified

4. Why Peer & Aftercare Support Provision of structured aftercare and peer support was identified as being a top 3 priority by: –All service user delegates. –All carer delegates. –The majority of alcohol treatment provider delegates.

5. How would this help (service user perspective)? Service Users & Carers feedback: –The worst thing is moving from support to nothing because I’ve achieved my goals. –We don’t just need treatment, we need support to keep on track afterwards. –A peer support system could stop me relapsing and having to go through treatment again. –Evenings and weekends are often the most difficult times for someone who has completed treatment. An out of hours buddy system would help during these times. –Peer support groups need help to be set-up and keep going. They can be very draining to run.

6. How would this help (treatment provider perspective)? Treatment Provider feedback: –Peer and aftercare support groups can help individuals self-manage their ‘recovery’ after formal treatment is completed –Peer support system may help sustain people’s recovery and minimise relapse and further referrals back into treatment.

7. Historic Alcohol Treatment model for Adults in Torbay Very severe dependence Severe dependence Moderate dependence Hazardous Harmful Residential Rehabilitation Brief interventions (TCT) Information & Advice Information & Advice (TCT) Level of alcohol use Specialist structured community treatment (DPT) Community detox (TCT) Specialist structured community treatment (DPT or TCT)

8. Developing Alcohol Treatment Model for Adults in Torbay. Very severe dependence Severe dependence Moderate dependence Hazardous Harmful Inpatient detox (DPT) Residential Rehabilitation Specialist structured community treatment (DPT) Community detox (TCT) Specialist structured community treatment (DPT or TCT) Brief interventions Information & Advice Level of alcohol use Peer & Aftercare self- management support

9. Conclusions Those that were closest to the treatment system identified continuity of support as being an integral part of treatment. Service users wanted to take control over their own well-being and longer-term recovery. Service user empowerment needs to be supported.

10. Service Procurement –Aftercare and Peer Support Service for those individuals that successfully complete their structured community or residential rehabilitation alcohol programmes and who would benefit from structured aftercare support from peers to sustain their treatment goals through self-management strategies such as ‘recovery plans’. –This service forms part of an integrated alcohol treatment system for Torbay that delivers a range of interventions to meet the assessed needs of people who experience alcohol-related harm.

11. This is a user..uhhh! patient.. Ah!.. User of services…. Actuall y my name is Carl

12. One Individual’s Perception “My journey is real –your pathway is made up”

13. “tell me and I’ll forget show me and I’ll remember involve me and I’ll understand” Chinese Proverb Facilitation of Recovery/Aftercare

14. GROUPS Join the group, it supports you. Take part Be a part You support others joining the group. SAFETY An Individuals wellbeing is more important than the group. Facilitation of Recovery/Aftercare

15. Everyone has something to offer. The balance of getting support and giving support will change over time. Opportunity for members to co facilitate and then to facilitate their own groups. Training opportunities to be developed. Mentoring and supervision to make “it” safe. Facilitation of Recovery/Aftercare

16. Professionally-directed, post-discharge continuing care can enhance recovery outcomes, but only 1 in 5 clients actually receives such care. Scientific Conclusions Dennis, M.L., Scott, C.S., & Funk, R. (2003). An Experimental Evaluation of Recovery Management Checkups (RMC) for People with Chronic Substance Use Disorders. Evaluation and Program Planning, 26(3), 339-352. Godley, S.H., Godley, M.D., & Dennis, M.L. (2001). The Assertive Aftercare Protocol for Adolescent Substance Abusers. In E. Wagner and H. Waldron (Eds.), Innovations in Adolescent Substance Abuse Interventions (pp. 311-329). New York: Elsevier Science Ltd. Ito, J. & Donovan, D.M. (1986). Aftercare in Alcoholism Treatment: A Review. In W.R. Miller & N. Heather (Eds.), Treating Addictive Behaviors (2nd ed., pp. 317-336). New York: Plenum Press. Johnson, E. & Herringer, L. (1993). A Note on the Utilization of Common Support Activities and Relapse Following Substance Abuse Treatment. Journal of Psychology, 127(1), 73-78. McKay, J.R. (2001). Effectiveness of Continuing Care Interventions for Substance Abusers: Implications for the Study of Long-Term Treatment Effects. Evaluation Review, 25(2), 211-232.

17. Outcomes of Peer Recovery Support Completion of addiction treatment AND participation in recovery mutual aid groups is more predictive of long-term recovery than either alone. Fiorentine, R., & Hillhouse, M. (2000)

18. Potential developments? SMART Groups Other Mutual Aid groups. Mentoring Peer based telephone support system. Web based support networks

19. Contact Judith Ward – Alcohol Team Lead, Torbay Care Trust. judithward@nhs.netjudithward@nhs.net Bruce Bell – Treatment Effectiveness Manager in Public Health, Torbay Care Trust. bruce.bell@nhs.netbruce.bell@nhs.net

20. Service User Involvement Self-Help Groups, Support Groups, Expert Patient Groups. Consultation, Partnership/collaboration, user Control.

21. Social Movement Theory “The social movements perspective fundamentally challenges the ways that we have learnt to organise and lead change in the NHS. It advocates that healthcare improvement strategies need to extend beyond the top down programme by programme approach to embrace a concept of citizen led (healthcare staff and/or user) change that draws upon unstructured and largely self- organising autocatalytic (self-fuelling) factors.” Helen Bevan, Institute for innovation & Improvement.

22. Steering Group/ Partnership Charter for Service User Involvement Lead On Torbay Service User Forum Lead on Mutual aid/ Self help Groups Recovery Action Plan Model Focus for Service Briefings Facilitate Aftercare Recovery Group Pool of Mentors & Facilitators Identify Training Needs Review Job Description Baseline Audit

23. Progress so far! Service User Involvement. Briefing of staff at multi agency away day. “Soft sell” to current people within or leaving the system. Recruitment – getting the right person for the post!