Presentation on theme: "Commissioning Mutual Aid Facilitation: Obstacles and Opportunities"— Presentation transcript:
1Commissioning Mutual Aid Facilitation: Obstacles and Opportunities Tony MercerPublic Health England29th April 2014
2Mutual aid groups in West Midlands AANACASmartMAPBirmingham5220112Coventry1461Dudley53Herefordshire15SandwellShropshire25Solihull4Staffordshire21StokeTelford & WrekinWalsallWarwickshire16WolverhamptonWorcestershireWest Mids Total175
3Mutual aid groups in East Midlands AANACASmartDerby105Derbyshire153Leicester12Leicestershire/Rutland172Lincolnshire34Nottingham309Nottinghamshire31East Mids Total149264
4OpportunitiesPublic health perspectivePHE toolkitEvidence baseObstaclesOrganisational changeStructural obstaclesIdeological obstacles
5Organisational change Duties and responsibilitiesPeopleMoney
6Structural obstaclesDefinitions – mutual aid, peer support and recovery community organisationsInter-agency joint workingKey-working - how long and how often?
8ACMD Recovery Standing Committee “What recovery outcomes does the evidence tell us we can expect?” “There is emerging evidence from a meta-analysis that a close match between personal beliefs and the choice of mutual aid group actually attended improves outcomes and that non-12-step groups are probably as effective as 12- step groups.”Atkins & Hawdon (2007) Religiosity and participation in mutual-aid support groups for addiction
9ACMD Recovery Standing Committee “What recovery outcomes does the evidence tell us we can expect?” Atkins & Hawdon (2007) Religiosity and participation in mutual-aid support groups for addictionthe effect of different recruitment strategiesinterclass correlations per primary recovery groups found that they were not homogeneousno direct measurement of the degree of the “religiosity” or “spirituality” of different groups was made despite their being substantial heterogeneity among groups
10ACMD Recovery Standing Committee “What recovery outcomes does the evidence tell us we can expect?” The association between 12-step mutual aid affiliation and good outcomes is strongest among people who are younger, white, less educated, unstably employed, less religious, and less interpersonally skilled Timko, DeBenedetti & Billow (2006) Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes
11Kelly & White (2012) Broadening the base of addiction recovery mutual aid In the most recent SMART participant survey (N=513)60.7% of members reported believing in some kind of God or Higher Power85.2% reported attending AA or other 12-step organizations in addition to SMART
12Public health perspective 0.10.20.30.220.127.116.11.8Social relationships: Overall findings from this meta-analysisSocial relationships: High vs. low social support contrastedSocial relationships: Complex measures of social integrationSmoking <15 cigarettes dailySmoking cessation: Cease vs. continue in patients with CHDAlcohol consumption: Abstinence vs. excessive drinkingFlu vaccine: Pneumococcal vaccination in adultsCardiac rehabilitation (exercise) for patients with CHDPhysical activity (controlling for adiposty)BMI: Lean vs. obeseSocial relationships have as great an impact on health outcomes as smoking cessation, and more than physical activity and issues to address obesity (Holt-Lunstad et al 2010)Drug treatment for hypertension in populations > 59 yearsAir pollution: low vs. highUNCLASSIFIED
13Public health perspective 5 ways to well-being important to all.May be especially lacking in drug users and needing attention during recovery, to support recovery.Mutual aid can contribute to most of the 5 ways – even ‘be active’ if people walk or cycle to meetings!
14Public health perspective PsychotherapeuticSocial NetworksBio Medical
15Public health perspective Asset Based Commissioning – look what's in the fridge before going to the supermarket
16PHE toolkitA briefing on the evidence-based drug and alcohol treatment guidance recommendations on mutual aidBrings together existing findings and recommendations from:•NICE Quality Standards and Clinical Guidelines•RODT: Medications in Recovery•ACMD: Recovery Standing Committee’s 2nd report on recovery outcomes
17Mutual aid self-assessment tool PHE toolkitMutual aid self-assessment toolAvailabilityPromoting mutual aidLeadership and workforceFacilitationLocal strategic planning and monitoring
18PHE toolkitFacilitating access to mutual aid: three essential stages for helping clients access appropriate mutual aid support
19PHE toolkitImproving access to mutual aid: a brief guide for commissionersLocal visionSelf-assessmentLocal action plan/steering groupService specificationsNDTMSEngaging with Mutual Aid Oct 2013
20PHE toolkit Improving access to mutual aid: a brief guide for alcohol and drug treatment service managersDevelop links with local groups/repsWorkforce knowledge and skillsLiterature and promotionFAMA/key-working/supervisionCare-planning documentationEngaging with Mutual Aid Oct 2013
21Evidence base If mutual aid works………. it will improve performance (more successful completions/less representations)there's an ethical case for doing it
22QS23 Quality standard for drug use disorders (2012) Quality statement 7: Recovery and reintegration People in drug treatment are offered support to access services that promote recovery and reintegration including housing, education, employment, personal finance, healthcare and mutual aid.
236/7 studies included focussed on 12 step mutual aid groups NICE Clinical Guidelines CG51 (2007) psychosocial interventions for drug misuse23 studies identified16 studies excluded6/7 studies included focussed on 12 step mutual aid groups2 x RCTs - McAuliffe (1990) and Timko et al.(2006)1 x RCT sub-analysis - Weiss et al. (2005)2 x cohort studies - Moos et al. (1999) and Ethridge et al. (1999)1 x prospective longitudinal study - Fiorentine & Hillhouse (2000)1 x case series - Toumbourou et al. (2002)
24NICE Clinical Guidelines CG51 (2007) psychosocial interventions for drug misuse Clinical summaryThere is limited but consistent evidence from these studies that 12-step attendance is associated with abstinence from illicit drugs and alcohol, and fewer drug and alcohol problems.Furthermore, involvement in such programmes can be improved by interventions from healthcare professionals to encourage regular attendance and active participation in such groups.
25Clinical practice recommendations NICE Clinical Guidelines CG51 (2007) psychosocial interventions for drug misuseClinical practice recommendationsStaff should routinely provide people who misuse drugs with information about self-help groups. These groups should normally be based on 12-step principles; for example, Narcotics Anonymous and Cocaine Anonymous.If a person who misuses drugs has expressed an interest in attending a 12-step self-help group, staff should consider facilitating the person’s initial contact with the group, for example by making the appointment, arranging transport, accompanying him or her to the first session and dealing with any concerns.
26NICE Clinical Guidelines CG115 (2011) Diagnosing, assessing and managing harmful drinking and alcohol dependenceFor all people seeking help for alcohol misuse:give information on the value and availability of community support networks and self-help groups (eg, AA or SMART Recovery)help them to participate in community support networks and self-help groups by encouraging them to go to meetings and arranging support so that they can attend
27NICE Clinical Guidelines CG115 (2011) Diagnosing, assessing and managing harmful drinking and alcohol dependenceTSF v CBT - Easton (2007)TSF v MET and CBT - MATCH (1997)TSF v coping skills - Walitzer (2009)TSF v couples therapy and psycho-educational intervention - Falsstewart (2005), Falsstewart (2006)Standard TSF v intensive TSF – Timko (2007)Directive TSF v motivational TSF and coping skills – Walitzer (2009)
28NICE Clinical Guidelines CG115 (2011) Diagnosing, assessing and managing harmful drinking and alcohol dependenceTSF was significantly better than other active interventions in reducing the amount of alcohol consumed when assessed at 6- month follow-upThose receiving TSF were more likely to be retained at 9-month follow-upIntensive TSF was significantly more effective than standard TSF in maintaining abstinence at 12-month follow-upDirective TSF was more effective at maintaining abstinence than motivational TSF up to 12-month follow-up
29ACMD Recovery Standing Committee “What recovery outcomes does the evidence tell us we can expect?” 9. The roles of recovery community organisations and mutual aid, including Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery, are to be welcomed and supported as evidence indicates they play a valuable role in recovery.
30ACMD Recovery Standing Committee “What recovery outcomes does the evidence tell us we can expect?” A range of recovery outcomes and sustained recovery are more likely to be achieved if people engage in mutual aid (AA) Fiorentine (1999), Kelly, Hoeppner, Stout & Pagano (2012) Mutual aid (AA) participants who become actively involved in helping others, for example as a sponsor, are more likely to do well Fiorentine, (1999), Pagano, Friend, Tonigan, & Stout, (2004) Having a sponsor early (AA) was beneficial and predicted increased abstinence from alcohol, cannabis and cocaine Tonigan & Rice (2010)
31ACMD Recovery Standing Committee “What recovery outcomes does the evidence tell us we can expect?” Being a sponsor (NA/AA) over a one-year period, was strongly associated with substantial improvements in sustained abstinence rates for injecting drug users Crape, Latkin, Laris & Knowlton (2002)“There is emerging evidence on other forms of mutual aid, for example, SMART Recovery”
32OpportunitiesPublic health perspectivePHE toolkitEvidence baseObstaclesOrganisational changeStructural obstaclesIdeological obstacles