Presentation on theme: "Richard McVey & Claire Hampson Increasing family-focused practice across an Organisation: Helping services become more family-focused."— Presentation transcript:
Richard McVey & Claire Hampson Increasing family-focused practice across an Organisation: Helping services become more family-focused
Introduction Substance misuse is associated with a range of social and health problems affecting the individual as well as the family within which the individual lives (Orford et al., 2005) E.g. about 4 million people in the UK suffering as a result of problem alcohol user in their family (Copello, et al., 2000) –important to develop strategies to meet their needs Growing research evidence to support the view that families and social networks can be influential when involved in treatment –On the whole, routine addiction services remains focused on the individual drinker or drug user (Copello & Orford, 2002)
Background Project part of a long programme of work aiming to understand the impact of alcohol and drug problems on the family and develop strategies in addiction practice to help reduce family strain Earlier work focused on: –understanding the impact of alcohol and drug use on family members (FMs)(Orford et al., 1998a) –natural family ways of coping (Orford et al., 1998b) –development and testing evidence-based family- focused intervention in primary care (Copello, et al., 2000) and specialist teams (Orford et al., 2009)
Aims Whole Organisation approach Provided a non-statutory addiction treatment Organisation an opportunity to receive training and on- going supervision in two family-oriented interventions: –The 5-Step approach –Social Behaviour and Network Therapy (SBNT) To promote a shift towards family-focused practice and to further advance implementation of family work into routine addiction services Allowed comparisons between teams at different time periods in order to evaluate the impact on the implementation of family-focused practice
Methods Mixed-methods quasi-experiment integrating action research Made up of 2 phases over a 3-year period –Phase one = pilot study: trained 2 teams (n=19) –Phase two = random assignment to training –2 teams received immediate training (n=24) –2 teams received delayed training (n=19) –(+1 team previously trained in IFM study) The Involving Family Members across the Organisation (IFMO) training and supervision package Two-day initial training event Eight monthly follow-up consultancy meetings One-day follow-up training event
Project timeline 4 teams 2 teams Random assignment Training & supervision period Baseline period Follow-up period Baseline Pilot study (2 teams) IMMEDIATE TRAINING DELAYED TRAINING
Evaluating the impact of the project Two questionnaires measuring professionals attitudes towards family-focused practice (pre, post, and follow-up) Attitudes to Addiction Related Family Problems Questionnaire (AAFPQ) Attitudes to Involving Family Members in Treatment Questionnaire (AIFMTQ) Diary-snapshot – to assess changes over time in staffs weekly activity Qualitative analysis of professionals comments during consultancy supervision meetings
Training & supervision period Training & Supervision period Mean total AAFPQ Score * * * Baseline period Follow-up period * Significantly greater than baseline Phase two results: Staff attitudes (AAFPQ) IMMEDIATE TRAINING DELAYED TRAINING * B1 PI B1=Baseline 1 B2=Baseline 2 PI=Post-intervention FU=Follow-up B2 FU Baseline period PI
Diary-snapshot results: phase two Proportion (%) of family-focused practice Training & supervision period Training & supervision period Follow-up period Baseline period IMMEDIATE TRAINING DELAYED TRAINING
Overall proportion of family-focused practice * *^ * Significantly greater than baseline. ^Significantly greater than training period.
A need to improve outcomes for all I had a session where a Mother and Daughter let some stuff out [in the session]. At the end of it they got up and hugged each other, apparently for the first time in 5 years Working creatively and flexibly The confidentiality form is a useful tool rather than a formality…I ask them [focal client] if your brother called me, could I talk to him? Im proactive in searching around Efficacious impact of the project Nothing comes of a one-off model workshop. It needs a follow-up intervention. The meetings are a useful as a constant reminder. Its good having the contact Recognising changes needed in practice and policy Admin will be amending the wording of the invitation letter to show clients that their FMs are welcome in the sessions Policy and procedures impeding family-focused practice It doesnt just fit into the cycle were funded for Limited family-focused practice within outside organisations GPs only refer drinkers, they dont think about the affected family members Perceiving and experiencing challenges and difficulties Weve had it rammed down our throats careful of the confidentiality, careful not to give anything away Individualistic practices remain A one-to-one can be quite precious and thats my preference to working Qualitative analysis: Main themes INTERNALEXTERNAL
Drivers for family work integration Permission to work in family focussed way Open flexible attitude vs opening a can of worms Management buy in Family work protagonists / champions Follow up in supervision / team meetings Addressing issues between consultancy sessions eg first appointment letter
Training needs 1-1 work vs 2+ clients in the room Working with FMs in own right vs seeing FC and FMs together Openness to looking for opportunities for family work Complex family therapy vs quick wins Family work = more work vs same/less work Selling family work to service users Confidentiality Conflict and communication issues How to deal with unsupportive network members No support network
Conclusions Study supports the use of an Organisational platform to promote the inclusion of affected family members within addiction treatment –Significant improvement in staffs attitudes towards family-focused practice –Significant increase in % of family-focused practice across the Organisation (19% at baseline to 34% post-intervention) –Number of family workers increased from 9 – 14 during the project Increases in positive attitudes and family-focused practice cannot be fully attributed to the training element of the project –Culture change permeating the whole Organisation?
Some final thoughts….. Teams and Organisations or the wider health system or both?
Thank you for listening For more information, please contact: Richard McVey: Claire Hampson:
References 1.Copello A, Templeton L, Krishnan M, Orford J, Velleman R. (2000a). A treatment package to improve primary care services for the relatives of people with alcohol and drug problems. Addiction Research, 8, 471 – Copello, A. & Orford, J. (2002). Addiction and the family: is it time for services to take notice of the evidence? Addiction, 97, 361– Copello, A., Orford, J., Velleman, R., Templeton, L., & Krishnan, M. (2000b). Methods for reducing alcohol and drug related family harm in non-specialist settings. Journal of Mental Health, 9, Copello, A., Velleman, R., Templeton, L. (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review 24, (4), Orford J., Natera, G., Copello, A., Atkinson, C., Mora, J., Velleman, R., el al. (2005a). Coping with alcohol and drug problems: The experiences of family members in three contrasting cultures. London: Brunner- Routledge. 6.Orford J., Natera, G., Davies, J., Nava, A., Mora, J., Rigby, K., Bradbury, C., Copello A. & Velleman, R. (1998a). Stresses and strains for family members living with drinking or drug problems in England and Mexico. Salud Mental V, 21, No Orford, J., Natera, G., Davies, J., Nava, A., Mora. J.. Rigby, K.,Bradbury, C., Bowie, N., Copello, A. & Velleman, R.(1998b) Social support in coping with alcohol and drug problems at home: findings from Mexican and English families. Addiction Research, 6, Orford, J., Templeton, L., Velleman, R. & Copello, A. (2005b). Family members of relatives with alcohol, drug and gambling problems: a set of standardised questionnaires for assessing stress, coping and strain. Addiction, 100, Roberts, M., Klein., A. & Trace, M. (2004). Towards a Review of Global Policies on Illegal Drugs. Drugscope – Report 1, 1 – UKATT Research Team (2005). Effectiveness of treatment for alcohol problems: findings of the randomised UK Alcohol Treatment Trial. British Medical Journal; 331, 541– Velleman, R., Templeton, L., Group, U. K. A. D. a. t. F. R., (2003). Alcohol, Drugs and the Family: Results from a long-running research programme within the U.K. European Addiction Research, 9 (3),