The Skills Consortium The proposed skills framework East of England Recovery & Reintegration Conference 20 th July 2010

A brief history of the consortium Convened to develop a sector led consensus on good practice and lead workforce development For the sector, by the sector Two large sector-wide stakeholder workshops in 2009 These tasked a smaller working group (the Core Group) to develop the ideas and the constitution Build it and they will come

Aims of the consortium To support the drug treatment sector to: Identify workforce needs required to promote and sustain beneficial treatment outcomes for service users and their communities Review, consolidate and develop existing workforce initiatives with a view to retaining the existing and future workforce Support employers and commissioners to equip practitioners and managers with the requisite skills, knowledge and attitudes.

The Core Groups approach Core Group: royal colleges; trusts; third sector; users; carers; membership organisations; educators Develop a constitution and establish a fully constituted consortium in June/July 2010 An elected executive Criteria for a representative membership (40-60) All stakeholders can access resources; tools etc. Launch a skills framework very shortly after the consortium becomes constituted Framework will be the wire-frame of the on-going work of the consortium

The roots of the framework Based on: Previous guidance (Care Planning Practice Guide in particular) NICE drug misuse guidance 2007 Clinical Guidelines Informed by emerging thinking on recovery and personalisation. It is also informed by ITEP, BTEI and Recovery, Engagement and Life Skills model developed by TCU. As interventions, approaches and technologies emerge it is anticipated that they can be absorbed by the framework.

The aims of the framework Aims to be an … integrated (coordinating elements of local systems) dynamic (responsive to need, moving service users forward) coherent (focussed on the service users journey) congruent (based on values of recovery and reducing harm) … model The intention is to give all evidence-based interventions and those from the Orange Book based on expert consensus a proportionate and integrated position in a conceptual model. Treatment adaptation/optimisation is key component of the model.

Segmenting delivery: the phases of treatment (columns) Based on current phases of treatment (CPPG and MoC). Informed by current thinking on recovery and TCU (ITEP/BTEI/RELS) Engagement: Establishing the process components of key working; developing the therapeutic relationship; build motivation for change and set initial treatment goals. Preparation: Refine treatment goals and actively prepare for change. Change: Initiate and maintain changes in substance use, behaviors and cognitions and build recovery capital. Reintegration: Strengthen community integration, develop recovery capital and exit formal treatment. (Reintegration starts at the beginning of treatment and runs throughout. Its focus may shift from safety initially and progress through social, and self- esteem related needs)

Segmenting delivery: the types of intervention (rows) Keyworking – process/support: elements of keyworking/case management which are offered to all clients and which form the bedrock of treatment Keyworking – low intensity psychosocial interventions: including psycho-educational interventions, manualised and mapping interventions Keyworking+: interventions requiring additional competencies, training and supervision structures High intensity or specialist interventions / Specialist/external services

Underpinning values The core group have explored a range of issue and concepts which have formed the underpinning values of the model. These will be developed as part of the Consortiums work programme. They include: A supported and facilitated transition from being clinically managed to taking personal responsibility through self-management. The vital role of harm reduction in recovery-orientated treatment. An increased focus on the service users strengths, focussing on the development of a positive identity outside of their drug use. An increased use of peer-based recovery mentors and the integration of structured treatment and indigenous recovery support groups. A greater emphasis on the physical, social and cultural environment in which recovery happens, i.e. a shift from clinic-based aftercare to community-based continuing care Manners Matter: factors that encourage clients to return and stay the course.

Keyworking – process Keyworking – low intensity interventions Interventions focussed on: building the therapeutic relationship; engagement with the care-planning process; building motivation for change and setting initial treatment goals. Session topics could include: personal strengths and resources cost-benefit of drug use ambivalence risk awareness and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Interventions focussed on: refining treatment goals and preparing for change. Session topics could include: commitment to change recovery goals & change plans triggers for using & management strategies personal & community resources and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Interventions focussed on: initiating and maintaining changes in substance use, behaviour and cognition, and building recovery capital. Session topics could include: cravings relapse prevention and lapse management leisure/vocational/educational plans personal and community resources skill development (social, personal, vocational) and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Interventions focussed on: strengthening community integration, developing recovery capital and exiting formal treatment. Session topics could include: future plans and support recovery check lists structuring time reviewing changes achieved skill development (social, personal, vocational) and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Keyworking+ – interventions requiring additional competencies Motivational Interviewing Family support Motivational enhancement therapy Contingency management (attendance) Low intensity interventions for common mental illness: Computer-based CBT Guided Self-Help Behavioural Activation Relaxation techniques Contingency management (BBV) Family support Contingency management (behavioral change) Community Reinforcement Approach Social Behaviour and Network Therapy Family support Community Reinforcement Approach Social Behaviour and Network Therapy Family support High intensity or specialist interventions / Specialist/external services BBV testing and vaccination Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Medically assisted recovery Inpatient assessment & stabilisation Oral/injectable substitute therapy Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Medically assisted recovery Inpatient assessment & stabilisation Oral/injectable substitute therapy CBT for depression and anxiety (IAPT) Behavioural Couples Therapy Family Therapy Psychodynamic therapy Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Residential and community rehabilitation Medically assisted recovery Community Detox Inpatient Detox Naltrexone (with CM) Psychodynamic therapy Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Residential and community rehabilitation Medically assisted recovery Naltrexone (with CM) Comprehensive assessment inc Child protection Risk Assessment/reassessment of recovery capital Cataloguing strengths Recovery/care planning Care coordination (if applicable) Risk management Crisis management Health monitoring Advocacy Coaching Pro-active engagement/re- engagement Building social networks Harm reduction Multi-agency work, including Child protection Mental health Appropriate supported/facilitated referrals to: Medical monitoring and healthcare Mutual aid Financial and legal advice Housing, employment, education and training The care plan should specify the detail of the case management interventions, as agreed with the service user. Case management and key working interventions may utilise mapping techniques and manuals to support their delivery. Keyworking ChangeChangePreparationPreparationEngagementEngagement Re/integrationRe/integration

Keyworking – process Keyworking – low intensity interventions Interventions focussed on: building the therapeutic relationship; engagement with the care-planning process; building motivation for change and setting initial treatment goals. Session topics could include: personal strengths and resources cost-benefit of drug use ambivalence risk awareness and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Interventions focussed on: refining treatment goals and preparing for change. Session topics could include: commitment to change recovery goals & change plans triggers for using & management strategies personal & community resources and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Interventions focussed on: initiating and maintaining changes in substance use, behaviour and cognition, and building recovery capital. Session topics could include: cravings relapse prevention and lapse management leisure/vocational/educational plans personal and community resources skill development (social, personal, vocational) and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Interventions focussed on: strengthening community integration, developing recovery capital and exiting formal treatment. Session topics could include: future plans and support recovery check lists structuring time reviewing changes achieved skill development (social, personal, vocational) and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings Keyworking+ – interventions requiring additional competencies Motivational Interviewing Family support Motivational enhancement therapy Contingency management (attendance) Low intensity interventions for common mental illness: Computer-based CBT Guided Self-Help Behavioural Activation Relaxation techniques Contingency management (BBV) Family support Contingency management (behavioral change) Community Reinforcement Approach Social Behaviour and Network Therapy Family support Community Reinforcement Approach Social Behaviour and Network Therapy Family support High intensity or specialist interventions / Specialist/external services BBV testing and vaccination Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Medically assisted recovery Inpatient assessment & stabilisation Oral/injectable substitute therapy Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Medically assisted recovery Inpatient assessment & stabilisation Oral/injectable substitute therapy CBT for depression and anxiety (IAPT) Behavioural Couples Therapy Family Therapy Psychodynamic therapy Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Residential and community rehabilitation Medically assisted recovery Community Detox Inpatient Detox Naltrexone (with CM) Psychodynamic therapy Counselling (registered/accredited) Specific health interventions Mutual aid/recovery communities Residential and community rehabilitation Medically assisted recovery Naltrexone (with CM) Comprehensive assessment inc Child protection Risk Assessment/reassessment of recovery capital Cataloguing strengths Recovery/care planning Care coordination (if applicable) Risk management Crisis management Health monitoring Advocacy Coaching Pro-active engagement/re- engagement Building social networks Harm reduction Multi-agency work, including Child protection Mental health Appropriate supported/facilitated referrals to: Medical monitoring and healthcare Mutual aid Financial and legal advice Housing, employment, education and training The care plan should specify the detail of the case management interventions, as agreed with the service user. Case management and key working interventions may utilise mapping techniques and manuals to support their delivery. Keyworking ChangeChangePreparationPreparationEngagementEngagement Re/integrationRe/integration Care/recovery plan Review /Optimise/Plan (Care Plan Review, TOP, other)

Limitations and focus of the framework It focuses on interventions and practice rather than service design or components Change will happen in several areas of someones life and at different rates. The service user is located in the phase relating to the key change identified in the recovery plan Integration with mainstream services is key but not directly addressed Pre and post treatment interventions/services are not yet included The model has informed the early development of the NTAs proposed recovery-orientated service framework. This framework will cover some of the broader issues relating to system & service design and commissioning.

The ambition for the framework The aim is that the framework becomes the front end or wire frame of an interactive web-based resource hub. The proposed work programme of the consortium is to populate the framework with: supporting detail (manuals, guidance, etc) emerging interventions shared learning training networks relevant occupational standards And to sponsor early adopters to develop interventions and test implementation.