It’s all change in Calderdale with a new adult drug and alcohol service Recovery Steps
we interview those involved…

On 2nd February 2015 a new service started delivering adult drug and alcohol services in Calderdale. A new partnership between DISC, St. Martin’s Health Care and The Basement Recovery Project replaces the Calderdale Substance Misuse Service (CSMS).

We talk to the partner organisations, but firstly, we managed to catch up with

Niamh Cullen from Calderdale Council and Commissioner for services:

RT: Can you explain a bit of the background to how we got to where we are today, e.g. the council being responsible for drug and alcohol services and the tendering process?

NC: I’m sure I don’t need to explain to you that problematic use of drugs and alcohol impacts on the whole of society, having devastating effects on individuals, families and communities. They cause a wide range of health harms including damage to physical and mental health.

The commissioning of drug and alcohol services is now the responsibility of the Public health team. Following changes to the NHS the Public Health team moved from the then Primary care trust (PCT) into Calderdale council. The council is a good place for public health and drug and alcohol services to sit as Public health refers to all measures to prevent disease, promote health, and prolong life among the population as a whole. It aims to provide conditions in which people can be healthy and the solutions tend to be broader than providing health services alone, Public health understands the impact of inequality, the environment and the importance of community on our health and well-being, so is very much in line with how we think about recovery.

Under European law we are legally obliged to re-tender contracts every 3 -5 years, and so much had changed since the contract we had was initiated that it was time to review what we needed to make recovery possible for the people of Calderdale.

RT: How did the Council decide what was needed in Calderdale?

NC: The previous commissioning framework had a treatment focus however our re-procurement of adult drug and alcohol services provided a welcome opportunity to modify this to conceptualise a ‘recovery journey including treatment’ as opposed to a ‘treatment journey including recovery’.

We used several methods to decide what that would look like for Calderdale:

  • We reviewed the latest evidence on what works
  • We commissioned a needs assessment that brought together all the information available to us about Calderdale’s picture of substance use, the information about those using treatment services and what assets we were using in the community.
  • We visited other areas in the region that had gone through similar processes to learn from them
  • And importantly we undertook a survey of the views of those currently using services

The previous service model had focussed upon engaging and retaining drug and alcohol users in treatment, unlike larger busy city’s, in Calderdale most of the drug users (heroin and crack) are known to treatment services.

We have a large number of people who have been in drug treatment for over six years, with a smaller number in treatment over 10 years.

Access to services was not equitable or geographically spread with treatment and recovery services have been centralised within Halifax.

There has been little movement of service users between local treatment and recovery providers, historically there were few referrals between CSMS and The Basement Recovery Project.

Nearly half of people were leaving treatment did so in an unplanned way, which we know means that people are unlikely to stay well.

We are worried that some 1,000 children in Calderdale are estimated to be at risk because of parental drug use and 9,000 because of alcohol. It is clear we needed to strengthen our approach to adult, children and young people’s safeguarding.

Times are a changing…heroin and crack use in England is falling, however new psychoactive substances , often called ‘legal highs’ are emerging and causing concern, heavy use of these can lead to acute harm to health and sometimes dependency. We also know of an increase in the use of over the counter medications and the misuse of prescribed medications and the need to ensure that our services are open to everyone that experiences a problem, whatever substance they use.

RT: What was it about the bid from DISC that won the contract?

NC: The decision on the bid was taken by a panel of 10 people from a range of backgrounds in health and social care; key partners from probation, housing and children’s services were involved. We also included a couple of people from out of the area who didn’t know local provision.

It is a rigorous two stage process; the panel agree set questions that are based upon the service model developed, agree what the scores are, and the answers needed to achieve those scores before the questions go out. Each panel member then reads and scores (it’s a lot of reading!)

The scores are then collated by a contracts manager not involved in the scoring and the panel reconvene to discuss. This process is repeated, with only 4 bidders being taken through to the second stage where a new more thorough set of questions are devised. DISC clearly scored more than anyone else which is why they were chosen!

RT: From a Public Health point of view, what are you hoping for?

NC: For Calderdale as a whole we want:

  • Individuals, families and communities to recover from drug & problematic alcohol use
  • That stigma relating to addiction is reduced to enable people to seek treatment
  • That the coherent Integrated Recovery Oriented Treatment System enables the best outcomes and experience for those entering the system
  • To see the development of a thriving and healthy recovery community that shows people who are struggling that recovery is possible and can be maintained

For individuals, we want

  • Freedom from dependence on all forms of drugs or alcohol
  • Prevention of infection, particularly blood borne viruses
  • Prevention of avoidable drug and/or alcohol related deaths
  • Reduction in crime and re-offending
  • Sustained employment
  • The ability to access and sustain suitable accommodation
  • Improvement in mental and physical wellbeing
  • Improved relationships with family members, partners and friends
  • The capacity to be an effective and caring parent
  • The capacity to be an effective member of the community

RT: How do you measure success?

NC: Our main public Health Outcome Indicator is:

Proportion of all in treatment, who successfully completed treatment and did not re-present within 6 months (PHOF 2.15 i/ii) this is measured centrally and basically means we need to get people treated and out with a good plan that enables them to stay well.

But locally we will sit down with DISC every 3 months to look at a whole range of outcome indicators that we have agreed locally, these will range from measuring the percentage of service users vaccinated against Hepatitis B to monitoring the coverage of structured mutual aid support groups across Calderdale.

There are in excess of 70 local measures that will hopefully help us to keep a grip of what is happening and help us to constantly improve what we do!

Next we talk to Michelle, our own Basement CEO:

RT: How did The partnership with DISC and St. Martin’s Healthcare come about?

MF: For TBRP, a small, specialist and locally led provider, we had to prepare ourselves for a new lead provider model. Inviting potential partners through our doors to discuss partnership working was the first step. This all began in the summer of 2014.

It was important for us to work with an organisation and the people within, who understood and respected what we did and how we did it. We knew what worked. Our results speak for themselves. We wanted a partner who would support our model and help to build on it and make it more accessible across Calderdale. DISC and St. Martin’s Healthcare had seen how we had generated locally led and driven networks and communities of recovery. This success had granted them the confidence to choose us as their preferred partner for abstinence based therapeutic recovery.

We are really pleased with the partnership. We were seeking a partner who was honest, open and transparent and we saw that in DISC. In particular, through discussions with Avril Tully, who represents the heart and values of DISC, we were convinced they would retain the connection with their original roots.

We were delighted to meet with St. Martin’s. It was so refreshing to meet Suzanna, Adam and Anna. They clearly understood the changes required from a clinical perspective, to the building of an integrated recovery pathway. The clinical lead Alun George, really understands an abstinence oriented approach such as ours and is committed to the staff team working in this positive way.

RT: Why the change?

MF: Here at TBRP we have always provided an abstinent based model. Historically, across the country, what has been commissioned is a medically managed model where, predominantly, we have dealt with the symptoms of addiction. It was only in 2010 that the government realised there was a better way and issued a new strategy which talked about recovery – ‘Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life’ – allowing individuals to take control of their own recovery journey. As a result of this change and as the pendulum swings the components of connectedness, hope and identity are key. By generating attractive icons of recovery in the community who are walking, living, breathing success ‘transmitters’, we hope to attract those caught in the treatment ‘net’ who are without hope or direction and convey that things can be different and here is the living proof.

RT: What will it look like?

MF: For someone looking for help today there is no “wrong door”. Anyone can walk into one of the three centres (with more places coming soon) and access services immediately. They are more likely to be met by someone in recovery who can support them through their recovery journey. The biggest difference today is that the menu of options is offered within the first seven days. Abstinence is discussed as part and parcel of planning an individual’s recovery roadmap. People are able to access support daily, with a range of interventions and they are exposed to those ‘transmitters’ of hope.

RT: What are the challenges?

MF: One of the major barriers in implementing a recovery model is that not only do those in active addiction need to be apparent to those in recovery who are living full, productive and meaningful lives, but the people who work in the system do too. This cultural shift from therapeutic pessimism to optimism will hopefully help overcome suspicions of mutual aid and community based recovery support resources across the area. In the first few weeks of implementation we can see changes as workers attend the community groups, utilise the recovery hubs for training sessions and as a result are exposed to people on their recovery journey (from start to end). Naturally, communication has already improved substantially.

Whilst it is early days, the new Todmorden recovery hub will be the embodiment of a totally integrated system where workers from all the partners, together with volunteers, and a new community recovery builder will take ownership of the service. Everyone should feel ‘at home’ and involved in ensuring every individual is supported no matter where they are on their journey.

RT: What does it all mean for someone already engaged with services?

MF: There are large numbers of people who have been in the ‘system’ for a number of years who may find the new way of working both a challenge and an opportunity. Some may have lost sight of why they came into services in the first place and this system transformation will hopefully reignite their ambition and motivation to make positive changes. In addition, pathways to abstinence through detoxification and opportunities beyond will become more seamless and accessible. We talk about utilising the right intervention at exactly the right time in the individual’s journey. One example of this is the use of the community detoxification home at Elland. Here we can provide support around detoxification towards abstinence in a community setting, whilst offering an interface with the wider recovery community.

RT: So what does the future look like?

MF: If you look across the country, there are great treatment providers and also great recovery communities. However, there is little evidence that they have ever had the opportunity to be in the same place at the same time. Many out there are so divided that there is a culture of ‘us and them’ and never the twain shall meet. Calderdale is privileged that we now have this opportunity to offer a seamless integrated recovery pathway for all. The partnership is committed to working together for the benefit of the individuals seeking help. We hope Calderdale can be an example of how the traditional treatment model can be turned upside down into a recovery model.

And now we talk to Philip Edwards, Assistant Director from DISC – the lead provider:

RT: Why did you decide to bid for the Calderdale contract?

MF:DISC has a proud history of working in partnerships with expert local service providers to deliver innovative, service led recovery for some of the most vulnerable people in society. Our organisations roots are firmly based in the north and we have considerable experience of working in environments similar to those found across Calderdale.
Our goal is to improve the lives of the individuals who access the service, their families and the wider community.

We had planned a year in advance prior to the contract being tendered. During this time we had established effective local partnerships, gathered service user feedback and an understanding of what was needed in Calderdale.

RT: What’s the vision of the new service?

PE: We believe the partners we are working with provide the specialist skills necessary to provide a complete drug and alcohol service for the residents of Calderdale. Whilst DISC bring an in-depth knowledge of recovery treatment interventions, The Basement provides innovative therapeutic recovery services, and St Martin’s completes the model by delivering prescribing and clinical recovery support.

Underpinned by our experience of delivering the WY-FI project, our links with commissioners, stakeholders, and our partnership offers an outstanding holistic approach to helping individuals, their friends and families become free from addiction. This is achieved by using a recovery orientated, life changing drug and alcohol treatment system that is bespoke to the needs of individuals.

RT: How are things going to be different for the person looking for help?

PE: Right from the start, we wanted to bring something new to Calderdale. Our recovery model service has a number of innovative features, all of which are supported by an individual’s Recovery Navigator. The main change of approach is a fully integrated approach to service delivery which includes; a Single Point of Access (SPOA) into the service, abstinence based support, detoxification support, mutual aid meetings, introductions to recovery communities and social activities, psychosocial interventions, peer led groups and employment, training and educational support. All these features have been developed based on proven success in services provided in other parts of the country..

RT: What does it all mean for someone already engaged with services?

PE: Initially, current service users will continue with their current programme of recovery. However, moving forward, there are new processes in place that eventually, every service user will migrate to. This will be a gradual process, and service users will be fully involved in any decisions that may change the way they receive care. The service will offer a fresh look at an individual’s recovery journey, their aspirations and treatment focussed goals.

Last but not least, we talked to Adam Smith, Quality and Performance Director at St Martin’s Healthcare Services (SMHS):

RT: Why did you decide to bid with TBRP and DISC for the Calderdale contract?

AS: DISC and SMHS already work in other areas of Yorkshire, SMHS is based in Leeds, so we are fairly local. We were impressed by the vision for a recovery service put together by the commissioners and really keen to work with The Basement Recovery Project in Halifax who has a strong reputation for delivering recovery focused activity. We believe in the benefits of an integrated approach delivering alcohol and other drug interventions from a single service.

RT: What’s the vision?

AS: Recovery can and does happen for those dependent on substances; everyone is capable of it. Substance misuse treatment is very much a team effort; we say to our clients they cannot hope for a healthy happy life drug free by acting alone – they need to be part of a mutual aid network where people support each other. We welcome working in partnership with DISC and The Basement in creating a recovery focused service. At SMHS we make sure our clients and the community around them are kept as safe as possible through various interventions such as daily supervised consumption of medication (if deemed necessary) and close liaison with clients’ GPs around other drugs they may be prescribed.

RT: How are things going to be different?

AS: Access to the service will be much clearer with our Single Point of Access phone number for clients or their GPs who want to refer in to us. Early engagement with recovery based activities and encouragement to attend mutual aid will offer immediate support to the client and shorten their journey to recovery and abstinence from drugs.

RT: What does it all mean for someone already engaged with services?

AS: Service users will be encouraged to engage in mutual aid, their medications will be reviewed to ensure maximum safety and effectiveness, and clear treatment plans agreed so that the service user, their family and their workers all understand the current challenges facing the client and what support is needed to overcome them.

RT: This is a new collaboration, what do you think the benefits are? 

AS: Service users will benefit from the combined expertise and experience of all three collaborating organisations. DISC and SMHS have a long history of working together in other areas, where we have had considerable success in helping clients become abstinent. We are really pleased to be working with the Basement Recovery Project who have a national reputation for delivering abstinence focused interventions. We will continue to learn from each other and develop as a result – resulting in continual improvements and developments for the Calderdale service, Recovery Steps.

A Final Note:

As I was sitting talking to TBRP, I heard of a great example of the partnership in action. A women, living in isolation couldn’t get past a day clean (she was attempting her own DIY detox from heroin). A peer, whom she had met in a local support group had previously offered her a place to stay in an attempt to get her past the early days, but, she continually relapsed at day four due to the intensity of her withdrawal symptoms. On referral into Recovery Steps, an appointment was made with a worker for that same day. She was offered substitute medication to allow her to stabilise, prior to gaining rapid access to the local detoxification house. This will allow her to detox in a recovery conducive environment before gaining access to a local ‘female only’ sober living house. Previously that ‘window of opportunity’ (the woman’s motivation) may have been missed in a traditional led medical approach. Obstruction created by various barriers and processes which took too long. I think this speaks volumes about a partnership based vision shared across providers.

Change is here!

Heath

Article featured in RecoveryTimes issue  8