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NETWORK A national newsletter on substance misuse management in primary care


Editorial


We are pleased to publish this families special edition of network and would like to thank Adfam and FDAP for all the help they have given us to produce it. The process has made us even more aware of the importance of this issue, in particular how hidden and unrecognised families’ needs can be. We hope that this edition helps to improve the service we provide for the families of drug and alcohol users − which may well have the result of improving the service drug and alcohol users receive themselves.


We are publishing this edition to coincide with our 5th


National primary care


development conference, Innovation in an austere climate in Newcastle on 15th October. If you are unable to make this event, watch out for the presentations on our website. We are launching our logo ‘refresh’ at our conference and on this edition. We hope you like it!


A date for your diaries − the RCGP 16th National Conference The public health agenda: making patient centred care the imperative will be in Harrogate on 12th


and 13th May 2011. Don’t miss


it, and we encourage you to put in a poster, paper or film/ other media with an example of good practice – you could win a free place at the 2012 conference.


SMMGP will be working hard to provide guidance in these uncertain times. Whatever happens, we are confident primary care will remain a central part of drug and alcohol treatment.


Hope you enjoy this issue!


Kate Halliday Network Editor


…continued from page 1


Despite the evidence of the benefits to supporting families in their own right, coverage of services is patchy. Perhaps as a result of this, many of the organisations offering support have been set up by families themselves, making it an incredibly positive community movement of people reaching out to support others who are having, or who have had, the same experiences. Two articles which strongly evidence this, are Gloria P’s description of her experiences with Al- Anon, page 3 and Patricia Boydell’s article which describes the important work of a family support group, Harbour, on page 5.


It is important to be aware that substance using parents can present specific harms to their children 5


5 Advisory Council on the Misuse of Drugs (2003) Hidden Harm: Responding to the needs of the children of problem drug users HMSO


, although substance use


alone does not result in poor parenting. In this edition we have not gone into detail regarding issues around child protection (though we would advise readers to revisit Martin Weatherhead’s excellent article on this subject 6


Sharma and Oliver Standing describe the latest developments in family services workforce development on page 16.


). However the effects of


parental substance use on children, and approaches to working with children to build their resilience and improve their outcomes is thoughtfully covered in Jo- Anne Welsh’s article on page 12.


There has been increasing emphasis on the needs of families of substance users, and the potential role they can play in improving treatment outcome in policy and guidance in recent years 7


,8 ,9 ,10 . However though


there has been an increase in the numbers of services commissioned for families of drug and alcohol users, there remain geographical inconsistencies. Joss Smith outlines Adfam’s five key challenges to delivering consistent levels of support to families of problem drug and alcohol users on page 9.


In the current climate it is increasingly important for services to prove that they are providing value for money and the National Treatment Agency (NTA) recognises that outcome measures for services for families are difficult to monitor. They suggest that outcome monitoring could include numbers in contact with services, repeat contacts and levels of service provided, self-reported measures of progress and data and targets relating to specific under- supported groups. Adfam’s We Count Too 11 provide some useful quality standards for services providing support to family members for services and commissioners. Commissioners should also build families’ needs into needs assessments, identify gaps in services, involve families in treatment planning, and ensure that the workforce is competent to work with the myriad of issues working with families can bring.


Services (including those that work with drug and alcohol users) often fail to assess and work effectively with families of substance users due to lack of knowledge, training and guidance. In order to address these barriers, adequate training must be put in place and Carole


6 http://www.smmgp.org.uk/html/newsletters/net026.php


7 Her Majesty’s Government (2008) Drugs: protecting families and communities The 2008 drug strategy


8 National Treatment Agency (2006) Supporting and involving carers: A guide for commissioners and carers


9 Department of Health (England) and the devolved administrations(2007). Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health, Scottish Government, Welsh Assembly Govern- ment and Northern Ireland Executive.


10 National Institute for Clinical Excellence (2007) Drug misuse: Psychosocial interventions Clinical guideline 51


11 Adfam, (2009) We Count Too Good Practice Guide and Quality Standards for work with family members af- fected by someone else’s drug use, 2nd Edition


2


Many services treating drug and alcohol users also need a cultural shift to work with service users as family members, rather than as individuals with no family ties – one in three of the drug treatment population have a child living with them for some of the time. Services also need to work more closely with other agencies to improve the needs of all family members. Elsa Browne summarises the National Treatment Agency’s approach to addressing these issues as outlined in their business plan on page 13, and there are examples of how services are meeting this challenge with the Family Intervention Project the Family Drug and Alcohol Court pilot, page 11.


Improving our services for families does not have to involve large structural changes. Sometimes it can simply mean changing our approach. On page 7 John Westhead takes us through some of the basics to improve the service we provide, and Chris Ford is Dr Fixit to a GP who is supporting the mother of someone who is using crack on page 14 See our top tips for working with families on page 15.


We must not forget the important role primary care can play in supporting family members. Interventions can include harm reduction measures such as hepatitis and HIV screening and immunisation for hepatitis A and B. Primary care is increasingly playing a role in involving family members in preventing drug related deaths by being involved in programmes administering naloxone such as Samantha Perry and Carole Hunter describe on page 8. Primary care can also play an essential role in reproductive planning and sexual health, as Mary Hepburn argues on page 4. Finally, primary care is well placed to provide the setting for the multi disciplinary work that is needed in the often complex area of working with the families of drug and alcohol users.


It is essential for all primary care practitioners to be aware of the benefits of working effectively with the families of drug users, particularly as GPs become increasingly involved in commissioning services. Support services for the families of drug and alcohol users fulfil many of the coalition government’s agenda including supporting a community approach, emphasising the families’ role in society, and promoting the voluntary sector as a way forward in social care. In this period of austerity we must ensure that these services continue to prosper and grow.


Kate Halliday SMMGP Policy and Development Manager and Vivienne Evans, Chief Executive Adfam


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