Substance Misuse

1
Substance Misuse Family Interventions From
prevention to crisis12th June 2008Rhoda
Emlyn-JonesOption 2 Cardiff the Vale
2
Children Parental Substance Misuse

• Between 1 in 4 1 in 10 children go home to a
  parent with a serious drug or alcohol problem (
  rising)
• Risk of serious harm
• Over represented in care system 60-80 of all
  children entering care

3

• Level 0 Universal services available to all
  families
• Level 1 Services targeted at vulnerable groups
  and communities
• Level 2 Services for children and families
  suffering early stress and temporary crises

4

• Level 3 Community-based support for children and
  families experiencing severe stresses and at risk
  of significant harm, family breakdown or
  compulsory entry into the care system
• Level 4 Support for children and young people
  living away from home in a variety of
  family-based or residential care settings

5
Focussing on vulnerable families with Drug
Alcohol related difficulties

• Level 0 Universal services need to identify
  families with emerging difficulties and do more
  to help them cope in the community
• Level 1 and 2 Services need to target and
  address the needs of the most vulnerable families
• Level 3 Need specialist services as alternative
  to family breakdown

6

• Universal low level services may not be
  enough
• we need
• Services at all levels that are
• Accessible, acceptable non-stigmatising
• Take an enabling whole child, whole family
  approach
• Interventions that
• Are evidence based
• Build upon what already works well is
  sustainable
• Staff must be suitably qualified trained to
  deliver to disadvantaged families
• Draw on expertise across Childrens and Adult
  Services

7
Family Services
Family Services
Drug Alcohol
Childrens Services
Adult Services
Transparent Family Services
Engage, build trust, Enhance motivation
Build on strengths
8
Evidential based practice

• Strengthening Families Level 1,2
• CRAFT Level 2
• Option 2 Level 3

9
Strengthening Families Programme (SFP)

• Universally targeted, well evidenced, primary
  prevention intervention based upon identified
  youth family related risk protective factors
• Open to any family living in Cardiff with young
  people between the ages of 10 - 14 years of age
• 7-week highly structured programme offered mainly
  through schools
• Multi-disciplinary group of trained certified
  facilitators who are supported by a co-ordinator

10

• SFP Format
• Families meet in groups Youths-Parents-Families
• SFP is a family strengths skills based
  curriculum that seeks to
• Build life Skills in Youth
• Enhance Parenting Skills
• Strengthen Family Bonds

RISK FACTORS
PROTECTIVE FACTORS
11

• SFP Key Points
• Learn ways to show love set limits
• Positive future orientation
• Building skills to avoid problems
• Recognising family strengths
• Develop empathy
• Communication relationship

12
SFP Outcomes of randomised control trials

• Follow up
• 5 years later
• Delayed initiation of alcohol, cannabis tobacco
  use
• Positive programme effects over time for
  parenting, youth substance misuse, peer
  resistance affiliation with peers, conduct
  problems, school related behaviours
• The difference between the SFP10-14 group the
  control group becomes more pronounced over time

13
CRA/ CRAFT

• COMMUNITY REINFORCEMENT APPROACH /AND FAMILY
  TRAINING
• Supported by 20 years of clinical research
• CRA CRAFT are comprehensive behavioural
  programmes
• Based on a belief that environmental behavioural
  contingencies play a powerful role in encouraging
  or discouraging substance use

14
3 Major Goals of CRAFT

• Reduce loved ones harmful drinking /or drug use
• (Family members use also reduced)
• To engage loved one in treatment
• Improve the Family members quality of life
  (emotional, physical relationship)

15
CRAFT key elements

• Motivational Focus
• Domestic Violence Precautions
• Functional Analysis of substance users Using
  Behaviour
• Communication Training
• Use of Positive Reinforcement
• Withdrawal of Positive Reinforcement
• Allowing for Natural Consequences
• Reinforcers for the family member
• Suggesting treatment to substance user

16
Overview of the Evidence

• CRA has outperformed 12-step programmes in
  multiple clinical studies Participants in CRA
  spent significantly less days drinking/using
• Clinically supported with inpatient, outpatient
  and homeless populations
• CRA identified as one of the most cost-effective
  alcohol treatment programmes
• CRAFT an average 70 of substance users accessed
  treatment (typically between sessions 5-8)
• Family Members functioning improves regardless
  of substance users engagement status

17
Bridging the Gap

• Childrens Services
• Child focussed
• Immediate response
• Transparency
• Risk elimination

• Substance Misuse Services
• Adult focussed
• At the clients pace
• Confidentiality
• Harm minimisation

18
Option 2s Aim

• To create a positive change in the way families
  function, thus enabling children to remain safely
  at home wherever possible.

19
Option 2s Model

• 4 to 6 week intensive intervention in the
  familys home
• Therapist is available 24 hours a day
• All agree behavioural outcomes
• The work is transparent
• Maintenance, follow up boosters

20
Option 2s Intervention

• Clear measurable, behavioural goals are agreed
• The familys values strengths are highlighted

• The familys preferred future is explored
• Skills training is provided in situ

21
Outcome of Option 2 Intervention

• During 2007 to 2008 Option 2 in Cardiff and the
  Vale worked with 34 families
• - 30 of these of families (88) remained
  together in the first year after the
  intervention 77 out of 83 children
• - 6 of the families had 7 children de-registered
  and 2 families had 2 children returned home
• - 3 cases were closed to Social Services

22
Workforce Implications

• Wider workforce
• Role legitimacy
• Role adequacy
• Role support

23
Workforce Implications cont.

• Train practitioners in family focussed
  interventions that recognise resistance as a
  normal part of the change process
• To ensure interventions are developed using
  effective core skills and proven models
• To ensure training is supported by the culture of
  the workforce and organisation

24
Messages from Families

• I feel happy, you know the proper happy, from
  inside.
• - K, a mother one month after the Option 2
  Intervention.
• Option 2 has made me become the person I want to
  be, not the person I would have become, a
  druggie, hopeless, lost my kids and everything.
• - L, a mother on an Option 2 evaluation form.

25
Option 2 Website
26
Many Thanks!

• Contact us any time!
• Option2_at_cardiff.gov.uk