As part of the 2020 NHS APA Virtual Conference, Tracy Braddock from Inclusion and Kersti Dolphin from Adfam gave a presentation on the design of One Recovery Bucks' family support service.
One Recovery Bucks is a partnership made up of Inclusion, Adfam, Oasis and Connection Support which supports a fully integrated substance misuse service throughout Buckinghamshire. This service includes clinical service, structured psychosocial interventions, harm reduction, recovery support, advice, information and signposting. In October 2017, One Recovery Bucks started delivering its family support service within its wider treatment service.
Why was a family support service needed?
There was a need for a family support service to "contribute to overall outcomes, whilst equally serving the needs of families and recognising that family members are individuals, not simply recovery capital,” explains Tracy.
In 2019, Adfam commissioned a survey to discover the impact that substance misuse has on families. The survey found that "1 in 3 people claim that they have been impacted by the substance misuse of a family member at some stage during their life."
This impact only seems to have worsened throughout the coronavirus pandemic.
As Kersti describes, the pressure on carers has increased, as "many families are postponing their need for support in the face of other familial challenges". Families are also experiencing "boundaries becoming more blurred with substance misuse accelerating and being very visible within the home".
Tracy commented that the service has seen "an increase in the need for family support, especially with increased alcohol use."
How was the family support service designed?
It was "essential to embed the Whole Family Approach" into all aspects of the service design.
The framework needed a usable delivery model (see slide 5 of the presentation), to provide mutual understanding for both the treatment service and the respective families.
It was also crucial to understand the difference between families and service users. As every family is different, a one-size-fits-all approach wasn't appropriate. Furthermore, not everyone has equal access to the service.
The service needed to be flexible, dynamic and adaptable to be able to mitigate some of the barriers to engagement. Kersti explains that this is a "constant consideration that needs persistent challenge and monitoring".
The team designed a model that aimed to challenge barriers of geography, demographics, cultural identity, finances, education, self-identity, family construct and substance problems.
Adfam "prides itself on being the voice of the unheard and having its work designed primarily by those with lived experience". The organisation is "passionate about honouring family members as individuals whose needs are as important as those suffering with substance misuse issues". This too was essential to build into the service design.
As Kersti described, "When families are running on empty, they have little to offer others. But when their batteries are recharged and full, they have the capacity to support their family and their loved ones in a more constructive manner".
How does the model link with other services?
As regular attendees at MASH (Multi-Agency Safeguarding Hub) meetings, social care and family services are essential.
On the substance front, Kersti explains that One Recovery Bucks works closely with substance services for young people, creating "close referral pathways so we can work with adults and they can work with children".
Aside from this, One Recovery Bucks also works with a wide range of other partners, including schools, social care, mental health providers and domestic violence services.
What are the service model pathways?
One Recovery Bucks introduced three pathways into its service model to reflect the differing needs of families.
Pathway 1: Identification and brief advice – Providing information about substances and treatments, harm minimisation and risk management. Minimal assessment and risk assessment is undertaken due to the brief nature of the exchange.
Pathway 2: Active participation/structured support – Upskilling and understanding the families' own behaviours, resources and resilience. A full assessment and fuller risk assessment is undertaken.
Pathway 3: Maintenance – Families are ready to move on. They recognise their autonomy and responsibility. This empowerment often means that they want to help others, perhaps through becoming volunteers or peers themselves.
What have been some of the outcomes of the family support service?
The One Recovery Bucks family support service has shown to achieve positive outcomes, with 9 out of 10 people leaving the service having "successfully completed all the work that they set out to do when they accessed the service."
Since the coronavirus pandemic, the service has become digital and numbers have remained stable for the online peer support group.