Annie Darby looks at the work of an outreach team in North East Lincolnshire.
By 2000 there was growing concern about the effects of substance misuse on users and their families in North East Lincolnshire – it was estimated that up to 70 per cent of acquisitive crime in the area was related to funding drug use.
I became a specialist health visitor in October 2002 and sought to find out what other agencies believed were the problems in relation to drug users and their families. I also surveyed 22 drug-using families. This formed the basis for identifying interventions and services that were required to improve outcomes and were the basis for the team that is in place now. It became clear that a team approach to supporting the health and social needs of drug users and their families could be effective, but needed to include:
* An outreach service: there needed to be a service that met the presenting needs and assisted families to integrate into mainstream services and the community. There should also be a service for general health and social needs.
* Flexibility: drug and alcohol use is a relapsing condition, so users and families will have periods when they are stable and need little support. But then there will be times of relapse when they will need intensive support. The team has a revolving door approach to working with families.
The team also has to work with all agencies in the area as drug and alcohol users move frequently and are engaged by professionals who have little prior knowledge of the families and children. And it must also work alongside drug and alcohol users and their families.
The aim is to address the presenting problem and help clients access services. The work is usually short term, but due to this being a relapsing condition most clients return to the team at various intervals. There is a confidentiality statement that clients are shown and consent is sought for information sharing. All the clients’ needs are assessed individually and a care plan is compiled.
With the exception of the carer development worker, none of the team are drug workers or addiction nurses (see Who is in the team?). All roles are outreach and clients are visited in their homes, at hostels, or drug treatment services.
My role as specialist health visitor has grown into developing the team and the services it provides. My work with clients is in primarily assessing the needs of drug-using families in response to referrals from social workers, drug workers and so on. The aim is to identify how the substance misuse is affecting the family and what services and interventions can be introduced to improve outcomes. The role involves identifying and addressing gaps in service provision.
These services include a women’s group, a “sleep clinic” for drug users and a service for pregnant drug users. Also, we provide a fast response service in conjunction with the police, the coroner and the ambulance service to support those affected by a drug-related death.
The nurse practitioner assesses and treats the general health needs of drug users and their families, assists with chronic disease management, and treats minor illnesses and injuries.
The child and family support worker provides a non-judgemental service for drug-using parents, promotes home safety, particularly in relation to substance use, helps families to access mainstream services, improves the lifestyle of children and parents by working with families on routines, child growth and development, and preparation for parenthood. Her caseload is 10 families. Once a family is engaged with mainstream services the case is closed, but families can and do come back.
The general support worker role has been crucial in delivering advocacy and integration work. She works on the ground with clients, often accompanying them to health appointments and supporting them through treatment.
The carer development worker supports carers, especially those caring for children, and facilitates the carer support group and manages the volunteers.
The children and young person’s worker role came out of research that emphasised the need for a service to support children who lived with drug and alcohol using parents. Children were put on the steering group and they named the project Fedup – Family Environment Drug Using Parents. The project offers group work, one-to-one support, or both to children aged 5-13 who are affected by someone else’s drug use. Parental consent is essential and has been rarely withheld.
The accommodation and misuse link worker assists and supports drug and alcohol users with housing, and integration into the community.
Evaluations by the team and by clients have shown that for just over 60 per cent of clients the service is assisting them to:
Engage in health and social care mainstream services and particularly drug treatment services.
Address their health needs – contraception uptake was particularly high. All clients are now immunised against Hepatitis B and C.
Social isolation had been reduced in 58 per cent of clients who are now participating in activities such as job training and support groups.
Our last evaluation showed that of the 10 families involved, six had the amount of statutory involvement reduced from “child protection registration” to “child in need”. Two families no longer needed any social service involvement.
Despite this, a significant number of families will become disrupted and may break down. The advantage of the team is that individuals and families can still receive a service, albeit from a different team member, which will provide them with health and drug treatment services and put them in contact with other mainstream agencies. CC
Annie Darby is the specialist health visitor for substance misuse for North East Lincolnshire’s drug and alcohol team. She works with a multi-agency team that addresses the general health and social needs of individuals and families affected by substance misuse. She was awarded the OBE for services to the NHS in June 2004.
Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.
This article describes the innovative approach taken within North East Lincolnshire drug and alcohol action team and primary care trust, to address the health and social needs of drug users, carers and families. The outreach team aims to address the presenting problem, and then integrate the individual and family into mainstream services. The team is multi-agency with a combination of health visiting, nursing, social work, housing and social support skills.