recently received funds from Glasgow's Reshaping Care for Older People Change Fund. Specific outcomes of the service are
Reshaping Care for Older People Community Capacity Building / Coproduction Case Study Glasgow City (1) Addaction – 55 Positive Contact: Julie Breslin
[email protected] Addaction is a UK wide substance misuse charity with over 40 years history. It has been established in the Glasgow North West area since 2006 and has managed a range of Community Alcohol Support Services. Through this work the service experienced an increasing number of older adults whose alcohol use was having a detrimental effect on their health and wellbeing, however their needs were not always best met by the more generic addiction services available. In 2009 through a successful Big Lottery bid, an Older Adults alcohol service was established, the only one in Scotland specifically tailored to meet the needs of older adults. The service has a team leader, 2 project staff and an administrator and its overall aim is ‘To improve the well-being of older adults who are problem drinking through establishing a bespoke age-specific service in West Glasgow’. The service has recently received funds from Glasgow’s Reshaping Care for Older People Change Fund. Specific outcomes of the service are: Increased understanding and awareness of problem drinking in an older population through the development of age specific information and educational tools More accessible service for older drinkers who may not have previously presented for help Increased social activity of individual and support to access new social situations Improvement in living conditions and practical skills through group and one-to-one interventions Improvements in health due to increased awareness of healthy eating, mediation compliance and impact of alcohol on medication and regular attendance for medical appointments Improved relationship with family and friends, decreasing isolation Improved self-esteem Addaction’s over 50’s alcohol service concentrates on two approaches – outreach and peer support. The service provides an assertive outreach model to engage older adults who are experience significant life style problems due to their alcohol use, through home visits and domiciliary care, providing one-to-one support and care planning. This is an essential element of the overall Addaction service. The service also facilitates a peer mentoring programme known as Mutual Aid Partnerships (MAP) which is a therapeutic peer led group supporting people to change negative thinking and behaviours, and to increase self-help skills in their recovery. Many service users of the existing Addaction Older Adults service have identified a need for further, ongoing, low level
support such as mentoring, access to appropriate social activities and general befriending and companionship, to assist maintain their recovery. 55 Positive is an add-on to this service focussing on continued support to assist participants maintain recovery and improved health, reduce social isolation and increase independence and one additional post of Peer Development Support worker has been employed to develop this aspect of the service. A key element of the service is the recruitment and training of Peer Recovery Champions (PRCs). These will be recruited from current/previous service users and each will undergo SCQF 6 accredited training and then will work alongside the Peer Development Worker to establish the service. PRCs will be well placed in their recovery to share their experience and offer support through home visits, accompanying to appointments and/or social events. 55 Positive will work with participants to also develop a programme of social and educational activities and encourage ongoing integration into the community. Referrals to the service can be made by any partner agency, including Community Addiction Team, hospitals, GPs, social work, housing services, local voluntary organisations or from individuals who wish to participate in the service. However to gain maximum benefit, it is important that more complex needs have been addressed and participants have a level of stability to enable them to engage in groups and respond to befriending support. There is evidence of the increase in problem alcohol use amongst the over 50s and an awareness of the need for age specific services. Recent reports and research have highlighted the complexity of issues around older adults with problem alcohol use. The report ‘Alcohol and Ageing’, Health Scotland 2006 has predicted that Scotland’s population of individuals over 65+ will increase significantly over the next 25-30 years. The report states that ‘At present 10% of this sector of the population exceed recommended drinking levels. If the 20% of present 45-64 year olds who exceed recommended levels do not reduce their drinking, the number of older people in Scotland who’s drinking may be a threat to health in old age will rise from 80,700 to 223,500 by 2031. This would have a major impact on health resources.’ The latest Alcohol Statistics Scotland 2011 reported that rates of alcohol related hospital discharges were highest in 50-54 age group and over two-thirds of deaths were alcohol was the ‘underlying cause’ were aged 50 or over. Data from General Lifestyle Survey 2009 in England and Wales suggests that men and women aged 65 and over are more likely to drink alone, drink at home and drink every day, than other age groups. Women aged 65+ are 10 times more likely to drink every day than women aged 16-24. These figures show that older adults who drink are at most risk of alcohol related illnesses and death, tend to drink isolation and are more likely to drink daily. Our Invisible Addicts 2011 by the Royal College of Psychiatrists identified that older adults require age specific services as their needs are different than those met in generic services suggesting ‘implementing and promoting service delivery based on need, but targeted in an age appropriate way through multi agency partnership’. The report also notes that ‘Older people can and do benefit from treatment and sometimes have better outcomes than younger people’. Outcomes
Many service users identify social isolation as an on-going issue, particularly when they become alcohol free and their health and well-being improves and often find it difficult to exit the service. The Peer Development Worker will focus on developing ways to maintain recovery, by establishing Peer Recovery Champions (PRCs), befriending support and facilitating social/educational activities. Key outcomes and indicators for 55 Positive are: Increase self-help and independence in the community Progress of 5 individual from service user to Peer recovery Champions 40 individuals will complete social/educational activities Individuals will progress to community resources external to Addaction Decreased reliance on peer development worker for support Reduce social isolation through increase preventative interventions Progress of 5 individuals from service users to PRC PRCs will consult with service users to plan and deliver social activities Increased access to befriending for older adults in recovery via PRCs 40 individual will complete social/educational activities Shift the balance of care from an institutional setting to a community setting 40 individuals will report an improvement in their health and wellbeing using the outcome star 40 individual will report a reduction inproblem alcohol use via Addaction outcome tool at group exit Through attendance at social activities individuals will fell less social isolated therefore less opportunity for problem drinking Individuals will report improved relationships with familyand friends 55 Positive will work to build community capacity by creating a network of PRCs who can support participants in the early stages of their recovery and by creating sustainable community links and networks which will support maintaining recovery. The activities and operation of the project will be designed jointly by Peer Development Worker, PRCs and participants and other opportunities to co-produce supports and services will be identified. A clear outcome of the current Addaction Older Adults service is the reduction in hospital admissions following referral and service. A recent sample of 23 referrals to the service from the NHS Acute Liaison Team directly from hospital, showed 12 had reduced readmissions, 7 had the same and 4 had an increase. The reduction in bed days can be costed and calculated and using this sample, approximately £50,000 was saved. Success Glasgow City Change Fund plan identified community capacity building as a local improvement measure, specifically improving health and wellbeing and tackling social isolation. The partnership has established a Third Sector Transformation fund to support Third Sector activities and initiatives which enhance community connections and/or improve health and well being for older Glasgow citizens in a community setting.
A process has been established to monitor and evaluate the initiatives resourced through this fund under the management of the Voluntary Action Fund under contract from Glasgow Council for Voluntary Service. Regular reporting and monitoring information will be gathered using an on-line system of LEAP (Learning, Evaluation and Planning). Projects will demonstrate success through reporting on their key outcomes, on their contribution to enhancing community connections and improving health and wellbeing and thereby contributing to the overarching aim of reducing demand on public services in the future. Heather Heather is in her early 60’s and has enjoyed a very creative career as a designer and as an art teacher. She has no financial problems, with a beautiful home in a popular area of Glasgow. She has a variety of interests including theatre and painting, a wide circle of friends. She had previously earned extra cash from lodgers and enjoyed holidays abroad and supporting her daughter with her young family In the context of the above, it was concerning that Heather was admitted to hospital with a severely impaired liver. It became apparent that Heather was drinking dangerous volumes of alcohol and in the months preceding the relationship with her daughter had significantly broken down. She was referred to Addaction by the hospital liaison team. On discharge from hospital Addaction visited Heather and she was offered intensive one-to-one support. This entailed twice weekly home visits, accompanying her to appointments with her Consultant and arranging joint visits with the NHS Community Addiction Team. This resulted in assessment for an in-patient unit for medically supported detoxification. The role of Heathers Addaction worker was to visit her at home, reduce the immediate harm caused by her alcohol use and help prepare her for her alcohol detox. Heather often cancelled appointments. This entailed several arranged and unscheduled visits where her worker used motivational interviewing techniques, supporting her ambivalence until she became aware of the serious health impact of her daily drinking. During the course of Addaction’s support, Heather identified a number of traumatic events she had experienced with her family including her mother’s death. She reporting using alcohol in a controlled way up until her career pattern changed and she became a supply teacher. Although she loved her job, she was coping less with day to day demands. However retirement brought further adjustments and her drinking escalated to daily consumption of up to a bottle of brandy. Her relationship with her daughter was damaged during this period and contact with her granddaughter withdrawn. Heather described feeling isolated from her family and detached from her previously enjoyable life style. It became apparent that Heather’s isolation was the key difficulty in her drinking and she began to understand changing this pattern would improve relations with her family. Heathers daughter and other family members were also supported by one of Addactions team with CRAFT. This is an intervention offered to families affected by a loved one’s addiction. The family were desperate to support Heather but were traumatized by the extent of her drinking and the profound impact on her health.
Throughout this period Heather continued to drink and missed many appointments. Heathers Addaction worker consistently visited during these periods of ambivalence and lapses in motivation at least once or twice weekly. Her daughter had resumed contact by telephone following the CRAFT support as she felt better able to cope with her mum’s drinking. Following a further hospital admission it was made clear to Heather that organ damage, including liver damage meant that abstinence was necessary or her life would be at risk. She was given a lot of emotional support through this time by her Addaction worker and agreed finally to access the unit to complete a detoxification. Her worker focused on relapse preventions strategies and identifying positive areas in Heather’s life where she found enjoyment. Some eight months later, Heather has been remained abstinent, with no reported lapses. She is in a relationship with a non-drinker who has helped to restore her home and garden. She enjoys her pursuits of theatre and has joined an art class in a local community centre to which she was introduced by Addaction. She has also renewed positive relationships with her family who are delighted with her progress. William, aged 67 “When Addaction came to visit me I was so relieved to be getting help. I had never had this before and didn’t know that this sort of help was available. I wish I’d had it years ago. I was so grateful. It helped to know that I could talk to somebody who did not judge me for the state of my house or for my drinking.” James, aged 66 “Before coming to Addaction I had several hospital admissions resulting from my drinking. Since I started coming to the group meeting in May I have not been back in hospital. The meeting have been the best form of therapy I have found. Previously I had counselling but this contributed to a sense of repetition and feeling stuck. I also tried AA but this did not work for me. I find the peer support element of the Addaction meeting so beneficial.” Kathy “I still come to the groups and see people where I was a year ago. It’s good for them to see how far I’ve come, and it’s good for me to see how far I come.” Charles, aged 61 “Of course Addaction helped! The group meetings were great, helping me get off the drink. I got to meet a lot of people. They gave me, and I gave them, confidence. It’s a great thing and my overall health has improved tremendously. I am eating well, everybody says I am looking better and with all the money I have saved from not drinking I have bought a car.”
