Practice example 1

Aquarius Family Alcohol Service (FAS) – Birmingham
Tel: 0212 685 6340
Information supplied by Wayne Darrell, FAS Counsellor

FAS is a specialist alcohol service set up to work with families where there are alcohol problems that are putting children at risk.  The service only receives referrals from social workers working for the Heart of Birmingham children and families teams.  Following referral, the first meeting with a family is a joint meeting with the social worker and FAS staff in which they all agree joint targets and goals.  This means that both sets of professionals and the service user are clear about goals.  It also means that everyone is clear about which professional is responsible for any required monitoring and supervision.  FAS staff will then arrange future meetings to focus on the parent’s alcohol use as well as its relationship to other problems in the family, for example, the perpetration of domestic abuse. 

The challenges

1. the two professionals and the service user can all have different ideas about the risk alcohol poses to them and their family depending on their understanding and professional perspective. This highlights the importance of talking and listening to each other’s concerns and expertise in order to ensure this partnership works.

The opportunities and benefits

1. the ability to form and maintain a relationship with the partner agencies enabling them to meet more of the client’s needs rather than a focus on one issue alone
2. it also helps to influence and educate the social work partners about alcohol and the provision of alcohol services.

Practice example 2 *

Multiple Needs Service, CASA – London
Tel: 0207 428 5955
Information supplied by James Lakey, Multiple Needs Counsellor

CASA provides a range of services to people needing support for their substance use.  The Multiple Needs Service (MNS) is specifically set up for people experiencing mental ill health and who are also using alcohol or illicit drugs.  The main role of the service is to help people to stay in contact with mental health services where an alcohol or drug issue may be getting in the way.  The service works closely with the local Mental Health and Social Care NHS Trust taking referrals from community psychiatric nurses and social workers based in the local Community Mental Health Teams.  Following the referral, CASA staff will meet with the service user to begin the assessment process.  This spans two sessions because of the holistic approach to assessment adopted by CASA.  Between these two sessions, and during subsequent 1:1 work between CASA and the service user, the referring social worker or CPN and CASA staff keep in close contact to ensure that they are sharing information and providing mutual support.  Service users are fully aware of the arrangement and the open confidentiality policy adopted by CASA.

The challenges

1. Service users will sometimes tell different stories or different parts of their story to the two professionals.  This can potentially create conflict between the professionals about appropriate interventions if they are not aware it is happening.
2. Having enough time to talk properly and make sure the partnership works effectively
3. Confidentiality and sharing of information.  Often the client does not feel comfortable about this but an agreement is put in place at the start so everyone is clear.

The opportunities and benefits

1. Mutual support of having another professional involved
2. Sharing of expertise and knowledge
3. Supportive relationship knowing that you can pick up the phone and talk to the social worker about a person’s care and discuss the implications of any new information on the person or those around them.

Practice example 3 *

Hull City Council Social Services Dept.
(Drug and Alcohol Service) Tel: 01482 335331
Written by Lynne Froud, Senior Practitioner (Substance Misuse)

The Drug and Alcohol Service of Hull City Council is a social service team.  We are informally integrated into the Hull Primary Care Trust (PCT) Addiction Service.  This enables us as workers to have access to a person’s medical information, database, clinical team, key workers and Community Psychiatric Nurse (homeless team).  Social Services’ specific role is to take on referrals for people who are seeking residential rehabilitation for their alcohol or drug problem and to complete the preparation, assessments and funding applications are completed with close liaison with the PCT’s Addiction Service. Social Services do not act as key workers.

The challenges

1. There are more organisational difficulties than individual difficulties. A general lack of resources is always a challenge.
2. Occasionally the culture of medical vs social models of working can become apparent and can cause some tensions – for instance – difference between the medical/social model and an understanding by clinical staff of social services role and remit within the team.
3. There can also be professional differences and different approaches to treatment but this is not always a negative thing.

The opportunities and benefits

1. Better communication, access to key workers and the clinical team.
2. Within the PCT Addiction Services there are large staff numbers which results in an enormous resource of different experience and skills.
3. Training opportunities are good both formal and informal
4. Integration into the PCT results in having access to inpatient facilities and being able to discuss issues at weekly team meetings – this makes the transition from inpatient detoxification to residential rehabilitation less complicated for the service user.
5. There is also an outreach worker who assists with engaging people into treatment. A good example would be when there is someone who is particularly vulnerable and chaotic, the outreach worker will physically go to their home address to encourage and transport them to appointments. Sometimes this is all that is needed to help someone’s motivation toward change.

Practice example 4 *

Option 2 - Cardiff
Tel: 02920 536 345
written by Mark Hamer, Senior Practitioner/Therapist
 
Option 2 works with families in crisis where there are serious child protection concerns and parental substance misuse. It works to enable carers to adequately parent their children and move the children out of the ‘Child Protection’ arena and into a ‘Child in Need’ situation. This requires intensive 1:1 work with a holistic focus and sometimes requires 7 days a week availability of workers.  Option 2 is part of the local authority Adult Services and is managed by a Social Services’ Drug and Alcohol manager. We take referrals only from childcare social workers and are physically located in a building alongside children’s services social workers.  We have informal arrangements to fast-track substance misusing parents into specialist substance misuse services.

The challenges

1. Cultural differences between different service areas can cause friction, e.g. Child focus of Children’s services, Adult Focus of Adult Services and Family Focus of our service.
2. Children’s services particularly seem to find it difficult to understand that while they will assess parenting and focus on the child’s needs, we will be looking at family functioning and looking at everybody’s needs. Although this holistic type of working is an integral part of the Framework for Assessment, it has caused some difficulties with some practitioners.
3. Lack of experienced practitioners in childcare teams often leads to fearfulness and over-reaction, unwillingness to work with risk.
4. Children’s Services make the decision of who should be referred to Option 2. Therefore those families that are labelled as ‘not engaging’, who may benefit most from the model, may not be referred.

The opportunities and benefits

1. Creating a bridge between adult and children’s services, sharing of skills, understanding and resources with positive outcomes for children and families.
2. The opportunity to work closely with the childcare teams and to influence the co-ordination of timely services to families.
3. The opportunity to work reflectively with referrers, supporting their assessment process.

Practice example 5

Glasgow Women’s Reproductive Health Service (WRHS)
Information supplied by Dr Mary Hepburn, Obstetrician

This service is a one-stop shop for women with drug and other social problems needing care or support around their reproductive health. The service comprises a number of obstetric clinics which are organised and run by midwives.  Each clinic involves a range of professionals including health visitors, obstetricians, midwives, addictions staff and social workers.  Addictions staff and social work staff are under shared management. The service works closely with a number of allied professions including mainstream social work teams and Glasgow addictions services.  Every fortnight the social worker in the clinic meets with the mainstream social work team to exchange information and pass on referrals for further support as needed.

The challenges

1. Realisation among the professionals that they were all on the same side
2. Need for information sharing and overcoming concerns around confidentiality
3. Agreeing professional standards and practice. 

The opportunities and benefits

1. Providing better care and doing so consistently
2. Addressing multiple needs
3. Issues less likely to get missed

Dr Hepburn is clear that a formal strategic approach is needed to ensure joint working and states that informal working arrangements are not adequate for the sustainability of such projects.  She emphasises the relationship to poverty and class differences in relation to the care outcomes for women, and stresses that the solution is a political one and needs to address the environmental factors and poverty in which many of the women live.

Practice example 6 *

Ru-OK? Brighton and Hove
Tel: 01273 293966
written by Dan Caruana, Senior Social Worker

Ru-ok? is a multi-disciplinary substance misuse service (tier 3) for young people, 10-19, in Brighton and Hove.  The service adopts a harm reduction approach and supports young people to address difficulties at home, in education, training, employment and with other issues such as housing.  We also aim to involve parents and carers in this work where desirable and helpful to the young person. We have a number of different relations with social services at different levels.  At a senior management level we are overseen by the Manager of the local YOT, who in turn reports to the assistant director of Children’s Services in the Children’s Trust.  On an operational level we have contact with the duty teams in the city, taking initial referrals from the public and professionals about child protection and children in need.  We also have contact with the local leaving care team and local family support/long term social work teams.  These are informal arrangements.

The challenges

1. Lack of understanding among social work teams about the structure of substance use services (there are 4 tiers of service and referrals need to be appropriately targeted)
2. Helping people to understand the concept of harm reduction and that it applies equally to young people as well as adults.
3. Having young people’s substance use recognised as a child protection issue to the same degree as parental substance use
4. Encouraging social workers in these teams to discuss routinely substance use issues with the young people on their case-load.   

The opportunities

1. Keeps the issue of young people’s substance misuse ‘on the agenda’ (i.e. in relation to child protection, leaving care, unaccompanied young asylum seekers etc). 
2. Supporting colleagues to locate young people’s substance misuse within the current Every Child Matters/CAF agenda’s, in a holistic way. 
3. Working together to produce practice guidance and establish accompanying training
4. Supporting foster carers to understand harm reduction approach