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Effective Interventions Unit Supporting families and carers of drug users: A review

CHAPTER 8: PRINCIPLES AND PRACTICE OF EFFECTIVE FAMILY SUPPORT

In this Chapter, we set out the core principles that seem to underpin effective support to families and carers and identify issues that can influence the development of effective practice. These are drawn from drawn our review of the evidence.

Principles of Family Support

• The prime focus of family support should be to address the needs of the family and the carer.
• Family support services should be open, accessible and non-judgemental.
• Families and carers should be involved in assessing needs and designing services.

Key Issues for Effective Practice

We have identified a number of key issues that influence and promote the development

of effective support for families and carers. Some of these issues are common to the range of agencies both at strategic and operational level who have a role in family support. Other issues are more directly relevant to specific agencies and service providers, family support groups and wider community groups. We have set out these issues below under

• DATS and partner agencies
• Agencies and service providers in the statutory and voluntary sector
• Family support groups

There is some overlap but this reflects the fact that some issues require action at different levels

1. Issues for DATs and partner agencies

• Agreeing clear aims and objectives for family support services in their area . It is necessary from the outset to establish a clear understanding of the purpose of family support: what it is and what it is not. Specifically, DATs and partner agencies need to be clear about the distinction between the needs of families and carers and the needs of the drug users and the implications for the purpose and nature of service provision.
• Assessing the needs of families and carers. This is the first step towards planning comprehensive and relevant services. A needs assessment should consider the need for practical, emotional and financial support, the scale of existing support and the gaps in provision. Information about how to conduct a needs assessment is contained in the EIU document "Integrated Care for Drug Users: Principles and Practice" (EIU 2002), http://www.drugmisuse.isdscotland.org/eiu/intcare/intcare.htm EIU will publish a more detailed Guide to Needs Assessment in early 2003.
• Consulting with families and carers. This is a key component of needs assessment. The support needs of families and carers, and of individual family members, vary and may change over time. DATs should actively engage with families and carers to identify the range of needs and obtain the families' views on the kind of support that they want. The EIU Guide to Community Engagement may offer some help on methods of engagement. It is at: www.drugmisuse.isdscotland.org/goodpractice/EIU_commeng.pdf.

Another source of help and advice is the Scottish Drugs Forum who now have a key role in developing and supporting community engagement and carer involvement across Scotland.

• Providing a central source of information. DATs are in an ideal position to compile information about sources of support (practical, emotional and financial) and to ensure that both agencies and families have access to such information. DATs should also ensure that they keep local family support groups informed about their plans, what they can do to support local groups and develop a clear point of contact between the DAT and local support groups. DATs should also consider providing training for family support groups in organisation and financial management .
• Working with others. The range of needs among families (see Chapter 4) clearly indicates that DATs and partner agencies should work together to meet those needs. This requires a common understanding about what constitutes family support, good communication and liaison arrangements and agreements on referrals, information sharing and confidentiality.
• Ensuring that staff have relevant skills and training. DATS and partner agencies and service providers should recognise that it is important that all staff have a thorough understanding of the impact of drug use on the family members and the need for sensitivity in engaging with them. They should consider sources of appropriate training. There may be scope for joint training with other agencies and with members of family support groups.
• Funding. Tight timescales and short term funding can reduce the time for DATS and partner agencies to consult thoroughly with those whose needs they aim to meet. This can mean that need is defined by others (professionals) rather than by the "clients". Making it a condition of submitting funding bids that families and carers are involved or that they are represented on bodies awarding funding could ensure that they are an integral part of decision making processes and developments. At a practical level, DATS could consider how they can offer financial support to family support groups to help with administrative costs.
• Monitoring and Evaluation. Systematic monitoring and evaluation is crucial to establishing how and why family support is or is not working, and to highlight areas for improvement. Good evaluation has the potential to improve services and maximise their co-ordination by identifying what works, what could be done better and what is ineffective. It helps to ensure that families and carers are receiving the best possible support to meet their needs. More information about Monitoring and Evaluation is contained in the EIU document on Integrated Care (see above).

2. Issues for agencies and service providers in the statutory and voluntary sectors

• Setting clear aims and objectives. This is necessary to ensure that agencies and service providers are clear about the nature and level of support that they can offer. It is also crucial that families or carers share that understanding in order to reduce the likelihood of misunderstanding or unrealistic expectations being raised. This can be especially important for drugs agencies for whom there may potentially be conflict about working with the drug user and supporting the family. If the family is going to be involved in the support being given to the drug users, it is essential that they have a clear understanding of boundaries such as confidentiality. Families and carers are more likely to appreciate it when services are honest and up front about what they can do and what they cannot.
• Support should be accessible. When planning support services it is vital to identify potential barriers that may prevent people from accessing that support. Such barriers include location and time. It is important to consider:

  is the location remote or difficult to reach by public transport?

  will families be concerned that the location that attendance will threaten their anonymity and confidentiality?

  is the service/support offered at appropriate times e.g. to take account of childcare responsibilities?

To be accessible, support needs to be well publicised. Finally, services should be open and approachable to combat the fear and apprehension often felt by families. Reception staff, as the first point of contact, should be suitably skilled to deal sensitively with families.

• Providing appropriate information verbally and in written form in user friendly and accessible formats on:

• the aims and objectives, and the approach used by the agency/ service provider
• types of drugs and their effects, and the nature of addiction and dependency
• arrangements for maintaining confidentiality, referral
• opening times, childcare facilities, what to do if appointments are unsuitable or missed
• services available from other providers and how to access them

• Training for staff. This should be designed to increase their knowledge and understanding of the impact of drug use on the family and to ensure that they have the skills to help them recognise and respond appropriately to the sensitivities of those seeking support. In particular it is vital to ensure that staff do not display what can be perceived as negative attitudes to families of drug users or indeed the drug user. Such attitudes often heighten the guilt, embarrassment and stress that families and carers experience and can prevent them from seeking support. As noted above, t here may be scope for joint training with other agencies and with members of family support groups.
• Consult with families and carers about how support can meet their needs. The support needs of families and carers, and of individual family members, are complex and vary over time. Agencies and service providers should carry out an ongoing dialogue with families and carers to identify the range of needs and obtain the families' views on the kind of support that they want.
• Consider involving families and carers in providing support. There is clear evidence that support given by people who have faced similar circumstances can be highly beneficial to families and carers. There are also a number of examples of family support group members developing new methods of providing support to others and, in addition, enhancing their own level of personal skills.
• Work with others who provide support. By doing so, agencies and service providers will gain a wider knowledge of what other methods of support exist in local areas, who offers it and how to refer families and carers on. It can also mean that information, practice and resources can be shared to maximise their benefits. By working with others, there can be opportunities to develop support methods that may otherwise be difficult for one single support provider to achieve. This could include respite, advocacy, counselling, and financial advice

Specific areas where joint working arrangements and procedures can help to ensure effective support are:

• joint training where there are common training needs for staff
• communication and liaison arrangements between statutory, voluntary and community agencies such as local family support groups.
• Ensure practice is consistent by developing clear policies, guidelines and standards of practice
• Constantly monitor and evaluate practice in order that best practice is developed. Agencies should be open to change and seek to identify ways in which support could be strengthened. The setting of clear aims and objectives is essential for evaluation. The EIU Evaluation Guides are available at http://www.drugmisuse.isdscotland.org/goodpractice/effectiveunit.htm .

3. Issues for family support groups

• Setting clear aims and objectives. While family support groups have a core aim of supporting family members, some groups extend their remit: for example to include lobbying for treatment services, providing practical support with transport or childcare. It is crucial that the aims and objectives are agreed and clearly understood by the members. They should also be clearly communicated to the DAT, agencies and professionals who may seek to engage with the group.
• Engage with DATs. Engagement is a two-way process. Family Support groups should capitalise on opportunities for engagement with the DAT, whether through the Drug Forum or other community engagement initiatives.
• Engaging with agencies and service providers. It is important to forge links with "professionals" who may be able to offer support in finding sources of funding, accommodation and establishing organisational structures. Above all, there are major benefits for the groups and for family members and carers in creating channels for the exchange of information. Family Support Groups have a potentially valuable contribution to make to the assessment of needs by the DAT and to the shaping of service provision. They may also be able to take on a "volunteer " support role for families working with agencies.
• Work with others. Families and carers can benefit from access to a wider range of support e.g. stress management, complementary therapies. Family Support Groups could work with agencies or other community groups to share knowledge of other types of services and collaborate in providing them.
• Making support accessible. Accommodation has to be appropriate the needs of families as well as easy to access in terms of location and timing. Common venues for meetings such as schools and health clinics may be seen by family members - initially at least - as too closely associated with agencies who are potentially threatening ( e.g. where there are children involved). Premises should be neutral and able to offer anonymity.
• Financial support. Members of family support groups often find themselves meeting the costs of transport, telephone and administrative costs. This is an issue where they should consider approaching the DAT and other agencies to negotiate some level of funding to help to achieve their stated aims and objectives.
• Developing training. Family support groups offer a range of support and this may include one-to-one support and counselling. There is a need to consider what type of training may be necessary to ensure that members are equipped to deal with sensitive and difficult issues that may arise. There are also training needs associated with organisational and administrative functions as groups become constituted and start to manage funding. DATs may be a source of advice about training opportunities.
• Providing information. Families and carers need good information about the nature of drug misuse and its effects on the individual. They also want information about types of treatment and what is available in their area. Family support groups have an important role in providing reliable information. DATs and agencies should be able to help with sources of information and may be willing to come along and talk to groups directly.
• Monitoring and Evaluation. This is equally as important for family support groups as for DATS and agencies. It is crucial that groups can demonstrate that their services are relevant and meeting the aims and objectives that they have agreed. This matters for the groups themselves so that they can improve their services where necessary; and so that they can demonstrate to DATS and other agencies that they are providing effective support. The EIU Evaluation Guides offer a useful resource in a user friendly format on the key aspects of designing and carrying out an evaluation

The Guides are available at http://www.drugmisuse.isdscotland.org/goodpractice/effectiveunit.htm.

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