Drug and alcohol services - improving holistic family support

Executive Summary

Scotland's national alcohol and drug strategy, Rights, Respect and Recovery, acknowledges that families are assets and key partners, with valuable knowledge and experience. Families have the right to support, in their own right, as well as the right to be involved in their loved one's treatment and support.

Culture: Developing a consistent high-quality holistic whole family approach and family inclusive practice in Scotland.

• Family Inclusive Practice holds families at the heart of service design, implementation, evaluation developing and equipping our workforce to deliver family inclusive systems change and sustained improvement.
• Family Inclusive Practice is more likely to exist and develop where services have a culture and ethos of openness and transparency, demonstrably respecting individuals and understanding and respect their lived experience.
• Ask the Family provides a range of information from children, young people and adult family members on Whole Family Support and Family Inclusive Practice and what it means to them.
• Strong, creative, trusting and enduring relationships between Alcohol and Drug Partnerships (ADPs) and Children's Service Planning Partnerships (CSPPs) are required to deliver the next phase of investment and expansion of services. The needs, experiences and views of families must be at the heart of these developments
• We must actively promote all family support options across a range of local services, platforms and networks, to ensure everyone knows what is available and how it can be accessed. This should be non-stigmatising and emphasise the confidentiality of support
• We should recognise that positive involvement of fathers helps increase the totality of family support and improve family wellbeing.

Services: Scotland is a country where individuals, families and communities have the right to health and life free from the harms of alcohol and drugs, are treated with dignity and respect and are fully supported within communities to find their own type of recovery.

• We intend to invest and expand services in Scotland. The needs, experiences and views of families must be at the heart of these developments.
• Family members have a clear voice/role in the development and evaluation of services.
• It is crucial that services include trauma-specific interventions where appropriate, ensuring that every aspect of service design and delivery is trauma-informed and trauma-responsive.
• Keeping the Promise means working to the 10 key principles that must underpin intensive family-based support services and sets specific challenges for services to move beyond a risk-based approach, to one actively based on addressing the challenges families face in order to promote their recovery from substance use.
• The Covid-19 Children and Families Collective Leadership Group supports partners at national and local levels across children's and adults' services to work together to ensure whole family support is provided in line with nationally agreed principles, free from stigma, and driven by the views and needs of families.
• Services must recognise that women in particular can face a range of barriers that can hinder them entering and sustaining attendance with treatment and recovery programmes.
• Whole Family Approaches, specialist services and mainstream statutory providers need to ensure their service responses are designed to support women overcome the trauma and loss that they often experience when involved in child protection and lose the care of their children.

Resources to Support Delivery: One of Scotland's Public Health Priorities is to reduce the use of and harm from alcohol and drugs, with a particular focus on reducing alcohol and drug deaths.

• Scotland's national alcohol and drug strategy Rights Respect and Recovery recognises that "there remains scope for improvement" in relation to effective, consistent information sharing and joint working between adult and children's services in supporting families and protecting children.
• Implementing the Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services for Alcohol and Drugs Services. Quality Principle 8: Services should be family inclusive as part of their practice, remains a key priority.
• Getting Our Priorities Right (GOPR): Scotland's guidance for services working with children, young people and families affected by substance use, recommends that "all child and adult services should focus on a 'whole family' approach when assessing need and aiming to achieve overall recovery".
• Getting It Right For Every Child (GIRFEC): provides a shared language for promoting, supporting, and safeguarding the wellbeing of children and young people.
• National Guidance for Child Protection in Scotland 2021: sets out how agencies should work together with children and young people, families, carers and communities to protect children and young people from abuse, neglect and exploitation.
• United Nations Convention on the Rights of the Child (UNCRC)willenshrine the rights of children into Scottish law.
• Medication-Assisted Treatment (MAT) Standards for Scotland Access, Choice, Support. People have the right to involve others, such as a family member or nominated person to support them in their journey. MAT sets out what the standards mean for families or "nominated persons".
• The national Covid-19 Children and Families Collective Leadership Group have developed a vision and blueprint for improving holistic family support, as part of developing work to drive forward whole system change, which links in with delivering the Promise.
• The Safe and Together model provides more detailed guidance and a practice framework for understanding Whole Family Approaches and the intersectionality with Domestic Violence and is adopted widely across Scotland.
• The CORRA Foundation's review of relationship-based practice developments found that there is still some way to go in Scotland in developing cohesive, co-ordinated approach to supporting the whole family in their experience of substance use.
• The Scottish Government's Partnership Delivery Framework sets out the partnership arrangements needed to reduce the use of and harm from alcohol and drugs.

Partnership Working: Strong partnerships ensure all family members (children, young people and adults) affected by substance use have access to relevant high-quality, holistic and consistent whole family approach.

• Families are unique, their experiences will be an asset and strength to local areas in developing/delivering appropriate whole family support. Their involvement from the outset is central and needs to be secured and continually strengthened by respecting, valuing and harnessing their lived experience to design and deliver the right high-quality local services that make a real difference to the lives of people who are affected by alcohol and drug related harms.
• Strong, enduring, collaborative working arrangements are needed between adult alcohol and drug services and children and families services.
• Partnership working across universal and targeted services, need to effectively work together in order to ensure a wide range of evidence-based family support options are available locally to support children, young people and adults.
• Children's Services Planning Partnerships, working alongside ADPs are instrumental in local delivery of the aspirations set out in RRR, ensuring that collaborative approaches to local planning, development and delivery of services across statutory and Third Sector partners is contributing to improved outcomes for children, young people and families through each areas Children's Services Plan with annual reporting on progress.
• A strong sustainable set of partnership arrangements need to be in place at local and national level with third and voluntary sector organisations who have skills, expertise and a proven track record in the delivery of whole family approaches. We all play to the strengths of local and national third/voluntary sector partners, creating trust, a positive set of relationships, a strong ethos and alignment between services.
• Joint commissioning approaches with adequate resources to back up delivery of the sustainable long term financial framework to meet the aspirations of this work are put in place.
• A common set of core outcomes are developed and agreed by all partner agencies.
• We will find ways to change how our current commissioning cycles and competitive tendering approaches work for us in developing sustainable services with deep roots in our communities.

Workforce: A trauma informed, compassionate, skilled and valued workforce who are family inclusive and able to increase feelings of safety and trust with families.

• The Scottish Government's ambition is for a trauma-informed and trauma-responsive workforce and services across Scotland, capable of recognising where children, young people and adults are affected by trauma and adversity, and able to respond in ways that prevent further harm, supports recovery and improves life chances. This ambition is supported by a National Trauma Training Programme, led by NHS Education for Scotland and is based on the Transforming Psychological Trauma: Knowledge and Skills Framework. This framework is designed to increase understanding of trauma and its impact, across all sectors of the Scottish workforce. A range of additional support materials is being prepared to support workforce development in relation to supporting the confident, competent workforce we need.
• Prioritising a motivated and energised workforce, creating space for quality supervision, coaching, peer support and reflective practice to support staff wellbeing/reducing staff burn-out and stress.
• Alcohol and drugs and wider workforce are trained in family inclusive practice and whole family approaches. We will collectively consider and review existing workforce development programmes at national and local level to ensure they contribute to skills for family inclusive practice, including use of the GIRFEC national practice model.
• Ask the Family identified the key elements families see as important for a "whole family workforce". These emphasise, amongst others, the need for holistic approaches, an inclusive ethos, strong commitment to the value of families, transparency, openness, and rights-based practice.
• Change in family dynamics and circumstances will create times where families require additional support and stability. The workforce needs to have the right levels of awareness and be able to adapt and respond to these circumstances. This will involve the workforce working with and staying close to families throughout times of change and crisis.
• Roles and responsibilities and understanding of partner agencies is essential for working together and complementing each other's skills and knowledge, with a core commitment to solution-focused, relationship-based, asset-based work and an asset-based ethos.