Drug and alcohol services - improving holistic family support

5. What do we mean by Family Inclusive Practice?

"Families are on the frontline of addiction every day with their loved ones. It's important that they are armed with as much knowledge and the coping tools they need to fight the battle for both themselves and those suffering with addiction. Nobody should be alone in this fight, and we are stronger together."

(Family Member from My Support Day)

This section provides:

• Families are assets and key partners
• What we mean by Family Inclusive Practice
• Key Principles of Family Inclusive Practice
• Family Peer Support

5.1 Rights, Respect and Recovery acknowledges that families are assets and are key partners. The strategy promotes families having the right to support, in their own right as well as the right to be involved in their loved one's treatment and support, as appropriate. Families come in many shapes and sizes, they can play a vital role in recovery and reduce the risk of drug and alcohol related deaths, even where relationships are fragile or damaged.

5.2 Family inclusive practice holds families at the heart of service design, implementation, evaluation and workforce development, as well as family inclusive systems change and improvement. This should take into account the perspectives of different family members, capturing diversity including race, gender, sexuality and lead to the development of a variety of pathways to access positive/consistent support for all families in a safe and responsive way.

5.3 Family Inclusive Practice supports active delivery of some of the following key principles:-

• Family is the first and main source of support for most family members.
• Families are regarded as holding many and varied strengths and assets, each with their own set of skills, resources and circumstances.
• Families often have strong loyalties to one another. They can perceive asking for, or accessing support or asking for help as risky or disloyal. When families feel able to ask for help, they can find the support they need is not available, or not suitable or not helpful.
• On average it takes 8 years for the family to reach support (Ask the Family). Faster more preventative help and support is key to family inclusive practice.
• All family members are "rights bearers"; they have a right to family support and to refuse services if they don't benefit from them, a right to survival and healthy development, a right to be involved in decisions that affect them; they also hold a right to social security, which includes suitable living conditions. Children, in particular hold the right for their best interests to be promoted and their rights under UNCRC upheld. All services must be rights-aware and rights respecting.
• Positive involvement of fathers helps increase the totality of family support and improve family wellbeing.
• Families live in communities and services need to understand those settings, the economic and social context that families live in, with a clear commitment to help families overcome multiple disadvantages isolation and exclusion – actively helping families to break these cycles.

"Families should be included and involved in decisions about service delivery and the outputs we offer". "Commissioning of services is often not family inclusive due to criteria and thresholds."

(Staff member, Making it work for Families, Fife)

5.4 Change in family dynamics and circumstances will invariably create times where families require additional support and stability. The whole family approach workforce needs to have the right levels of awareness and be able to adapt and respond to these circumstances. This will often involve the workforce staying with the family throughout times of crisis and going the extra mile. Building trusting, respectful, boundaried relationships along with motivation to sustain change is essential. Recent Scottish based research^{[24] [25]} recognises the importance of this relationship-based practice, with consistent, reliable, flexible, accessible, and long-term support. This also links to the ten principles from The Promise which underpin intensive family based support services in paragraph 3.15.

5.5 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. Similarly an understanding of the issues faced by families – individually and collectively and that families are key to so many aspects of progress – with a commitment to helping family members grow through awareness and accumulation of knowledge, skills and resilience.

"Family recovery should be visible. Shame needs to be removed and support put in place."

(Family Member from All In The Family)

5.6 Family inclusive practice can help reduce alcohol and drug related deaths and save lives^[26]. Up-skilling family members through peer support as first responders will bridge a gap within the community between both family members and services. Families have asked for this through services such as The Beacons ^[27], both locally and nationally. This has helped scope and shape All in the Family service within the service to create and develop the Family First responder network.

"This support will save life and First Responders can offer this support and begin to provide a route map to begin to repair family life and provide effective support to both their loved one and to those affected because of their love for an addict."

(Family member from My Support Day)

5.7 Consistency and stability in everyday family life often means families affected by substance use are in contact with universal services to meet their fundamental needs such as:

• housing.
• opportunities for employment and training/education.
• benefits and debts.
• accessing affordable childcare.
• families spending time together.
• ability to visit a family member in prison.

5.8 Strong, enduring, collaborative working is needed for whole family service responses and should be core to our partnership work, across universal and targeted services, directing them to effectively work together to meet a wide range of structural, community, familial and individual needs. The ongoing review and delivery of quality principles in support of RRR are aimed at reinforcing this^[28].