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Nicole Ridgwell of Ridouts answers your legal questions
' We have received criticism for not providing clear patient pathways on exit from our residential treatment service . We are very focused on aftercare and have strong relationships with fellowships and community groups – however these are informal . How should we present our evidence to demonstrate that we provide this ?'
NICOLE ANSWERS : While the question does not confirm whether the criticism originates from CQC , the local authority or a third party commissioner , the answer remains broadly the same : to refer to the standards against which you are being measured and ensure that you produce the evidence in the recommended format . The easiest way to demonstrate compliance is to use the language of the body assessing you .
For example , within their specialist substance misuse services provider handbook , July 2015 , CQC set out their commitment to focusing on ‘ transitions between services , care pathways and joint working as part of our inspections of specialist substance misuse services ’. It highlights the importance of addressing both physical and mental health needs and enabling service users to achieve a good quality of life by assisting with aspects of wellbeing such as housing , employment and social participation . CQC always focuses upon the ability of services to provide a holistic person-centred approach , with integration of healthcare professionals , to meet individuals ’ needs and expected outcomes .
A service looking to demonstrate compliance , therefore , would ensure their policies identify stages during treatment when post-rehab support is discussed and advice given . Care plans and patient notes should record these conversations , include evidence of when and to where individuals were signposted , and aftercare organisations should be required to provide confirmation of arrangements made with individuals prior to discharge from the service .
However , that is easier said than done if relationships are informal , and you should begin to formalise those relationships so that you do not encounter the same criticisms again . Services are expected to provide documented proof of an integrated care pathway , from initial assessment through to post-treatment referrals and aftercare plans . Your protocols should list the organisations and groups with which you have relationships and on whom you rely for aftercare , and should identify which types of service users are suitable for referral to which group . Finally , your files should demonstrate that you put those policies , procedures and protocols into practice .
In circumstances where you have yet to draft formalised policies , I would suggest obtaining as much evidence of your actual practices as possible – such as statements from the groups themselves , questionnaires completed by service users and excerpts from care notes .
The question of what appropriate aftercare looks like is a timely one . The inspection system for substance misuse services is currently being re-evaluated by CQC , with the expectation that more services will become subject to regulation than ever before ; among those will be certain categories of aftercare . This may assist services by structuring expectations and reducing the chance that services are caught out by not appreciating the need for formalised policies .
Nicole Ridgwell is a solicitor at Ridouts LLP , www . ridout-law . com
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ResouRces coRneR
Focus on
FEW WOULD DISAGREE that adult family members of people with substance problems rarely receive consistent responses across frontline agencies . Dealing with substance users leaves little space for working with ‘ others ’ who continue to be viewed , primarily , as providing potential support systems for recovery or as allies in dealing with childcare concerns . Lacking training , practitioners may be wary of engaging more fully with relatives . It is easier to signpost them to self-help groups ; these will not suit everyone or may not provide a forum for addressing all their difficulties . However , a model has been developed which concentrates entirely on helping relatives to cope .
The 5-Step Method is present-focused . It discards the notion that the causes of substance problems inevitably lie in past family problems and views relatives as ‘ ordinary people facing highly stressful circumstances ’. As such , family members tend to adopt one of three coping styles – ‘ standing up to it ’; ‘ putting up with it ’; ‘ becoming independent ’. Each of these has advantages and disadvantages and the practitioner ’ s task is to help the person explore what is best for him / herself and then adopt effective coping strategies and build supportive networks . The practitioner style mirrors that used in motivational interviewing : non-judgemental ; use of open questions ; reflective listening etc .
The ‘ steps ’ are themes to be worked through with the family member : Step 1 – listening ; exploring stresses Step 2 – providing targeted information Step 3 – discussing coping responses Step 4 – enhancing social supports Step 5 – exploring what else might be needed .
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The 5-Step Method offers services a valuable tool for working with relatives , says George Allan
The method is readily learned , and can be adapted to various settings and deliver ed flexibly over a shorter or longer number of sessions . It is important , however , that sufficient time is given to step 1 and that step 3 is not addressed too early .
The 5-Step Method chimes with guidance given by NICE . As the gold standard for working with relatives , commissioners should build it into every contract for services for substance users so that their family members receive due attention .
‘ Commissioners should build it into every contract for services for substance users so that their family members receive due attention .’
The application of the model is fully described in The 5-Step Method : Principles and practice . Coppello , A ., Templeton , L ., Orford , J . and Velleman , R . 2010 . Drugs : Education , Prevention and Policy , 17 ( s1 ). This supplement to the journal also contains papers exploring the development of the model and is well worth accessing in full .
George Allan is chair of Scottish Drugs Forum and author of Working with Substance Users : a Guide to Effective Interventions ( 2014 ; Palgrave )
18 | drinkanddrugsnews | February 2017 www . drinkanddrugsnews . com