Drug and alcohol services - improving holistic family support

8. The workforce we need for delivering WFA and Family Inclusive Practice

"A third of professionals would like more training on whole family approaches/family inclusive practice."

(Circle – Conversations for Change)

This section highlights:

• The need for whole family approach skills across the workforce, evidence from Ask the Family on the most important key workforce requirements and qualities.

8.1 To deliver the required step change in how alcohol and drug services can contribute to and develop WFA/FIP we need a skilled, confident, trauma-informed workforce, who see constructive and meaningful support for individuals in their recovery journey, as well as being able to contribute to supporting the whole of the family as part of their core professional role. This needs a motivated and energised workforce. Staff wellbeing, reduced staff burn-out, tackling stress and vicarious trauma are key to getting the best out of the workforce. It means creating space for quality supervision, coaching, peer support and reflective practice. Part 3 statutory guidance on Children's Services Planning highlights the importance of partners considering local workforce development as key to ensuring early intervention, with availability of a trauma-informed workforce which is "able to respond to the needs of children, young people and families in a safe, effective, person-centred and trauma-informed way, as soon as there are signs of difficulty."

8.2 For many years substance use professionals across all sectors (NHS/Local Authority/Third Sector) have trained their workforces to largely focus on the individual recipient of treatment, care and recovery support. Getting Our Priorities Right, the National Child Protection Guidance and associated protocols have improved the extent to which substance use professionals identify and have regard for dependent children's care and welfare. The recently developed Medication-Assisted Treatment (MAT) standards for Scotland offer further opportunities to develop rights-based, trauma-informed and inclusive treatment, care and support services linked to whole workforce training and development activity and a shift toward shared decision making, co-production and responsivity to changing needs.^[35]

8.3 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^[36].

"Sometime qualities of workers are more important than skills, we can teach and train however can't teach/train someone to have compassions and care". "We should have apprenticeship opportunities in WFA services."

(Making it work for Families, member of staff)

8.4 A specific substance use workforce development plan is being developed by the Scottish Government, which amongst other things will improve the readiness of the workforce to change practice and culture, develop knowledge and skills to confidently implement the transformational changes required by Keeping the Promise and UNCRC implementation.

8.5 There has been much less of a focus on workforce learning and understanding on the needs of wider families, or the need for us to see each individual service user as someone who has wider caring and familial responsibilities, who relies on others for support and help within the family and to who others may rely upon. This is the essence of WFA – a workforce who can engage with individuals in their day-to-day practice – but who also routinely and confidently can locate individuals in a much wider context as parent, carer, cared for.

"We know that family members and their vulnerabilities interconnect; people do not operate in silos, but this is not reflected in the way we work… Often, we support one person, one concern at a time… Practitioners are working in a silo and in doing so there is a duplication of effort, strained resources, practitioners giving disjointed or contradictory messages to families, and uncoordinated interventions" (Safer Lives, 2021)

8.6 The Ask the Family programme in Annex A has identified the key elements that they see as important for a 'whole family workforce'. These emphasise, amongst others, the need for:-

• holistic approaches and engendering an ethos of mutual respect and understanding.
• an inclusive ethos at service and individual practitioner level.
• an understanding of and commitment to children and human rights-based practice.
• strong commitment to the value of families.
• a commitment to developing relationship-based practice and skills.
• transparency and openness.
• active and participative helping of families.
• understanding of relationships and power dynamics in families.
• commitment to learning from lived experience.

8.7 As part of this framework the WFA/FIP national group considered some other key structural issues that need to be addressed as part of our approach to workforce development for delivery of WFA/FIP. These include:

• An ability and commitment to collaborate with other services and with families.
• A culture where services and staff are able to understand the spectrum of relationships (supportive, nurturing, strength and asset-based), the misuse of power and trust, need to understand trauma, healing individuals and families and are confident and competent to address and respond to these harmful behaviours.
• Protected and optimised caseload management to support relationship-based practice.
• Peer support and high-quality supervision is essential, enhancing skills, knowledge and innovative practice.
• Roles and responsibilities and understanding of partner agencies is essential for working together and complementing each other (e.g. solution-focused, relationship-based, asset-based).
• A commitment to learn and train together in improving our knowledge, skills, confidence and competence and working to a common, positive, rights-based ethos in our whole family approach.

8.8 There is an increased understanding in the development of policy and practice both locally and nationally to involve people with lived experience. This has been beneficial in terms of encouraging services to be more person centred and developing strategies that include issues that affect people.

8.9 RRR is clear that children, young people, parents and other family members must be involved in the planning, development and design of services at a local, regional and national level, as is embedded within statutory requirements for Children's Services Planning.

"Do not think I would be here without the support I have received, have managed to change things and feeling more positive about the future."

(Person with alcohol and drug issues)

8.10 Developing Family Inclusive Practice around the Whole Family Approach, will ensure local policies, procedures and services will better meet the needs of families in accessing support, receiving the support that meets their needs and sticking with the services.

8.11 Circle, a service co-located in both adult recovery and children and families' services. and based in East Lothian, undertook a "plan, do, study, act"^[37] cycle over the course of one year to gain an understanding of families' experiences of three service systems and professionals' views on family inclusive practice.

8.12 The findings from the professionals who participated demonstrated the following:

• Recovery services and family support services need to work closely to develop referral routes and protocols. A third of respondents informed the review that between 50% and 100% of their client group were not in contact with recovery services, suggesting referral routes and protocols could be better developed for these agencies
• More awareness/training and understanding of family inclusive practice. Just under a third (29%) felt that they had a good understanding of family inclusive practice, while 18% felt they did not andalmost all (94%) indicated that they would benefit from having more information. Many also cited the need for training (41%), participation tools (35%) and practice tools (29%).
• Appetite for joint working to improve family inclusive practice. Almost half (47%) of the services felt that family inclusive practice was 'a lot' of a priority in their service, 29% felt it was "a little" priority,while65% of all services felt there was 'room for improvement'.