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E. Evidence for family support interventions and integrated service provision (Recovery Model) |
Summary There is highly processed and review-level evidence that involving families in recovery care plans for affected individuals and providing support for family members themselves is beneficial to improve outcomes for both parties. Rationale NICE Clinical Guidance 51 [1] general considerations include :
Staff should also :
Where the needs of families and carers of people who misuse drugs have been identified, staff should :
There is review-level evidence that community reinforcement and family training (CRAFT) is effective in engaging treatment resistance substance-abusing individuals. Included studies were small scale but assessed as good quality with high programme fidelity. Evidence also suggests that irrespective of treatment engagement by the affected individual these programmes are beneficial to families and significant others. [2] In their Scottish Government-commissioned review for the Scottish Child Care and Protection Network, Mitchell and Burgess (2009) [3] identify evidence from one US- based study (Gregoire and Schulz 2001) examining drug treatment outcomes that found support from significant others emerged as having a strong, positive relationship with assessment completion and treatment outcomes, and custody outcomes. It is worth noting that this support was more commonly received by males as women in the study sample were more likely to have significant relationships with men who were themselves misusing substances. There is review-level evidence from UK-based qualitative studies to suggest that targeted family support interventions where drugs (and/or alcohol) use exists have a positive influence on the lives of parents and children, including remaining together as a family despite previous child protection concerns at referral, although evidence of effect on child welfare outcomes is not known. Projects were characterised as child-focused with a strength-based approach to assist families (individuals and as a whole) to identify their issues and how to address them. Interventions were community-based with substantial contact time. There is review-level evidence that integrated substance treatment and family support services may be successful in assisting women to reduce their drug and alcohol use, and to bring about changes that support their parenting and family life. Both programme completion and length of stay within treatment appear to be key factors in influencing positive outcomes for women. There is review evidence to suggest that interventions based on the stress-strain- coping-support theoretical model: the 5-Step Intervention is effective in reducing stress symptoms and improving family member coping responses. [4]
Scottish policy and practice note Quality Principles: Standard Expectations of Care and Support in Alcohol and The Adult Support and Protection (Scotland) Act 2007 [6] seeks to protect and benefit adults at risk of being harmed. The Act requires councils and a range of public bodies to work together to support and protect adults who are unable to safeguard themselves, their property and their rights. It provides a range of measures which they can use. The public bodies are required to work together to take steps to decide whether someone is an adult at risk of harm, balancing the need to intervene with an adult's right to live as independently as possible.
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