Innovation Exchange

Community Hub to Address Substance Misuse

Introduction

Key activities

Benefits and impacts

Learning

The Community Hub @ Boots is a multi-agency virtual team which takes a collaborative approach to the needs of individuals, families and communities affected by substance misuse. The process of recovery from addiction requires a range of services, skills and approaches which can be ineffective if provided in isolation and without co-ordination. The Hub at Boots pharmacy in Dundee’s Albert Street brings together NHS, Council, voluntary and private services in the heart of a community to offer easily accessible services at one location, offering initial assessment and access to a wide range of additional services, including services for children and families, housing and benefits, harm reduction and support to access GPs and recovery groups. Team members were required to change their approach to work, learn new skills and respond to unfamiliar situations and, despite many challenges, have remained very committed to this innovative way of working.

Theme: Partnership and Collaboration

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This project signifies a shift in the approach to service provision for individuals and families affected by substance misuse. It was set up following a comprehensive review of alcohol and drugs issues in Dundee which involved service users, carers, service providers and local communities. Since its inception, the project has made it possible for individuals and families to access joined-up services and support without being stigmatised, all from one community location. It has successfully engaged and maintained contact with vulnerable and hard to reach individuals and made great progress at developing recovery-focused services.

 

The Community Hub was developed to respond to stigma experienced by individuals and families affected by substance misuse, to ensure support and interventions are easily accessible and to respond directly to the presented needs. In addition, the virtual team was set up to achieve high level and effective collaboration (including from Boots Pharmacy staff) and to ensure effective focus on customers.

The process of recovery from substance misuse requires a range of different services, skills and approaches. If provided in isolation and in a non-coordinated way, these services can often be ineffective, duplicative and difficult to access. The Community Hub in Albert St integrates treatment services (including ORT prescribing / harm reduction) together with services for children and all the other support which individuals and families require to achieve recovery and well-being. Service users, carers and community members took part in a focus group / conference as part of the Alcohol and Drugs Review, and their experience of the impact of services and their views on improvements required directly influenced the development of the Community Hub. Service users told us they would like to access services that are non-stigmatising, that support them to take responsibility for their own recovery, that include their families’ needs and that work together from the one location. The Community Hub was set up to achieve these requirements, and has delivered.

 

 Development of the Hub was co-ordinated by the Alcohol and Drug Partnership Support Team, who liaised with all partners to progress the initiative. Two staff members (from the NHS and a voluntary agency) led the operational side of the development. Each organisation identified one or two staff members to be part of the virtual team, with staff selected for their skills, interests and willingness to participate. Negotiations took place with Boots Pharmacy regarding the use of their premises and working jointly with their staff.

 

The barriers overcome included resistance from organisations (arguing they were too busy to participate) and resistance from staff (concerned about working in a new way and from a different environment without being clear of their role). Also, at the initial stages, some service users refused to co-operate with the team, as they thought they were being ‘spied on’ and were suspicious of receiving services from the Hub. However, with time, service users began to see the benefits and engage successfully.

 

More recently a Hub coordinator has been brought in to continue to build on the early success of the project and to support the moving forward and development of the initiative.  There is continual interest from both specialist and non-specialist services to become part of the Community Hub team.  This is widening the support, knowledge and resources being offered to individuals, families and community affected by substance misuse.

This new development is still in the process of shifting from a ‘test of change’ to being established as a permanent project.  Some of the infrastructure required for delivering a multi-agency collaborative service from a community location still needs to be developed. This includes the development of a robust and meaningful performance measuring system. Nevertheless, we are already aware of some significant impacts achieved by the project, including:

 

  • For individual and families affected by substance misuse – for the first time individuals are receiving a holistic service, delivered jointly by a range of organisations (through a virtual team) from the one community location. Evidence shows the virtual team is successfully maintaining engagement with very vulnerable and hard to reach individuals. The team can be supporting up to 20 individuals a week with a range of supports being offered.  In the past 8 months over 100 interventions have been undertaken which have included, benefit/welfare claims, housing issues, overdose advice (52 Naloxone supplies), child and family support, referrals into recovery groups, adult learning program’s and health.  A community optician visits the hub once a month and they have offered 25 screening appointments and 22 pairs of glasses have been dispensed.   Support is also provided to help individuals to access services outwith the Pharmacy (e.g. through GPs, Dundee North Law Centre). Families and carers are able to access services which, although available in the past, they nevertheless struggled to engage with. It took time and dedication from the virtual team to build relationships of trust with individuals. Initially, many were suspicious of the new project, they felt team members were spying on them and were reluctant to engage. It became apparent that, if this project was to succeed, there would be a need for service users to undergo some form of culture change and learn to accept a different way of accessing services. Several months later, there has been a clear shift in the attitudes of service users and greater acceptance of this approach.

 

  • Co-production - the community hub is in the process of putting together a small focus group with individuals who are accessing the pharmacy to allow us to get their views/opinions of the hub.  The hope is this will become an on-going steering group who will support the hub moving forward and promote to their peers, family and communities.

 

  • For the general public and the community - more services available to the general public from the Pharmacy. Community members popping into the Pharmacy are able to have a conversation regarding a range of health and wellbeing issues with team members and, if required, book in-depth sessions. In addition, the overall day-to-day operation of the Pharmacy runs more smoothly, making the experience of receiving a service and shopping more pleasurable.

 

For the services, including Boots – the virtual team successfully developed a meaningful sense of ‘teamness’. Staff developed new skills, they know and understand more about the work of other services and feel they are making a difference. Organisations learned to conduct their business in different ways – for example, conference calls are used on a weekly basis for team meetings. Boots believe this is positive for their business and help them deliver the service to their customers and the community.

Individuals recover from substance misuse when they and their families are supported to develop and maximise their recovery capital, and when all services respond simultaneously to the range of presented needs. This is the aim of the Community Hub @ Boots and why it represents leading practice.

 

The key innovative element of this project is that individuals and families affected by substance misuse receive services and support from one community location delivered by a multi-agency team operating jointly and effectively. This means individuals are not stigmatised when they access services, their needs are dealt with quickly, and they are encouraged and supported to progress with their recovery. Consequently, individuals who collect their ORT prescription on a daily basis from the Boots Pharmacy, but previously accessed no other services and received no other support (and therefore did not progress with their recovery) are now receiving additional services and support to help their recovery.

The ability of the virtual team to deliver services to the general population is also innovative. Individuals accessing the Pharmacy can access immediate, quick and confidential interventions (sometimes involving just a short conversation) about alcohol consumption and other well-being issues.

 

The collaboration with Boots Pharmacy is another innovative element. Placing the virtual team in the pharmacy and developing joint working with pharmacy staff means that customers receive a better service and the entire working of the pharmacy runs more smoothly and harmoniously than before. There has been a reduction in shop-lifting, a drop in inappropriate or angry behaviour amongst service users, and less frequent gathering of drug users and dealers outside the Pharmacy. These improvements benefit the whole community.

The next stage is to start delivering brief alcohol interventions, ORT detox groups, Anxiety/Relaxation groups, and SMART/SMART FAM groups from the Pharmacy with the support of the virtual team.

Contact details:

To find out more about this case study, please contact:

 

Steven Dalton

Alcohol and Drug Partnership Lead Officer

Dundee City Council / NHS Tayside

sdalton@nhs.net

01382 434093

Case study added to site: June 2016

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