Tag Archives: work

2012 Project365 (Day 327)

Afternoon teaAfter work today I went out with my work colleagues for afternoon tea at the OGH. It was delicious and very filling and the company was pretty good too.

The team have been absolutely brilliant because it can’t be easy for them either – there is no-one to replace me whilst I am on maternity leave so my colleagues are having to bridge the gap and look after my clients whilst I am off.

So, a lovely couple of hours with a lovely team!

2012 Project365 (Day 37)

Day 37 - Family Partnership Model ModelFor the last few weeks I have been doing some training called The Family Partnership Model (FPM) training. It is basically about working in partnership with the clients and enabling them to see their strengths, weaknesses and well as look at their own resolutions to address their situation. It tries to avoid the professionals becoming the experts and it is very much an empowerment model.

It was a good course, and the only real complaint I have is that the title and the language excludes a lot of people because it assumes that it is only appropriate for work with families, this model works really well with all sorts of people. I hope that they might change the language in the training and make it much more inclusive.

Anyway, today’s picture is of one of the tasks in our training course. We had to get into groups and make a model that represents the FPM. It was a bit of a fun and our model was meant to represent a bridge, with the ‘HELPING PROCESS’ written on it. The little red and yellow blobs are meant to be the people involved in the process, both helpers and clients and the feathers represent all of the ‘fluffy ‘ bits of therapeutic work such as empathy, unconditional positive regard etc. Seriously, I can make paper and feathers and lolly sticks mean anything I want!!!

New job

Well tomorrow is that start of another era. I start a new job – still in drug and alcohol but I suspect it will be rather different to my last job! I am kind of looking forward to going back to work, but to be perfectly honest I like being at home. I like being able to cook and bake and sew and I don’t even mind cleaning. However, I have to go back to work to make some cash so we can buy a house!!! Now we just need The Mister to get a job and life will be almost perfect.

Still here

Hello people, I am still here but I have been really busy and I am properly knackered. Back at work now and things are really manic as ever. Lots of changes are happening there which means loads of stress and unnecessary anxiety which makes things a bit more difficult.

I have joined Slimming World and lost 5lbs on my first week which I was pretty pleased about. There is loads that you can eat on this diet which makes things somewhat easier! Last Sunday The Mister and I went for a gym induction and I have been a couple of times since then. This morning I had an appointment there to get my programme sorted. I am concentrating on cardio to help with weight loss. However, I feel absolutely shattered now and really, really stiff. Hope I can keep it up.

Hopefully I will be the incredible shrinking woman soon!

Cameron and drugs

The Guardian newspaper at the weekend produced an article entitled “David Cameron shifts drug addicts treatment to live-in schemes” which stated that the Prime Minister has requested a revised drug policy to be in place by the end of the year.

They report that in PM Direct debate this week David Cameron stated…

“The last government became too target obsessed. It was all about how many addicts are in touch with treatment agencies, and this, in too many cases, really meant the addict was talking to someone and maybe getting some methadone, which is a government authorised form of opium, rather than heroin. It did not really address the problem – that [the addict] had a drug habit.

“I would like to … try to provide – difficult though it will be given the shortage of money we have been left – more residential treatment programmes. In the end, the way you get drug addicts clean is by getting them off drugs altogether, challenging their addiction rather than just replacing one opiate with another.”

I thoroughly agree with Mr Cameron that the last government was totally target obsessed, something that I have blogged about in the past, but I cannot agree with the idea that we need to promote residential rehabilitation over substitute prescribing. We also aren’t very good about moving people through the treatment system and pursuing abstinence. However, it is not quite as straightforward as Mr Cameron would like it to seem.

Dealing with addicts is a tricky business at times. They are often very opinionated about the type of treatment they would like to have, they can be difficult to engage and they are often very resilient. As individuals they can be extremely challenging, which in a weird way is one of the joys of working with them.

There are several difficulties with promoting residential rehabilitation as the primary form of treatment.

1) The cost. A stay in residential rehabilitation will cost approximately £8000 – £12000 for a 6 month stay, and that is a conservative costing. In 2008 the National Treatment Outcome Research Study estimated that methadone would cost on average £55 per person per week. A cost of £2,860 per person per year. Whilst we may not always like it, substitute prescribing is far cheaper than residential treatment.

2) The readiness of the client. When I used to send people to residential rehab I had to do loads of preparation work with them. We had to consider whether they were suitable for inpatient treatment and what might be the right resource for them. We expected them to be stable in treatment and engaging in group work in the community. In reality, not every client is ready to go to rehab. They need to find the point when they are prepared, physically and emotionally, to enter ongoing long term treatment. For some people this will never happen.

3) Maintenance treatment reduces crime. People who are maintained on methadone need to engage in less (ideally no) criminal activity to fund their habit. This benefits the wider community.

4) Maintenance treatment improves healthcare in patients. If individuals no longer have to engage in unsafe injecting practices they are less likely to be hospitalised with major illnesses and injuries caused by illicit drugs use. This could be anything from overdose to DVT’s to falling off a bridge whilst under the influence etc.

These are just a few issues related to the maintenance in the community vs. residential rehabilitation debate. However, I feel I should add a caveat to this. My comments here might lead some people to think that I would rather see people opiate dependent than becoming drug-free. This is categorically untrue. One of the biggest pleasures I had was seeing people progress through rehab and become drug free. Those people undoubtedly had the best chance of achieving lifelong, sustainable change and being able to be a fully functioning member of society. However, I also had to recognise that some people just were not in the place to be able to make those changes. They hadn’t reached the stage in their lives where they were able to consider a life without drugs.

To quote David Cameron again when he said

“It was all about how many addicts are in touch with treatment agencies, and this, in too many cases, really meant the addict was talking to someone and maybe getting some methadone, which is a government authorised form of opium, rather than heroin. It did not really address the problem – that [the addict] had a drug habit.”

If the government want to invest in making positive changes to drug treatment then they should be providing the funding for services to be able to train their drug and alcohol workers to make them highly professional and specialised workers. It is almost impossible to underestimate what a difference a really fantastic worker can make to the client. That therapeutic relationship can really lead to change, whether it be motivational work in order to help people progress onto more intensive treatment, or whether they are discussing harm minimisation practices. A good drug worker is part of the journey, they are not just “someone to talk to”; they are treatment in and of themselves.

Anyway, I don’t know what I am ranting about this. They are going to reduce investment in drug treatment in 2012 so there will probably be no changes anyway!

Back to work

Well, I have just finished my first week at work. I have started working at a homelessness service which provides primary healthcare to those with no fixed abode, or who are in vulnerable accommodation. The team has access to GP’s, dentists, mental health nurses, support workers and the drug team, in which I will be working.

The team members are all really lovely although they have been under loads of pressure and people seem really quite maxed out. The plus side is that they seem very supportive. The clients are an interesting bunch. Like most vulnerable people with multiple needs they are extremely challenging, and when you have a few of these in the waiting room it can be quite confrontational. On one day this week we had the police called to a fight outside, the ambulance called to a bloke who collapsed and blood all over the reception area (no idea how that got there!)

There is so much to learn but I think I am going to really enjoy it. The only downside is that I won’t be able to go shopping in town without being hassled by clients, and I have to commute an hour each way. Watch out for the amount I am reading to increase significantly!

Hurray!

I got the job!! I thought I had done an OK interview but I wasn’t sure whether I would get it or not. They originally told me that they would let me know today but the decision was made by 4ish yesterday so they phoned me then. Not sure when I am going to start as they have to take up references and get the CRB check done but at least I can go off on honeymoon knowing that I have something to come back to.

*Big happy dance!!*

A week of lasts

WARNING – THIS IS A VERY LONG POST!!!!!

This week has been a very strange one in the grand scheme of things. It has been a week of “lasts” and goodbyes.

It was my last Sunday at St Marks in Colney Heath, my last church small group (a group which is called “Bernard” and when I asked why the response was “because it is a good name”. We had a curry on that evening and they presented me with a gift of spices and things for curry and a rice cooker. My last Pilates class, some of which I have been in class with for over 5 years.

Most importantly though today was my last day at work. Since 17 September 2001 I have been employed as a Specialist Social Worker at an NHS Trust in a Community Drug and Alcohol Team. I had made huge efforts to keep myself busy all week, finishing off with clients, writing up their notes, handing them over to their new key worker with prescriptions completed up to the end of March, and generally making sure they will be ok. Today however was officially my last day and I had done all that I needed to do. My work was complete and I went on a long round of goodbyes to people I worked with. I described this as feeling like Cher’s World Farewell Tour – it seemed never ending.

I am not sure how I feel about leaving. In some way I feel relieved. The job was getting more paperwork and statistics driven and it was becoming very political. My time with my clients and the way I was able to work with them was being squeezed and I was not able to be as creative as a liked. I wanted the chance to be able to work with people in whatever was was successful to their ongoing recovery, but that wasn’t possible as things were statistics driven. My frustrations were mirrored by my clients, and it was only by working overtime to do the paperwork that I was able to fit in any time with them at all. I used to deliver substance misuse training to child protection and health professionals, but that stopped about 18 months ago. I felt de-skilled and demoralised and yet, in many ways, I loved my job.

My clients could be absolute pains in the backside. They were often difficult and challenging, but also they were resilient, funny and honest. Their lives regularly put any Eastenders storyline to shame and if their histories had been written down people would have accused them of embellishing the stories. However, what I have realised over the last couple of weeks is that many of these clients have such a hard time attaching to and relating to people and the loss of a drug worker who may have worked with them for years cannot be underestimated. I did laugh though, when one client who has really put me through my paces over the years, describing me as “A fucking pain in the arse” told me that I was the best drug worker she ever had. I gently reminded her that she very eloquently told me in August last year that she hated me and never wanted to see me again. At this she laughed, and said “yeah, but you were one of the few people who didn’t disappear when I spoke to you like that. I knew I was out of order, but I knew that you would always look out for me and be honest with me.”… and then she laughed again and said “I still think you are a fucking pain in the arse”. That comment, followed by a genuine hug meant more to me than completing any set of statistics.

My colleagues could almost be as much of a pain in the backside as my clients. Over the years I have come to realise that most people who work in drug and alcohol work have big personalities, characters and attitudes. As a result confrontation is a part of the work. We confront, argue and challenge each other as much as we do with the clients. Substance misuse work seems to take a certain type of person. I still believe you can teach people the theories of drug and alcohol work, ways of working with people, and the technicalities and skills they need to know. What you can’t teach them is the character they need to cope with this sort of work. It takes a special sort of person, and the team I worked for was comprised of some amazingly talented and funny people. I will especially miss my colleague Jo, who started work a week after I did. We were both very green and inexperienced and we made some monumental cock-ups over the years, but I learnt a lot of medical stuff from her as a nurse, and I know that she learnt a lot from me with regard to social care and intervention. I will also miss my colleague Nuala. Quite simply a brilliant alcohol nurse who totally knew her stuff.

Working with doctors always brings real challenges. They are difficult at times, but you just have to learn how to handle them!!! It’s nearly always possible to get them to do what you want if they think it is their idea in the first place!!! I had the pleasure and privilege of working with Professor Fabrizio Schifano. A brilliant consultant psychiatrist who not only knew his stuff, but was incredibly personable. One of the things I am most sad about it that the team is gradually being eroded by poor management and the recruitment of practitioners with no background of either social work or nursing. The services are much poorer for this and the lack of experience is evident when dealing with complex cases.

I am sad, in so many ways, and yet I still feel like it is not quite real. Like I am going on holiday and I will come back to my job in a couple of weeks. The decision to move on is so clearly the right one, and yet I feel as though a huge chapter of my life is ending. I hope that I will be able to find another job in Yorkshire in which I will be able to be so fulfilled. I am excited, as well as being a bit anxious.

I owe an enormous debt of gratitude to my colleagues and clients. They have taught me so much and I will miss them.