One of the aims of the first National Drugs Forum was to provide an opportunity for community-based services to inform colleagues about their work, to exchange knowledge around what works, and to identify information gaps. The workshops were a recognition the dynamism and commitment of these services.
They were designed to enable shared learning and encourage discussion among practitioners, activists and administrators who face similar challenges. The forum appointed a rapporteur to each workshop and a brief report on each workshop was presented at the final plenary session. The rapporteurs’ final reports are presented below.
Each report presents an overview of each presentation, including some key issues raised in the discussion after each presentation.
More details on the content of the presentations are available through the slide packs available at: https://www.drugsandalcohol.ie/php/ndfabstracts.php
WORKSHOP 1: Supporting prevention work in the community
Michéal Durcan, Western Region Drug and Alcohol Task Force (WRDATF)
Planet Youth is an evidence-based approach to preventing children and adolescents from initiating drug use. The model originated in Iceland and has been rolled out in communities in 18 countries to date. A dramatic decrease in substance use among Icelandic adolescents since 1997 has been attributed to this model. In the 1990s, a group of Icelandic social scientists, policymakers and practitioners began collaborating in an effort to address the increasing levels of drug and alcohol use among Icelandic young people. The prevention model that emerged involves the regular collection of data from young people through a school-based questionnaire on background factors, substance use, social circumstances, and potential risk and protective factors associated with substance use. The findings are used by local stakeholders to plan and deliver a set of prevention responses. There was a broad range of prevention interventions introduced in Iceland, which involved significant public expenditure, for example, structured high-quality recreational activities for young people and support for families to spend more time together. The impact of the interventions is then measured through regular data collection, interventions amended in response to the findings, and any new issues identified. The outcomes found in Iceland have gone beyond drug and alcohol use and include: lower suicide rates; lower obesity rates; less alcohol use at university age; improved general mental health and wellbeing; improved youth facilities and services; less early school leaving; and, less crime and imprisonment.
In association with local partners, WRDATF has committed to supporting the introduction of Planet Youth in parts of the region: the task force has committed to taking the lead on managing the survey and its analysis. Because of the resources required, in collaboration with WRDATF, other agencies (e.g. Tusla and the Health Service Executive) will have to take responsibility for developing the interventions. Data have been collected using the standardised Planet Youth tool with students in transition year in secondary schools across Galway, Mayo and Roscommon. Data collection was successful with 4,600 forms returned from across 83 schools. These are currently being analysed by the team in Iceland and the findings of this baseline survey will be reported on at the end of February 2019.
Key points made in the discussion:
- There is a need to ensure that interventions from the Planet Youth model are adapted so that they are culturally appropriate. For example, the curfews imposed in Iceland would not be appropriate in the Irish context.
- The funding structure in Iceland allows for taxes collected locally to be spent locally. An innovative and clever approach to resourcing the project in the western region will be required.
- There are good relationships with sporting clubs and facilities in the western region that could be supported to develop innovative interventions.
- Innovative approaches will be needed to engage with parents. Parents who attend regularly can help build capacity within the community.
- There needs to be a long-term commitment to this programme: change will take at least a couple of years to bring about.
- The programme would benefit from establishing a formal mechanism through which young people could contribute to the development of initiatives and the programme as a whole.
From L to R: Dr Brigitte Manteuffel of the Georgia Health Policy Center; Minister Catherine Byrne TD; Dr Darrin Morrisey, chief executive of the Health Research Board; and Dr Karen Minyard, director of the Georgia Health Policy Center, at the National Drugs Forum
Drug-Related Intimidation Reporting Programme: interagency working and supporting families
Aoife Frances, National Family Support Network, and Brian Woods, Garda National Drugs and Organised Crime Bureau
The National Family Support Network (NFSN) is a self-help organisation supporting the development of family support groups and networks throughout Ireland. Through its work it raises awareness of the difficulties faced by families in coping with substance misuse, while recognising the important role that families play in supporting the recovery of the person using drugs. NFSN identified the need for a programme to support those experiencing drug-related intimidation and debt. Approximately one-third of the calls for support they were receiving related to these issues.
Most calls come from mothers of people who use drugs and who were in debt. In response to this, NFSN worked with the Garda National Drugs Unit (now part of the Garda National Drugs and Organised Crime Bureau) to establish the Drug-Related Intimidation Reporting Programme (DRIRP) in 2013.
The purpose of the programme is to respond to the needs of drug users and family members who are experiencing drug-related intimidation. It is a challenging programme and the speakers noted that drug-related intimidation is not an issue that receives much discussion in other European countries. Therefore, there is a lack of knowledge and evidence about how best to set up and run such a programme. Both organisations are undertaking a review of the programme.
Key points presented in the workshop:
- Good positive collaboration between the delivery partners is essential for the success of the programme.
- Family members are hesitant about approaching the Gardaí in the traditional way for a number of reasons, including fear of reprisal from dealers and that their family member would be arrested given that possession is criminalised.
- Gardaí are trained through the programme to support the families. An important feature is that people can meet with the nominated Garda Inspector but there is no obligation on the family to make a formal complaint. They can just get support and advice.
- Staff and client safety are of major concern.
- The consistency in language that has come from the programme to name ‘intimidation’ is helpful – this has been seen as positive for families and communities.
- Dealing with drug-related intimidation is a priority in the current policing plan. To back this up, there are new strands of training on drug-related issues under development for Gardaí.
- The NFSN is planning to deliver a train-the-trainer programme for organisations around the country so that they can work with their local Gardaí on the topic. Additional resources are needed.
Key points made in the discussion:
- While there is a need nationally for services that support those experiencing intimidation, projects do not want to be identified as an ‘intimidation project’ as such. It presents too many risks for staff and clients/participants.
- Ongoing cuts in funding for community projects put communities at increased risk.
- Initiatives such as DRIRP need careful evaluation; there is a need to look at how they coordinate with communities in particular.
- Resources need to be made available to provide the services and make the necessary changes in response to the findings of any evaluation/research.
- The requirement of any community programme, such as the Social Inclusion and Community Activation Programme (SICAP), to ask for participants’ names and supporting information was described as a ‘disaster’. It prevents people who are experiencing intimidation from accessing services.
Professor Harry Sumnall of Liverpool John Moores University speaking at the National Drugs Forum
The Let’s Learn About Drugs and Alcohol Together (LLADAT) programme
Sancha Power, Health Service Executive
Let’s Learn About Drugs and Alcohol Together (LLADAT) is an alcohol awareness and drug education programme aimed at second-year senior cycle students and their parents in the Mid-West. It is designed to support the existing work being carried out in schools through Social, Personal and Health Education (SPHE) and the new Wellbeing programme. It sets out to engage parents in shared dialogue around substance use through two workshop sessions that are held during out-of-school hours. The first workshop is just for parents; the second for parents and pupils. The presenter noted that it is ‘hard to evidence education and prevention initiatives’; therefore, to illustrate the success of the programme she reported on, for example, positive relationships with participants and the ongoing interest of schools in the programme. Among the strengths of the programme identified were that it takes a multimodal approach, it encompasses the family, and supports what is already being delivered in schools.
Key points made in the discussion:
- The programme is not available to be delivered elsewhere at the moment.
- There were some concerns about the programme covering solvent use – that this may encourage its use in a context where they were no longer widely used. However, the presenter noted that their use was evident in the area of delivery.
Design and implementation of a pilot programme to reduce student drinking: Responding to Excessive Alcohol Consumption in Third-level (REACT)
Susan Calnan, University College Cork
High levels of alcohol use have been found among third-level students in Ireland. In 2014, the Health Service Executive (HSE) commissioned a research team to develop a public health intervention to address alcohol use among third-level students. Responding to Excessive Alcohol Consumption in Third-level (REACT) was developed in collaboration with the Health Matters team at University College Cork, the Irish Student Health Association, and the Union of Students in Ireland (USI). Its development followed a three-step process: systematic review, knowledge exchange forum, and expert consultation. The programme is an environmental rather than an educational initiative; as such it takes a settings approach rather than focusing on the individual. Therefore, it is focused on bringing about change in the culture, processes and policies of the university in relation to alcohol use. For example, the presenter mentioned interventions such as offering alcohol-free student accommodation and social spaces. REACT is currently being implemented in 15 higher education institutions across Ireland.
While the programme’s evaluation has not yet been completed, the presentation covered a range of preliminary findings from the process element of the evaluation and the work with students.
Key points presented in the workshop:
- The majority of students who were engaging in hazardous drinking defined their own drinking as low risk – indicating low levels of awareness of own drinking among students.
- In terms of concerns about their own drinking, ‘spending too much money on alcohol’ emerged as the biggest concern for students and ‘negative impact on physical health’ as the second biggest.
- A ‘considerable proportion’ of the students saw the control of alcohol consumption as their personal responsibility rather than that of the third-level institution they are attending.
Key points made in the discussion:
WORKSHOP 2: Dual diagnosis: using partnership and peer support as resources in treatment
Dual Diagnosis: a community-led response
Jennifer Clancy, Clondalkin Drug and Alcohol Task Force
The Drug and Alcohol Task Force Treatment and Rehabilitation subgroup had become aware of a higher number of more complex dual diagnosis cases, with little or no interagency casework. Initial meetings with the Community Mental Health Team took place in August 2014.
A social worker and clinical nurse manager joined the subgroup, and as part of the implementation of the National Drug Rehabilitation Framework, training on substance misuse issues and responses was delivered to mental health staff, and training on mental health issues and responses was delivered to substance misuse staff. This led to the establishment of an interagency Dual Diagnosis working group.
The working group gathered baseline data; identified barriers to developing care pathways; training needs; gaps in services; and formalised relationships between services. Documents to formalise shared care were developed and a case management approach agreed.
The outcomes of this approach were that there was a reduction in the duplication of services; integrated care pathways were developed; better understanding of different services’ roles; reduction in hospital stays; utilisation of standardised assessment tools; and the provision of Wellness Recovery Action Plan (WRAP) as part of general substance misuse service provision.
Miriam Coffey of the North Inner City Drugs and Alcohol Task Force, who attended the National Drugs Forum in November 2018
The establishment of a ‘seeking safety’ group in the National Drug Treatment Centre for supporting patients’ substance dependence and a history of trauma
Siobhan Rooney and Ruth Anne Buckley, Health Service Executive
‘Seeking safety’ is a manualised, evidenced-based treatment for post-traumatic stress disorder/trauma and substance misuse, utilising cognitive behavioural therapy and psychoeducational approaches that are problem–solution oriented and can be applied in groups or in one-to-one sessions. The process commenced with staff training in the approach, with an advertisement for the planned group placed on the notice board in the National Drug Treatment Centre.
Sessions commenced by checking in with each participant, and continued with a quotation and handout from the manual. The objective is to engage with the client emotionally, provide a point of inspiration, and to relate the handout subject matter to the clients’ lives, with rehearsals of coping skills, role play, and discussions. Participants’ feedback was positive, with improvements in self-esteem, confidence, assertiveness, and with the course described by participants as practical and straightforward.
Elements considered important were peer support, the social aspect, lack of exclusion criteria, the ability to miss sessions and rejoin without requiring a catch-up, and peer learning.
Minister of State with responsibility for Health Promotion and the National Drugs Strategy, Catherine Byrne TD, giving the closing address at the National Drugs Forum
Addressing dual diagnosis within a residential treatment programme serving women with complex needs
Anita Harris, Coolmine Therapeutic Community
The women’s residential service in Coolmine had identified a need for dual diagnosis supports, given that dual diagnosis was associated with higher dropout rates, lower psychological health, and high rates of prescribed medication to deal with the management of emotions.
The intervention was a mental healthcare plan, devised and coordinated by a visiting consultant psychiatrist, and delivered by both substance misuse and mental health staff, alongside the existing addiction treatment of the therapeutic community. The approach involved was psychoeducational, with a resistance to prescribing psychotropic medication for the first six weeks.
Features included reduced barriers to appropriate care, faster access to mental health services, an interagency approach, and integrated care planning. Outcomes included reduced medication, improved retention rates, improved family dynamics, reduced hospital emergency attendances, and improved mental health.
Dual diagnosis: emotional regulation skills training in Keltoi
Peter Sherry and Ruth Anne Buckley, Health Service Executive
The development of an emotional regulation skills approach to substance misuse is based on the viewpoint that substance misuse is viewed as self-soothing behaviour. This is further complicated by the relationship between trauma and substance misuse. Various examples were presented from the literature to evidence this.
Emotional regulation incorporates individuals’ attempts to manage emotionally charged states, including anxiety, low mood, depression, stress and post-traumatic stress disorder. Keltoi staff observed hyper (hypervigilance, impulsivity and anger) and hypo (depression and disassociation) arousal states in clients, and conducted qualitative research in relation to the use of emotional regulation.
The emotional regulation skills training included use of the ‘Window of Tolerance’ approach, mindfulness, cognitive behavioural therapy, and coping strategies. The evaluation indicated that participants developed an ability to identify and discuss their emotions, increased their self-esteem, self-regulation, normalised their emotions, and increased their quality of life.
Key aspects were considered to include the ability to deliver the intervention in groups or as one-to-one; the ability to deliver the intervention to clients at various stages of their recovery; peer support; free staff training; dual use as a staff self-care tool.
- Data: The four interventions/initiatives were able to identify the negative impact of not responding effectively to dual diagnosis, which bolstered their arguments for commencing their initiatives.
- Vision: Each had a model or intervention approach that they were able to describe clearly to their potential partners.
- First steps: Each were clear on what they were able to start with, were able to then learn from their experiences, and develop further positive working relationships with partners from those initial experiences.
WORKSHOP 3: The role of social reintegration in recovery
Social enterprise and co-production: a synergy-promoting social reintegration
Paul Delaney, The Cornmarket Project, Wexford
The Cornmarket Project is an interagency community-based treatment and rehabilitation project under the auspices of Wexford Local Development. The project works with clients in recovery from substance addiction to promote a stable and productive lifestyle. The social enterprise and co-production initiative is a major plank of the portfolio of services provided by the Cornmarket Project. The social enterprise and co-production initiative works with clients in recovery from substance addiction to improve their chances of moving to employment. The initiative grew from the Community Employment Drugs Rehabilitation scheme, which was a national initiative to promote vocational training and employment for clients in recovery. The social enterprise initiative designs t-shirts and bags and a wide range of paraphernalia that are used at conferences and other social events. The initiative has been recognised as an example of good practice and was awarded a place on the Social Innovation Fund’s social enterprise development accelerator programme 2018. An innovative feature of the social enterprise initiative is that participants receive a job reference to enable them to improve their chances of securing other employment opportunities.
Clients working with the social enterprise initiative can also avail of working with the Change Outcome and Impact Measurement (COAIM) system, which forms a major part of the work in the Cornmarket Project overall. The COAIM system is focused on client assessment and progression and works with clients to improve their quality of life in 10 domains, including offending behaviour; accommodation; pro-social activities; anger and emotion management; attitudes and cognitive style; drug and alcohol misuse; lifestyle and associates; relationships and family issues; training and employability; and financial issues and debt. Data presented at the workshop suggest that clients achieved positive change in nine of the 10 domains; positive changes to accommodation status were less pronounced for clients, which are likely to be influenced by the shortage in accommodation options on a national basis.
Key points presented in the workshop:
- Co-production is not just a word, not just a concept, it is a meeting of minds coming together to find a shared solution. In practice, it involves people who use services being consulted, included, and working together from the start to the end of any project that affects them.
- Projects are strengthened when the focus is on measuring outcomes for clients rather than outputs for services.
- Projects need to recognise and understand the lived experience of people in recovery and offer them a holistic and integrated suite of services to meet their needs as they present.
- The quality of life indicators included in the COAIM system could be used by other services to assess progression and positive change in outcomes for clients.
Parents Under Pressure programme working with high-risk families in recovery from substance addiction
Emma Timmins, Parents Under Pressure programme
The Parents Under Pressure (PUP) programme is primarily delivered in the residential setting of Ashleigh House, which is run by the Coolmine Therapeutic Community as part of the suite of services provided to clients in recovery from substance addiction. Ashleigh House is a residential therapeutic community for women, expectant women, and mothers with young children, and is designed to help women in recovery develop the skills they need to live a drug-free independent life. Ashleigh House is the only mother-and-child residential treatment programme in Ireland. The PUP programme was designed in Australia to cater for the needs of high-risk families, including families with parents in recovery for substance misuse. The programme recognises that parents who are receiving treatment for substance use quite often experience difficulties coping with other areas of life, such as family functioning, child behaviour problems, and mental health difficulties. The programme includes 12 core modules that are manual based and combine psychological principles with a case management model; it is delivered over a 20-week period. The programme is an assets-based intervention and promotes the development of empowerment and resilience in the target group.
The workshop heard that the PUP programme was introduced to the women in recovery in Ashleigh house when staff identified a gap in service provision. Staff noticed that although the women were making progress in their recovery, for some of them it was difficult to develop an emotional attachment to their children. Their difficulties in forming these emotional attachments mainly stemmed from their feelings of guilt around letting down their children when they were in active addiction. These feelings of guilt were often exacerbated by their feelings of anxiety and depression, which staff believed, if left untreated, could undo a lot of the progress they were making on other matters. The main results from a recent evaluation of the PUP programme in Ashleigh House were cited in the workshop, and reported that women experienced reductions in depression, anxiety and stress when measured as part of the before-and-after assessments when the programme was introduced.
Key points presented in the workshop:
- The PUP programme provides an opportunity for the women to engage in incremental learning, which means they have the chance to move at their own pace.
- A key mechanism of the programme is when the women accept that they do not need to be a perfect parent; a good enough parent will suffice, and being recognised as a parent is invaluable to the women.
- Women engaged in the programme build their own sense of belief through their efforts to become better parents, and the sharing of this belief with other women spreads the collective impact for many.
- The PUP programme has also been delivered through the day service recovery programme in Coolmine, and retention in the day service delivery is sometimes higher than that achieved in the residential setting.
- In some cases, the fathers of the children are also engaging with the PUP programme.
- The PUP programme provides the women with an opportunity to identify and develop their strengths as parents – vital to sustaining their progress and recovery.
Recovery coaching as a mechanism to build recovery capital
Paul Duff, Recovery Academy Ireland
Recovery Academy Ireland primarily comprises people in recovery from substance addiction and includes their supporters, advocates, researchers, and professionals who want to promote and champion the concept of recovery. The key objective of the academy is to create a community for those in recovery and give them, their families, and allies a voice and a vision of hope for the future. The Recovery Academy is instrumental in developing and supporting ‘recovery coaches’ to mentor and give practical assistance to people in early recovery. A recovery coach is someone who has established and sustained their own recovery, has completed a training course in recovery coaching, and is committed to promoting recovery in the community and making recovery an attractive option.
The core training course for recovery coaches is run over five days and involves talks and group work around the following topics: overview of recovery coaching; recovery pathways; ethics and professional practices; exploring the helping relationship; your own boundaries; disclosure and risk; communication and coaching skills; understanding and applying models of wellbeing and motivation; relapse; recovery check-ins; and next steps. The training is accredited by OCN Learner Recovery Coaching Education. This is equivalent to QQI/FETAC Level 3 and is recognised in the United Kingdom.
Plans to expand the number of recovery coaches in Ireland were outlined to the workshop. It was proposed that a total of 32 coaches will be trained in two rounds of training from 2019; this will include 17 coaches from the Greater Dublin Area and 15 nationally, from outside Dublin. In addition to the formal training, they will do 12 hours a week voluntary work over a 25-week placement in relevant services with additional training. They will be supervised by a mentor with oversight from the coordinator over the 25 weeks of placement.
Key points presented in the workshop:
Peer Leadership Development and Integration programme
Nicola Perry, Community Response
The Peer Leadership Development and Integration programme is delivered over 30 hours in total and spans six weeks’ delivery. The programme includes 10 modules with the aim of developing a range of competencies required to build capacity in peer leadership and underpin facilitation and engagement in a group environment. The overall aim of the programme is to build individual resilience, capacity, and social capital to sustain recovery and community inclusion.
The workshop learned about the results of an evaluation of the programme that included 20 participants completing two programmes of training. Participants were assessed before and after they engaged with the training. It was claimed that participants reported a 25% improvement in motivation, a 40% increase in their capacity to provide peer support, and 92% indicated an improvement in their own health and wellbeing. In addition, participants reported an increase in levels of knowledge, skills, and competencies in relation to the programme modules.
Overall, improvements were noted in motivation, ambition, personal development, peer support, and personal stability; it was claimed that the outcome areas assessed were deemed material to building social capital to help sustain rehabilitation and build capacity for peer leadership. It is planned to roll out four more programmes to create a wider base of participants in 2018/19.
Key points presented in the workshop:
- The programme benefitted from a mid-programme review which integrated feedback from participants and allowed for real-time changes to be made to the modules and the delivery of the programme to incorporate learning that participants identified as part of their training needs.
- The programme benefitted greatly from the input by participants and intends to include former participants in the next roll-outs, for development and inclusion.
- The programme coordinators plan to have inputs about post-course training options built into the core programme for greater clarity.
- Key to the success of the programme is creating a safe space where participants can feel free to experiment with change.
WORKSHOP 4: Harm reduction services: engaging with people who use drugs
Assertive Case Management: a collaborative approach to target supports at those most at risk
Dawn Russell, Ana Liffey Drug Project
This presentation described two of Ana Liffey’s low threshold projects ongoing in Dublin city which provide case management based on National Drugs Rehabilitation Framework (NDRF) tools. These projects are delivered by a multidisciplinary team targeting clients with complex needs or those not currently engaging with existing services through outreach, in-reach, or home visits where required. The projects are slightly varied as they catered for different groups in two different parts of the city. The projects had input from a wide range of stakeholders, including An Garda Síochána.
The outcomes were measured using care plan goals, the Pulse system, and self-assessment using standardised questionnaires. Given the client group, there were indications of success in both groups, such as improved engagement with health and addiction services and reduced antisocial behaviour.
Summary of presentation, highlighting what had worked well in the two different projects:
- Multiagency oversight group
- Clear tasks and targets
- Regular, action-focused case meetings
- Case meetings with An Garda Síochána (where appropriate).
And what did not work so well:
- Clients unable to meet the current entry criteria for detoxification services
- Application of Outcomes Star (an assessment tool for measuring change)
- Lack of shared care plans under NDRF
- Lack of clarity about continuum of care and access criteria.
A collaborative response to chemsex in Ireland
Kiran Santlal and Adam Shanley, Gay Men’s Health Service
The presenters first gave a detailed overview of chemsex, that is, the use of drugs (frequently GHB) to facilitate or enhance sexual experience and the often complex issues related to the practice. There was a summary of a recent study which found in the target group that 27% of those who responded had engaged in chemsex in the previous 12 months. For example, one-quarter reported that chemsex had a negative impact on their lives and one-third felt that they would like help or advice about it.
The collaborative approach to addressing this issue was described by the presenters. It involved the Health Service Executive, the Gay Men’s Health Service, HIV Ireland, Gay Switchboard Ireland, BeLonG To, Healthy Ireland and Drugs.ie.
The goal was to address not just drug use but also sexual and mental health in any intervention. The primary intervention was the provision of harm reduction advice and information in clubs, universities, etc.
The secondary intervention was to assess the harmful use of GHB in services where LGBT people access health or addiction services, for example, Gay Men’s Health Service or Ana Liffey Drugs Project. The tertiary services manage the harmful effects of using GHB through treatment, for example, detoxification in the National Drug Treatment Centre (NDTC). There have been 98 referrals for GHB detoxification since 2014, where the majority received treatment as outpatients.
Key points presented in the workshop:
- The Chemsex Working Group needed to involve many different agencies in order to address this complex issue and is a good example of multiagency cooperation.
- There are significant health and psychological risks related to chemsex, which require specific interventions, some of which need to be long term to prevent relapse.
- GHB detoxification can be successfully managed in the NDTC clinic as an outpatient.
- To address the problems associated with chemsex, agencies must continue to look for innovative ways to target these high-risk populations.
‘I’m not a lone soldier’: a multidisciplinary response to the management and treatment of benzodiazepine use within the general practitioner setting
David Gibney and Brian Foley, Ballymun GP Community Partnership Addiction Project
This multidisciplinary partnership for problem benzodiazepine use is located in the Ballymun Family Practice, delivered by staff from Ballymun Youth Action Project and funded by the Ballymun Local Drug and Alcohol Task Force. It has been running since 2006, in response to a study in the area which highlighted the problems with benzodiazepines.
The aim of the partnership is to provide a service for people who want to address their benzodiazepine use, including accessing detoxification or further treatment. Every week, nine dedicated hours of counselling are provided either at the GP practice or at another centre by a trained addiction counsellor.
The project allows better, more flexible (and more discreet) accessibility to treatment, earlier intervention, and integration of medical and psychosocial services. It improves links with other services and does reach other problem drugs, such as alcohol and methadone.
The majority of clients are men and most receive counselling. The most common presenting drug was Valium or a Z-drug, followed by alcohol and cocaine. Many have a dual diagnosis. There were positive outcomes for many of the clients.
The presentation summarised some of the important lessons learned in relation to improving GP knowledge of current street tablet use, addiction counselling, importance of providing a non-stigmatising location, and multidisciplinary cooperation.
Emma Fox, Clondalkin Drug and Alcohol Task Force
The SAFE campaign developed initially because of concerns raised by An Garda Síochána and Irish Rail about a rise in public drug use and antisocial behaviour around the train station in Clondalkin, Dublin. This led to the creation of an interagency group to look at solutions to the issue, comprising initially Clondalkin Drug and Alcohol Task Force (CDATF), An Garda Síochána, Irish Rail, various local addiction services, and then joined by the South Western Regional Drug and Alcohol Task Force (SWRDATF), the Health Service Executive and other addiction services to provide support along the Kildare–Dublin railway line.
At the initial meetings, the partners raised their individual concerns and together the joint initiative was formulated. SWRDATF, Ana Liffey Drug Project, South Dublin County Council and the HSE Addiction Services Outreach Team were brought on board to provide the interventions. The aim of the initiative was to provide information to the target group about services available locally. Additionally, the initiative wanted to reduce drug litter, levels of public drug use, and antisocial behaviour in the train stations. A steering group was set up to progress the initiatives. The presenter stressed that all this was done with no extra resources but with ‘goodwill and genuine buy-in’.
In March 2018, the SAFE programme was rolled out on a pilot basis, where an outreach team would try to engage with those in the identified location once a week. It was officially launched in October 2018.
Part of the remit of the steering group was to collect information on the situation. Clondalkin’s location on the edge of Dublin made it easily accessible to people from Kildare, Laois, Westmeath and Tipperary. People reported coming to Clondalkin to buy drugs or to access services anonymously. The age ranged from 21 to 58 years and 60% were women. Noted among the group were limited information about safe injecting and limited access to services in their own area. The problem of crack cocaine was also highlighted.
Positive outcomes and successful factors:
- Some very positive outcomes included: 257 client engagements; 240 clients availed of clean safe equipment; reduction of drug litter and antisocial behaviour.
- The successful factors identified in the process were:
– There was a collaborative approach from all partners, building professional relationships, with commitment to the process.
– There were clear roles and responsibilities for the steering group, providing guidance and delivering outputs.
– There was an experienced outreach team able to make contact and build trust and relationships with the clients.
– There was regular communication between the outreach team and the steering group, with a lead driver for the project locally.
Key points presented in the workshop/made in the discussion:
- A gap or need was identified by different agencies which brought them together to work collaboratively.
- Each partner was able to bring their own experience and perspective to the process and pool resources to address the issue. This process needed transparency.
- Goodwill and buy-in, along with a common goal, enabled the process to succeed in the four examples.
- Any interventions or approaches need to be client-centred, because what they identify as important may not be what drug services feel is most important. This is vital as the target group for these interventions cannot or will not access services through the traditional pathways either because of complex needs or fear of stigma, for example.
- The interventions therefore also need to be appropriate. This often calls for novel or innovative approaches to meet the needs of this client group. Such new interventions can sometimes be met with resistance; therefore, time is needed to build trust and relationships between services and clients.
- The success of the projects not only depended on the good interagency cooperation but very much on the skill, dedication, and expertise of the staff delivering the interventions.
The reports on the workshops were compiled by Lucy Dillon, Chris Purnell, Martin Keane, and Suzi Lyons. The workshops were chaired by Tara Deasy, William Flannery, Joe Kirby, and Eamon Keenan.
The National Drugs Forum would like to thank the chairs and rapporteurs of all these sessions for their generosity and professionalism and for their excellent work prior to, during, and following the forum.
Dr Karen Minyard speaking at the National Drugs Forum