ROSC presentation from October 2015

1. NATIONAL QUALITY DEVELOPMENT
Argyll and Bute – Developing a
Recovery Oriented System of Care
23rd
October 2015
A national resource of expertise on drug issues

2. Who are we?
National Quality Development
Neil Stewart
Head of Quality & Workforce Development
Bruce Thomson
National Quality Development Manager
Workforce Development Programme
George Burton
Workforce Development Programme Manager

3. 1. What is a ROSC?
2. What is recovery-oriented
practice?
3. ROSC in Argyll and Bute.
4. Your service in the A&B ROSC.
5. Quality Framework.
6. Developing the ROSC.
3
Programme

4. ROSC – A Working Definition
A ROSC is a system of services, supports and other
resources in a community, which supports people at
all stages of need during the process of recovery
from problems related to the use of alcohol or other
drugs
Any service or resource could potentially be a part of
a ROSC if it provides assistance to people within the
service user group (including family & significant
others)

5. Chameleons or Caterpillars?

6. Recovery-focused systems transformations involve more than
minor refinements to existing models of addiction treatment.
Such transformations require a fundamental reconstruction of
service concepts, practices, and policies. They start with the
realization that no one person, episode of care, system of care,
or governmental entity has the resources to support long-term
individual and family recoveries for all who need it.
Partnerships are fundamental to achieving transformation. We
have used the metaphor of the chameleon and the caterpillar
to underscore that systems transformation must involve a
deep and enduring change in the character and identity of
addiction treatment and all of the relationships involved in it
rather than superficial commitment to new rhetoric and a few
new service appendages.
(Lamb, Evans & White)

7. Distinguishing features
of a ROSC
• Person-centred
• Inclusive of family and significant others
• Keeping people safe and free from harm
• Provision of individualised and comprehensive
services - such as housing, employability and
education
• Services that are connected to the community
• Services that are trauma-informed
(Scottish Government)

8. Principles and Components of a ROSC
• Strength-based assessments
• Range of services to meet needs at all stages of
recovery
• Evidence-based interventions
• Integration of services and resources
• Transparent, seamless pathways across services and
other supports
• Clarity of roles and communications
• Can draw on community-based resources

9. ...more principles & components
• Collaborative decision-making
• Involves multiple stakeholders
• Outcomes-driven
• Shared definition of recovery?
• Linked to quality framework
• Adequately and flexibly funded
• ROSC structure and function is clearly
understood by all stakeholders

10. Engagement Preparation Change Completion Re-integration

12. ROSC – exercise
• To what extent is this description appropriate
to Argyll and Bute context?
• Highlight any uncertainties, reservations or
concerns you may have.

13. Phases of a ROSC
• Engagement
• Preparation
• Change
• Completion
• Re-integration
Each phase of the recovery journey requires
different types of support. Some services may
be involved at ALL stages, some are more
closely associated to particular phases.

14. Phases of a ROSC
In rural settings, such as Argyll & Bute, it is
apparent that support and care throughout
the phases of the ROSC may be carried out by
the same individual, wearing different “hats”.
What are the implications of this, and how well
is this currently managed?
Think about workforce development, service
user choice, confidentiality etc.

15. Implications for practice
• Workforce Development.
• Screening and Assessment.
• Consistent language across sectors and
services.
• ROSC and Recovery “kite-marking”.
• Unconditional positive regard and belief in
recovery.
• Becoming a recovery enabler.
• Recognition that the workforce is part of the
community and what this means.

16. Implications for practice
• Services and sectors have their own priorities.
• Links must be made to show that supporting
recovery helps to meet these outcomes – e.g.
fewer failed tenancies, reduction in anti-social
behaviour and offending behaviour, improved
mental and physical health, improved
employability, support for family members
and carers
• Can be difficult to “believe” in recovery as lots
of contact with services takes place when
people are having difficulties.

17. ROSC Case Studies
1. How would this person be treated within the current
system?
2. Identify specific services & resources appropriate to
the 5 stages in recovery (engagement, preparation,
change, completion, re-integration).
3. Assess the likely quality of recovery experience and
identify difficulties they might encounter, such as any
gaps in care and support.

18. Quality framework
• Scottish Government guidelines for ADPs
• Quality Principles
• Self assessment, monitoring and audit – at
service and ROSC level
• Recovery Outcomes – choice of tool

19. Quality Principles
1. You should be able to quickly access the appropriate drug or alcohol
service that supports your recovery.
2. You should be offered high quality, evidence based treatment, care and
support interventions which enable your recovery.
3. You should be supported by workers that are appropriately trained and
supervised to assist you throughout your recovery journey.
4. You should be involved in a full, strength based assessment that ensures
the choice of recovery model and therapy is based on your needs and
aspirations.

20. Quality Principles (cont’d)
5. You should have a recovery plan that is person-centred and addresses
your holistic health, care and social needs.
6. You should be involved in regular reviews of your recovery plan to ensure
it continues to meet your needs.
7. You should have the opportunity to be involved in an on-going evaluation
of the delivery of services at each stage of your recovery.
8. Services should be family inclusive as part of their practice.

21. Example of how to assess
service performance
1. You should be able to quickly access the appropriate drug
or alcohol service that supports your recovery.
waiting times – against HEAT
service information available / distribution
difficulties or barriers to access
support provided to assist access
service user engagement with service

22. another example...
6. You should be involved in regular reviews of your
recovery plan to ensure it continues to meet your needs.
review of recovery progress
service user involvement in review
planning for longer term support needs
move-on planning and support

23. Levels of multi-agency partnership
1. Co-existence: clarity between different agencies as to respective roles
2. Co-operation: different agencies sharing information, pooling knowledge and
skills; recognising the mutual benefits and value of partnership working
3. Co-ordination: planning together; sharing some roles, responsibilities and
resources; agreeing to making adjustments/improvements to service provision
to avoid overlap
4. Collaboration: longer-term commitments between partners, shared leadership,
control, resources and risk-taking. Agencies agree to work together on strategies
or projects, contributing to shared goals
5. Co-ownership: different agencies commit to a common vision and goals, making
significant changes in what they do and how they do it
Relationship may develop further over time

24. Advantages of good partnership working
• Clarity of expectations and terms of engagement
• Decisions that take into account the views of different
stakeholders
• Integration of roles
• Effective communications
• Understanding of each other’s priorities and constraints
• Consistency of provision and avoidance of duplication
• Seamless services and transitions for service users
• Constructive management of problems/conflict

25. Barriers to good partnership working
• a lack of information sharing across agencies and
services
• duplication of assessments by different services
• poor co-ordination and integration across agencies
• haphazard referring-on of clients between agencies
• a lack of continuity and inconsistent levels of service
provision
• lack of understanding of cultures within other agencies
• unclear accountability

26. Resource mapping –
questions to consider
• What resources & services are abundant?
• What resources & services are scarce or unavailable?
• How strong are the pathways between the resources?
• Does everyone have equal access to the
resources/services? Identify any inequalities or barriers.
• How often are resources & services used?
• How are resources & services contacted? e.g. phone, e-
mail, direct access
• What development/information-sharing activities are
carried out between services?
• How are partnerships maintained and strengthened?

27. Partnership working exercise
1. What is already in place and working well?
Identify any barriers which will have to be overcome?
What will be needed in terms of:
Processes
Communications
Workforce development - internal / joint
Other arrangements
2. What are the priorities for development of the partnership?
How will the effectiveness of the partnership be monitored and where will responsibility be
located? How can service users contribute?
Are there implications for partnerships with other agencies?

28. Checklist: How will you know
when you’re getting there?
1. Agreed written description / illustration of local model,
communicated and visible to all stakeholders
2. Statement of commitment from partners
3. Responsibility identified (e.g. development & monitoring group –
led by ADP)
4. Quality Principles embedded in system and processes in place to
assess performance
5. Service user outcomes – choice(s) of system

29. Checklist: How will you know
when you’re getting there?
6. Improvement plan developed and implemented
7. Culture of continuous improvement
8. Workforce development needs identified, planned and
delivered
9. Area needs assessment up-to-date
10. Service user involvement (strategic and service level);
hard to reach groups

30. Action matrix
Self Service ADP / System
Short-term
Medium-term
Long-term

31. Main Office
Scottish Drugs Forum
91 Mitchell Street
Glasgow G1 3LN
t: 0141 221 1175
f: 0141 248 6414
e: enquiries@sdf.org.uk
www.sdf.org.uk
Edinburgh
139 Morrison Street
Edinburgh EH3 8AJ
t: 0131 221 9300
f: 0131 221 1556
e: enquiries@sdf.org.uk
www.scottishdrugservices.com
Scottish Drugs Forum (SDF) www.sdf.org.uk is a company limited by guarantee,
registration no. 106295 with charitable status and is also a registered Scottish charity
registered SC 008075. Registered Office: 91 Mitchell Street, Glasgow, G1 3LN
Find drug services in your area:
www.scottishdrugservices.com
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www.hepatitisscotland.org.uk
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