Relationships, Collaboration and Openness: a blueprint for those working in alcohol and drug services

Background and Context

In early 2021, South Ayrshire Alcohol and Drug Partnership set out on a Learning Review in partnership with Horizons Research, with the aim of producing a base of research evidence and evaluation data to guide the ADP in its next phase of commissioning and planning. The ADP Learning Review has now concluded, having generated a wide range of insights and set out some key priority areas of work for taking forward.

In the past two years, the ADP has also undertaken several new activities to explore new approaches to supporting people with multiple and complex needs around alcohol and drug use. Firstly, the Connect4Change pilot was commissioned by the ADP as an assertive outreach service to provide intensive support to vulnerable people who may be at risk of an alcohol or drug-related death. In addition, the ADP has helped to fund the Community Navigator pilot in HMP Kilmarnock, which aims to support and guide men being liberated from prison to reduce the harm caused by violence and substance use, improve overall wellbeing and reduce the likelihood of future imprisonment. Finally, as well as looking at the processes, impacts and outcomes of the ADP, the ADP Learning Review grew to encompass several other scoping and research activities aimed at exploring how we can best provide support to people in South Ayrshire, including a Residential Rehabilitation scoping study, several Tests of Change around the Whole Family Approach and support for children and young people, and research into the practicalities of developing a hub-and-spoke model One Stop Shop in South Ayrshire.

Looking at both the Learning Review and the ADP’s other activities, including the two pilots, we can now identify some themes which have continually emerged as being key to bringing about positive outcomes and changes in practice. These themes and principles have a key role to play in guiding the work of the ADP as it moves forward, in particular with the development of a new ADP Commissioning Plan.

Theme one: Collaboration

Firstly, collaboration both between and within different services is clearly of key importance in driving positive outcomes for people in South Ayrshire. In essence, collaboration is about different people and organisations working together in order to achieve common goals. In this context, collaboration means partners from across different parts of the system working in a positive, coordinated way to achieve the shared aspirations of the ADP.

One of the key strengths of the Connect4Change pilot, for example, was its multidisciplinary nature – bringing together staff with different skill sets from a range of professional backgrounds to work towards the shared aim of reducing drug and alcohol-related deaths in South Ayrshire. The collaborative, interdisciplinary nature of C4C has been crucial in enabling the service to provide holistic support to individuals touching upon many aspects of their lives, with 45% of individuals supported during the pilot reporting reduced substance use, 50% showing improved mental health and 52% having improved relationships with their partner, family or friends. In addition, the pilot evaluation highlighted the extent to which C4C staff valued and learned from working with colleagues with different backgrounds and experiences.

The importance of collaboration has also been borne out by the findings of the broader ADP Learning Review. The process evaluation, for example, found evidence of a strong aspiration towards collaborative working amongst ADP partners, while also noting the difficulties that differing organisational cultures and priorities can cause in this respect. The ADP has since taken several steps to drive a further increase in collaborative practice across the full breadth of the partnership, for example by extending the role of chairing ADP sub-groups to include a number of third sector partners as co-chairs.

Looking forward, collaboration will be essential if the ADP is to meet both its current strategic ambitions and the new national-level priorities in place for alcohol and drug treatment services. To give one example, the Medication Assisted Treatment (MAT) Standards currently being implemented across Scotland include several requirements for the provision of MAT to include links and pathways to other kinds of treatment and support. Standard 6, for instance, says that services delivering MAT should support people to grow their social networks by linking them to mutual aid services and recovery networks, Standard 8 requires that all people will have access to independent advocacy and support for housing, welfare and income needs, and Standard 9 states that people should be able to receive mental health care at the point of MAT delivery.¹ Achieving the full implementation of the MAT Standards, then, will involve lots of collaboration between different parts of the system in South Ayrshire.

1. Scottish Government (2021), Medication Assisted Treatment (MAT) Standards for Scotland: Access, Choice, Support.

Theme two: Relationships

Secondly, relationships have emerged as another key factor contributing towards positive impact amongst alcohol and drug-related services in South Ayrshire. Relationships are of course fundamentally about the ways in which two or more people are connected with each other, and relate to one another. In this context, both the relationships which people working in services form with people accessing services and the relationships between different staff working in services have significant roles to play in helping services achieve positive outcomes.

The Community Navigator pilot provides an excellent example of the importance of the first of these two relationships. At the heart of this service is the relationship between the Navigator and the individual being supported – before, during and after their return to the community from HMP Kilmarnock. The pilot evaluation found that the Navigators’ approach to building relationships with the men they supported was key to the success of the pilot, including by listening to the service users’ thoughts about their challenges and what was important to them; being patient, persistent and flexible; being non-judgemental; and being down-to-earth, relaxed and informal. As a result, 87% of service users returned to the community continued engaging with Navigators after their release from prison, while 90% reported an increased motivation to reduce their alcohol / substance use. In addition, it was also found that the establishment of positive, trusting working relationships between Navigators and prison staff, with regular contact and effective information-sharing, further helped in enabling the successful delivery of the service.

Another key finding from the broader ADP Learning Review, meanwhile, was the importance of relationships as the context for collaboration across different parts of the system in South Ayrshire. Enabling the exchange of ideas, opportunities and knowledge across system boundaries represents a key role and function for the ADP, and the importance of providing opportunities for these kinds of exchanges to take place was affirmed by the findings of both the process and impact evaluations.

Looking forward, it is clear that these kinds of relationships within services will have a very important part to play in bringing about the realisation of the ADP’s ambitions. Residential rehabilitation, for example, is another area identified by the Scottish Government as a key priority for the years ahead, as part of the National Drugs Mission.² To increase the provision of residential rehabilitation in South Ayrshire, the ADP has overseen the establishment of the ROADS (Recovery Out of Drug & Alcohol Support) service, a multi-agency team working to develop and implement pathways for individuals in South Ayrshire to access placements.

Relationships are absolutely fundamental to the work of ROADS, with the team including both a Peer Recovery Worker and a Family Worker to ensure that the individuals the team supports are connected to the recovery community and other forms of support before, during and after their placement at a residential facility. Positive working relationships between ROADS and other services in South Ayrshire, as well as with the residential facilities themselves, are also crucial to making the process of attending residential rehabilitation as smooth as possible for the individuals being supported.

• ² Scottish Government (2022), National Mission on Drug Deaths: Plan 2022-2026. Pg 14.

Theme three: Openness to new ways of working

Finally, an openness to new ways of working, including a flexible approach to meeting the needs of people using services, is also something which the two pilots have shown to be important in helping deliver positive changes in the lives of individuals accessing services in South Ayrshire. In a sense, both the Connect4Change pilot and the Navigator pilot were the products of an openness to new ways of working, in that they sought to implement and explore the effectiveness of new ways of delivering support which were not previously present in South Ayrshire. In addition, the learning from both of the pilots provides further examples of how being innovative and flexible in our approach to supporting people can contribute to positive outcomes.

Looking first at C4C, it is clear that one of the things that service users appreciated most about the pilot was the team’s willingness to be flexible and accommodating in how they communicated with and supported individuals. A service user survey carried out towards the end of the pilot, for example, found flexibility of support to be the most common reason cited as to why the pilot was thought to be helpful, including both the flexibility of the C4C team in meeting people at locations convenient for them and the flexibility of individuals being able to drop-in to receive support at the C4C offices. With regards to the Navigator pilot, meanwhile, the Community Navigators tailored the support to each individual they supported in a personalised and flexible way, by (for example) offering flexible appointment times where this would improve the prospects of engagement, and by increasing the frequency of the support provided to individuals who were particularly anxious about their return to the community. Finally, both the C4C and the Navigator pilots had to work in innovative and adaptable ways to ensure they could continue to provide support throughout the changing restrictions in place during the pilots as a result of the Covid-19 pandemic.

The findings of the broader Learning Review indicate the importance of an openness to new ways of working too. As part of the impact and outcomes evaluation, for example, a survey was carried out of individuals in South Ayrshire who have accessed support with their alcohol or drug use in the past 12 months. While survey respondents were generally positive about the quality of the support they had received, they were somewhat less likely to feel that the support they had received had been joined-up, while a lack of follow-up / aftercare was one of the most frequently-identified negative aspects identified by respondents regarding the support they had received. This suggests that finding new ways in which to coordinate and link the support they provide with that of other services in South Ayrshire would enable ADP partners to further increase their positive impact on the lives of the people they work with.

It is also important to recognise here how difficult it is to implement new ways of working, and to invest in the collaborative relationships needed to make it work. At various points during the pilot, C4C experienced difficulties in relation to issues including staffing, access to data management systems, referral criteria, and the organisational structure of the service. The Navigator pilot evaluation, meanwhile, high-lighted challenges when working with community services as being one of the main barriers experienced during the pilot, with a lack of communication from some of these services seen as limiting the positive impact of the Navigators for some individuals. Determination and resilience on the part of the partners involved has proven crucial in ensuring that there has been a perseverance with these new ways of working despite challenges and difficulties such as these – recognising that working in a collaborative way, through a particular set of relationships, is in part ‘the work’ when it comes to these kinds of projects.

In the future, flexibility and openness to new ways of working will be highly important as the ADP continues to work towards achieving its priorities in a changing local and national context. For example, the ADP has over the past year carried out several Tests of Change relating to both the Whole Family Approach and support for children and young people. A willingness to innovate and adapt amongst partners will be key in learning from and, where appropriate, implementing / upscaling these tests going forward. In addition, the ADP is currently working on plans for a mobile Outreach Vehicle and a hub-and-spoke model One Stop Shop to operate across different parts of South Ayrshire. These exciting proposals will both in their own ways add new elements to the range of alcohol and drug-related support available to people in South Ayrshire, and a spirit of openness and flexibility amongst the partners involved will be crucial in bringing these plans to fruition.

Working across system boundaries: skills and competencies

Of course, a common characteristic of both the C4C and the Navigator pilots was that they involved people working and collaborating across different parts of the system in South Ayrshire, whether that is the prison system, the local recovery community, third sector organisations providing treatment and support around alcohol and drug use or statutory services in areas such as health, housing and social work. This is not easy, and for the pilots to work, the staff involved needed to possess a range of skills and competencies conducive to enabling joint-working and partnership across system boundaries. These skills and competencies include:

• An ability to work across both personal/interpersonal and sector boundaries;
• Being able to engage in collaborative relationships and processes as well as hierarchical “telling” relationships and processes;
• Acting as knowledge brokers, able to pass information, connect ideas and generate new knowledge. This is characterised by the response “we must tell XYZ about ABC”;
• Acting as relationship brokers – able to create and build relationships where previously people were separate or disconnected;
• An ability to build trust in groups and communities and being able to model, give and enact trust;
• Being psychologically adept – able to deal with and work with different paradigms, mental models and mind-sets;
• Having an appreciative mind-set, not starting with people and issues as a problem, but searching for what works well and what is positive as a way to build constructive energy and change, and;
• Being person-centred in terms of approach, meeting people where they are at and taking responsibility for helping to address their issues.

There are many ways in which staff demonstrating these kinds of skills was crucial to the positive impact made by the C4C and Navigator pilots.

Firstly, with regards to the skill of building and enacting trust, many of the people with whom C4C worked had previously engaged unsuccessfully with core treatment services, and as a result over time had developed a sense of distrust and/or animosity towards alcohol and drug services. It was therefore key that the C4C team, including its peer support workers, was able to connect with and rebuild a sense of trust amongst the people they supported, overcoming any suspicions they may have held towards services and increasing their receptivity to receiving support with problems in their lives caused by alcohol or drug use. The C4C team made a wide range of practical interventions aimed at building this kind of trust amongst those they supported, including making themselves available to be contacted by text or mobile phone whenever suited and accompanying those they supported to appointments with other services when this was desired.

Secondly, we can see that the skill of being relationship brokers is something which was at the heart of the Navigator pilot in particular. Leaving prison and returning to the community can be difficult in a wide range of ways, particularly when individuals have few sources of support they feel they can rely on and consequently feel separate and disconnected from the communities they find themselves in following their liberation. The Navigators therefore worked to create links and relationships between the men they supported and community-based services in areas such as housing, mental health, benefits advice and addiction, while also maintaining their own relationships with the individuals in question. The Navigators also made practical interventions such as providing public transport tickets and helping furnish newly moved-into accommodation, all with the aim of making the people they supported feel a part of and connected to the local communities they returned to.

Finally, both pilots required staff to have the psychological adeptness needed to work with and support people with vastly differing mindsets, at different stages in life and at differing places with regards to their relationships with alcohol and drug use. Collaboration across organisational boundaries was also at the core of both pilots, as explored earlier in this article.

In the years ahead, these kinds of skills and competencies will be crucial across the work of the ADP as a whole, in a shifting national context in which ever-greater demands are being placed upon ADPs in terms of performance and impact. Good leadership will be key in enabling this to take place – giving staff the space, time, trust and permission to work in new ways and collaborate across system boundaries, and helping make organisational cultures in general more collaborative and system-oriented. In addition, the work the ADP will be undertaking to take forward the findings of the Learning Review – including innovative commissioning and systems-based planning and monitoring – will aim to further embed a culture of strong relationships and greater collaborative practice across the Partnership.

Looking forward: the ADP Commissioning Plan

The learning which has emerged from the two pilots discussed in this article, as well as from the ADP Learning Review more broadly, will now play an important part in shaping the new ADP Commissioning Plan. The overarching purpose of the new Commissioning Plan will have be to act as the mechanism for turning the ADP’s ambitions and principles into reality, through the commissioning of creative, compassionate and collaborative services. In the months and years ahead, increased collaborative practice, strong and trusting relationships, and an openness to new ways of working will all have a key role to play in making this happen.

The new Commissioning Plan will also seek to reflect the values of ethical and collaborative commissioning, which include transparency and an openness to influence from all stakeholders, including people who use services. As a result, whether you work for an ADP partner, use any ADP-commissioned services, or are in any other way linked to the wide range of work undertaken by South Ayrshire ADP, we encourage you to get involved with the process of developing the new Commissioning Plan and play your part in helping the Partnership deliver as positive an impact as possible for the people of South Ayrshire in the years to come.