Brief Intervention Counselling Service Report 2015

Brief Overview of service:

In 2011 the HSE Addiction Service, the Treatment and Rehabilitation Subcommittee and the Wicklow Child & Family Project, project promoter of the counselling service, were all instrumental in the implementation of the Brief Intervention Counselling Service. The idea behind the Brief Intervention Counselling service was that it would support and compliment the HSE counselling service and the HSE outreach team.

Through consultation with the stakeholders it was decided a Brief Intervention Counselling model was the most appropriate, cost effective option to provide a suitable intervention for service users. It was agreed that the service would be monitored and reviewed to assess its impact and to ensure that it fulfilled its purpose, met identified need and was value for money. Positive results of the yearly reviews and the availability of ongoing funding ensured the continuity of this much needed service.

Purpose:

The purpose of the BIC service is to meet the needs of individuals affected by addiction issues. Clients are offered one to one brief intervention counselling sessions to assist them in understanding and managing their substance use. The counsellors support the clients in making informed choices and decisions and assist them through a short series of goal focused sessions.

Service Delivery:

The Wicklow Child & Family Project Manager engaged appropriately qualified counselling staff; deals with all queries and organises client reviews where relevant. A psychotherapist, with appropriate addiction training, and 2 counselling psychologists were engaged, two female and one male, this allowed for gender balance. Engaging 3 counsellors assisted in accommodating the service geographically and ensured that the high numbers requiring a service would not have a lengthy wait. The counsellors were affiliated to a recognised body. They abided by their affiliated body code of ethics and adhered to the Department of Children & Youth Affairs Children first: National Guidance for the Protection and Welfare of Children.

Each counsellor was actively engaged in supervision with a supervisor affiliated to a recognised body. All provided their own professional insurance and indemnified relevant organisations. The service was managed so that it would be easily accessible, goal specific, a minimal waiting period and no long assessment process The BIC service would be offered for an initial 6 week period with the option of an additional 6 weeks following a review with the project promoter and counsellor.

Initially a referral pathway approach was not adopted i.e. clients were not referred in and were not referred on by the service. Relevant information would be given to clients on addiction services and general services in the east coast region that may be suitable to their needs. However a referral pathway approach was adopted following the establishment of the Rehabilitation Integration Service. This service, alongside other ECRDATF funded agencies, refer into the BIC service. Were appropriate following active participation in the BIC service clients may be referred onto either Living Life Counselling service, Wicklow Child & Family Project therapeutic service or the HSE addiction counsellors.

Premises:

The BIC service is delivered from 3 separate premises; a unit in the Wicklow Enterprise Centre, House No 3, Collins Street Arklow and the Wicklow Child & Family Project main office in Wicklow Town. The house in Arklow and the unit in the Wicklow Enterprise Centre also house the ECRDATF Rehabilitation Integration Workers and provide a meeting space for the ECRDATF.

The Wicklow Child & Family Project engages in a Licence agreement with Crosscare at House No 3 Collins St Arklow, which is jointly leased with Living Life Counselling Service.

House No 3 Collins St Arklow Town also provides a meeting space for a Family Support Group and Narcotics Anonymous.

Case Management:

Management of cases was carried out between the project promoter and the counsellor. Policies & procedures, intake forms and confidentiality policies were implemented. Attendance and commitment to the process were closely monitored. As per the policy if a client did not attend for two consecutive weeks without prior cancellation they then reverted back onto the waiting list. If the client was referred to the BIC service from another agency that agency was informed of this decision in order that the client was not left unsupported.

When a client was approaching the end of the 6 week term the project promoter, the counsellor and were appropriate the referrer reviewed the client’s progress to assess if a further 6 weeks would prove beneficial to the client. If a decision was made that a further 6 weeks would be of benefit this would then be offered to the client with their full agreement. If it was identified a client may benefit from longer term therapy following their engagement with the BIC service this was discussed with the project promoter and a suitable service was identified.

Inter-Agency Work:

The HSE input in to the development of the service was integral to best practice. The creation of an interagency dynamic also assisted in meeting the need of clients who wanted immediate support and were not looking for a long term engagement or harm reduction service.

The ECRDATF funded projects were all informed of the service and an information leaflet was designed with service information and distributed. ECRDATF funded projects and projects in the region were informed that people seeking support for their addiction could also contact the service directly.

2015 BIC service operational issues and outcomes:

Operational Issues:

Staffing:

Mr Adam Jensen – Counselling Psychologist

Ms Tracy O’Neill – Counselling Psychologist

Ms Bernie McGrane – Psychotherapist, Addiction Counsellor

Referral Pathway & Case Management:

Protocols were put in place to ensure a structured referral process into the BIC service, these include referral form, intake form, confidentiality agreement, client counselling policy and exit letter. Regular links were established between referrers, counsellors and project promoter to facilitate ongoing monitoring of the service. This ensured an active interagency approach to the delivery of the service and effective case management which resulted in the client’s needs being addressed appropriately.

Inter-Agency Collaboration:

ECRDATF & HSE Rehabilitation Integration Workers – Tiglin - Arklow Springboard - Living Life – Simon - HSE Outreach Team – Probation – GP’s.

Close links with ECRDATF and sub committees.

Costs:

The hourly rate paid per session to the counsellor was €50; the cost for no show at scheduled appointment was €30 per hour.

NDTRS Health Research Board:

Regular data is collected from clients accessing the BIC, (with their approval), and forwarded to the NDTRS.

Outcomes:

• The BIC counsellors played a significant role in supporting the clients by providing a psycho-educational role to the impact their continued drug use has on their psychical and mental health.
• Clients have reported that a benefit of accessing BIC is the increased acceptance in their relationships.
• The brief intervention model provided clients with the opportunity of thinking differently about their substance misuse.
• The BIC proved a valuable tool for treatment for problematic substance misuse.
• The counsellors supported the clients in making informed choices and decisions through goal focused sessions
• The service allowed for access to information on other relevant services in the region
• Regular meetings to discuss case management and review work practice and protocols ensures the service was delivered in line with best practice
• Providing information/reports on the BIC service at ECRDATF subcommittee level ensures openness and transparency of the service and allows for ongoing feedback, review and monitoring.
• All ECRDATF funded projects had the opportunity of linking their client group into the BIC service
• Using a BIC model meant that a larger number of clients had the opportunity of accessing the service, this helps in the management of waiting lists
• Expenditure was closely monitored and the Project Promoter delivered the service within budget
• Fees paid and money expended were deemed to be value for money and were based on comparatives with other services
• A clear referral process proved beneficial in meeting the client’s identified needs and effective case management
• Stronger inter-agency links provided more structured supports to clients accessing BIC

*Please refer to statistical data attached.

Findings:

• There still appears to be a trend of Lyrica being prescribed for any issue
• Some drugs are getting cheaper which makes them more accessible
• Arklow saw an increase in the use of crack during 2015
• Cannabis is still a major problem
• The use of bubble and trippy bubble has been an issue
• It seems to be uncertain what drugs are being snorted
• High levels of suicidal ideation amongst unemployed males struggling with relationship issues due to unemployment and related issues of addiction and financial hardship
• An increasing number of clients using non prescribed prescription drugs of unknown efficacy and origin, causing deep psychological harm
• Links between the Tiglin day programme and the BIC proves beneficial to the service user
• Some methadone clients state they receive little or no help or encouragement from the relevant agencies, in reducing their methadone, despite any interest on their behalf to reduce
• Recurring issues that appear to have an impact on substance abuse and depression:-
• Delayed grief
• Relationship issues
• Financial stress
• Low coping resources
• Some clients report that their experiences with the mental health services has been inadequate.
• Clients who engage well in the BIC service and identify that longer term therapy would be beneficial find it difficult accessing a further service and very clearly state that they would rather continue with
• the same counsellor
• On occasion post rehab clients have accessed the BIC service. The BIC service has been of great benefit to these clients and they appear to work well with this type of approach.
• Lack of available supports to a client on completion of counselling, for example a day programme/stabilisation group. A client requires an outlet specific to their needs to assist them in having a sense of
• purpose and putting a structure on their day
• Clients presenting with dual diagnosis not always accessing additional appropriate services to meet their needs

Challenges:

• Clients accessing BIC that are awaiting a court date often disengage after their court case
• Often clients accessing residential rehabilitation services have to be accessing counselling prior to admittance. This may increase referrals to BIC.
• No aftercare service in the area – post rehab counselling
• Engaging and holding a client in the counselling process when their environment is so chaotic
• Younger clients aged 18-22 years seem to have a difficult time engaging with counselling, due to ambivalence and lack of social / work options to support sobriety and sober lifestyle.
• Clients experiencing addiction having the ability to commit to a counselling process
• Many clients form attachments during the BIC and find it hard to let go, without any follow up service to attend.
• Fluctuating waiting lists i.e. geographical areas and amount of referrals
• A clients non-engagement with the BIC service when offered an appointment
• Demand for long term therapy
• The inability to facilitate under eighteens

Recommendations:

• The continuation of the BIC service
• That counsellors continue to provide information and relevant support to clients to ensure they are accessing all appropriate services specific to their needs
• That counsellors ensure close links, were appropriate, with the clients mental health practioner. This would only be with the clients approval
• Ongoing collaboration between relevant agencies
• Ongoing promotion of the BIC service
• To include post rehab counselling in the BIC service
• Explore the possibility of offering extended therapy within the BIC service for clients who would benefit from continued support
• Explore the need for an under eighteen service.

Thanks go to the ECRDATF, ECRDATF Coordinator, Treatment & Rehabilitation committee, ECRDATF funded projects, ECRDATF Rehabilitation workers, HSE Outreach Team and HSE Rehabilitation workers for their continued support during 2015.

Christine Keegan, Project Promoter

Manager Wicklow Child & Family Project