«Learning and legacy JULY 2016 Contributors: Mark Wood, MSc, MFDAP (Chief Executive) “Transitions is a well needed service, which is well ...»
Transitions Residential Therapeutic Communities
Learning and legacy
Mark Wood, MSc, MFDAP (Chief Executive)
“Transitions is a well needed service, which is well conceived”
Professor Adrian Bonner, Specialist Services Adviser (incl addictions) to the Salvation Army.
“Transitions is a thrilling vision for an important mission”
Pete Greig, Founder of 24-7 prayer and Director of Prayer for HTB and Alpha International.
Council of Reference:
Professor Adrian Bonner, Specialist Services Consultant to the Salvation Army internationally Dr Andy Partington, Former Director of Yeldall Manor (Residential Rehabilitation Centre) Huseyin Djemil, Director of Green Apple Consulting (A specialist substance misuse consultancy) Steve Clifford, General Director of the Evangelical Alliance Pat Prosser, Training Adviser to Life For The World Trust (national Christian addictions charity) Pete Greig, Founder of 24/7 prayer and Director of Prayer for HTB and Alpha International Laurence Singlehurst, Director of Cell UK and former Director of YWAM England Dr Jo-Joy Wright, Consultant Clinical Psychologist with children and adolescents, and member of the Christian Child Care Forum Contents p.5 Introduction to Transitions RTC
- Responding to need
- A window of opportunity
- Uniquely vulnerable - young people with drug/alcohol dependence problems
- The transition from young people’s to adult services p.7 The focus on youth in transition p.8 Vision, Mission, Values, Values p.9 Business plan summary
- Finance and Funding
- Outcome Measures
- Company strategy
- Referrals p.14 Challenges and solutions
- Shared Lives
- Host pack p.16 Regulations
- Benefits and funding for supported housing p.18 Starting over p.20 Appendix 1: Programme overview p.21 Appendix 2: Evidence base p.23 Appendix 3: Organisational structure and map p.25 Appendix 4: Shared Lives - Ongoing costs and funding p.28 Appendix 5: CQC definitions of residential treatment and recovery houses p.34 Appendix 6: Financial projections Introduction
Purpose and aims of this learning and legacy document:
Clarify the unique situation facing young people and young adults with addictive behaviour in the UK.
Present the rationale and evidence base for Transitions innovative approach.
Clearly explain the different options considered and elucidate the decision making process.
Reflect on our experience and suggest learning for others who are considering setting up similar projects This document chronicles the learning of charitable company Transitions Residential Therapeutic Communities, who set out on a journey to establish a Residential Therapeutic Community (RTC) for 16-25 year olds with drug/alcohol problems and addictive behaviour.
Transitions was founded by Mark Wood, who has both the practical experience and qualifications necessary to lead the organisation. Mark is supported by a strong team of trustees chaired by Doctor Phil Moore, a GP involved in health commissioning.
As a newly established Charitable Company Limited by Guarantee, Transitions was primarily concerned with serving London and the home counties by providing holistic treatment for 16-25 year olds with addictive behaviour. This would be unique in the UK as the only residential service offering transitional support and treatment for under-18s through to 25 year olds with drug/alcohol and other addictive behaviour.
We planned to open our first RTC in Hertford in February 2016, as a pilot project for 1 year, and as a result of our evaluation and learning from the pilot, we hoped to open further Residential Therapeutic Communities in other locations.
It is widely known in the drug and alcohol field in the UK that there are no residential treatment services for under-18s, and this has been confirmed by our research. Young people’s residential rehabilitation has always been a complex and challenging arena. Before embarking on the journey to establish our first RTC we were already aware that Middlegate Lodge in Lincolnshire, often touted as the last residential rehab for young people, had closed in 2011 due to lack of funding. We then discovered a hidden gem, Companions in Stafford, but this too closed in the summer of 2014.
So why set out on this journey?
Responding to need A report in 2013 from the Centre for Social Justice states “one in 20 adults in England (1.6 million) is dependent on alcohol and one in 100 (380,000) is addicted to heroin or crack cocaine.” When combining the costs of alcohol harm and illicit drugs, the financial burden alone is a huge £35 billion.1 No quick fix: Exposing the depth of Britain’s drug and alcohol problem. Centre for Social Justice.
1 August 2013.
Youth substance use is also a significant issue – levels of cannabis use and binge drinking in the UK are some of the highest in Europe1, and new psychoactive substances (nicknamed ‘legal highs’) have made a dramatic impact on youth substance use. According to the United Nations Office on Drugs and Crime “The largest market for legal substances that imitate the effects of illicit drugs in the European Union is the United Kingdom”2 amongst 15-24 year olds.
To cap it all off over 20,000 young people are receiving specialist support for drug/alcohol misuse on a yearly basis3. Other potentially addictive behaviours, such as self-harm and eating disorders are also increasing, and these are sometimes associated with drug/alcohol misuse.4 5 A window of opportunity “Addiction is a developmental disease - it typically begins in childhood or adolescence.” (National Institute on Drug Abuse).
In 2011 a government research report entitled “Specialist drug and alcohol services for young people – a cost benefit analysis” estimated the average lifetime cost of a young person becoming an adult drug or alcohol user at £46,145 - £91,964. The report demonstrated every single £1 spent on treatment for adolescents results in £5 to £8 of savings compared with addressing the problems later on. 10 Academic research suggests 30% - 40% of teenagers who use alcohol and cannabis (moderate/heavy usage) will develop substance misuse problems in adulthood. However, for those using class A drugs, 95% will continue as adults.6 Therefore, treatment for young people and young adults is vital before they develop entrenched substance use and addiction, and the UK government drug strategy recognises this. For “young people who develop dependency, the aim is to become drug or alcohol free.
This requires structured treatment with the objective of achieving abstinence”.7 Uniquely vulnerable - young people with drug/alcohol dependence problems There is widespread recognition that young people in treatment for drug or alcohol problems have multiple needs, and a complete package of care is essential including treatment, supported housing, 2 United Nations Office on Drugs and Crime.
http://www.unodc.org/unodc/secured/wdr/wdr2013/World_Drug_Report_2013.pdf, p.87 3 Statistics on Drug Misuse in England: 2013. Lifestyles Statistics, Health and Social Care Information Centre 4 Truth hurts: report of the National Inquiry into self-harm among young people. London: Mental Health Foundation. 2006.
Eating disorders in the UK: service distribution, service development and training. Report from the 5 Royal College of Psychiatrists’ Section of Eating Disorders. March 2012.
http://www.rcpsych.ac.uk/files/pdfversion/CR170.pdf 10 Department for Education. Research Brief. Specialist drug and alcohol services for young people – a cost benefit analysis [Online]. Available at https://www.education.gov.uk/publications/eOrdering Download/DFE-RB087.pdf 6 Specialist drug and alcohol services for young people – a cost benefit analysis. Frontier Economics. 2011.
Drug Strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to 7 Live a Drug Free Life. HM Government. 2010.
reparenting and education support.7,8,10 Transitions holistic programme will address this (see Appendix 1).
There is also a clear link between drug/alcohol misuse and mental health problems in young people9.
Where this is the case, extra support will be provided as necessary.
Hertfordshire’s Drugs Strategy highlights concerns about failing to meet the needs of looked after children over the next 2-3 years, with numbers likely to increase, and “other vulnerable groups that are of high priority, namely young people not in education, employment or training, truants and excludees and those with unsettled accommodation.”10 Transition from young people’s to adult services In line with national strategy recommendations concerning youth in transition to adult services, Hertfordshire’s Drugs Strategy also recognises the importance of providing age appropriate treatment for 18-24 year olds. In fact several years ago the Drugscope report ‘Young people’s drug and alcohol treatment at the crossroads', suggested a service was created specifically for 16-25 year olds “who are developing more serious substance use problems that do not correspond to existing concepts of ‘problem drug use.’”8 A government report on children’s residential homes underlines this, as it reminds us there are a greater percentage of older children in care than previously, and those above school leaving age now make up a substantial minority. “Transitions become increasingly important, including access to adult services (Stein and Munro, 2008)”.10 The focus on youth in transition Transitions RTC planned to establish a residential service offering treatment and transitional support for 16-25 year olds with drug/alcohol and associated addictive behaviour.
This would be unique in the UK and there were 2 key reasons why we decided to go for young people aged 16 -25, rather than focusing exclusively on under 18s. One was simply practical and the other was in recognition of the identified needs of this group and lack of service provision. In order to work 7 Drug Strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life. HM Government. 2010.
Drugscope. Young people’s drug and alcohol treatment at the crossroads: what it’s for, where it’s at 8 and how to make it even better [Online]. Available at http://www.drugscope.org.uk/Resources/ Drugscope/Documents/PDF/Publications/YoungPeopleCrossroadsReport.pdf (accessed on 25 th May 2012).
Mental illness, Offending and Substance Misuse leaflet. Royal College of Psychiatrists (2012).
9 http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/mentalillness,offendingand.aspx Hertfordshire Drugs Strategy Plan for 2012-2015.
10 11 Living in Children's residential homes. Research Report. David Berridge, Nina Biehal, Lorna Henry. March 2012.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/184079/DFE-RR201.pdf with young people under 16 years of age, Transitions would have needed to be registered with Ofsted as an education provider. This was felt to be too time consuming for a small charity trying to pioneer a new approach to young people’s rehabilitation.
The level of demand for this type of specialist service for under-16s was unclear, whereas research has clearly demonstrated reasons to approach young people in transition to adulthood as a distinct group with unique needs concerning substance misuse. There is a clear need for this type of service especially for care-leavers, young offenders, homeless young people and young adults, and other adolescents who need an intensive package of treatment and support.
Despite the clear evidence for providing a specialist service to this age group, it is fraught with complexities.
While 16-25 year olds with drug/alcohol problems and addictive behaviour clearly need relevant treatment, probably only a relatively small percentage require residential treatment.
This age group is also not renowned for engaging in abstinence based services, which residential rehabilitation is by necessity.
Of those who would benefit from a service like Transitions, it is likely that a significant proportion would be presenting with a dual diagnosis ie. a mental health and substance misuse problem.
Statutory services would not consider placing under-18s in the same building as over-18s, due to safeguarding concerns, namely the risk posed to vulnerable young people by older residents.
However, none of these potential obstacles were insurmountable, and when a local family offered their home for us to pilot the project we felt this was an adventure God was leading us on.
Vision, Mission, Aims & Values We spent the first year building our team and agreeing our vision, mission, aims and values, while we considered the next steps necessary to set up Transitions and explored different legal organisational structures.
Our Vision is:
“A Residential Therapeutic Community for young people aged 16-25 with drug/alcohol problems and other associated addictive behavioural issues.”
Our Mission is:
“Transitions RTC” is about journeying with young people to support them, in adolescence, making the transition to a life free from addictive behaviours through spiritual transformation, personal development and growth, discovering their purpose and experiencing fun and freedom.
Our mission is inspired by the story of the success of a group of dispossessed homeless people, crossing the Jordan river, making the transition to the promised land and learning to live life God’s way.
We Aim to be:
Residential Therapeutic Community-focussed Appropriate primarily for 16-21 year olds.
Serving young people primarily from the home-counties and London A progressive, responsive and abstinence-based programme.
Accommodating young people of both genders – initially we will provide for whichever gender is least catered for.
A spiritual Christian response.