Recovery in Nottingham (RiN)
Delivering visible drug recovery in Nottingham
Recovery in Nottingham (RiN) is an innovative consortium of local organisations that have come together to deliver an integrated drug treatment system and recovery pathway for Nottingham.
The consortium, driven by the RiN Partnership Board, comprises experienced and specialist health and social care providers with a proven track record of delivery.
The service is the central component of a treatment system which aims to achieve sustained recovery from all types of drug misuse for individuals through the provision of fully integrated,
personalised and evidence based treatment and re-integration.
The consortium consists of:
Nottinghamshire Healthcare NHS Trust - positive about providing integrated healthcare services, including substance misuse, mental health, learning disability and physical health services.
Double Impact who have provided recovery focused substance misuse interventions and aftercare since 1988.
BAC-IN a local BME and peer led culturally specific, recovery focused drug and alcohol service.
Framework Housing Association (FHA) deliver housing, support, drug and alcohol treatment, training, care and resettlement services to homeless and vulnerable people.
Recovery in Nottingham offers a fully integrated and seamless recovery focused pathway for drug users.
The service is delivered to service users that are:
- Using drugs
- Aged 18 years and over
- Residents of Nottingham City or those residing outside Nottingham City that are registered with a Nottingham City GP
The Access Team are the ‘front door’ of RiN and are the single point of access to drug treatment for all drug users. The Access team has many ‘doors’ ensuring maximum engagement. They are based at Broad Street but work across a variety of outreach settings targeting ‘hard to reach groups’. They carry out the initial assessment of clients entering treatment, providing harm reduction advice and brief interventions, engaging the client in treatment and linking in with the coordination of recovery.
Drug use trends are changing rapidly at the moment and the Access Team keep up to date with what is happening locally and nationally. This ensures that the harm reduction advice is relevant and pragmatic and based on the clients lifestyle and drug use.
Recovery Coordinators and Recovery Workers
Recovery Coordinators provide additional support for a person throughout their treatment journey from the start of recovery through to aftercare. All service users have treatment plans that involve therapeutic interventions. Recovery capital is built up through the function of recovery coordination, utilising recovery plans.
Recovery plans are tailored to the individual and can include housing advice, access to groups, and 1:1 sessions in addition to drug treatment.
Housing Specialist Advisor
There are three surgeries a week at The RiN on Tuesdays, Wednesday and Fridays 2pm – 3pm.
The RiN Treatment Team (Non-Complex)
The treatment team manage the medico-psychosocial treatment for those clients that have problematic substance misuse overseen by a Consultant Addiction Psychiatrist. A clinical assessment takes place by a skilled clinician and a treatment plan is drawn up together with the clients. Service Users are booked in with a prescriber who agrees the medication and treatment plan; this may be an independent non-medical prescriber (NMP) who can initiate treatment where complexities do not exist. A meeting is held weekly where the Consultant Addiction Psychiatrist, NMP, clinicians and recovery coordinators meet to discuss new patients and their treatment needs thereby ensuring governance and good practice.
The RiN Treatment Team (Shared Care)
The Shared care team manage approximately 500 clients within the community in a variety of settings including GP practice and satellite services. Clinical staff and GPwSI utilise the expertise of a Consultant Addiction Psychiatrist within RiN in cases that are particularly complex and refer clients into the Treatment Team (complex) where necessary. Increasing numbers of complex clients are managed in shared care especially where GPwSI are experienced in working with the client group.
The Shared Care staff are experienced in managing prescription issues, safeguarding and liaison with partner agencies. The staff team are expected to make clinical decisions in terms of prescription alterations with the clients that are seen in shared care and then that care is agreed in liaison with the GPwSI. GPwSI’s being able to trust the staff team is essential to the smooth running of Shared Care service.
Additional recovery coordination is utilised to support GPwSI’s, clinician’s and patients in Shared Care to improve the recovery outcomes for service users. Locality work is important to the RiN as it improves engagement whilst offering service user choice.
The RiN Treatment Team (Complex)
The criteria for the Complex Needs Service (CNS) within the Treatment Team are service users deemed to have issues relating to:
- Safeguarding issues including open child protection ICPC cases, pregnancy or domestic violence
- Complex prescribing, requested anything other than Methadone or Buprenorphine (Subutex)
- Mental health issues/problems. Not meeting formal psychiatric thresholds but still exhibiting mental health problems. Possible needing medication for mental health.
- Significant alcohol problems – drinking large quantities or binges in addition to drug taking
- Significant health problems – pain related, major health issues, epilepsy, diabetes etc.
Individuals with complex needs receive a comprehensive package of care. Recovery coordination is integrated into the treatment teams as recovery support needs are identified. Care plans are enhanced by recovery focused interventions.
The treatment team is particularly interested in the growing complexity of long term service users. Addiction issues are increasingly complicated by mental health issues (particularly personality disorder) and physical health issues (particularly pain complications). The Consultant Addiction Psychiatrists involvement enables the Treatment Team to treat those conditions whilst also managing the addiction element. How best to address ‘multiple morbidity’ is an on-going challenge.
Managing complex service users within addiction is harm reduction led. Recovery will often necessitate long periods of harm reduction prior to full or partial recovery.
Recovery Group Programme
Cannabis has become an increasingly problematic drug in recent years, and a cannabis group could be a useful tool to help to support clients on their journey to recovery.
‘Do you smoke cannabis to avoid dealing with problems?’
‘Do you plan your life around cannabis use?’
The group meets every Saturday, 12 noon to 1pm, at The Recovery Centre.
It is important for women, who are on their journey to recovery to have a safe environment where they can talk about their issues and their journey. The women’s group meets once a week and the worker has built up a strong rapport with the group, which has enabled the women to improve their confidence, self-esteem and reduce isolation. Group discussions have included areas such as what do you want from recovery? Discussions also include, reducing anxiety levels as well as confidence building discussions. These are topics that the women have identified themselves and a female team member always leads the group.
The men’s group meets once a week. The men identify the topics for discussion and these have included self worth and self esteem, health and hygiene and building self confidence and resilience. It is important to allow men a safe space to talk about issues that may be causing them concern. A male Recovery worker always leads this group.
Treatment Exit group (Text)
The TEXT service is a project designed to support clients who are seeking to address their dependencies to substitute prescriptions, such as Methadone and Buprenorphine (Subutex). This is achieved through a process of weekly, facilitated peer support sessions, and a structured programme of workshops which are designed to increase awareness, provide relevant information, and lead to sustainable changes in perception and behaviours.
Aims of the group;
To reduce the amount of clients who become trapped in long-term dependency to substitute prescriptions.
To aid in breaking the cycle of clients’ long-term dependency on treatment agencies, cultivating an atmosphere of recovery, independence, and positive expectations in the future.
To provide a safe, conducive setting where clients are able to state their needs and goals, and begin working towards meeting them.
To offer clear, current, closely supported pathways for clients through the process of prescription reduction; becoming substance free; integration into the aftercare service; participation in education, training, workshops and volunteering; securing domiciliary stability if necessary; increasing employment possibilities and potential, leading to reintegration into mainstream society.
To train clients who progress through the project into peer mentor positions, gaining them the qualifications and experience required to be able to participate in the facilitation of the Text service.
To provide a peer-led environment, encouraging identification between clients who have experienced the journey through becoming prescription-free and those who are looking for models of success to aspire to. Also, the visibility of clients who have progressed through the project helping to foster an atmosphere of trust in the process.
The TEXT service achieves these goals by working in close liaison with the relevant external agencies, especially the prescribers of individual clients, ensuring a consistent, extensive support framework, and that all advice and information offered to clients runs in parallel, and avoids conflicting with the medical advice given by the statutory agency concerned.
Full assessments are conducted on initial appointments, and extensive, relevant care-plans are devised by the client, covering all areas of support highlighted by the client. These range from: substance use, housing, mental/physical health, criminal justice support, benefits/debt/welfare advice, etc. Care-plans are reviewed every four weeks to ensure needs are being met, and the response to changing needs is prompt and effective).
The Peer Support group is a mutual support group where service users talk about whatever issues they are currently facing and receive feedback from their peers. It is a forum for shared experience and support around substance use issues but also day to day issues, struggles and successes. As a group they use some simple strategies, in the form of worksheets and discussion to support change, motivation and management of difficult feelings.
The group find they can open up and discuss sensitive issues among their peers and with a facilitator who is in recovery.
Group members describe the group as “a safe place to talk about drug problems, a way of getting structure in their lives, somewhere to interact with others, an alternative to using drugs and somewhere to get some positivity in their lives.”
Poetry/creative writing group
The creative writing group will be regular 1hour and 30 minute session designed with the intention of providing a safe and stimulating space for those individuals who are interested in exploring their creativity through the use of creative writing exercises. The session will be facilitated to ensure that exercises are delivered safely, and that the remit of the group is adhered to and all attendees are assured a duty of care. Each group session will be designed to meet the specific requirements of the individuals attending – taking into consideration levels and standards of written English and also the capacity to engage of the attendees. It is intended to be a creative session with the focus on engaging the imagination, rather than a focus on the academic aspect. This also ensures that anyone of any written standard can attend the group. The use of creative writing within a recovery setting is a great tool for encouraging self expression, building confidence, self esteem, offering an on going interest or activity, enhances social skills, personal awareness, and also harnesses those resourceful, imaginative faculties that are incredibly useful for any person who is beginning or continuing a process of reimagining their lives and their futures.
RiN Aftercare is a service for Adults who have experienced problematic alcohol and drug use and are ready to make lifestyle changes. This is a service for individuals who are stable and no longer using illicit drugs. The team is made up of Recovery Co-ordinators, Peer Support Workers and Peer Mentors either working towards or already professionally qualified to FDAP standards (Federation of drug and alcohol professionals).
The service provision has a Recovery and Re-integration focus offering accredited training, relapse prevention, complimentary therapies, peer support, peer mentoring, community work placement programmes, and access to self help programmes such as SMART, AA and NA. Additional help is available in the informal meeting area “Open access”, a community setting for like minded individuals.
Aftercare conduct a comprehensive assessment of where you are to identify goals and ambitions in your recovery. From here a bespoke care pathway and plan will be developed and the appropriate support put in place to enable you achieve this purpose.
Gender specific men’s/women’s group
Job support Group
Dealing with Change group
Eating disorder/ body image group / health and nutrition
Drugs awareness /alcohol awareness (Accredited courses)
Peer Support Group
Mentoring (Accredited Courses) + Practical work placement
Mentoring training (non accredited)
Emotional management/building confidence group (Accredited course)
Evening Groups (self Help)
BBV Support Group
Aftercare Group (Step Ahead & Horizons)
Smart Recovery Group
AA (Step Group)
Weekend Courses (Self Help)
Social activities Self help group (Both Saturday and Sunday) – Relatively new
Evening and weekend groups are all self help. All groups are well attended. The opening of the building is supported by staff members.
We also make available a study room at all times including evening and weekends to help support clients doing accredited courses.
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