Template for Good Practice Case Study

Name of project

“RAPID’s contribution to addressing the challenges of addiction in County Louth”

General aim of project

To work in collaboration with service providers, families and individuals at risk of drugs and alcohol misuse and to do so in the context of the five pillars of the National Drugs Strategy - Prevention, Treatment, Rehabilitation, Supply & Reduction, Research and Information.

What theme is it under?

Activity crosscuts all RAPID Strategic Themes; Community safety/Physical Environment Improvement Scheme; Health /Family Support; Training & Employment; Education and including youth.

How did the project come about (origins, rationale)

The Local Authority as lead agent and working under the auspices of the social inclusion agenda of the RAPID programmes identified the issues of alcohol and substance misuse as contributory factors to ongoing Anti Social Behaviour, criminal damage and family disruption. Based on this evidence and given the geographical location of two large urban areas within County Louth, Drug Advisory groups /networks were established. The RAPID programme was identified by the Local authority as secretariat and facilitator of these groups. The Dundalk Drugs Advisory group was established in 2006 and the Drogheda Drugs Addiction Network came into being in 2009. Although both structures have a similar terms of reference there are variations in emphasis. The membership of these structures is made up of statutory voluntary/community organisations and public representatives.

Statement /clarification of the problem/need/issue

From 2001- 2006, County Louth was reported to have the highest average incidence of new cases presenting for drug treatment (Reynolds et al., 2007). It was agreed that we needed to tackle this issue and look at “What” the current level of service provision was in the urban areas; “Who” were the providers and “How” they were impacting on the service user, their families and the wider community. The Issue - A large numbers of young people from Louth RAPID areas were presenting with addiction issues thus the need for more interagency cooperation on the subject of addiction at local level. For example there were:

 Significant levels of substance misuse (cannabis/alcohol) among young people e.g. 16-25 year olds (80%) accessing Local Training Initiatives  Problem of alcohol and cannabis use among youth those accessing the Garda Diversionary Projects  Impact on families living with addiction

1  Peer Pressure from young people themselves for drugs/alcohol free facilities  Drogheda had the highest waiting list in the County for methadone services  ASB linked to alcohol/drug consumption  Numbers of young people from the urban areas are in prison on drugs/alcohol related issues  Extensive waiting list in Louth RAPID areas for harm reduction services  Low investment of main stream resources  Lack of information in the community about existing resources and mechanisms for referrals  Need for greater engagement with General Practitioners

Structure for response

The Drogheda Drugs Advisory Network (DDAN) and Dundalk Drugs Action Group (DDAG) were endorsed by their respective Area Implementation Teams and their Councils. Memberships of the groups were drawn from the cross cutting themes together with additional expertise in the addiction field to advise and develop a co-ordinated response to alcohol and substance misuse.

Dundalk Initially the Dundalk Drugs Advisory Group (sub structure of AIT under the Health & Family support theme) hosted a half day seminar on drugs misuse. This event provided for information/awareness locally and identified a number of key actions under the five pillars. This was followed by a commissioned piece of local research concerning drug misuse in Dundalk by Queens University’s School of Sociology, Belfast, from which 15 recommendations were identified. DDAG reviewed the recommendations and prioritised six actions to form their plan for 2009 -2013. Following the review the DDAG changed their name to focus on actions rather than as an advisory body.

Its membership is made up of 8 members from the community/voluntary sector, 4 public reps, 2 Local authority officials, 1 Garda Drug Squad rep., 2 HSE personnel, 1 NERDTF rep. and 1 service user. From time to time the DAG co-opts additional expertise to progress actions as per specialism. In 2009, 5 working groups were formed to progress the six priority actions identified.

Drogheda

The Drogheda Drugs Advisory Network conducted an audit of local area addiction services and supports including those in the Community sector. The Network with the support of DBC (Drogheda Borough Council) identified what funding had been allocated by the HSE for addiction services in the Region (€760,000).The NERDTF (North Eastern Regional Drugs Task Force) funding allocation is public knowledge. (1.1m) The approximate numbers on waiting lists for methadone treatment, the number of GPs involved in this service and the numbers of detox facilities with their linked referral processes were recorded. The Network also looked at the existing levels of support for families experiencing addiction. On the basis of this information the focus for the short-medium term was agreed. The membership of the DDAN includes NERDTF, Peer Youth Education, local Coordinator of the Strengthening

2 Families Programme, the School Completion Coordinator and Home School Community Liason Coordinator, An Garda Siochana, Drogheda Youth Development, the two Garda Diversion project Coordinators, the NERDTF, Homeless Aid reps., Acts of Compassion Rep., Pillar Family Support, Local Community Drugs and Alcohol Team, HSE Outreach Counselling Rep., Drogheda Community Drugs & Alcohol Forum and Councillors.

What is their interest in the project

Dundalk Drugs Action Group & Drogheda Drugs Advisory Network were established to provide a coordinated response to the addiction issue thus facilitating better networking and information exchange as well as providing a platform to improve the resources available. It was agreed that the work of both groups should proceed in consultation with those working within the addictions field, allied professionals and community activists.

Role and linkage if any with LDC In Drogheda

The Louth Community Development Company formerly Drogheda Partnership had a remit around the addiction issue up until 2008 as part of the community development programme. In 2003 they conducted a literature review highlighting the addiction problem in RAPID estates. Concurrently the Area Implementation Team (AIT) through the community reps had been promoting training and awareness of the addiction issue by encouraging participation in a range of training organised by Drogheda Community Services Centre and the NUI Addiction Studies Certificate courses held in Drogheda. Once the remit for addiction was transferred to the NERDTF the Partnership was no longer directly involved. As the AIT became more engaged in supporting initiatives locally it was agreed via the Community Safety Sub-Group that there was a need for greater coordination thus the formation of DDAN. Also since 2004 Drogheda Partnership now the Louth Community Development Programme has provided resources to assist with community training targeting at risk young males. In 2011 the Strengthening Families Programme in Drogheda was jointly funded by LCDP and RAPID. Presently the linkage is participation on the Area Implementation Team and LCDP representation on three critical sub groups namely Health, Family Support and the Strengthening Families Steering Group.

Dundalk

Currently, apart from reporting at the Area Implementation Team there is no linkage with the Local Development Company. Previously they assisted in part payment of the Queens Research and allocated some funding to the group in 2009 to run a small grants scheme for frontline services in Dundalk RAPID areas to address the drugs issue. They also had a representative on the committee but no longer do so.

Leadership , role and contribution of each partner

Leadership is provided through independently appointed chairpersons of the groups. The RAPID co-ordinators administer and facilitate the monthly meetings. The RAPID co-

3 ordinators also maintain the links with the relevant stakeholders around the timely implementation of specific actions and provide progress reports.

The Community & Voluntary representatives

 Bring expertise and knowledge of substance misuse in their locality  Contribute to the work plans and provide feedback to the wider community  Provide linkage with the various fellowships, Alcoholics Anonymous, Narcotics Anonymous, and Gamblers Anonymous  Assist in the development of policies and services in the areas based on that experience  Provide experience around support for families touched by addiction

Public representatives

 Bring to the group their knowledge of the communities and localities they represent  Consult with the communities they represent and bring their views to the work of the action group  Win support for the agreed actions, including the various projects and policies, both with other public representatives and the wider community  Bring formality to decisions and influence policy

Statutory representatives

 Are proactive in assisting the work of both groups and bring relevant information from their agencies of any change in services  Assist in the development of appropriate responses to substance misuse in the Drogheda/Dundalk area  Identify and inform their agencies of proposed changes that need to be made to their policies and practices  Inform on appropriate strategies to address the impact of addiction on families

Other representatives/Guest presenters

 Assist in ensuring co-ordination and co-operation between their organisations on specific actions/aspects of the group work plans.  Keep the groups informed of their strategies to address substance misuse and social inclusion issues and to inform their organisations of the work of the groups.

Process of engaging with relevant agencies and establishing common ground (vision)

Drogheda The Drogheda Drugs Advisory Network was assembled by the RAPID Coordinator and at a meeting of agencies, volunteers and Elected Members a Terms of Reference was agreed. A

4 Councillor took a motion to Council endorsing the Network. Following several meetings and on the basis of data presented a short-medium term affordable plan was agreed. The emphasis is on families, family support, prevention, harm reduction, education and awareness including frontline staff. The objective is to raise awareness of the problem and its consequences and give hope that there are supports available.

Dundalk As Dundalk Drug Action Group has Public reps, statutory, voluntary/community sections represented at their monthly meeting. The process of engagement around the identified actions was not difficult to progress. The group strategically linked the local development of these actions to key indicators nationally, where possible. The report from Queens as previously mentioned was the spring board from which some of actions were achieved. Action 1- To invite a Service User on to the membership of the group & source training supports for service user and training for DDAG (Recommendation 15) Completed Action 2- Progress a Local Community Alcohol detox service (completed) and a Regionally Residential Detox/rehabilitation Centre within the Urban Vision/Mount avenue plans(Regeneration area of Dundalk) (Recommendation 6) Action 3-The Training of frontline Staff that addresses attitudes of people towards those who are addicted or dependent on drugs (Recommendation 10) Action 4- The Identification of G.P’s – (Recommendations 11 & 12, rolled into one priority). Action 5- Progress Targeted specific actions, Taxi services, licensed premises, explore drug free estates/”Drug Watch areas” (under the supply and reduction pillar) Action 6- The Introduction of Harm Reduction measures in Dundalk and the provision of Outreach support and further development of the Family Support initiatives for family members to access (Recommendation 13) Completed

Planning process Both groups prioritised key actions with Dundalk Drug Action Group taking the above 6 key actions from the Queen’s research report, five working groups were formed to implement.

General Description of the project Who exactly are you targeting and reaching?  Individual Service users with a drug dependency and their Families  Individuals with an alcohol dependency  General practitioners and practice nurses, Public Health Nurses  Frontline service providers E.g.: Pharmacy staff/ Housing staff, schools etc.  Drug suppliers and their associates through the Garda Drug Squad  Youth at risk of either becoming addiction dependent or who are already alcohol /cannabis users  Families and individuals experiencing the harmful impact of addition.  Schools to raise awareness of addiction issues

5 Outline the key elements of response to the need(s)

Drogheda key elements of response Awareness & Prevention: The DDAN focuses on prevention of addiction and while this process has been ongoing since 2003 it has become more targeted at youth at risk through the existing service providers with direct access to young people. By engaging with young people and their representatives it became clear that for some teens alcohol consumption is considered a norm and the progression is on to cannabis and heroin. In the Family Support Sub Group discussions are under way to begin parental awareness education at pre-school through the families/parents located in RAPID areas.

The DDAN has responded to the issue by supporting one to one and small group work undertaken in the Diversionary Projects. Also training has been delivered to frontline staff working directly with families and young people. RAPID also serves as a conduit for resources from the County Development Board, Drogheda Borough Council and access to free counselling services. Each partner within the Network focuses on what they can do to address the agreed actions. An audit of services was completed in 2011 and will continue to be updated and circulated. An open afternoon was held in 2011 followed by an evening seminar which was accredited by the Council of General Practitioners. The accreditation required the endorsement of GPs locally and while only two practices attended the seminar several contacted with apologies which is progress. GPs are the first line of contact for families and they are critical to the delivery of the methadone treatment service. The Network supports the Local Community Drugs and Alcohol Team which began in 2010. Funding was allocated for the development of their website for training for service users.

Harm Reduction Strategy Harm reduction approach is used by the LCDAT (Louth Drugs and Alcohol Team) to reduce harm to the individual, family and community at large. It was introduced in response to calls from service users in Drogheda.

The Louth Drugs and Alcohol Team successfully collaborated with the Ana Liffey project to bring an outreach needle exchange initiative to Drogheda which was subsequently rolled out in Dundalk and the rest of the region.

Diversionary Activities

Providing young people with alternative outlets is an established approach. The FRC, CABLE, Boyne, Lourdes Community Recreation Centre, Community House Network and Southside Youth all work to provide alternatives for young people. Louth LEADER Partnership funds Summer Projects in RAPID areas. It has taken several years to build trust in the RAPID estates in Drogheda on the sensitive issue of addiction but this is now well established with very strong links between the RAPID programme, An Garda Siochana, Tenant Liaison and Anti social behaviour investigator. The Coordinator frequently takes confidential requests for assistance from individuals to pass on to the relevant agencies.

6 Parenting Supports

In Drogheda the Rapid Coordinator Chairs the SFP and acts as a parent facilitator over the 14 weeks of the training with the support of Drogheda Borough Council. Also with resources from the RAPID Community Support Budget the network supported a post-Strengthening Families initiative targeting vulnerable families resident in RAPID estates. Discussion on how to develop this further is now on the agenda.

Relationships developed within the Network have opened doors to pro bono counselling for individuals looking for assistance.

Dundalk Key elements of Response Through our research, we saw the need was greatest within the RAPID areas and local authority estates. Our response has taken a three pronged approach concentrating on those areas in particular.

I. Identifying Gaps This was a need to develop better co-ordinated addiction services response within the Dundalk RAPID areas and Dundalk Town. DDAG developed terms of reference for local research to be carried out concerning misuse of drugs. This research was funded through the RAPID support budget and the Local partnership company.The research focused on people’s observations of the nature of drug misuse within the community, people’s experiences with local drug and addiction services, pharmacies and general practitioners, and the extent and nature of gaps in service delivery.

II. The development of appropriate responses The conclusion of the researched resulted in 15 recommendations; DDAG reviewed these recommendations and prioritised 6 key actions as outlined above. A community alcohol detox service was established as a national pilot site and opened its service in November 2011. This pilot will run to December 2012 and on evaluation if successful, it is envisaged to further develop the model to include other drugs including opiates. Currently, it allows individuals dependent on alcohol to detoxify using a number of methods including pharmacology and psychosocial interventions, harm reduction techniques supported by a range of wrap-around services e.g. counselling, aftercare, housing advice and training opportunities. In this regard effective multi-agency working is essential. The Introduction of Harm Reduction measures and the provision of Outreach support and further development of the Family Support. The needle exchange service is aimed at reducing the incidences of harm for injecting heroine users, it is provided one day per week out on the street (RAPID/LA Estates) at designated locations and at two clinics held in the HSE addiction services and the Simon community. It is supported by members of DDAG and a reporting mechanism has been established through the Social forum of the County Development Board.

7 Drug Outreach and signposting services- This service was established in the RAPID area of Cox’s Demesne during 2011, as a direct result of the growing needs of service users and their families to engage with a support service in their own communities. This is currently a support for substance misusers and their families within the community to access the treatment services, both locally and nationally and includes the psycho-social interventions. Community Addictions Links worker Role- This service was established to provide valuable information/sign posting and advocacy service to substance misusers and their families within the community in the Dundalk RAPID areas specifically. The role will compliment and feed directly into the Drug Outreach worker service. Family support initiatives- having identified the need for family support services, the RCO along with a member organisation has established a weekly Friday morning Family Support Group, who have been meeting for the past two years and are now accessing training for trainers so they can continue with their group and expand into their own communities. A gender specific support group, an Al-Ateen group and a Narcotics Anonymous mixed group was also established that meet weekly. Funding was secured through the Young people’s Facilities and Services fund for youths engaging with illicit substances to access counselling sessions- (as a direct result of the Head shops)

III. To improve the resources available- to enable a co-ordinated response to drug misuse DDAG and the DDAN are the Local Authority’s response under the RAPID social inclusion programme to drugs misuse in the urban areas. As previously stated community/voluntary /statutory and public reps continue to come together and work on implementing the priority actions identified. One of the key projects that Dundalk Drug Action Group will focus on over 2012 is the provision of a regional residential /rehabilitation service located within the Dundalk area. Proposals are developed to look for a funding for a development worker and a residential facility. Cross border agencies (Co-operation and Working Together-CAWT) have been approached in this regard, currently, it is more than likely that the local authorities in Louth and Newry and Mourne will be the lead partners in this venture, so the project can gather momentum and attract the necessary funding. Training of frontline staff- the working group have developed this specific training on how to addresses attitudes of people towards those who are addicted or dependent on drugs. They are looking at how to fund and roll out the training course in 2012, to key frontline staff in the private/statutory/community sectors.

Outline lessons learned from an agency perspective and from a Rapid perspective. Why did it work? What aspects did not work well? If you were doing it again what would you change? And why?  More interagency collaboration and greater accountability around service provision in RAPID areas.  Relationships have been strengthened between the statutory agencies and other key service providers at local and regional level. Uniquely the RAPID Coordinators in the Region now participate in the meetings of the North Eastern Regional Drugs Task Force on a rota basis.  Engagement with GPs is evolving and will continue to be progressed  Since the economic downturn staff is constantly changing in the HSE addiction services .This is challenging not only for interagency collaboration but more specifically for the service user.

8  Member organisations have an opportunity to learn about the statutory service provision and vice versa.

What are the demonstrable outcomes and impacts for Individuals/Community/Agencies

Drogheda Outcomes/Impacts

The DDAN set up late in 2009 and was formally endorsed in 2010 it is now gaining momentum and while each partner organisation continues to deliver their services, the Network provides the mechanism for collaboration. Considerable work has been done via the Drogheda RAPID programme since 2001 on the addiction theme and the Network is building on this work.  120 people participated between 2002-2009 in NUI Addiction Certificate courses including a number of RAPID area residents and future service providers across the Region  Seminars in 2004 and 2007 with the 2007 being hosted by young people  2009- 2011 Louth wide recruitment to the Louth Community Addiction Studies programme.  Support recruitment to the Community addiction Studies Course in Drogheda Community Service Centre.  Individuals are receiving one to one support through the projects due to contact made within the Network or as a consequence of training funded by the RAPID programme.  LDAT through the Needle Exchange Programme has accessed 29 individuals  Targeted Group training was delivered to youth at risk in the diversionary projects  Peer Youth Education commenced in Drogheda schools in 2008 and in 2009 the Network via RAPID successfully accessed funding to continue the work  Peer Education Training in community was built into the work of Drogheda Youth Development.  2009 Dormant Accounts funding provided resources for community based Peer Education  Audit of services 2011  Open day and Seminar 2011  9 Families and 14 youths involved in 14 weeks training SFP with a further 9 referrals for the 2012 programme  8 Families involved in Coaching For Coping Pilot –funded Community Support Budget  Accreditation from Irish Council GPs for professional development of GPs attending seminars  29 clients have accessed the new harm reduction/needle exchange service  URRUS staff training to agencies and frontline staff on the subject of addiction 2009  Trust has grown between residents, ASB Unit and An Garda Síochána

Dundalk Outcomes/Impacts

 New services have been established in the Dundalk Urban area as a result of DDAG  The community addictions studies course was developed by URRUS(Irish for "strength" or "confidence), a Ballymun Youth Action Project and continues to roll out annually, in 2010- 2011 course, Over 120 candidates attended for interview and 25 places were offered, 24

9 completed the course, to date since its roll out in Louth 75 participants have completed the course.  Improved access for services users in Dundalk to key new services- outreach services, community alcohol detox and needle exchange services  New and improved family support initiatives were developed  GP interventions continue to be made in order to encourage engagement in the Dundalk Methadone programme.  Frontline service providers work is supported and promoted through DDAG who ran a small grants fund in 2009 (€20,000 in total from Local Development Company)  Positive engagement with service users and the Statutory/community/voluntary service providers continues and allows for collaboration on actions  Awareness is raised on addiction issues among other statutory providers whom are not currently members of DDAG.  Dundalk Drug Action Group have recently had a budget line agreed by Dundalk Town Council in their annual financial report  A mechanism for referral for those in recovery from drug misuse wishing to avail of FAS services has being devised and referrals can be made through the North Eastern Regional Drugs Task Force and DDAG.

Draw on the aspects of Service Integration or service improvement within the project. Describe the level of collaboration /partnership, benefits of pooling contributions, resources and roles.  Services coming together and working to address the issue of addiction.  There is now greater recognition of the addiction issue and it cross sectoral impact.  Stronger ties between the service providers and Local Authorities in the two urban areas.  Secondary Schools in Dundalk and Drogheda are actively promoting addiction awareness throughout the Urban areas  Highlighting the extent of the problem to Oireachtas members and Local Councillors through the work of both groups.  Elected reps and officials of Louth Local Authorities are more familiar with the problem of addiction and its impact on families and the wider community.  There is less duplication of service provision  Regional, cross border and local networking opportunities have arisen for service providers when introducing new services e.g. needle exchange  Participation of service users on both groups allows for less jargon and keeps discussions real  It can create an opportunity to report on progress across all the linked sub-groups of the AIT  Resource trained youth workers to deliver outreach peer education to targeted young people  RAPID Co-ordinators attend Regional Drugs Task Force Meetings

10 How does this project fulfil the Rapid objectives? What key outcome elements of RAPID does it achieve :

Use of existing services and resources to collectively target the problem –The DDAG and DDAN build on the work of existing service providers and they advocate the development of a co-ordinated and integrated response to issue of substance misuse. They have identified gaps in service provision having regard to evidence available on the extent and specific location of substance misuse and used the expertise and resources within the group to target and implement specific actions

 Promotion of existing services -Promoting the existing statutory/community/voluntary services and signposting service users and their families to these services is part of role of the DDAG & DDAN. As a result of close collaboration within the membership of the both groups, participants have become more aware of the existing services available and the potential for further progress. In Dundalk, the outreach worker and community addiction links worker fulfil this role; both roles are embedded within the Dundalk RAPID areas  Improvements in existing service provision- The interagency collaboration within the groups has resulted in the development of new services in both towns. Access has significantly improved to addiction, family support and detox services locally. The provision and promotion of the needle exchange service, the Strengthening Families programme, and the alcohol detox facility and family support interventions means more service users are accessing these new measures and are being linked into services they require.  Improvements in community or agency participation - The activities undertaken in both areas to date reflect the identified needs of the areas and depend on the co-operation of the existing service providers. Both groups have benefitted as the right people were around the table which was important in being able to overcome the many challenges encountered in rolling out the actions and ensuring that the maximum benefit of the service provision could be availed of by the service users and their families. The issue of addiction is now out in the open, and as a consequence of cooperation and interagency collaboration access and linkage to services has been improved. The learning will continue allowing for its adaptation when changes/improvements are required on the actions.

Outreach Services in Cox’s Demesne RAPID area

Case Study

The Client is a 21 year old male who has been using benzodiazepines for about six years. An example of his current use is 5-15 Valium (D10’s) per day. Client also smokes cannabis daily but does not drink alcohol. He started using drugs when he was 11 years old and began with cannabis. Client smoked heroin for about 1 year up until 6 months ago but has had no heroin use since. He has support from his mother and brother. He also works closely with a

11 community project key worker at “The House”, Youth and community project, in the Cox’s Demesne RAPID area.

Client was referred into outreach support at “the House” and has been working with the Outreach Support Worker to reduce his use of benzos and reduce his risk. Client has been informed and is interested in a community approach to benzo detoxification and this has been discussed with a representative from NERDTF and his G.P.

For further information please contact:

Valerie Artherton, Drogheda RAPID Co-ordinator:, 086 – 9272015, [email protected]

Paula Gribben, Dundalk RAPID Co-ordinator: 086 -0492339, [email protected]

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