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What Enhances the Formation of Social Bonds & Facilitates Better Engagement & Retention in an Addiction Service?

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What Enhances the Formation of Social Bonds & Facilitates Better Engagement & Retention in an Addiction Service? What enhances the formation of social bonds & facilitates better engagement & retention in an addiction service? Dr. Gerard Moore, Mr. Daniel Phelan, Dr. Rita Glover, Dr. Catherine McGonagle and Ms. Clódagh O’Sullivan Acknowledgements The authors wish to acknowledge The support and assistance of the staff of the STAR Project Ballymun in the conducting of this research. Information on the STAR project is available at www.starballymun.ie The participation and contribution of service users and staff for their participation in the observation phase, as well as the focus groups and interviews. The Irish Research Council, for funding this research project and without whom none of this would have been possible. The research was undertaken between May 2018 and November 2018. The findings are as a result of a research collaboration between Dr. Gerard Moore, Mr. Daniel Phelan, Dr. Rita Glover and Dr. Catherine McGonagle of the Dublin City University (DCU) School of Nursing and Human Sciences, Ms. Clódagh O'Sullivan of St. Vincent's Hospital, Dublin 3 and the staff and service users of the STAR Project Ballymun. The contact details of the researchers are listed below: Dr. Gerard Moore: [email protected] Mr. Daniel Phelan: [email protected] Dr. Rita Glover: [email protected] Dr. Catherine McGonagle: [email protected] Ms. Clódagh O'Sullivan: [email protected] 2 Contents Executive Summary ................................................................................................................... 5 Introduction ................................................................................................................................ 9 STAR ......................................................................................................................................... 9 Literature Review..................................................................................................................... 14 Addiction .............................................................................................................................. 14 Social Bond .......................................................................................................................... 16 Group Treatment .................................................................................................................. 18 Therapeutic Relationship...................................................................................................... 20 Retention ........................................................................................................................... 23 Engagement ...................................................................................................................... 24 Therapist Differences ....................................................................................................... 25 Connection ........................................................................................................................ 26 Empathy ............................................................................................................................ 26 Trust .................................................................................................................................. 27 Personal Therapist Attributes and Techniques ................................................................. 28 Ruptures in the Alliance ................................................................................................... 29 Therapist actions which help and hinder the relationship ................................................ 29 Service user Factors .......................................................................................................... 30 Factors which may harm the relationship ......................................................................... 32 Difficulties in the relationship .......................................................................................... 34 Conclusion ............................................................................................................................ 35 Methodology ............................................................................................................................ 36 Findings.................................................................................................................................... 39 Philosophy ............................................................................................................................ 40 Therapeutic Alliance ............................................................................................................ 44 Cohesion ............................................................................................................................... 49 3 Safe Haven ........................................................................................................................... 56 Walking the Talk .................................................................................................................. 61 Social Bonds ......................................................................................................................... 68 Philosophy Trade-offs/Enhancing the Philosophy................................................................... 71 Trauma Informed Approach ................................................................................................. 71 Fostering Dependence .......................................................................................................... 73 Upskilling ............................................................................................................................. 75 Conclusion ............................................................................................................................... 77 References ................................................................................................................................ 78 Appendices ............................................................................................................................. 106 4 Executive Summary Purpose of the Study The purpose of the research was to explore if there are key skills that staff members at the STAR Project Ballymun use or particular ways that they relate to service users which help with the formation of social bonds, which in turn leads to increased levels of service user engagement and retention. This summary presents the main findings and recommendations. Data for the study was collected through a literature review, ethnographic observation, interviews and focus groups; this included 60 hours of observation, 17 individual interviews and 2 focus groups with staff and service users. Philosophical Position The findings showed that STAR is very successful at engaging and retaining service users and it is their ability to form strong social bonds which is the key to its success. This is achieved through the philosophy of the project which is made up of three central tenets: a non-punitive approach, person-centred care and trauma informed care. The person-centred care approach facilitates the formation of a partnership between staff and service users in which they work together to achieve personalised recovery goals unique to each individual service user. The non-punitive approach stipulates that service users are not punished or judged for having a relapse, which results in the reduction of shame and the promotion of honesty. This non-punitive stance is experienced by service users as facilitative to their recovery, with some participants reporting that this approach was less evident in other models of addiction treatment. Trauma Informed Care allows service users to seek appropriate treatment for any possible underlying issues they may have, allowing them to fully engage in the service. The three interrelated strands of STAR’s philosophy produce an approach to the treatment of substance misuse that is considered to be unique and different to many mainstream addiction models and provides a platform for the formation of social bonds. Therapeutic Alliance The philosophy also shapes therapeutic alliance, cohesion between service users, a safe environment and the staffs’ approach to service provision, each of which in turn aid the formation of social bonds. There was evidence of strong therapeutic alliances in the project and as a lone factor it has been shown to be a significant predictor of treatment adherence and 5 retention in substance abuse health care. The staff place a considerable focus on the formation of an early therapeutic alliance which has been shown to predict both service user engagement and post-treatment substance-use outcomes. They do this through adopting a personal, respectful and collaborative approach to formal interactions such as assessments, which has the added benefit of reducing anxiety. Staff also place an emphasis on building trust and a strong connection with service users which they achieve through maintaining a non-judgemental approach, promoting mutuality and actively listening to service user narratives and feedback. A Cohesive Group Group cohesion is the attachment of the service users to the group as a whole and has been identified as one of the most important therapeutic factors in group therapy; the data showed service users at STAR to be a united and cohesive group. Service users used phrases such as ‘no cliques’ and ‘family atmosphere’
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