Positive Practice Partnership - Developing Excellence in Family Recovery

UK evidence from services, workers and families

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CRAFT helps make significant savings on the public purse

March 2016

HOME OFFICE GRPHIC

PROPS North East and Positive Practice have gathered performance data on CRAFT programmes for a typical group of 32 carers. They were asked each time to score on a scale of one to 10 their understanding of substances, their relationships with the substance misuser and other family members, and how they viewed their own wellbeing. The data shows that on average  during a five-month period of intervention from an initial assessment to exit (as shown in the graphs below):

  • Conflict between the carer and substance misuser decreased by 66 pct
  • Misusers entering treatment increased from 43 pct to 75 pct
  • Carers’ relationships with their families improved by 50 pct
  • Carers’ wellbeing rose by up to 200 pct

Using a Home Office measure estimating the annual economic and social cost of each substance misuser to be £44,000, this performance based on 24 misusers from the PROPS data, or 75pct, entering treatment as a result of CRAFT, would equate to an annual saving of £1.06m a year (as illustrated above).

 The accompanying graphs also show the intervention’s effectiveness, based on questionnaires given to carers every three to four sessions as part of a group or on a one-to-one basis. The chart (below) shows that the knowledge and understanding of the physical and the psychological effects of substance misuse increases as a carer works through the programme. “Carers’ understanding of CRAFT develops along with other skills,” said Nicola Mansfield Jones, operations manager of PROPS, which has used the intervention for five years.

understanding

Carers report ‘ups and downs’ in their relationship with the misuser. This typical pattern is explained by the misuser initially noticing a change in the carer, who becomes less aggressive and less inclined to blame or humiliate.

As the misuser realises this ‘pull-back’ isn’t giving them free-range and that other things are coming into play such as rewarding and withholding reward, they create conflict again to try to get the carer to return to past behaviour.

“For example, if the carer was arguing, the misuser would therefore have a perfect reason to go out and use or drink,” said Nicola. “Through CRAFT the carer avoids this by becoming more confident in managing conflict.”

There is a similar pattern in the relationship with other family members (below). If they are not aware of why the carer’s behaviour has changed they may become resentful and angry or feel that the misuser isn’t being ‘punished’.

relationship family

 

“Using CRAFT skills of communication the carer can manage these situations effectively,” said Nicola. “Graph scores show that carers become more confident and able to cope better, not only with the misuser, but in general (below).

Functioning

“Most PROPS’ volunteers are carers or former carers and some have gained employment with our service as workers, bringing a wealth of experience.”

The dip in the score which correlates with the increase in conflict with the misuser is natural (below). Here the carer may start to doubt and lose hope – but reassurance from the worker and a reminder of their own goals puts them back on track again, with the scores resuming their rise.

Relationsip Substance

The average figure for misusers in treatment increases across the five questionnaires from 42 pct at the start of the CRAFT programme to 75 pct on completion after touching 86 pct.

“The decrease from the high value is because the misuser entered treatment and no longer needs intervention or that they have, through carer support, changed their behaviour significantly with most engaging in a pro-social activity such as volunteering or gaining employment,” said Nicola.

 

Credit for the accrediation programme - from a worker

February 2017

I am an Alcohol Worker based in Derbyshire.  I have experience of attending numerous training courses for professional development to expand my helping skills. 

What I have found with the shorter courses is that it takes a good deal of commitment to follow though and integrate the knowledge and skills into my work in a systematic way. 

However, I am passionate about helping families and concerned others cope and effectively respond to a problematic drinker in their family.  For this reason I was determined to reinforce my CRAFT learning. 

I started by reading all the worksheets and useful resources I received on the CRAFT course and incrementally introduced elements of CRAFT into my family work. 

Additionally, I repeatedly read the Smith and Meyers book ‘Motivating Substance Misusers to Enter Treatment’ as I proceeded with the above. 

I also found ‘Beyond Addiction’ by Foote, which is written for families, excellent and regularly recommend it to families. 

The service I work for has a system of peer supervision and we devoted sessions to supporting each other with CRAFT skills work.

CRAFT is a form of behaviour therapy which assists concerned others to learn how to positively reinforce none drinking/using behaviours. 

But when you think about it, successfully using CRAFT as a professional worker with families is also a learnt behaviour which needs to be reinforced. 

This is where the Positive Practice Partnership accreditation programme comes in. 

Basically it involves recording your CRAFT sessions and submitting them for feedback on whether they match the CRAFT Procedures. 

I have been so impressed with how comprehensive, informative and supportive that feedback has been. For me it has made the difference in assisting me to move towards a professional CRAFT practice.

Tom McGahan, Alcohol Worker, Derbyshire Alcohol Advisory Service

 

 

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