Occupational Therapy within the Family Drug and Alcohol Court
Occupational Therapy role within the Family Drug and Alcohol Court (FDAC) involves working with parents facing drug and alcohol misuse, mental health issues, and domestic abuse. Evaluations show positive outcomes for children in FDAC care proceedings, with higher rates of family reunification and decreased substance misuse.
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Occupational Therapy within the Family Drug and Alcohol Court Izzie Johnson Isobel.johnson@ghc.nhs.uk Layla Betteridge Layla.betteridge@gloucestershire.gov.uk
Izzie Johnson 2013-2015: 2015-2017: 2017-2021: 2021-Present: MSc Occupational Therapy, University of Derby Psychiatric Intensive Care Unit (Occupational Therapist) CAMHS (Registered Practitioner) TACS (Registered Practitioner)
Layla Betteridge 1996-1999: 1999-2001: 2001-2003: 2003-2013: 2013-Present: CAMHS Operational Lead for Interagency Teams (Functional Family Therapy) BSc Occupational Therapy, Oxford Brookes University Adult Community Mental Health (Occupational Therapist) Psychiatric Intensive Care Unit (Occupational Therapist) Low Secure Forensic Inpatients (Therapy Lead/Unit Manager)
Family drug and alcohol court (FDAC) The Family Drug and Alcohol Court (FDAC) is an alternative family court for care proceedings. It is specially designed to work with parents who struggle with drug and alcohol misuse. However, parents coming into FDAC will often have other difficulties as well, including mental health problems and experiences of domestic abuse. FDAC is all about trying to solve the problems that have led the local authority to bring the parent to court. FDAC tests whether parents can make enough change quickly enough for what their child or children need . www.fdac.org.uk Nationally there are 14 specialist FDAC teams, working in 22 courts and serving families in 38 local authorities Supported by the Centre for Justice Innovation
FDAC Evaluation Report: Foundations, Aug 2023 Children with a primary carer in FDAC care proceedings were more likely to be reunified with their primary carer at the end of the care proceeding in comparison to children with a primary carer in non-FDAC care proceedings (52.0% versus 12.5%). A higher proportion of FDAC than comparison parents had ceased to misuse drugs or alcohol by the end of the proceedings (33.6% versus 8.1%). The proportion of hearings being contested was lower for FDAC than standard care proceedings (4.2% versus 23.8%). A lower proportion of FDAC cases used external expert witness assessments compared with non-FDAC care proceedings (7.7% versus 96.1%). Children in FDAC sites had lower probability of being placed in LA care compared with non-FDAC care proceedings (28.6% versus 54.7%).
Turn around for children service (TACS) Role WTE Service Manager 0.8 Local Services: - CGL (substance misuse treatment provider) - GDASS (Domestic Abuse Support Service) - Community Wellbeing Service (Social Prescribing) - Adult Education Clinical Team Lead (Currently RMN) 1.0 Social Worker 2.0 Apprentice Social Worker 1.0 Mental Health Practitioner (Currently 0.8 RMN and 0.8 OT) 1.6 Consultant Psychiatrist 0.2 Substance Misuse Lead 1.0 Senior Family Support Worker 0.8 Health Visitor 1.2 Speech and Language Therapist 0.4 Local Authority Administrators 2.0
Occupational Therapy Role Development 2021 Skill mix review and annual report Advocated for occupational therapist to complement existing MDT Addiction as a Dark Occupation Exploration of interests, meaningful Occupation and roles/routines to replace addiction and aid recovery Developing role within team well received Paired Outcome Measures
Occupational therapy intervention within the Mental Health Practitioner role Use of MOHO Assessments: OCAIRS, OSA, MOHOST Use of Occupational Formulation Focus on person as an occupational being, more than their substance use Understanding substance use as a dark occupation, which holds significant meaning Finding alternative ways to meet the occupational need that substance misuse provided
TACS at the Cavern coffee morning Local, welcoming venue One morning a week, all FDAC parents welcome to play games, chat, have a hot drink Purpose: -Promotes local community resource/venue -Promotes informal peer support from others going through the same process -Enables informal occupational assessment -Contributes to development of therapeutic relationship with TACS professionals
Peer mentoring FDAC graduates are invited back to volunteer with the service in a peer mentor role. Linking in with the Participation and Inclusion Team Promotes visible signs of recovery and supports hope. Enables the FDAC graduate to experience a different role and identity
Contributions to court reports Fortnightly non-lawyer reviews, in which the parents meet with the Judge to discuss progress. TACS Professionals contribute to the report. Recent development parents also contribute to the report. Balance of OT positivity (strengths based) vs. reality of the parents progress in terms of meeting the needs of the children. Language that cares
Future plans Use MOHO assessment tools routinely, and as an outcome measure Consider reviewing the TACS assessment process to include occupational therapy in its own right Develop group programme to address occupational needs Including OT within the annual report to commissioners/CAMHS managers
References FDAC-report.pdf (foundations.org.uk) Amorellia CR (2016) Psychosocial Occupational Therapy Interventions for Substance-Use Disorders: A Narrative Review. Occupational Therapy in Mental Health, 32(2): 167-184. Andersson C, Eklund M, Sundh V, Thundal K-L, Spak F (2012) Women's patterns of everyday occupations and alcohol consumption. Scandinavian Journal of Occupational Therapy, 19(3): 225-238. Cloete LG, Ramugondo EL (2015) I drink : Mothers alcohol consumption as both individualised and imposed occupation. South African Journal of Occupational Therapy, 45(1): 34-40. Stewart K, Fischer T (2015) Rethinking occupation: Use and addiction. The British Journal of Occupational Therapy, 78(7), 460- 461. Wasmuth S, Crabtree JL, Scott PJ (2014) Exploring addiction-as-occupation. British Journal of Occupational Therapy, 77(12), 605 613. Wasmuth S, Pritchard K, Kaneshiro K (2016) Occupation-based intervention for addictive disorders: a systematic review. Journal of substance abuse treatment, 62, 1-9. Rojo-Mota G, Pedrero-P erez E, Huert-Uertas-Hoyas E (2017) Systematic review of occupational therapy in the treatment of addiction: models, practice, and qualitative and quantitative research. American Journal of Occupational Therapy, 71(5), 1-11.
