integrating family-focused practice into routine addiction services

299 Pages·2013·13.62 MB·English

by  Claire L. Hampson

INTEGRATING FAMILY-FOCUSED PRACTICE INTO
ROUTINE ADDICTION SERVICES
by
Claire L. Hampson

A thesis submitted to
The University of Birmingham
for the degree of
DOCTOR OF PHILOSOPHY

School of Psychology
University of Birmingham
September 2012
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University of Birmingham Research Archive

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ABSTRACT

This thesis reports the evaluation of a training program aimed to promote a whole
Organisation shift towards greater involvement of affected family members (FMs) within
addiction treatment and services. A two-phase quasi-experimental design integrating action
research is described.
Phase one (Pilot phase) involved two teams within the Organisation receiving a family-
focused training and on-going supervision package. During this Pilot phase the evaluation
outcome measures were developed and pilot tested. Phase two then involved selecting two
further teams at random to receive the training package (‘Immediate’ training) whilst the two
remaining teams served as a control and received the package following a delay (‘Delayed’
training). The package was delivered to all managers and front-line staff within each team.
This thesis reports the evaluation of the impact of the training and support upon a range of
outcomes using pre and post quantitative and qualitative measures over a three-year
period. Staff who had received immediate training reported significant increases in positive
attitudes towards family-focused practice; as well as increases in the proportion of family-
focused practice in their daily routine work. Significant improvements in attitudes were,
however, also evident in the absence of the training package during the delayed comparison
group’s waiting period. Possible reasons for the findings are presented along with qualitative
analyses that illustrated the complex and sometimes hidden experiences and views of staff,
which helped to aid the interpretation of the statistical findings.
The study supports the use of an Organisational platform to implement change towards more
family-focused addiction treatment. Overall, the results indicate that addiction services are
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capable of implementing family-focused practice; however, success depends on many factors
at the level of the individual service provider, Organisation and outside environment in which
the Organisation is situated.

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To Mum, Dad and Dave

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ACKNOWLEDGEMENTS

For this thesis to be possible there are many people I would like to show my gratitude to. I am
particularly grateful to Professors Alex Copello and Jim Orford for their guidance,
supervision and support since September 2008. I feel so very privileged to have been a part of
their research group and would not be where I am today without them.

A huge thank you also to Richard McVey, Annette Fleming and Helen Garratt at Aquarius
Action Projects for their enthusiastic collaboration in this project. Thank you for your time
and support during the last four years. I also want to thank all members of staff at Aquarius
for their patience and on-going support and for allowing me to take up their busy time on
numerous occasions.

Thanks to Pat Evans for her countless hours of administrative support and for providing our
research office with much needed PhD respite (heat magazines!)

Thanks to my friends and family for their support and encouragement during this long and
busy period of time. It was great to meet such an amazing group of other PhD students and I
will always treasure the memories of our numerous ‘big weekends’ in Wales, Cumbria and
Devon (to name just a few).

A very special thank you to my boyfriend Dave for his constant love and support during what
turned out to be an uncertain period of time. I know I can’t have been easy to live with!

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Finally, I wish to thank my Mum and Dad for their everlasting love and encouragement. This
thesis wouldn’t exist without your support. Thank you for always being there, both
emotionally and practically.
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DISSEMINATION

The contents of this thesis have been presented at conferences for The Society for the Study
of Addiction (SSA), U.K. (2011), National Institute on Drug Abuse (NIDA) Blending
Addiction and Practice, U.S.A. (2010), International Network for Brief Interventions for
Alcohol Problems (INEBRIA), UK. (2009), The Society for the Study of Addiction (SSA)
PhD student symposium, U.K. (2010 & 2011), and the University of Birmingham Graduate
Researcher Conference (2010).

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CONTENTS

CHAPTER ONE ----------------------------------------------------------------------------------------- 1
EFFICACY AND IMPLEMENTATION OF FAMILY INTERVENTION: A LITERATURE REVIEW - 1
INTRODUCTION --------------------------------------------------------------------------------------------- 1
AIMS OF THIS LITERATURE REVIEW ---------------------------------------------------------------- 2
EFFICACY OF FAMILY INTERVENTIONS FOR SUBSTANCE MISUSE: A ‘TERTIARY’ REVIEW
---------------------------------------------------------------------------------------------------------------------- 4
RESULTS ------------------------------------------------------------------------------------------------------ 4
WHAT CAN BE CONCLUDED FROM THIS TERTIARY REVIEW? --------------------------- 27
IMPLEMENTING FAMILY INTERVENTION FOLLOWING TRAINING: A SYSTEMATIC REVIEW
-------------------------------------------------------------------------------------------------------------------- 30
INTRODUCTION ------------------------------------------------------------------------------------------- 30
METHODS --------------------------------------------------------------------------------------------------- 31
RESULTS ---------------------------------------------------------------------------------------------------- 36
DISCUSSION ------------------------------------------------------------------------------------------------ 66
WHAT CAN BE CONCLUDED FROM THIS SYSTEMATIC REVIEW? ----------------------- 72

CHAPTER TWO -------------------------------------------------------------------------------------- 74
RESEARCH FRAMEWORK AND METHODOLOGY ----------------------------------------------------- 74
AIMS OF THE RESEARCH ------------------------------------------------------------------------------ 74
DESIGN ------------------------------------------------------------------------------------------------------ 76

CHAPTER THREE ----------------------------------------------------------------------------------- 99
PILOT PHASE: QUANTITATIVE ANALYSIS AND RESULTS ------------------------------------------ 99
INTRODUCTION ------------------------------------------------------------------------------------------- 99
METHOD ---------------------------------------------------------------------------------------------------- 100
ANALYSIS -------------------------------------------------------------------------------------------------- 105
RESULTS --------------------------------------------------------------------------------------------------- 107
DISCUSSION ----------------------------------------------------------------------------------------------- 110

CHAPTER FOUR ------------------------------------------------------------------------------------ 116
THE DEVELOPMENT AND VALIDATION OF A NEW FAMILY-FOCUSED ATTITUDE
MEASURE ------------------------------------------------------------------------------------------------------ 116
INTRODUCTION ------------------------------------------------------------------------------------------ 116
METHOD ---------------------------------------------------------------------------------------------------- 117
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STATISTICAL ANALYSES ----------------------------------------------------------------------------- 121
RESULTS --------------------------------------------------------------------------------------------------- 122
DISCUSSION ----------------------------------------------------------------------------------------------- 129

CHAPTER FIVE -------------------------------------------------------------------------------------- 135
PHASE TWO: STAFF ATTITUDES TOWARDS FAMILY WORK -------------------------------------- 135
INTRODUCTION ------------------------------------------------------------------------------------------ 135
METHOD ---------------------------------------------------------------------------------------------------- 136
STATISTICAL ANALYSES PLAN -------------------------------------------------------------------- 139
RESULTS --------------------------------------------------------------------------------------------------- 141

CHAPTER SIX ---------------------------------------------------------------------------------------- 158
PHASE TWO: FAMILY-FOCUSED PRACTICE --------------------------------------------------------- 158
INTRODUCTION ------------------------------------------------------------------------------------------ 158
METHOD ---------------------------------------------------------------------------------------------------- 159
STATISTICAL ANALYSES ----------------------------------------------------------------------------- 160
RESULTS --------------------------------------------------------------------------------------------------- 161
DISCUSSION ----------------------------------------------------------------------------------------------- 169

CHAPTER SEVEN ----------------------------------------------------------------------------------- 175
QUALITATIVE ANALYSIS AND RESULTS --------------------------------------------------------------- 175
STAFF EXPERIENCES OF WORKING FAMILY-INCLUSIVELY FOLLOWING TRAINING ----- 176
INTRODUCTION ------------------------------------------------------------------------------------------ 176
METHOD ---------------------------------------------------------------------------------------------------- 177
RESULTS --------------------------------------------------------------------------------------------------- 182
SUMMARY OF BARRIERS AND ENABLERS OF FAMILY WORK --------------------------- 202
DISCUSSION ----------------------------------------------------------------------------------------------- 205
LESSONS LEARNED FROM THE PROJECT ------------------------------------------------------------ 209
INTRODUCTION ------------------------------------------------------------------------------------------ 209
METHOD ---------------------------------------------------------------------------------------------------- 210
RESULTS --------------------------------------------------------------------------------------------------- 210
DISCUSSION ----------------------------------------------------------------------------------------------- 219

CHAPTER EIGHT ----------------------------------------------------------------------------------- 224
DISCUSSION, IMPLICATIONS AND CONCLUSIONS ------------------------------------------------- 224
SUMMARY OF FINDINGS ------------------------------------------------------------------------------ 224
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