How our services work

Recovery means different things to different people.  It is a broad and complex journey that people must take at their own pace.

It is much wider than substance misuse alone, and can take many forms including:

• reducing risk taking;
• overcoming dependence;
• improving health;
• improving quality of life;
• and achieving personal fulfilment.

 

The Welsh Government has created a national framework for substance misuse  services and has adopted the following definition of recovery:

‘Recovery from problematic drug or alcohol use is defined as a process in which the difficulties associated with substance misuse are eliminated or significantly reduced, and the resulting personal improvement becomes sustainable.’

The recovery approach builds independence and skills over time, ensuring people ‘own’ their own journey towards sustained self-management and freedom.

Recovery capital

Recovery capital refers to the internal and external resources a person has to achieve and sustain behavioural change and recovery.

Recovery capital and what impacts on substance use is unique to every individual but some key areas we find useful to look at include:

• Substance misuse and sobriety
• Psychological health
• Physical health
• Community involvement
• Social support
• Meaningful activities
• Risk taking
• Housing and safety
• Recovery experience

 

Barod aims to support individuals at every opportunity to look at what recovery capital they have and what they would like to work on; helping them to reinforce the changes and progress they make.

 

Mutual Aid Partnerships

We encourage our service users to attend recovery activities, such as the annual recovery walk on Pen Y Fan mountain (organised by Chooselife in partnership with Barod), and the annual Wales-wide National Service User conference.

We promote peer to peer support opportunities such as:

• AA and NA fellowships
• Hepatitis C support groups
• Recovery Cymru based in Cardiff
• CASM – Carmarthenshire support group for families and carers
• Swansea groups E2E

For more information on the Recovery Framework, see it HERE

 

Barod is a harm reduction based organisation.

This means that we want to help to reduce the harm caused by substance use – to the user, their family and friends and to the wider community.

But harm reduction doesn’t mean that we are the opposite to abstinence, nor does it mean that we ‘condone’ or ‘encourage’ substance use.  We recognise that the recovery journey is more than just one or the other approach; we recognise our service user’s right to make informed choices for themselves and we recognise that one size does definitely not fit all.

Harm reduction is the foundation of our policies, programmes, services and interventions.  It is a necessary element of the recovery journey, at every stage.

In short, harm reduction can, and does, save and improve people’s lives.

Some ways we help to reduce harm include:

• Overdose and Naloxone training and kits for opiate users and concerned others
• Needle exchange services and safer injecting techniques
• Access to opiate substitute therapy for opiate users
• Dried blood spot testing for blood borne viruses (BBVs)
• Vaccination against hepatitis B
• Supported referrals for individuals to BBV testing, vaccination and treatment
• Access to criminal justice services for users facing criminal charges associated with their substance use
• Oral hygiene information and access to NHS dentists
• Fire risk assessments and practical interventions to reduce fire risks in service users’ accommodation
• Sexual health interventions (including long acting reversible contraception and provision of condoms)
• Relapse prevention programmes

Barod has an in-house Harm Reduction Group attended by staff throughout our organisation. The aim of the group is to ensure that we deliver against our Harm Reduction Strategy and implement the points in our action plan.

We believe that service users hold the key to ensuring that the services we provide meet their own needs and the needs of others.  Each individual is the expert in what will work best for them, so we make sure that service user involvement is fundamental to our ethos and operations.

We view service user involvement at 3 distinct levels:

Involvement in personal care planning

• We ensure that service users are fully informed so that they can be involved in shaping their personal care plans and treatment journey.
• It is crucial that when service users first attend our services that they know what is expected of them and what to expect from us, what services are on offer and the limits of what we can offer.
• We provide a welcome booklet to everyone at the first appointment.  The booklet gives an overview of our services, outlines our confidentiality and complaints procedures, provides contact details and more.
• Service users are offered an assessment of their needs at their first appointment.
• The questions we ask in the assessment help the service user and their worker to identify areas they can look at, that are important to the service user.  These goals will then be written into a care plan that will guide their future sessions.
• The service user should be at the heart of the care plan, it should be individual to them and they should have a copy to take away with them.

Involvement in Barod service development

• Barod believes in continuous improvement and we see our service users as being key to this.  We want to know what works and what does not work well in the way we operate.  We believe that service users are in the best place to help us get things working right.
• We encourage service users to make comments and complaints.  If service users are not happy with any aspect of our services we want to know.  We can only improve if we know the areas we need to work on and what we need to develop.
• When we change the way we operate or set up new developments we are committed to asking service users their opinions about the proposed changes.  As well as supporting regular service user support groups, both internally and externally, we will set up focus groups or survey service users if we plan changes to the organisation or a particular service.
• We ensure that service users are involved in interviews for new staff as we believe that service users know what qualities they wish to see in our workforce.
• We have anonymous feedback boxes at all Barod premises and we ask that our service users use these to give us feedback – good or bad.  The comments we receive via the boxes are looked at regularly by senior management and a service user representative.  Once we have considered the comments we will provide a response that will be clearly displayed at every office.
• Every year we conduct at least one anonymous organisation-wide service user survey.  The outcomes of these will be published on our website.

If you want to get involved in any of these opportunities to feedback, chat to your worker or use the feedback boxes in your local building.

Strategic user involvement

• Whenever possible we support service users to become involved in strategy and planning.  The commissioners (funders) of substance misuse services are responsible for coordinating substance misuse treatment systems to make sure that a range of services are funded to suit the needs of local populations.
• To do this commissioners need to know about local substance using trends, gaps in service provision, what works and what doesn’t.  Again, service users often hold the answers to this.

Look out for opportunities to get involved or let your case worker know if you are interested in the politics of substance misuse and planning across areas or regions so we can contact you directly.

Unfortunately, overdose is common amongst injecting drug users. Naloxone is a life-saving drug that can, in most cases, prevent or delay an overdose, giving the emergency services time to arrive.

Naloxone is an opiate antagonist that temporarily reverses the effects of overdose.  It lasts approximately 20- 30 minutes and provides a window of opportunity to save a life.

The Naloxone take-home scheme allows opiate users and their concerned others to complete a short training session on Naloxone and how to use it.  They are given a kit to take away with them.

Barod staff routinely discuss the risks of overdose and what to do in case of an overdose with service users.

 Information to reduce the risk of overdose includes:

• Do not mix drugs (especially opiates with other downers or alcohol)
• Do not use alone
• Use much smaller amounts if you have had any break from using
• Longer term users are more at risk than new users
• People are more at risk if they have previously experienced overdose
• Injectors are 14 times more likely to overdose on heroin than those who smoke it

 

Individuals are encouraged to become aware of the signs of overdose which include:

• Snoring/gurgling noises (this usually means that the person’s airway is blocked – tilt the person’s head back after checking for vomit)
• The body’s extremities start turning blue – lips, fingernails, ears
• Shallow breathing
• Gasps for air – difficulty breathing
• You are not able to rouse the person or get them to wake up
• No pulse

 

Remember the acronym CARA.

• Call an ambulance
• Airway (make sure it is clear)
• Recovery position
• Administer Naloxone

 

All drug related deaths are monitored by Barod and we examine the cases in multi-agency meetings to see if there are any learning points.  One of our core aims is to reduce the number of drug related deaths in Wales.

The establishment of needle exchange schemes across the UK in the 1980’s is widely regarded as one of our most successful health promotion and harm reduction initiatives.

Needle exchange is vital part of the work we do to help reduce the harms caused by substance use.  It’s a discreet and confidential space where service users can get support and advice, as well as clean and safe equipment.

Needle exchange services are always confidential.  Staff will ask some basic information which will be entered into an anonymised database called NEO.  This information is used to identify patterns or trends of use and equipment used, as well as information on referral to other services.  Names or other identifiable information will never be shared.

Where are our needle exchanges?

Barod provides needle exchange services during normal working hours in its bases

at:

• Swansea
• Caerphilly
• Merthyr Tydfil
• Blackwood
• Ebbw Vale
• Llanelli
• Aberystwyth
• Haverfordwest
• Dyfed Harm Reduction Bus

 

We clearly display the addresses of pharmacies offering needle exchange on the doors of our services.

What do we supply in our needle exchange?

We provide a full range of leaflets and equipment including:

• Vitamin C sachets
• Citric sachets
• Condoms
• Stericups/Cookers
• Needles and barrels in a range of sizes
• Written resources / information leaflets including those aimed at users of Performance and Image Enhancing Drugs (IPEDS)
• Foil to encourage injecting heroin users to change their route of administration to smoking
• Water ampoules
• Sharps bins for safe disposal of all equipment

 

Needle exchange provides an opportunity for service users who may not be in contact with any other services to engage directly with specialist drugs workers on pressing issues concerning their injecting habits, injecting sites and general health.

All staff delivering needle exchange services are trained and competent in providing safer injecting advice and use the opportunity to engage with injecting drug users.  We also encourage the safe return of used equipment and provide sharps bins to each individual using the needle exchange.

Barod is a member of the Welsh Needle Exchange Forum.  We work in line with evidence based practice including updated NICE guidelines, Welsh Government’s treatment framework  and our in-house Needle Exchange Policy.

Check out our Facebook Live video below, taking you on a tour of one of our needle exchanges