Many clients will show some obvious traits of substance misuse which will include gouching, which is the effect of the hit from Heroin/Methadone (Heroin substitute). Gouching is when the client will be quite alert at the beginning of a group session, but within 10 15 minutes they will start to appear as they are falling asleep. They may start to bow their head and if you call them they immediately wake up. Another of the physical signs of substance misuse of a client with a Heroin addiction would be the eyes rolling or the plain struggle to keep them open.
I have found that clients with a Crack or Cocaine addiction tend to be the other scale as these drugs are stimulants. I have had clients high from a binge from the night before who have attended group sessions and been very talkative, eyes quite wide with an obvious redness of the lack of sleep. These physical signs can vary dependant on the lapse of time from finishing their misuse session to attending the group session, so for e. g. f the client had not yet been to sleep they would seem very hyperactive, jittery and very fidgety, but if they may have had a few hours sleep the physical signs can be quite different, so they are irritable due to tiredness. They would be quite slouched and not so conversational because they are on what it known as a come down. All the euphoria has now left the body and the body in a sense is returning to its normal state. Substance misuse can also just as easily affect a clients whole behavioural pattern as well as their emotional and social interactions.
The behavioural indications can be the client just not being their usual self, this could be a few varying factors, but once you get to know a client you understand how they behave towards different things that affect them. They could easily become emotional too which could be the client is purely upset and feel like they have let their self down because they may have been abstinent for a while and not been able to handle a certain situation or simply had a trigger which they could not control and went and used on it.
Many clients that I deal with on a day to day basis do suffer with a variety of ailments and illnesses and are prescribed medication for these. They range quite broadly from medication to manage a mental illness to taking medication in order to help keep their blood thin enough so not to suffer from DVT. Some of these prescribed medications will make our clients appear to be under the influence of a substance when really they are not.
As professionals this is why you need to collate important information from the assessment stages so you can ask questions about a clients medication and what the side effects may be as well as do your own research to back up any information already given. Within CRI as we have the consent to sharing information form if this has been signed you may want to contact the GP with a breakdown of what the side effects may be and the effect it would have on a client with substance misuse issues alongside the immediate risk factors too.
Many of the prescribed medications for mental health illnesses and depression will make clients seem as they are falling asleep, not really focusing on what is going on and spaced out, but this is not the case and if you are aware of a clients conditions then you would know best how to assess the situation at the given time. I regularly attend training provided by CRI and local boroughs or other services within the locality so that I am fully up to date with the new trends and old trends of drugs that are available, where the bad batches are being distributed and the strength of what is about on the streets at the current time.
This is down to you as an individual to also do your own research on the internet of what is going on in the drug scene and ask questions. If you hear of something that you are unaware of ask those questions, you never know when you will come across a client that may have a particular problem with that substance and you may be the person that needs to help them. I have found that clients can be quite knowledgeable so ask them questions too and go back and check on the information provided with others.
I do not feel that one person will or can know everything, but this is when team members should draw upon one another to have a wide knowledge within a team so all areas are covered in most instances. Probation This is a criminal justice service that works alongside all those who have committed a crime and have been sentenced to either serve a custodial sentence, suspended sentence, community order or DRR.
Most people will have a period of licence that they will have to attend appointments to discuss what they are doing with their lives. This is where clients will attend to be tested for substances and these results are fed back to CRI Stabilisation Day Programme. Probations service also has the ability to tap into other services and a certain amount of resources that will enable clients to gain help in ETE, Housing services or referral units, Drug Intervention groups.
CASS Community Alcohol Stabilisation Services This service works with clients whose main or preferred substance of choice is alcohol. This service will help work with clients extensively and support them if they require a detox and hold support groups, some peer lead and coffee mornings. They also will be given a key worker who will work with them on a 1-2-1 basis. CDAS Community Detox All of these services will complete an assessment of individuals to see the risks attached with the individual.
The assessment will show if they can help the client, what treatment can be put in place for them and the extent of the problem that the individual is currently experiencing. If each of these individual services are unable to help an individual they will then refer them on to a service that can assist them better within the area that they require the support and help in. With most organisations there will be an eligibility requirement in order for a service to work with you as well as protocols for accessing these services.
Our organisation work very closely with Oasis as an aftercare treatment provider for clients who are not abstinent, but we also have our own organisation that provides aftercare treatment, but you must be totally abstinent from alcohol and drugs for a minimum period of two weeks and you also cannot be on a script. The referral procedure for Oasis would initially be a phone call to the service and letting them know that you have a client is almost completed their 12 week period of their DRR with you and that they have for e. g. nother 12 weeks left on their order where they are required by law to continue to access drug services. An appointment is booked for you and the client to attend and on this visit to Oasis as a project worker you are required to bring along the clients care plans, the completed risk assessment with any updates or amendments and a TOPs form for statistical information to be provided to NDTA. On arriving at the appointment with the client, a key work session will take place and you will also give information to the new key worker with regards to the clients background.
The care plan review will be completed with the client there and a copy retained by our organisation to be kept on their file. The new key worker will also discuss with them what their service can offer them in regards to follow on treatment and what days they will attend, the groups etc. A new treatment plan is formulated with the new key worker there and then. The eligibility for gaining access to Oasis is that you are from the borough, that you have a substance misuse problem and ideally want help and support with coping and dealing with these issues.
Some of the other services have more stringent protocols and eligibility. For example if you were trying to get your client referred to go to residential rehab, you need to send a fully completed referral form to CDAS or the NHS, this is then discussed whether they feel that the potential client has shown the commitment required in order to put them before the funding panel of commissioners to prove that they are ready to take on a huge part of their recovery journey.
If the decision to grant them the funding, the client then has to do a detox within the community for two weeks prior to being admitted to the residential rehab. If a client leaves the detox and does not complete this they will lose their place within the rehab or it may be put on hold until they have completed it. The organisation that I work in have clients sentenced on a DRR which means that they do not want to be here, but have no choice but to be there.
We are usually the get out of jail card for most of them and unfortunately some of our clients are like revolving doors. However, I see this position as a vocation and not just a job and I am very aware that many of the clients do not want to be with us, but I hold hope that I still may be able to assist them on their individual journey on the path to recovery. I am also very conscious of the fact that not everyone can be helped and that is the nature of the career that I work within.
My approach to those clients that do not want to be in services is to explain what my role here is and make them fully aware of all the things the onward referral services can do for them. I give clients as much information as possible about the service and highlight the things that would work for them. It is not always an easy task and some clients are very stubborn and when it gets to the brick wall stage where I feel I have exhausted every possible route to get them to engage with the onward service I remind them that they have a legal requirement to ttend the services and if they do not abide by the DRR it will be reported to their probation officer and may be classed as a breach, which means returning to court to answer to the judge and the order can be revoked and a prison sentence given in its place. When undertaking an assessment of a client, I make sure that I gather as much background information as possible. This may be from the DIP team that I work very closely alongside and if I have knowledge of them working with probation services I will contact their probation officer and request information from them also.
I feel it is best to be very prepared so that you can summarise with them their history and spend more time dealing with the immediate things that are proving to be difficult and that they need the support and assistance to make their recovery journey as smooth as possible. If in my information gathering of a client, if something particular comes up that for e. g. they need to be escorted to their appointments. I will ensure that I speak with the person or key worker to ensure that the dates and times are suitable for all parties concerned.
I have many clients that also have many appointments to attend in general, so trying to space them out so the client has sufficient time to attend or make appointments on a regular day and time so it will not interfere with any other obligations. If a client has many services involved in their life I will ensure that we have a meeting on a regular basis that includes everyone to minimise the amount of appointments the client has to attend and information is shared in one place at one time. All information is recorded on our CRiis system as soon as the meeting has finished.
I think this is good practice so that you do not forget anything important that needs to be recorded for ease of reference for others if they have to see your client whilst you are away. This is also good for when writing review reports for the courts or the probation officers. When assessing a client I feel it is highly important to know their background, history of substances and the life line. If you have a thorough knowledge of the client it is easier to assess the risks to them and others accurately and ensuring that you follow out you duty of care to the client as well as others.
This way you also cover yourself from potentially being in the firing line if you ensure you have done a thorough job of the risk factors and highlighting them to your manager if you feel that something is not quite right. It is extremely important to regularly review the risk assessments as things change very quickly with clients. Not any one day is the same for them and they live high risk lives. We ensure that our clients have a 1-2-1 key work session at least every two weeks and the risk is monitored, but if the client does not prove to have high risks it is reviewed every six weeks.
Our service is quite small so the team de-brief after every group session and discuss each client that has attended and sometimes we highlight possible risky situations which will be noted as a risk and monitored until the risk has gone or the client has left. If the risk assessment is not reviewed you can put your client at risk as well as your service and everyone that your client comes into contact with. The client is fully involved in the assessment process as the main bulk of our information comes from the individual.
I ask them to be as open and as honest as possible as I can only help them if they tell me the truth. At this point I will be taking into consideration traumatic events in their life, when substance misuse started and what the flow of substances are and of the individual poly drug uses. Many of our clients have been through services before, but I always ask if they know why they are here? Have they attended groups before? What are they like in a group setting? How they feel with mixing with others who are at different stages of treatment?
By asking them various questions and listening to the clients feedback, body language & non verbal reactions, I will then know whether they are suitable for the DRR or if they may need to access another service for more specialist treatment. I follow the assessment procedure and ensure all the necessary paper work is completed and all paper work signed by the client and I. I deal with chaotic, abusive and aggressive clients daily. I feel that with my aggressive clients that you need to remain firm and not lose control.
I would not put myself in a situation that is overly risky, but you must be a little thick skinned and own the group. The boundaries must be put in place from the on start or this kind of behaviour will rear its ugly head too often. Each situation is different and with the more chaotic clients its more about trying to get them into some sort of structure. Ensure that appointments are written down or set in their phone so they remember. I will also text clients when they have an appointment with the service or are due in for group and we find in our service that some of the clients need this level of help.
Even the clients that do not need that sort of assistance find it helpful because of they do not feel like attending the text message helps to plant the seed and makes them attend. On the completion of the full assessment, the client and I will look through the information gathered and highlight the priorities areas that we will focus on in the first instance. This are not fixed in stone and if things change as we go along through the course of the treatment process we will address them or re think the order of priority.
I feel that if you have to make an assessment on a child or young person you do need to follow the same principles as you do for an adult. I would involve the main carer or person with the main parental responsibility whether this is a foster carer etc. The process would involve gathering as much information as possible with regards to the young person or childs likes, dislikes, how they react to things, what they were like as a child, traumatic events that may have occurred in their life, what they are like at school, everything that could give me an incite to this young person or childs personality.
From gathering all the information, which would include talking to their school or educational facilities they attend, social services if they have been involved and any other agency that has had involvement with the child or young person, this should give me as a professional a very good idea of what the young person or child is like and then the final thing would be asking the young person or child questions and seeing what their response would be.
I feel that I would not personally be able to assess their level of maturity at present as I am not qualified in that area, but if it was something that I had to undertake I would take the steps to involve a child psychologist to accurately assess the level of their maturity. I feel that this area is very specialist and any work that I would undertake would be of another form of information gathering in order to assist with any additional treatment plans that may be put in place to help the young person or child.
There are guidelines and legislation that need to be adhered to when dealing with young persons or children which include: Victoria Climbe Report Baby P Which have highlighted areas in the past that have been missed and because of that we have unfortunately lost some very precious children. We also have the Childrens Act 2004 which was amended to include that responsibility of services, organisations, care homes & foster carers with the duty of care to a child. During the initial assessment the client is informed of the complaints procedure and offered a copy of their care/treatment plan.
The clients are encouraged to complete ITEP maps so they are more involved in the whole process and to recognise that once things are written down on paper how real they actually are. This is sometimes the point when everything becomes real to the client and they begin to take a different view of what is really going on for them in their life and realise that they do need support and help in some areas. We endeavour to keep a good working practice within our team and to sustain good working partnership with all other agencies that we work along side.