Barriers or Bridges? CityWide. CityWide. Drugs Rehabilitation Projects the Road to Recovery. A CityWide Consultation Report. Drugs Crisis Campaign

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1 Barriers or Bridges? CityWide Drugs Crisis Campaign 11 Cadogan Road, Fairview, Dubin 3 Te: / Emai: Web Drugs Rehabiitation Projects the Road to Recovery A CityWide Consutation Report CityWide Drugs Crisis Campaign design and print by Printwe Design

2 Barriers or Bridges? Drugs Rehabiitation Projects the Road to Recovery CityWide Consutation Report 2014

3 CityWide Drugs Crisis Campaign CityWide Drugs Crisis Campaign is a nationa network of community activists and community organisations that are invoved in responding to Ireand's drugs crisis. CityWide was set up in 1995 to bring together Dubin communities that were strugging with the heroin crisis. We now work nationay inking communities across the country deaing with a range of substance issues. 2 CityWide works to promote and support a community deveopment approach to the drugs probem - this means invoving the peope who are most affected by the probem in deaing with the probem - drug users, their famiies and communities. Print and design by Printwe Design, 17 Church Street East, North Wa, D3

4 Tabe of Contents 1. Introduction to DRPs & to the Consutation Report 5 Objectives of consutation List of those consuted Index of tabes Acknowedgements 2. About the Drug Rehabiitation Projects (DRPs) 9 Background to their set-up Roe of DRPs Structure Referras Eigibiity 3. Benefits of Drug Rehabiitation Projects 13 Context for DRPs Benefits experienced by participants Stabiity & structure Support Confidence buiding Education Impact on famiies Views of agencies Wider community impacts 3 4. Budget & Poicy Changes to CE 18 Changes specific to CE Socia Wefare Act 2012 Changes in budget 2013 Secondary benefits 5. Impacts of these Changes 21 Overa take-up of DRP paces Reduction in appicationssection 1 Participation rates based on payment type Participant profie changes New barriers to participation Other impacts from changes in SW 2012 DRPs responding to changes 6. Concusions and Recommendations 30 Appendix 34

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6 Introduction Section 1 The Drugs Rehabiitation Projects (DRPs), formery known as Specia Community Empoyment Drugs Projects, have been a core eement of the Nationa Drugs Strategy (NDS) since the ate 1990s, deivered by FAS and now by the Dept. of Socia Protection (DSP). The DRPs have provided the main vehice for the deivery of drugs rehabiitation services since rehabiitation was recognised as a distinct piar of the NDS in Whie mainstream Community Empoyment operates as part of the state s abour market strategy, by providing community-based work experience and training to ong-term unempoyed peope, the setting up and deveopment of DRPs as part of the NDS has aowed the CE mode to be used to deiver a rehabiitation programme for recovering drug users that does not have a specific abour market focus. The roe of DRPs within the NDS is to provide community-based support systems to reintegrate recovering drug users back into their communities and into broader society. This roe of DRPs, as distinct from mainstream CE, has aso been recognised in the 2007 Rehabiitation Strategy, which states that: CE Drug Projects have been designated as specia projects in recognition of the fact that they are not operating as a abour market mechanism in the same way as mainstream CE, but rather as a support mechanism through which drug rehabiitation programmes can be deivered. 5 This specia status has been formaised and operationaized through the agreement of the 9 points of adjustment and 1,000 CE paces are ring-fenced for use by DRPs under the conditions outined in the 9 points (see appendix 1 for fu conditions). Rationae for consutation In the budget of 2012, the government announced that it was beginning a process of increasing the abour market focus of mainstream CE. As part of this process it introduced a series of budget changes in the Socia Wefare Act 2012 that resuted in reduced payments to particuar categories of CE participants, reduced budgets for participants training and reduced running costs for sponsor projects. There was a strong reaction from CE projects to the budget changes, both in reation to the impact on participants and potentia participants, but aso to the ack of consideration within the abour market focus for the impact on the ongoing deivery of many vita community services provided by CE projects. A review of the CE scheme was announced by government but the key changes announced in the budget were impemented in advance of the review. Particuar concerns were expressed by DRPs that the distinct roe of the CE Drug Rehabiitation Projects as part of the NDS had not been specificay considered by government as part of these changes to CE and that in the appication of these changes, DRPs were now being viewed as part of a abour market strategy in the same way as mainstream CE, despite their ceary defined rehabiitative roe in the

7 NDS. There was aso concern that other changes incuded in the Socia Wefare Act 2012 that were not specific to CE coud have a negative impact on participants recovery. These concerns were expressed to Citywide through the DRP Network and it was decided to carry out consutation with DRPs, project participants and partner agencies to estabish exacty how the changes in poicy and practice in reation to Community Empoyment, as we as more genera changes in the Socia Wefare Act 2012, are impacting on the work of the DRPs and to ook at how any chaenges arising as a resut coud be addressed. Objectives of the consutation Examine and document the benefits of the Drug Rehabiitation Projects (DRPs) on communities, participants and famiies most affected by drug probems. Consut with recovering drug users, community drug projects and a range of stakehoders to ascertain how changes in egisation and poicy are impacting on deivery of services. Engage with potentia participants to ascertain what the barriers are to taking up these programmes Identify the measures needed to address the issues arising from these changes. Make recommendations based on the roe of the DRPS as a core eement of the Nationa Drugs Strategy. 6 List of those consuted Consutations were undertaken with the foowing groups: Onine surveys of DRP Managers (24 respondents) with foow up focus group meetings of project managers Individua interviews with 11 peope currenty participating on DRPs Individua interviews with 11 peope who have decined to take up a position on a DRP. Seven Community Drug Projects Four Loca Drugs Task Forces Referring organisations and poicy-makers as foows: Nationa Drug Rehabiitation Impementation Committee (NDRIC) Socia Incusion Division, HSE Department of Socia Protection Probation Services Rehabiitation Integration Service, HSE Baymun Job Centre Index of Tabes: Tabe 1: DRP survey response to question where do you get referras from? 10 Tabe 2: Impact of participation in CE on secondary benefits for recipients of certain socia wefare payments 19 Tabe 3: Overa take-up of DRP paces by T. Code/Referred Participants 21 Tabe 4: Comparative CE participation numbers for those in receipt of One Parent Famiy payment (OPF), disabiity, and iness benefits between 2012 and Tabe 5: Comparative T-code participation numbers for those in receipt of concurrent disabiity or OPF payment between Dec 2011 and November

8 Acknowedgements Citywide woud ike to thank a of those who participated in this consutation. In particuar we woud ike to thank the CE participants (and those eigibe for CE) for sharing their direct experiences and for their frank contributions. We aso want to express our gratitude to the DRPs, Community Drug Projects, and partner and referring agencies. Our thanks aso go to TSA consutancy for 7 conducting individua interviews and eading focus groups. Finay we wish to acknowedge the considerabe efforts of the members of the advisory group who provided vauabe critica advice, support and commentary.

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10 About the Drug Rehabiitation Projects (DRPs) Section 2 Background The Nationa Drug Strategy Team (NDST) was estabished in 1996 as the nationa co-ordinating structure for the government s drugs strategy and, through its membership of the NDST, FAS identified the Community Empoyment Scheme as a potentia source of support for recovering drug users. An interagency subcommittee was set up by the NDST to deveop the framework for CE Specia Drug Projects and to set the criteria for its operation. The framework document was approved by government and CE Specia Drug Projects (now DRPs), became a core eement of the Nationa Drugs Strategy. In recognition of the roe of DRPs as rehabiitation programmes nine key operationa and eigibiity adjustments were made (see Appendix 1). On January 1st, 2012 responsibiity for Community Empoyment transferred from FÁS to the Department of Socia Protection (DSP). There are 1,000 ring-fenced CE paces that are set aside for drug rehabiitation ony and aocated to support the area pans of Drug Task Forces. The majority of these paces are ocated in dedicated Drug Rehabiitation Projects (DRPs) that were set up specificay for the purpose of responding to community drug probems. Other individua paces are ocated within mainstream CE schemes that have aocated one or more paces for peope in recovery from drug use. There are 47 dedicated schemes in Ireand 1, and the majority of these (35 schemes, or 74%) are ocated in Dubin. 9 The roe of DRPs The DRPs provide recovering drug users with an opportunity to participate on a rehabiitation programme in a oca community drugs project for 19.5 hours per week. The programmes provide eements of persona deveopment, group work, education and training and aim to provide participants with stabiity in their ives so that they can address their drug use and reintegrate into the ives of their famiies and communities. DRP participants do not have a traditiona job function or job description as in mainstream CE. They do, however, engage in a range of rehabiitation activities which utimatey prepare them for a return to better heath, education and/or empoyment. Each participant has an ILP (Individua Learning Pan) which sets out their goas and objectives and identifies the supports avaiabe to them to achieve these objectives. The ILP is deveoped with the participant as part of a process of individua case management and care panning, which is part of an overa continuum of care. Key supports to participants incude counseing, key-working, addiction work, compementary therapies and practices, etc. DRPs aso carry out a significant eve of advocacy work for participants with a range of state agencies, refecting the interagency approach that is integra to drugs rehabiitation. 1 Source: Department of Socia Protection

11 Structure Each DRP is an independenty managed community project with its own Board of Management and ega status. As we as CE funding, projects may receive funding from the HSE and Drugs Task Forces, the ETB (previousy VEC), Probation Services and the Department of Socia Protection (other than CE). A sma number of DRPs were set up specificay for women and whie most DRPs woud have a defined geographica area, in practice this is operated fexiby and potentia participants are assessed on basis of need. Referras As woud be expected in an interagency approach, DRPs receive referras from mutipe sources, with drug treatment centres (incuding methadone cinics) being the main source. Another significant source of referras are community and vountary drug services. Socia work services and the Department of Socia Protection (DSP)/other government departments aso provide some referras. A survey of DRPs estabished the foowing referra patterns: TABLE 1: DRP SURVEY RESPONSE TO THE QUESTION WHERE DO YOU GET REFERRALS FROM? 10 % of respondents Drug treatment centre/ cinic 75% Community/ vountary drug services 71% Sef-referra 67% Probation and prison services 46% Other community services 46% Homeess services/ organisations 38% GPs 33% Socia work services 21% Other 13% Eigibiity for participation on DRPs Rehabiitation paces 2 The Nationa Drug Rehabiitation Framework has estabished protocos for referras to DRPs To be eigibe for one of the 1,000 ring-fenced CE drug rehabiitation paces on a DRP, a person must be over 18 years and in receipt of a Socia Wefare payment, they shoud be referred from a drug treatment/support service and undergo assessment of suitabiity for participation on the programme 2.

12 Support workers One of the 9 specia conditions for DRPs (see appendix 1) is that up to 25% of approved project paces may be used to recruit support workers for the project. Support workers are not referred through addiction services and are not counted in the 1,000 ring fenced paces. They must meet the standard eigibiity criteria for CE in reation to SW payments. They work to support the projects and rehabiitation participants by engaging in a range of activities from administration and house - keeping to advocacy, educationa supports, co faciitation and (foowing appropriate training and supervision) buid professiona supportive reationships. CE payments Payment on CE is inked to Socia Wefare rates but is treated as a wage and is iabe for tax. Up unti 2012, peope on Disabiity and One Parent Famiy payment received these aowances in addition to their Socia Wefare payment. 11

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14 Section 3 Benefits of Drug Rehabiitation Projects Context for DRPs It is essentia in ooking at the benefits of DRPs to pace their work in the context of the ives of their participants. DRPs emphasise how crucia it is to the effectiveness of their work to have an adequate understanding of the barriers to participation that are part of the ife experience of many recovering drug users. These existing barriers to participation are primariy inked to disadvantage and drug use and incude ow sef-esteem, ow eves of iteracy or modest educationa achievements, poor heath, insecure housing, weak socia networks, poor famiy reationships and imited access to chidcare. Whie the motivation to address their drug use and improve their ives can be high for many drug users, the abiity and capacity to engage in the practica day-to-day steps that are required to engage in a structured programme can initiay be very ow. This capacity is negativey affected by concern about participation costs, uncertainty about future status on Socia Wefare, uncertainty about entitements whie on CE, as we as practica issues such as organising chidcare, being we presented in appearance, keeping to a timetabe etc. It is in this chaenging context that DRPs carry out their work. Consutation was carried out with DRPs and project participants, as we as some partner agencies to describe the main benefits that they identify from participation in DRPs. 13 Benefits experienced by participants Interviews were undertaken with individuas who were currenty participating in a DRP, in which they discussed the benefits and impacts of their participation. Broady speaking the benefits and impacts fa into four different areas: Stabiity & Structure, Support, Confidence Buiding & Education. A names of interviewees have been changed to protect their anonymity. Stabiity & Structure The most important benefit as identified by participants is the stabiity, structure and routine that these projects provide. This was identified as a principa reason for taking up positions on DRPs: I just needed some stabiity, and the routine as we and I heard it was a very good programme. Tina Most of us in here now that are in recovery, need to be doing something constanty, because in the bink of an eye you coud just sip back into your od ways. Brian

15 Some beieved that without the structure and support offered in the CE programme, they woud have reverted to crime or drug use. Indeed one interviewee beieved that were it not for the DRP she woud probaby be dead and credited the project with changing her ife: It has given me structure in my ife and kept me out of troube as we... if I hadn t got this I d be in troube with the Guards. Caro Being on the programme has given me a chance to give my kids a better ife as we. Caro Support According to participants, the supports provided in these projects are essentia. The supports primariy identified incuded key worker and peer support. These support mechanisms heped to increase coping skis and deveop team-working abiities. Many peope become isoated through their drug use, and team-buiding activities hep to rebuid trust and reationships with peope. The support most often referred to was the individua attention provided by the key worker: 14 You have a key worker and they check in with you every so often to see how you are doing... it keeps you on your toes... keeps you focused on your recovery... you re staying on track. Thomas Since starting here I think I m achieving a ot...i have a key worker that ooks out for me, I never had that before and it s changed my ife. Caro It s given me a bit of confidence back, it s given me a boost in my confidence you know, having a key worker there, someone to speak to where before I d be sitting with thoughts in my head. Peter Being in a group with other drug users addressing their addiction issues was identified as being important in providing support and roe modeing: There s another ad I know that s on the course here...he s cean now off everything, he s an inspiration on the group, it shows there is ight at the end of it, you know, how you can come out. Peter Confidence Buiding Participants interviewed fet that their sef-esteem and confidence had been enhanced as a resut of taking part in the DRP....when I went on drugs I ost a ot of my confidence and my sef-esteem and I just think this course has brought it back to me again...i m earning every day, my brain is active, I can see my probems now, I can see what I m good at. Rosie I m finding my voice again... Sabrina It s definitey heped; it has turned my ife around. Peter

16 Education A key confidence buiding measure was the avaiabiity of education for participants. The transformative and empowering effect of education was noted both by participants and by referra and state agencies. DRPs enabed participants to gain forma quaifications and deveop new skis as many participants had itte forma education. We do Engish, maths, computers and every second week we do drama which I ove... it s briiant... I d be ost without it. Caro Participation in a DRP has resuted in providing the foundation for many peope to continue with education. For many of the participants, their invovement in DRPs enabed them to set goas for the first time in many years. Most of these goas invoved further education, accessing empoyment, or working with young peope. Thomas expressed an interest in working with others affected by addiction, in particuar young peope: I d just ike to be abe to have an impact on some of the youth growing up in the areas where I grew up so that they woudn t end up going down some of the routes that I went down which ead to drug addiction. Thomas Being on the programme has given me a chance to give my kids a better ife as we. Caro Views of agencies 15 A of these impacts were mutuay reinforcing and are beieved by participants to have had a ife-changing impact. These views were refected by state and referring agencies which attested to the transformative impact of DRPs on a aspects of participants ives, and the ives of their famiies. These agencies spoke about the positive impacts that DRPs have had on famiies and the wider community, and made the point that they occupy a unique space in this regard as there are no other simiar rehabiitation services in the State. Community Drug Projects 3 confirmed the key roe of DRPs in providing drug users in recovery with a structure to their ives; this was seen as crucia in minimising the risk of reapse. It was aso seen that, as participation continued, this stabiity and structure formed a basis for other benefits to accrue. For exampe, participation in education enhanced the confidence of participants who coud then take a greater roe in their own chidren s education, for exampe, by supporting them with their schoo work. According to one community drugs project manager:... providing service users with an opportunity for constructive activity, has a stabiising infuence on famiies and kids. The participants get into the habit of bringing their chidren to schoo. It gives them a sense of webeing and the hope that they can change their ives around so the impact is very positive. 3 Community Drug Projects are set up in Drugs Task Force Areas. They are independent, ocay run projects that provide a range of services and supports to drug users, their famiies and to the wider community.

17 Wider community impacts Referring agencies beieved that having DRPs ocated in the communities most affected by serious drug probems was important because, not ony do they provide oca access to services, but in so doing they make visibe the tangibe and positive outcomes of rehabiitation, giving hope of recovery from drug use. This can hep to re-estabish fractured reationships within the community. You can see peope who were once addicted and are now cean and working. It can give hope to parents and sibings of recovering drug - users; their sons and daughters can change their ives around. It is very positive for the community to see residents going on to third eve. It raises peope s expectations in their community... This is very important as there are extremey ow eves of participation in third eve. Other community projects aso noted that many DRPs have made significant contributions to their oca communities by initiating and participating in oca activities and events. For exampe, in one area a DRP in partnership with the oca community deveoped a very successfu community garden. 16 State and referring agencies concurred with this perspective. They referred to events that have been hed to mark participants graduation from education programmes, and it was beieved that such events have had a positive impact on the community in that they can mitigate the negative attitudes towards drug users. Moreover, they highight that recovery, change and rehabiitation is possibe. The point was made that DRPs are supporting participants to become active in their community to become community supporters rather than community supported.

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19 Section 4 Budget & Poicy Changes to CE Changes specific to CE A number of significant egisative and budgetary changes to how CE operates were announced in Budget The first set of changes referred to the operation of the scheme. The Budget provided for a reduction in the training and materias budget for CE schemes by 66 percent, with a reduction from 1,500 per participant to 500 per participant. Foowing significant obbying from CE scheme sponsors, staff and participants, it was announced in February 2012 that CE projects coud avai of up to 1,000 training and materias grant per participant; however, this payment was discretionary and projects needed to provide a cear and transparent demonstration of need for the eve of funding. A financia review of CE schemes was carried out by the Dept. of Socia Protection, with the foowing outcomes: 18 Impementation of cost savings through restructuring of materias grant. Reduction in supervisory costs by impementing new supervisory ratios specified (1 Supervisor to 25 Participants 4 ). The overa participant training budget is to be hed by DSP community services in each region, rather than a fixed aocation hed by each project on the basis of number of participants. The overa impact of these changes on DRPs has been a reduction both in the training budget avaiabe for participants and the resources avaiabe to the project to meet basic running costs of their programmes. Socia wefare act This does not appy to DRPs as the ratio of supervisor to participant is 1:7 (as per the 9 points of adjustment agreement see appendix 1) Budget 2012 aso announced changes to entitements of new CE participants, which were provided for in the Socia Wefare Act As previousy outined, eigibiity for CE is based on being in receipt of state payments generay Jobseeker s Benefit/Aowance (formery Unempoyment Benefit/Assistance), Disabiity Aowance or One Parent Famiy Payment (OPFP). Up unti 2012, peope on Disabiity and OPFP received the CE payment in addition to their Socia Wefare payment; however, the 2012 egisation provides that new entrants to the CE scheme (those recruited from January 2012) are no onger entited to receive a weeky Socia Wefare payment whie participating on CE. This change affects a new entrants to CE in receipt of Disabiity Aowance, Iness Benefit and OPF payments. The weeky CE payment is a minimum of 208 per week, or a payment equivaent of an increase of 20 on weeky Socia Wefare payments. With the oss of the concurrent payment, the weeky financia gain from participation on CE has gone from approximatey 208 (the rate of CE participation) to 20, for those who were in receipt of the concurrent payment.

20 Socia wefare changes in Budget 2013 In addition to these changes, there have been budgetary provisions which have reduced Socia Wefare payments for OPF Payment, Iness Benefit and Disabiity Aowance and age reated reductions in the rates for Jobseeker s Aowance. Further changes were introduced with respect to the OPF payment, concerning the age imits for chidren in respect of whom an OPF payment is made. With regard to the Househod Package (payabe to those in receipt of Disabiity Aowance amongst other Socia Wefare payments), the Teephone Aowance was reduced as was the number of weeks that the Fue Aowance is payabe. There was a genera reduction in the rates of Chid Benefit. Secondary benefits When peope come on to a CE Scheme they retain their entitement to secondary benefits that they received before starting on the scheme. This situation has not changed but significant confusion has been caused by the fact that changes have been made to the underying entitements to secondary benefits, depending on the type of payment received. The timing of these changes has meant that they are being seen by CE participants as part of overa changes to payments on CE. For individuas on Disabiity Aowance, Invaidity Pension, Bind Pension and Iness Benefit participating on CE, they retain their medica card and retain an entitement to the secondary benefits that they were receiving immediatey before going onto Community Empoyment (provided the participants continue to satisfy the conditions for these benefits). These are summarised beow: 19 Tabe 2: Impact of participation on CE on secondary benefits for recipients of certain socia wefare payments Secondary Disabiity Bind Invaidity Iness Benefit Aowance Pension Pension Benefit Fue Aowance May be Affected Free Trave Retain Retain Retain Househod Benefits Retain Retain Retain Retain Package Medica Retain Retain Retain Retain Card Mobiity Retain Retain Retain Retain Aowance Bind Wefare Retain Retain Retain Retain Aowance

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22 Impacts of these Changes Section 5 Consutation was carried out with DRPs and project participants, as we as some partner agencies to estabish exacty how the changes in poicy and practice in reation to Community Empoyment, as we as more genera changes in the Socia Wefare Act 2012, are impacting on participation. Overa take-up of DRP paces Citywide surveyed 37 Community Empoyment Drug Rehabiitation Projects (DRPs) between March 2012 and November 2013 in reation to the impact that changes in the Socia Wefare Act 2012 were having on uptake to their programmes. We asked projects for comparative numbers of CE participants on 31st December 2011 (before SW 2012 came into force), on 31st March 2012, on October 26th 2012 and finay on November 1st The survey in March 2012 showed that take up numbers for T. Code/Referred participants 5 had reduced by 8.5%. By October of that year the take up numbers had faen by 24%. In the fina survey (Nov 2013) take up figures for T. Code participants were down by 19% on approva numbers. Approved Numbers Actua Numbers March 12 (-8.5%) October 12 (-24%) November 13 (-19%) Reduction in appications In consutation with DRPs, the most commony cited impact of SW Act 2012 was a reduction in the number of appicants for vacancies. It is more difficut to recruit participants who are on OPF Payment and those on Disabiity Payment. Many projects noted a dramatic reduction in appications from women. One DRP noted that since the impementation of the Socia Wefare Act 5 T. Code is the DSP/FAS term for cients referred to the 1000 ring fenced paces for drug rehabiitation

23 2012 and the changes to CE, they have ony received appications from men. The project was concerned about this as much work has been undertaken over the years to attract women into the service. Even more concerning was the impact on one women specific programme that had to make the decision to open its programme to men because of faing numbers of femae appicants. Cients on Disabiity and One Parent payments are reuctant to come forward for Community Empoyment. The cost of taking up Community Empoyment i.e. trave, chidcare is a huge financia pressure. The peope are sti out there, but DRPs are imited in their abiity to remove the newy created barriers. Our numbers have dropped significanty since the beginning of 2012, with up to one third of rehab paces eft unfied. We have 7 vacancies advertised twice in the ast three months with no uptake from participants peope on OPFP and Disabiity payments are not prepared to come off their SW payment in case they can t get it back at the end of the programme. 22 It is aso more difficut to recruit those on Disabiity Payment and DRPs are concerned that, as there are no other drugs rehabiitation services in pace for this group, this wi ead to significant unmet needs amongst drug users who require support in their recovery. The difficuties experienced by DRPs in recruitment are aso highighted in the experience of the Nationa Drug Rehabiitation Impementation Committee (NDRIC). NDRIC has gathered information on the impact of changes in the Socia Wefare Act 2012 on communities within and outside Dubin and has anaysed the ack of progression on to DRPs as the most prevaent issue coming to its attention. This information was geaned from ten piot rehabiitation sites that were set up in the summer of 2012 and NDRIC has aso recorded a arge increase in the numbers of cases in its gaps and bocks process which have been attributed to the changes in the Socia Wefare Act. Participation rates based on payment type The foowing data provides us with a more detaied picture of CE participation rates based on payment type. First we ook at the nationa data, then we compare participation rates on DRPs by payment type and finay we ook at the changes in gender and age profies of DRP participants: A CE participation The figures beow show the changes in the nationa participation rate of those who were in receipt of a concurrent Socia Wefare payment between the period September 2011 and September In a categories, a stark reduction in numbers is recorded.

24 Tabe 4: Comparative CE participation numbers for those in receipt of OPF payment, disabiity, and iness benefits between 2012 and 2011 Socia Wefare Payment Sept 2011 Sept 2012 % change One Parent Famiy payment 4,508 3,060-32% Disabiity aowance 1,864 1,416-24% Iness benefit % Invaidity payment 1,390 1,039-25% Bind person s pension % Source: Dept of Socia Protection DRP participation rates Citywide tracked changes in T. Code participation (drug rehabiitation paces) by peope in receipt of a concurrent payment from December 2011 to November In December 2011, 78% of T. Code CE participants in Drug Rehab Projects were in receipt of either a concurrent Disabiity Payment or One Parent Famiy Payment (OPFP). By October 2012 that percentage had reduced to 65% with a marked drop in those on a Disabiity payment. The fina Citywide survey in November 2013, shows that ony 19% of participants on DRPs maintain a Disabiity concurrent payment and ony 6% are in receipt of OPFP (= 25% of T. Code participants). 23 Tabe 5: Comparative T-code participation numbers for those in receipt of concurrent disabiity or OPFP Dec 2011 March 2012 Oct 2012 Nov 2013 Disabiity 51% 45% 39% 19% OPFP 27% 24% 26% 6% Participants coming off concurrent payment to take up a DRP CE pace The November 2013 survey asked projects how many new participants (started since Jan 2012) have come off a concurrent payment to take up a pace: Came off Disabiity Payment: Came off OPFP: 27 (7.5% of actua numbers) 23 (6.5% of actua numbers)

25 Comparison: In December 2011, DRPs reported that 78% of DRP participants were either in receipt of disabiity or OPFP concurrent payment. In November 2013, DRPs reported that the percentage of participants sti in receipt of a concurrent payment is ony 25% and the percentage of new participants who came off a concurrent payment to take up a pace is 15%. Participant profie changes The Socia Wefare Act 2012 changed the entitement to concurrent OPF Payment & CE Aowance (the vast majority of peope caiming these payments are women), and Budget 2013 reduced the rate of Job Seeker s Payment for those under 26 years. To assess if these changes were impacting on the participant profie in DRPs, in November 2013 we asked for information on gender and age profie changes. Gender Nineteen of the responding projects are open to both men & women and of those projects 69% (13) said that since the changes in SW 2012 there was an increase in the number of mae participants in their programmes. Age 24 Whie 8 projects saw no rea change in the age profie of participants, the majority of projects (11) saw a marked increase in the numbers of young men coming forward, and 6 projects aso reported an increase in the numbers of young women 6. The new profie of participants shows an increase in younger peope on the ower Jobseekers Aowance payment. For these, there is a financia benefit to participation on CE, as weeky payment can increase from 144 per week to 208 for those aged 25 to 26 years and from 100 to 208 for peope under the age of 25 years. New barriers to participation In describing the benefits of DRPs in an earier section of the report, it was emphasised how crucia it is to the effectiveness of DRPs to have an understanding of the underying barriers to participation that are part of the ife experience of recovering drug users. In the consutation DRPs highighted the chaenges aready there in addressing these barriers and expressed serious concerns that additiona barriers are resuting from the changes that have been introduced. These barriers are eading to needs not being met, rather than an eimination or reduction of demand. The peope who need rehabiitation supports are sti out there, but DRPs are imited in their abiity to address the barriers. The views of DRPs on why paces are not being taken up concurred with those of the participants.

26 Remova of financia incentives The 2012 Socia Wefare Act wiped out the financia incentive that had encouraged participation in DRPs from peope on a disabiity payment and those parenting aone. The financia gain for participation has gone from 208 per week to 20 per week. A DRPs expressed concern that these changes have removed an effective incentive for recovering drug users to participate and are now pacing financia barriers to participation for those that experience significant marginaisation. Current CE participants and potentia CE participants who did not take up paces were asked for their views on why there has been a reduction in appications. A of them identified that the oss of concurrent payments for those on One Parent Famiy or Disabiity Payment has resuted in the oss of an effective financia incentive: When I came on the programme I had my one parent payment and I got the CE payment it made a huge difference to me I coud afford to pay chidcare. I ove being on the programme but I don t think I woud have taken up a CE pace if I d have ost my one parents payment. Caro I d ove to have a pace on a CE but I coudn t afford to take it up. Lisa Regaining disabiity payment at end of CE DRPs and referring agencies aso reported the fear amongst potentia CE participants that they woud not regain their Disabiity Payment once their time in a DRP came to an end. This fear was beieved by a the agencies to be a major disincentive to participation on CE. 25 Potentia candidates on D.A. wi not give up payment to come on project....the risk invoved in coming off a One Parent Famiy Payment or Disabiity Aowance is too much for this target group. The point was made by one community drugs project that security and certainty about the future was very important for peope in recovery and that any uncertainty around these issues woud undermine participation and utimatey undermine potentia for recovery. Interviewees who had decined a CE DRP pace, identified concerns about not regaining Disabiity Payment on competion of CE as the key factor preventing their participation. These Interviewees said that if there was a guarantee that the Disabiity Payment woud be restored at the end of CE, it woud be an important assurance: If I did not ose my entitement to getting Disabiity Payment back once the CE programme ended, I woud do it. Stephen I woud be afraid that it woud take a ong time to get the Disabiity back. It woud do my head in with the worry and I woud be afraid that I woud reapse as a resut. Thomas

27 Secondary benefits The reductions in other benefits incuding the Househod Package (namey, reductions in aowances for teephone, fue aowance) have exacerbated the effects of financia difficuties, and in some cases, these changes are incorrecty perceived as being reated to participation on DRPs. Participants reported a perception that taking part on CE wi impact on the Househod Package, and other secondary benefits amongst peope on disabiity payments. If they just et me keep everything in [the Househod Package] I d go without any extra payment. Car If I ost the Househod Package, I d be down between 90 & 100 per month... the bus pass is aso very important to me. Stephen DRPs reported that there was a ack of carity and inconsistency in information provided by DSP staff with regard to participation on CE and entitements to secondary benefits. This inconsistency was beieved to have created anxiety, creating a barrier to access for prospective DRP participants. For those who had decined CE participation, the fears around oss of the Househod Package and other secondary benefits were major considerations Additiona costs of participation 26 The additiona costs of participation, for exampe, transport, chidcare cannot be sufficienty met by the additiona 20 provided to participants. Interviewees who had not taken part in CE (but were eigibe) spoke about the additiona costs of CE participation as a disincentive. Participation on CE was perceived to ead to a cost for interviewees, and they woud inevitaby be worse off if they participated on CE. I can barey survive now. Kevin I woud have been out of pocket. The extra 20 woud not have covered transport or buying your own unch. Terry. Other impacts since 2012 Appication of abour market mechanism rues Concern was expressed by DRPs about the increasing appication of abour market mechanism rues that are inappropriate in a rehabiitation programme. DRPs are now expected to appy rues around sick pay and eave in a way that is not consistent with the deivery of a rehabiitation programme, where time off for medica appointments and treatment is often a core part of an individua s programme. The current poicy of sick pay and uncertified eave are not reaistic to our target group needs in ight of a singe payment structure. The process of deducting from the participant s aowance is extremey counterproductive

28 to the therapeutic reationships between participants and the project. There was particuar concern about indications from DSP staff that if a participant eft a DRP before the competion of the schedued programme that this coud have a negative effect on the individua s Socia Wefare Payment. Again this woud be totay inconsistent with the roe of a rehabiitation programme in addressing reapse, which is a norma part of recovery and which needs to be addressed therapeuticay when it happens. Support workers DRPs have aso reported difficuties in recruiting and maintaining support worker positions and unsurprisingy, the reasons for these difficuties are consistent with those in recruiting for rehabiitation paces, with the oss of the concurrent payment as the major disincentive to participation. DRPs have expressed fears that the reduction in support worker appications wi ead to projects osing their entitement to these posts if they remain unfied. One Manager of a DRP noted: Without maintaining their Socia Wefare payment, CE has become a ess attractive option for them: there may be costs associated with taking up the CE pacements i.e. trave, unch, chidcare which the basic CE payment does not cover. We have aso had individuas wiing to take up posts but when tod that their Rent Aowance wi be reduced have decined paces. In the past the majority of our support workers woud have accessed further education and training in the area of addiction...we have recenty been informed by our DSP officer that the participants cannot use their training grant towards this cost as it is too highy accredited...on another occasion training was decined by the DSP officer because it was not FETAC accredited (the tota training hours were 2 with a tota cost of 30 euro). 27 The above comment indicates how changes in training have become a further compicating factor with regard to recruiting support workers. Other exacerbating factors are the perceived ikeihood that support workers wi ony be in pace for one year and the engthy deays in gaining Garda cearance for participants. Another DRP manager commented: DSP say we may have to et support workers go after one year. It takes us neary a year to train them up.

29 DRPs responding to changes In November 2013 Citywide asked DRPs to comment on how they were deaing with the changes that have occurred since the introduction of SW The combination of a reduction in appicants and a change in appicant profie has meant that many DRPs have had to change their approach to deivery, resuting in a pressure to adapt existing programmes for new target groups and to run a number of different programmes at the same time, a at a time of reduced resources. Whie DRPs have responded and wecomed the opportunity to work with younger peope these changes are presenting chaenges. Many of the younger appicants are not opiate users and programmes have to be adjusted to respond to the needs of stimuant & poy-drug users: The changes initiay had a devastating effect on our recruitment figures. Peope were aso uncear about how the changes woud affect their secondary payments and advice from SW offices was often contradictory. We had to change our service and considered a number of options: drug free group, women ony group, or young adut group (18-24/25). 28 We eventuay targeted young aduts and now have a separate service for them. We sti work with the other cohort of oder opiate users and remain concerned that this traditiona group have been dispaced and disincentivised as a resut of SW We have had to make huge adjustments to our programme in order to try to retain or attract new participants. We have had to break into two separate programmes: stabiisation and drug free. As a resut of the changes we are now working with more peope with menta heath concerns. We have had to accept men onto what was previousy a programme for women ony. This has been a major upheava of the previous programme. More peope under 25 years are ooking for CE paces, party as resut of reduced SW payment. Many younger cients are stimuant users - programmes have had to be adapted to meet their needs. We see young peope on unempoyment payments coming forward who are ooking for a pace because they are getting hasse from SW they are missing motivation to address their drug probems. We are very concerned about what wi happen to oder drug users with on disabiity payments who are not coming forward. Stabiity [of the women] is changing - we are getting women who are ess stabe than before. Drug use is more chaotic. Housing is ess secure. Poverty is increasing. Chid protection issues are increasing. Domestic vioence issues are becoming reguar events rather than 'occasiona' events as before.

30

31 Concusions and Recommendations Barriers and Incentives to Participation Section 6 The major impact identified for DRPs in the research is, on the one hand, the fa in appications for paces on (Specia CE) Drug Rehabiitation Projects from peope who are on One Parent Famiy Payment or Disabiity payments and the increase in appications from peope who are on Job Seekers Payment. This change has resuted in a noticeaby different profie of peope coming forward i.e. there is a decrease in women and an increase in men, the age profie is owering and the eves of stabiity in reation to drug use are more varied. The majority of projects have seen a spike in appications from younger men over the past two years; this younger cohort may never have used heroin, but use a cocktai of iega drugs, tabets and acoho. This provides a more chaenging environment in which to deiver rehabiitation programmes. 30 DRPs in the main were set up based on a mode of working with peope who were on methadone and attending treatment cinics and were therefore inked into the system. DRPs are experienced in deveoping good practice to respond to changing drug use patterns and projects have adapted to participant profie changes by restructuring to accommodate where they can, and the consutation pointed to a range of programme reaignment incuding targeting younger aduts by providing separate services and offering stabiisation and drug free programmes. Budget 2012 wiped out the financia incentive for peope parenting aone and those with on disabiity payments to address their addiction probems, thereby creating additiona barriers to participation for these groups. It must be recognised that even before the introduction of changes in the 2012 Budget, genera barriers exist for recovering drug users attempting to address their drug use through accessing CE/rehab. These barriers are primariy inked to disadvantage and drug use and incude ow sef-esteem, ow eves of iteracy or modest educationa achievements, poor heath, insecure housing, weak socia networks, poor famiy reationships and imited access to chidcare. As DRPs are the main providers of rehabiitation programmes for peope in recovery from drug use (and in some communities, the ony provider), there are no aternative rehabiitation options avaiabe to the groups who are not participating now. Recommendations to Remove Barriers and Incentivise Participation The barriers that now exist for participants, in particuar for those on One Parent Famiy Payment and Disabiity payments, must be addressed based on their need to access CE for drugs rehabiitation. The foowing recommendations if impe - mented woud reduce barriers and encourage participation:

32 The participant shoud be guaranteed to be restored to their previous payment status at end of scheme in order to remove disincentive of insecurity. The DSP shoud carify and communicate this in writing to DRPs. No secondary payments shoud be ost or decreased as a resut of going on scheme. The time imits appied to mainstream CE shoud not be appied to DRP participants. More than one chance shoud be given to peope trying to dea with their drug probems. Enabe CE participants to access Famiy Income Suppement (FIS) 7. Introducing a specia dispensation to aow CE participants appy for FIS woud support the incusion of participants with chidren. Benchmark CE with the JobsBridge programme 8, by providing participants with an additiona 50 per week. Programme Deveopment & Deivery Difficuties in recruiting have a knock-on effect on the DRPs eve of resourcing, as there is a reduction in budgets if projects do not maintain the number of participants at the approved eve. The overa operating budget of the project decreases and the positions of supervisors and assistant supervisors are open to review if numbers fa beow a certain eve. This eve of insecurity and uncertainty is seriousy detrimenta to the panning and deivery of structured rehabiitation programmes, in particuar at a time when DRPs are trying to adapt and respond to the needs of changing target groups and in the ong run affects the future viabiity of projects. 31 The appication of mainstream CE conditions in reation to issues such as sick eave and of socia wefare rues in reation to eaving programmes eary are competey at odds with the therapeutic practice of DRPs and if impemented wi have a serious impact on the projects reationships with their participants, again with impications for future viabiity. Recommendations on Programme Deveopment & Deivery Care Pans are operated through the Nationa Drug Rehab Impementation Framework and support the individua to progress in addressing their drug probems and integrating back into their famiies and their communities. Community Empoyment operates Individua Learner Pans (ILP). There is a need to ook at how ILPs and care pans can be integrated so that pans are reaistic to the requirements of DRP participants. Joint information and training sessions with DSP and DRP staff shoud take pace on an annua and ongoing basis so that there is a mutua understanding of the context of drugs rehabiitation. A cear and consistent process needs to be in pace in appying for additiona training budgets. Training provisions shoud remain fexibe and varying eves of accreditation shoud continue to be permitted in ine with the specia conditions which aows up to 30% of training budget to be non-accredited. 7 FIS does not appy for participants on Community Empoyment. 8 The nationa internship programme

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