Background: Brain damage including cognitive impairment associated with alcohol-related brain damage (ARBD) is not always easy to diagnose (1). Few UK services have been established for people with diagnoses related to PAU and cognitive impairment, dementia or ARBD (1,2). Care providers are not always skilled in ARBD (3) and statutory provider staff may be reluctant to offer care and support (4). ‘The Seeds of Exclusion’ Salvation Army (SA) research found that 59% of 967 homeless people accessing SA services screened positively for alcohol dependency (5). One in five hostel dwellers were found to have ARBD (6), and it is likely that ARBD also exists among SA service users. In 2013, The SA appointed Drug and Alcohol Support Workers in Corps to enhance community based service provision for those with problematic drug and alcohol use.
The study aims to establish:
1. Levels of knowledge about ARBD amongst SA clients, volunteers and staff
2. What SA supports and services work best for whom and in what circumstances and why this is the case
3. Research learning to enable more closely tailor supports and services to client need
4. Recommendations for staff support and training around gaps identified
Method and methodology: Fieldwork was undertaken at three SA Corps walk-in centres. 57 people joined focus groups and interviews including clients, volunteers, SA staff, people on placements and external agency staff.
Realist inspired evaluation is identifying contexts, mechanisms and outcomes and creating programme theories to support SA service provision.
Findings evidence salutogenic SA engagement addressing the health and wellbeing of people medically described as “hard to reach” (2) but who may be accessing SA services daily.
'Three strikes and you’re welcome' reflects repeated SA salutogenic engagement with people affected by exclusion and alienation. Non-judgemental welcomes enable opening of otherwise firmly closed doors to recovery. Learning is applicable to other agencies supporting similarly affected people.
“If it wasnae fur The Salvation Army I think I'd be lying in the gutter an' that's the God's honest truth.” SA client
References
(1) Royal College of Psychiatrists, Royal College of Physicians of London, Royal College of General Practitioners and Association of Neurologists 2014, College report CR185. Alcohol and brain damage in adults with reference to high-risk groups, Royal College of Psychiatrists, London.
(2) McCabe, L. 2006, Working with people with alcohol-related brain damage, The Dementia Services Development Centre, University of Stirling.
(3) McCabe, L. 2005, Alcohol related brain damage: knowledge and attitudes of frontline care staff, Alcohol Education and Research Council, London.
(4) Scottish Advisory Committee on Drug Misuse and Scottish Advisory Committee on Alcohol Misuse (2003) Mind the gaps: meeting the needs of people with co-occurring substance misuse and mental health problems. Edinburgh: Scottish Executive.
(5) Bonner, A., Luscombe, C., van den Bree, M. & Taylor, P. 2009, 07-last update, The seeds of exclusion 2009 https://s3-eu-west-1.amazonaws.com/uki-che.salvationarmy.org/41281856-cd9d-4c4f-9c43-672e34cae846_The%20Seeds%20of%20Exclusion%202009.pdf [2014, 07/05].
(6) Gilchrist, G. & Morrison, D.S. 2005, "Prevalence of alcohol related brain damage among homeless hostel dwellers in Glasgow.", European Journal of Public Health, vol. 15, no. 6, pp. 587-588
Please select one of the following:: Realist research (other) , Please select a maximum of two themes from the following list:: Exploring 'Mechanisms' , Please select a maximum of two themes from the following list:: Other
