Applying psychological theory to understand the difficulties and supporting factors in implementing family based approaches in alcohol treatment services

Applying psychological theory to understand the difficulties and supporting factors in implementing family based approaches in alcohol treatment services. The current study investigated staff perceptions regarding whether recommendations for family based approaches to be made available in alcohol treatment services were being implemented. This included exploration of factors that staff perceive may either impede or facilitate family based work. There were two stages of data collection. Stage 1 involved collecting demographic and descriptive information from the participating services to establish the homogeneity of the sample and whether family work was offered by each service. For Stage 2, 18 staff from seven alcohol treatment services were recruited. Semi-structured interviews were audio-taped, with interview questions based on theoretical domains which explored respondents’ perceptions of the implementation of the guidelines and family based work. The interview transcripts were analysed twice, initially to give an indication of the respondent’s perception of the level of success of implementation but also to identify pre-determined theoretical domains which supported and impeded implementation of family based work. The transcripts were then reanalysed to indicate relationships between domains, to provide a hierarchical framework for organising the themes and to identify other themes which may have been missed in the first analysis. The first analysis indicated variability in the level of success of implementation across services. Further exploration indicated factors contributing to more successful implementation which included staff believing that family work was likely to lead to positive results, providing it was compatible with their skills and perceptions o f their role and identity, and they were motivated to provide it. Barriers to implementation identified by staff included: ‘Environmental context and resources,’ (e.g. lack of funding and time, inadequate space, inaccessible working hours and staffing levels); ‘social influences’ (e.g. lack of support from management and the team); and ‘emotions’ (e.g. fear, anxiety and lack of self-confidence in doing family work). The study also identified facilitators and barriers to family work at different levels: Staff participant; problem drinker and family; and the organisation. The results suggested that staff perceptions of family based work, the culture o f working within addiction services, and perceiving the problem as within the individual problem drinker were particular barriers to family based work. The study therefore demonstrates the importance of considering the social construction of the problem and the socio-cultural context to help facilitate implementation of family based work in alcohol treatment services. ACKNOWLEDGEMENTS I would like to thank many people for their input in the completion of this thesis. A huge thank you to all the participants from the alcohol teams who took part in this study because without their time and valuable contributions this piece of research would not have been possible. I would also like to sincerely thank my academic supervisor Dr Marilyn Christie for all her advice, time and patience. Throughout this process your encouragement and support has helped keep me motivated. I would also like to say a special thank you to Dr Sue Kellett and Dr Noelle Robertson for their contributions and expertise. Finally, I would like to thank all of those people around me who have supported me over the last three years, particularly my husband Aaron, for his tolerance and understanding.