Respecting rights in recovery: evaluating a rights based advocacy service

Aim
The overarching aim of this evaluation of an independent advocacy training service provider, and independent rights-based advocacy service was to examine the impact of RAPA¹ training, document the QoL of candidates and clients using the advocacy service in the context of recovery.

Methods
Using mixed methods to gather quantitative and qualitative data we evaluate Reach Advocacy (RA) service, an independent rights-based advocacy service in the context of recovery from the perspectives of Trainers, RA Volunteers, RAPA Candidates, and Clients (pre-Candidates) attending RA. Fieldwork took place in and around the premises of Reach Advocacy based in Coatbridge, and service providers within North and South Lanarkshire and Glasgow. RA client perspectives of rights-based advocacy were documented using semi structured interviews. In addition, the WHOQoL-100² questionnaire was used at initial contact and after a period of ten months after initial contact, measuring QoL in the context of recovery. RAPA candidate therapeutic attitudes to working with vulnerable client groups were documented pre and post RAPA training using an adapted AAPPQ³.

Findings
1 An inclusive rights-based approach to advocacy in the context of recovery is innovative and markedly different from existing needs and issues-based service provision for problem AOD⁴ users and dual diagnosed individuals.

2 Candidates successfully completing The SCQF level 7 RAPA document higher levels of therapeutic commitment using the adapted AAPPQ which indicates that the RA services staffed by individuals with lived experience can and do create education opportunities in the context of recovery using innovative and national standardised vocational education.

3 Service provision underpinned by Human Rights and lived experience of individuals in recovery, impact positively on quality of life (QoL) across the social determinants of health documented using the WHOQoL-100. We evaluated the suitability of using the WHO QoL questionnaire on individuals in recovery and discovered that the longer the candidates and precandidates (RA clients) were in recovery, broadly, the higher the scores in each of the 6 domains in the WHOQoL-100. This has allowed us to introduce a new term into the recovery lexicon, that of ‘recovery oriented QoL’. The longer a candidate is in recovery, the higher QoL mean scores. Conversely, clients attending RA, who have not maintained or achieved long term recovery have low QoL mean scores.

Recommendations
A rights-based person-centred approach to problem AOD use and dual diagnosed individuals requires a new way to understand how to commission services. This means a move from needs based approaches that focus on one issue such as drug and alcohol consumption, mental health, treatment compliance, or on housing that create eligibility criteria, which can also be perceived as barriers to recovery.

A rights-based approach to problematic AOD use and dual diagnosis services requires universal services and commissioners to have as their starting point, the understanding that vulnerable and marginalised AOD users and dual diagnosed individuals present with complex and concurrent issues whilst experiencing the effects of marginalisation and discrimination.

The Social Security Bill (Scotland) 2018 describes newly devolved social security powers. Amendment 35 states that any Advocacy Worker working with vulnerable individuals has to abide by the advocacy service standards within a nationally recognised quality assured advocacy award by the Scottish Qualifications Authority (SQA). The RAPA provided by Reach Advocacy fits this criterion. The advocacy training standards indicate that services providing training in Advocacy should have embedded quality assured processes.

The RAPA has been quality assured and assessed by the SQA and fits these criteria. The RAPA training is underpinned by a strong focus on Human Rights aligned to The Scottish Governments Scottish National Action Plan (SNAP) and (P.A.N.E.L) principles of Participation, Accountability, Non-Discriminatory, Empowerment, Legality.

We recommend that service purchasers and providers acknowledge that problematic AOD users, and dually diagnosed individuals are rights bearers, and existing services as duty bearers should fully embrace Rights Based Advocacy (RBA), not in a tokenistic manner, to access government funding, but at the forefront of service provision.

¹ Reach Advocacy Practice Award
² World Health Organisation's quality of life 100 item questionnaire
³ Alcohol and Alcohol problems perception questionnaire
⁴ Alcohol and other drugs