1. Context

Scope

This capability framework is for the drug and alcohol treatment and recovery workforce. It should be read alongside the 10-year strategic plan for the drug and alcohol treatment and recovery workforce (2024–2034).

This framework underpins the national drug and alcohol treatment and recovery workforce transformation programme, developed following the Independent review of drugs by Professor Dame Carol Black. The independent review found that the Drug and Alcohol National Occupational Standards (DANOS) no longer reflect the current needs of the sector. This capability framework provides new guidance on the knowledge and skills required for core roles within the sector. The existing DANOS competencies will remain in the National Occupational Standards (NOS).

This new capability framework will support the development of a multidisciplinary workforce with the consistent capability to deliver high-quality treatment and recovery services.

Aims

This framework identifies core capabilities for 15 core roles in the sector. It aims to enable safer and more effective practice by:

• describing the skills, knowledge and behaviours required for 15 core roles in the adult and children and young people’s (CYP) drug and alcohol treatment and recovery workforce
• providing capability statements for core unregulated roles in the sector (such as drug and alcohol workers)
• helping to standardise key capabilities across the sector to support the consistency and quality of drug and alcohol treatment and recovery service provision
• helping to support consistency in job descriptions, titles and contracts across the sector
• outlining the capability requirements for effective supervision
• supporting training, education and research, and identifying potential career progression and continuing professional development (CPD) for core roles across the sector
• aiding service providers and commissioners in assessing skills gaps within the sector
• helping to inform the design and commissioning of a multidisciplinary workforce, able to deliver evidence-based treatment and support
• providing a firm foundation for future workforce and service planning and design

Roles in scope

The roles considered in this capability framework are detailed below.

The following 11 core roles have both role profiles and lists of capabilities:

• drug and alcohol workers*
• children and young people’s drug and alcohol (CYP D&A) workers
• senior drug and alcohol workers
• family support workers (adult-focused)
• family support workers (children and young people-focused)
• Nursing and Midwifery Council (NMC)-registered nurses, including non-medical prescribers and registered nursing associates
• Health and Care Professions Council (HCPC)-regulated practitioner psychologists
• Social Work England (SWE)-registered social workers
• General Pharmaceutical Council (GPhC)-registered pharmacists and pharmacy technicians
• drug and alcohol peer support workers (PSWs)
• commissioners

* Services use a range of job titles for workers providing direct care, treatment and support. These include recovery co-ordinator, outreach worker and criminal justice drug and alcohol worker. Here, as in the Drug and Alcohol Treatment and Recovery Services National Workforce Census, all roles that provide in-person and digital clinical work, and usually hold a caseload of people in structured treatment (including key working, harm reduction, outreach and psychosocial interventions with people who use(d) drugs and/or alcohol) are subsumed under the generic title of drug and alcohol worker.

The following 4 core roles have role descriptors only, as there are existing frameworks and/or guidance in place:

• medical workforce including addiction psychiatrists and GPs
• leaders and managers
• counsellors

Role descriptors for these roles are in section 7 and links to external guidance that should be followed in conjunction with this framework. It is vital for those using this document that these roles are viewed as integral to the drug and alcohol treatment and recovery system, and that this external guidance is referred to.

Settings in scope

When this capability framework refers to ‘drug and alcohol treatment and recovery services’, ‘service providers’, ‘workforce’ or ‘sector’, it does so in reference to local authority (LA) -commissioned community, inpatient and residential treatment and recovery service providers. Where this capability framework refers to ‘lived experience recovery organisations’ (LEROs), it refers to all LERO provisions regardless of whether they are commissioned by an LA.

This framework is applicable to the following settings:

• LA-commissioned adult and CYP community drug and alcohol treatment and recovery, residential rehabilitation and inpatient detoxification service providers, including NHS and third sector providers and some LA-delivered service provision
• services funded by LAs through the local drug and alcohol treatment budget and those funded by the public health grant, the Supplemental Substance Misuse Treatment and Recovery Grant, the Rough Sleeping Drug and Alcohol Treatment Grant, the Individual Placement and Support initiative and any other drug and alcohol treatment and recovery-related direct grants from the Office for Health Improvement and Disparities (OHID) to LAs. This includes services provided by general practitioners (GPs) who are commissioned to treat people dependent on drugs and alcohol by an LA as part of a shared care arrangement with a specialist drug and alcohol treatment service, or as part of an LA-commissioned primary care-led or other specialist treatment service
• LEROs, which are organisations led by people with lived experience of recovery that deliver a range of harm reduction interventions, peer support and recovery support, and help people to access and engage in treatment and other support services
• LA drug and alcohol-specific commissioning teams in public health

Roles and settings out of scope

The following roles and settings are out of the scope of this capability framework as they are not part of the LA-commissioned drug and alcohol treatment and recovery workforce:

• non-specialist workers who screen and refer into specialist drug and alcohol settings
• pharmacists and pharmacist assistants in retail, community pharmacies and hospital pharmacies (only pharmacists directly employed by treatment and recovery services are within scope)
• GPs treating people dependent on drugs and alcohol but not commissioned to do so by an LA as part of a shared care arrangement with a specialist drug and alcohol treatment service, or as part of an LA-commissioned primary care-led or other specialist treatment service
• NHS England-commissioned drug and alcohol treatment teams in secure settings
• NHS England-commissioned Alcohol Care Teams

2. How to use this framework with existing and forthcoming implementation resources

Implementing this capability framework will be an ongoing process, with the drug and alcohol treatment and recovery sector working towards standardised workforce roles.

How to use this framework

Commissioners and service providers should use this capability framework to ensure that their workforce has the required skills, knowledge and behaviours to enable services to deliver the rounded care and treatment required by their population.

The workforce is not expected to meet all capability requirements at entry level or early career stage but should be supported to work towards them through training and development opportunities, effective supervision arrangements and the provision of high-quality clinical leadership. This is especially true for PSWs who may be joining the workforce following unemployment and will, in many cases, be entering for the first time without having completed any specialist training.

It is therefore unlikely that people applying for PSW roles will already have all the capabilities outlined in the PSW framework. Employers must therefore ensure that induction and tailored learning and development plans help PSWs to incrementally develop the capabilities required for their role.

To enhance the growth of regulated professionals within teams, several factors need to be considered. It is essential to have a sufficient number of experienced and senior regulated professionals already established within the team. This ensures their ability to provide clinical supervision, establish effective governance structures, train the next generation of regulated professionals and offer valuable career progression opportunities.

The framework should be used by managers and service providers to inform:

• job descriptions
• workforce development, commissioning and training/development plans

The capabilities in this framework should be considered as fundamental to each specified role and are not designed to be used in a ‘pick and mix’ fashion. The exceptions to this rule are:

• the practitioner psychologist, nursing and pharmacist and pharmacy technician capabilities. This is because these frameworks cover more than 1 role type with different types of professional registration and roles. The practitioner psychologist framework specifically covers registered consultant and non-consultant clinical, counselling and forensic psychologist roles. The nursing framework covers registered nurses, nursing non-medical prescribers and nursing associates. The pharmacy framework covers registered pharmacists and pharmacy technicians.
• the PSW capabilities. As acknowledged in the PSW role profile, PSWs’ roles vary widely in practice from service to service: for example, some workers focus on providing one-to-one support and running peer support groups, while others provide broader support through social and community activities. Service providers may find that not all the capabilities listed in the PSW framework are relevant or required for the PSWs they employ, depending on the nature of their service. It is the responsibility of the service provider to ensure that capabilities are adhered to where required – for example, if PSWs working in a given service offer one-to-one support, then the capabilities listed in the framework regarding this must be in place.

Some of the roles covered in this capability framework are inter-related and should be looked at together. These are:

• senior drug and alcohol workers working with adults must have all the capabilities outlined in the drug and alcohol worker framework. Senior drug and alcohol workers working with children and young people must have all the capabilities outlined in the children and young people’s drug and alcohol worker framework.
• family support workers (children and young people-focused) must have all the capabilities in the family support worker (adult-focused) framework. This is because they work with adult family members.

Some of the roles covered in this capability framework are regulated professional roles. The capabilities outlined in this framework are the specific capabilities required by these professionals when working in a drug and alcohol treatment and recovery setting. These setting-specific capabilities are intended to sit alongside existing competency frameworks and regulatory requirements for regulated professions. These frameworks do not replace or supersede any such existing competency frameworks. Regulated professionals must work in line with their professional regulation requirements.

This capability framework has been developed for core roles working in the drug and alcohol treatment and recovery settings in scope. They are necessarily generic. This means they do not account for the specific commissioned services in each local area. It is imperative that local services ensure that people have the right capabilities and experience to perform the roles they are employed in. This includes ensuring that staff have the capabilities and experience to work with populations with different vulnerabilities especially in relation to domestic abuse and harms experienced by children.

Because these capabilities will be implemented in the context of current and future workstreams, it is important that they are seen as integrated with the strategic developments flowing from the Independent review of drugs by Professor Dame Carol Black. As such, the framework needs to be viewed as part of the 10-year drug and alcohol treatment and recovery workforce strategic plan, which provides a comprehensive plan for implementing the various aspects of the drug and alcohol treatment and recovery workforce ambitions. The framework should be used with the key existing and forthcoming resources. These resources are outlined in the following sections.

Existing implementation resources

This framework needs to be used in conjunction with current planning advice and resources, notably the:

• Commissioning quality standard: alcohol and drug treatment and recovery guidance for LAs to support them in commissioning effective alcohol and drug treatment and recovery services in their areas
• Drug misuse and dependence: UK guidelines on clinical management, which indicate how clinicians should treat people with problematic drug use
• relevant National Institute for Health and Care Excellence (NICE) guidance on interventions for people who use(d) drugs and/or alcohol problematically
• 2022 and 2023 Drug and Alcohol Treatment and Recovery Services National Workforce Censuses, which provide data on the current workforce and so a baseline for future developments. Annual findings are summarised in a published national report, with LA-level reports provided to LAs and service-level reports provided to employers
• 10-year strategic plan for the drug and alcohol treatment and recovery workforce (2024-2034) was published in May 2024. It outlines the actions required and key milestones in workforce development between 2024 and 2034. It is focused on growing, training and developing the workforce. This will include bringing more new and experienced professionals into the sector and supporting the development of high-quality training for roles that are currently unregulated such as drug and alcohol workers.

Forthcoming implementation resources

Forthcoming resources and projects that will be relevant to the implementation of this framework include:

• the drug and alcohol treatment and recovery workforce calculator, which will inform good practice for services by matching the needs of the population they serve to the range and number of roles they should consider recruiting for
• UK clinical guidelines for alcohol treatment

3. Terminology

Key terms used in this framework are defined below.

People who use(d) drugs and/or alcohol

Language differs across the drug and alcohol treatment and recovery sector. However, after considerable stakeholder consultation with a wide-ranging group of experts, including experts by experience, families/carers, PSWs, clinicians (including regulated professionals) and service providers, the term ‘people who use(d) drugs and/or alcohol’ is considered the preferred term to describe those who require support and/or treatment for their drug and/or alcohol use.

For ease of reading, this has often been shortened to ‘people’ throughout this framework where appropriate. Therefore, unless otherwise specified, where the term ‘people’ is used it pertains to people who use(d) drugs and/or alcohol.

Capabilities that apply to working with children and young people who use(d) drugs and/or alcohol, or children and young people affected by parent/carer problematic drug and alcohol use will be specified.

Capability versus competence

Competence frameworks usually detail the attitudes, knowledge and skills associated with specific clinical activities – for example, the competence required to deliver a behavioural intervention. This capability framework has a different focus. It is made up of a set of role profiles and, for some roles, a set of capability statements, for the core roles in drug and alcohol treatment and recovery services and commissioning.

This means describing what each of these core roles can contribute (hence ‘capabilities’), setting it out in a way that makes it possible to compare professions and identify what each has in common and where their distinctive contribution lies.

A capability framework is less granular than a competence framework, with capabilities pitched at a strategic level that clearly sets out the parameters of the different roles, albeit that some interpretation may be required to identify the specific capabilities involved. This latter point is important as it allows commissioners, managers and trainers to adapt specific job descriptions and training models within the overarching context of the capabilities to reflect the diverse nature of drug and alcohol services and the populations they serve.

As outlined in section 2 above, regulated professionals must work in line with their professional regulation requirements and existing professional competency frameworks for their role.

Clinical and clinician

The terms ‘clinical’ or ‘clinician’ are sometimes seen as synonymous with ‘medical’ and as implying that a particular model of care is being advocated. In this capability framework, these terms refer to activities carried out by anyone in a role that is delivering or supporting treatment and care, in line with clinical and treatment guidelines, directly to people using drug and alcohol treatment and recovery services. This includes drug and alcohol workers and CYP D&A workers. The term in this context is not synonymous with the ‘medical model’. It refers to a range of evidence-based approaches, including psychosocial interventions, as detailed in national clinical guidelines. This use of the terminology is consistent with the Department of Health and Social Care’s (DHSC) Drug misuse and dependence: UK guidelines on clinical management.

Although PSWs are employed and paid to offer direct support and advice to people, they do so in a manner that draws upon the concept of peer support – using their own lived experience to guide the process, rather than clinical and treatment guidelines. For this reason, and because they are not clinically trained, PSWs are not considered ‘clinicians’ for the purpose of this framework; nor are they considered to undertake clinical work in line with clinical and treatment guidelines.

OHID has summarised the evidence for and value of peer support in helping people start and sustain recovery from problem drug and alcohol use. This includes how the ‘lived experience of a peer volunteer or worker helps to overcome the power difference that often exists in the relationship between a clinician and the person they are supporting’. Research shows that ‘peers can offer the people they support a strong sense of personal connection, encouragement and hope, through participating in purposeful activity’.

While their role is not clinical, PSWs require regular access to supportive supervision, which should include an element of reflective practice (as defined later in section 3), offering them a space to review and reflect on their work with an appropriately trained clinician or senior PSW. This should also include an opportunity to talk about areas that they might experience as difficult or distressing and must be differentiated from line management or case management. It is vital that service providers ensure that supportive supervision and reflective practice are made available to promote and maintain the wellbeing and safety of both PSWs and the people they are supporting.

Clinical governance

‘Clinical governance’ describes the organisational frameworks, structures, processes and culture needed to ensure that healthcare organisations and individuals within them can assure the quality of the care they currently provide and thereby seek to improve it (DHSC, Clinical governance guidance, 2011).

Effective clinical governance will include ongoing monitoring and assessment of clinical effectiveness; risk management; people’s experience of and involvement in services; communication; resource effectiveness; strategic effectiveness; and learning effectiveness. Effective clinical governance is vital in the implementation of this capability framework and clear plans will be outlined in the forthcoming strategic plan for the drug and alcohol treatment and recovery workforce, which will look to implement and sustain effective clinical governance within the sector.

Problematic drug and alcohol use

This framework adopts the term ‘problematic’ where contextually it is necessary. However, it is important to recognise that there is justified sensitivity around the word ‘problematic’. This is because the term can be used judgementally and can be a description applied to a person who may or may not experience their drug and alcohol use in this way. People will make their own decisions as to whether their use is harmful to themselves or those around them. However, it is the case that the focus of drug and alcohol services is on addressing harms related to drug and alcohol use, either socially, physically or psychologically. It is in this sense that the term ‘problematic’ is used.

Clinical supervision

In this framework, ‘clinical supervision’ is defined as a collaborative formal process that takes place in an organisational context. It is part of the overall training and development of clinicians and facilitates the development of the supervisee’s competencies, ensuring that they practise in a manner that conforms to current ethical, organisational and professional standards and promotes their own wellbeing. It is important that clinical supervision involves reflective practice as defined below.

Reflective practice

‘Reflective practice’ is a process that enables supervisees to engage in analytical thinking about a situation and understand how it has affected them and/or their practice. It enables the supervisee to identify areas for learning and development and develop self-awareness. It also supports sharing and learning from colleagues and offers a space for the supervisee to think about their own wellbeing.

Regulated workforce

As defined in the Professional Qualifications Act 2022, the ‘regulated workforce’ refers to roles that require an essential level of training for registration with a professional body to be able to fulfil the role.

Unregulated workforce

The ‘unregulated workforce’ are people who, at the time of writing, do not need to have an essential professional qualification and registration with a governing body for the purpose of their role.

Lived experience

‘Lived experience’ is the experience of people and families who were previously affected by problematic drug or alcohol use and are now in recovery. This is distinct from ‘learned experience’, which people can get through studying, practising or exposure. People can, and typically do, have a mixture of both lived experience and learned experience.

4. Underpinning principles and requirements

The following have been identified as underpinning principles and should be considered relevant to all workers in the drug and alcohol treatment and recovery sector.

Trauma-informed care

Trauma is a common lived experience for many people with problematic drug and alcohol use (Dass-Brailsford, P and Myrick, AC. ‘Psychological Trauma and Substance Abuse: The Need for an Integrated Approach’. Trauma, Violence, & Abuse 2010: volume 11, pages 202–213). Trauma-informed care involves recognising and understanding the impact of trauma and developing and maintaining an empathic and trusting therapeutic relationship that helps people to feel safe sharing their stories. It ensures that people are not viewed or treated as labels or diagnoses, but as individuals with unique stories, strengths, and needs. Trauma-informed care relies on a collaborative approach to all aspects of assessment, care, and treatment in which people feel able to make informed choices at every step. This is vital because, without this approach, people can be re-traumatised by negative experiences of services; for example, people may experience treatment as being done ‘to’ them rather than ‘with’ them. Re-traumatisation can have significant negative consequences on people’s mental health and view of the world. It may impact their motivation to connect with and use services and therefore impede their recovery.

Recovery-oriented approach

Across all adult roles, it is assumed that clinicians will adopt a recovery-oriented approach. This is an individualised orientation that involves using strategies to empower people to use their strengths and skills to help them lead the life that they choose when experiencing problematic use of drugs and alcohol, supporting each person to have control over their life. Importantly, this also means that people should be helped to define what recovery means for them – for example, whether this means abstinence or a form of harm reduction, such as controlled drinking.

A linked set of principles underpin this approach:

• seeing each person as an individual and not just focusing on their alcohol and/or drug use or their mental health
• acknowledging and working with individual differences (such as age, gender, culture, beliefs, and support networks)
• working with people to identify and build their personal, social and community recovery capital, rather than focusing on ‘deficits’
• connecting people to the wider recovery community (for example, through peer support groups, mutual aid, social and learning activities or LEROs)
• understanding each individual’s situation and experience
• holding in mind that each person’s recovery journey is likely to be a mix of achievements and setbacks, rather than a straight path
• supporting the person to have a meaningful life that is based on their choices, goals, strengths and abilities

In essence, the recovery-oriented approach is a journey, moving people away from the harm and the problems they experience towards a healthier and more fulfilling life.

Evidence-based practice

Evidence-based practice is fundamental to drug and alcohol treatment and recovery. Therefore, this framework should be used alongside relevant clinical guidelines as detailed in section 2. When using this framework, it should be assumed that all capabilities listed – be they around knowledge, assessment, care and treatment planning or delivery of intervention – must be informed by evidence-based practice. This applies to all roles, including non-clinical roles.

Co-occurring needs multidisciplinary working

People who use(d) drugs and/or alcohol may have several co-occurring needs that often require diligent joint working with external agencies. These needs may relate to mental and physical health problems, learning disabilities, poor or unstable housing, and/or pregnancy and postpartum needs. These co-occurring needs may often have mutual influence, but there is a risk that they are seen as the responsibility of different services. This can lead to fragmentation rather than the person’s needs being addressed holistically. There is good evidence to suggest that outcomes are better when people receive care that encompasses all areas of difficulty and integrates treatment (Wüsthoff E, Waal H and Gråwe R. ‘The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression – a group randomized trial’. BMC Psychiatry 2014: volume 14, issue 67).

In practice, care for people with co-occurring needs could be co-ordinated by the same person or by relevant clinicians working in collaboration to deliver a care package. This means that clinicians need the capacity to co-ordinate care through referral to and liaison with other members of a multidisciplinary team (MDT), or external services if this is deemed appropriate. Clinicians will then need to share information, monitor progress and troubleshoot any problems that emerge in co-ordinating care. It also points to the importance, and perhaps the challenge, of developing and maintaining strong links across systems of care.

While non-drug and alcohol specialist services and healthcare providers are out of the scope of this capability framework, it is recognised that there is a need for stronger links between the LA-commissioned drug and alcohol treatment and recovery sector and the wider health and social care system. Safer and more effective care can be achieved by enabling the drug and alcohol workforce to refer to and use the skills of those within wider systems.

Two examples illustrate why this is important:

• stakeholders report that mental health services are often reluctant to take on people who use(d) drugs and/or alcohol, meaning that drug and alcohol workers are left to hold risk and to work with mental health problems for which they may not have the appropriate skills
• stakeholders report that people who use(d) drugs and/or alcohol rarely see their GP, leaving the drug and alcohol workforce to manage often complex physical health problems

Stronger links with services and more effective referral pathways will minimise this issue and ensure that people are able to access the care, treatment and support they need. As such, collaboration between all system partners at local, regional and national levels will ensure greater cohesion and enable the operational effectiveness of these frameworks.

Forming a working alliance

Strong evidence exists outlining the benefits of a positive working alliance (also known as a therapeutic alliance) between clinicians and the people they are working with (Roth AD and Fonagy P (2005). What Works for Whom? A Critical Review of Psychotherapy Research, 2nd edition, Guilford Press). This is characterised by a strong, supportive, trusting and non-judgemental relationship. Not only does this make engagement with a service more likely, but it also makes it more likely that interventions will be successful. These alliances are associated with clinicians displaying empathy, listening attentively to the person’s story, being consistent and reliable, being responsive, and demonstrating the capacity to collaboratively identify the person’s needs and goals.

Person-centred working

Person-centred working is an important principle that involves respecting the treatment and support preferences of individuals and fully considering the goals that are meaningful and important to them. It is rooted in working with the whole person, involving them in decision-making and supporting them to actively manage their own health and wellbeing.

Therapeutic optimism

Clinicians and PSWs should hold a genuine belief in the possibility of recovery and demonstrate this in their interactions with people. This also means demonstrating a commitment to helping people identify what recovery means for them and helping them achieve this.

Challenging stigma

People who use(d) drugs and/or alcohol often experience stigma when in contact with services and in the wider community. This has an important consequence in that they may be reluctant to access services due to an expectation of stigma and rejection and a sense of shame. This, in turn, leads to significant health and social inequalities. Challenging stigma is part of clinicians’ and PSWs roles – being alert to the ways in which negative perceptions can influence not only their own behaviour but that of colleagues within and external to their own service.

Clinical supervision

Clinical supervision is important for people who are training to become regulated professionals but are yet to qualify. It is also just as relevant for regulated and unregulated clinicians, as it plays an important role in maintaining and developing their skills and ensuring best practices.

Supervision should be offered by individuals with relevant training, direct experience of the interventions being supervised, thorough knowledge of the process of supervision (Generic competencies associated with the process of supervising psychological interventions can be found in the UCL Competence Framework for Supervision), and understanding of the role being supervised (ensuring that supervisors are aware of the person’s remit, as well as their likely level of experience and expertise). It should involve reflective practice (as defined in section 3) and should be distinguished from other forms of supervision as outlined below.

Supportive supervision for PSWs

While not considered clinicians, PSWs require regular access to supportive supervision, which includes reflective practice (as defined in section 3), offering them a space to review and reflect on their work with an appropriately trained clinician or senior PSW. This should also include an opportunity to talk about areas that they might experience as difficult or distressing and must be differentiated from line management or case management. It is vital that service providers ensure this is made available to promote and maintain the wellbeing and safety of PSWs and the people they are supporting.

Distinguishing clinical supervision, management supervision and professional supervision

Clinical supervision focuses essentially on skills development; for example, core skills in developing the therapeutic alliance, motivational work and any more specific techniques or interventions used. It also offers clinicians a space to reflect on their work, including its impact on them and on their professional development. Clinical supervisors need to be trained and competent in providing the interventions they are supervising.

Management supervision focuses on ensuring that organisational policies and procedures are followed, performance is monitored and appraised, and operational issues such as managing caseloads are handled effectively.

Professional supervision supports profession-specific aspects of the work and the governance of these within a professional group. It ensures adherence to profession-specific standards and capabilities.

Seniority and supervision

Across the range of workers in an MDT, individuals with more substantial training and experience will usually be able to undertake more complex work and have a greater perspective on the work as a whole. They will be able to draw on this to offer advice and support to colleagues from their own profession as well as other members of the team.

Critically (and distinct from giving advice), they should offer clinical supervision as part of their formal role. This responsibility should be recognised when considering how to structure staff time.

Supervision, clinical governance and leadership

Supporting effective and safe treatment is an important part of the role of all senior members of an MDT, regardless of their profession or background training. This is a shared responsibility rather than the preserve of any one profession and is based on seniority and expertise rather than role title. Collaborative leadership is the responsibility of all who work with people using services – it promotes multidisciplinary working, shared decision-making and inclusive practices, ensuring that clinical governance and leadership are distributed across the MDT, which in turn enables safer and more effective practices.

Delivering clinical governance and leadership through an MDT promotes a comprehensive and effective approach to treatment and care, addressing a diverse range of people’s needs. This can be achieved in a variety of ways. Clinical supervision is a primary tool as it should be part of routine practice and so accessed by all members of the MDT on a regular basis. As such it plays a key role in workforce development, fostering a culture of collective responsibility and continuous improvement.

Working with families, carers and affected others

People who live, or share lives, with people who use(d) drugs and/or alcohol are often at the forefront of providing support and maintaining a stable family life, which can cause considerable stress. This may include children, as well as partners, carers and close relations. This means that services should be aware of those affected by a person’s drug and/or alcohol use, and should offer direct support where appropriate, and/or a referral to another service. It must comply with national legislation and statutory guidance on child and adult safeguarding by, among other things, recognising and acting on safeguarding concerns (such as domestic abuse and harms experienced by children) whether working with the family as a whole or with individual family members. The term ‘affected others’ is used throughout this framework in addition to ‘family/carers’ as acknowledgement that people may have supportive networks that do not fall into these categories.

Working with people who are involved in the criminal justice system

People who use(d) drugs and/or alcohol are more likely than average to come into contact with the criminal justice system. Many of them will face the stigma of being labelled as ‘offenders’ and will find it much more difficult to secure education, training or employment. They may come from backgrounds characterised by social inequality and injustice and may have co-occurring mental and/or physical health problems.

The challenge for services is to ensure that they receive support that is responsive to their needs and ensures continuity, particularly for people leaving prison, who are likely to drop out of treatment without well-rounded support. Care should be taken to maintain the benefits of treatment and protect the recovery capital gained in treatment while in custody. Appropriate key information should be shared between the prison treatment and community treatment services in a timely manner to allow for early engagement upon release. Where possible, this support should be provided in peoples’ own local communities, given that this is where their support networks are most likely to be found.

Assuring equality, diversity and inclusion in the workforce and service delivery

NHS England has set out an Equality, diversity and inclusion improvement plan detailing the steps that need to be taken to address inequalities in the workforce. This requires services to identify barriers and biases as well as targeted action to overcome specific inequalities, discrimination and marginalisation experienced by certain groups and individuals (including, but not limited to, those with protected characteristics under the Equality Act 2010). In line with best evidence and practices, the principles of these pieces of guidance should be echoed and The Local Government Association, Charity Commission and National Council for Voluntary Organisations also provide guidance on assuring equality, diversity and inclusion in the workforce and service delivery. embedded in the drug and alcohol treatment and recovery workforce and service delivery as appropriate to the organisation type.

Supporting a work environment that promotes wellbeing for staff

There is a broad recognition that working in any health and social care setting can be stressful, and that this can be compounded if the work environment itself does not offer support to individual team members or conveys a message that experiencing the predictable consequences of stress (for example, depression or anxiety) represents a failure on the part of the worker. Encouraging self-care is an important part of staff management. Systems of support (such as supervision) need to be integrated into service structures. A well-functioning team will be alert to indications of stress among colleagues and will be able to address this in a manner that is supportive and effective. It will also be well versed in preventive approaches to workplace stress.

5. Clinical role capabilities

5.1 Drug and alcohol worker capabilities

Role profile

Drug and alcohol workers deliver and co-ordinate treatment, care and support for people, primarily to promote their recovery, mental and physical health, safety and social inclusion and to reduce harm associated with problematic drug and alcohol use. They carry out comprehensive, individualised assessments of the physical, psychological and social needs of people and use evidence-based psychosocial interventions (such as motivational interviewing, cognitive behavioural therapy (CBT) – informed techniques and contingency management) to help people begin or maintain their recovery journey.

Drug and alcohol workers adopt a person-centred, trauma-informed approach, ensuring that people are aware of their treatment and support options and can make informed decisions about these. They work collaboratively with people to develop, implement and evaluate care and treatment to help them meet their goals. They work closely with families, carers and affected others to promote everyone’s recovery.

As well as delivering one-to-one support, they often facilitate groups focused on reducing harm, supporting treatment outcomes, initiating recovery and preventing relapse. Drug and alcohol workers require a broad skill set that enables them to adopt this truly person-centred approach, including the skills to recognise when a person should be referred to, or supported to access, a specialist service or professional. They work closely with a wide range of professionals and external services, such as mental health, housing and employment services, referring people accordingly to ensure their needs are met.

Overarching capabilities

• able to consistently deploy evidence-based care and support strategies to promote and provide person-centred, trauma-informed care, as well as providing information, advice and guidance to people, including families, carers, affected others and other professionals
• able to exchange information with people, including families, carers and affected others (where appropriate), using active listening, compassion, empathy and co-production techniques
• able to work independently with people, within the scope of the role and operational policies, protocols and procedures
• able to manage own caseload and time effectively – can ascertain priorities, tasks and resources, taking account of changing circumstances, risks and the needs of people
• able to understand current research happening in the sector and share opportunities to engage in research with people, including families, carers and affected others
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of signs and symptoms of problematic alcohol and drug use and dependence, severity of dependence, complexity of needs, and appropriate interventions, and so able to assess individual support needs
• knowledge of trauma-informed approaches and the ways trauma may present in people, and so able to apply this to enable a trauma-informed approach within services
• knowledge of mental health and mental health problems, and so able to detect early warning signs that a person may be struggling with their mental health, or is likely to struggle in the future without appropriate support, and so able to respond, escalate or refer in line with the requirements of their role
• knowledge of the social, cultural and economic influences, individual experiences and behaviours that are associated with problematic drug and alcohol use and health inequalities
• knowledge of the range of pharmacological interventions employed in drug and alcohol services and of the importance of using psychosocial interventions alongside these
• knowledge of the main side effects associated with common pharmacological treatments for problematic drug and alcohol use, and so able to escalate concerns or distress to the prescriber
• knowledge of common physical health problems and withdrawal signs and complications associated with problematic drug and alcohol use, and so able to recognise signs of these, escalate or refer accordingly and respond to medical emergencies safely and effectively
• knowledge of the harm associated with the psychological or physical effects of drugs (including new psychoactive substances and patterns of use) and alcohol, and so able to use psychoeducational skills to promote understanding and awareness of these effects
• knowledge of adult and children’s safeguarding legislation and guidance, and so able to recognise and respond to concerns in line with local and organisational safeguarding policies and procedures, and able to escalate safeguarding concerns within their service or externally
• knowledge of the prevalence and patterns of domestic abuse victimisation and perpetration in the drug and alcohol treatment population, and how to enquire about this sensitively as part of everyday assessment and review skills
• knowledge of national legislation, local policy, procedures and networks of support for people who experience domestic abuse, and pathways to behavioural programmes for perpetrators
• knowledge of the relationship between the Mental Capacity Act 2005, human rights legislation and other legislation as relevant to people, and so able to support and protect their welfare, wellbeing and freedom of choice
• knowledge of local policies and procedures relevant to information-sharing, confidentiality and data protection legal frameworks

Engagement, assessment and care/treatment planning

• able to build and maintain collaborative therapeutic relationships with people, maintaining professional boundaries while acting in a non-judgemental, compassionate manner
• able to undertake screening and assessment of a person’s drug and alcohol use, using validated tools to identify patterns and potential harm and deliver evidence-based brief or extended interventions where indicated and appropriate to the level of risk identified
• able to carry out comprehensive, person-centred assessments of people’s drug and alcohol use and their psychological, social, financial and health needs
• able to assess strengths as well as needs as part of assessment processes
• able to carry out a risk assessment, ascertaining psychological, physical and social risks to/from people, and develop plans to manage these risks with the person, including harm reduction interventions
• able to recognise risk concerns that require additional support from senior/regulated clinicians or external services and escalate/refer accordingly
• able to develop, implement and review personalised treatment and recovery care plans with people (including families, carers, affected others, the MDT and other professionals) that meet the person’s unique needs and build on their strengths
• able to provide tailored information about the range of treatment, care and recovery support options, including psychosocial and pharmacological interventions that are within the scope of their expertise

Harm reduction, treatment and recovery interventions

• able to provide people (including families, carers, affected others and other professionals) with evidence-based harm reduction interventions, injecting and other safer drug use equipment, and safer drug and alcohol use advice (including on safer injecting)
• able to provide advice to people with alcohol dependence on the risks of abruptly reducing alcohol use
• able to provide health education/promotion on the effects of and potential interactions between alcohol and drugs and physical and mental health
• able to plan, deliver and evaluate care collaboratively with people using a range of evidence-based approaches, such as mapping techniques and motivational interviewing, recognising the person’s unique psychological, social, cultural, health and physical needs, strengths and preferences
• able to tailor interventions depending on the severity of dependence and complexity of need, and indicate appropriate interventions
• able to provide one-to-one support to people through keywork sessions and informal contact and follow-up, and facilitate groups focused on reducing harm, supporting treatment outcomes, initiating recovery and preventing relapse
• able to personalise care and support for people from different groups, including (but not limited to) those who are women, from ethnic minority backgrounds, from LGBTQ+ communities, neurodivergent, of different ages, experiencing co-occurring mental or physical health conditions, involved with the criminal justice system, experiencing homelessness or unemployment and veterans
• able to offer advice and support on a range of health, social and other needs, including but not limited to housing, employment, education and developing social networks
• able to encourage people to engage with a range of health and social care services and other forms of support as required, such as their GP, dentist, housing services, the recovery community and peer support groups
• able to facilitate access to mutual aid (12-step and non-12-step groups) by providing information, supporting attendance, developing motivation and monitoring goals
• where appropriate and/or required, able to actively encourage health promotion or social inclusion by assisting people with arranging or attending appointments and advocating on their behalf
• able to support people to connect with others with lived experience, including the wider recovery community, enabling them to access peer support and develop their social networks
• able to deliver trauma-informed care to people, including family, carers and affected others
• able to support the delivery of evidence-based pharmacological interventions, including opioid substitution treatment medicine pick-ups and supervised consumption arrangements, that work for the individual
• able to use a range of evidence-based psychosocial interventions to support people to change their behaviour, such as motivational interviewing, contingency management and CBT-informed interventions
• able to respond appropriately to crises, such as by using verbal and non-verbal skills to de-escalate people in distress, seeking help from colleagues, or escalating to appropriate services when required (including emergency services)
• able to manage transitions, including joint agency planning and information exchange, to ensure that people moving between settings receive effective continuity of care (for example, from children’s to adult services, or from hospital, prison, inpatient detox or residential rehabilitation into the community)
• able to provide recovery monitoring (recovery check-ups) after the person leaves treatment or recovery support services, offering motivational sessions focused on proactive attempts to re-engage people in treatment and recovery support services where required
• able to provide lower-intensity interventions focused on sustaining recovery after a person has met their treatment goals, offering ongoing assessment and psychosocial interventions, such as motivational interviewing and relapse prevention
• able to recognise own limitations and limitations of the service, and refer people to an appropriate health, social care or other service where indicated
• able to update clinical and case management records, ensuring clear and effective communication and documentation

Multidisciplinary working

• knowledge of the importance of team and multi-agency working in meeting people’s needs
• knowledge of the roles of different professionals within the MDT and wider multi-agency network, seeking the expertise of others when required or indicated
• able to work collaboratively with a variety of professionals including health and social care and criminal justice staff, both within their own team and externally, including developing and maintaining active pathways between services
• knowledge of the range of organisations in the health and social care system, criminal justice system and other services and sources of support, and so able to support access/referral to these when required
• able to challenge stigma around problematic drug and alcohol use to promote social inclusion and non-judgemental and compassionate treatment of people, advocating for this both within internal and external services and the wider community
• able to work in a wide variety of environments where required, for example hospitals, prisons and schools

Service development

• knowledge of the function and role of their service
• able to contribute to the development, application and evaluation of organisational policies and procedures
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrating inclusion through interaction with individuals and groups
• able to support co-production by actively involving people in service improvement where possible – for example, by seeking their views, gathering feedback, and providing them with information on relevant activities that they may wish to be involved in
• able to participate in and contribute to audits, service evaluation and quality improvement projects relevant to own work
• able to participate in incident reviews and apply learning from adverse events
• able to promote the inclusion of the experiences of people, including families, carers and affected others, and their outcomes in the service’s values and across the system
• able to support an environment that promotes partnership working with people and recognises the value of lived experience and peer support

Learning and development

• able to actively participate in learning opportunities and demonstrate self-improvement
• knowledge of role boundaries and the importance of clinical and management supervision
• knowledge of the importance of reflective practice in improving treatment, care and support of people, and in promoting own self-care and wellbeing
• able to recognise when advice or guidance is needed from a senior member of staff or regulated practitioner and to act on this
• able to engage in regular clinical supervision to support learning and development and enable reflection on practice
• able to prepare for and participate in appraisals or regular review meetings and agree a personal development plan
• able to maintain up-to-date knowledge and understanding of drugs (including new psychoactive substances and patterns of use) and alcohol
• able to engage in regular management supervision to support working in line with organisational and professional policies
• able to identify CPD needed to perform the job role competently and confidently
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise

5.2 Children and young people’s drug and alcohol worker capabilities

Role profile

CYP D&A workers co-ordinate and deliver the treatment, care and support needed by children and young people who use(d) drugs and/or alcohol to promote their wellbeing, safety, mental and physical health and social inclusion. They provide comprehensive, individualised assessments of the needs of children and young people. They use evidence-based psychosocial interventions, such as motivational interviewing, alongside integrated care planning to help children and young people begin or continue their wellness journey.

They adopt a person-centred approach, ensuring that children and young people are aware of their treatment and support options. They are mindful of the complex interplay around mental capacity, consent and safeguarding that can affect informed decision-making. They work closely with families and/or carers and the wider multidisciplinary system, including children’s social care, schools, other education providers, youth justice services, CYP mental health services, and health and social care providers, to ensure that the unique needs of children and young people are met.

Children and young people who use(d) drugs and/or alcohol often have multiple vulnerabilities. These can include adverse childhood experiences and ongoing difficulties related to abuse, neglect, family/carer mental health issues and parental problematic drug and alcohol use. CYP D&A workers co-ordinate and deliver trauma-informed care, often in partnership with other professionals, that meets the child or young person’s needs and manages and reduces any ongoing risk, including safeguarding risk. Alongside the wider MDT, CYP D&A workers play a key role in promoting the safety of children and young people in relation to risk issues including child and adult safeguarding, and domestic abuse working in line with relevant national legislation and guidance, and organisational procedures.

In addition to this often complex work, CYP D&A workers regularly support universal and targeted prevention interventions, supporting evidence-based educational programmes in schools (such as those found in the personal, social, health and economic education curriculum), one-to-one psychoeducation, and targeted work with vulnerable young people, including in-reach and outreach work with the local community.

CYP D&A workers normally work with children and young people aged 12 to 17, with transition arrangements up to the age of 24 in some cases, depending on local service models and commissioning arrangements. This means that they need a broad skill set to understand and meet the developmental needs of different age groups.

Overarching capabilities

• able to work independently with children and young people within the scope of the role and operational policies, protocols and procedures
• able to manage own caseload and time – can ascertain priorities, tasks and resources, taking account of changing circumstances, risks and the needs of people
• able to hold a caseload of children and young people, co-ordinating care and support in a safe, evidence-based and collaborative manner
• able to co-ordinate and case manage the care of a child or young person
• able to consistently deploy evidence-based treatment, care and support strategies to promote and provide person-centred care, including providing information, advice and guidance to children and young people, parents, carers, families, children’s social care workers, education providers, health professionals and others
• able to work with children and young people and understand the differences in intervention, treatment, care, legal frameworks and support needs related to childhood, adolescence and young adulthood
• able to manage transitions, including joint agency planning and information exchange, to ensure that children and young people moving between settings receive effective continuity of care (for example, from children’s to adult services or from hospital into the community)
• able to meet the needs of neurodiverse children and young people, and provide treatment, support, care and intervention according to their unique needs
• able to recognise and meet the needs of children and young people with a range of disabilities (including but not limited to learning or developmental disabilities such as foetal alcohol spectrum disorder), offering evidence-based behavioural strategies to manage symptoms, and promoting mental, emotional and physical health
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to understand current research happening in the sector and share opportunities to engage in research with children and young people, their families, carers and affected others
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of trauma-informed approaches and the ways trauma may present in children and young people, and so able to apply this to enable a trauma-informed approach to working with children and young people and within services
• knowledge that children and young people’s needs and strengths are holistic and that the impact of drug and alcohol use is interconnected with a range of factors and needs, and so able to screen/assess these needs collaboratively and plan, co-ordinate and deliver treatment, care and support to address and meet these needs
• knowledge of children and young people’s development and the adverse impact that personal or family/carer issues such as mental health issues, domestic abuse and problematic drug and alcohol use can have on this
• knowledge of the social, cultural and economic influences, individual experiences and behaviours that are associated with children and young people’s problematic drug and alcohol use and health inequalities
• knowledge of a range of evidence-based pharmacological interventions for children and young people’s drug and alcohol use, and how these can be integrated with psychosocial interventions
• knowledge of the main side effects associated with common pharmacological treatments for drug and alcohol use, and so able to escalate concerns to the prescriber
• knowledge of mental health and mental health problems, and so able to detect early warning signs that a child/young person may be struggling with their mental health, or may struggle in the future without appropriate support, and so able to respond, escalate or refer in line with the requirements of their role
• knowledge of common physical health complications associated with drug and alcohol use, and so able to recognise signs of these and escalate or refer accordingly
• knowledge of the harm associated with the psychological or physical effects of drugs (including new psychoactive substances and patterns of use) and alcohol, and so able to use psychoeducational skills to promote understanding and awareness of these effects
• knowledge of the complexities of safeguarding children and young people, and so able to embed local policy and relevant legal frameworks (such as the Children Act 2004) into daily practice
• knowledge of adult and children’s safeguarding legislation and guidance, and so able to recognise and respond to concerns in line with local and organisational safeguarding policies and procedures, and able to escalate safeguarding concerns within their service or externally
• knowledge of the prevalence and patterns of domestic abuse victimisation and perpetration in the drug and alcohol treatment population, and how to enquire about this sensitively as part of everyday assessment and review
• knowledge of national legislation, local policy, procedures and networks of support for people who experience domestic abuse, and pathways to behavioural programmes for perpetrators
• knowledge of local policy and legal frameworks pertaining to consent (such as the Gillick competence)
• knowledge of parental responsibility (as defined in legislation) and how to support effective parental involvement
• knowledge of the implications of parental responsibility, the dynamics of parental relationships, and the need for active engagement and parental/carer involvement in working systemically with the child or young person
• knowledge of the needs of looked-after children and care leavers up to the age of 24

Engagement, assessment and care/treatment planning

• able to build and maintain collaborative therapeutic relationships with children and young people and, where appropriate, families, parents, carers and affected others, maintaining professional boundaries while acting in a non-judgemental, compassionate manner and encouraging engagement
• able to plan, deliver and evaluate treatment, care and support collaboratively with children and young people, recognising their unique psychological, social, cultural, health and physical needs, preferences and strengths
• able to exchange information with children, young people, families, parents, carers and affected others (where appropriate) using active listening, compassion, empathy and collaborative techniques
• able to carry out comprehensive, person-centred assessments of children and young people’s drug and alcohol use, educational needs and psychological, social and health needs, including any vulnerabilities such as the impact of family/parental mental health issues or problematic drug and alcohol use
• able to assess strengths as well as needs as part of assessment processes
• able to carry out risk assessments, identifying any safeguarding concerns and ascertaining psychological, physical and social risks to/from children and young people, including risks particularly pertinent to this age group (such as child exploitation and abuse, education loss, self-harm and harmful social media use)
• able to develop plans to manage risks with children and young people and their families, carers and affected others, including harm reduction interventions, and to escalate accordingly where additional support from senior or regulated professionals or external services such as children’s social care is required
• able to develop, implement and review personalised care plans with children, young people, families/carers, the MDT and other agencies that meet the young people’s needs and build on their strengths
• able to personalise care and support for children and young people from different groups, including (but not limited to) those who are girls and women, from ethnic minority backgrounds, neurodivergent, of different ages, from LGBTQ+ communities, experiencing co-occurring mental or physical health conditions, not in education, employment or training, and involved with youth offending services

Harm reduction, specialist and targeted interventions

• able to use a range of evidence-based psychosocial interventions to support children and young people in behaviour change, emotional health and resilience (such as motivational interviewing, harm reduction, skills training, CBT-informed techniques, group work and family work, including multi-component programmes)
• able to plan, deliver and evaluate care collaboratively with people using a range of evidence-based approaches such as those listed above, recognising the person’s unique psychological, social, cultural, health and physical needs, strengths and preferences
• able to co-ordinate and deliver (often in partnership with other professionals) trauma-informed care to children and young people that meets their needs and manages and reduces any ongoing risks, including safeguarding risks, and vulnerabilities
• able to respond to crises in a range of ways, such as working with the wider MDT and other agencies to meet urgent needs, using verbal and non-verbal skills, seeking help from colleagues, or escalating to appropriate services when required, including emergency services or children’s social care
• able to use psychoeducational skills to promote children and young people’s understanding and awareness of the effects of drugs and alcohol
• able to offer advice, support and referral to address a range of health, social care and other needs (including education, training, employment and accessing health and social care services)
• able to encourage children and young people to engage with a range of health, social care and other services and opportunities, such as education and training providers, where necessary or beneficial
• able to provide people (including children, young people, families, carers, affected others and other professionals) with evidence-based harm reduction interventions and safer drug and alcohol use advice
• able to provide advice on reducing the risk of drug or alcohol use
• able to provide health education/promotion on the effects of and potential interactions between alcohol and drugs and physical and mental health
• where appropriate and/or required, able to actively encourage health promotion or social inclusion by assisting children and young people with arranging or attending appointments and advocating on their behalf
• able to facilitate and support access to age-appropriate peer support for young people, where appropriate
• able to provide follow-up appointments after the child or young person leaves drug and alcohol services, offering motivational sessions focused on proactive attempts to re-engage the child or young person in drug and alcohol services where required
• able to recognise own limitations and limitations of the service, and refer children and young people to an appropriate health or social care professional or service where indicated
• able to update clinical and case management records, ensuring clear and effective communication and documentation

Multidisciplinary working

• knowledge of the roles of different professionals within the MDT and wider multi-agency network, seeking the expertise of others when required or indicated
• knowledge of a range of relevant organisations in the health and social care system and services provided, referring children and young people when required
• knowledge of, and able to demonstrate the importance of, teamwork in meeting children and young people’s needs
• able to work inter-professionally with services that support children and young people, liaising with professionals, offering education sessions, and attending meetings where appropriate
• able to work collaboratively with a variety of professionals including health, social care and education staff, both within their own team and externally, including developing and maintaining active pathways between services
• able to develop and maintain active pathways between other children and young people’s services and support, such as children’s social care, health and social support, housing, education, training and employment, and the youth justice system
• able to challenge stigma around drug and alcohol use to promote social inclusion and non-judgemental and compassionate treatment of children and young people within internal and external services and the wider community, including education providers, youth justice and children’s social care
• able to offer specialist advice, consultation and information to external agencies about young people’s drug and alcohol use
• able to provide specialist advice and advocate on behalf of the child or young person to the wider professional network from a drug and alcohol use perspective
• able to proactively support a culture of social inclusion and equality of opportunity for children, young people and families, including those with protected characteristics
• able to recognise when advice or guidance is needed from a senior member of staff, regulated practitioner or safeguarding lead, and to act on this

Service development

• knowledge of the function and role of their service
• able to contribute to the development, application and evaluation of organisational policies and procedures
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrating inclusion through interaction with individuals and groups
• able to promote and support age-appropriate collaboration by actively involving children, young people, parents, carers and affected others in service improvement where possible (for example, by seeking their views, gathering feedback, and providing them with information on relevant activities that they may wish to be involved in)
• able to participate in and contribute to audits, service evaluation and quality improvement projects relevant to own work
• able to participate in incident reviews and apply learning from adverse events
• able to promote the inclusion of the experiences of children and young people and their families, carers and affected others in the service’s values and across the system

Learning and development

• able to actively participate in learning opportunities and demonstrate self-improvement
• knowledge of role boundaries and the importance of clinical and management supervision
• able to engage in regular clinical supervision to support learning and development and enable reflection on practice
• knowledge of the importance of reflective practice in improving the treatment, care and support of children and young people, and in promoting own self-care and wellbeing
• able to prepare for and participate in appraisals or regular review meetings and agree a personal development plan
• able to maintain up-to-date knowledge and understanding of drugs (including new psychoactive substances and patterns of use) and alcohol
• able to engage in regular management supervision to support working in line with organisational and professional policies
• able to identify CPD needed to perform the job role competently and confidently
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise

5.3 Senior drug and alcohol worker capabilities

Role profile

Senior drug and alcohol workers are experienced professionals with in-depth knowledge of working with people who use(d) drugs and/or alcohol and are therefore able to provide a supporting clinical leadership role with a focus on coaching, mentorship, career and wellbeing support and guidance and support around good practice ways of working to colleagues especially drug and alcohol workers.

Depending on which age groups they have experience working with, senior drug and alcohol workers must have the capabilities that are expected of drug and alcohol workers, or CYP D&A workers (as detailed in sections 5.1 and 5.2), as well as the additional capabilities listed below. This means that these senior drug and alcohol worker capabilities must be used with the relevant adult or children and young people’s drug and alcohol worker capabilities, rather than in isolation.

They work both directly and indirectly with people who use(d) drugs and/or alcohol, by providing guidance to other staff and/or by providing care and support to people themselves. Due to their enhanced experience, these are often people with the most complex and severe needs within their services.

Senior drug and alcohol workers work with regulated and senior colleagues to uphold the wider clinical governance structure, ensuring safe, evidence-based practice. They can support the development of staff through training and coaching, contribute to service and policy development, and provide ad hoc support to team members as needed, to enable effective practice and staff wellbeing. This range of activity contributes to day-to-day management and leadership.

While senior drug and alcohol workers provide clinical and management supervision, this is not expected to be the primary focus of their role.

They often contribute to service and policy development, as well as development of staff through training, coaching and supervision.

Overarching capabilities

Senior drug and alcohol workers are expected to have the capabilities of the adult drug and alcohol worker role, or the CYP D&A worker role, depending on which age groups they work with. The capabilities below indicate the additional knowledge and skills they require to operate at a senior level.

• able to consistently provide clinical leadership with a focus on coaching, mentorship, career and wellbeing support and guidance and support around good practice ways of working to colleagues including drug and alcohol workers

Application of knowledge

• in-depth knowledge of the range of needs that people who use(d) drugs and/or alcohol may have, including their treatment and recovery, mental and physical health, social needs and risk, and so able to provide advice, guidance and leadership to other staff in relation to meeting these needs
• knowledge of adult and children’s safeguarding legislation, and so able to provide advice, guidance and leadership to other staff where necessary, and able to escalate safeguarding concerns within their service or externally where indicated

Engagement, assessment and care/treatment planning

• able to provide mentorship and guidance to other staff on working with people presenting with complex needs and high risk in relation to their drug and alcohol use, mental and physical health, safeguarding and social needs, including engagement, assessment and planning treatment/care
• able to hold and manage a small and complex clinical caseload where necessary

Multidisciplinary working

• able to seek guidance and work collaboratively with regulated professionals where indicated to meet the needs of people who use(d) drugs and/or alcohol
• able to work with senior colleagues to navigate and manage challenges in relation to accessing external services, for example mental health services
• able to actively participate in and lead MDT meetings with a focus on the treatment, care and support of people, including families, carers and affected others
• able to support colleagues to recognise and manage crises effectively
• able to offer advice and consultation on care for people to internal and external colleagues
• able to lead work alongside internal and external colleagues to address health inequalities and stigma

Service development

• able to contribute to creating and sustaining a culture that provides evidence-based care and treatment, and promotes best practices, through effective clinical leadership
• able to stay abreast of best practices regarding service and workforce development, learning from and sharing with other services within the sector and embedding best practices within their service
• able to contribute to, and advocate for, staff wellbeing, including providing support after incidents, and embedding general best practices relating to staff wellbeing
• able to participate in serious case reviews, including leading on learning after the event processes
• able to participate in policy development, ensuring co-production with people affected by policies, such as those who use and/or work in services
• able to participate in the planning, development and evaluation of their service
• able to contribute to a range of performance management processes where required, including but not limited to probation management, staff sickness and disciplinary procedures
• able to deputise for senior management where appropriate, safe and required
• able to participate in managing staff vacancies and understand the implications for their service, including involvement in recruiting temporary staff or redeploying existing staff as needed
• able to participate in staff recruitment processes, including job description creation, assessment of the suitability of candidates, and job interviews
• able to lead on service development, service improvement and innovation

Learning and development

• able to advocate for regular clinical supervision of other staff, to maintain professional development, quality care and high service standards
• able to deliver clinical supervision, in line with their competence and clinical governance structures, to other staff and to receive regular clinical supervision from senior colleagues for their own practice
• able to advocate for relevant CPD activities for all staff, and arrange and facilitate protected time to pursue these
• able to deliver ad hoc one-to-one sessions for the purposes of staff support and guidance, offering coaching, clinical leadership, and career and wellbeing support
• able to contribute to the development of induction programmes for new staff and offer guidance and coaching to other staff members
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise
• able to engage in and support research for the further professionalisation and development of the sector
• able to stay updated about and update other staff on advances in the field of drug and alcohol services

5.4 Family support worker (adult-focused) capabilities

Role profile

Drug and alcohol family* support workers are skilled professionals who work to offer emotional, practical and social support and advice to adults affected by their family member’s drug and alcohol use. Their role focuses specifically on the needs of the family member, rather than the person who uses drugs and/or alcohol. They work with family members and carers of people who may or may not currently be engaged in treatment, as well as affected others.

* Family can mean different things to different people and does not necessarily indicate biological, marital, romantic or legally protected relationships. Many people have ‘non-traditional’ family networks, which may include people they are not biologically, legally or romantically related to, but who they may consider family. Drug and alcohol family support workers work across this sphere, engaging people who have various relationships with people affected by drug and/or alcohol use. For the purposes of these capabilities, the terms ‘family’ and ‘carers’ are used where relevant to reflect this diversity.

Drug and alcohol family support workers support the wellbeing of the people they work with by providing interventions through different approaches, including but not limited to Community Reinforcement and Family Training, 5-step, motivational interviewing and trauma-informed approaches.

These psychosocial interventions offer ongoing support, helping family members process and respond to the impact of their family member’s drug and/or alcohol use, and building emotional resilience. In addition, they play a vital part in facilitating access to peer support and mutual aid. Alongside the wider MDT, adult family support workers play a key role in promoting the safety of family members in relation to risk issues including child and adult safeguarding, and domestic abuse working in line with relevant national legislation and guidance, and organisational procedures.

The role of drug and alcohol family support workers can be as complex and varied as the people they support, and often involves advising on a broad range of issues including housing, financial support and health, as well as assisting people to access relevant services.

For ease of reading, where the standalone term ‘people’ is used in relation to this role’s capabilities, it is referring to family, carers and affected others.

Overarching capabilities

• able to consistently deploy evidence-based support strategies to promote and provide person-centred, trauma-informed support, including providing information, advice and guidance to people, including families, carers, affected others and other professionals
• able to exchange information with families, parents, carers and affected others (where appropriate) using active listening, compassion, empathy and co-production techniques
• able to work independently with people, within the scope of the role and operational policies, protocols and procedures
• able to manage own caseload and time effectively – can ascertain priorities, tasks and resources, taking account of changing circumstances, risks and needs of people
• able to understand current research happening in the sector and share opportunities to engage in research with people, including families, carers and affected others
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, UK clinical guidelines for alcohol treatment, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of the significance of family dynamics, behaviours and relationships for individual wellbeing, and so able to see the family/support network as a whole and understand its relevance to supporting people affected by the person’s drug and alcohol use
• knowledge of trauma-informed approaches and the ways trauma may present in people, and so able to apply this to enable a trauma-informed approach within services
• knowledge of problematic drug/alcohol use and dependence, related harm in the context of family members, and the range of treatment and support options, working in collaboration with treatment workers as appropriate
• knowledge of mental health and mental health problems, and so able to detect early warning signs that a person may be struggling with their mental health or is likely to struggle in the future without appropriate support, and so able to respond, escalate or refer in line with the requirements of their role
• knowledge of adult and children’s safeguarding legislation and guidance, and so able to recognise and respond to concerns in line with local and organisational safeguarding policies and procedures, and able to escalate safeguarding concerns within their service or externally
• knowledge of national legislation, local and organisational policy and procedures when assessing people’s care and support needs
• knowledge of prevalence and patterns of domestic abuse victimisation and perpetration in the drug and alcohol treatment population, and how to enquire about this sensitively as part of everyday assessment and review
• knowledge of national legislation, local policy, procedures and networks of support for people who experience domestic abuse, and pathways to behavioural programmes for perpetrators
• knowledge of the relationship between the Mental Capacity Act 2005, human rights legislation and other legislation as relevant to people, and so able to support and protect their welfare, wellbeing and freedom of choice
• knowledge of local policies and procedures relevant to information-sharing, confidentiality and data protection legal frameworks

Engagement, assessment and care/treatment planning

• able to build and maintain collaborative therapeutic relationships with people, maintaining professional boundaries while acting in a non-judgemental, compassionate manner
• able to carry out comprehensive, person-centred assessments of a range of needs, including psychological, social, financial and health needs
• able to assess strengths as well as needs, using a whole-family approach as part of assessment processes
• able to carry out a risk assessment, ascertaining psychological, physical and social risks to/from people, and develop plans to manage these risks with the person
• able to ensure the safety of people who may be experiencing domestic abuse by ensuring that their support and use of the service remains confidential, and that their support pathways do not cross with those of the perpetrator(s) of abuse
• able to recognise and respond to child safeguarding and able to escalate internally or externally in line with national legislation and local and organisational procedures
• able to recognise and assess risk around domestic abuse, offer emotional and practical advice, and support the person by referring them to external agencies where appropriate
• able to escalate concerns around domestic abuse risk where indicated, for example through safeguarding and Multi-Agency Risk Assessment Conference referrals
• able to recognise risk concerns that require additional support from senior/regulated clinicians or external services, and escalate/refer accordingly
• able to develop, implement and review personalised support plans with people that meet the person’s unique needs and build on their strengths
• able to assess the role and needs of the person within their family system/support network, and understand their own strengths in order to plan support
• able to assess caring responsibilities and identify support that the person may require, such as a carer’s assessment, and so able to provide information on specific support and facilitate access to relevant services
• able to assess drug and alcohol use in the person they are supporting if there is an indication that they may also be using drugs and/or alcohol problematically, and able to plan support accordingly
• able to recognise that families and social support systems are diverse, varied and may differ greatly from person to person, and so able to tailor assessments according to the person’s unique needs and strengths

Family support interventions

• able to provide evidence-based family support interventions to help families and carers affected by their family member’s drug and/or alcohol use
• able to provide advice and guidance on self-care and promote mental health through a range of psychosocial interventions, including psychoeducation
• able to facilitate and/or arrange self-care activities, for example through individual or group wellbeing sessions and workshops, or support in accessing external activities
• able to co-ordinate and deliver (often in partnership with other professionals) trauma-informed care to families that meets their needs and manages and reduces any ongoing risks, including safeguarding risks and vulnerabilities
• able to advocate for, support access to, and/or assist in arranging peer support activities, for example carers’ groups and family support groups
• able to facilitate access to family-specific mutual aid (12-step and non-12-step groups) by providing information, supporting attendance, developing motivation and monitoring goals
• able to refer or support people with access to a carer’s assessment, and provide information on support available, including but not limited to financial, social and psychological support
• able to use a whole-family approach to recognise when additional family members, including children, require support, and enable them to access relevant services
• able to offer advice and support on a range of health, social and other needs, including but not limited to accessing mental health services and developing social networks
• knowledge of a range of services that might benefit parents/carers or family members (such as perinatal mental health services, health visitors and family therapists) and ability to support parents/carers or family members in accessing these services
• able to personalise care and support for people from different groups, including (but not limited to) those who are women, from ethnic minority backgrounds, from LGBTQ+ communities, neurodivergent, of different ages, experiencing co-occurring mental or physical health conditions, involved with the criminal justice system, experiencing homelessness or unemployment, and veterans
• able to support people to connect with others with similar experiences, including the wider recovery community, enabling them to access family and carer peer support and develop their social networks
• able to recognise own limitations and limitations of the service, and refer people to an appropriate health, social care or other service where indicated
• able to update clinical and case management records, ensuring clear and effective communication and documentation
• able to agree and maintain confidentiality boundaries when working with people whose family may be seeking support within the same service
• able to respond appropriately to crises, such as by using verbal and non-verbal skills to de-escalate people in distress, seeking help from colleagues, or escalating to appropriate services when required (including emergency services)
• able to support people in deciding whether, and how, they want to be involved in their family member’s treatment where this is appropriate, and able to support them in this involvement

MDT working

• knowledge of the importance of team and multi-agency working in meeting people’s needs
• knowledge of the roles of different professionals within the MDT, and able to seek the expertise of others when required or indicated
• able to work collaboratively with a variety of professionals including health and social care and criminal justice staff, both within their own team and externally, including developing and maintaining active pathways between services to ensure safe and consistent practice and support for the whole family or support network
• knowledge of the range of organisations in the health and social care system, including children’s social care, adult social care, the criminal justice system and other services and sources of support, and so able to support access/refer to these when required
• able to challenge stigma around problematic drug and alcohol use to promote social inclusion and non-judgemental and compassionate treatment and support of people, advocating for this within both internal and external services and the wider community
• able to advise multidisciplinary colleagues and external agencies on a range of issues pertaining to drug and alcohol family work
• able to work closely with children and young people’s focused family support workers (if in a service where this is a separate role), enabling a whole-family approach

Service development

• knowledge of the function and role of their service
• able to contribute to the development, application and evaluation of organisational policies and procedures
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrating inclusion through interaction with individuals and groups
• able to support co-production with family and carers by actively involving people in service improvement where possible – for example, by seeking their views, gathering feedback, and providing them with information on relevant activities that they may wish to be involved in
• able to participate in and contribute to audits, service evaluation and quality improvement projects relevant to own work
• able to participate in incident reviews and apply learning from adverse events
• able to promote the inclusion of the experiences of people, including families, carers and affected others, and their outcomes in the service’s values and across the system
• able to support an environment that promotes partnership working with family members and carers in planning and delivering support

Learning and development

• able to actively participate in learning opportunities and demonstrate self-improvement
• knowledge of role boundaries and the importance of clinical and management supervision
• knowledge of the importance of reflective practice in improving care and support for people, and in promoting own self-care and wellbeing
• able to recognise when advice or guidance is needed from a senior member of staff or regulated practitioner, and to act on this
• able to engage in regular clinical supervision to support learning and development and enable reflection on practice
• able to prepare for and participate in appraisals or regular review meetings and agree a personal development plan
• able to engage in regular management supervision to support working in line with organisational and professional policies
• able to identify CPD needed to perform the job role competently and confidently
• able to work closely with children and young people family support workers (if in a service where this is a separate role), enabling a whole-family approach
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise

5.5 Family support worker (children and young people-focused) capabilities

Role profile

Like adult family support workers, children and young people-focused family support workers in the drug and alcohol sector are skilled professionals who work with, and offer emotional, practical and social support and advice to, families affected by the problematic drug and alcohol use of a parent/carer or other family member. However, in this case the specific focus is on the resulting impact on, and support needs of, children and young people.

Children and young people-focused family support workers typically work with both children and parents (or other adult family members) to achieve improved safety, wellbeing and resilience for children and young people as a priority. Alongside the wider MDT, children and young people-focused family support workers play a key role in promoting the safety of family members in relation to risk issues including child and adult safeguarding, and domestic abuse working in line with relevant national legislation and guidance, and organisational procedures.

The interventions they offer include one-to-one or group support for children and young people as well as parents; work with parents to strengthen parenting skills; and interventions with parents/carers and children together to strengthen their relationships. The role requires specialist knowledge of working with children and young people ranging in age from infancy to 18 years old, with transitional support for vulnerable young adults up to the age of 24 in some cases depending on local service models and commissioning arrangements.

Like the adult family support worker role, children and young people-focused family support workers work with children and young people whose parent/carer or family member may or may not currently be engaged in treatment.

In addition to the capabilities outlined below, children and young people-focused family support workers must also have the capabilities expected of adult family support workers (as detailed in section 5.4). This means that these children and young people-focused family support worker capabilities must be used with the adult-focused family support worker capabilities, rather than in isolation.

For ease of reading, where the standalone term ‘people’ is used in relation to this role’s capabilities, it is referring to children and young people affected by family/carer problematic drug and alcohol use.

Overarching capabilities

• able to consistently deploy evidence-based care and support strategies to promote and provide person-centred care, including providing information, advice and guidance to children and young people, parents, carers, families, children’s social care workers, education providers, health professionals and others
• able to exchange information with children, young people, families, parents, carers and affected others (where appropriate) using active listening, compassion, empathy and collaborative techniques
• able to work independently with children, young people and family members within the scope of the role and operational policies, protocols and procedures
• able to hold a caseload of children, young people and family members, co-ordinating care and support in a safe, evidence-based and collaborative manner
• able to work with children and young people and understand the differences in intervention, treatment, care, legal frameworks and support needs related to infancy, childhood, adolescence and young adulthood
• able to manage multi-agency working and transitions, including joint agency planning and information exchange, to ensure that children and young people moving between settings receive effective continuity of care (for example, from children’s to adult services, or between schools)
• able to meet the needs of neurodiverse children and young people, and provide care, support and interventions according to their unique needs and strengths
• able to recognise the needs and strengths of children and young people with a range of disabilities (including but not limited to learning or developmental disabilities such as foetal alcohol spectrum disorder), offering evidence-based behavioural strategies and/or referral to appropriate services to manage symptoms, and promoting mental, emotional and physical health

Application of knowledge

• knowledge of trauma-informed approaches and the ways trauma may present in children and young people, and so able to apply this to enable a trauma-informed approach to working with children and young people and within services
• knowledge of children and young people’s development and the adverse impact that parental/family problematic drug and alcohol use can have on this
• knowledge of mental health and mental health problems, and so able to detect early warning signs that a child/young person may be struggling with their mental health, or may struggle in the future without appropriate support, and so able to respond, escalate or refer in line with the requirements of their role
• knowledge of the complexities of safeguarding children and young people, and so able to embed local policy and relevant legal frameworks (such as the Children Act 2004, the Children and Social Work Act 2017 and Working together to safeguard children) into daily practice
• knowledge of local policy and legal frameworks pertaining to consent (such as the Gillick competence)
• knowledge of parental responsibility (as defined in legislation) and how to support effective parental involvement
• knowledge of the implications of parental responsibility, the dynamics of parental relationships, and the need for active engagement and parental/carer involvement in working systemically with the child or young person
• knowledge of the needs of looked-after children and care leavers up to the age of 24

Engagement, assessment and care/treatment planning

• able to carry out comprehensive, multi-agency, person-centred assessments of children and young people’s educational, psychological, social and health needs and strengths, and how parental/family problematic drug and alcohol use impacts these needs
• able to carry out comprehensive multi-agency person-centred assessments of parent/carers with the aim of supporting parenting and family functioning
• able to carry out risk assessments, identifying any safeguarding concerns and ascertaining psychological, physical and social risks to/from children and young people, including risks particularly pertinent to this age group (such as child neglect, physical, emotional or sexual abuse, sexual exploitation, education loss, self-harm, harmful social media use and exposure to domestic abuse)
• able to develop plans to manage risks with children and young people, together with a parent/carer or family member where appropriate, with additional support from senior or regulated professionals or external services as required
• able to assess young people’s caring responsibilities and identify support needed, such as a young carer’s assessment, and so able to provide information on specific support and facilitate access to relevant services

Children and young people’s family support interventions

• able to promote children and young people’s understanding and awareness of their parent/carer’s or family member’s drug and/or alcohol use, and the effects this may have on them growing up
• able to provide emotional support to children and young people to promote resilience, for example by developing coping mechanisms and identifying and using support networks
• able to provide support to kinship carers such as grandparents, recognising their unique and complex needs
• able to co-ordinate and deliver (often in partnership with other professionals) trauma-informed care to children and young people that meets their needs and manages and reduces any ongoing risks, including safeguarding risks and vulnerabilities
• able to offer advice, support and referral to address a range of health, social care and other needs (including to education, health and social care services)
• able to facilitate and support access to age-appropriate peer support for children and young people affected by the problematic drug and alcohol use of a parent/carer or family member
• able to work with parents/carers or family members with current or past problematic use of drugs and/or alcohol, and MDT colleagues who work with them, to provide advice and support in developing parenting skills using a range of evidence-based approaches
• able to work with parents/carers and children together to support communication and strengthen relationships
• able to support parents to develop or strengthen family routines and boundaries for family functioning
• knowledge of a range of services that might benefit children and young people and ability to support them in accessing these services
• able to personalise care and support for parents/carers and children and young people from different groups, including (but not limited to) those who are girls and women, from ethnic minority backgrounds, neurodivergent, of different ages, from LGBTQ+ communities, experiencing co-occurring mental or physical health conditions, not in education, employment or training, and involved with youth offending services
• able to respond to crises in a range of ways, such as working with the wider MDT and other agencies to meet urgent needs, using verbal and non-verbal skills, seeking help from colleagues, or escalating to appropriate services when required, including emergency services or children’s social care

Multidisciplinary working

• knowledge of a range of relevant organisations in the health and social care system and services provided, referring children and young people when required
• able to contribute to a child in need plan (section 17), child protection plan (section 47) and other safeguarding assessments in line with local policy and relevant legal frameworks (such as the Children Act 2004, the Children and Social Work Act 2017 and Working together to safeguard children)
• able to work collaboratively and share information responsibly with early help services and children’s social care, liaising with the employing service to ensure adequate clinical support, supervision, relevant training and experience for this work
• able to work inter-professionally with services that support children and young people, liaising with professionals, offering education sessions, and attending meetings where appropriate
• able to work collaboratively with a variety of professionals including health, social care and education staff, both within their own team and externally, including developing and maintaining active pathways between services
• able to develop and maintain active pathways between other CYP services and support, such as children’s social care, health and social support, housing, education, training and employment, and the youth justice system
• able to offer specialist advice, consultation and information to external agencies about the impact of parental/family problematic drug and alcohol use on children and young people
• able to work closely with adult family support workers (if in a service where this is a separate role), enabling a whole-family approach

5.6 Nursing capabilities

Role profile

This role profile applies to NMC-registered nurses (in all areas, including adult, child, mental health and learning disability), non-medical nurse prescribers and registered nursing associates working in an LA-commissioned drug and alcohol treatment and recovery setting.*

* The capabilities in this section are specific to nurses working in a drug and alcohol service and so assume the capabilities specified by the requirements of NMC registration.

Registered nurses working in alcohol and drug treatment and recovery services are key to achieving a range of health and social care outcomes and bringing enhanced awareness of physical and mental health co-morbidities via triage, assessment, care and treatment. Nurses focus on the physical and mental health and wellbeing of people who use(d) drugs and/or alcohol through comprehensive assessment; pharmacological and psychosocial treatment; intervention and recovery care planning and care; education to increase awareness of co-occurring mental and physical health problems and risks; and supplying, dispensing, monitoring and reporting on the effects of medicines. In addition, non-medical nurse prescribers lead on the assessment and management of medically assisted withdrawal. The skills of nurses hold a significant role in the sector in the identification and management of alcohol and drug-related health problems. Nurses can deliver direct physical and psychosocial care, as well as providing clinical leadership, governance, education and service quality improvement.

These capabilities cover a range of nursing roles and, as such, there are limits to the capabilities for each nursing role type depending on the individual type of registration, experience and qualifications. It is especially important to note that, while nursing associates will contribute to most aspects of care, including delivery and monitoring, registered nurses will take the lead on assessment, planning, evaluation and leadership. Registered nurses will also lead on managing and co-ordinating care, with contributions from the nursing associate within the integrated care team. Those using this capability framework must adhere to the principles set out in the NMC Code, which requires ‘professional commitment to work within one’s competence’ as a key underpinning principle. Service providers must not expect all nursing professionals to fulfil the full list of capabilities, and should refer to individual registration details, as well as experience and qualifications, when using the nursing capabilities.

Overarching capabilities

• practise in line with the NMC professional standards for practice (the NMC Code), as per their registration requirements
• able to understand current research happening in the sector and share opportunities to engage in research with people, including families, carers and affected others
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, UK clinical guidelines for alcohol treatment, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of signs and symptoms of problematic alcohol and drug use and dependence, severity of dependence, complexity of needs, and appropriate interventions, and so able to assess individual support needs
• knowledge of trauma-informed approaches and the ways trauma may present in people, and so able to apply this to enable a trauma-informed approach within services
• knowledge of the harm associated with the psychological or physical effects of drugs (including new psychoactive substances and patterns of use) and alcohol, and so able to use psychoeducational skills to promote understanding and awareness of these effects
• knowledge of medicines management, and so able to dispense, administer and advise (and, where applicable, prescribe following additional non-medical prescribing training) on medications, including controlled drugs and medicines to manage alcohol withdrawal, Patient Group Directions (PGDs) and Patient Specific Directions (PSDs); working in accordance with national guidelines and local policies and procedures (including advice around interactions with other prescribed and over-the-counter medicines and how they interact with alcohol and drugs)
• knowledge of mental health difficulties and how these co-occur and interact with problematic drug and alcohol use
• knowledge of the risks of polypharmacy (including those associated with individuals who are using non-prescribed drugs), and so able to liaise with primary care services to co-ordinate prescribing and manage the additional considerations/risks of having multiple potential prescribers involved in care
• knowledge of local policies and procedures relevant to information-sharing, confidentiality and data protection legal frameworks
• knowledge of the social, cultural and economic influences, individual experiences and behaviours that are associated with problematic drug and alcohol use and health inequalities
• knowledge of current biopsychosocial models relating to problematic drug and alcohol use, motivation and behaviour change processes and recovery
• knowledge of mental health, physical health, social care and other relevant services, and the referral criteria and pathways to these
• knowledge of adult and children’s safeguarding legislation and guidance, and so able to recognise and respond to concerns in line with local and organisational safeguarding policies and procedures, and able to escalate safeguarding concerns within their service or externally
• knowledge of research methods

Engagement, assessment and care/treatment planning

• able to conduct a comprehensive assessment of drug and alcohol use, including substance(s) and amount used, pattern of use, route of administration, and presence and severity of dependence
• able to conduct comprehensive health screening assessments and triage for physical and mental health conditions related to drug and alcohol use, using a range of specialist assessment tools
• able to build and maintain collaborative therapeutic relationships with people, maintaining professional boundaries while acting in a non-judgemental, compassionate manner
• able to assess strengths as well as needs as part of assessment processes
• able to complete assessments that inform treatment and recovery care plans
• able to co-produce, implement and review treatment and recovery care plans with people (including families, carers, affected others, the MDT and other professionals) that meet the person’s unique needs, build on their strengths and aim to improve general physical and psychological health and wellbeing as required in the context of behaviour change, leading to a healthier lifestyle
• able to assess medication side effects, signs of acute withdrawal, intoxication, detoxification and overdose
• able to assess for early indicators of mental and physical health co-morbidities in relation to drug and alcohol use, including suicidality
• able to assess people’s need for managed withdrawal and detoxification from drugs and alcohol to ensure they are offered person-centred, evidence-based treatment within the setting most appropriate to their physical, mental, social and circumstantial needs
• able to provide ongoing assessment of care, evaluating and amending treatment and recovery care plans and treatment options as appropriate
• able to determine the most appropriate service to deliver treatment for moderate to severe mental health difficulties, and refer accordingly
• able to assess and manage risk and respond to people presenting risk in relation to their mental or physical health, including risk of overdose, suicide and self-harm, using relevant validated assessment tools where indicated (such as for depression, anxiety and withdrawal)
• able to complete a wide range of observation assessments, which may include interpretation of test results including but not limited to blood pressure, pulse, respiration/oxygen saturation, breathalyser readings, electrocardiograms, fibroscanning, urinalysis results and blood tests
• able to co-ordinate and navigate systems for complex cases, ensuring a multi-agency collaborative approach

Interventions: supporting managed withdrawal and detoxification

• able to support detoxification from drugs and alcohol by assessing the appropriateness of community-based treatment, and offering education around the process of managed withdrawal and recovery to the person and the family member/friend who is supporting them
• able to provide information and support on managed withdrawal and recovery to family, carers and affected others
• able to directly deliver pharmacological and psychosocial drug and alcohol treatment interventions for managed withdrawal from drugs and alcohol
• able to support the management of medication side effects and respond accordingly to signs of acute withdrawal, intoxication, detoxification and overdose
• able to use validated withdrawal management assessment tools, including but not limited to the Clinical Institute Withdrawal Assessment for Alcohol – Revised, the Clinical Opiate Withdrawal Scale and the Subjective Opiate Withdrawal Scale
• able to facilitate treatment to support detoxification by admission to and discharge from inpatient settings when community treatment is unsuitable
• able to recognise complications in withdrawal and respond appropriately in an emergency

Interventions: harm reduction, physical, psychological and social interventions

• able to provide harm reduction information, advice and interventions to people, including carers, families, affected others and other professionals
• able to plan, deliver and evaluate care collaboratively with people using a range of evidence-based approaches, such as mapping techniques and motivational interviewing, recognising the person’s unique psychological, social, cultural, health and physical needs, strengths and preferences
• able to deliver trauma-informed care to people, including family, carers and affected others
• able to personalise care and support for people from different groups, including (but not limited to) those who are women, from ethnic minority backgrounds, from LGBTQ+ communities, neurodivergent, of different ages, experiencing co-occurring mental or physical health conditions, involved with the criminal justice system, experiencing homelessness or unemployment, and veterans
• able to provide early identification, screening, care planning/referrals and treatment for drug and alcohol-related physical illnesses, such as alcohol-related liver disease, brain injury and dementia
• able to provide information, guidance, advice, clinical interventions and treatment for health promotion and risk management, including but not limited to vaccines, blood-borne virus screening and treatment, liver screening, alcohol use in pregnancy (including risks to the unborn child), acute alcohol withdrawal, alcohol poisoning, smoking cessation, safer sex, physical healthcare, mental health care, wellbeing and lifestyle advice
• able to provide physical healthcare, including wound dressing and abscess care, promote good personal healthcare and provide associated harm reduction advice
• able to provide people (including families, carers, affected others and other professionals) with evidence-based harm reduction interventions, injecting and other safer drug use equipment, and safer drug and alcohol use advice (including on safer injecting)
• able to provide advice to people with alcohol dependence on the risks of abruptly reducing alcohol use
• able to provide health education/promotion on the effects of and potential interactions between alcohol and drugs and physical and mental health
• able to support people’s access to secondary care, including but not limited to recovery support services, residential rehabilitation and mental health liaison services as indicated
• able to facilitate access to mutual aid (12-step and non-12-step groups) by providing information, supporting attendance, developing motivation and monitoring goals
• able to support people to connect with others with lived experience, including the wider recovery community, to access peer support and develop their social networks
• able to deliver psychosocial interventions to support treatment outcomes and enhance recovery, as well as for common mental health problems like anxiety and depression
• able to conduct, co-ordinate and manage clinical and health-based activities and processes
• able to facilitate groups that support health, wellbeing, recovery and treatment
• able to manage transitions, including joint agency planning and information exchange, to ensure that people moving between settings receive effective continuity of care (for example, from children’s to adult services or from hospital, prison, inpatient detox or residential rehabilitation into the community)
• able to provide recovery monitoring (recovery check-ups) after the person leaves treatment or recovery support services, offering motivational sessions focused on proactive attempts to re-engage people in treatment and recovery support services where required
• able to provide lower-intensity interventions focused on sustaining recovery after a person has met their treatment goals, offering ongoing assessment and psychosocial interventions, such as motivational interviewing and relapse prevention

Multidisciplinary working

• able to provide clinical leadership alongside other regulated members of the MDT
• able to provide clinical leadership, advice and consultation around vulnerable people, specific cohorts with distinct patterns of use and complex cases, especially where there are concurrent conditions
• able to actively participate in and lead MDT meetings with a focus on the treatment, care and support of people, including families, carers and affected others
• able to support colleagues to recognise and manage crises effectively
• able to offer advice and consultation on care for people to internal and external colleagues
• able to work alongside internal and external colleagues to address health inequalities and stigma
• able to offer joint assessment and treatment planning to partner organisations in their work with people
• able to play a central role in embedding a culture of continuous quality improvement and risk management across services
• able to advise and support managers and staff in carrying out their responsibilities
• able to facilitate liaison and communication between external services to enhance access to primary care, secondary care, mental health care and other services
• able to develop MDT understanding and knowledge of mental health services and other relevant partner organisations, and the referral criteria and pathways to these
• able to support MDT colleagues to work jointly with partner organisations around the care of people with co-occurring mental health and drug and alcohol use conditions
• able to advocate for access to appropriate health, social care and partner agencies, and challenge discriminatory practices where people are excluded from services based on problematic drug and alcohol use
• able to contribute to operational and strategic partnership work to develop treatment pathways and improve access to physical and mental health care and talking therapy services for people

Clinical supervision and leadership

• knowledge of clinical supervision models and how to apply these to the MDT drug and alcohol treatment and recovery service context
• able to provide structured clinical supervision to other members of the team
• able to provide regular management supervision according to organisational guidance
• able to provide leadership to the team and expertise from the nursing perspective on delivering treatment and support to people
• able to offer training and placements on nursing training programmes around working with problematic drug and alcohol use

Service development

• knowledge of the function and role of their service
• able to contribute to and lead on the development, application and evaluation of organisational policies and procedures
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrating inclusion through interaction with individuals and groups
• able to support co-production by actively involving people in service improvement where possible – for example, by seeking their views, gathering feedback and providing them with information on relevant activities that they may wish to be involved in)
• able to supervise, educate and mentor other team members, including but not limited to fellow nurses, nursing students, nursing/healthcare assistants and nursing associates
• able to develop and lead on clinical governance structures and processes
• able to identify and develop effective joint working relationships and pathways with other services to meet the wider needs of people (for example, with mental health and primary/secondary care treatment services for co-occurring conditions common in the drug/alcohol treatment population)
• able to attend service reviews to enhance service development and continued quality improvement
• able to offer teaching, internally and externally
• able to participate in quality improvement
• able to support data monitoring, clinical audit and service development
• able to design and create systems to measure the impact and effectiveness of service interventions
• able to engage in and support clinical research for the further professionalisation and development of the sector
• able to co-produce research and service development projects with people, families, carers and affected others
• able to collaborate with higher education establishments to support research
• able to offer service development project opportunities to nursing training programmes, to support the continuation of interest and expertise in problematic drug and alcohol use nursing
• able to participate in incident reviews and apply learning from adverse events
• able to promote the inclusion of the experiences of people, including families, carers and affected others, and their outcomes in the service’s values and across the system
• able to support an environment that promotes partnership working with people and recognises the value of lived experience and peer support
• able to recognise own limitations and limitations of the service, and refer people to an appropriate health, social care or other service where indicated
• able to update clinical and case management records, ensuring clear and effective communication and documentation
• able to lead on service development, service improvement and innovation

Learning and development

• able to maintain NMC registration by meeting the requirements set by the NMC
• able to engage in supervision (clinical and management) as required to develop and maintain the skills to be competent and confident in meeting these capabilities
• able to identify CPD needed to perform the job role competently and confidently, in line with professional and regulatory body requirements, and seek out opportunities to meet these requirements
• able to prepare for and participate in appraisals or regular review meetings and agree a personal development plan
• able to participate in peer-to-peer supervision
• knowledge of role boundaries and the importance of clinical and management supervision
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise

5.7 Practitioner psychologist capabilities

The psychological professions include 21 distinct occupations, including psychologists, psychological therapists and psychological practitioners. There are new roles in the psychological professions that are particularly relevant to drug and alcohol services, including mental health and wellbeing practitioners and clinical associates in psychology. Only practitioner clinical, counselling and forensic psychologist roles (including consultant and non-consultant practitioner psychologists) are in the scope of this framework. A drug and alcohol counselling capability framework is available separately. Other psychological professions are in scope of the drug and alcohol treatment and recovery workforce strategic plan as potential new and expanding roles to introduce to drug and alcohol treatment and recovery service models.

Role profile

The HCPC regulates psychologists under the generic term ‘practitioner psychologist’, which includes clinical, counselling, educational, forensic, health, occupational, and sports and exercise psychologists. This capability framework is limited in scope to clinical psychologists, counselling psychologists and forensic psychologists. Other practitioner psychologists are outside the scope of this framework, although it is noted that health psychologists may also be relevant to services in the future.

Practitioner psychologists within the scope of this framework (clinical, counselling and forensic psychologists) have specialist knowledge and skills relating to the application of psychological evidence and theory to drug and alcohol treatment and recovery services and systems. They are equipped with the competencies to deliver direct interventions while also taking roles in leadership and governance alongside other regulated colleagues. Within treatment services and systems, clinical, counselling and forensic psychologists can improve the quality and outcomes of drug and alcohol treatment with their knowledge and skills around the delivery of evidence-based psychological and psychosocial interventions for problematic drug and alcohol use and co-occurring mental health difficulties. Psychologists’ training also equips them with competencies around training, clinical supervision and reflective practice, drawing on a broad science of psychology. These enable them to support multidisciplinary colleagues to develop the clinical skills to competently deliver psychosocial interventions and psychologically informed and trauma-informed care. Capabilities in research methods enable psychologists to contribute to service improvement. Practitioner psychologists support the wider health and social care system to work more effectively with people through training, consultation and partnership working.

Psychology assistants hold unregulated support roles that play an important part in supporting service delivery, development and evaluation in some drug and alcohol services under the supervision of HCPC-registered practitioner psychologists. They extend the reach of HCPC-registered practitioner psychologists by supporting their work. However, psychology assistants will not take the lead on assessment, planning, treatment, evaluation or leadership. Those using this capability framework must adhere to the principles set out by the HCPC, which stipulates that practitioner psychologists must ‘meet the standards of proficiency that are relevant to their scope of practice – the areas of their profession in which they have the knowledge and skills to practise safely and effectively (The standards of proficiency for practitioner psychologists).

Overarching capabilities

• practise in line with the HCPC standards of proficiency, as per their registration requirements
• able to understand current research happening in the sector and share opportunities to engage in research with people, including families, carers and affected others
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, UK clinical guidelines for alcohol treatment, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of signs and symptoms of problematic alcohol and drug use and dependence, severity of dependence, complexity of needs, and appropriate interventions, and so able to assess individual support needs
• knowledge of trauma-informed approaches and the ways trauma may present in people, and so able to apply this to enable a trauma-informed approach within services
• knowledge of the harm associated with the psychological or physical effects of drugs (including new psychoactive substances and patterns of use) and alcohol, and so able to use psychoeducational skills to promote understanding and awareness of these effects
• knowledge of the common pharmacological interventions used in the treatment of problematic drug and alcohol use
• knowledge of mental health difficulties and how these co-occur and interact with problematic drug and alcohol use
• knowledge of local policies and procedures relevant to information-sharing, confidentiality and data protection legal frameworks
• knowledge of evidence-based psychological interventions for problematic drug and alcohol use and co-occurring mental health difficulties
• knowledge of evidence-based psychological interventions for families and affected others
• knowledge of the social, cultural and economic influences, individual experiences and behaviours that are associated with problematic drug and alcohol use and health inequalities
• knowledge of mental health, physical health, social care and other relevant services, and the referral criteria and pathways to these
• knowledge of current biopsychosocial models relating to problematic drug and alcohol use, motivation and behaviour change processes and recovery
• knowledge of adult and children’s safeguarding legislation and guidance, and so able to recognise and respond to concerns in line with local and organisational safeguarding policies and procedures, and able to escalate safeguarding concerns within their service or externally
• knowledge of research methods

Engagement, assessment and care/treatment planning

• able to conduct a comprehensive assessment of drug and alcohol use, including substance(s) and amount used, pattern of use, route of administration, and presence and severity of dependence
• able to provide psychological assessments of people that identify their strengths and motivations for behaviour change, and link the complex domains of drug and alcohol use and social, physical and mental health problems
• able to collaboratively develop a psychological formulation with people that makes sense of their problematic drug and alcohol use, and any co-occurring mental health and other difficulties, in the context of their life experiences and relationships, and so facilitate understanding, identify diagnoses where appropriate and indicate interventions
• able to complete assessments that inform treatment and recovery care plans
• able to co-produce, implement and review treatment and recovery care plans with people (including families, carers, affected others, the MDT and other professionals) that meet the person’s unique needs and build on their strengths
• able to develop a sequential psychological treatment plan to manage complex difficulties alongside the other aspects of drug and alcohol treatment
• able to identify neurodivergent needs (such as attention deficit hyperactivity disorder and autism spectrum disorder) and refer to specialist services where needed and available
• able to provide ongoing assessment of care, evaluating and amending treatment and recovery care plans and treatment options as appropriate
• able to provide comprehensive neuropsychological assessments of cognitive ability and identify people’s strengths and any problems or limitations, make appropriate recommendations to colleagues around adapting care, and refer to specialist services where available
• able to assess for early indicators of mental and physical health co-morbidities in relation to drug and alcohol use, including suicidality
• able to assess and manage risk and respond to people presenting risk in relation to their social needs and mental or physical health, including risk of overdose, suicide and self-harm, using relevant validated assessment tools where indicated (such as for depression, anxiety and withdrawal)
• able to co-ordinate and navigate systems for complex cases, ensuring a multi-agency collaborative approach
• able to use formulation to communicate a psychological understanding of needs to other involved services, to enhance care
• able to determine the most appropriate service to deliver treatment for moderate to severe mental health difficulties, and refer accordingly

Harm reduction, treatment and recovery interventions

• able to deliver psychoeducation around a biopsychosocial understanding of problematic drug and alcohol use and mental health difficulties, and how these difficulties can co-occur
• able to deliver psychological therapy that addresses difficulties with problematic drug and alcohol use and co-occurring common mental health difficulties
• able to plan, deliver and evaluate care collaboratively with people using a range of evidence-based approaches, such as mapping techniques and motivational interviewing, recognising the person’s unique psychological, social, cultural, health and physical needs, strengths and preferences
• able to deliver trauma-informed care to people, including family, carers and affected others
• able to provide people (including families, carers, affected others and other professionals) with evidence-based harm reduction interventions, injecting and other safer drug use equipment, and safer drug and alcohol use advice (including on safer injecting)
• able to provide advice to people with alcohol dependence on the risks of abruptly reducing alcohol use
• able to provide health education/promotion on the effects of and potential interactions between alcohol and drugs and physical and mental health
• able to deliver evidence-based interventions that support the development of skills for managing difficult emotions
• able to deliver evidence-based psychological interventions to family, carers and affected others
• able to personalise care and support for people from different groups, including (but not limited to) those who are women, from ethnic minority backgrounds, from LGBTQ+ communities, neurodivergent, of different ages, experiencing co-occurring mental or physical health conditions, involved with the criminal justice system, people experiencing homelessness or unemployment and veterans
• able to facilitate access to mutual aid (12-step and non-12-step groups) by providing information, supporting attendance, developing motivation and monitoring goals
• able to support people to connect with others with lived experience, including the wider recovery community, enabling them to access peer support and develop their social networks
• able to manage transitions, including joint agency planning and information exchange, to ensure that people moving between settings receive effective continuity of care (for example, from children’s to adult services or from hospital, prison, inpatient detox or residential rehabilitation into the community)
• able to provide recovery monitoring (recovery check-ups) after the person leaves treatment or recovery support services, offering motivational sessions focused on proactive attempts to re-engage people in treatment and recovery support services where required
• able to provide lower-intensity interventions focused on sustaining recovery after a person has met their treatment goals, offering ongoing assessment and psychosocial interventions, such as motivational interviewing and relapse prevention
• able to support people’s access to secondary care, including but not limited to recovery support services, residential rehabilitation and mental health liaison services as indicated

Multidisciplinary working

• able to provide clinical leadership alongside other regulated members of the MDT
• able to provide clinical leadership, advice and consultation around vulnerable people, specific cohorts with distinct patterns of use and complex cases, especially where there are concurrent conditions
• able to actively participate in and lead MDT meetings with a focus on the treatment, care and support of people, including families, carers and affected others
• able to take a lead role with other regulated professionals in developing and overseeing the delivery of evidence-based psychological and psychosocial interventions in a service, ensuring that MDT colleagues have the training, competencies and supervision to deliver these to the required standard
• able to apply psychological knowledge and formulation to the everyday work of the MDT, to support delivery of psychologically-informed care (such as using psychological formulation to shape keyworker intervention)
• able to support the MDT to deliver trauma-informed care, including formal training followed by ongoing regular consultation and support to apply this to the everyday work of the team
• able to provide expertise to the MDT around a psychological understanding of co-occurring mental health difficulties
• able to develop MDT understanding and knowledge of mental health services and other relevant partner organisations, and the referral criteria and pathways to these
• able to support MDT colleagues to work jointly with partner organisations around the care of people with co-occurring mental health and drug and alcohol use conditions
• able to play a central role in embedding a culture of continuous quality improvement and risk management across services
• able to support colleagues to recognise and manage crises effectively
• able to offer advice and consultation on care for people to internal and external colleagues
• able to advise and support managers and staff in carrying out their responsibilities
• able to facilitate liaison and communication between external services to enhance access to primary care, secondary care, mental health care and other services
• able to offer joint assessment and treatment planning to partner organisations in their work with people
• able to work collaboratively with partner organisations who work with people, to ensure there is good knowledge about, and access to, drug and alcohol treatment services
• able to advocate for access to appropriate health, social care and partner agencies, and challenge discriminatory practice where people are excluded from services because of problematic drug and alcohol use
• able to contribute to operational and strategic partnership work to develop treatment pathways and improve access to mental health and talking therapy services for people who use(d) drugs and/or alcohol
• able to work alongside internal and external colleagues to address health inequalities and stigma

Clinical supervision and leadership

• knowledge of clinical supervision models and how to apply these to the MDT drug and alcohol treatment and recovery service context
• able to provide structured clinical supervision to more junior practitioner psychologists and assistant psychologists, in line with the guidance from professional and regulatory bodies
• able to provide training and clinical supervision to MDT colleagues in line with the guidance from professional and regulatory bodies, focused on the competent delivery of evidence-based psychosocial interventions to people, including families, carers and affected others
• able to provide regular management supervision, where appropriate, according to organisational guidance
• knowledge of how to help teams set aside structured time to think psychologically (such as reflective practice and team formulation meetings)
• able to identify the training and development needs of junior practitioner psychologist colleagues within the service, and facilitate access to the relevant training and opportunities
• able to offer training and placements on practitioner psychology training programmes around working with problematic drug and alcohol use

Service development

• knowledge of the function and role of their service
• able to lead on service development, service improvement and innovation
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrating inclusion through interaction with individuals and groups
• able to conduct audit and service improvement projects
• able to design and create systems to measure the impact and effectiveness of service interventions
• able to contribute to the evidence base around psychological interventions for people who use(d) drugs and/or alcohol problematically, and co-occurring mental health difficulties, through practice-based research
• able to co-produce research and service development projects with people, families, carers and affected others
• able to collaborate with higher education establishments to support research
• able to offer service development project opportunities to practitioner psychologist training programmes, to support the continuation of interest and expertise in drug and alcohol specialist psychology
• able to use psychological skills to interpret research for the organisation/service
• able to evaluate the delivery and impact of psychosocial interventions in the service
• able to provide structured opportunities for teams to develop a psychological understanding of people and their problematic drug and alcohol use treatment needs (for example, team formulation meetings)
• able to support teams to develop the capacity to reflect on their work, through modelling, training and formal reflective practice opportunities
• able to provide expertise around staff support and interventions to promote staff wellbeing
• able to participate in incident reviews and apply learning from adverse events
• able to develop and lead on clinical governance structures and processes
• able to identify and develop effective joint working relationships and pathways with other services to meet the wider needs of people (for example, with mental health and primary/secondary care treatment services for co-occurring conditions common in the drug/alcohol treatment population)
• able to attend service reviews to enhance service development and continued quality improvement
• able to offer teaching, internally and externally
• able to participate in quality improvement
• able to support data monitoring, clinical audit and service development
• able to engage in and support clinical research for the further professionalisation and development of the sector
• able to recognise own limitations and limitations of the service, and refer people to an appropriate health, social care or other service where indicated
• able to update clinical and case management records, ensuring clear and effective communication and documentation
• able to supervise, educate and mentor other team members, including but not limited to assistant psychologists, mental health and wellbeing practitioners and other psychological professions
• able to promote the inclusion of the experiences of people, including families, carers and affected others, and their outcomes in the service’s values and across the system
• able to support an environment that promotes partnership working with people and recognises the value of lived experience and peer support

Learning and development

• able to engage in supervision (clinical and management) as required to develop and maintain the skills to be competent and confident in meeting these capabilities
• able to maintain HCPC registration through participating in, and keeping a record of, regular relevant CPD
• able to identify CPD needed to perform the job role competently and confidently, in line with professional and regulatory body requirements, and seek out opportunities to meet these
• able to develop specific competencies to deliver specific evidence-based psychological interventions or psychological therapies, and participate in CPD and supervision to maintain registration or accreditation with the relevant professional organisations
• knowledge of role boundaries and the importance of clinical and management supervision
• able to participate in regular supervision from an appropriately experienced psychological professional, in line with the guidance from professional and regulatory bodies, incorporating aspects of clinical and professional supervision
• able to participate in peer-to-peer supervision
• able to participate in the model-specific supervision required to deliver psychological interventions or psychological therapy safely and effectively
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise

5.8 Social worker capabilities

Role profile

This role profile applies to SWE-registered social workers who are employed as social workers in an LA-commissioned drug and alcohol treatment and recovery system.

Social workers hold in-depth knowledge and accompanying legal literacy in a range of areas, such as mental health, disability, young people, ageing, housing, employment, financial wellbeing, family systems and trauma.

Social workers work with complexity and understand and address social factors to promote health and reduce treatment inequalities and stigma, while promoting recovery for a vulnerable population.

Social workers employ anti-oppressive approaches and apply the principles of social justice, social inclusion and equality to decision-making and working practices. In line with existing professional regulatory standards for social workers, social workers must have knowledge of anti-racist and anti-discriminatory practice, understanding the impact of racism and discrimination on different groups of people, including impact of systemic racism and discrimination. Social workers work holistically and collaboratively with the person, assessing complex needs, facilitating risk planning, and supporting complex decision-making. They seek to understand the connections between multiple contexts in the person’s life and work, using a person-centred approach to address these. Social workers use evidence-based practice to provide interventions to people and focus on building strong relationships with them, supporting people to make changes using psychosocial motivation.

The expertise of social workers in child and adult safeguarding is vital in the context of drug and alcohol services, supporting responsible decision-making that is tailored to this sector. They support and protect vulnerable people, bringing a multi-agency approach to high-risk situations. They also provide capacity-building and leadership in this area for the MDT, including drug and alcohol workers.

Social workers support service function and caseload management, working alongside other clinicians and peer support workers. They provide social care expertise and professional leadership, delivering reflective practice to support the improvement of the MDT’s practice. Social workers model good practice and support the practice development of others, including social work students and apprentices, newly qualified social workers, and drug and alcohol workers.

Social workers are systems navigators, building strong partnerships to improve the experience of, and health and social care outcomes for, people using services. They enable people to access care and support to meet multiple needs and build on strengths, connecting services from across the sector.

These capabilities cover a range of social work roles; therefore, limitations to these will depend on the knowledge and experience of the individual social worker. These capabilities have been developed for social workers working with adults. Where a social worker working in drug and alcohol treatment and recovery settings is working with children and young people and families, they must have the relevant experience and capabilities drawing on existing child and family social work competency frameworks, and the care and support provided must be age-appropriate.

Overarching capabilities

• practise in line with the professional standards set by SWE, as per their registration requirements
• able to understand current research in the sector and share opportunities to engage in research with people, including families, carers and affected others
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, UK clinical guidelines for alcohol treatment, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of signs and symptoms of problematic alcohol and drug use and dependence, severity of dependence, complexity of needs, and appropriate interventions, and so able to assess individual support needs
• knowledge of trauma-informed approaches and the ways trauma may present in people, and so able to apply this to enable a trauma-informed approach within services
• knowledge of the harm associated with the psychological or physical effects of drugs (including new psychoactive substances and patterns of use) and alcohol, and so able to use psychoeducational skills to promote understanding and awareness of these effects
• knowledge of the social, cultural and economic influences, individual experiences and behaviours that are associated with problematic drug and alcohol use and health and social inequalities
• knowledge of relational practice involving interpersonal and intrapersonal dynamics, including power dynamics, conflict, patterns, connection, resolution and restorative practice
• knowledge of mental health difficulties and how these co-occur and interact with problematic drug and alcohol use
• knowledge of current biopsychosocial models relating to problematic drug and alcohol use, motivation and behaviour change processes and recovery
• knowledge of mental health, physical health, social care and other relevant services, and the referral criteria and pathways to these
• knowledge of adult and children’s safeguarding legislation and guidance, and so able to recognise and respond to concerns in line with local and organisational safeguarding policies and procedures; able to escalate safeguarding concerns within their service or externally; and able to provide leadership to colleagues on safeguarding issues and partnership working
• knowledge of domestic abuse, exploitation, coercion and control, and able to work in partnership to safeguard and protect people, and to know when to refer and escalate to external agencies
• knowledge of how to balance presenting risks with the rights of the person, using information, observation, legal literacy and contextual factors
• knowledge of local policies and procedures relevant to information-sharing, confidentiality and data protection legal frameworks
• knowledge of research methods

Engagement, assessment and care/treatment planning

• able to conduct a comprehensive assessment of drug and alcohol use, including substance(s) and amount used, pattern of use, route of administration, and presence and severity of dependence
• able to assess strengths as well as needs as part of assessment processes
• able to provide harm reduction information, advice and interventions to people, including carers, families, affected others and other professionals
• able to incorporate key social work knowledge, skills, concepts and critical analysis into all drug and alcohol assessments
• able to build and maintain collaborative therapeutic relationships with people, maintaining professional boundaries while acting in a non-judgemental, compassionate manner
• able to assess for early indicators of mental and physical health co-morbidities in relation to drug and alcohol use, including suicidality
• able to provide ongoing assessment of care, evaluating and amending treatment and recovery care plans and treatment options as appropriate
• able to determine the most appropriate service to deliver treatment for moderate to severe mental health difficulties, and refer accordingly
• able to assess and manage risk and respond to people presenting risk in relation to their social needs and mental or physical health, including risk of overdose, suicide and self-harm, using relevant validated assessment tools where indicated (such as for depression, anxiety and withdrawal)
• able to complete assessments that inform treatment and recovery care plans
• able to co-produce, implement and review treatment and recovery care plans with people (including families, carers, affected others, the MDT and other professionals) that meet the person’s unique needs and build on their strengths
• able to lead on, or contribute to, assessments to support decision-making, planning and partnership approaches (such as, but not restricted to, parenting capacity assessments, Mental Capacity Act assessments and safeguarding enquiries)
• able to co-ordinate and navigate systems for complex cases, ensuring a multi-agency collaborative approach
• able to undertake, or support teams to undertake, preparatory work, assessment, referral, and funding applications for rehabilitation placements

Harm reduction, treatment and recovery interventions

• able to use a range of evidence-based psychosocial interventions to support people to change their behaviour, such as motivational interviewing, contingency management and CBT-informed interventions
• able to personalise care and support for people from different groups, including (but not limited to) those who are women, from ethnic minority backgrounds, from LGBTQ+ communities, neurodivergent, of different ages, who have co-occurring mental or physical health conditions, involved with the criminal justice system, people who are experiencing homelessness or unemployment and veterans
• able to deliver trauma-informed care to people, including family, carers and affected others
• able to provide people (including families, carers, affected others and other professionals) with evidence-based harm reduction interventions, injecting and other safer drug use equipment, and safer drug and alcohol use advice (including on safer injecting)
• able to provide advice to people with alcohol dependence on the risks of abruptly reducing alcohol use
• able to provide health education/promotion on the effects of and potential interactions between alcohol and drugs and physical and mental health
• able to support people’s access to secondary care, including but not limited to recovery support services, residential rehabilitation and mental health liaison services as indicated
• able to facilitate access to mutual aid (12-step and non-12-step groups) by providing information, supporting attendance, developing motivation and monitoring goals
• able to support people to connect with others with lived experience, including the wider recovery community, enabling them to access peer support and develop their social networks
• able to manage transitions, including joint agency planning and information exchange, to ensure that people moving between settings receive effective continuity of care (for example, from children’s to adult services or from hospital, prison, inpatient detox or residential rehabilitation into the community)
• able to provide recovery monitoring (recovery check-ups) after the person leaves treatment or recovery support services, offering motivational sessions focused on proactive attempts to re-engage people in treatment and recovery support services where required
• able to provide lower-intensity interventions focused on sustaining recovery after a person has met their treatment goals, offering ongoing assessment and psychosocial interventions, such as motivational interviewing and relapse prevention
• able to undertake, or support teams to undertake, residential rehabilitation reviews, signposting and aftercare planning
• able to use relationship-based practice skills to sustain relationships where appropriate, and able to successfully navigate challenging and sensitive conversations when required
• able to deliver psychoeducation to support the understanding of behaviour and feelings related to life experience and trauma, including developing and sharing resources to support this
• able to recognise own limitations and limitations of the service, and refer people to an appropriate health, social care or other service where indicated
• able to update clinical and case management records, ensuring clear and effective communication and documentation

Multidisciplinary working

• able to provide clinical leadership alongside other regulated members of the MDT
• able to provide clinical leadership, advice and consultation around vulnerable people, specific cohorts with distinct patterns of use and complex cases, especially where there are concurrent conditions
• able to actively participate in and lead MDT meetings with a focus on the treatment, care and support of people, including families, carers and affected others
• able to support colleagues to recognise and manage crises effectively
• able to offer advice and consultation on care for people to internal and external colleagues
• able to work alongside internal and external colleagues to address health inequalities and stigma
• able to offer joint assessment and treatment planning to partner organisations in their work with people
• able to play a central role in embedding a culture of continuous quality improvement and risk management across services
• able to advise and support managers and staff in carrying out their responsibilities
• able to facilitate liaison and communication between external services to enhance access to primary care, secondary care, mental health care and other services
• able to develop MDT understanding and knowledge of social care services and other relevant partner organisations, and the referral criteria and pathways to these
• able to advocate for access to appropriate health, social care and partner agencies, and challenge discriminatory practices where people are excluded from services based on problematic drug and alcohol use
• able to support MDT colleagues to work jointly with social services around the care of people with co-occurring mental health and drug and alcohol use conditions
• able to contribute to operational and strategic partnership work to develop care pathways and improve access to social services and mental health and talking therapy services for people

Clinical supervision and leadership

• knowledge of clinical supervision models and how to apply these to the MDT drug and alcohol treatment and recovery service context
• able to provide structured clinical supervision to other members of the team
• able to provide regular management supervision according to organisational guidance
• able to provide leadership to the team and expertise from the social work perspective on delivering support and care to people
• able to offer training and placements on social work training programmes around working with problematic drug and alcohol use

Service development

• knowledge of the function and role of their service
• able to contribute to and lead on the development, application and evaluation of organisational policies and procedures
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrating inclusion through interaction with individuals and groups
• able to support co-production by actively involving people in service improvement where possible, for example, by seeking their views, gathering feedback, and providing them with information on relevant activities that they may wish to be involved in
• able to supervise, educate and mentor other team members depending on knowledge, training and experience, including but not limited to fellow social work colleagues, social work trainees and drug and alcohol workers
• able to develop and lead on clinical governance structures and processes
• able to identify and develop effective joint working relationships and pathways with other services to meet the wider needs of people (for example, with mental health and primary/secondary care treatment services for co-occurring conditions common in the drug/alcohol treatment population)
• able to attend service reviews to enhance service development and continued quality improvement
• able to offer teaching, internally and externally
• able to participate in quality improvement
• able to support data monitoring, clinical audit and service development
• able to design and create systems to measure the impact and effectiveness of service interventions
• able to engage in and support social work research for the further professionalisation and development of the sector
• able to co-produce research and service development projects with people, families, carers and affected others
• able to collaborate with higher education establishments to support research
• able to offer service development project opportunities to social work training programmes, to support the continuation of interest and expertise in drug and alcohol specialist social work
• able to participate in incident reviews and apply learning from adverse events
• able to promote the inclusion of the experiences of people, including families, carers and affected others, and their outcomes in the service’s values and across the system
• able to support an environment that promotes partnership working with people and recognises the value of lived experience and peer support
• able to lead on service development, service improvement and innovation

Learning and development

• able to maintain SWE registration by meeting the requirements set by SWE
• able to engage in supervision (clinical and management) as required to develop and maintain the skills to be competent and confident in meeting these capabilities
• able to identify CPD needed to perform the job role competently and confidently, in line with professional and regulatory body requirements, and seek out opportunities to meet these
• able to prepare for and participate in appraisals or regular review meetings and agree a personal development plan
• able to participate in peer-to-peer supervision
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise

5.9 Pharmacist and pharmacy technician capabilities

Role Profile

This role profile applies to GPhC-registered pharmacists and pharmacy technicians working in an LA-commissioned drug and alcohol treatment and recovery setting.

Please note pharmacy assistants are out of scope of this framework. Pharmacy professionals working in retail community pharmacies and hospital pharmacies are also out of scope.

As medication experts, pharmacy professionals are integral members of the MDT who contribute significantly to the comprehensive support and treatment of individuals with problematic drug and alcohol use.

Within local drug and alcohol treatment and recovery services, pharmacy professionals deliver pharmaceutical care and pharmacological treatment interventions to people who use services, alongside duties such as (but not limited to) acting as designated controlled drugs accountable officers and medicines safety officers. Some pharmacists may also hold qualifications as independent prescribers.

More senior roles will involve strategic-level responsibilities emphasising clinical governance, such as prescribing analyses, development and subsequent implementation and review of formularies, and engagement with external stakeholders such as the wider pharmaceutical industry, controlled drugs local intelligence networks, and community pharmacies and their associated local pharmaceutical committees.

These strategic-level responsibilities are vital for maintaining the continued confidence and competence of the pharmacy profession and central to maintaining connectivity with frontline services to enable organisational resilience (such as pharmacists offering prescribing clinics).

Due to their unique knowledge of dispensing processes and medicines-related legislation, and their appreciation of the community pharmacy working environment, pharmacy professionals are ideally placed to lead on responding to prescription queries (such as prescription wording), medicines supply issues, reviewing and managing responses to associated incidents, mortality reviews, complaints, alerts and audits, including Home Office compliance and community pharmacy quality assurance visits and service level agreement negotiations for advanced services.

As these capabilities cover pharmacists and pharmacy technicians, there will be limits to the capabilities for each role due to their different responsibilities, level of experience and seniority, type of registration held, and qualifications. It is important to note that pharmacy technicians work under the supervision of pharmacists and will contribute to most administrative aspects of pharmaceutical care, including preparation and dispensing of medications; where appropriate, they can also provide information/advice to other professionals and people using services, depending on their level of knowledge and experience. Pharmacists will hold more senior positions and have decision-making responsibilities.

While there is some overlap regarding pharmacist and pharmacy technician roles and responsibilities, each role has its own defined remits and expertise. Service providers must not expect all pharmacy professionals to fulfil the full list of capabilities, and should refer to individual registration details, as well as experience and qualifications, when using these capabilities. As regulated healthcare professionals, pharmacists and pharmacy technicians are accountable for working within their own scope of professional practice as per GPhC standards which require pharmacy professionals to ‘recognise and work within the limits of their knowledge and skills’.

Overarching capabilities

• practise in line with GPhC standards for practice as per their registration requirements
• able to understand current research happening in the sector and share opportunities to engage in research with people, including families, carers and affected others
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, UK clinical guidelines for alcohol treatment, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of signs and symptoms of problematic alcohol and drug use and dependence, severity of dependence, complexity of needs, and appropriate interventions, and so able to assess individual support needs
• knowledge of trauma-informed approaches and the ways trauma may present in people, and so able to apply this to enable a trauma-informed approach within services
• knowledge of mental health difficulties and how these co-occur and interact with problematic drug and alcohol use
• knowledge of current biopsychosocial models relating to problematic drug and alcohol use, motivation and behaviour change processes and recovery
• knowledge of the harm associated with the psychological or physical effects of drugs (including new psychoactive substances and patterns of use) and alcohol, and so able to use psychoeducational skills to promote understanding and awareness of these effects
• knowledge of medicines management, and so able to dispense, administer and advise (and, where applicable, prescribe following additional independent prescribing training) on medications, including controlled drugs and medicines to manage alcohol and/or drug withdrawal, PGDs and PSDs; working in accordance with national guidelines and local policies and procedures (including advice around interactions with other prescribed and over-the-counter medicines and how they interact with alcohol and drugs)
• knowledge of formulary management and high-risk prescribing processes
• knowledge of medication optimisation processes, including procurement, prescription requirements, and medicines supply and storage issues, in accordance with national guidance, associated best practices and legislative requirements
• knowledge of clinical reporting systems, including clinical and prescribing data analyses and community pharmacy processes
• knowledge of the risks of polypharmacy (including those associated with individuals who are using non-prescribed drugs), and so able to liaise with primary care services to co-ordinate prescribing and manage the additional considerations/risks of having multiple potential prescribers involved in care
• knowledge of local policies and procedures relevant to information-sharing, confidentiality and data protection legal frameworks
• knowledge of mental health, physical health, social care and other relevant services, and the referral criteria and pathways to these
• knowledge of the social, cultural and economic influences, individual experiences and behaviours that are associated with problematic drug and alcohol use and health inequalities
• knowledge of adult and children’s safeguarding legislation and guidance, and so able to recognise and respond to concerns in line with relevant local and organisational safeguarding policies and procedures to escalate safeguarding concerns within their service or externally, and able to escalate safeguarding concerns within their service or externally
• knowledge of research methods

Engagement, assessment and care/treatment planning

• able to conduct a comprehensive assessment of drug and alcohol use, including substance(s) and amount used, pattern of use, route of administration, and presence and severity of dependence
• able to conduct comprehensive health screening assessments and identify physical and mental health conditions related to drug and alcohol use, using specialist assessment tools
• able to assess strengths as well as needs as part of assessment processes
• able to build and maintain collaborative therapeutic relationships with people, maintaining professional boundaries while acting in a non-judgemental, compassionate manner
• able to complete assessments that inform treatment and recovery plans
• able to co-produce, implement and review treatment and recovery plans with people (including families, carers, affected others, the MDT and other professionals) that meet the person’s unique needs and build on their strengths
• able to assess medication side effects, signs of acute withdrawal, intoxication, detoxification and overdose
• able to support the management of medication side effects and respond accordingly to signs of acute withdrawal, intoxication, detoxification and overdose
• able to provide ongoing assessment of care, evaluating and amending treatment and recovery care plans and treatment options as appropriate
• able to assess for early indicators of mental and physical health co-morbidities in relation to drug and alcohol use, including suicidality
• able to assess people’s need for managed withdrawal and detoxification from drugs and alcohol to ensure they are offered person-centred, evidence-based treatment within the setting most appropriate to their physical, mental, social and circumstantial needs
• able to assess and manage risk and respond to people presenting risk in relation to their mental or physical health, including risk of overdose, suicide and self-harm, using relevant validated assessment tools where indicated (such as for depression, anxiety and withdrawal)
• able to support people’s access to secondary care, including but not limited to recovery support services, residential rehabilitation and mental health liaison services as indicated
• able to co-ordinate and navigate systems for complex cases, ensuring a multi-agency collaborative approach

Harm reduction, treatment and recovery interventions

• able to provide harm reduction information, advice and interventions to people, including carers, families, affected others and other professionals
• able to directly deliver pharmacological and psychosocial drug and alcohol treatment interventions for managed withdrawal from drugs and alcohol, including but not limited to dispensing/supply activities, supervised consumption and medicines administration
• able to plan, deliver and evaluate care collaboratively with people using a range of evidence-based approaches, such as mapping techniques and motivational interviewing, recognising the person’s unique psychological, social, cultural, health and physical needs, strengths and preferences
• able to deliver trauma-informed care to people, including family, carers and affected others
• able to provide people (including families, carers, affected others and other professionals) with evidence-based harm reduction interventions, injecting and other safer drug use equipment, and safer drug and alcohol use advice (including on safer injecting)
• able to provide advice to people with alcohol dependence on the risks of abruptly reducing alcohol use
• able to provide health education/promotion on the effects of and potential interactions between alcohol and drugs and physical and mental health
• able to provide medicines-related advice, medicines optimisation reviews and, where qualified, structured medication reviews
• able to personalise care and support for people from different groups, including (but not limited to) those who are women, from ethnic minority backgrounds, from LGBTQ+ communities, neurodivergent, of different ages, experiencing co-occurring mental or physical health conditions, involved with the criminal justice system, experiencing homelessness or unemployment and veterans
• able to provide early identification, screening, care planning/referrals and treatment for drug and alcohol-related physical illnesses, such as alcohol-related liver disease, brain injury and dementia
• able to provide information, guidance, advice, clinical interventions and treatment for health promotion and risk management, including but not limited to vaccines, blood-borne virus screening and treatment, liver screening, alcohol use in pregnancy (including risks to the unborn child), acute alcohol withdrawal, alcohol poisoning, smoking cessation, safer sex, physical healthcare, mental health care, wellbeing and lifestyle advice
• able to manage transitions, including joint agency planning and information exchange, to ensure that people moving between settings receive effective continuity of care (for example, from children’s to adult services or from hospital, prison, inpatient detox or residential rehabilitation into the community)
• able to recognise own limitations and limitations of the service, and refer people to an appropriate health, social care or other service where indicated
• able to update clinical and case management records, ensuring clear and effective communication and documentation

Multidisciplinary working

• able to provide clinical leadership alongside other regulated members of the MDT
• able to provide clinical leadership, advice and consultation around vulnerable people, specific cohorts with distinct patterns of use and complex cases, especially where there are concurrent conditions
• able to actively participate in and lead MDT meetings with a focus on the treatment, care and support of people, including families, carers and affected others
• able to support colleagues to recognise and manage crises effectively
• able to offer advice and consultation on care for people to internal and external colleagues
• able to work alongside internal and external colleagues to address health inequalities and stigma
• able to offer joint assessment and treatment planning to partner organisations in their work with people
• able to play a central role in embedding a culture of continuous quality improvement and risk management across services
• able to advise and support managers and staff in carrying out their responsibilities
• able to facilitate liaison and communication between external services to enhance access to primary care, secondary care, mental health care and other services
• able to develop MDT understanding and knowledge of mental and physical healthcare services and other relevant partner organisations, and the referral criteria and pathways to these
• able to advocate for access to appropriate health, social care and partner agencies, and challenge discriminatory practice where people are excluded from services because of problematic drug and alcohol use
• able to contribute to operational and strategic partnership work to develop treatment pathways and improve access to mental and physical healthcare services for people who use(d) drugs and/or alcohol

Clinical supervision and leadership

• knowledge of clinical supervision models and how to apply these to the MDT drug and alcohol treatment and recovery service context
• able to provide structured clinical supervision to other members of the team
• able to provide regular management supervision according to organisational guidance
• able to provide leadership to the team and expertise from the pharmacy perspective on delivering treatment and support to people
• able to offer training and placements to trainee pharmacists and pharmacy technicians, pharmacists or pharmacy technicians around working with problematic drug and alcohol use

Service development

• knowledge of the function and role of their service
• able to contribute to the development, application and evaluation of organisational policies and procedures
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrating inclusion through interaction with individuals and groups
• able to support co-production by actively involving people in service improvement where possible, for example, by seeking their views, gathering feedback, and providing them with information on relevant activities that they may wish to be involved in
• able to supervise, educate and mentor other team members, including but not limited to pharmacy technicians
• able to develop and lead on clinical governance structures and processes
• able to identify and develop effective joint working relationships and pathways with other services to meet the wider needs of people (for example, with mental health and primary/secondary care treatment services for co-occurring conditions common in the drug/alcohol treatment population)
• able to attend service reviews to enhance service development and continued quality improvement
• able to offer teaching, internally and externally
• able to participate in quality improvement
• able to support data monitoring, clinical audit and service development
• able to design and create systems to measure the impact and effectiveness of service interventions
• able to engage in and support clinical research for the further professionalisation and development of the sector
• able to co-produce research and service development projects with people, families, carers and affected others
• able to collaborate with higher education establishments to support research
• able to offer service development project opportunities to pharmacy training programmes, to support the continuation of interest and expertise in drug and alcohol specialist pharmacy
• able to participate in incident reviews and apply learning from adverse events
• able to promote the inclusion of the experiences of people, including families, carers and affected others, and their outcomes in the service’s values and across the system
• able to support an environment that promotes partnership working with people and recognises the value of lived experience and peer support
• able to lead on service development, service improvement and innovation

Learning and development

• able to maintain GPhC registration by meeting the requirements set by the GPhC
• able to engage in supervision (clinical and management) as required to develop and maintain the skills to be competent and confident in meeting these capabilities
• able to identify CPD needed to perform the job role competently and confidently, in line with professional and regulatory body requirements, and seek out opportunities to meet these requirements
• able to prepare for and participate in appraisals or regular review meetings and agree a personal development plan
• able to participate in peer-to-peer supervision
• knowledge of role boundaries and the importance of clinical and management supervision
• able to deliver training to team members and external agencies, based on knowledge, skills and expertise

6. Non-clinical role capabilities

6.1 Drug and alcohol peer support worker capabilities

Role profile

Drug and alcohol peer support workers (PSWs) have direct lived experience of their own or someone else’s problematic drug and alcohol use and recovery. They are trained and employed to support and encourage adults using their lived experience as underpinning guidance. They are able and ready to use their lived experience, skills and knowledge to support others to reduce harm, engage with treatment and other support services, and initiate and sustain recovery. The relationship between PSWs and people is based on non-judgemental mutual respect, honesty, appropriate boundaries and compassion. Using empathy and compassion based on shared experiences, they empower others on their recovery journey, recognising that there are many pathways to recovery.

Drug and alcohol PSWs use their own unique skills and lived experience to work collaboratively to advocate on behalf of people. They represent visible recovery and foster a sense of hope for others on their recovery journey. They enhance engagement and social inclusion and promote co-production within organisations and services by ‘being alongside’ people. They also play a key role in challenging the stigma faced by people by sharing their experiences to enhance understanding within teaching and training. A key part of the role is championing social justice and promoting equality, inclusion, health and wellbeing by supporting people to access health, social care and other support services.

PSWs have highly valued lived experience, but there is a risk of relapse for them in their own problematic drug and alcohol use, or of a change in their own mental health needs. They need support to cope with potential triggers and the demanding nature of peer support, which can be emotionally draining and stressful.

Employers should ensure that PSWs are provided with high-quality supervision and support from a suitably trained and experienced clinician or senior PSW (pro rata for part-time staff), as outlined in section 4.

PSWs roles vary widely in practice from service to service: for example, some workers focus on providing one-to-one support and running peer support groups, while others provide broader support through social and community activities. Service providers may find that not all the capabilities listed below are relevant or required for the PSWs they employ, depending on the nature of their service. It is the responsibility of the service provider to ensure that capabilities are adhered to where required – for example, if PSWs within their service offer one-to-one support, then the capabilities listed below regarding this should be in place.

As noted earlier in ‘How to use this framework’, the workforce is not expected to meet all capability requirements at entry level or early career stage but, should be supported to work towards them through training and development opportunities, effective supervision arrangements and the provision of high-quality clinical leadership. This is especially true for PSWs who may be joining the workforce following unemployment and will in many cases be entering for the first time without having completed any specialist training. It is therefore unlikely that people applying for PSW roles will already have all the capabilities listed here and employers must ensure that induction and tailored learning and development plans help PSWs to incrementally develop the capabilities required for their role.

Overarching capabilities

• able to use lived experience of their own or a partner’s or family member’s problematic drug and alcohol use and recovery to guide supportive work
• able to consistently deploy evidence-based peer support strategies to promote recovery
• has the resilience, readiness, experience and competencies to engage in peer support work
• able to manage own workload and time effectively, can ascertain priorities, tasks and resources, taking account of changing circumstances, risks and the needs of people
• able to understand current research happening in the sector and share opportunities to engage in research with people, including families, carers and affected others
• able to identify safeguarding concerns and follow organisational and local safeguarding procedures and able to escalate accordingly to social care in line with statutory guidance and local procedures, where appropriate
• able to integrate and align with key standards and national clinical guidelines of relevance to their peer support role, including Drug misuse and dependence: UK guidelines on clinical management, UK clinical guidelines for alcohol treatment, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• knowledge of trauma-informed approaches and the ways trauma may present in people, and so able to apply this to enable a trauma-informed approach within services
• knowledge of common physical health complications associated with problematic drug and alcohol use, and so able to recognise signs of these and escalate to clinical members of the MDT or refer as necessary
• knowledge of the harm associated with the psychological or physical effects of drugs (including new psychoactive substances and patterns of use) and alcohol, and so able to use psychoeducational skills to promote understanding and awareness of these effects
• knowledge of mental health and mental health problems, and so able to detect early warning signs that a person may be struggling with their mental health, or may struggle in the future without appropriate support, and so able to respond, escalate or refer in line with the requirements of their role
• knowledge of adult and children’s safeguarding, and so able to recognise and respond to concerns in line with local and organisational safeguarding policies and procedures, and able to escalate safeguarding concerns within their service or externally
• knowledge of the relationship between the Mental Capacity Act 2005, human rights legislation and other legislation as relevant to people, and so able to support and protect their welfare, wellbeing and freedom of choice
• knowledge of the prevalence and patterns of domestic abuse victimisation and perpetration in the drug and alcohol treatment population, and so able to escalate any concerns to relevant clinicians
• knowledge of the social, cultural and economic influences, individual experiences and behaviours that are associated with problematic drug and alcohol use and health inequalities
• knowledge of local policies and procedures relevant to information-sharing, confidentiality and data protection legal frameworks

Engagement

• able to engage people by initiating contact, listening and starting to develop relationships in outreach, initial assessments and engagement opportunities
• able to build and maintain collaborative, supportive relationships with people, including families, carers and affected others (where appropriate) in a non-judgemental, compassionate manner, using active listening, empathy and collaborative techniques while maintaining professional boundaries
• able to make every contact count by engaging people in conversations about their health, wellbeing and recovery, encouraging behaviour change, and supporting people to access support to make that change

Peer support interventions

• able to provide people (including families, carers, affected others and other professionals) with evidence-based harm reduction interventions, injecting and other safer drug use equipment, and safer drug and alcohol use advice (including on safer injecting)
• able to provide advice to people with alcohol dependence on the risks of abruptly reducing alcohol use
• able to provide health education/promotion on the effects of and potential interactions between alcohol and drugs and physical and mental health
• able to work collaboratively with people, recognising the person’s unique psychological, social, cultural, health and physical needs, strengths and preferences
• able to provide one-to-one peer support to people through sessions, informal contact and follow-ups
• able to offer personalised peer support to people, including families, carers and affected others, bringing an understanding from their own lived experience to help others reduce harm, access and engage with treatment (where relevant), and initiate and sustain their recovery
• able to deliver trauma-informed support to people
• able to show curiosity about each person’s unique living (current) and lived (past) experience by listening attentively and showing respect and acceptance
• able to share their own relevant lived experience clearly and supportively to inspire and support people on their own recovery journeys, recognising when to share and when to listen and that there are many pathways to recovery
• able to promote recovery through active support by ‘buddying’ people, and so helping them access meaningful participation in the recovery community (including activities and networks, recovery support services and the wider community)
• able to help people develop, track and realise personal goals through practical and emotional support
• able to personalise care and support for people from different groups, including (but not limited to) those who are women, from ethnic minority backgrounds, neurodivergent, from LGBTQ+ communities, of different ages, experiencing co-occurring mental or physical health problems, involved with the criminal justice system, experiencing homelessness or unemployment, and veterans
• able to identify psychological, physical and social risks to people and escalate them to an appropriate clinician

Supporting recovery by encouraging the use of resources

• able to support recovery by taking a coaching and supporting stance, being alongside someone in recovery
• able to explore which community resources people are already engaged with, their personal interests and the barriers they face to further community engagement, and assertively link people with community resources matched to their interests
• able to facilitate access to mutual aid (12-step and non-12-step groups) by providing information, supporting attendance, developing motivation and monitoring goals
• able to encourage people to engage with a range of health and social care services where necessary or beneficial, such as their GP, dentist, housing services, the recovery community and peer support groups
• where appropriate and/or required, able to actively encourage health promotion or social inclusion by assisting people with arranging or attending appointments and advocating on their behalf
• able to advocate on behalf of people in situations where the voice of the person is not being heard
• able to facilitate or co-facilitate peer support groups focused on reducing harm, supporting treatment outcomes, initiating and sustaining recovery, and preventing relapse; or groups focused on ‘diversionary’ activities such as art, music, physical activity, wellbeing and social connection
• able to provide recovery monitoring (recovery check-ups) after the person leaves treatment or recovery support services, offering motivational sessions focused on proactive attempts to re-engage people in treatment and recovery support services where required
• able to facilitate, co-facilitate and deliver training for other professionals, covering topics such as stigma and recovery, and sharing one’s own lived experience and that of others (with their permission)
• able to support transitions, including joint agency planning and information exchange, to ensure that people moving between settings receive effective continuity of care (for example, from children’s to adult services, or from hospital, prison, inpatient detox or residential rehabilitation into the community)

Multidisciplinary working

• knowledge of the importance of team and multi-agency working in meeting people’s needs
• able to work collaboratively with a variety of professionals and support groups, both within their own team and externally, including developing and maintaining active pathways between services
• able to advocate for the perspective of people who use(d) drugs and/or alcohol, while also maintaining their professional boundaries, role and responsibilities
• knowledge of different professional roles within and outside the team
• knowledge of when the needs of people require escalation to a clinician, within or external to their service, and able to act upon this
• able to challenge stigma around problematic drug and alcohol use to promote social inclusion and non-judgemental and compassionate treatment, care and support of people, both within internal and external services and the wider community
• able to work in a wide variety of environments where required, for example hospitals and prisons

Service development

• knowledge of the function and role of their service
• able to contribute to the development, application and evaluation of organisational policies and procedures
• able to support a work environment that promotes wellbeing and self-care for staff, actively practising self-care
• able to promote and advocate for equality and diversity, including eliminating unlawful discrimination, harassment and victimisation, fostering good relations between those with and without protected characteristics, and demonstrate inclusion through interaction with individuals and groups
• able to support co-production by actively involving people in service improvement where possible, for example, by seeking their views, gathering feedback, and providing them with information on relevant activities that they may wish to be involved in
• able to participate in and contribute to audits, service evaluation and quality improvement projects relevant to own work
• able to participate in incident reviews and apply learning from adverse events
• able to promote the inclusion of the experiences of people, including families, carers and affected others, and their outcomes in the service’s values and across the system
• able to support an environment that promotes partnership working with people and recognises the value of lived experience and peer support
• able to recognise own limitations and limitations of the service, and refer people to an appropriate health, social care or other service where indicated
• able to update records about people accessing support, ensuring clear and effective communication and documentation

Learning and development

• able to engage in regular supportive supervision and other types of support that aid learning and development and enable space to reflect on their role
• able to use reflective practice principles to improve support for people, and promote own self-care and wellbeing
• able to recognise the limitations of their role and seek the advice and expertise of others when required or indicated
• able to maintain awareness of own limitations, knowledge gaps and potential conflicts of interest
• knowledge of role boundaries and the importance of supportive management supervision
• able to actively participate in learning opportunities and demonstrate self-improvement
• able to maintain up-to-date knowledge and understanding of drugs (including new psychoactive substances and patterns of use) and alcohol and so able to promote understanding and awareness of these effects
• able to prepare for and participate in appraisals or regular review meetings and agree a personal development plan
• able to engage in regular management supervision to support working in line with organisational and professional policies
• able to identify CPD needed to perform the job role competently and confidently

6.2 Commissioner capabilities

Role profile

This role profile applies to senior commissioners in the LA drug and alcohol treatment and recovery sector, who would typically also hold a team leader position and a wider portfolio of other services beyond drug and alcohol treatment and recovery services.

Commissioners lead and oversee local services’ response to reducing drug and alcohol harm, including high-quality, effective and person-centred treatment and recovery systems. They provide system stewardship and strategic leadership. Commissioners are responsible for a systematic and structured process of identifying needs and marshalling resources across health and social care systems to best meet those needs.

At a minimum, this includes ensuring local adherence to a commissioning cycle that enables effective and proportionate investment of public funding to procure treatment and recovery services that are responsive to local need and build on local assets, while remaining in line with national strategy, policy and clinical guidelines.

The commissioning process involves a cyclical approach of analysing, planning, implementing and reviewing the services and support required by a local population. As such, it also involves managing complex budgets and multiple grants, contracts, and system and service improvements to better meet needs with the resources available.

This involves cultivating relationships and working closely with key partners across the system, including but not limited to people with lived and living experience, local communities, members of the public and providers to:

• understand population needs
• determine key priorities
• design, plan and identify resources available, and what services exist or are absent, to meet identified needs and build on local assets
• bring together services, partners and wider stakeholders to work as a system, to deliver the required and agreed outcomes
• collaborate with system partners to build relationships and develop pathways and joint working processes with other parts of the health and social care system (for example, with mental health services and through local safeguarding partnerships)

These competencies align with the Commissioning quality standard (a high-level framework that provides further guidance on processes, partnerships and systems for effective drug and alcohol service commissioning) and the Independent review of drugs by Professor Dame Carol Black.

Drug and alcohol recovery commissioning partnerships (where commissioning partnerships are discussed, this is a reference to the wider drug and alcohol recovery commissioning partnership) aim to develop effective whole and integrated systems that address the diverse and complex needs of the target population. It is important to note that specialist treatment services are not the whole system, but one element which sits within the wider health and social care system.

Commissioners aim to ensure that support is not only available but is also effective and efficient, and responsive to the changing needs of the community that the partnership serves. Commissioners are responsible for commissioning and monitoring the delivery of a full range of safe, effective and evidence-based alcohol and drug support that is available locally. This includes ensuring that service providers have the appropriate clinical governance structures and processes in place.

Commissioning also involves strategic partnership development and systems leadership, both of which are essential for the successful operation of a treatment and recovery system.

Within the drug and alcohol sector, there is a substantial diversity of providers operating across various sectors: the NHS, voluntary providers, community interest companies and the private sector. These providers span different areas in the field, and managing this range of provider types is a critical aspect of the commissioning role.

The capabilities set out below should be read alongside the Commissioning quality standard.

Overarching capabilities

• able to proactively commission activities that improve outcomes for people with problematic drug and alcohol use, families, carers, affected others and those in recovery, ensuring a cohesive and integrated approach that covers prevention, early intervention, harm reduction, treatment and recovery
• able to identify, support and align the activities of organisations and services that, although not under the commissioner’s direct financial or contractual control, have an impact on the community being served
• able to lead the procurement, performance/contract management and development of service/support provision under their direct financial control
• able to lead, co-ordinate and manage a commissioning team with a range of functions and expertise
• have a broad understanding and knowledge of the needs of the target population, current evidence regarding balanced specialist treatment and recovery systems, and drug and alcohol-related issues, including the impact of problematic drug and alcohol use on people, families, communities and members of the public
• able to use their broad understanding and knowledge to advise and liaise with national, regional and local bodies as appropriate
• able to support and work flexibly with and across diverse commissioning partnership services, negotiating to gain agreement on strategies, operational plans and services, working within complex local political environments and with sensitive agendas
• able to develop a business case to advocate for funding within and across different settings in the wider community and public sector systems
• able to support the development of a culture shift that challenges stigma around problematic drug and alcohol use through advocating on behalf of the community – both internally within the system/commissioning partnership and externally among members of the public, local communities, services in the wider community and public sector systems – to promote social inclusion and non-judgemental, compassionate prevention, early intervention, harm reduction, treatment and recovery for people
• able to integrate and align with key standards and national clinical guidelines, including Drug misuse and dependence: UK guidelines on clinical management, UK clinical guidelines for alcohol treatment, and NICE recommendations for interventions for individuals with problematic drug and alcohol use

Application of knowledge

• comprehensive knowledge of the local context/population, including but not limited to health and social care systems, wider public sector systems, the criminal justice system and the experiences of diverse populations, and able to apply strategic partner data/intelligence to service planning and delivery
• able to apply knowledge of local government processes, including local political systems, and navigate these to liaise with elected members for effective partnership working across various settings
• knowledge of the regulations and legislation in relation to procurement, and their application within specific local settings
• knowledge of public health, problematic drug and alcohol use, policy and practice
• knowledge of effective recovery-oriented systems of care from harm reduction to recovery (including medical, clinical, relational and psychosocial interventions and peer support), and able to apply this to service planning and delivery
• knowledge of how to apply a trauma-informed approach to treatment and recovery support, and to service commissioning, design and delivery

Learning and development

• able to use managerial supervision and training opportunities to develop knowledge and skills around commissioning practice
• able to develop, maintain and update drug and alcohol-specific expertise and knowledge, including knowledge of relevant government policy guidance and legislation
• able to share knowledge and learning to identify and embed best practices and new research about drug and alcohol treatment and recovery among teams and wider services within the commissioning partnership
• able to identify CPD needed to perform the job role competently and confidently

Service and system development

• able to contribute to and lead on strategy and policy development that aligns with local needs (including the needs and strengths of members of the public and local communities) and national standards
• able to ensure that robust clinical governance structures are in place and can draw upon advice/information from clinical and non-clinical leads, and clinicians, to ensure that safe and effective care is delivered
• able to use activity and outcomes data in collaboration with the wider partnership to identify solutions and drive improvements
• able to specify and monitor the implementation of guidance about recovery and lived experience initiatives, including recovery support services
• able to champion co-creation* with people with living and lived experience at all service levels as appropriate (for example, consultation, participation, partnership and peer leadership)
• able to address unequal power structures and systems by fostering equitable power dynamics, ensuring that spaces for meaningful engagement are safe and conducive to participation for people with living and lived experience
• able to understand, develop and communicate agreed service outcomes based on strategic data/intelligence to inform commissioning decisions, and work to deliver these outcomes in collaboration with all services within the commissioning partnership

* Co-creation encompasses co-design (defining problems and solutions with people who use services) and co-production (implementing solutions together with people who use services).

7. Other clinical and non-clinical role descriptors

7.1 Medical workforce role descriptor

This role descriptor applies to all General Medical Council (GMC) registered doctors working in an LA-commissioned drug and alcohol treatment and recovery setting.

Roles and settings out of scope are:

• GPs treating people dependent on drugs and alcohol but not commissioned to do so by an LA as part of a shared care arrangement with a specialist drug and alcohol treatment service, or as part of an LA-commissioned primary care-led or other specialist treatment service
• doctors working in NHS England-commissioned drug and alcohol treatment teams in secure settings or NHS England-commissioned Alcohol Care Teams

The medical workforce is integral to the safe and effective delivery of care and treatment within the drug and alcohol sector.

Doctors working in drug and alcohol services have a range of specialisms, come from a variety of backgrounds (including but not limited to psychiatry, general practice and hepatology) and have a range of qualifications, interests and competencies. This diversity of skill sets enables the unique and varied needs of people within services to be met.

Doctors play a key role in developing and sustaining safe, effective and evidence-based practice through the provision of clinical leadership, MDT working and contributing to upholding a solid clinical governance structure.

Comprehensive guidelines on the competencies required for doctors working within this sector have been developed and published by the Royal College of Psychiatrists and the Royal College of General Practitioners. Entitled Delivering quality care for drug and alcohol users: the roles and competencies of doctors, these should be used by commissioners, providers and clinicians in conjunction with this framework to inform the necessary capabilities for doctors in this field.

In addition, doctors working within the sector must adhere to the professional standards outlined by the GMC.

7.2 Leaders and managers role descriptor

Leaders and managers ensure the effective provision of high-quality drug and alcohol treatment and recovery services. They are instrumental in providing strategic leadership and maintaining clinical oversight and clinical governance for safe and effective practice.

These roles require a dynamic approach, encompassing service development and collaboration with operational managers, service managers and professionals with clinical experience and sound knowledge of drug and alcohol treatment and recovery, to ensure effective service function and enhanced outcomes.

Key priorities include leading teams to achieve agreed outcomes, oversight of governance structures, finance and resource management, oversight of staff wellbeing and development, delivery of services and interventions that meet complex needs, and ensuring the safety of and recovery-oriented care for people who use the service.

Leaders and managers who hold Care Quality Commission (CQC) registered manager status will also be required to ensure CQC regulatory requirements are satisfied.

The capabilities required for this role are outlined in existing leadership frameworks such as Leadership for empowered and healthy communities: A framework or the NHS Leadership Academy’s Leadership Framework. These should be used by commissioners and providers, in conjunction with this framework, to inform the necessary capabilities for these roles.

7.3 Counsellors role descriptor

This role descriptor applies to counsellors working in an LA-commissioned drug and alcohol treatment and recovery setting.

Counsellors will have, or will be working towards, registration/accreditation with a recognised counselling register accredited by the Professional Standards Authority (PSA). As a minimum standard, the typical registration requirement for counsellors as per the Scope of Practice and Education framework for counselling and psychotherapy with adults (SCoPEd framework*) is SCoPEd B or C, but for specific roles, where defined as such, SCoPEd A may be sufficient. These registration requirements align with the PSA’s SCoPEd framework.

*The SCoPEd framework, developed in partnership by six bodies who hold accreditation with the PSA, describes the essential training practices and competence requirements for professionals working with adults in the field of counselling and psychotherapy.

Counsellors play a key role in enabling recovery. They help people to address a range of emotional and psychological challenges, assisting them to navigate the complex issues that likely lie behind problematic drug and alcohol use, and to foster positive change.

Counsellors are integral members of the MDT, offering unique and specialist insights and approaches to care. In addition, they can play an important part in the delivery of clinical leadership, particularly in providing clinical supervision as appropriate, and enabling reflective practice depending upon their training, level of experience and competencies.

Counsellors must practise within their level of competence and education and satisfy membership with a recognised accrediting professional body to demonstrate that they meet both educational and professional standards and adhere to ethical codes.

Specific capabilities for counsellors are not outlined in this document, as this work has been carried out by the British Association for Counselling and Psychotherapy (BACP). Drug and alcohol treatment and recovery service providers should refer to the BACP Addictions Counselling Competence Framework, which provides further guidance.

8. Appendix 1: Methodology

This work was overseen by a steering group representing NHS England, the NHS Workforce, Training and Education directorate, OHID and the National Workforce Skills Development Unit (NWSDU).

To develop the capabilities for relevant roles, working groups were convened, each consisting primarily of frontline staff within that professional group or others with relevant expertise (for example, heads of service). Working group attendees were invited to describe their activities in a typical day and to identify what knowledge, skills and training are involved in delivering their role. On this basis, a draft set of capabilities was developed, and these were reviewed for comment by the working group. Membership of these groups can be found in Appendix 2.

An Expert Advisory Group provided oversight and expert feedback on the draft capabilities. Its membership represented stakeholders from across the sector, including clinicians and other workers, managers, commissioners, experts by experience and specialist charities. Membership of this group can be found in Appendix 3.

A Lived Experience Working Group was convened to answer a broad set of questions on the knowledge, skills and behaviour they feel are necessary for the drug and alcohol workforce, as well as reviewing the language and terminology being used. This information was used to edit the capabilities. Membership of this group can be found in Appendix 4.

In addition, an editorial review was provided by the National Collaborating Centre for Mental Health.

9. Appendix 2: Membership of capability development working groups

Drug and alcohol worker

Chairs: Amber O’Brien, Clinical Adviser (NWSDU) and Becky Richens, Clinical Adviser (NWSDU)

• Wilfildah Chidavaenzi, Senior Recovery Worker, Change Grow Live (CGL)
• Martyn Davies, Senior Alcohol High Intensity Use Co-ordinator, Turning Point
• Des Kirby, Harm Reduction Lead, Turning Point 
• Paul Leigh, Regional Trainer, CGL
• John McNeil, Recovery Navigator, Humankind/Likewise Sheffield
• Richard McVey, Head of Service, Aquarius
• Tony Pearson, Director of People and Culture, Phoenix Futures

Children and young people’s drug and alcohol worker

Chairs: Amber O’Brien, Clinical Adviser (NWSDU) and Becky Richens, Clinical Adviser (NWSDU)

• Sam Dixon, Team Leader, We Are With You
• Eilish Gilvarry, Deputy Medical Director, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, and Honorary Professor Addiction Psychiatry, Newcastle University
• Vivien Hughes, Young People’s Treatment Service Lead, We Are With You
• Chloe Medhurst, Cognitive Behavioural Therapist, We Are With You
• Mark Menning, Practice Manager, East Sussex County Council
• Jenny Robertson, Service Manager, CGL
• Shirley Rusdale, Young Person’s Substance Misuse Worker, CGL
• Jennifer Rushworth-Claeys, Head of Young Person’s Service Delivery, We Are With You
• Claire Trimmer, Substance Misuse Practitioner, Catch 22

Senior drug and alcohol worker

Chairs: Vanessa Bailey, Clinical Adviser (NWSDU) and Amber O’Brien, Clinical Adviser (NWSDU)

• Lisa Cartwright, OHID Project Manager, CGL
• Laura Clark, Team Leader, Forward Trust
• Paul Farr, Senior Substance Misuse Worker – Inclusive Health East Riding Partnership, Humber Teaching NHS Foundation Trust
• Rebecca Gibson, Team Leader – Substance Misuse, Hartlepool Borough Council
• Julia Gottlieb, Advanced Recovery Practitioner, Turning Point
• Lisa Grogan, Step Down Navigator – Changing Futures, Red Rose Recovery
• John Hall, Team Leader, CGL
• Kirsty Martin, Service Manager, CGL
• James Millar, Team Leader, Forward Trust
• Alexander Murray, Team Leader, HMP Downview – Forward Trust

Kate Halliday (Addiction Professionals) and Rick Bradley, Head of Learning and Development (With You) also supported the conception and development of this role.

Family support worker – adult-focused and children and young people’s focused

Chairs: Vanessa Bailey, Clinical Adviser (NWSDU) and Amber O’Brien, Clinical Adviser (NWSDU)

• Vivienne Evans, Chief Executive, Adfam
• Claire Hagelburg, Family Intervention Worker, PROPS North East
• Tracey Harrison, National Hidden Harm Lead, CGL
• Hazel Jordan, Alcohol Treatment Programme Manager, OHID
• Norma (Nogugu) Mabuya, Family Worker, HMP Downview – Forward Trust
• Adele Mulligan, Children and Families Worker, CGL
• Dave Reade, Service User and Carer Lead – East Riding Partnership, Humber Teaching NHS Foundation Trust
• Ruth Squire, Head of Children and Young People, CGL
• Robert Stebbins, Policy and Communications Lead, Adfam
• Helen Thompson, Chief Executive Officer, PROPS North East

Nursing

Chairs: Amber O’Brien, Clinical Adviser (NWSDU) and Becky Richens, Clinical Adviser (NWSDU)

• Lydia Duncan, Team Manager, Greater Manchester Mental Health NHS Foundation Trust
• Gillian Heaton, Lead Nurse and Non-Medical Prescriber, Greater Manchester Mental Health NHS Foundation Trust
• Della McGrath, Nurse, CGL
• Beth Nash, Nurse, Turning Point
• Temitope Odeyemi, Cluster Lead Nurse, CGL
• Hannah Osborn, Substance Misuse Nurse, Surrey and Borders Partnership NHS Foundation Trust
• Emma Richardson, Clinical Director, Forward Trust
• Michael Sandiford-Turnock, Public Health Clinical Governance Lead (SMS Services), Essex County Council
• Susannah Spindler, Service Manager, Surrey and Borders Partnership NHS Foundation Trust
• Polly Tarbotton, Regional Lead Nurse, Humankind
• Irene Wilson, Clinical Nurse Specialist/Non-Medical Prescriber, Surrey and Borders Partnership NHS Foundation Trust

Practitioner psychologist

Chairs: Louise Martin, Consultant Clinical Psychologist (CGL) and Amber O’Brien, Clinical Adviser (NWSDU)

• Melanie Day, Consultant Clinical Psychologist and National Clinical Lead for Psychology in Substance Use, We Are With You
• Daniel Donkor, Consultant Clinical Psychologist, Turning Point
• Megan Drysdale, Assistant Psychologist, Avon and Wiltshire Mental Health Partnership NHS Trust
• Andre Geel, Consultant Clinical Psychologist, Central and North West London NHS Foundation Trust, and Addiction Professionals Chair
• Callum Gray, Assistant Psychologist, Avon and Wiltshire Mental Health Partnership NHS Trust
• Poonam Koria, Senior Assistant Psychologist, Turning Point
• Jan Larkin, Head of Psychology, Turning Point
• Mani Mehdikhani, Consultant Clinical Psychologist, CGL
• Tim Meynen, Development and Management of Clinical Placements, South London and Maudsley NHS Foundation Trust
• Dr Luke Mitcheson, Consultant Clinical Psychologist, South London and Maudsley NHS Foundation Trust and National Clinical Adviser – Addiction and Inclusion, OHID
• Sarah Stacey, Consultant Clinical Psychologist and Inclusion Professional Lead for Psychology, Midlands Partnership University NHS Foundation Trust, and Chair for the Division of Clinical Psychology Faculty of Addictions, British Psychological Society (BPS)
• Karen Van-Gerko, Consultant Psychologist for Cheshire and Merseyside, CGL
• Claire Wyatt, Team Practitioner Psychologist, We Are With You

Social worker

Chairs: Vanessa Bailey, Clinical Adviser (NWSDU), Amber O’Brien, Clinical Adviser (NWSDU) and Ellie Reed, Head of Social Work – Principal Social Worker (CGL)

• Jason Brandon, Mental Health Social Work Lead – Office of Chief Social Worker, DHSC
• Leanne Ellaway, Social Work and Safeguarding Lead – Bristol Drug and Alcohol Treatment System, Avon and Wiltshire NHS Mental Health Partnership Trust
• Liesl Glover, Social Worker/Senior Mental Health Practitioner – Westminster Rough Sleepers Drug and Alcohol Service, Turning Point
• Helen Hewitt, Social Work Lead, CGL
• Jeni Hunneyball, Social Work Lead, CGL
• Fiona Khan, Social Work Lead, CGL
• Kayleigh Mell, Social Worker, East Riding of Yorkshire Council Drug and Alcohol Service
• Deborah O’Neill, Senior Social Worker and Practice Educator, CGL
• Rebecca Ogilvie, Social Worker, Gateshead Council
• Rebecca Pettifor, Senior Social Worker and Project Manager, CGL
• Kirsty Young, Principal Social Worker – Head of Social Work, The Alcohol and Drug Service

Pharmacist and pharmacy technician

Chairs: Vanessa Bailey, Clinical Adviser (NWSDU) and Roz Gittins (Chief Pharmacy Officer, GPhC and Immediate Past President, College of Mental Health Pharmacy)

• Mohammed Fessal, Director of Pharmacy, CGL
• Patrick Gorey, Lead Pharmacist, Humankind
• Caroline Grundy, CGL
• Janki Lakha, Clinical Services Manager – City and Hackney Recovery Service, Turning Point
• Nadia Morrison, Pharmacist/Independent Prescriber, Turning Point
• Kevin Ratcliffe, Consultant Pharmacist – Addictions, National Non-Medical Prescribing Lead, Prescribing Lead – North Birmingham, CGL
• Anshu Rayan, Deputy Chief Pharmacist, Central and North West London NHS Foundation Trust
• Christine Rowlands, Chief Pharmacist and Health and Justice Lead, Spectrum Community Health – Community Interest Company
• Jennifer Scott, Prescriber, Turning Point and Senior Lecturer, Bristol University
• Soyar Sherkat, Advanced Specialist Pharmacist Addiction, Central and North West London NHS Foundation Trust
• Chris Todd, Senior Clinical Pharmacist, Devon Partnership NHS Trust
• Esther Tunkel, Lead Pharmacist, Turning Point
• Katherine Watkinson, Head of Medicines Optimisation and Pharmacy, Turning Point
• Barbara Zub, National Pharmacy Technician, Humankind

Drug and alcohol peer support worker

Chairs: Amber O’Brien, Clinical Adviser (NWSDU) and Becky Richens, Clinical Adviser (NWSDU)

• Rachel Ayres, Volunteer Manager, Bristol Drug Project
• Larry Eve, Service Manager, The Basement Project
• Michelle Foster, Chief Executive Officer, The Basement Project
• Dave Higham, Chief Executive Officer, The Well Communities and College of Lived Experience Recovery Organisations (CLERO) Connector lead
• Stuart Honor, Manager, The Basement Project
• Rach Lowes, Peer Support Worker, Recovery Connections
• Graham Miller, Chief Executive Officer, Double Impact
• Adam Petson, Peer Support Worker, Recovery Connections
• Sophie Stone, Peer Support Worker, Double Impact

Commissioner

Chairs: Vanessa Bailey, Clinical Adviser (NWSDU), Rob Hardy, Associate Director (NWSDU) and Ben Hughes, Head of Wellbeing and Public Health: Marginalised Groups (Essex County Council) and Chair (English Substance Use Commissioners Group)

• Lisa Byrne, Surrey County Council
• Niamh Cullen, Calderdale Council
• Luann Donald, Senior Adviser Workforce, Local Government Association
• Alistair Flowers, Public Health Strategist – Islington Public Health, Islington Council
• Kim Hager, Joint Commissioning Manager and Drugs Partnership Lead – Communities and Public Protection Public Health, Cornwall Council
• Mark Knight, Greater Manchester Combined Authority
• Cavelle Lynch, Buckinghamshire Council
• Sarah Quilty, Nottinghamshire County Council
• Kirsty Walton, Strategic Lead Health Related Harm, Leicester County Council

10. Appendix 3: Membership of Expert Advisory Group

Chair: Dr Luke Mitcheson, Consultant Clinical Psychologist (South London and Maudsley NHS Foundation Trust) and National Clinical Adviser – Addiction and Inclusion (OHID)

• Rick Bradley, Head of Learning and Development (With You)
• Rolonde Bradshaw, Team Leader (Red Rose Recovery)
• Ed Day, Clinical Reader in Addiction Psychiatry (University of Birmingham), Consultant in Addiction Psychiatry (Birmingham and Solihull Mental Health NHS Trust) and Chair (Society for the Study of Addiction)
• Vivienne Evans, Chief Executive Officer (Adfam)
• Professor Eilish Gilvarry, Deputy Medical Director (Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust) and Honorary Professor Addiction Psychiatry (Newcastle University)
• Stuart Green, Drug and Alcohol Service Manager (Aspire Doncaster Drug and Alcohol Services) and CLERO Lead
• Kate Halliday, Executive Director (Addiction Professionals)
• Linda Harris, Chief Executive Officer (Spectrum Community Health – Community Interest Company) and Member (NHS England Health and Justice Clinical Reference Group)
• Ben Hughes, Head of Wellbeing and Public Health: Marginalised Groups (Essex County Council) and Chair (English Substance Use Commissioners Group)
• Dr Mike Kelleher, Consultant Psychiatrist and Associate Medical Director (South London and Maudsley NHS Foundation Trust) and National Clinical Adviser – Addiction and Inclusion (OHID)
• Des Kirby, Harm Reduction Lead (Turning Point)
• Dr Faisal Mahmood, Head of Counselling and Psychotherapy (Birmingham Newman University) and Member (BACP Expert Reference Group for Addiction Counselling Competencies)
• Karen Marsh, Deputy Head of Operations – Community Drug and Alcohol Services and Practice and Development Lead (Inclusion, Midlands Partnership University NHS Foundation Trust)
• Benedicta Mbambo, Chief Nurse and Non-Medical Prescriber (VIA)
• John McNeil, Recovery Navigator (Humankind/Likewise Sheffield)
• Richard McVey, Head of Service (Aquarius)
• Dr Margaret Orange, Associate Director – Addictions Governance (Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust)
• Tony Pearson, Director of People and Culture (Phoenix Futures)
• Ellie Reed, Head of Social Work – Principal Social Worker (CGL)
• Professor Tony Roth, Emeritus Professor – Clinical, Education and Health Psychology, Division of Psychology and Language Sciences (University College London)
• Dr Louise Sell, Consultant Psychiatrist (Pennine Care NHS Foundation Trust), Non-Executive Director (Stockport NHS Foundation Trust), Trustee (Early Break) and Chair (OHID Alcohol Clinical Guidelines)
• Julia Sharp, Programme Lead – Substance Misuse (Gateshead Council)
• Hannah Shead, Chief Executive Officer (Trevi), Member (Choices) and Chair (Women’s Treatment Working Group)
• Dot Smith, Chief Executive (Recovery Connections) and Member (CLERO)
• Sarah Stacey, Consultant Clinical Psychologist and Inclusion Professional Lead for Psychology (Midlands Partnership University NHS Foundation Trust) and Chair for the Division of Clinical Psychology Faculty of Addictions (BPS)
• Caroline Thatcher, HR Director (Forward Trust)
• Raj Ubhi, Director of Children and Young People’s Services (CGL)
• Katherine Watkinson, Head of Medicines Optimisation and Pharmacy (Turning Point)
• Stephen Willott, GP (Windmill Practice) and Public Health Clinical Lead – Alcohol and Other Drugs (Nottingham City Council)
• Alice Wiseman, Director of Public Health (Gateshead Council) and Addiction Lead (Association of Directors of Public Health)
• Tim Young, Chief Executive Officer (The Alcohol and Drug Service)

Facilitators

• Vanessa Bailey, Clinical Adviser (NWSDU)
• Joana Escaria, Project Manager (NWSDU)
• Atiya Fazalbhai, Project Manager (NWSDU)
• Rob Hardy, Associate Director (NWSDU)
• Amber O’Brien, Clinical Adviser (NWSDU)
• Hannah Poupart, Project Manager (NWSDU)
• Becky Richens, Clinical Adviser (NWSDU)

Observers

• Iain Armstrong, Programme Manager (OHID)
• Pete Burkinshaw, Alcohol and Drug Treatment and Recovery Lead (OHID)
• Harjinder Kaur-Heer, Programme Manager (National Directorate for Workforce, Training and Education, NHS England)
• Laura Pechey, Programme Manager (OHID)
• James Shutt, Senior Project Manager (National Directorate for Workforce, Training and Education, NHS England)
• Louis Michalakis, Senior Project Manager (National Directorate for Workforce, Training and Education, NHS England)

11.  Appendix 4: Membership of Lived Experience Working Group

Chairs: Vanessa Bailey, Clinical Adviser (NWSDU) and Amber O’Brien, Clinical Adviser (NWSDU)

• Veronique Allwood
• Rolonde Bradshaw
• Kristina Colquhoun
• Pete Craig
• Sharon Cutler
• Lisa Hawdon
• Emma-Louise Kelly
• Chenise Knox
• Rachel McKeown
• Linda Mearns
• Jack Morgan
• Lee O’Grady
• Ben Pennell
• Rebecca Powell
• Fatema Rahman
• Lynsay Railton
• Rachel Robinson
• Jake Saddington
• Cobain Sheridan
• Mike Stephenson
• Adam Talbot
• Adam Taylor
• Chad White
• Martin Wignall

Publication reference: PRN01499