Author: vp513

St. Anne’s – Goodbye for now!

After what seems like a very short five weeks, my time at St. Anne’s has come to an end. I’ve settled in well and have a great relationship with the service users, so it seems almost too soon to be leaving!

The main aim of my project was to collect data on Spice use (more on that later), but during my time here I’ve also become involved in a lot more of the work that St. Anne’s does. I’ve helped to run the breakfast club every week, which was a great way to meet the clients and talk to them about my project. I was also part of service user involvement sessions, which are designed to allow people to have their say on how St. Anne’s is run and what sort of services it offers. This sense of involvement is at the core of St. Anne’s ethos; service users are encouraged to take an active role in changing their lives and addressing issues that affect them. It’s been really rewarding to see how some of the clients have managed to turn their lives around with the help of the staff.

Back to my project, then. Due to the nature of the work that St. Anne’s carries out and their client base, my data set is smaller than I’d hoped. However, it still offers an eye-opening and valuable insight into Spice use among the service users, which was the aim. It’s not possible to share too much on my blog (due to the confidential nature of the information) but what I can say is that a large volume of service users are dealing with the effects of Spice on a daily basis. This can be anything from blacking out, becoming anxious or aggressive, hearing voices, to witnessing the death of a close friend. I’ve been quite surprised and humbled by the honesty of the clients when we’ve been discussing Spice; the vast majority of people have fallen over themselves to help me get the information I needed. This has been collected into a report for the staff at St. Anne’s, and can hopefully be used as a tool to help them move forward in dealing with Spice use among their clients. The whole process has been fascinating, frustrating and (at times) even upsetting, but it’s been worth it.

I also focused a lot of my efforts on gathering information from the staff at St. Anne’s about their own experiences of Spice. The general mood was one of frustration; the staff have to deal with people who have taken Spice on a daily basis, and quite often these people can become aggressive, behave erratically, or just unresponsive. It’s really forming a barrier between clients and staff, preventing the latter from doing their job.

With this is in mind, I decided to run a service user involvement session for both clients and staff to discuss the findings of my project. The aim was to present what I’ve found to everyone, then allow staff and service users to discuss their experience of Spice in a ‘safe’ space. I felt that it was really important bridge the gap between the staffs’ perception of Spice and the actual experiences of the clients. The session was a huge success; staff opened up to the service users about their feelings of frustration and annoyance, which I think helped clients to see how their actions may be affecting others. Equally, service users then shared their own stories of their experience of Spice, and this allowed the staff to see the other side of the coin. A client may be behaving erratically or being aggressive, but underneath that there is a person who may be extremely frightened or struggling with addiction.

At the end of my internship, I hope that my work will allow St. Anne’s to more effectively tackle the use of Spice among their clients. It was just the tip of the iceberg in terms of Spice research, but I hope that in the future others will be able to use my study as a basis for more widespread research. To the wonderful team at St. Anne’s, it is definitely not goodbye. The work they do is challenging but invaluable to their service users, and I’ll be joining them again (this time as a volunteer) after my graduation.

 

Weeks two and three at St. Anne’s: gaining trust

It’s nearing the end of my third week at St. Anne’s, so it’s definitely time for another blog post. Before we dive into the details, I thought it might be a good idea to clarify some of the jargon I’ll be using throughout my posts.

A ‘client’ or ‘service user’ is someone who has come to St. Anne’s for any kind of assistance, from help with housing or substance abuse problems, to just wanting a shower and a hot meal. St. Anne’s has many different clients, but my project is focused on those who are ‘vulnerably housed’. This term is a bit foggy; it covers just about everything from street homeless (what we tend to think of when we hear the word homeless) to someone living in a hostel, right the way through to people who actually have their own tenancy. You’ll soon pick it up!

Despite the fact that I’ve worked at St. Anne’s before (see my previous blog post) it still took some time to settle in again. For the first week, I heard a lot of “So what are you doing here, then?” “Do you work for a charity?” “Are you a support worker, or what?”. The team at St. Anne’s doesn’t usually change much, so a new face was something of a novelty for the service users.

After this initial novelty wore off, one of the biggest challenges I’ve faced during these first few weeks of the project is how to engage with the service users, and how to persuade them to chat to me about Spice. As you can imagine, some clients can be difficult at times, and often have a hard time trusting people they deem to be professionals (that includes me, apparently). It was my job to make them see that I wasn’t asking questions to be rude or critical, I was simply trying to find out more about Spice. Over the past three weeks, I’ve learnt (sometimes the hard way) how to put clients at ease, so I thought I’d share my top tips with you.

  1. Talk to services users as you would anyone else. People who are vulnerably housed are often cut off from the rest of society, they are used to being shunned and mistrusted. You need to show them that you respect them and their opinion, just like any other person. Be friendly, and don’t be frightened or too formal.
  2. Try to remember their name. Now, this seems pretty obvious, but I’ve found that it makes a huge difference to the service users at St. Anne’s. As I said before, the vulnerably housed often feel rejected by society and as a result can be quite defensive; making an effort to remember someone’s name lets them know that you’ve not just dismissed them because of their position.
  3. Let them be the expert. Compared to most of the services users I have spoken to, my knowledge of Spice (from its various effects to the price of a bag) is pretty rubbish. They are the experts, and it’s important that you treat them as such. Listen to what they say, it might sound odd or even silly to you but you’re not the one taking this drug, they are. I’ve found that this approach also helps to gain the trust of the service users; they spend a lot of time being on the receiving end of help or guidance (from doctors, social workers, etc.) so I think that they enjoy the chance to actually give their own opinions and advice.

So, using these basic ‘tools’ (if you like) I think I’ve managed to gain the trust of a lot of the clients. Many of them remember my name, and will say hello if they see me. It’s really nice to feel part of the community at St. Anne’s. In terms of my project, it’s helped me to engage with the service users and to get them to open up about their experiences with Spice. It’s a little too early to go into the details of my findings, but one thing in particular that has struck me is the sheer volume of service users that take Spice. I’d been told that it was very popular among the vulnerably housed by both the staff at St. Anne’s and associated health professionals, but I didn’t quite understand the scale of the problem until I witnessed it first-hand. Literally every single person I have asked in the last three weeks has taken Spice at least once.

The poster shown below is displayed in the reception area of St. Anne’s; I walk past it every day. Worryingly, during my time here I have spoken to clients  and staff who have experienced (or witnessed someone else experiencing) all of the listed effects of so-called ‘legal highs’. It’s not pleasant to talk about, but hopefully my project will play a small part in raising the public’s awareness of the dangers of Spice.

 

 

St. Anne’s Community Services – who, what, where and why?

I thought I’d dedicate my first blog post to explaining at little bit about my internship, and the organisation that I’ll be working with over the coming weeks.

St. Anne’s Community Services is a charity based in Leeds that provides a huge variety of services to many groups, from the homeless to those with mental health problems, from asylum seekers to people with substance abuse issues. In 2014 (see my previous Charity Insights blog posts!) I carried out a project at St. Anne’s that was focused on Alcohol Related Brain Damage, or ARBD, in the homeless. I really enjoyed working with the team at St. Anne’s and really admired the (often difficult) work that they do, so it’s no surprise that I’m back again!

This year, my project is focused on Spice, a synthetic cannabinoid that, until May 26th, was classified as a ‘legal high’. Before this date, it was legal to sell Spice in the UK, so it could be purchased on the internet and even in shops. Due to increasing concerns about the effects of Spice on both the physical and mental health of its users, on May 26th this year it became illegal to sell it, or to possess with intent to sell.

Spice comes in hundreds of different varieties, is relatively cheap, and can have a huge range of effects, most of which are not desirable. These range from black-outs, anxiety and a racing heart to seizures, psychosis and even death.

So where does my project come into all this? During my time at St. Anne’s in 2014 I spoke to quite a few service users who had mentioned Spice. I didn’t know what it was, so decided to investigate. After speaking to the staff and doing some research of my own, I realised just how serious this problem was, especially amongst the homeless. Worryingly, because Spice has only begun to be abused relatively recently, there is little or no data available on its use, long-term and short-term effects.

During my internship this year, then, I will be gathering information from service users at St. Anne’s (who are homeless or what we call ‘vulnerably housed’) about their experiences with Spice. In addition, I will also be working closely with the staff to gauge their knowledge and experience of the drug and its effects. The aim is to help St. Anne’s understand how and why the homeless are using Spice, if they contact the emergency services as a result, and how they are obtaining it now that the law has changed. We also want to ensure that the staff have all the knowledge they need to identify someone who has taken Spice, and ensure that they receive the appropriate care. It’s a challenging area, but it’s so important that we learn more about this really worrying trend.

If you want to find out a bit about the effects of taking Spice, watch the episode of ‘999: What’s Your Emergency?’ that was broadcast on 11th July 2016 on Channel 4. It shows how the emergency services are trying to deal with the devastating effects of legal highs, and is a bit of an eye opener. Take a look.

Week four/five: the end

It’s hard to believe that my time at St. Anne’s is over – four weeks has flown by! Over the past week (alongside my usual screening programme) I’ve been involved in several events with St. Anne’s, such as helping to run their service user drop-in session yesterday. It was a chance for people to make suggestions or raise concerns about the services on offer at St. Anne’s, as well as to sample the Krispy Kreme doughnuts on offer! I really enjoyed getting involved with the service users and hearing their opinions on the services they use everyday, and it really highlighted to me how important St. Anne’s is to some of these people. During my project I’ve seen the same faces passing through, whether it’s to get help with benefits, take a class in computer skills or even just to take a shower. I’ve been amazed by the sheer range of services and help available to anyone, all under one roof – and I feel really honoured to have been a (albeit small) part of it.

Anyway, back to my project. I’ve been analysing the data I’ve collected and have prepared a report for the staff at St. Anne’s about ARBD. It consists of the data analysis itself, an information leaflet about ARBD and some advice on the next steps to tackle this little-known condition. I really hope that with the data I’ve collected, St. Anne’s can begin to raise awareness of ARBD amongst their staff and their service users, eventually spreading this knowledge to other relevant organisations. ARBD is a serious condition that makes everyday life extremely difficult for those affected, and these people need to be noticed by clinicians and charity workers, and given appropriate help. My project will hopefully be the first step along this path.

To conclude, I’ve learnt a huge amount during my time at St. Anne’s, from data analysis and report writing skills to dealing with difficult people on a daily basis. It’s been immensely rewarding, challenging and above all fun! Although this is officially the end of my internship with St. Anne’s, I’m hoping to volunteer with them again in the future. They are truly an amazing organisation, and deserve all the help they can get.

The end of week three at St. Anne’s

Week three is just about over and it’s probably been my favourite (and the most interesting) week so far. I’ve spent a lot of time designing a leaflet about ARBD for staff I discussed in my last blog post, and a large part of that has been to do my own research on the condition. This involved literature searches and lots of journal articles! The whole point of my project with St. Anne’s was to help raise awareness of the severity and prevalence of ARBD in vulnerable groups, and the lack of resources on this subject really highlighted the need for greater awareness of the condition.

Besides researching ARBD, I’ve also been hard at work screening clients for signs of the condition. By now I’ve got pretty good at the process (I can even perform the screen without the instructions!) and know how to make clients feel comfortable and relaxed. What I’ve really noticed during my time at St. Anne’s is the honesty of the clients – they are very open about any worries they may have about their memory and their alcohol/drug use. It’s something I’ve come to really admire, and it should make my data much more reliable.

So with just one more week to go, I’m getting ready to analyse the data I’ve collected and give the staff at St. Anne’s my resources on ARBD. I’m already sad to leave and my project is not even finished yet!

Hard at work researching!
Hard at work researching!

Week two draws to a close…

My second week at St. Anne’s is nearly over, and I feel like I’ve settled in nicely. As I’ve carried out more and more screening I’ve become much more confident with the process, and when explaining the results to service users. The staff have been working really hard to raise awareness of my screening amongst service users and as a result I’ve been pretty busy!

Throughout my time at St. Anne’s, my perception of the homeless and people with alcohol/substance abuse problems has changed dramatically. It’s often difficult to admit that we have prejudices towards these groups, but I’ll put my hands up and say that before I began my project I had always been a bit frightened or suspicious of them. Over the past two weeks, I’ve had the chance to talk to many people I’d never normally interact with, such as the homeless, recovering alcoholics, and people who are alcohol and drug-dependent. Hearing their stories (through the screening process) has helped me  to understand how circumstance often lands people in positions they never expected to be in, and has really shown me that there’s no need to be skeptical or scared of these people – they are, after all, just people. I’ve never had so many interesting conversations, or laughed so much!

Despite all the fun, I’ve faced some new challenges this week. Many of the people who’ve asked to be screened for cognitive impairment this week speak English as a second language, which makes the scoring of the Montreal Cognitive Assessment complicated. Some parts of the assessment are designed to test verbal fluency and abstraction, so for people for whom English is a second language this can be more difficult. Frustratingly, there is no guidance on how to adjust the scoring of the assessment  in this situation available, so I’ve had to adapt the process how I see fit to ensure I get accurate data.

I’ve also spent some time talking to the staff at St. Anne’s about ARBD (Alcohol Related Brain Damage) and interestingly they knew very little about the condition. From my (admittedly still small) data set it’s clear that ARBD is a problem amongst the service users, so the staff were concerned that they weren’t well-informed on the subject. Using this, I’ve started designing a leaflet for the staff at St. Anne’s to inform them about ARBD, its symptoms and what to do if they suspect a service user may be suffering from the condition. This lot should keep me busy until my next blog post!

 

Week one draws to a close

My first week at St. Anne’s is (prematurely, for this week anyway!) over, and already I feel like I’ve learnt a huge amount.

Arriving at the breakfast club on Tuesday morning, in all honesty I was terrified. I was convinced no one would want to be screened for cognitive impairment while they were having their breakfast! But as soon as I arrived the staff made me feel very welcome, and went out of their way to make sure I felt comfortable. It was important to ensure that the service users felt at ease with me, so for a while I just helped out serving tea and toast, chatting to the people who came in. Through this (and the posters I’d designed earlier in the week) I managed to talk about my project with some of the services users, who agreed to be screened. The results of the screening are confidential and so can’t be discussed here, but I will say that they were fascinating. Some of the service users screened even agreed to be screened again at different times, to see how their result changed.

After Tuesday’s unexpectedly productive start, I felt really positive about the results of my project. But, as is usually the way, later on in the week the nature of my project again posed more challenges for me. We’ve been blessed with some beautiful weather over the past few days (even up North) which means that most of the homeless men at Holdforth Court (the hostel where I am carrying out the majority of my screening) were out enjoying the sunshine like the rest of the world. Today, for example, I didn’t manage to screen anyone at all! It is frustrating, but I chose this project because I enjoy a challenge. If the heatwave continues I’ll have to come up with new ways to attract attention to my screening programme. Despite a few setbacks, I’ve definitely learnt a lot this week. I feel much more confident interacting with the service users, and ready for whatever next week throws at me!

For now, though, I’m finishing a little early this week to head down to Brighton to take part in the Trailwalker: The Challenge 2014 for Oxfam and the Gurkha Welfare Trust this weekend. Wish me luck!!

Day one at St. Anne’s Community Services

Week One

My project

Since it’s my first blog post I’ll just give a brief overview of my internship project. Over the next four-six weeks I’ll be working with St. Anne’s, a charity based in Leeds that provides a range of services to vulnerable groups in society, from the homeless to people with learning disabilities. My project involves working with St. Anne’s to screen groups of people for cognitive impairment, linked to ARBD – Alcohol Related Brain Damage.

 

ARBD is an umbrella term for various symptoms associated with physical damage to the brain, caused by both the toxic effects of alcohol and vitamin deficiencies that accompany its long-term use. At present, very little is known about the prevalence and severity of this condition in vulnerable groups, such as those with a history of alcohol and substance abuse. The aim of my project is to identify possible cases of cognitive impairment through screening volunteers at a homeless hostel for men, and a breakfast club for homeless men and women, and use this data to examine the incidence of ARBD among these groups. My project is a kind of pilot study, to see if there is a need for more widespread screening for ARBD, or a service in Leeds (and, potentially, around the UK) to help these people.

Day one!

My first day started with a meeting at Holdforth Court – a homeless hostel for men run by St. Anne’s – with some members of the St. Anne’s team. It’s hard for me to put myself in the shoes of some of the people I will be screening; most of them are homeless and many are alcohol-dependent, so it was important to discuss how I was going to approach the topic of screening with these people.

The screening tool I’ll be using (the Montreal Cognitive Assessment) consists of some questions to assess various cognitive domains (excuse the jargon!). Often, people with a history of long-term substance abuse do have impaired cognitive function and problems with their memory, so you can imagine that it’s a sensitive subject. Myself and the St. Anne’s team spent some time deciding how I’ll approach the subject with their service users (more jargon!), and we agreed that over the next week I’ll spend some time at Holdforth Court and a breakfast club run for homeless people just socializing with the service users. It’s important that they feel comfortable enough with me to allow me to perform the screen, so I’ll be spending some time just getting to know them.

At the moment I’m feeling pretty excited about the project, although I am nervous about doing something so different from usual life at Imperial! It’ll be nice to actually get out there and interact with the service users on a personal level, and to hopefully be able to help any that do show signs of cognitive impairment.

My internship took another surprising turn when we were trying to come up with ways to encourage people to attend the screening sessions, and it looks like I’m going to be putting my baking skills to the test! I’m going to (attempt) to whip up some cakes to entice people to be screened, although the staff at St. Anne’s of course have to sample them first! I never expected my internship to involved my culinary skills, but that’s what I think I’m going to enjoy so much about this project – it’s constantly adapting and presenting me with new challenges.

For the rest of the day I’ve been designing some posters to put up around Holdforth Court explaining what I’m doing and why, hopefully to encourage people to volunteer to be screened. I’ll keep you updated on how it all goes!

The first section of the MoCA, showing some of the questions asked.
The first section of the MoCA, showing some of the questions asked.