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NTA Residential Rehabilitation Event Welcome Baroness Massey of Darwen Building Recovery Realising the potential of residential rehabilitation Paul Hayes Chief Executive, NTA Radical National vision Local delivery Individual choice Rewarding success Architecture Public Health England Local Authorities Service Users Providers 2011/12 from “Treatment system” to “Recovery system” BRiC Successful completions Patient Placement Criteria PbR Skills Recovery networks Families Jobs / houses Prison / community Rehab – an underused resource Dialogue Respect Understanding Shared vision Working market Choice Outcomes VFM Sustainability Key themes for Commissioners & Providers March 2011 Mark Gillyon Head of Delivery - North Models of Care (3?) Building Recovery in Communities MoC 3 Building Recovery in Communities 2007 Clinical Guidelines Integrated Drug Treatment System (IDTS) Recovery Mutual Aid, successful completions, the supportive role of families, the importance of housing and employment Support through the system User choice and responsibility Families and safeguarding Targeting the right interventions, to the right people, at the right time. The new framework The over arching aim of the new framework is to support local areas in developing their systems and services to become recovery focused, highly ambitious and offer a real opportunity for sustainable recovery. The sector is changing... Different models of delivery ‘Traditional’ Locally commissioned and locally provided ‘Quasi-residential’ The commissioning environment is changing... Funding in 2011/12 Funding in 2012/13 Funding from 2013 onwards Outcome-based systems, Payment by Results, and the leadership of Directors of Public Health / Health & Wellbeing Boards Other things will change... Successful completions The number of people leaving drug treatment free of their drug(s) of dependency Payment by results Model / length focus vs. specific required outcomes Data About 2/3 report to NDTMS New models / new data problems The future of PTB Within Public Health ring-fence, for Health & Wellbeing Boards Data support NDTMS Regional Teams Data collection, support, training, analysis Rehab Online Marketing Testimonials Vacancies Evidencing outcomes and value Client Provider Commissioner Future developments Colin Bradbury Residential Rehabilitation Event 29th March 2011 Contents 1. Payment by Results 2. Case Mix Adjustment 3. Residential Rehabilitation Outcomes Payment by Results - Background A recovery programme, not a treatment programme Around 6 pilot local authority areas April – Sep 2011: co-design, running 2011-2013 Independent evaluation 4 outcomes (interim & final) identified: Leaving treatment free from drug(s) of dependency Re/Offending Employment Health & Wellbeing (interim only) Payment by Results Opportunities and challenges Payment by Results Moving away from process/ front end targets Giving providers freedom and flexibility to innovate and sub-contract what they need Letting the market show “what works” Encouraging new providers to enter the market Developing a single point of contact model A need to avoid perverse incentives Delivering more outcomes with the same money Ensuring small/ new providers are able to compete Case Mix Case Mix Using treatment and re-presentation data to predict outcome for new treatment entrants Push and pull factors for recovery Allowing comparisons of outcomes in similar areas and services – segmenting on the basis of probability of recovery Limited to the data we have Says something about an individual’s chances, but nothing about how best to help them... RR outcome research Rehabilitatio n Outcomes a prospective outcome study of publicly funded providers of drug and alcohol residential rehabilitation expert academic and provider advisory group Peer reviewed academic journal Consult on which sort of models should be included In summary... How might we further incentivise recovery, moving beyond the existing evidence base? Payment by Results How can we ensure accurate tariffs are set and there is a level playing field? Case Mix Adjustment How could we ensure people get the right treatment at the right time? Patient Placement Criteria What role can residential rehabilitation play in this? Outcomes Study “Patient Placement Criteria” John Marsden NTA Senior Academic Advisor Reader in Addiction Psychology, Institute of Psychiatry, KCL National Residential Rehab Events - London 29th March 2011 Background No “one size fits all” recovery pathway Some people have strong preferences about their care Wide differences in treatment needs Evidence for layered or combination interventions • Single prescribing or psychosocial interventions • Combination prescribing and/or psychosocial packages Evidence from the adaptive continuing care literature Principle of changing direction if no therapeutic benefit PPC expert sub-group David Best UWS (chair) Tom Kirkwood TTP Nicola Adamson Worcestershire Commissioning Tim Leighton Action on Addiction Karen Biggs Phoenix Futures Peter McDermott The Alliance Jayne Bridge Mersey Care Wendy Dawson Ley Community DH observers: Mark Prunty & Ed Day Uni of Birmingham Vivienne Evans Adfam Jason Gough Yorks. & Humber Service User Forum Kate Hall GMW Linda Harris Wakefield & RCGP Dave Knight RCN NTA project team International correspondents: William White, Alexandre Laudet, Arthur Evans, Mike Dennis, Robert Ali, Steve Shoptaw, Min Zhou Goal Better matching of individuals to treatment packages Promote clinical expertise and personal preference Progressive treatment system; recovery-oriented A wider array of evidence supported interventions “PPC” in practice Resource for personalising and optimising treatment Screening for risk, need and preference Adaptive care criteria (sequencing and layering) Criteria for judging therapeutic response Justification for specific intervention or continuing care PPC – adaptive care criteria Screening process 4 individual specifiers: 1. Current recovery/treatment status 2. Substance use 3. Positive intervention preferences 4. Contra-indications PPC individual specifiers Treatment Preferences ☐ Stay in local community ☐ Medication-assisted recovery ☐ Active involvement of social network in recovery plan ☐ Inpatient detoxification ☐ Intensive shorter or longer-term residential treatment in local area (1-12 months) ☐ Intensive shorter-term residential treatment away from locality (1-6 months) ☐ Intensive longer-term residential treatment away from locality (6-12 months) ☐ Preference to continue to work on recovery goals at same or different level of care PPC individual specifiers Contra-indications ☐ Significant risk of domestic violence ☐ Lack of drug-free partner/spouse ☐ Significant cognitive impairment or learning difficulties ☐ Active hepatitis or abnormal liver parameters ☐ Unwilling/able to sustain the regularity of attendance required ☐ Unwilling/able to comply with conditions of residence ☐ Current or previous experience of psychosis ☐ Unlikely to be able to maintain 24 hour abstinence in a day programme setting ☐ In education, training or employment which is best maintained during treatment ☐ Has dependants, no arrangements for care can be made or are inappropriate PPC – adaptive care criteria 3 domains 1. Severity (dependence, health, risk, neglect) 2. Complexity (response, environment) 3. Strengths (personal, social, economic) 18 PPC Dimensions Severity and complexity ☐Physiological dependence ☐Psychological dependence ☐Overdose risk ☐Relationships and communication ☐General medical conditions ☐Psychological disorders ☐Personality factors ☐Trauma and stress ☐Criminal involvement ☐Risk and neglect ☐Treatment and recovery history ☐Recovery environment Strengths (recovery capital) ☐Change motivation and therapeutic alliance ☐Quality of living situation ☐Supportive social network ☐Roles and responsibilities ☐Vocational skills and independence ☐Coping and outlook PPC – taking it forward Further development with field Pilot testing Monitoring and refinement Does using produce better outcomes? Incorporate outcome risk adjustment Adjust for push and pull factors