Transcript Transformation Journey of Treatment and Rehabilitation Programs

CURE & CARE
Treatment Scenario in Malaysia
Compulsory Treatment
• Provided for drug dependants
since 1983
• Drug Rehabilitation Centers (DRC) &
Supervision in the Community
• 22 DRCs – capacity of 7,000 residents
• Supervision - 55,000 estimated in the community
How can N.A.D.A take care of the
massive numbers in the community?
Why NADA needs to Transform?
Success
SuccessRate
Rate
75%
75%??
50%
50%??
20%
20%??
10%
10%??
Treatment
Treatment
Compulsory
Compulsory
Services
Services
Treatment
Treatment
Programs
Programsinin
Reluctant
Reluctant &&
DRCs and
andthose
those
Resistant
ResistantClients
Clients DRCs
undergoing
undergoing
Problems
in
the
Problems in the
Supervision
Supervision
DRCs
DRCs
Parents,
Parents,
Families
Families
Stigmatized
Stigmatized
Residents
Residents––
criminalized
criminalized
(records)
(records)
Changes
Changes
Impact
ImpactofofNew
New
drugs
drugson
onClients
Clients
Need
Needfor
forClinical
Clinical
Approach
Approach
GTP & NKRA
Concept of
1Malaysia
…what do we want
to transform
..what matters
most to the
‘rakyat’/people
or clients
….how can we touch
the hearts & souls
of the people or
clients with big fast
results…
Registration Office– Sg. Besi
Psychiatrist/ Medical Officers
Treatment Wards
CONCEPT
OPEN ACCESS SERVICES
 Voluntarism or Walk-in
 Support from parents or
family
 Referral
 Outreach / Motivate
 No Legal Implications
 No Pre-conditions
 No stigma
 Private and Confidential
 Options for clients
 Community-based
Program
 Clients as patients
SCOPE OF SERVICES
INPATIENT
1, 2 & 3 Months Package
Clients Needs and
Assessment
#
4, 5 & 6 Months Package
Appontment Based
CLINICAL
SERVICES
Medical Detoxification
Psychiatric Interventions
REFERRAL AND
ADVOCACY
#
OUTPATIENT
METHADONE
MAINTENANCE
THERAPY
Opiate Clients
Public, Family dan Clients (
Hospital, Social Welfare.
TRANS CC
1-3 bulan package
Temporary transit
Hypnotherapy
FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH
• EARLY RECOVERY
• RELAPSE PREVENTION
• SOCIAL SUPPORT GROUPS
• FAMILY PROGRAM
• COUNSELING & GUIDANCE
• MEDICAL & HEALTH EDUCATION
• RELIGIOUS & SPIRITUAL
• VOCATIONAL SKILLS TRAINING
PSYCHOSOCIAL
• OUTING/EXCURSIONS
• MEDICAL DETOXIFICATION
• METHADONE MAINTENANCE
• PYSYCHIATRIC INTERVENTIONS
• HIV/HEP/TB/STI TREATMENT
• INHALAN
• ALCOHOL & NICOTINE
• IMMUNIZATION
• INFECTIOUS DISEASES
SCREENING
CLINICAL SERVICES
• DENTAL SERVICES
DRC VS. C&C CLINIC
DRUG REHAB. CENTERS
C&C CLINIC
Compulsory Treatment & Admission through
the Law; Criminal Records; Stigma
Open Access Services – Voluntary Admission;
Considered as Patients
Treatment-based services only
Focus on medical, psychiatric & clinical
treatment
Treatment for opiate-based addicts; all males
and separate for women
Treatment for all substance abusers (opiate,
ATS, inhalant) – males, females & adolescent
are separated
Treatment Duration – 2 years

Treatment duration – 1-3 months (inpatient),
4-6 months (outpatient)
Capacity for residents in DRCs – 7,350
Number of clients that accessed services at 8
C&C Clinics – 9,041
Cost of food – RM8.00 x 30 days x 12 months
/person = RM 2,880
Cost of food – RM8.00 x 30 x 3 months =
RM720.00
Loss of Property caused by violence, arson
No incidence of violence or arson
OUTPUT ( NO OF CLIENTS)
C&C CLINICS
CLIENTS
REFERAL AND
ADVOCACY
OUTPATIENT
364
1036
130
757
75
1200
465
784
60
138
94
106
99
263
243
35
19
251
TOTAL
SG.BESI
KOTA BHARU
BKT MERTAJAM
TAMPOI
KUCHING
PAPAR
TAMPIN
JERANTUT
KARANGAN
INPATIENT
724
92
497
467
30
94
175
207
118
TOTAL
549
126
117
737
2404
1549
4570
5,933
6098
4580
8767
16,855
ACCUMULATIVE
TOTAL 2012
ACCUMULATIVE
TOTAL
1491
742
954
1072
161
188
487
450
388
OUTCOME STUDY AT C&C CLINIC
COMPARISON OF CLIENTS AT COMPULSORY DRC
AND CLINIC CURE & CARE FOR 2010 12000
10820
10000
8000
6000
5569
5864
CCRC
4619
4000
2000
0
Julai 2010 - Jun 2011
Julai 2011 - Jun 2012
C&C
OUTCOME STUDY AT C&C CLINIC
• Reduced by
37.1%
• 61%
Injecting
drug
use 46% to 8.9%
• 90%
Ready to
recommend the
clinic to family and
friends
Confident of not
using drugs in
the near future
Clients satisfied
with services
•
94.4%
OUTCOME STUDY AT C&C CLINIC
Drug use history
Substance
Heroin
30 days
BEFORE first
visit to C&C
Past 30
days
67.1%
4.8%
Benzos; Dormi, Clona, Valium,
Xanax
Syabu, Meth, Ice
12%
2.0%
13.9%
2.1%
Pil Kuda
3.3%
2.2%
3 or more substances in the same
day
10.8%
1.7%
OUTCOME STUDY AT C&C CLINIC
Health status, needs and access
• In general, how satisfied are you with the
medical attention you receive for your health
problems (other than drug addiction) at the
Cure and Care Clinic?
Satisfied 69.3%
Very satisfied 23.9%
Not very satisfied 5.6%
OUTCOME STUDY AT C&C CLINIC
Qualitative analysis: Opinions and feedback on C&C program
and services.
• Overall, happy with the C&C concept
• C&C encourages voluntary and ambulatory care and
rehabilitation
• MMT is seen as a stabilizer giving 2nd chance
• Programs offered by C&C were well received
• Good support from C&C staff, Counselors and Medical Team
OUTCOME STUDY AT C&C CLINIC
METHADONE MAINTENANCE PROGRAMME
2010
2011
2012
CCSC
1024
CCSC
1380
CCSC
1530
CCRC
0
CCRC
21
CCRC
40
Klinik
C&C
0
Klinik
C&C
351
Klinik
C&C
1735
Jumlah
1024
Jumlah
1647
Jumlah
3305
Example
text
936
(67.8%)
clients employed in 2011 compared to 543 (53%)
clients in 2010.
OUTCOME STUDY AT C&C CLINIC
56.3%
42.7%
54.3%
77.6%
72.1%
75.9%
• Helped maintain jobs
• Helped get into government support services
• Continued education
• Improved family relations
• Obtained permanent homes
• Prevented arrest into prisons
KAJIAN KEBERKESANAN PROGRAM
OUTCOME
AT C&C CLINIC
KLINIK
C&C STUDY
OLEH UNIVERSITI
MALAYA
73.8%
78.3%%
76.7%
94.9%
94.4%
65.4%
• Prevented admission into Compulsory DRCs
• Helped family or friends to get treatment and
rehabilitation
• Access to medical care
• Very satisfied with the methadone maintenance
programme
• Reduced drug cravings
• Obtained skill training
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU
OUTCOME STUDY AT C&C CLINIC
CRIME HISTORY
Average number of times inpatients and outpatients have been sent to
prison, lock up, or PUSPEN
Institution
BEFORE C&C
Since coming to the C&C
Lock-up
3.50
0.57
Prison
1.06
0
PUSPEN
0.61
0
OUTCOME
STUDY
KAJIAN KEBERKESANAN
PROGRAMAT
KLINIKC&C
C&C KOTACLINIC
BHARU
Mental Health
30
30 days before coming to
C&C
26
25
22
In the Previous 30 Days
20
15
11
11
10
5
0
Experienced serious depression, sadness, hoplessness, or loss of
interest
Experienced serious anxiety/tension-uptight, unreasonably worried,
inability to feel relaxed?
AFTERCARE
Outpatient
CCSC
Options for Aftercare Services after
discharge from C&C Clinic :
CCH

as outpatient with the same C&C
Clinic or other facility; or

CCSC (Cure & Care Service Centres);
or

CCH (Community Caring House)
CCVC
AFTERCARE
SERVICES
TransCC

CCVC (Cure & Care Vocational
Centre) – vocational skills training

TransCC – Transitional Cure&Care
facility
NADA District
Offices
We Care, We Serve