Transcript Waltham Forest Substance Misuse Needs Assessment and

Waltham Forest Substance Misuse Needs
Assessment and Treatment System Review
Eric Ayesu-Boapeah – Senior Public Health Strategist
Trevor Givans – Substance Misuse Commissioning Manager
Outline
• Purpose of HNA and Service Review
• Policy Context
• Prevention and Early Intervention -Key Issues and
recommendations for Alcohol and Drugs
• Treatment Systems - Key Issues and recommendations
for Alcohol and Drugs
• Young people in Transition
• Current Model
• Current Budget
• Future Model
Purpose of HNA and Service Review
• Identify the substance misuse related needs of the
people of Waltham Forest
• Describe the wider impacts, risk and harms associated
with the substance misuse
• Support the substance misuse service reconfiguration
process
• Inform the commissioning strategy
Policy Context
Underpins
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The Government’s Alcohol Strategy, March 2012
The Drug Strategy 2010
Our health and wellbeing today
Public health outcomes framework 2013-2016
Health and social care act 2012
Commissioning for Recovery (NTA 2010)
JSNA
Prevention and Early Intervention
Key Issues and recommendations -Alcohol
Key Issues - Alcohol
• Higher alcohol related hospital admissions and projected
to go up based on the historical data.
• About 20% of WF residents identified as risk drinkers
• Alcohol specific hospital admissions for men in WF in
2010/11 were significantly higher than England and
London.
• The admission rate for women in WF is higher than
London average but the differences are not statistically
significant.
Key Issues - Alcohol
• 3,026 alcohol related recorded crimes in WF in 2011/12.
• Most alcohol related incidents occur in the following
wards – High Street, Lea Bridge, Wood Street and
Leytonstone. These wards have higher indices of
multiple deprivations than the WF average.
Alcohol Related Hospital Admissions,
Waltham Forest, 2002/3 -2011/12
Recommendations
• Review current Alcohol liaison nurse post to ensure that
it would include case finding and deliver IBA; medical
management of patients with alcohol problems; liaison
with community alcohol and other specialist services
• Embedding IBA in frontline staff as part of their initial
assessment process. This will help to reduce alcohol use
to low risk level
• Full analysis of alcohol-related hospital admissions in
WF is undertaken to establish which particular groups
need to be targeted
Recommendations
• Review current alcohol treatment pathway to include
prevention, early intervention, treatment and
recovery
• Embedding school based substance misuse
education and interventions into the WF school
nurses programme.
• Greater utilization of outreach and safer
neigbourhood services to identify street drinking
hotspots to refer into appropriate services
Recommendations
• Population level awareness raising and social marketing
targeted at groups at risk of hazardous or harmful
drinking. This includes health promotion in pub settings
• Examine the potential to use local authority powers to
limit proliferation of alcohol outlets. For example, local
licensing departments can take into account the links
between the availability of alcohol and alcohol related
harm when considering a license application.
Prevention and Early Intervention
Key Issues and recommendations - Drugs
Key Issues - Drugs
• 1,463 people aged 15 to 64 classified as OCUs in WF.
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Estimated 5,033 class A; 14,765 any drugs; 11,409
cannabis.
• WF is categorised in the ‘HIGH’ group for prevalence of
Hepatitis C Virus (HCV) together with 24 other borough
in London, which means that over 50% of those who
injected in the last year were HCV positive.
Key issues- Drugs
• 1,076 drugs offences recorded by police in WF between
August 2011 to July 2012, compared to the 1,526
offences recorded between August 2010 and July 2011 29.5% reduction
• Three wards in the borough accounted for 27.4% of all
drugs recorded offences in the borough, with High Street
ward accounting for 11.9%; Forest 8.6% and Hoe Street
6.9%.
Recommendations
• Ensure wider coverage and better uptake of blood borne
viruses screening and immunisation
• Increase drug awareness training through frontlines staff
• Engage community based generic services (tier 1) to
identify signs of substance misuse e.g. domestic
violence, safeguarding and risks of hidden harm.
Recommendations
• Ensure substance misuse is incorporated into any health
promotion work in schools including Pupil Referral Units
and alternative provisions
Treatment System
Key Issues and recommendations -Alcohol
Key Issues - Alcohol
• About 464 clients had contact with alcohol treatment services
during the last 12 months (April 2012 – March 2013)
• New presentation were 72% (332)- higher than England
average 68% - The referral from GP (6%) in WF was lower
than England (18%)
• 66% (306)of the users left the treatment service – higher than
England average (64%)
• WF received most of its referrals from ‘Self, Family and
Friends’
Referral source into treatment of all new
presentations (YTD), 2012/13
Recommendations
• Reconfigure current Alcohol Treatment service to include
clear referral pathways between hospital, community
specialist services and primary care
Treatment System
Key Issues and Recommendations Drug
Key Issues
• 492 new referrals were made into the treatment system in
2011/12
• Overall there were 1,206 clients in treatment with 13% of
those clients having been in the treatment system over two
years
• 467 clients left the treatment system which accounts for about
39% of those in treatment in 2011/12
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Low referral rate from GPs 2% (8); 24% from criminal
Justice systems; 42% were self referrals; drug service 16%
and others 17%
Key Issues - Drugs
• WF had 267 adult opiate clients and 188 adult nonopiate clients in treatment per 100,000 population
• Between 2010 and 2012 on average about 95 opiate
users each year successfully completed treatment. This
amounts to 21% (20) being represented in the treatment
services
• During the same period, a higher proportion of nonopiate clients (95%) compared to opiate clients (67%)
successfully completed their treatment service within a
year
Key issues
• WF Opiate users re-presenting to the treatment
services were higher than the cluster average between
2011 and 2012
• On average about 203 non-opiate users each year
successfully completing treatment services between
2010 and 2012. Of these, 6% (12) re-presented into the
treatment services
• WF non-opiate users representing to the treatment
services was lower than the cluster average between
2010 and 2012
Key issues - Drug
• 9% (40) of the drug treatment population had dual
diagnosis issues
• 278 admissions were logged in 2011/12 where there
was a primary or secondary diagnosis of drug related
mental health and behavioral disorders
Key Issues - Drugs
• 351 opiate clients in contact with DIP but were not
engaged with the treatment system in WF in 2011/12. Of
this, 89% (311) were men and 11% (40) were women
• 448 non-opiate clients in contact with DIP but were not
engaged with the treatment system in WF in 2011/12. Of
this, 91% (406) were men and 9% (42) were women
Referrals routes to the treatment system
Representation by opiate clients, 2012/13
Non-opiate clients and representation, WF, 2010 2012
Clients in contact with DIP but not engaged with the
treatment system - Community and Prison Combined,
WF 2011/12
Drug related dual diagnosis- London
admissions, 2011/12
Recommendations
• Improve recovery focus stepped approaches which does
not focus solely on abstinence.
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Increase access to GP Shared Care and primary care
services for more stable service users.
• Increase access to Employment, Training, Education to
ensure clients have access to supported housing and
encourage diversionary activities which steer clients
away from substance misuse such as sport, art, music
etc.
Recommendations
• Increased partnership and promotion work to develop
stronger links between community based generic
services to reinforce and strengthen recovery and lessen
the risks of relapse.
• Ensure all staff across all sectors, who regularly come
into contact with clients with substance misuse or dual
diagnosis (mental health and substance misuse), have
the appropriate training and support relevant to their
needs
Recommendations
• Commissioners to develop robust performance
management systems to ensure effective monitoring
• Investigate reasons behind lack of engagement with
treatment system particularly high attrition rate in
criminal justice
• Robust mobile care planning across treatment system
partnership
Young People – Key Issues
Young people struggle with the transition to adult
services and there are the obvious issues of their
vulnerabilities within adult services and the
appropriateness of these facilities for their needs
There is no dedicated service in the borough to deal
with young adults whose main substance is cannabis
or cannabis and alcohol. Currently 722 deals with
these clients or most of them would drop out. However
the service is being reviewed due to recent budget
cuts
Young People - Recommendations
• To have a dedicated person in 722 and a counterpart
within adult services to deal specifically with clients aged
18-25 (transition phase). There should be an allocation
of funding for this post from adult services.
Current Model
Considerations for Treatment Models
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Size and scope of specialist provision
Size and scope of primary care provision
Integrated or separate drug & alcohol pathways/services
Choice/personalisation
Buildings
Sustained funding
Ensuring continued provision while re-tendering
Considerations for Treatment Models
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Size of aftercare element
Support to parents/families
Care navigation through system
Single point of entry and single assessment or multiple
entry points
• Workforce development
• Harm reduction
• Referral Pathways
Treatment Models
INTEGRATED RECOVERY – LOTS MODEL (Model 1)
Multiple Access Point
Integrated Case Management System
Self/Community
referrals &
representations
Direct professional
referrals
Satellites
LOT 1
Outreach –
Engagement –
Access &
Mentoring &
Recovery –
Aftercare
Services
Open access –
meet/great – outreach –
integrated assessment service navigation ––
service user/carer, peer
mentoring support &
advocacy – aftercare –
prison resettlement –
ETE Services
LOT 2
Psychosocial
Intervention &
DIP/IOM Services
Structured Day
Programme –
Structured Counselling
– keyworking recovery/treatment
support – abstinent
groups – alcohol &
stimulant specific
groups & DIP/IOM &
integrated access to
Tier 4 Services
(residential rehab)
LOT 3
Clinical Intervention
Services
Specialist Prescribing
Services – GP Shared
Care – BBV & NX –
Supervised
Consumption –Alcohol
Community Detoxes –
Hospital Liaison –
integrated access to
Tier 4 services
(Inpatient Detox)
Satellites
RECOVERY CAPITAL SUPPORT & COMMUNITY
INTEGRATION
Satellites
Multiple Exit Points
INTEGRATED RECOVERY WITHIN 1 SERVICE - (Model 2)
Single Access Point
Integrated Case Management System
Integrated Recovery Services
Specialist Prescribing & GP Shared
Care
BBV – Healthcare
Needle Exchanges incl Pharmacy
NX’s & Supervised Consumption
Alcohol Services
Structured Counselling
Structured Day Programme
Service user/carer involvement
Recovery services incl Peer Mentoring
& ETE services
DIP/IOM
Assertive Outreach
Aftercare
Tier 4
RECOVERY CAPITAL SUPPORT & COMMUNITY INTEGRATION
Single Exit Point
INTEGRATED RECOVERY WITH SEPARATE SATELLITE PROVISION & ALCOHOL SERVICE
(Model 3)
Multiple Access Point
Integrated Case Management System
Integrated Recovery Services
Alcohol
Satellites
Specialist Prescribing & GP Shared
Care
BBV – Healthcare
Needle Exchanges incl Pharmacy
NX’s & Supervised Consumption
Structured Counselling
Structured Day Programme
Service user/carer involvement
Recovery services incl Peer Mentoring
& ETE services
DIP/IOM
Assertive Outreach
Aftercare
Satellites
Tier 4
RECOVERY CAPITAL SUPPORT & COMMUITY INTEGRATION
Multiple Exit Points
Integrated Primary care/Community
based Led
Point of Entry
Decommission complex
services, replace with GPs
GPs
Prevention T1 and 2
Rapid Prescribing
Primary Care
Should they be Care Navigators, OR
Social Workers (Newly qualified)
Group
Work /
Counsell
ing
GPs
DIP
CLIENT PROGRESS
PANEL – Multi Agency
Rehab
Detox
Aftercare/Recovery
Personal & Personal Health Budgets