Transcript Slide 1

Care Packages in Substance Misuse Treatment
Development of MH Care Clusters: overview
 Service users in MH, clinicians found:
idiosyncratic referral pathways + conflicting views on priorities
+ differing views on effective treatment
 idiosyncratic packages of care
Research  Care Clusters + Clinical Decision Support Tool: Service
users with similar needs  same Care Cluster
Clustering based on dimensions, including:
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type & severity of symptoms
■
complexity and chronicity of disorder
+ knowledge of case history (diagnostic and historical information)
 standardised Packages of Care, based on needs
MH Care Clusters and Care Packages
 Clusters: developed common assessment tool (MH clustering tool)
 allocate to appropriate ‘cluster’
 begin to identify appropriate package of care
 Care packages:
– Activities of Intervention  9 major categories, agreed aims of
activities
– Care Packages combine ‘Core’ & ‘Additional’ elements of care
– Service Users with broadly similar needs receive the Core Elements
in a Care Package + specific Additional Elements appropriate to
their particular needs
– Elements are linked to NICE and other best practice guidance
Adapting the Care Packages approach to Substance Misuse
Same principles as in MH:
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Service Users with broadly similar needs receive similar Care Packages
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Combinations of evidence-based interventions to achieve intended outcomes
How to organise Care Clusters & Care Packages for Substance Misuse?
 cluster on two dimensions:
– primary substance
– complexity (incl. polydrug use, risk, social factors, mental health…)
 5 main Care Packages, plus MH interventions in SM treatment:
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opioid dependence (complex)
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opioid dependence (non-complex)
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alcohol dependence (complex)
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alcohol dependence (non-complex)
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other substance misuse
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MH interventions in SM treatment
Substance Misuse Care Packages
 Some Core and Additional elements (interventions) are common to
ALL Care Packages
 Other elements only appear in one or two Care Packages
 Example Care Package: Complex Alcohol Dependence
Core elements specific to this care package:
– Alcohol dependence: detoxification prescribing (community)
– Alcohol dependence: B vitamin prescribing
– Alcohol dependence: relapse prevention prescribing
Additional elements for this care package, include:
– Opioid dependency - substitute prescribing: detoxification
– TIER 4 In-patient treatment
– Tier 4 Care co-ordination
Competences
 Care Packages combine elements delivered by different staff with
different competences
 Psychosocial and other specialist competences: clarify ‘levels’ for
elements of Care Packages
 Draws on Routes to Recovery: Psychosocial Interventions for Drug
Misuse, all relevant NICE guidance, UK Clinical guidelines
 Keywork, keywork plus, specialist competences
What are ‘Recovery’ competences..?
 Key skills and attributes of practitioners
 Service culture
 promotes ‘recovery values’ and attitudes in practitioners
 structured approach to review and recovery planning