Transcript Recovery in N lincs.

Recovery in North Lincs.
Presented by
Charlotte Harrison & Helen Kirk
from the Junction.
Supported by Ben Gow and Stephen Storrs
Nta recovery presentation 22/10/10
leeds/ CVH
1
The Junction North Lincolnshire

Legal partnership between RDASH and ADS.

Employ 24 staff of mixed disciplines
 Nurses, councillors, structured day programme workers, social
worker.
 Links to DIP, MH, BBV nurses, midwife, housing, probation,

Provide services for
 Core specialist drug treatments.
 Shared care within 9 satellite bases or GP surgeries

Support Multi disciplinary multi agency working within the locality
Nta recovery presentation 22/10/10
leeds/ CVH
2
Background to pilot
Largest shared care practice supported by experienced GP’s
supported by practice and Junction.
 Locality and commissioners refocusing on throughput.
 Staff energised by ITEP/ recovery training.
 Prime opportunity to respond to several drivers for progress and
change form strategic, local and staff level
 Proposal put to commissioners using the flexibility of the smaller
team at shared care – pilot agreed, naturally the next step for stable
service users
 Ongoing consideration to larger team, a service redesign was
running concurrently in the core service.
Nta recovery presentation 22/10/10
leeds/ CVH
3
What was the pilot?








Weekly clinic 1;1 work
Key worker led
To motivate service users to support teir aspirations and capabilities
Small start planned to not be to resource intensive.
Opportunity to trial ITEP mapping tools
Specific recovery care plan for individualised needs
Criteria used to identified clients initially.
Contract devised in conjunction with service user panel
Nta recovery presentation 22/10/10
leeds/ CVH
4
What did we offer?
Individualised care plans and named key working- one size does not fit
all
 Initial recovery capital assessment
 Flexible negotiated reductions for planned detoxification from
medication.
 Agreed plan for unmet needs. Sign posting, onward referral,
advocacy, accompany, peer mentoring.
 Involvement of significant others and family in planning, and
appointments and support.
Nta recovery presentation 22/10/10
leeds/ CVH
5
What are the outcomes?

Completed treatments month. Initial target for project 8 completed
discharges

Attendance figures
 100% in q1
 95% in q2

Numbers on pilot 20 at start now 50
Planned
discharges
Quarter 1

Completed treatments
Quarter 2
Quarter 3
Nta recovery presentation 22/10/10
leeds/ CVH
3
1
4+3 OCT
6
Service user feed back
 “the worker really believed in me.”


“the dentist referral is so important- your smile is
your face and everyone knows your past when
your teeth are bad”
“please come to my house to meet my familyyou have only seen me in your clinic and I am
proud of what I have achieved”
Nta recovery presentation 22/10/10
leeds/ CVH
7
Key findings – so far.




Therapeutic relationship is crucial to role- service users need to feel
supported and empowered by worker.
Everyone has some recovery capital but the treatment approach
needs to recognise where the service user is and adapt the
intervention
Recovery is infectious- use successes to motivate other in to
believing they can do it too
 Recovery champions
 Peer mentoring
Recovery needs to be introduced at the start of the treatment
journey
Nta recovery presentation 22/10/10
leeds/ CVH
8
Activity.

The next slide will be a model many people will be familiar with that
explains how people develop, learn and achieve their own potential.
It also suggests that this process will not the completed if there are
deficits.

This model can be considered for service users journey and shows
recovery is supported be research in many formats
Nta recovery presentation 22/10/10
leeds/ CVH
9
Maslow model
What needs to be
In place for recovery
Nta recovery presentation 22/10/10
leeds/ CVH
10
Do flip chart exercise
What needs to be in place for
recovery?
Nta recovery presentation 22/10/10
leeds/ CVH
11
Maslow model
What needs to be
In place for recovery
Becoming a recovery
champion
Hope.
Self belief, acceptance,
hope. detoxification
Support, family, NA, AA
Honesty. Daily activity with
purpose
Script / abstinence from
illicit
Housing, prescribing,
benefits.
Nta recovery presentation 22/10/10
leeds/ CVH
12
Inclusion in treatment model

Concurrent review of service model allowed inclusion of 3 addition
staff with relevant training in to the programme delivery

Staff with recovery experience have been linked to other disciplines
as new model developed

Senior Recovery practitioner to support all staff through MDT
process in locality for consistency.

Work in progress with commissioners to develop this further in other
shared care clinics
Nta recovery presentation 22/10/10
leeds/ CVH
13
Our Model
JUNCTION NEW CLIENT (see pathways induction and script initiation completed recovery concept is introduced and discussed throughout the treatment journey)
MDT Process Used to Design Holistic Care/ Recovery Plan for Phase of Treatment (Stabilisation, maintenance, recovery)
Care/recovery plan to support progress to next phase e.g. Stabilisation to maintenance or recovery, incorporating where appropriate
multi agency work, family and carer’s etc
Ready for Recovery
Maintenance
Stabilisation
Highest recovery Capital reduced risk, may
have progressed through treatment phases
or short history of substance misuse
Service user has a significant level of stability
states wants to be maintained at this point in
time. Those in maintenance will have
recovery re-discussed 6 monthly
Highest risk, most complex needs,
lower recovery capital needs
intensive support to build confidence
and recovery capital
focus of care planning to increase recovery capital
Intensive recovery
support
Planned reduction
regime
If suitable for subutex
or symptomatic detox
support with this
Planned
Treatment
Exit
Referral
to Shared
Care
Recovery
Care co-ordinator ensures individual is linked in with
Counselling / Prescribing/ Recovery Leads partner
agencies etc as appropriate to their needs to enhance
recovery capital and support progress to the next
treatment phase
RELAPSE (re assess)
Outcomes
Good client experience
Improves family, and social networking
Growth to community benefit
Lowering or stigma and increasing integration
Change in attitudes and outlook
Enhanced Aspirations
Nta recovery presentation 22/10/10
leeds/ CVH
14
Most complex needs






Most complex.
Dual needs
Multi agency working
Highest risk life style
Ongoing chaotic drug use
Limited capacity for recovery
at this point





Workers need to Aim to
achieve stability and increase
recovery capacity.
Assertive engagement
Interagency working.
Outreach, home visits
Maintaining script whilst
addressing deficits in recovery
capacity
Nta recovery presentation 22/10/10
leeds/ CVH
15
Previously maintenance






Considered maintenance
Some evidence of stability,
client may considers progress
adequate.
Unwilling to consider
prescription change
Fearful of change
Entrenched behaviours that
prevent progress.
Some unmet needs





Change achieved by
Care plan for unmet needs as
specific goals.
Engage in alternative context to
challenge perception, ie.
motivational interviewing. ITEP
Recognise and build on success,
ie, family support.
Use of recovery champion, peer
mentoring , group support.
Nta recovery presentation 22/10/10
leeds/ CVH
16
New in to treatment / detoxing





New entry clients- short drug
using histories or detoxing
currently
Low level use
Not in treatment previously
Previous successful treatment
exits

Planned reductions





Consider subutex, or
symptomatic detox,
Introduce recovery from
inductions 1.1 support
Family support programme
Plan time limited prescribing
by negotiation
Maximise recovery potential
Relapse prevention
Nta recovery presentation 22/10/10
leeds/ CVH
17
Future development







Staff training
Development of the recovery champion role
Visioning with commissioners for future planning
Measuring outcomes
Celebrating successes
Raising the profile of success –
Promoting the development of recovery champions in to recovery
groups.
Nta recovery presentation 22/10/10
leeds/ CVH
18
Thanks for your time…
Any Questions??
Nta recovery presentation 22/10/10
leeds/ CVH
19