Transcript Cocaine Services

Cocaine Services
IN AN IDEAL WORLD – HOW
SHOULD THEY WORK?
Presentation Overview
Key Considerations for Service Provision
 Outline aims of service provision relating
to 4 groups of stimulant users as
highlighted by SACDM working group
 Focus mainly on role of dedicated
stimulant services
 Barriers to service development
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Service Design
Every aspect of the service should be measured
against its ability to:
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Reduce BARRIERS
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Increase OPPORTUNITIES
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Keep SERVICE USER at the centre
Reducing Barriers
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Consider Target Group/s
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What needs to be done?
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Who is best placed to do this?
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What training & support do they need?
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Ensure that this is available
Early Experimenters
Aim: Ensure that individuals, especially
young people, make informed decisions
about drug use & take necessary steps to
reduce potential risks
Early Experimenters – cont’d
Target population:
 General population
 Individuals and groups known to be
experimenting
 Services who work with young people
 Parents
 High risk occupations / students
Early Experimenters – cont’d
Information - Accessible and Credible
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Information about Cocaine should be available
through existing contact with young people and
included in drugs education.
Targeted information should be a feature to
those at high risk eg universities & colleges, high
risk occupations.
Training, support and service information must
be accessible to teachers, youth workers,
parents etc.
Media campaigns etc should target this group
Regular Stimulant Users
Aim:
 To reduce harm associated with regular
stimulant use
 To prevent problematic or dependent drug
use
 To provide access to other specialist
services for those experiencing problems
Regular Stimulant Users
Target Population:
 Regular stimulant users
 Peers
 Parents
 Staff at clubs & events i.e. managers,
promoters, security staff, first aid providers
 Employers
 Services / professionals who work with
and /or provide education to young people
Regular Stimulant Users
Service Provision
 Credible and easily accessible harm
reduction information designed by
specialist providers
 Targeted delivery of interventions where
regular users are e.g. clubs, pubs, on the
street
 Easy access to services for problematic
users
Harm reduction information should
be targeted and include:
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Direct harm
associated with drug,
methods patterns etc
Risk to self and
others e.g. sex work,
employment
Prevention of
problematic use and
progression to opiates
to deal with come
down
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Access to specialist
advice or help
Wide range of
information sources
Anonymous access
such as helpline.
Peer education
Specific locations
identified at local level
eg A&E, NX, GUM.
Targeted delivery
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Input by specialist services to planning of
festivals / events involving young people
Input to clubs & pubs
Presence at events
Promotion and provision of Chill Out area –
provision of water, fruit, condoms, staff with
specialist knowledge and skills
Partnership working with Events Organisers, pub
managers, First Aid providers, Ambulance
Service etc
Consider and regularly review where regular
users are, and deliver targeted service tailored
to group, place and time.
Easy access to services for
problematic users (bridge)
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Easy access to services for problematic
users
One specialist service targeting both regular
and problematic use – to avoid barrier of
referral, establish trust and credibility
Use opportunity for motivational interventions
Reduce period between 1st use and seeking
help (10 years)
Problematic Stimulant Users
Aim:
To reduce harm associated with problematic
stimulant use and provide opportunities to
address problems and support positive
change
Problematic Stimulant Users
Target Population:
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Primary stimulant users who are experiencing
problems related to their use
Parents / partners of problematic stimulant
users
Generic agencies in contact with target group
Mental Health services
Employers and Trades Unions
Minimise barriers & create opportunities
to access specialist service
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Provide range of referral routes
Keep requirement for personal information to a
minimum
Access through Telephone Helpline, outreach
venues, referrals from other services
Provision of drop-in service including
complementary therapies
Flexible opening times
Ensure that reception staff are trained and
sensitive to service user needs
Specialist services need the ‘right’ image to
attract target group
Minimise barriers & create opportunities
to access specialist service
Provide training to generic services to
improve response to Cocaine users
 Target mental health services, A & E,
generic drug services
 Ensure that drugs helpline workers have
high level of knowledge and understanding
of stimulant use and specialist services
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Problematic Stimulant Users –
Specialist Services
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Should be holistic and tailored to individual
need – use of assessment as an intervention
Emphasis on motivational skills
Identification of problems and areas of
desired change
Provision of a range of co-ordinated
interventions to provide structured
programme
Problematic Stimulant Users
Interventions
Based on assessment, interventions
should provide a structured programme,
tailored to individual need.
 Assessment should highlight problems
relating to physical health, mental health,
relationships, and social circumstances
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Problematic Stimulant Users
Interventions
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Core interventions should include:
counselling; skills training (eg problem
solving, relaxation); lifestyle change
(including diet); cognitive behavioural
approaches including relapse prevention
and lapse management; complementary
therapies; harm reduction
Problematic Stimulant Users
Interventions
Easy access to:
 Mental health assessment and treatment
services as & when required
 Symptomatic prescribing
 GP services
 Psychologist
Specialist Service – essential
features
Specific project image
 Track record with user group
 Credibility with service users
 Trusted
 In touch with local trends at street level
 Flexible and responsive to changing
trends
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Specialist Service – essential
features
Staff team (Core)
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Multi-disciplinary team
High level of knowledge & understanding of
stimulant use, user groups and related issues
Experienced
Must include mental health expertise
Commitment to user group
Training skills
Specialist Service – essential
features
Staff team (Core/sessional or fast track)
 Mental health assessment and treatment
 Symptomatic prescribing
 Psychologist
 GP services
Overcoming Barriers - examples
Complementary therapies - especially
acupuncture should be available
 Use of texting is beneficial for a range of
reasons
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Opiate / Stimulant co-users
Aim:
To adapt services designed for opiate
users, so that they more effectively
address needs in relation to stimulant use
Opiate / Stimulant co-users
Target Population:
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Heroin users who are also using Crack /
Cocaine / Amphetamines
Individuals who are prescribed Methadone or
other opiate substitutes and using stimulant
drugs (usually Crack)
Prescribing services, needle exchange/harm
reduction services, generic drug services
Opiate / Stimulant co-users
Assessment of co-users is more complex
than opiate use alone
 Assessments need to take account of
relationship between patterns and
circumstances of drugs used, how one
effects the other and the impact of
prescribing
 Service users need to be encouraged to
disclose stimulant use without fear of
service being withdrawn
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Opiate / Stimulant co-users
Co-users require a flexible service
 Workers in these services require specific
training and support from specialist
services
 Opportunistic support can be provided
through enhanced needle exchange
services, outreach services, projects for
sex workers etc
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Overcoming Barriers to effective
Service Development – priority areas
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At Strategic level, plans and models of service
delivery must be reviewed to take account of
best practice for stimulant users.
Strategy must address all stages
Primary stimulant users must be prioritised
Service development and design MUST be
informed by individuals / groups who have direct
knowledge and experience with the user group
The delay between identifying a need and
delivery MUST be reduced
Overcoming Barriers to effective Service
Development – priority areas
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Commissioning arrangements should be
outcome based (realistic), and support
responsive and creative services rather than be
prescriptive.
Professional and post qualifying training requires
specific input
Media portrayal of Crack users / myths needs to
be balanced with accurate, factual information
Services / projects need to be adequately
resourced and supported
Funding needs to be secure to ensure that
learning is not lost, and high quality staff are
recruited and retained.
Senga MacDonald
Drugs Action
7 Hadden Street
Aberdeen
AB11 6NU
Email:
Tel:
[email protected]
01224 577120