Transcript soho rapid access clinic.

SOHO RAPID ACCESS
CLINIC.
AIMS:
To provide a client focussed, low threshold flexible
prescribing service.
 To offer an easily accessible assessment and
treatment service to rough sleepers in Westminster.
To provide information and advice to drug and alcohol
users aimed at harm minimisation.
BACKGROUND:
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Pilot project Oct 99-April 00, partnership between Westminster
DAT, BKCW, Westminster Social Services, Hungerford Project
and Rivendell Clinic.
Engaging “rough sleeping” drug users in the Soho Area,
assessment, prescribing services, access to detox and rehab.
Over 70 assessments carried out in 6month period.
Follow up shows good levels of retention in treatment, but
increase in use of Crack. Application for funding to R.S.U, which
is successful.
Oct 00 Soho Rapid Access Clinic works from the Hungerford
Project, while waiting for premises. Hungerford Project continue
to be closely associated with SRAC, which is now funded jointly
by BKCW and The Rough Sleepers Unit.
BACKGROUND:
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SRAC opens at Dean St Hostel Jan 2001, in partnership with
Bridge Housing and Arlington Care Association.
SRAC continues to be funded by R.S.U until July 2002, when it
is absorbed into CNWL Mental Health Trust, and funded by
Westminster Substance Misuse Commissioners.
All referrals to SRAC are made through named referrers, who
work for external agencies, there is a close relationship with the
local Substance Misuse Units.
SRAC is staffed by a consultant psychiatrist, a team coordinator, staff grade Dr, 3 clinical nurse specialists and an
administrator.
PARTNERSHIP WORK
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SRAC currently works with a number of partners.
Equinox, Hungerford, Central CAT team, Westminster CAT
team, Passage Centre, Mobile Needle Exchange, Connections
at St. Martins, are the current main referrers.
The clinic is based in Dean St Hostel, which is run by Bridge
Housing.
All referrals are accompanied by their external worker.
Extensive liaison and support from SRAC staff to referrers and
agencies involved with service users.
SERVICES OFFERED
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Assessment, medical, psychological and social. Access to full
psychiatric assessment
Referral for in patient detox
Referral to Care Managers for funding
Methadone titration and on going prescribing
Subutex prescribing
Community alcohol detox
Off site assessment if needed
Treatment for a twelve week period
Assurance of transfer of prescribing
Re titration on release from prison
Extensive harm minimisation information relating to drug using
practices
PHILOSOPHY & MODEL OF
WORK
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The assessment workers are trained nurses, who have worked
in drug services in both the voluntary and statutory sector, and
have experience within the field of homelessness.
Although the assessment tools are cumbersome, the clinic
practises flexibility with information gathering, aiming for a
sensitive and detailed history to assist with titration.
Medical appointments are flexible, most prescribing
appointments offered within two working days, with opportunity
for “on the spot titration” if appropriate.
The atmosphere of the clinic is informal, and sensitive to the
social exclusion of it’s service users
A BRIEF GLIMPSE INTO THE
INJECTING PRACTICES AND
CONCERNS OF A GROUP OF
ROUGHSLEEPERS
BACKGROUND
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The Soho Rapid Access
Clinic noticed increasing
reports of “combined” drug
injecting, heroin & crack
cocaine prepared and
injected together.
The client group all have a
recent and often protracted
history of rough sleeping,
little or negative experience
of prescribing services.
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Traditional treatment
services have had difficulty
engaging this population in
treatment.
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Service users were
expressing concern about
the lack of information
available on “snowballing”,
experiencing more injecting
problems, and having
difficulty stopping or
controlling their combination
use.
RESPONSE:
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Service user questionnaire completed by 14 service users,
seeking their views and experiences.
No previous experience of a programme for crack use.
Interest in additional help with problems they associated with
snowballing and crack use.
Triggers for increasing or continuing use were: money, craving,
boredom and living in a West End hostel where drug use is
pervasive
RESPONSE:
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Focus group to invite user involvement and consultation.
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Feedback from this group has informed, and been part of the
development of a series of user informed supportive educational
groups.
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The group is currently in a period of review, having run at three
West End hostels, in the substance misuse units.
COMBINATION DRUG USE
QUESTIONAIRE
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Basic questionnaire completed by 91 service users. This is in
addition to service requirements.
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All service users asked at initial contact about sharing injecting
equipment., approximately 98% confirm sharing, many within
the past 24 hrs.
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Also high levels of groin injecting, amongst this group, users site
ease of access being a primary reason for groin injecting.
Responses
Client Gender Breakdown
80
70
60
50
40
30
20
10
0
76
15
Male
Female
Gender
Client Age Breakdown
60
49
Responses
50
40
27
30
20
15
10
0
16 - 24
25 - 30
Age Range
35-44
Bl
ac
k
3
Af
ric
an
er
ea
n
8
O
th
Eu
ro
p
Iri
sh
Sc
ot
6
Bl
ac
k
te
W
hi
te
W
hi
te
sh
Br
iti
80
70
60
50
40
30
20
10
0
W
hi
te
W
hi
Responses
Ethnicity
70
3
1
Crack & Heroin Combination
Responses
100
80
60
40
20
0
Yes
No
Combine crack and heroin in the same
syringe?
cc
on
al
ly
e
Frequency
ic
ab
le
ve
r
Ne
Ra
re
ly
as
i
tim
3
No
tA
pp
l
O
he
of
t
45
40
35
30
25
20
15
10
5
0
M
os
t
ay
s
Al
w
Responses
How often are they combined?
42
31
9
3
If using crack on its own, do you smoke or
inject?
47
Responses
50
40
30
22
20
6
10
8
3
0
Mainly
smoke
Mainly inject
Both
Neither
Not
Applicable
Problems since injecting crack?
60
56
50
40
26
30
20
10
0
Yes
No
Not Applicable
In
re
as
ed
Problems
th
er
s
5
O
Us
ag
...
Ac
ce
ss
10
Ve
in
hr
om
b.
..
15
/T
20
DV
T
Ab
sc
es
se
s
M
iss
ed
Hi
ts
Frequency
Main problems from injecting crack.
35
30
30
25
16
11
8
9
4
0
Frequency
Interested in a crack group?
45
40
35
30
25
20
15
10
5
0
40
16
6
Don't Know
Yes
No
tin
w
an
d
n
Topics
an
d
fo
w
s
10
...
ra
m
g
11
on
pr
og
llo
ay
ec
tin
s
er
s
ng
ra
vi
Sa
fe
rI
nj
C
Tr
ig
g
Responses
12
D
in
g
ra
ck
pp
C
is
su
es
st
o
on
re
la
te
d
n
ea
lth
do
at
io
13
ox
,r
eh
ab
H
g
rm
15
et
ut
fo
20
D
C
In
Session Topics
25
21
17
17
14
10
5
0
SUMMARY
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What can agencies learn from excluded service users who are
homeless?
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What prevents services from keeping up with the changing drug
use patterns/market ?
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How can we respond to drug using practices which challenge
traditional treatment provision?
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How can we respond to the increase in injecting problems, and
service user’s concerns?