Models of Care for Drug Service Provision

Richard Bryant-Jefferies

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315347851
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Models of Care for Drug Service Provision encourages a greater understanding of the Models of Care system, and how it can be used in the interest of clients' health and well-being. It describes the different range of treatment responses that can be offered and illustrates the patient's journey through this model. It uses a fictitious account of a client with a drug problem to highlight the various technical aspects of treatments and issues that can commonly arise.

"This new book is a wonderful reminder that we are dealing first and foremost with human beings who are complex, vulnerable and who also happen to have a drug problem. Our treatment professionals need to be well informed, up to date and responsive to the needs of clients. They also need to be understanding, tolerant and resourceful. Models of Care for Drug Service Provision assists them by providing a framework within which to work and by helping to bind together the range of professionals and services into a system of care."
— Don Lavoie, National Treatment Agency

PART 1

An explanation of
Models of Care

CHAPTER 1

Introducing Models of Care

The following chapter is very much drawn from section 2 of the NTA’s Models of Care publication (2002). Rather than attempt to rewrite what has already been said,and perhaps lose some of the definition in the process,it seemed more sensible to collate key ideas and present them in a somewhat compressed and hopefully readable form.

The Models of Care document overall sets out a national framework for the commissioning of adult treatment for drug misuse (drug treatment) expected to be available in every part of England to meet the needs of diverse local populations. (NTA, 2002, p. 3)

This is a major step forward, establishing a national and co-ordinated approach to drug treatment.

The overriding concept behind Models of Care is that Drug Action Teams (DATs) should be seeking to develop an integrated drug treatment system in their area, not just a series of separate services. In the last few years, DAT members have received increasing funding to expand the capacity of the various modalities of treatment,but it is also felt that efforts must be made to combine these modalities into a seamless system of ‘care pathways’ for patients. The Models of Care approach describes how these processes of care would work, based on the menu of treatment services that have already been incorporated into DAT treatment plans,but now expressed in terms of 4 treatment ‘tiers’. (NTA, 2002, p. 5)

Implementation targets

The NTA has set certain implementation targets before the DATs:

To have agreed by January 2003 the joint planning mechanism, and lead individual, that will be responsible in a DAT area for pursing the implementation of Models of Care. By October 2003 to have completed an assessment of whether the assessment and referral mechanisms (and treatment providers) in your DAT area are operating according to the evidence-based patient placement criteria and treatment protocols outlined in the Models of Care document. The next step, due by November 2003, is to agree and publish a local referral, screening and triage system,supported by an information-sharing policy, making clear the referral points into the drug treatment system,who is responsible for conducting the various levels of assessment,how referrals are made into the main modalities of treatment,the protocols for information sharing and exchange, and the assessment forms and instruments that will be used. Finally, by March 2004 locally defined care pathways, and a local system of care co-ordination should have been agreed and published. (NTA, 2002, p. 8)

A look at the NTA website will give you updates and information on the developments taking place around the country. Integrated care pathways are being generated, for instance, defining the responses to a diagnosed dual diagnosis, or to specific aspects of drug treatment needs, for instance, injectable prescribing.

Assessment forms are also being generated for use across DAT regions, ensuring that agencies are working to similar criteria and that information exchange can occur between agencies, and between tiers.

Four tiers

These are described as follows.

• Tier 1: Non-substance misuse specific services requiring interface with drug and alcohol treatment.
• Tier 2: Open access drug and alcohol treatment services.
• Tier 3: Structured community-based drug treatment services.
• Tier 4 services: Residential services for drug and alcohol misusers:
  • – Tier 4a: Residential drug and alcohol misuse specific services
  • – Tier 4b: Highly specialist non-substance misuse specific services.

Tier 1 Non-substance misuse specific services requiring interface with drug and alcohol treatment

Tier 1 services do not have a substance-specific role, but they provide an opportunity for screening drug misusers, engaging with them and initiating referral on to local drug and alcohol treatment services in Tiers 2 and 3. Tier 1 provision for drug and alcohol misusers may also include assessment, services to reduce drug-related harm,and liaison or joint working with Tiers 2 and 3 specialist drug and alcohol treatment services. Tier 1 services are crucial to providing services in conjunction with more specialised drug and alcohol services (e.g. general medical care for drug misusers in community-based or residential substance misuse treatment or housing support and aftercare for drug misusers leaving residential care or prison).

Tier 1 services are offered by a wide range of professionals,including primary care or general medical services, general social workers, teachers, community pharmacists, probation officers, housing officers and homeless persons’ units. These professionals are not substance misuse specialists, but will have been trained to recognise and assess the presence of drug and alcohol misuse in order to refer people on to other agencies offering specific treatment responses.

The importance of training is emphasised in Models of Care,to ensure that professionals working in Tier 1 services can effectively identify and assess drug misuse. It is likely that there will be a need for developing liaison posts so that Tier 2 and 3 services can collaborate with Tier 1, for instance in areas where there are high levels of pregnancy and maternal health need,or a high transient homeless population attracted into the area by the presence of hostel accommodation.

Models of Care emphasises that:

Drug misusers in all DATs in England must have access at local levels to the following Tier 1 services located within local general health and social care services:

• a full range of healthcare (primary, secondary and tertiary), social care, housing, vocational and other services
• drug and alcohol screening, assessment and referral mechanisms to drug treatment services from generic, health, social care, housing and criminal justice services
• the management of drug misusers in generic health, social care and criminal justice settings (e.g. police custody)
• health promotion advice and information
• hepatitis B vaccination programmes for drug misusers and their families. (NTA, 2002, p. 17)

Tier 2 Open access drug and alcohol treatment services

Tier 2 services will offer a range of services for drug misusers, including needle exchange, drug (and alcohol) advice and information services, and general support, including harm reduction support, not delivered in the context of a care plan,and low-threshold prescribing programmes aimed at engaging opioid misusers with limited motivation,while offering an opportunity to undertake motivational work and reduce drug-related harm. Specialist substance misuse social workers can provide services within this tier, including the provision of access to social work advice, childcare/parenting assessment, and assessment of social care needs. Shared-care services with primary healthcare are also included in this tier, though this may vary depending upon the complexity of the clients’ needs who are being supported through this approach.

A key element in defining the services within this tier is their low threshold of access, and the limited requirements on clients to receive services. Access will be by self-referral as well as via other agencies: Tier 1 who have identified a problem requiring Tier 2 intervention or triage assessment that may be carried out by local Tier 2 services, or higher Tier 3 or 4 services when a client has been assessed as requiring the kind of community support and intervention of a Tier 2 service as part of a care planned and care co-ordinated response.

The aim of the treatment in Tier 2 is to engage drug and alcohol misusers in drug treatment and reduce drug-related harm. Tier 2 services do not necessarily require a high level of commitment to structured programmes or a complex or lengthy assessment process. Models of Care points out that Tier 2 services require competent drug and alcohol specialist workers, and that the tiers do not imply lower skills within lower tiers.

Drug misusers in all DATs in England must have access to the following Tier 2 open-access specialist drug interventions within their local area:

• drug- and alcohol-related advice, information and referral services for misusers (and their families), including easy access or drop-in facilities
• services to reduce risks caused by injecting drug misuse, including needle exchange facilities (in drug treatment services and pharmacy-based schemes)
• other services that minimise the spread of blood-borne diseases to drug misusers, including service-based and outreach facilities
• services that minimise the risk of overdose and other drug- and alcohol-related harm
• outreach services (detached; peripatetic and domiciliary) targeting high-risk and local priority groups
• specialist drug a...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Foreword
• About the author
• Acknowledgements
• Introduction
• Part 1 An explanation of Models of Care
• Part 2 The patient’s journey through Models of Care
• Part 3 Reflecting on the success of Models of Care for this patient
• Reflecting on Mark’s journey through Models of Care: a psychiatrist’s perspective
• Reflecting on Mark’s journey through Models of Care: a family therapy perspective
• Emerging themes: reflections of a nurse consultant
• Conclusion
• References
• Index