Adult drug treatment plan 2006/07 Part 3: Planning Grids



Safer Stronger Doncaster Partnership

Drug and alcohol treatment and recovery planning in the community 2017/18

Planning Framework

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Delivery Plan :

|Key milestones |By when |By whom |RAG |

|1. Quarterly performance management meetings with Aspire, monthly Operational Performance meetings with service manager/leads |Quarterly and monthly |Quarterly Contract | |

| |meetings during 17/18 |management meeting | |

| | |Operational group | |

| | |meeting | |

|2. Performance management oversight of the specialist needle exchange with further development of specialist services for Image and Performance |Ongoing monthly |Operational group | |

|Enhancing Drugs |monitoring of progress |meeting | |

|3. Performance Activity management oversight of the community recovery hub locations (Thorne/Stainforth, Mexborough, Bentley and town) |Provider reports to |Public Health substance | |

| |monthly Operational |misuse team/Aspire | |

| |Performance Group | | |

|4. Performance management of specialist inpatient detoxification at New Beginnings |Quarterly reports to |Public Health substance | |

| |Contract Management |misuse team/Aspire | |

| |Group | | |

|5. Participation in Local Alcohol Action Area activities of complex lives/blue light initiative and safe haven bus in town centre |Assertive outreach and |Public Health | |

| |engagement multi |Multi-disciplinary | |

| |-disciplinary panel, |health and social care | |

| |weekly safe haven |representatives | |

| |delivery between Easter| | |

| |and St Leger weekend | | |

|6. Mapping of opportunities to deliver prevention initiatives across the Public Health Directorate with participation in a minimum of 4 campaigns |Ongoing prevention |Public Health | |

|by the provider throughout the year, linked to national timings of campaigns. (Schedule of campaigns to be devised by April 2017) |activities and |Directorate/ substance | |

| |campaigns |misuse team/Aspire | |

|Other Comments/Updates: |

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Planning Section 2: Maintaining and improving access to treatment

Identification of key priorities following needs assessment relating to access to the drug treatment system:

The previous implementation of a single point of access model (SPOA) for both drug and alcohol use (single or combined) has proved successful, and produced major improvements in access for clients by streamlining processes and making efficiencies in delivery.

The SPOA function will operate across the recovery hubs, to accept self or professional referrals, with a single assessment process covering the domains of substance use/risk/health/social and legal needs, and safeguarding of adults and children. A full range of open access interventions (Tier 2) are available within the SPOA in town centre (and relevant to non-opiate use such as over the counter medication and Novel Psychoactive Substances): brief intervention, peer support, mutual aid, socialisation and networking to enhance recovery capital, relapse prevention, one to one support, group work, advice and information, motivational enhancement and advice on ‘DIY’: safer drinking and home drugs detox.

The Partnership expects that the provider will make best use of tools and frameworks in order to assist public health to be able to make a strong case for continued investment in treatment. The provider will be supported to understand and tackle drug related deaths by investigating the causes of any drug related deaths that might occur locally, as part of the multi-disciplinary drug related deaths forum .

The provider will adopt best practice at all times as indicated by NICE guidance, such as the recently published Prevention guidance. The effectiveness of clinical governance systems will be kept under continuous review via quarterly Clinical Governance Review meetings

It is expected that the provider will ensure that the workforce is appropriately trained and skilled and have the knowledge and understanding to be able to undertake their role requirements competently and effectively.

In line with the current Doncaster Hidden Harm Strategy and Action Plan, adult and young people’s treatment providers will deliver an approach named ‘Families Moving on Together’ (Families MOT). This is a more localised approach, replacing the previous Moving Parents And Children Together (MPACT) programme for which a licence agreement was needed. As per specification and local agreement, services will offer specific interventions for parents based on the impact of drug and/or alcohol use on parenting, the role of social services, positive parenting and the safe storage of medication. The provider will ensure staff are available to participate in the local delivery of Families MOT training and interventions to families, funding and facilitating up to 4 cohorts per year.

Drug treatment best serves these children by ensuring their parents help to overcome their drug dependency, stabilise their lives and focus on their caring responsibilities. Having a parent stable in drug treatment can be a protective factor for these children.

Effective drug treatment should be a core component of any practical, local efforts to reduce the harm to children of drug users. It should also be part of a multi-agency approach to supporting families affected by substance misuse. Being in treatment provides stability for families and can immediately have positive impacts on families, reducing risk and harm caused by chaotic drug use. The best thing for these parents is to work at achieving their treatment goals.

Recovery-focused drug treatment should involve collaboration between drug treatment services, children’s and adult social care and other local family services (e.g. Early Help, Stronger Families, parenting support programmes), to ensure that families affected by substance misuse get all the help they need and that children are protected.

This approach to families, also forms a local response to the All Party Parliamentary Group on children of alcoholics ‘Manifesto for Change’

The Aspire delivery model incorporates a satellite service delivered at the recovery hubs by a team of non- medical prescribers, targeted at clients who choose to be seen in their local area of residence (subject to a suitable assessment) .

Provision of a full range of needle exchange paraphernalia will continue across all pharmacy and specialist exchange outlets, and naloxone will be supplied via the specialist exchange. The ‘Pharmoutcomes’ IT system will be utilised by RDASH to manage the subcontracted pharmacy services function. There is an expectation that the needle exchange services will be able to respond appropriately to the need of all clients who access the service, this will include clients using Image and Performance Enhancing Drugs and men who have sex with men and who are engaged in ChemSex.

The Partnership will continue to ensure there is sufficient medical clinic and other staff capacity to facilitate seamless treatment on release from prisons, that recovery plans are fully transferable, and that the community treatment team has arrangements in place to facilitate engagement of prisoners on the day of release.

|Expected outcomes 2017-18: |

|Streamlined access to drug and alcohol treatment delivered by SPOA model |

|Recovery Hubs delivering in Town, Bentley, Thorne/Stainforth and Mexborough |

|Performance management oversight of recovery outcomes of non-medical prescribers |

|Provision of full range of needle exchange paraphernalia across Doncaster |

|Continuity of treatment and recovery journey between community and prisons |

|Provision of appropriate care pathways for addiction to medication and Novel Psychoactive Substances |

|Delivery of families Moving On Together (MOT) programme (up to 4 cohorts per year) |

Delivery Plan:

|Actions and milestones |By when |By whom |RAG |

| 1. Performance management oversight of SPOA function |quarterly meetings |RDASH/Aspire performance| |

| |throughout the year |management meeting | |

|2. Delivery of shared care in Town, Bentley, Thorne/Stainforth and Mexborough |Ongoing via Operational|PH substance misuse | |

| |group meetings |team/ /Aspire team | |

|3. Provide foil, sterile spoons and wipes across all needle exchange outlets via subcontracts |Q1 to Q4 from April |/Aspire Service Manager | |

|. |2017 monitored by | | |

| |‘Phamoutcomes’ system | | |

|4. Capacity is maintained within CJIT to engage prisoners prior to, and on day of release |Q1 to Q4 from April |/Aspire Service Manager | |

| |2017 and at monthly | | |

| |Operational group | | |

| |meetings | | |

|5. Pathways are in place to support clients with addiction to medications and novel psychoactive substances |From April 2017 |/Aspire Service Manager | |

| | | | |

|Update: Specialist service to act in an advisory role regarding prescribing to Addiction To Medication clients, Psychosocial Interventions | | | |

|available in the specialist service for both groups of clients. | | | |

|6. Monitor activity of Families MOT programmes including number of participating families, where referred from, evaluations (which include |Ongoing via Project 3 |Public Health substance | |

|identification of future needs of families) and number of training Families MOT staff within services. |(coordination of |misuse team (adults & | |

| |programmes) & monthly |C&YP) | |

| |Operational group | | |

| |meetings. | | |

|Other Comments/Updates: |

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Planning Section 3: Delivering recovery and progress within treatment

Identification of key priorities following needs assessment relating to recovery and effectiveness of the drug treatment system:

As needs assessment shows there is an aging population of opiate users likely to suffer from chronic health problems, it is important that the Partnership maintains a pro-active focus on harm reduction, in balance with the needs of the recovery agenda. A comprehensive Harm Reduction Strategy will be updated during 2017/18, and this implementation will be performance managed by the Harm Reduction Strategy Group.

Review processes have been in place to review all clients (in accordance with Strang 2) and ensure that an aspirational focus on recovery and successful exit from treatment is maintained. Looking at segmented lengths of treatment journeys, the review panels ensured that treatment was optimised where appropriate, and planned for successful discharge where appropriate. However it is acknowledged that clients with complex needs may need to remain in the treatment system and/or may have an episodic engagement with treatment. Further work will take place during 2017-18 to address and minimise illicit use on top of prescribed treatment, via the RDT (recovery and diagnostic tool) and Standard Operating Procedure and point of contact testing. This will be monitored via the monthly Operational group with the provider.

The Partnership is committed to supporting a treatment system that delivers quality and effectiveness and wants to see improving recovery rates. The provider will be expected to demonstrate continuous improvement in drug treatment and should be able to make evident how it intends to respond to or how it will implement new practice guidance such as the National Drug Strategy (when it is published) or the revised clinical guidelines published in 2017. It is expected that the provider will horizon scan for emergent patterns of drug use and respond to changes in the prevalence of alcohol and drug use.

The Partnership supports treatment providers in the community and prisons to provide evidence based interventions and continuous improvement to maximise the benefit of treatment and improve recovery outcomes. This includes promotion of the 2017 UK Guidelines on the Management of Drug Dependence.

Contractual financial incentivisation will be attached to delivery of assertive engagement with treatment resistant, vulnerable clients, to ensure their progress within treatment, as outlined in Planning section 1. The challenge remains for the Aspire model to ensure an adaptive treatment system, where phasing and layering of treatment in accordance with Strang is implemented.

A Family worker, jointly funded by Stronger Families and RDASH charitable funds, will adopt a whole family approach to support families where a parent or partner is affected by substance misuse.

Support for carers and family members will continue to be supported by Aspire and is currently provided by the Support for Change group.

The Partnership will continue to support the development of and assertive linkage to mutual aid groups which have seen increasing numbers of attendees.

|Expected outcomes 2017-18: |

|Partnership Harm Reduction Strategy is implemented and monitored |

|Delivery of optimised treatment with a focus phasing and layering in accordance with Strang 2 guidance |

|Whole family support delivered, where parents are affected by substance misuse |

|Carers and relatives of clients are supported |

Delivery Plan:

|Actions and milestones |By when |By whom |RAG |

|1. Performance manage delivery of the Partnership Harm Reduction Strategy |Quarterly monitoring |Harm Reduction | |

| |meetings |Strategy Group | |

|2. Implement ‘using on top’ Standard Operating Procedure |April 2017 and ongoing|Aspire | |

|3.Delivery of whole family support to families where parents are affected by substance misuse |April 2017 and ongoing|Aspire | |

|4. Maintain support to carers and relatives via Support for Change |April 2017 and ongoing|Aspire | |

|Other Comments/Updates: |

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Planning Section 4: Achieving outcomes and successful completions

Identification of key priorities following needs assessment relating to outcomes, discharge and exit from the drug and Alcohol treatment system:

A performance related financial incentive of 2.5% of the annual contract value, linked to top quartile performance of the Public Health Outcomes Framework indicator 2.15, successful treatment completions for drugs which do not then represent within 6 months, which was in place during 2016-17, will be replaced by a 1.25% annual contract value incentive linked to process indicators for assertive work with treatment resistant clients of all substances and those with complex needs. A monthly Operational Performance Group will support the quarterly contract performance meetings, to oversee performance.

The Partnership will expect the provider to respond to new and emerging evidence around drug and alcohol treatment and anticipate that they will implement recommendations as they develop so that the needs of clients their families and carers can be fully met.

Drug and alcohol structured day care (at the social space) and structured day programmes will continue to be delivered at Rosslyn House and New Beginnings and the recovery hubs.

The New Beginnings detox unit will provide 6 Doncaster beds of medically supported inpatient detoxification for both drugs and alcohol clients.

Performance monitoring of out of area rehab activity will continue to ensure that best value outcomes are obtained from residential rehab placements.

The Partnership recognises the importance of mutual aid as a vehicle to sustain change for clients and assertive engagement of clients with local groups continues to be facilitated by staff.

Weekly ‘recovery check- up’ telephone calls will be delivered to clients on exit from treatment to assist recovery. Where the client has identified this request – this will be a planned intervention delivered in line with the NICE – orange book by mentors trained to do so.

|Expected outcomes 2017-18: |

|Financial incentive in place linked to assertive work with treatment resistant and complex needs clients |

|Delivery of integrated drugs and alcohol structured day care and structured day programme |

|Medical in-patient detoxification available at New Beginnings |

|Best value outcomes from out of area residential rehab placements are obtained |

|Delivery of follow up recovery check- up phone calls to clients |

Delivery Plan:

|Actions and milestones |By when |By whom |RAG |

|1. Financial incentive in place linked to assertive work with treatment resistant and complex needs clients |Monthly monitoring |Operational Performance | |

| | |Group | |

| | |Quarterly contract | |

| | |monitoring group | |

|2. Delivery of integrated drugs and alcohol structured day care/structured day programme model |April 2017 and ongoing |Operational Performance | |

| | |Group | |

| | |Quarterly contract | |

| | |monitoring group | |

|3. Delivery of 6 medical model detoxification beds at New Beginnings |April 2017 and ongoing |Operational Performance | |

| | |Group | |

| | |Quarterly contract | |

| | |monitoring group | |

|4. Maintain commissioning oversight of out of area rehab activity via scrutiny of monthly reports, costs and selection of providers |Quarterly reports |Public Health substance | |

| | |misuse team | |

| | |Aspire service manager | |

|5. Delivery of recovery check-up phone calls to clients |April 2017 and ongoing |Aspire | |

|Other Comments/Updates: |

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