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DAAP AGM 30 November 2005 Models of Care for Alcohol Misusers Trevor Mc. Carthy DAAP AGM 30 November 2005 Models of Care for Alcohol Misusers Trevor Mc. Carthy Senior Policy Officer: Alcohol NTA More treatment, better treatment, fairer treatment 1

Alcohol: It’s a drug Jim, but not as we know it. NTA More treatment, Alcohol: It’s a drug Jim, but not as we know it. NTA More treatment, better treatment, fairer treatment 2

Treatment for Problem Drinkers A. B. C. D. E. F. G. H. Physical health Treatment for Problem Drinkers A. B. C. D. E. F. G. H. Physical health Psychological adjustment Vocational adjustment Social adjustment Interpersonal adjustment Legal status and criminal activity Poly-drug use, where relevant HIV / Hepatitis risk taking, where relevant Raistrick D & Heather N 1998: Review of the effectiveness of Treatment for Alcohol Problems. Unpublished report for Do. H. Commissioning Standards. SMAS. 1999 NTA More treatment, better treatment, fairer treatment 3

National Alcohol Harm Reduction Strategy for England: 4 strands 1. Improved, better-targeted, education and National Alcohol Harm Reduction Strategy for England: 4 strands 1. Improved, better-targeted, education and communication 2. Better co-ordination and enforcement of existing powers against crime and disorder 3. Encourage industry to promote responsible use & take a role in reducing alcohol-related harm 4. Better identification & treatment of alcohol problems NTA More treatment, better treatment, fairer treatment 4

NTA Work to support Alcohol Harm Reduction Strategy for England n Consult & develop NTA Work to support Alcohol Harm Reduction Strategy for England n Consult & develop Models of Care for Alcohol Misusers (Mo. CAM) – informed by national key stakeholder group n Commission ‘Review of the Effectiveness of Treatment for Alcohol Problems’ (includes BI & cost effectiveness) n Ambition: in partnership with Healthcare Commission develop criteria congruent with NHS standards for new review & inspection function n Complementary work e. g. Alcohol Needs Assessment Research Project (ANARP) and local Toolkits [DH] n Develop draft implementation strategy with DH NTA More treatment, better treatment, fairer treatment 5

What is Mo. CAM? n A framework describing what should be commissioned in each What is Mo. CAM? n A framework describing what should be commissioned in each local area n Evidence based guidance n Consensus based: professionals and service users n Mainstreaming alcohol interventions to develop integrated local alcohol treatment systems NTA More treatment, better treatment, fairer treatment 6

What is different? n Alcohol is more pervasive: higher levels of prevalence than drugs What is different? n Alcohol is more pervasive: higher levels of prevalence than drugs & more front line contact n No significant new money allocated n Regional performance management not yet defined n Links to crime and disorder qualitatively different n UKATT isn’t NTORS – different evidence base n Alcohol’s profile is on the rise NTA More treatment, better treatment, fairer treatment 7

Typology of drinkers Severely-Dependent Problem Drinkers Moderately-Dependent Problem Drinkers Harmful Drinkers Hazardous Drinkers Low-Risk Typology of drinkers Severely-Dependent Problem Drinkers Moderately-Dependent Problem Drinkers Harmful Drinkers Hazardous Drinkers Low-Risk Drinkers Abstainers N. B. ‘Drinking patterns are not fixed for life’: Strategy Unit Interim Report 2004 NTA More treatment, better treatment, fairer treatment 8

What is in Models of Care for Alcohol Misusers n 4 Tiered model: following What is in Models of Care for Alcohol Misusers n 4 Tiered model: following Models of Care n Local systems for screening and assessment n Adopting a stepped care approach n Emphasis on care plans in structured care n More explicit co-ordination of care for people with multiple issues e. g. mental health, drug problems, homeless, domestic violence (young people) NTA More treatment, better treatment, fairer treatment 9

Stepped care approach to alcohol treatment n the least intrusive and expensive intervention that Stepped care approach to alcohol treatment n the least intrusive and expensive intervention that is likely to be effective is the first line of treatment, and more intensive services are offered only if the initial step proves inadequate Sobell & Sobell 2000 n Stepped care as a helpful concept which: n Broadly describes existing service organisation n Can inform commissioning strategies n Applied flexibly would allow service users choice NTA More treatment, better treatment, fairer treatment 10

Alcohol Treatment System The 4 Tiers Tier I: Mainstream n Targeted screening n Information Alcohol Treatment System The 4 Tiers Tier I: Mainstream n Targeted screening n Information and brief advice n Referral n “Shared care” Tier 2: Mainstream or Specialist n Open access or outreach n Brief interventions & treatment n assessment and referral n “Shared Care” Tier 3: Community Specialist n Comprehensive assessment n Care planned treatment n Managed withdrawal n Psycho-social treatments Tier 4: Residential Specialist n In-patient managed withdrawal & psycho-social treatment n Residential rehabilitation NTA More treatment, better treatment, fairer treatment 11

Implications for Tier 1: all frontline workers n Capacity building for Tier I: all Implications for Tier 1: all frontline workers n Capacity building for Tier I: all staff enabled to: n Identify hazardous & harmful drinkers & those drinking over sensible limits n Provide information on low risk drinking n Provide brief advice to reduce alcohol harm n Make referrals for more intensive treatment NTA More treatment, better treatment, fairer treatment 12

Alan Cartwright. 1999. NDSAG Conference. Role Adequacy Role Support Therapeutic Commitment Therapeutic Process NTA Alan Cartwright. 1999. NDSAG Conference. Role Adequacy Role Support Therapeutic Commitment Therapeutic Process NTA More treatment, better treatment, fairer treatment 13

Alan Cartwright. 1999. NDSAG Conference. Non Facilitative Behaviour Poor Alliance Role Insecurity Resistant Service Alan Cartwright. 1999. NDSAG Conference. Non Facilitative Behaviour Poor Alliance Role Insecurity Resistant Service User NTA More treatment, better treatment, fairer treatment 14

New Quality requirements could look like … Quality Criteria for Commissioners & Providers, ideally New Quality requirements could look like … Quality Criteria for Commissioners & Providers, ideally to be reviewed or inspected by Healthcare Commission New Commissioning Alcohol Treatment Systems Criteria n Commissioning n Performance monitoring n Meeting needs of a diverse population NTA More treatment, better treatment, fairer treatment 15

Quality requirements for providers could be … n n n n Screening & Brief Quality requirements for providers could be … n n n n Screening & Brief Interventions Assessment Care planning Evidence-based treatment Meeting needs of people with complex needs Exiting treatment: aftercare and support Managing alcohol services In line with NHS Standards for Better Health 2004 NTA More treatment, better treatment, fairer treatment 16

Which Drinkers? n NSFs Mental Health; Coronary Heart Disease; Older People; Diabetes & the Which Drinkers? n NSFs Mental Health; Coronary Heart Disease; Older People; Diabetes & the Cancer Plan n Mental Health (Dual Diagnosis Good Practice Guide 2002; National Suicide Prevention Strategy) n Sexual Health (young people and risk) n Health Inequalities (HIm. Ps, LSPs) NTA More treatment, better treatment, fairer treatment 17

Mo. CAM consultation n Phase 1: over 100 responses January 2005 n Phase 2: Mo. CAM consultation n Phase 1: over 100 responses January 2005 n Phase 2: over 100 responses – including key stakeholders and series of events: providers, commissioners, users and carers n Most responses very favourable to Mo. CAM draft overall n Most responses tended to have one main area where they wanted more focus; some consensus emerged n Concern expressed about availability of resources for service provision and enhancement NTA More treatment, better treatment, fairer treatment 18

Consultation responses n Considerable variation from one liners to erudite essays – most completed Consultation responses n Considerable variation from one liners to erudite essays – most completed pro-forma response sheet n Significant consensus for increased emphasis for family members and others affected and Domestic Abuse n Understandable concern about resources to enhance service provision and delivery n Evident that most of the responses represented a considerable amount of work, frequently involving several contributors NTA More treatment, better treatment, fairer treatment 19

Essential equipment for Commissioners: NTA More treatment, better treatment, fairer treatment 20 Essential equipment for Commissioners: NTA More treatment, better treatment, fairer treatment 20

Commissioners’ In-Tray late 2005 / early 2006: n Mo. CAM – final text n Commissioners’ In-Tray late 2005 / early 2006: n Mo. CAM – final text n Mo. CAM Alcohol Treatment Pathways guidance n Review of the Effectiveness of Treatment for Alcohol Problems n Summary of the Review n ANARP Toolkit NTA More treatment, better treatment, fairer treatment 21

What next ? n n n n Implementation strategy will be crucial Small amounts What next ? n n n n Implementation strategy will be crucial Small amounts of new monies until 2008 / 2009 Defend existing alcohol treatment services Prioritisation or resources in next Spending Review Build commissioning structures and monitoring Increase alcohol competence in mainstream workforce Build support for families and users Encourage local alcohol champions Pssst. Don’t tell anybody we told you this but … Tackling alcohol misuse will improve health. NTA More treatment, better treatment, fairer treatment 22

Do you need Glasses? There are, it has been said, two types of people Do you need Glasses? There are, it has been said, two types of people in the world. There are those who, when presented with a glass that is exactly half full, say: this glass is half full. And then there are those who say: this glass is half empty. The world belongs, however, to those who can look at the glass and say: ‘What’s up with this glass? Excuse me? This is my glass? I don’t think so. My glass was full! And it was a bigger glass!’ NTA More treatment, better treatment, fairer treatment TERRY PRATCHETT: The Truth 23

Principles for Strategic Implementation of Mo. CAM “Brains first and then Hard Work. ” Principles for Strategic Implementation of Mo. CAM “Brains first and then Hard Work. ” THE HOUSE AT POOH CORNER A. A. Milne London 1928 NTA More treatment, better treatment, fairer treatment 24

Here’s hoping… “Help me to hope. But help me not to hope too much” Here’s hoping… “Help me to hope. But help me not to hope too much” MAGGIE GEE: My Cleaner. Saqi 2005 NTA More treatment, better treatment, fairer treatment 25

In 1969 I gave up women and alcohol and it was the worst 20 In 1969 I gave up women and alcohol and it was the worst 20 minutes of my life. NTA More treatment, better treatment, fairer treatment

NTA More treatment, better treatment, fairer treatment NTA More treatment, better treatment, fairer treatment

Teenage Dreams So Hard To Beat Teenage Kicks – The Undertones NTA More treatment, Teenage Dreams So Hard To Beat Teenage Kicks – The Undertones NTA More treatment, better treatment, fairer treatment