Safer Stronger Doncaster Partnership
Drug and alcohol treatment and recovery planning in the community 2014/15
Planning Framework
Planning Section 1: Commissioning for positive outcomes
Identification of key priorities following needs assessment relating to commissioning system:
During 2013-14 the previously separate drug and alcohol services were integrated together to provide an integrated drug and alcohol treatment and recovery system. Performance management oversight during the year indicated that the integrated system was successful in delivering recovery outcomes. Successful exits for the Partnership reached at 11.2% and the target for 2014-15 is 12%. There will be a continued focus on improving successful completion rates particularly for the DIP client cohort -see grid 4.
Procurement plans for the adult drug treatment system are to re-tender with new contracts in place from April 2016. During 2014-15 and 15-16 20-25% of the funding allocation for substance misuse will be reduced in preparation for the new tender funding envelope. RDASH have therefore produced operational plans to redesign services within the reduced funding envelope, with a new staff structure in place from September 2014. There will be 3 staff teams: single point of access, community treatment and recovery support.
The remodelling will treat the same number of clients with the same recovery outcomes, with savings achieved by phasing and layering of key working, targeting the most complex needs, in line with Strang 2011(Recovery Oriented Drug Treatment).
An agile shared care staff team will only attend shared care clinics sessions at satellite bases rather than being based there full time.
The mentor team will be relocated to New Beginnings, bolstering New Beginnings as a ‘recovery hub’ within the treatment system.
A GP community alcohol pathway has been commissioned with 19 practices participating in order to provide screening, brief interventions, extended brief interventions and prescribing for alcohol. The long term aim is to reduce alcohol related hospital admissions and deaths. Uptake of services and performance will be monitored during 2014/15.
The Partnership recognises the challenge of responding to the use of Novel Psychoactive Substances and addiction to medications and the Substance Misuse Thematic Group will drive a multi-agency response with co-operation between treatment services, trading standards and SY Police.
There will be an exploration of potential and possibilities to enhance and expand prevention/ upstream work, by mapping and utilising opportunities that exist within the Public Health Directorate to deliver this.
Expected outcomes 2014-15:· Performance management oversight of the integrated drug and alcohol treatment system, with 3 functional RDASH/DAS staff teams, within reduced financial envelope
· Relocation of mentor team to New Beginnings
· Reduction in alcohol related hospital admissions and deaths
· Maximising opportunities to deliver prevention intitatives
Delivery Plan :
Key milestones / By when / By whom1. Monthly performance management meetings with DAS and RDASH, and to assess functioning of redesigned system (new staff structure in place from September 2014) in context of new stand-alone contract between RDASH and DMBC / Ongoing monthly meetings / JCG
Performance management structure to be agreed
2. Relocation of mentor team to New Beginnings / September 2014 / RDASH
3. Performance management oversight of the community alcohol pathway / ongoing / Drug Strategy Unit
4. Mapping of opportunities to deliver prevention initiatives across the Public Health Directorate / Q2 / Drug Strategy Unit
Other Comments/Updates:
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 implementation of a single point of access model (SPOA) during 2013/14 for both drug and alcohol use (single or combined) has produced major improvements in access for clients by streamlining processes and making efficiencies in delivery. This model will continue in 2014/15 and beyond, albeit with a reduced funding envelope. The SPOA accepts 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 are available within the SPOA (and relevant to non-opiate use such as over the counter medication and legal highs): 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.
New clients attend a suite of motivational interventions prior to commencement of prescribed interventions, and thus develop aspirational recovery plans before they enter structured treatment.
There will be a clearer clinical demarcation of levels of need between GP shared care and specialist services, with patients with the most complex needs being seen by the specialist Consultant. In shared care there will be a move to a more clinic focussed approach, with an agile staff team only attending clinic sessions in satellite bases rather than being based there full time. The locations of the satellite bases will be reviewed in terms of suitability for the increased clinic focussed provision. Non-medical prescribers will continue to offer targeted support to prisoners on release and clients undergoing detoxification.
Provision of a full range of needle exchange paraphernalia will continue across all pharmacy and specialist exchange outlets the numbers of which increased by 2 in 2013/14.
The Partnership will continue to ensure there is sufficient medical clinic and other staff capacity to facilitate treatment on release from prisons, that recovery plans are fully transferable, and that CJIT has arrangements in place to facilitate engagement of prisoners on the day of release.
The Partnership will continue to support community development initiatives which facilitate and encourage people to enter the treatment system. Local drug support groups have developed in Thorne, Edlington, Askern and Denaby with support from the Partnership.
Expected outcomes 2014-15:· Streamlined access to drug and alcohol treatment delivered by SPOA model
· Review of shared care satellite bases
· 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
· Community development initiatives are supported which encourage entry into the treatment system
· Provision of appropriate care pathways for addiction to medication and Novel Psychoactive Substances
Delivery Plan:
Actions and milestones / By when / By whom1. Performance management oversight of SPOA function ( in context of stand-alone DMBC/RDASH contract) / quarterly meetings throughout the year / Governance arrangements/meeting structure to be determined
Drug Strategy Unit
2. Review of shared care local delivery bases / Ongoing via quarterly monitoring meetings / Shared Care Monitoring Group
3. Provide foil, sterile spoons and wipes across all needle exchange outlets / Q1 to Q4 ongoing / Drug Strategy Unit
4. Capacity is maintained within CJIT to engage prisoners prior to, and on day of release / Q1 to Q4 ongoing / DDAS service manager
JCG
5. Support is provided for Edlington, Thorne, Askern and Denaby drug and alcohol action groups / Q1 to Q4 ongoing / JCG
Drug Strategy Unit
6. Pathways are in place to support clients with addiction to medications and novel psychoactive substances / Q2 / RDASH Service Manager
Other Comments/Updates:
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 has been updated during 2013/14, and this implementation will be performance managed by the Harm Reduction Strategy Group during 2014/15.
A process is 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 will ensure that treatment is optimised where appropriate, and plan for successful discharge where appropriate. However it is acknowledged that clients with complex needs may need to remain in the treatment system. The redesigned service model will be performance managed to ensure an adaptive treatment system, where phasing and layering of treatment in accordance with Strang is implemented.
The Partnership invested significant resources in a range of accredited psychosocial intervention (PSI) training following an audit of PSI during 2012/13. This has equipped staff to deliver high quality PSIs, and the percentage of PSIs being delivered as recorded by data set J is now 99%.
Support for carers and family members will continue to be provided by the Parents Understanding Problems of Addiction (PUPA) group and 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 2014-15:· Partnership Harm Reduction Strategy is implemented and monitored
· Delivery of optimised treatment with a focus on planned exits
· Carers and relatives of clients are supported
Delivery Plan:
Actions and milestones / By when / By whom1. Performance manage delivery of the Partnership Harm Reduction Strategy / Quarterly monitoring meetings / Harm Reduction Strategy Group
2. Implement review panel process for clients in prescribed treatment / Ongoing / DDAS
3. Maintain support to carers and relatives via PUPA group and Support for Change / Ongoing / Drug Strategy Unit
PUPA
DDAS
Other Comments/Updates:
Planning Section 4: Achieving outcomes and successful completions
Identification of key priorities following needs assessment relating to outcomes, discharge and exit from the drug treatment system:
A successful completions working group continued to develop a treatment exits action plan during 2013/14, performance now stands at 11.2% against a local target of 12%. The working group will continue to oversee implementation of effective treatment, successful completions and re-presentation actions during 2014-15.
Drug and alcohol structured day care and structured day programmes based at Rosslyn House and New Beginnings are now integrated for both client groups. The New Beginnings detox unit is now providing socially supported 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.
During 2012/13 the Partnership agreed a model of recovery support interventions (‘aftercare’) based on the expansion and extension of remit of existing Doncaster West Development Trust staff, to provide both housing and debt advice in addition to existing education, training and employment support. This model has proved very successful and will continue to be evaluated for outcomes during 2014/15.
The Partnership recognises the importance of mutual aid as a vehicle to sustain change for clients. A mutual aid event will be held for RDASH and DAS staff to ensure that assertive engagement of clients with local groups continues to be facilitated by staff.
An 8 week motivational enhancement programme for 15 people has been commissioned from Doncaster Rovers in the Community, designed to increase confidence, fitness and boost team skills of participants.
Expected outcomes 2014-15:· Planned treatment exits performance is improved from 11.2% to 12%
· Implementation of integrated drugs and alcohol structured day care and abstinence based structured day programme
· Best value outcomes from out of area residential rehab placements are obtained
· Pathways into housing, education, training and employment are maintained and housing and debt advice is available as part of recovery support interventions
· Delivery of 8 week motivational enhancement programme for 15 people
Delivery Plan:
Actions and milestones / By when / By whom1. Delivery of treatment exits (and re-presentations) action plan / Monthly meetings / Successful completions working group
RDASH
2. Implementation integrated drugs and alcohol structured day care/structured day programme model / Ongoing / Governance framework to be agreed in context of stand-alone contract
3. Maintain commissioning oversight of out of area rehab activity via scrutiny of monthly reports, costs and selection of providers / Quarterly reports / Drug strategy Unit
Adult Commissioning Manager
DDAS service manager
4. Performance management of Doncaster West Development Trust recovery support interventions programme / Quarterly performance meetings / Drug Strategy Unit
Doncaster West Development trust
5. Delivery of 8 week Doncaster Rovers in the Community programme for 15 people / Q1 / Doncaster Rovers in the Community
Drug Strategy Unit
Other Comments/Updates:
Treatment plan – Planning Framework Name of partnership and prison establishment(s): Safer Stronger Doncaster Partnership 1/4
Date: February 2014