Report to Blanchardstown Interagency Protocols Initiative (BIPI) Steering Group:

Mapping of Rehabilitation Progression Paths

July2010

Susan Bookle, MBS

Co-ordinator: Blanchardstown Interagency Protocols Initiative

Table of Contents

1.Introduction

1.1Purpose

1.2Approach

1.3Report Format

2.Local Context

2.1Demographic Profile

2.2Social Exclusion

2.3Impact of the Recession

2.4Drug Usage

2.5Collaborative Working

3.National and Local Policy Framework

3.1National Drugs Strategy

3.2National Drugs Rehabilitation Strategy 2001-2008

3.3National Drug Rehabilitation Integration Committee

3.4Blanchardstown Strategic Priorities

4.Models of Inter Sectoral Working

4.1Definition

4.2Comparison of Models

4.3Continuum of Integration

5.Rehabilitation Progression Paths

5.1Rehabilitation Progression Path

5.2Harm Reduction

5.3Treatment

5.4Stabilisation

5.5Detoxification

5.6After Care

5.7Four Tier Model

6.Snapshot of Current Services

6.1Community Drugs Teams

6.2Tolka River Project

6.3Coolmine Therapeutic Community

6.4Rehabilitation Integration Service

6.5Genesis

6.6Local Employment Service

6.7BLDTF

7.Conclusions and Recommendations

7.1Conclusions

7.2Recommendations

Appendices

Appendix 1:National Drugs Strategy Organisational Structure 2009-2016

Appendix 2:Additional Information re. CDTs

Appendix 3:Referral Data for TolkaRiver Project

Appendix 4: CTC Service Provision

Appendix 5:National Policy

Appendix 6:Konrad- interagency questions

Appendix 7:NDRIC membership

1.Introduction

This report was produced during April and May 2010 and aims to provide organisations involved in the Blanchardstown Interagency Protocols Initiative (BIPI) with:

a)An overview of the current national and local drugs polices

b)An outline of collaborative best practice

c)A summary of the services provided bythe partners involved in BIPI

d)Brief profiles of the BIPI partner organisations

e)A summary of the achievements and challenges faced by the organisations involved in BIPI

f)Recommendations for the future development of the BIPI initiative.

This information is relevant within the local Blanchardstown context.

1.1Purpose

This report aims to provide factual information which will be used by the BIPI steering group to determine their core objectives for the coming year.

1.2Approach

This report is based on:

  • Documentary analysis of relevant national and local policy documents which include:

key local reports, internal plans, reports, policies and procedures and other documents supplied by the organisations involved in BIPI

  • Face to face interviews with the managers / coordinators of the nineorganisations involved in BIPI. These interviews were of one to two hours in duration and in most instances were held in the organisations’ offices.
  • Analysis of a short questionnaire completed by the organisations involved in BIPI (see appendix 4).
  • Face to face interviews with staff of Blanchardstown Local Drugs Task Force (BLDTF).

1.3Report Format

This report is structured as follows:

Section 2:Local context

Section 3:National and local policy framework

Section 4:Models of inter sectoral working

Section 5:Rehabilitation progression paths

Section 6:Snapshot of current services

Section 7:Conclusions and recommendations

Appendices with supporting information are also included.

2.Local Context

This section describes the environmental context within which BIPI exists. Section headings are as follows:

  • Demographic profile
  • Social exclusion
  • Impact of the recession
  • Drug usage
  • Collaborative working

2.1Demographic Profile

The 2006 CSO census revealed that Blanchardstown was unique in Ireland in terms of pace of population growth and ethnic diversity:

  • The population of Dublin 15 was at 90,974,which was greater than that of Limerick city.
  • Dublin 15 which was the fastest growing urban area in the country. The population of the designated Local Drugs Task Force area within Dublin 15 was 63,000, growing by 13,000 people, (23%). National population growth in 2006 was 8%.
  • The population of Dublin 15 grew by over 80% in fifteen years.
  • 11% of young people in Blanchardstown were aged 0-5, almost double the national average of 6.6%.
  • The level of those under 18 was 30%, compared to the national average of 20.4%.
  • Foreign nationals accounted for almost 21% of all residents in Dublin 15 in 2006. This is more than double the national average of 10%.
  • Blanchardstown is also home to large numbers of Travellers, almost 700 in the last census. It is striking that the average age of Travellers is 18 compared to an average age of 33 nationally.

Many of these factors have contributed to the levels of social exclusion in Blanchardstown which correlate with problematic drug use.

2.2Social Exclusion

  • Social exclusion affects communities across Blanchardstown. Low education levels, dependence on social welfare, anti social behaviour and high levels of parenting alone characterise these communities.
  • RAPID designation of estates in Corduff, Mulhuddart, Blakestown and Mountview, prioritised resource allocation and service delivery in these areas.
  • However, a) the rapid development of estates ancillary to RAPID communities, b) the shift in housing policy and c) the impact of the recession is resulting in local concerns regarding the high levels of social exclusion in other parts of Blanchardstown, (particularly in areas where private rental while claiming rent allowance are high e.g. Huntstown, Hartstown and Ongar).
  • Given the current economic climate the rates of rent supplement and mortgage allowance dependence is likely to have increased.

2.3Impact of the Recession

  • The current economic climate is having a substantial effect on the lives of people living in Blanchardstown.
  • Large numbers of people from the area worked in construction, retail and service industries. However, these sectors have been badly hit by the current crisis.
  • In April 2010, 8,116 people were on the live register in Blanchardstown. An increase of 53% or 2,812 people is recorded in 18 months since October 2008.[1] An additional 600 people from Blanchardstown have been transferred to the Social Welfare Office on the Navan Road, thus increasing the numbers to 8,716.[2]
  • The highest number of people on the live register are between the ages 25-34 – 35% (2,935 people).
  • Many of these opportunities were available locally and attracted people to buy starter houses in the area. The reality facing many of these people, many of whom have young families, is that they are in negative equity and are struggling to repay monthly mortgages.
  • People who lived in areas that traditionally experienced social exclusion had also managed to obtain employment. However low skills and education levels make them extremely vulnerable at this time.
  • Young people are most affected by unemployment. The young demographic in Blanchardstown is very vulnerable.
  • The rapid development and growth of Blanchardstown resulted in services struggling to keep pace with demand. Cuts in public expenditure have impacted badly in Blanchardstown. Inadequate service levels across a range of services have been further diminished e.g. no FAS training centre.
  • Drug misuse continued to rise throughout the boom. There is no evidence that the current recession is resulting in reduced drug taking across Blanchardstown. Community leaders are concerned that the high youth population, lack of structured activity (as a result of unemployment) and availability of drugs will lead to more people developing serious drug issues.

2.4Drug Usage

Drug misuse became a significant in the 1980s when young people from predominately disadvantaged areas in Dublin became involved in the use of illegal (street) substances such as hash, cocaine, benzodiazepines and heroin. Heroin use is still a serious problem and continues to devastate communities, which includes parts of Blanchardstown. Some communities in Blanchardstown are experiencing second (and in some cases third) generation drug use having identified heroin use as an issue for the first time in the early 1990’s.

Drug addiction can lead to homelessness, involvement in crime and drug related deaths.[3] It can also have detrimental physical, social, mental and emotional consequences for the individual. Effects on immediate family in particular and society in general can be far-reaching and devastating. Recent drug trends have seen a significant movement towards polydrug use. Drug users take a number of substances, the consequences of which increase risk factors significantly. This trend is a serious issue, which has been recognised nationally and is evidenced locally. Cocaine, hash and benzodiazepines use are of growing concern in Traveller community in Blanchardstown.

Distribution of drugs in Ireland is now managed by a number of large drug gangs with well established links to serious criminal activity. This dynamic has added a new dimension to the drug problem and one which has further devastated disadvantaged communities, including parts of Blanchardstown.

Figures from the 2007 HSE ‘Central Treatment List’ indicate that around 2,500 people are currently on methadone maintenance programmes in Ireland, the majority of which are in Dublin. 300 methadone users from Blanchardstown are registered. The numbers of drug users are not declining in Blanchardstown.

2.5Collaborative Working

Blanchardstown has a strong tradition of inter agency collaborative working despite the relative newnessof the area. This approach has helped to develop a range of services and infrastructure across the area to respond to community needs. Organisations working with drug users have been involved in the following two inter-agency collaborative initiatives in recent years: Blanchardstown Interagency Protocols Initiative (BIPI) and Inter Agency Protocols (IAP).

Blanchardstown Interagency Protocols Initiative (BIPI)

In 2001 eight organisations who worked with drug users (primarily heroin users) became involved in an initiative to respond to three agreed blocks to client progression:[4]

  • Service delivery was not being smoothly delivered between the agencies
  • Duplication and overlapping of services, coupled with a lack of co-operation blocked client progression
  • Service gaps existed, which resulted in clients not accessing appropriate services.

This initiative became known as BIPI and the agencies involved worked to respond to the above blocks by enhancing inter-agency co-operation, developing protocols to support client progression and by devising a tracking system to validate client progress.

At this time, the Health Service Executive (HSE), Dublin North Central, through its Rehabilitation Integration Service (RIS), led this initiative. Funding was sourced to support the initial work in Blanchardstown through Equal, an EU funded programme under its Employability Pillar. The evaluations of BIPI carried out in 2005 and 2006 highlighted that the initiative had “considerable success in generating increased co-operation between the eight service delivery organisations in Blanchardstown in its work with drug users.”[5] While BIPI was very influential in changing how agencies worked together locally, it also influenced the development of key national strategies including the national rehabilitation strategy 2007.

The following three factors were particularly noted as impacting on the work of BIPI:[6]

a)The lack of a national framework

b)Gaps in treatment and rehabilitation options for clients

c)Access to accurate data and statistics

The external and local environment has changed considerably since then. Significant national policy and structural changes in relation to drugs services have been announced. Despite progress to fill service gaps, the recession and significant reduction in available government funding is challenging the sustainability of service delivery locally. However, BIPI recently secured funding through the LDTF emerging needs fund which enabled a part time co-ordinator to be employed. The focus of this role over the coming year is to develop and enhance the BIPI initiative at this crucial time.

The organisations currently involved in BIPI are:

  • Mulhuddart Corduff Community Drugs Team (MC CDT),
  • Blakestown Mountview Community Drugs Team (BM CDT),
  • Hartstown Huntstown Community Drugs Team (HH CDT),
  • HSE Rehabilitation Integration Service (RIS),
  • Genesis Counselling Service,
  • Local Employment Service (LES),
  • Coolmine Therapeutic Community (Coolmine TC),
  • TolkaRiver Project (TRP).

BIPI is supported by the Blanchardstown Local Drugs Task Force (BLDTF).

Blanchardstown Offenders New Directions (BOND) is no longer part of the BIPI initiative due to their closure in 2009. Genesis counselling service joined the BIPI initiative in 2010.

Inter agency Addiction Protocols Blanchardstown (IAP)

Following from the outcomes of the BIPI protocols, organisations involved in harm reduction and stabilisation which included the 3 CDTs and HSE Addiction Services began to formally collaborate and develop tools to assist client’s progress with treatment. A series of protocols to underpin this work have recently been finalised.

These include protocols on:

  • Communication
  • Confidentiality
  • Multiagency care plans
  • Problem solving

These protocols are now commencing roll out between the agencies and are targeting clients who are at the initial stages of progression.

3.National and Local Policy Framework

This section presents an overview of the national and local drugs policy framework. In summary there is:

  • An Office for the Minister for Drugs (OMD)
  • The national drugs strategy that is focusing on collaboration
  • A national rehabilitation strategy that outlines collaborative working, with recommended processes and an implementation team which is working to respond to the recommendations on the rehab working group.

This all fits well with Blanchardstown BIPI initiative.

3.1National Drugs Strategy

In 2009 the Office of Minister for Drugs (OMD) was established. It has responsibility for co-ordinating responses to drugs issues across Departments and is placed under the auspices of the Department of Community, Equality and Gaeltacht Affairs. The OMD incorporates the work and structures of the former Drugs Strategy Unit (DSU) and the National Drugs Strategy Team (NDST).[7]An interim National Drugs Strategy 2009-2016 was launched in 2009, which will be replaced by a National Substance Misuse Strategy by the end of this year (2010). The inclusion of alcohol within the drugs strategy framework was announced in 2009, which expands the remit of national drugs strategies to include responses to alcohol for the first time.

The overall strategic objective of the interim National Drugs Strategy 2009-2016 is to:

Continue to tackle the harm caused to individuals and society by the misuse of drugs through a concerted focus on the five pillars of supply reduction, prevention, treatment, rehabilitation and research.

The treatment and rehabilitation objectives centre on:

  • Developing a national integrated treatment and rehabilitation service that provides drug free and harm reduction approaches for problem substance users
  • Encouraging problem substance users to engage with, and avail of, such services

3.2National Drugs Rehabilitation Strategy 2001-2008

In May 2007, the report of the working group on drugs rehabilitation was launched. This strategy encompasses interventions aimed at a) stopping, b) stabilising and/or reducing the harm associated with a persons’ drug use as well as c) addressing a persons’ broader health and social needs. This strategy also clearly states that the process of drug rehabilitation should begin at the first point of contact a drug users makes to a drug related service. This is an important statement as it takes a clear stance to define rehabilitation in a field where there are differing views.

The National Drugs Rehabilitation Strategy names a number of specific high risk drug using groups who should be targeted by services to support progression. These are: a) Homeless people, b) Ex prisoners, c) Children of drug using parents, d) Prostitutes, e) Travellers, f) Mental health and g) Ethnic minorities. It also states that the main funding bodies to fund rehabilitation are LDTFs, FAS, HSE and Probation services.

The strategy acknowledged difficulties in supported progression as including:

a) Lack of co-ordination,

b) Reluctance of agencies to share information,

c) Differing views on lead agency,

d) Steps to rehabilitation giving rise to ineligibility,

e) Divergence between the views of clients and their medical practitioners on facilitating staged withdrawal

The strategy strongly states the need to:

a) Increase co-ordination of services

b) Develop quality standards,

c) Identify and address staffing needs to achieve these standards

The strategy recommends best practice approaches to supporting rehabilitation progression through:

  • Preparation for and rapid access to rehabilitation. This should follow a thorough needs assessment, full and accurate information with a menu of options presented to the client who is central to the process and all decisions in relation to their rehabilitation.
  • Addressing social and environmental factors such as housing, family, education, social life and employment. The strategy outlines the importance of clients engaging in meaningful activities which build structure, develop skills and provide alternatives to drug use.
  • Retention in a residential programme which is approximately 3 months long. These programmes should work with clients in a respectful and dignified way, balancing work, rest and social activities.

One of the main features of the report recommends substantial structural changes on a local basis to increase and improve rehabilitative outcomes. It recommends a practical model of interagency working based on the:

a)Development of formal protocols to facilitate interagency co-operation and information sharing to develop care plans

b)Development of service level agreements to complement the protocols

c)Recruitment of a senior rehabilitation co-ordinator with 10 rehabilitation co-ordinators and appropriate levels of staff, to oversee the development of the protocols

d)Development and monitoring of standards in services

e)Development of template assessment instruments for problem drug users at different stages of progression

f)Development of templates for individual care plans

g)Further training for rehabilitation service providers

The report recommends the establishment of a national drug rehabilitation implementation committee (NDRIC) to a) oversee and monitor the implementation of the report, b) develop agreed protocols and service level agreements, c) develop a quality standards framework, d) oversee case management and care planning e) identify core competencies and training needs to ensure these needs are met. A Senior Rehabilitation Co-ordinator employed by the HSE would chair and oversee the work of NDRIC.

3.3National Drug Rehabilitation Integration Committee

The NDRIC was established in 2007 and is composed of representatives from OMD, Regional and Local Drugs Task Forces, and other key stakeholders[8]. There are no representatives from the RIS. Its role includes:

  • Overseeing and monitoring the implementation of the recommendations in the rehabilitation report
  • Developing the agreed protocols and service level agreements
  • Developing a quality standard framework which builds on existing standards
  • Overseeing case management and care planning processes
  • Identifying core competencies and training needs and ensuring that such needs are met

NDRIC has recently completed a framework document. It highlights the need for person centred approaches with appropriate services in place to support progression. The framework outlines a comprehensive integrated model of rehabilitation provision. It promotes care planning and case management which is agreed by appropriate services (called the care team). It proposes that the HSE play the lead role in relation to case management.