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Keltoi Rehabilitation Programme

Keltoi Rehabilitation Programme. Post-discharge Outcome Study. Ms. Emma White*, Dr. Ciaran Browne, Mr. Brendan Mc Kiernan, Dr. Brion Sweeney *Corresponding author: emma.white@esri.ie. Study Aim.

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Keltoi Rehabilitation Programme

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  1. Keltoi Rehabilitation Programme Post-discharge Outcome Study Ms. Emma White*, Dr. Ciaran Browne,Mr. Brendan Mc Kiernan, Dr. Brion Sweeney *Corresponding author: emma.white@esri.ie

  2. Study Aim • To measure post-discharge outcomes for clients of the Keltoi therapeutic residential facility for former drug-users. • What is the impact of the Keltoi process on individuals’ lives?

  3. Introduction to Keltoi • Therapeutic residential facility for opiate users over the age of sixteen who want to realise and maintain a drug-free lifestyle. • Eight-week rehabilitation programme: • Cognitive behavioural approach. • Emphasis on occupational work. • Prior to admission, clients need to be drug-free, physically stable and committed to remaining drug-free.

  4. Introduction to Keltoi contd. • Pre-admission assessment takes ten days on average. • 31% admission rate for 485 applications during study period. • 6% of clients not accepted. • 52% chose not to proceed. • 10% were not drug-free.

  5. Keltoi Approach • Unique approach in Ireland: • Focus on living skills rather than insight - a way of living. • Evidence-based: • Feedback and evaluation functionspart of the programme design. • Outcomes as primary indicator of success.

  6. Evaluation Overview • Independent process: • Interviews and analysis carried out by external researchers. • Externally funded: Health Research Board (HRB). • To evaluate the satisfaction of clients whilst resident in Keltoi. • To evaluate the satisfaction of staff whilst working in Keltoi. • To evaluate the outcomes of clients who undertake the Keltoi programme. • To compare outcome effectiveness with other services.

  7. Outcome Study Design • Consecutive clients were recruited on admission between November 2002 and August 2004: • No exclusion criteria, including non-completion of programme. • No clients refused to participate. • Consent was obtained to make contact between one and three years post-discharge.

  8. Methodology • Clients were contacted minimum one year post-discharge. • Interview: • Standardised outcome instrument. • Feedback questionnaire were completed. • Trained independent interviewers. • 30-day period prior to interview.

  9. Methodology contd. • Maudsley Addicition Profile (MAP): • Drug use. • Criminal involvement. • General health. • Sexual behaviour. • Employment and social functioning. • The data was analysed using SPSS statistical software package. • Cross-sectional outcome results were obtained for the sample.

  10. Follow-up

  11. Recruitment & Completion Of the ninety-four clients recruited to thestudy, 82% (n=77) completed the programme. 83% 83% Gender of RecruitedClients (n=94) Programme Completion byGender (n=70)

  12. Results • This study defines an abstinent client as an individual who is abstinent from all substances including alcohol, cannabis and substitute prescription drugs.

  13. Results:Abstinence - Available Cases Abstinence Exc. Alcohol & Cannabis in Past30 Days (n=80) Yes 65% (n=52) No 35% (n=28) Abstinence in Past30 Days (n=80) Yes 51% (n=41) No 49% (n=39) Abstinence Exc. Alcohol in Past 30 Days (n=80) Yes 60% (n=48) No 40% (n=32)

  14. Results:Abstinence – Intention to Treat Abstinence Exc. Alcohol & Cannabis in Past30 Days (n=80) Yes 55% (n=52) 10% No 45% (n=28) Abstinence in Past30 Days (n=80) Yes 44% (n=41) 7% No 56% (n=39) Abstinence Exc. Alcohol in Past 30 Days (n=80) Yes 51% (n=48) 9% No 49% (n=32)

  15. 12% 21% 50% 61% 88% 79% 50% 39% Results:Abstinence – Completion & Gender Programme Completionby Abstinence (n=70) Abstinence in Past 30 Days by Gender (n=70)

  16. All Clients: Criminal Activity inPast 30 Days (n=80) Abstinent Clients: Criminal Activity in Past 30 Days (n=41) Results: Crime

  17. Results: Health • Ten physical and ten psychological symptoms experienced: • Always (=4), Often (=3), Sometimes (=2),Rarely (=1) or Never (=0). • The sum of the ten numerical values is the respective health score. • Lower scores indicate higher levels of wellbeing. • Minimum = 0. • Maximum = 40. • Physically and psychologically, abstinent individuals reported higher levels of wellbeing. • Men reported marginally better levels of wellbeing than women.

  18. Results: Physical Health

  19. Results: Psychological Health

  20. Results: Risk Behaviour • 6% (n=5) clients reported injecting behaviour. • All polydrug users. • All using heroin. • 6% (n=5) of clients did not have a regular partner and had sex without a condom. • Mean number of sexual partners was four.

  21. Results: Employment • 50% (n=40) of clients had paid work in the past 30 days. • 48.7% (n=38) of clients reported formal unemployment in the same period. • Not mutually exclusive. • Keltoi aftercare team report that many former clients are engaged in education and/or training.

  22. Results:Social and Personal Contact

  23. Results:Suicidal Thoughts and Mortality • 19% (n=15) of the cohort reported thoughts of ending their own life within the past 30 days, of whom 4% (n=3) were abstinent. • Two clients are reported to have died before their interview took place. • The mortality rate over the two years of the study was thus 2.13% (2/94). • There is no record of these deaths with the General Mortality Register (GMR), or relevant Coroners' offices. • Three further clients are believed to have died post-interview.

  24. Results:Contact with Drug-related Services Contact with Drug- related Services (n=71)

  25. Results: Key Summary • Follow-up 85%. • Abstinence: • 51% abstinent. • 60% abstinent excluding alcohol. • 65% abstinent excluding alcohol and cannabis. • In general, abstinence was associated with minimal criminal activity and higher positive outcomes with respect to crime, health and risk behaviours, social and personal functioning and employment.

  26. Outcome Effectiveness • Keltoi • 85% of cohort traced. • 77% programme completion rate. • 60% abstinent 1-3 years (exc. alcohol). • Research Outcome Study in Ireland (ROSIE) • 68% of cohort traced. • 66% programme completion rate. • 41% abstinent at 1 year (exc. alcohol).

  27. Evaluation Limitations • No verification of self-reported abstinence. • No control group. • Aggregated effects of all treatment services. • Cross-sectional. • Non-random. • Employment measure did not capture training and education.

  28. Conclusions • Programme completion rates were high. • Impact and outcomes for clients was high: • Abstinence. • Considerable reduction in risk and social harm behaviours. • High rates of engagement with services are associated with greater likelihood of abstinence: • Client satisfaction. • Value for money. • Abstinence leads to positive outcomes for clients and society.

  29. Recommendations 1. A health-outcomes focused monitoring- system should be introduced within the drug treatment system. 2. Regular data on outcomes should be published by all services. 3. A longitudinal controlled study would permit comparison of the Keltoi model with other treatment approaches.

  30. Recommendations contd. 4. It is necessary to understand what did not work with the non-abstinent group of clients. 5. There is a need to understand how these clients could be re-engaged in treatment services. 6. More research is required to investigate mortality rates.

  31. Acknowledgements • Clients who agreed to participate. • Staff and management team at Keltoi. • Rehabilitation workers who completed follow-ups. • Health Research Board for funding. • Health Services Executive.

  32. Discussion

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