End of Year Partnership Meeting on Drug and Alcohol Treatment Delivery

1. End of Year Partnership Meeting on Drug and Alcohol Treatment Delivery 27 February 2012

2. DOMES Report • Growth in successful completions for opiates – baseline for 2010/11 is 62. Q3 shows progress is -8% • Actions: • Weekly reporting now underway to ensure a clear ongoing picture of completions against monthly target (12 monthly) • Contract of main provider is being varied to include financial penalty for failing to discharge enough client against trajectory • Data cleansed to rectify issues with drug episodes which become alcohol episodes • 4 year + data audited and cohorts identified – low doses, early in treatment journey, employed, women, parents • Increased capacity within social work team to allow wider implementation of care navigation work – also case tracking coordinator function extended to be system wide (was criminal justice) • Assessment function now absorbed into main tier 3 provider to reduce hand-offs • Workshop scheduled on 08/09 March to work on – access, coordination and discharge functions

3. DOMES Report • Growth in proportion of those in treatment remains static, though below aspiration of 12-14% for opiates. Corrective actions as prior slide • Re-presentation rate currently low compared to national, though may be masked by lower volume of discharges? • Successful completions amongst Criminal Justice clients slightly above national comparison. Representations also slightly lower than national.

4. DOMES Report • In treatment – slightly lower average length of time in treatment, though 2-4 year cohort higher than national picture: • Revised care navigation system scrutinises all new referrals, headed by Local Authority team (similar to some LASAR implementations) to organise full care package • Also enables care package to be tuned to support re-presenters with more intensive interventions

5. DOMES Report • Criminal Justice clients remain higher proportion than national picture: • Intensive work has been undertaken with IOM to improve pathways and optimise integrated delivery • Friday prison leavers accommodated via multi-agency Saturday appointments (DISC / C4) • Also criminal justice staff working into prescribing agency to enhance engagement / target those dropping out from IOM pathways • Revised SDC programme launched on 08 February

6. Nos Into Effective Treatment • Has dropped away by 3% across the year though static for around 9 months following initial drop • However, data cleansing exercise relating to TOP will cause reduction. Corrective actions: • Also weekly reporting established in relation to new clients accessing the system • Work to engage hidden populations using Recovery Champion Function and Lifeline (as per 2009/10 recovery) • Lifeline introducing challenge to all accessing needle exchange to engage effectively in treatment • Also see care navigation / IOM improvements

7. TOP Outcomes • Currently comparing favourably in most areas to national picture. Housing continues to require improvement: • Cyrenians now providing assertive outreach in support of homelessness team via Homeless Transition fund award • Specialist housing support from Housing Options team has been extended to provide broader coverage • Continued funding to Wearside Women in Need to provide refuge accommodation

8. Waiting Times / Harm Reduction • No current issues with waiting times for Drugs, though pressures beginning to increase for alcohol as volume accessing services (particularly for structured psychosocial work) • Harm reduction measures continue to improve slowly from last report as pathways bed in • Audit underway to improve uptake of Hep C testing • Campaign planned for June / July to

9. Parents and Families • Data completeness is high, though indicating inconsistent picture with national – greater proportion with children though not residing with them • Hidden Harm Workshop on 29 February: • Outcome base reporting • Augmentation of YOS FIP to provide family integrated programme • Refresh action plan from 2010 strategy • Embedding Whole Family Approach alongside partners

10. Summary of Key Planned Discharge Actions • Weekly reporting • Contract variation / financial penalties • Ongoing care navigation meetings • 3 way handovers introduced including maintained contact to ensure engagement is embedded • Cohorts identified for targeted / accelerated work • Increased inter-agency working to help re-engagement and reduce dropout

11. Re-design • Agreement has been sought from: • Safer Sunderland Board • Prevention and Staying Healthy Board • To be presented to CCG by DPH at next meeting • Simplified lead provider model

12. Revised Model • RECOVERY • OUTCOMES • Interim - • Reduced • substance misuse / • Abstinence • Improved H&WB • Injecting • - Housing • BBV • Successful • Treatment • Completion • Sustained - • Reduced • re-presentation • Reduced • Offending e.g. Housing Family Service Psychosocial Interventions Specialist Harm Reduction Lead Provider Self Referral DIP Hospital Professional referrals Whole Family Approach Clinical Interventions e.g. Employment

13. Lead Provider - Responsibilities • All interventions to be delivered in line with NICE Guidelines • Initial and comprehensive assessment – including setting Intervention Package / Tariff and Clustering • Recovery focused care planning (encompassing both stabilisation and abstinence pathways) • Pro-active case management / case conferencing • Access to residential placements • Hidden Harm / Safeguarding • Hospital In-Reach • Dual Diagnosis • Harm Reduction (A+I / Referral) • Peer Support and Mentoring • Assertive outreach and re-engagement • Access to mutual aid organisations • Specialist housing support for substance misusers • Community Integration and ETE • Specialist Family Support for Whole Family Approach • Ownership and Management of information system including outcome measures

14. Clinical Provision - Responsibilities • All interventions to be delivered in line with NICE Guidelines • Substitute prescribing • Detoxification – community and inpatient • General Healthcare Assessment and Interventions • Communicable disease interventions – BBV screening / immunisation • Expectations – rapid access (1 week) / HCA (100%) / Reduction (90%) / Abstinence (90%) / Planned Exit (80%)

15. Psychosocial Provision - Responsibilities • All interventions to be delivered in line with NICE Guidelines • A range of evidence based interventions that can be utilised on a needs-led basis • Cognitive Behavioural Therapy • Motivational Enhancement Therapy • Social Network and Environment Based Therapies • Behavioural Couples Therapy • Structured Day Programmes • Expectations – rapid access (1 week) / H&WB improvement (?%) / Planned Exit (80%)

16. Specialist Harm Reduction - Responsibilities • All interventions to be delivered in line with NICE Guidelines • Open Access – drugs / alcohol / PIEDs • Referral to treatment where appropriate • Advice and information • BBV screening and immunisation • Coordination of pharmacy needle exchanges • Collection of relevant data – e.g. for HPA • Expectations – rapid access (open access / extended hours) / BBV uptake (?%) / Equipment Return Rate (80%)

17. Connected Recovery • Joint venture led by NECA and NERAF • Utilising facility in central Sunderland to provide an abstinence based facility, utilised by all providers: • Veteran’s groups via Forces for Good • AA and NA groups • IOM Structured Day Care abstinence programme • Women’s group • Community Integration • NECA in reach to Jobcentre plus

18. Proposed Payment Structure Reduced re-presentation Reduced Re-Offending Planned Discharges H&WB Reduced substance misuse Abstinence Block Payment

19. Recovery Champion Function • Recovery champion function – • 30 peer mentors identified within Sunderland. Will be utilised in April / May to carry out wide scale consultation with service users to identify barriers to progress • Following this to be completed with workforce following exercise in Durham • Recovery brand under development after Middlesbrough model providing a unified brand across diverse services • Legal support sourced via Sunderland University legal department

20. Any questions? xxx.xxxxx@xxxx.xxx.xx xxxxxx.xxxxxxxx@xxxxxxxxxx.xxx.xx xxxxxx.xxxxx@xxxxxxxxxx.xxx.xx