National survey of care co-ordination in drug treatment services ( NatSOCC )

1. National survey of care co-ordination in drug treatment services(NatSOCC) Centre for Research on Drugs & Health Behaviour, Imperial College London Institute for Criminal Policy Research,Kings College London Study Team: Tim Weaver, Paul Turnbull, Nicky Metrebian, Mike Crawford, Jeffrey Fehler, Carmen Aceijas & Tim Rhodes. Researchers: Jo Hart, RA to be appointed @ ICPR

2. Background Models of Care(NTA, 2002) • High quality, efficient & effective drug treatment requires: • Range of interventions & treatment modalities. • Co-ordination with general health, social care &CJS interventions. • Integration & co-ordination of services. • Models of Care therefore: • Defined elements of a comprehensive local service. • Described integrated care pathways through tiered service provision. • Introduced / formalised procedures for assessment, care planning, care co-ordination, monitoring and review (i.e. Case Management)

3. What is Case Management? • Planned, needs-led approach to the longitudinal, clinical management of clients with complex, chronic, enduring or relapsing health problems. Aims of Case Management: • Maintain contact / engagement • Improveaccess to, and co-ordination of service delivery • To improve health status and social functioning (precise clinical outcomes targeted varies with treatment setting & client group). Rationale: Needs tend to be: • Multiple, complex, span health & social care • Enduring, variable over time • Require intervention from a range of agencies • Outcomes improved when interventions are co-ordinated.

4. How does Case Management work?

5. How does Case Management work?

6. How does Case Management work?

7. Case Management in UK Drug Treatment(Models of Care, 2002)

8. Since Models of Care …

9. Since Models of Care … Community integration / treatment completion

10. Study Aims • Examine the implementation of care co-ordination in drug treatment services. • Describe emerging models of case management practice. • Identify how case management impacts upon: • engagement, re-engagement, retention & follow-up, and, • co-ordination across the tiered substance misuse service and key partner agencies (i.e. the mental health service and the CJS). • To use the findings to identifying models or approaches with potential to enhance treatment outcomes … … and which may be subject to formal evaluation.

11. Method Two-phase investigation: • Phase I: National survey of treatment services. • Phase II: Multi-method observation of care co-ordination practice and process-based outcomes (engagement and retention) in 8 centres.

12. Phase I:National survey of treatment services • Comprehensive survey of drug treatment services in English DATs that provide Tier 3 interventions. • Statutory & non-statutory services included. • Services providing Tier 2 or Tier 4 interventions ONLY will be excluded. • Services that provide Tier 2 or Tier 4 interventions will be included if these are provided in conjunction with Tier 3 interventions.

13. Phase I: Scope of Survey Team structure: • Managing organisation. • Relationship to DIP teams and DIP functions. Services provided: • Interventions provided • Target population. • Composition of team and skills mix. Progress with case management • Extent to which assessment, care planning, care co-ordination, monitoring and review has been implemented within current caseload. Model of case management: • Individual or team management? • Caseload size. • Duration of care co-ordination: Are clients offered care co-ordination on a time-limited or open-ended basis? • Budgets: Do care co-ordinators control or have any access to a budget? • Assertiveness & management of non-compliance. • Commitment to outreach.

14. Phase II:Observation of care co-ordination Setting: • Purposive sample of 8 Tier 3 services that represent the typology of emerging models of case management practice. Sample: • 2 Social Care providers (Turning Point). • (1 with high degree of integration with CJIT’s, 1 with low degree of integration with CJITs). • 6 NHS providers • 3 with high degree of integration with CJIT’s, 3 with low degree of integration with CJITs).

15. Phase II:Observation of care co-ordination Assessments: • Keyworker activity. • Work diary and questionnaire. • Case Management process and outcome. • Longitudinal case record to measure care co-ordination inputs (assessment, care plan content, interventions delivered, contacts made) and assess the process-based outcomes achieved (engagement, retention in treatment at 90-days, comprehensiveness of care plans). • Retrospective case-note review of clients subject to CPA. • Qualitative interviews with care co-ordinators • Focus-groups with clients. • to asses each parties experience of care co-ordination, perceived utility and factors that facilitate of hinder enhanced outcome.

16. Progress • MREC approval (though not local R&D!) • Ongoing Literature Review. • Drafted and piloted Phase I survey questionnaire. • Worked with colleagues at NTA & University of Manchester to compile database of Tier 3 service providers. • Started rolling survey of 700+ services identified to date. • Currently designing Phase II instruments (pre-pilot). • Phase II to be piloted and implemented by April.