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Cornwall & Isles of Scilly DAAT

Promoting recovery. Cornwall & Isles of Scilly DAAT. Tier 4 Interventions Commissioning to Meet Needs and Deliver Outcomes Square Pegs, Round Holes Kim Hager. What is Commissioning?. Strategic activity of Assessing needs Assessing resources and services

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Cornwall & Isles of Scilly DAAT

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  1. Promoting recovery Cornwall & Isles of Scilly DAAT Tier 4 Interventions Commissioning to Meet Needs and Deliver Outcomes Square Pegs, Round Holes Kim Hager

  2. What is Commissioning? Strategic activity of • Assessing needs • Assessing resources and services • Developing a strategy to make best use of available resources to meet identified needs.

  3. Commissioning Cycle Needs Assessment Priorities & Outcomes Operational Plan Monitor & Review Purchasing Activities

  4. ‘In-patient’ • Assessment • Observed titration • Supervised interventions • Stabilisation • Withdrawal • Up to 6 weeks • Free

  5. CIOS Tier 4 Needs Assessment Engaged in effective treatment • 1,886 ADUs • 1,265 PDUs • 1,615 Severe & dependent drinkers • 10% require ‘in-patient’

  6. Evidence & Outcomes • Better outcomes • Cheaper • Effects of T4 ‘cumulative’

  7. CIOS ‘Stepped Approach to Detox’ • DIY • Supported DIY • Community ‘Home & Dry’ LES • Community Nurse supported • Community Hospital • General Hospital • Residential Independent Sector

  8. Assess, Stabilise, Detox

  9. Why not just buy more places? • Care Co-ordinator capacity • Skills development • Preparation capacity • Contingency capacity • Aftercare capacity • Rehab budget and capacity • Financial assessment process • We were building a residential assess, stabilisation and detox unit

  10. Residential Rehab Services • Estimate 5% of treatment population (131) • Actual 60 • Gap 71 • Average cost of a 12 week placement £7,000 £497,000

  11. Adult Social Care • Adult Social Care payments and processes • Managing the impact of means testing • VACs and Community Care • Reform of Adult Social Care • ‘Putting People First’ • Personalisation

  12. ‘Putting People First’ • Diverse and innovative provision • Services tailored to people’s needs & aspirations • Focused on outcomes Enable people to • exercise choice and control over the types of services they want • directly shape the services that are commissioned on their behalf

  13. What Have we done to improve? System Re-design • Pathways • T4 options at Assessment, Care Plan & Reviews • Unblocked the bottleneck • Stopped rationing people out • Raised awareness of evidence base and Standard item on all commissioning & treatment tasking meetings

  14. Criteria • Preparation A process, not an activity Preparation & Engagement Checklist Preparation groups are not compulsory Preparation for Change Manual Visits encouraged & supported • Unplanned discharge/contingency plan • Clinical plan agreed by both RMOs • Aftercare Plan • Care Co-ordinator remains up to 3 months

  15. Alcohol & Drugs T4 Panel • Once funding agreed, can go/return within 3 months • Made requirements/requests of T4 Providers

  16. Local providers Boswyns Broadreach Chy Colom Bosence Farm • Commissioning is a Partnership • Worked hard to change and better meet needs • Constant evolution of practice • Service characteristics have greater impact on success than client motivation

  17. Why did you leave early? They took me off my anti-depressants too My family couldn’t manage The plan changed I was the only druggie Drugs got in It wasn’t what I expected I couldn’t sleep I went a little crazy I couldn’t think straight and there was no one to talk to at night They wouldn’t let you have music in your room or tapes to listen to at night. Not allowed to watch tv when you want

  18. Why residential? Never managed it in the community Peer support A safe and supportive environment All under one roof Spending a lot of time with people who have similar issues Time to look at issues and work on them intensively Being able to deal with the feelings underneath Family interventions away from home Time out, distance My keyworker coming to visit

  19. Challenges • Finding the Tier 4 services to meet the needs • Adapting services to meet needs • Homelessness • Bridging the Gap – reintegration needs

  20. Specific needs • Co-morbid mental health problems • Co-existing alcohol problems • Clients with dependent children (31%) • Couples • Stimulant users • Young adults • People with disabilities • People with learning difficulties • Unassessed/undiagnosed problems • Respite

  21. Different approaches required • Treatment naïve (50%+) • 0-6 months • 6 months – 2 years • 2-4 years • 4 years+ (21%)

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