Alcohol Intensive Case Management Project (Pilot)

1. Westminster Drugs Project Alcohol Intensive Case ManagementProject (Pilot) Danny Heckman, November 2010

2. Project Overview • Project set-up: August2009 • Target group: severely alcohol-dependent individuals with a history of poor engagement • Model: assertive community outreach • Set-up: sole worker, small caseload (10-12 clients at any one time)

3. Project Overview Aims and Objectives • To reduce the severity and longer term consequences of severe alcohol dependency to adults with histories of treatment resistant behavior. • To reduce the level of unplanned utilization of acute health care services by treatment resistant alcohol dependants including a reduction in non planned admissions. • To increase levels of engagement with both primary health care and specialist alcohol treatment services

4. Project Overview Purpose To increase health gains to the individual andachieve costs efficiencies by • Operating a proactive and assertive approach to engagement; • Offering flexible access, including assessment and treatment in the community where required.

5. Plus 1 or more: • Presence of co-morbid illness • Socially isolated • High levels of social need (e.g. housing) • Each of the below: • Severely alcohol dependant adult • High levels of inappropriate contact with acute health care services • Poor history of engagement with alcohol treatment services Project Overview Engagement Criteria and Client Eligibility Wandsworth Residents

6. Project Overview Referrals Referral Leaflet Promo Posters Business Cards Referral Form

7. Client Group Participant Details • 40 referrals to date • 25 starts, of those 17 have been on programme for 3 months or more • 15 non starts: declined and non-eligible Reasons for non-start on programme: • Referrers failed to get full consent from client • Client didn’t meet all entry criteria • Clients change their minds once back out in the community • Alcohol did not present as main issue (inappropriate referrals) • Our service duplicated or was incompatible with other service(s) already being accessed by client

8. Client Group Profile • Average age 41-55 • 88% are Male • 92% are White of which: 72% White British, 12% White Irish and 8% White Other • 36% of clients are council tenants, 32% of clients are homeless or in temporary accommodation • 96% are unemployed • 76% are single, divorced, separated or widowed. Only 24% are married, cohabiting or other type of relationship

9. Client GroupKey Presenting Issues Health Social Family Exclusion Mental Health TB Cirrhosis of the liver Social Exclusion Dementia Homelessness Alzheimers Heart Failure Unemployment COPD Diabetes Schizophrenia Financial Hardship Housing Korsakoffs

10. Client Group Profile on entry How many years client had been alcohol dependent

11. Client Group Profile on entry

12. Project Delivery Delivery Methodology Based on 5 key principles: Principle 1 - Flexible engagement Principle 2 - Multiple engagements Principle 3 - Facilitated and rapid access to services Principle 4 - Coordinated approach to care Principle 5 - Holistic approach to meeting needs

13. Access to medically assisted withdrawal Project Delivery Direct Support in engaging with services Community case management & care assessment Services & Pathways Facilitating Multi-agency intervention Single point of contact Intensive Alcohol Project Psychosocial Interventions Facilitated Frequent Contact Referral to other specialist services Comprehensive assessment of needs

14. Project Delivery Base line data • Client referral details • Alcohol consumption • Client’s last period of abstinence • Physical health • Mental health • A&E admissions: planned/unplanned • Hospital admissions: planned/unplanned • Contact with alcohol treatment services • Pattern of engagement with Primary Care services (e.g. GP etc) • Social needs

15. Client Support Structure Project Delivery RED AMBER GREEN Daily Weekly Monthly Level of Support

16. Project Delivery Project SupportVolunteers • Befriend & mentor dependant drinkers • Contribute to a reduction in alcohol related unplanned admissions • Proactively seek to engage & sustain dependent drinkers in treatment • Volunteers, together with the co-ordinator, would also offer to accompany a client to the service. • Volunteers aspirations

17. Outcomes and Achievements Hard Outcomes • Reduction in Alcohol Consumption – 82% (14/17) • Improvement in Managing Medicine – 76% (13/17) • Improved Housing – 76% (13/17) • Improvement In Diet – 82% (14/17) • Improvement In BMI – 59% (10/17) • Number of clients into sustained treatment – 47% (8/17) • Number of clients completed rag status – 58% (10/17) Soft Outcomes • Improved risk awareness • Improvement in help seeking behaviour • Improved contact with health services • Better informed about services • Help with finance and debts • Feeling less isolated • More relaxed and improved well-being • Improved family relationship

18. Key Lessons Communication and partnership Proactive methodology Value of service Collaboration between medical staff and project worker Structured process/programme Research

19. Data on utilisation of acute health care by 10 clients engaged with ICM project compares 6 months pre and 6 months post engagement • Initial analysis indicates: • A 60% reduction in ambulance call outs • A 60% reduction in A&E attendances • A 35% reduction in unplanned admissions • A 30% increase in planned admissions • A 26% reduction in occupied bed nights

20. Evaluation and Client Feedback Six service users were interviewed by Adrian Brown • A simple rating scale had been developed to score some aspects of the service which the project workers felt highlighted their benefits for their clients. • These aspects were: • Health behaviour, 6 questions • risk awareness, 4 questions • family, 4 questions • housing, 4 questions • help-seeking behaviour, 6 questions • contact with health services, 5 questions • A total of 29 areas within these subjects.

21. Evaluation and Client Feedback Health behaviour “I was very rarely eating. Danny encouraged me to eat fruit”. “They made me aware that there were health problems”. Risk awareness

22. Evaluation and Client Feedback Help-seeking behaviour “As soon as I walked out of hospital (in the past) I relapsed, but this time they were there”. “They helped me to get 9/10 confidence in achieving abstinence”. Family “My wife gave me an ultimatum to leave, I had to sleep in the box room. Now we are moving into a new home, she is well-pleased”. Housing & home “I used to get different people every day for home help, dial a ride and so on - they helped make this less people”. “I had been behind on my rent and had a seven days warning”. Contact with health services “They have helped me go to the medical appointments”.

23. Evaluation and Client Feedback • What do you value most about the service? • Nothing is too much for them. They would phone me at home, so I knew support was there. They cycled to my house! • They remind me and come with me for hospital appointments. Sometimes I would not have the money. When I did not understand the doctor they explained things to me. • If I have any queries I can’t cope with, they help me sort out those problems. They helped coordinate all these people involved with me – I don’t know where they are all from! • What would you want to tell anyone about them? • “When you are using drugs you think you can cope but it’s a twisted sort of coping. They straighten you out.”

24. Future Building on the model Conclusion The ICM project has the potential to both reduce the overall utilisation of acute health care and deliver a shift towards more planned care and completed treatment episodes.

25. Contact Details DANNY HECKMAN Alcohol Intensive Case Management Worker Tel: 0208 875 4400 Mobile: 0794 773079 Email:danny@wdp-drugs.org.uk