“Patient Placement Criteria”

“Patient Placement Criteria” John Marsden NTA Senior Academic Advisor Reader in Addiction Psychology, Institute of Psychiatry, KCL National Residential Rehab Events - London 29th March 2011

Background • No “one size fits all” recovery pathway • Some people have strong preferences about their care • Wide differences in treatment needs • Evidence for layered or combination interventions • Single prescribing or psychosocial interventions • Combination prescribing and/or psychosocial packages • Evidence from the adaptive continuing care literature • Principle of changing direction if no therapeutic benefit

David Best UWS (chair) Nicola AdamsonWorcestershire Commissioning Karen BiggsPhoenix Futures Jayne BridgeMersey Care Wendy DawsonLey Community Ed Day Uni of Birmingham Vivienne EvansAdfam Jason GoughYorks. & Humber Service User Forum Kate HallGMW Linda HarrisWakefield & RCGP Dave KnightRCN PPC expert sub-group • Tom KirkwoodTTP • Tim LeightonAction on Addiction • Peter McDermottThe Alliance • DH observers: Mark Prunty & NTA project team • International correspondents: William White, Alexandre Laudet, Arthur Evans, Mike Dennis, Robert Ali, Steve Shoptaw, Min Zhou

Goal • Better matching of individuals to treatment packages • Promote clinical expertise and personal preference • Progressive treatment system; recovery-oriented • A wider array of evidence supported interventions

“PPC” in practice • Resource for personalising and optimising treatment • Screening for risk, need and preference • Adaptive care criteria (sequencing and layering) • Criteria for judging therapeutic response • Justification for specific intervention or continuing care

PPC – adaptive care criteria Screening process 4 individual specifiers: 1. Current recovery/treatment status 2. Substance use 3. Positive intervention preferences 4. Contra-indications

PPC individual specifiers Treatment Preferences ☐ Stay in local community ☐ Medication-assisted recovery ☐ Active involvement of social network in recovery plan ☐ Inpatient detoxification ☐ Intensive shorter or longer-term residential treatment in local area (1-12 months) ☐ Intensive shorter-term residential treatment away from locality (1-6 months) ☐ Intensive longer-term residential treatment away from locality (6-12 months) ☐ Preference to continue to work on recovery goals at same or different level of care

PPC individual specifiers • Contra-indications • ☐ Significant risk of domestic violence • ☐ Lack of drug-free partner/spouse • ☐ Significant cognitive impairment or learning difficulties • ☐ Active hepatitis or abnormal liver parameters • ☐ Unwilling/able to sustain the regularity of attendance required • ☐ Unwilling/able to comply with conditions of residence • ☐ Current or previous experience of psychosis • ☐ Unlikely to be able to maintain 24 hour abstinence in a day programme setting • ☐ In education, training or employment which is best maintained during treatment • ☐ Has dependants, no arrangements for care can be made or are inappropriate

3 domains 1. Severity(dependence, health, risk, neglect) 2. Complexity(response, environment) 3. Strengths(personal, social, economic)

18 PPC Dimensions Strengths (recovery capital) ☐Change motivation and therapeutic alliance ☐Quality of living situation ☐Supportive social network ☐Roles and responsibilities ☐Vocational skills and independence ☐Coping and outlook Severity and complexity ☐Physiological dependence ☐Psychological dependence ☐Overdose risk ☐Relationships and communication ☐General medical conditions ☐Psychological disorders ☐Personality factors ☐Trauma and stress ☐Criminal involvement ☐Risk and neglect ☐Treatment and recovery history ☐Recovery environment

PPC – taking it forward • Further development with field • Pilot testing • Monitoring and refinement • Does using produce better outcomes? • Incorporate outcome risk adjustment • Adjust for push and pull factors

“Patient Placement Criteria”