Tier 3 Alcohol Service for Adults

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Tier 3 Alcohol Service for Adults

• A workshop on developing ideas for the best
  methods of service delivery

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Recent Key Documents that guide service delivery

• NICE guidance due in 2011 for
• Public Health Guidance
• Clinical Guidelines
• Clinical guidelines for alcohol use disorders
• 2. Alcohol Harm Reduction strategy 2004
• 3. MOCAM June 2006
• 4. Review of the Effectiveness of Treatment
  for alcohol problems Nov 2006

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Key Themes

• Mocam says
• Screening, brief interventions
• Equitable access to assessment and treatment
• Harm minimisation
• Assessment at appropriate skill levels
• Stepped Treatment and stages of change
• Treatment for SMI
• Through Care and aftercare
• Monitoring and evaluation

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Key Themes Treatment Modalities

• Project MATCH revealed a lot of unexpected
  things
• 12 step approaches and CBT as intensive
  treatments are no more or less effective than
  briefer treatment
• Mocam suggests that
• Research indicates there is a cumulative effect
  of a series of alcohol treatment episodes.
• Pochaska and and DiClementes Stages of Change
  Model suggests People need a cycle on average
  of eight episodes before lasting changes are
  established

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Broadening the Base of Alcohol Problems

• Suggests that Public health should promote
  healthy drinking patterns
• Hazardous and harmful should be dealt with in
  generalist Teams / environments
• Moderately to severely dependent should be dealt
  with in specialised teams /environments.

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Current Position in Derbyshire County

• Tier 2 provider well established in the north of
  the county in DAAS.
• Tier 2 has been provided by CAT (County Alcohol
  Team) in south recently.
• Tier 3 CAT across the county.

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Current Position in Derbyshire County
Tier 4 assessments for Rehab placements and
arranging admission if required by CAT CAT, upto
Jan 2008/09 roughly 1500 referrals that led to
around 740 treatment episodes. 1st Appt non
attendance 11.5 Follow-up non attendance
7.5 Service user reps involved in best practice
groups
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Referral PathwayPresent

• Open referral system
• Referral reaches CAT sectorised workforce so
  appropriate sub-team picks up referral. Duty
  worker available for comment daily.
• Referral to first assessment face to face
  currently averaging 17 days. Alcohol Concern,
  suggest a national target of 15 days (The Poor
  Relation, 2008)
• Client seen (in own home) comprehensive
  assessment, Risk management.
• Care plan negotiated with client.
• Carers encouraged to be involved.
• Treatment given delivered reviewed.
• Discharge planning.
• Treatment stepped down and referral on to other
  services if appropriate / available.

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Referral PathwayFuture
New plans for DAAS to act as hub for all
alcohol walk in / phone in enquiries. GPs and
other health social-care professionals to be
encouraged to speak directly with CAT duty worker
at Unity Mill 01773 829966
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Working With Other Services

• CMHT/CAHTT (CAHTT referrals received more
  frequently than CMHTs)
• DAAS
• Probation
• Hospital
• Social Inclusion Services
• Social Services (Safeguarding Children)
• Domestic Abuse Services

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Current Service positives as identified by
Service user and GP feedback

• One to one working
• Negotiated care plans and treatment goals
• High availability of Non Medical Prescribers
• Disulfram and Acamprosate available and shared
  care agreements in place.
• Availability of Qualified experienced duty-worker
  for more or less instant advice.
• Home based treatment for around 90 of clients
  Comparatively rapid access for treatment.
• Flexible into early evenings.
• Mobile workforce.
• Research based interventions delivered to alcohol
  dependant clients in the home, with stringent
  clinical governance framework in place.

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Current Service Deficits

• Lack of day care provision
• No county based rehab facilities.
• More community based social inclusion work
• Choose and Book.
• Education programmes for health and social care
  professionals could be improved
• Dual Diagnosis issues can complicate treatment
  pathways.
• Alcohol induced dementia
• Pabrinex at health centres.
• 7 day a week tier 3 access.

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Ideal Service Aspirations the Rolls Royce
Service

• Thinking back to Mocam and some of the issues we
  have raised, and any experiences you can bring,
  could you now spend 30 minutes in 2 small groups
  designing a Tier 3 service that would meet the
  needs of Derbyshire County as a whole, from
  Glossop to Swadlincote, Ashbourne to Long Eaton-
  if money was no object.

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In Closing

• Thanks for your comments we will endeavour to
  utilise them as best we are able.