Community Drug and Alcohol Team

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Community Drug and Alcohol Team

• Mental Health Directorate
• Integrated Division
• Cwm Taf NHS Trust
• Paul Williams, Clinical Nurse Manager
• Lehane Ryland, CPN Team Leader

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Community Drug and Alcohol Team

• Tier 3 statutory service provider
• Community outpatient service
• Specialist substance misuse prescribing and harm
  minimisation service
• Treatment of drug and alcohol dependence and/or
  complex issues related to substance misuse

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Philosophy of Care

• The services of CDAT are client centred, and
  follow a harm minimisation ethos
• Holistic care, confidentiality, respect for
  individual autonomy, personal dignity and choice
  are paramount
• The engaging and retaining of clients in
  treatment is an essential component
• Current government strategies, frameworks,
  national and local policies, underpin the
  delivery of our service, based upon research and
  evidence based practice.

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Staffing

• Medical staff Consultant Psychiatrist
• Staff Grade
• SHO
• Nursing staff Clinical Nurse Manager
• Advanced Nurse
  Practitioner
• Team Leaders
• CPNs
• Support Workers
• Clinical Psychologist
• Administrative staff

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Referral Process

• Referral Form
• Single Point of Entry (SPOE)
• - multi agency process
• - weekly meeting
• - identify/prioritise need
• - referrals to other agencies

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Specialist Assessment

• Holistic assessment
• Medical and Nursing assessment
• Substance use - all lifetime and current use,
  triggers to use, availability, routes of use,
  withdrawal symptoms

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Specialist Assessment

• Physical health - impact of substance use, BBV
• screening/vaccination, medication, bloods, drug
  screening,
• BMI, clinical observations, nutrition, sexual
  health.
• Mental Health - impact of substance use, past
  and current
• diagnosis, medication, mental state examination,
  cognitive
• functioning.
• Social Functioning - personal and family
  history,
• children, employment, social environment.

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Specialist Assessment

• Forensic - past/current criminal activity.
• Past Treatment/Measures- what has helped
  before, clients strengths.
• Motivation - cycle of change.

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Specialist Assessment

• Clients Treatment Choice medication, goals.
• Risk Assessment - identify risk of
  aggression/violence, suicide/self harm, neglect
• Formulation of care plan agreed with client

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Complex Issues

• Co-occurring substance misuse/mental health
  problems (dual diagnosis)
• Child Protection/Child in Need
• Forensic
• POVA
• Chronic/severe physical health e.g. liver
  diseases cirrohsis,HCV,HBV,HIV,
• Pregnant Women
• IV drug use
• Poly drug use
• Chaotic/high risk behaviour

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Interventions

• Opiate Substitution Prescribing
  (maintenance/detox)
• Alcohol related prescribing
• Home Detox
• Clinic Detox
• Referral to in patient detox/rehabilitation

• Sexual Health clinic
• Consultant Midwife joint ante natal service
• BBV screening/specialist referral
• Needle Exchange

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Interventions

• Psychological assessment
• Motivational Interviewing
• Harm reduction
• Health promotion
• Relapse prevention
• Cognitive Behaviour Therapy

• Mental health interventions
• Community pharmacy liaison
• Community outreach work

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Benefits

• Improved communication
• Improved risk management
• Less admissions to hospital

• Appropriate intervention relating to diagnosis
  and competence
• Holistic care planning reflecting individual need
• Assertive approach to maintain engagement

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Benefits

• Less omissions/mistakes
• Rapid access to treatment in some cases
• Retention in treatment
• Seamless transfer between services

• Decrease in duplication of work
• Joint case files where appropriate
• General health improvement
• Improved outcomes for all aspects of care

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Partners

• Pharmacists
• GPs
• Midwives
• Health Visitors
• Substance Misuse Social Workers
• General medical/surgical staff

• Mental Health Services
• Sexual Health Services
• Voluntary Sector
• Childrens Services
• Service Users
• Psychologist

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Partners

• Drug Intervention Programmes
• Criminal Justice Services
• Forensic Services
• Commissioners Welsh Assembly Government

• POVA
• Police
• Probation
• Housing
• Domestic Abuse Teams

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Examples of Partnership Working with CDAT

• RCT GP Shared Care Scheme CDAT, GP, Drugaid
• Home Detoxification Service - CDAT, GP, Drugaid
• Alcohol Liaison Service CDAT, Local Authority,
  TEDS, District General Hospital

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Examples of Partnership Working with CDAT

• Antenatal Service Consultant Midwife, CDAT
• Safe Haven CDAT, Police, GP
• Sexual Health Service CDAT, Sexual Health
  Specialists

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Integrated Services

• MIDAS CDAT, Drugaid, Local Authority Social
  Worker Jointly located in Merthyr Tydfil
• RISMS CDAT, Drugaid, TEDS, Jointly located in
  Llwynypia
• Alcohol Liaison Service CDAT, TEDS, Local
  Authority Social Worker Jointly located in
  Church Village.

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• Thank you for your attention