Care Packages in Substance Misuse TreatmentCare Packages in Substance Misuse TreatmentDevelopment of MH Care Clusters: overviewDevelopment of MH Care Clusters: overview

Service users in MH, clinicians found:idiosyncratic referral pathways + conflicting views on priorities

+ differing views on effective treatment

idiosyncratic packages of care

Research Care Clusters + Clinical Decision Support Tool: Service users with similar needs same Care Cluster

Clustering based on dimensions, including:

■ type & severity of symptoms

■ complexity and chronicity of disorder

+ knowledge of case history (diagnostic and historical information)

standardised Packages of Care, based on needs

MH Care Clusters and Care PackagesMH Care Clusters and Care Packages

Clusters: developed common assessment tool (MH clustering tool)

allocate to appropriate ‘cluster’

begin to identify appropriate package of care

Care packages:

– Activities of Intervention 9 major categories, agreed aims of activities

– Care Packages combine ‘Core’ & ‘Additional’ elements of care

– Service Users with broadly similar needs receive the Core Elements in a Care Package + specific Additional Elements appropriate to their particular needs

– Elements are linked to NICE and other best practice guidance

Adapting the Care Packages approach to Substance MisuseAdapting the Care Packages approach to Substance Misuse

Same principles as in MH:

Service Users with broadly similar needs receive similar Care Packages

Combinations of evidence-based interventions to achieve intended outcomes

How to organise Care Clusters & Care Packages for Substance Misuse?

cluster on two dimensions:– primary substance

– complexity (incl. polydrug use, risk, social factors, mental health…)

5 main Care Packages, plus MH interventions in SM treatment:

■ opioid dependence (complex) ■ opioid dependence (non-complex)

■ alcohol dependence (complex) ■ alcohol dependence (non-complex)

■ other substance misuse ■ MH interventions in SM treatment

Substance Misuse Care PackagesSubstance Misuse Care Packages

Some Core and Additional elements (interventions) are common to ALL Care Packages

Other elements only appear in one or two Care Packages

Example Care Package: Complex Alcohol Dependence

Core elements specific to this care package:

– Alcohol dependence: detoxification prescribing (community)

– Alcohol dependence: B vitamin prescribing

– Alcohol dependence: relapse prevention prescribing

Additional elements for this care package, include:

– Opioid dependency - substitute prescribing: detoxification

– TIER 4 In-patient treatment

– Tier 4 Care co-ordination

CompetencesCompetences Care Packages combine elements delivered by different staff with

different competences

Psychosocial and other specialist competences: clarify ‘levels’ for elements of Care Packages

Draws on Routes to Recovery: Psychosocial Interventions for Drug Misuse, all relevant NICE guidance, UK Clinical guidelines

Keywork, keywork plus, specialist competences

What are ‘Recovery’ competences..?

Key skills and attributes of practitioners

Service culture

promotes ‘recovery values’ and attitudes in practitioners

structured approach to review and recovery planning