The Skills Consortium

The proposed ‘skills framework’

West Midlands workforce consultation event

1st November 2010

Overview

The context of workforce development-established and emerging

The Skills Consortium & the evolution of the skills framework

The framework

Resources & next steps

Context: Suite of evidence-based clinical guidance 2007

NICE: National Clinical Practice Guideline No. 51. Drug Misuse: Psychosocial Interventions

Orange: NICE and expert consensus

Contexts: Psychosocial Interventions

“Pharmacological treatments for cannabis and stimulant misuse are not well developed, and therefore psychosocial interventions are the mainstay of effective treatment.” (NICE 2007)

“Treatment for drug misuse should always involve a psychosocial component.” (DoH 2007)

“Psychological treatment has a role as important as substitute prescribing in treating opiate-dependent clients….” (NTA 2005)

“Both pharmacological interventions and psychosocial treatment are more effective when they work together in an integrated and harmonised manner.” (DoH 2006)

NICE 51 Key priorities for implementation

Brief interventions (structured feedback advice / motivational enhancement)

•Facilitated self-help

•Contingency Management (CM)

- targeting drug use

- targeting physical health compliance

•Behavioural couples therapy

•CBT for common mental illness (anxiety disorders and depression)

Orange went further- based on expert consensus

Motivational interviewingContingency Management (attendance, behavioural change and BBV)Low intensity interventions for common mental illness:

Computer-based CBTGuided Self-HelpRelaxation techniques

Relapse preventionMapping TechniquesCommunity Reinforcement ApproachBehavioural Couples TherapySocial Behaviour and Network TherapyCBT for depression and anxietyPsychodynamic Therapy

Does adding psychosocial therapy to OST improve outcomes?

• Ball and Ross’s study of methadone programs (1990)

• McLellan et al (1993) conducted a 24-week clinical trial involving 3 treatment groups:

– methadone with minimal counselling

– methadone plus moderate (i.e. more intensive) counselling

– methadone plus enhanced counselling (including on-site medical/psychiatric, employment, and family therapy)

• NTORS

– patients in MMT who received drug problem counselling sessions had significantly better heroin and cocaine outcomes than those receiving no counselling

+ NICE

The evidence generally indicates 3 key factors:

• Workers who have clear techniques achieve better outcomes

• Supervision and governance is key

• Outcomes are determined by the quality of the working alliance

Implementation

Whatever the skills / potential of individual practitioners, the evidence suggests that the

quality of the organisation has a more substantial impact on effective outcomes than

either the intervention chosen or worker involved

Manualised therapy

STICKING TO THE THERAPY MANUAL:

A HAPPY MEDIUM WORKS BEST

US study on dynamics of cocaine treatment found:

• counsellors who either strictly followed a counselling manual or largely ignored it had the worst outcomes

• departing from the therapeutic script without abandoning the overall structure seems a positive attribute .

Barber J.P. et al., 2006

For the NTA- the three ‘must do’s’

1. Organisational competence

2. Care coordination / case management competence

3. Deliver evidence based psycho-social interventions

The Skills Consortium and

the evolution of the skills framework

A brief history of the consortium

Convened to develop a sector led consensus on good practice and lead workforce development

For the sector, by the sector

Two large sector-wide stakeholder workshops in 2009

These tasked a smaller working group to develop the ideas and the constitution

‘Build it and they will come’

Large stakeholder group endorsed the framework in July

Executive now formed

November website launch

Recovery orientated systems

‘One of the key principles of a recovery-orientated model is it's integrated. That is, all of the constituent parts, all the various elements of a local system are co-coordinated, speak the same language, communicate with each other and have a congruous set of values and principles that orbit around the affirmative and empowering possibilities of recovery….

Every part of the system is involved in a collaborative effort to increase positive outcomes …….. allow greater flexibility and non-linear movement between system elements.’

NSPs in a recovery-orientated system,

Stephen Bamber

From this…….to this……..

HR, MI, ITEP, CM….. recovery communities………

The roots of the framework

Based on:

Previous guidance (Care Planning Practice Guide in particular)

NICE drug misuse guidance

2007 Clinical Guidelines

Informed by emerging thinking on recovery and personalisation.

It is also informed by ITEP, BTEI and ‘Recovery, Engagement and Life Skills’ model developed by TCU.

As interventions, approaches and technologies emerge it is anticipated that they can be absorbed by the framework.

Phases of treatment: Care Planning Guide

Stages of TreatmentStages of Treatment

RetentiRetentionon& &

ChangeChange

Early Early RecoveryRecovery

Changes in Changes in •ThinkingThinking• ActingActing

Early Early RecoveryRecovery

Changes in Changes in •ThinkingThinking• ActingActing

EarlyEarlyEngagementEngagement

• ParticipationParticipation• Therapeutic Therapeutic

Relationship Relationship

EarlyEarlyEngagementEngagement

• ParticipationParticipation• Therapeutic Therapeutic

Relationship Relationship

TreatmentTreatmentReadinessReadiness

::• Needs-Needs-

RisksRisks• SeveritySeverity• MotivatioMotivatio

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TreatmentTreatmentReadinessReadiness

::• Needs-Needs-

RisksRisks• SeveritySeverity• MotivatioMotivatio

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““TCU Mapping” Interventions for TCU Mapping” Interventions for Adaptive Treatment ProcessAdaptive Treatment Process

OrientationOrientation Re-EntryRe-Entry

MappingMappingJourneyJourney

WorkshopWorkshopfor Menfor Men

TransitionTransitionto Re-entryto Re-entry

Using ClientUsing ClientAssessmentsAssessments

MappingMapping Care PlansCare Plans

DownwardDownwardSpiralSpiral

Mapping Mapping ’’12 Steps12 Steps’’

ParentingParentingSkillsSkills

WorkshopWorkshopfor Womenfor Women

Treatment ATreatment A Treatment BTreatment B

PreparingPreparingfor Changefor Change

GettingGettingMotivatedMotivated

CM/RewardCM/RewardStrategiesStrategies

BuildingBuildingNetworksNetworks

BetterBetterCommComm

HIV RiskHIV RiskReductionReduction

UnlockingUnlockingThinkingThinking

ReducingReducingAngerAnger

© 2009

“TCU Mapping-Enhanced Counseling”

The Framework

Engagement Preparation Change Completion Reintegration

DeliveryDeliveryDeliveryDeliveryPreparationPreparationPreparationPreparation ChangeChangeChangeChange Completion Completion Completion Completion EngagementEngagementEngagementEngagement

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Comprehensive assessment incChild protectionRisk

Assessment/reassessment of recovery capital

Cataloguing strengths

Recovery/care planningCare coordination (if applicable)Risk managementCrisis managementHealth monitoring

AdvocacyCoachingPro-active engagement/re-engagementBuilding social networksHarm reduction

Multi-agency work, includingChild protectionMental health

Appropriate supported/facilitated referrals to:

Medical monitoring and healthcareMutual aidFinancial and legal adviceHousing, employment, education and training

The care plan should specify the detail of the case management interventions, as agreed with the service user.Case management and key working interventions may utilise mapping techniques and manuals to support their delivery.

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Care planned

Engagement Preparation Change Completion Reintegration

Comprehensive assessment incChild protectionRisk

Assessment/reassessment of recovery capital

Cataloguing strengths

Recovery/care planningCare coordination (if applicable)Risk managementCrisis managementHealth monitoring

AdvocacyPro-active engagement/re-engagementBuilding social networksHarm reduction

Multi-agency work, includingChild protectionMental health

Appropriate supported/facilitated referrals to:

Medical monitoring and healthcareMutual aidFinancial and legal adviceHousing, employment, education and training

The care plan should specify the detail of the case management interventions, as agreed with the service user.Case management and key working interventions may utilise mapping techniques and manuals to support their delivery.

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Resources

Design

Guidance and evidence

Manuals

Competencies

Training

Implementation

Shared Learning

In the mean time………

and the Psychosocial Interventions Resource Libraryhttp://www.nta.nhs.uk/PIRL.aspx

Skills Consortium Work Plan

Three strands:

• Populating the framework/ implementation/ early adopters

• Qualifications

• Evidence and research