Centre of Excellence by Bunoir

Tackling alcohol abuse

Out of crime and into service

Targeting offenders Strengthening workforces

Improving access treatment Respect and integrity

Responsiveness

D Estigmas T O X I F and I C Aequality TION Challenging Learning partnership

Delivering value for money

Improving wellbeing Promoting prevention STABILISATION

Accessibility Tackling alcohol abuse REHABILITATION

Drug treatment

Out of crime and into service

Targeting offenders Strengthening workforces

Improving access treatment

Responsiveness Challenging stigmas and equality Respect and integrity Learning partnership

Delivering value for money

Improving wellbeing Promoting prevention Drug treatment

Accessibility

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Ending dependency, transforming lives Ending dependency, transforming lives

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Contents 03 Introduction 04 The Partnership 05 The Commissioning Body 06 The Consortium 06 Inclusion Drug Alcohol Services 06 Phoenix Futures 07 Midland Heart 07 Rehabilitation and After Care Team (RACT) 08 The Centre of Excellence 10 The Staff Structure 10 Staff Structures â&#x20AC;&#x201C; organisational charts 10 RACT Team 11 Roles and Responsibilities 12 Accessing services 12 Referral and Assessment 13 Referral and Assessment Flowchart 14 The Treatment 14 Detoxification 14 Stabilisation 14 Preparation for Rehabilitation 14 Rehabilitation

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15 Moving Forward 15 Continuing Care

Introduction The Partnership Accessing services

communities

Ending dependency, transforming lives

adults and communities

working in partnership with service users

adults and communities

Ending dependency, transforming lives working in partnership with service users

Moving Forward

The Treatment

This document outlines the proposed treatment programme of activity within the Tier 4 â&#x20AC;&#x2DC;Centre of Excellenceâ&#x20AC;&#x2122;: a partnership between Birmingham Drug and Alcohol Action Team (BDAAT), Birmingham City Council (BCC), Inclusion Drug Alcohol Psychological Services, Phoenix Futures and adults and communities Midland Heart. adults and

The Centre of Excellence

Introduction

Ending dependency, transforming lives

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

South Staffordshire and Shropshire Healthcare

NHS Foundation Trust

working in partnership with service users

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

working in partnership with service users South Staffordshire and Shropshire Healthcare NHS Foundation Trust

adults and communities

South Staffordshire and Shropshire Healthcare

NHS Foundation Trust

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

Ending dependency, transforming lives

South Staffordshire and Shropshire Healthcare NHS Foundation Trust working in partnership with service users

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

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Moving Forward The Treatment Accessing services The Centre of Excellence The Partnership Introduction P A G E 4

The Partnership Birmingham Drug and Alcohol Action Team (BDAAT) and Birmingham City Council secured capital funding from the National Drug Treatment Agency (NTA) that led to the development of the ‘Centre of Excellence’, a creative and innovative approach to residential drug and alcohol treatment due to open in May 2010. This led to the creation of a consortium: •

Inclusion Drug Alcohol Services, part of South Staffordshire and Shropshire Healthcare NHS Foundation Trust.

•

Phoenix Futures - who successfully gained the contract to provide specialist treatment intervention services.

•

Midland Heart - who provide the premises.

Introduction The Partnership The Centre of Excellence Accessing services The Treatment Moving Forward

The Commissioning Body Birmingham Drug and Alcohol Action Team (BDAAT) is part of both the Safer Birmingham Partnership and Health and Well Being Partnership. It is comprised of all the main statutory agencies including Health, Birmingham City Council, Primary Care Trusts, National Offender Management Service, Prisons and Voluntary Service. BDAAT commissions drug and alcohol treatment services on behalf of the partnership. BDAATâ&#x20AC;&#x2122;s remit is to reduce the harm caused by drugs and alcohol in order to improve health and wellbeing. BDAAT approaches this through strategic co-ordination, collaborative action, pooled resource investment, and the commissioning of evidence based, effective, quality services.

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BDAAT oversees the quality of treatment provided and assesses what is needed each year through a Needs Assessment and Treatment Planning process. The aim is to ensure that drug and alcohol users are given safe and appropriate treatment options that can support them to overcome their addiction issues in the long term.

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Inclusion Drug Alcohol Services South Staffordshire and Shropshire Healthcare NHS Foundation Trust achieved â&#x20AC;&#x2DC;Foundation Trust of the Yearâ&#x20AC;&#x2122; in 2008. Since it was established in 2001 when three smaller Trusts joined together, the Trust has provided mental health and drug and alcohol services which link health and social care responses to service users and criminal justice needs. Inclusion Drug Alcohol Services is part of the Specialist Services Directorate of the Trust. Inclusion was established in 2002 to meet the needs of people with drug and alcohol issues.

The Treatment Accessing services The Centre of Excellence The Partnership Introduction

The Consortium

Inclusion currently provides a range of drug alcohol services within prisons and the community. We work in prisons across the Midlands and South of England, providing community services in Birmingham and Swindon. We also provide psychological therapies throughout the city of Liverpool.

Phoenix Futures Phoenix Futures is the leading provider of care and rehabilitation services for people with drug and alcohol problems in the UK. Through 40 years experience of transforming lives we have developed a diverse portfolio of services across community, prisons and residential settings. As a national charity treating over 13,000 people a year for substance misuse, we are a leading provider of rehabilitation services. Phoenix Futures runs residential rehabilitation services across the UK, including adult services in Sheffield, Wirral, Tyneside, Glasgow and Hampshire; a women only service at Portland House (Newark); and two family services based at Sheffield and Brighton.

adults and communities

Ending dependency, transforming lives

adults and communities

Inclusion works within clinical guidelines and recognised models of good practice to deliver services that aim to minimise drug/alcohol related harm forworking drug/alcohol users in partnership with service usersand their families and the wider community. We place a high emphasis on involving service users, their families and their South Staffordshire and Shropshire Healthcare friends when developing services. NHS Foundation Trust

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working in partnership with service users

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South Staffordshire and Shropshire Healthcare NHS Foundation Trust

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working in partnership with service users

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

Introduction The Partnership

Rehabilitation and After Care Team (RACT)

We are passionate about communities and our vision is to create opportunity, enthuse residents and become one of the most efficient providers of affordable housing and community investment services.

We are proud to work in collaboration with service users, their parents and carers, and as a result have developed many individual bespoke programmes, which in turn have fostered a thriving peer support group network. This, we believe, is due to our unique continuing care programming.

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The RACT is part of the Vulnerable Adults Division, which is in the Adults and Communities Directorate. We believe a multi-disciplinary perspective allows us to work flexibly, in partnership with all substance misuse treatment providers in Birmingham.

The Treatment

Birmingham City Council has been providing defined substance misuse residential rehabilitation services for over fifteen years. The RACT has grown incrementally in that time and now provides a comprehensive substance misuse service, specialising in assessment for rehabilitation programmes and, following residential treatment, continuity of care to support on-going recovery.

Accessing services

Midland Heart is one of the top ten regeneration groups in the country and the largest based in the Midlands. Every year we invest more than ÂŁ100 million in improving homes, building new ones and making neighbourhoods more desirable and sought after places to live.

The Centre of Excellence

Midland Heart

adults and communities Ending dependency, transforming lives

working in partnership with service users

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

adults and communities South Staffordshire and Shropshire Healthcare

Ending dependency, transforming lives

NHS Foundation Trust working in partnership with service users

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South Staffordshire and Shropshire Healthcare

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Heart will be located at 15 Park Road South, Hockley, Birmingham. The building is due to be completed by May 2010. It will house the delivery of stabilisation, detoxification and rehabilitation treatment interventions

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Introduction

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on a residential and community basis.

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The 18-bedded unit provided by Midland

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Moving Forward The Treatment Accessing services

Inclusion Drug Alcohol Services, Phoenix Futures and Birmingham City Council Adults and Communities Directorate, will combine their resources of six distinct staff skill groups to provide residential and community treatment intervention services to drug and alcohol service users in need of Tier 4 treatment in Birmingham. The staff skill groups will include nursing staff (RMN and RGN), medical and psychiatric doctors, rehabilitation workers, social workers, clinical psychologists and peer supporters. All staff will receive a structured induction. They are required to participate in mandatory training and additional specialist training in the various addictions and issues that may present. All staff will be DANOS competent and will have or be working towards a minimum NVQ 3 qualification. Three organisations will be working together in partnership in the Centre to deliver a multidisciplinary approach to managing the health, social and therapeutic intervention of the clients that receive treatment on a residential and a community day care basis. The charts and table overleaf illustrate staffing structures within the new service, and the roles and overall responsibilities of the professionals involved.

Staff Structures â&#x20AC;&#x201C; organisational charts INCLUSION

PHOENIX FUTURES Service Manager 1.0 FTE

Service Manager Band 8a

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The Centre of Excellence

The Staff Structure

Administrator 0.5 WTE

Administrator 1.0 WTE

Nurse Team Manager 1.0 WTE Band 7

Lead Specialist Prescriber 0.5 WTE

Clinical Psychologist 0.5 WTE Band 8b

Team Manager 1.0 FTE

Nurse Team Leader 1.0 WTE Band 6

Specialist Prescriber 0.4 WTE/Sessions

Clinical Psychologist Assistant 1.0 WTE

Drug Workers 5.5 FTE

Nurses 7.0 WTE

Sessional Workers 10hrs/FTE

Health & Social Care Workers 6.0 WTE

RACT Team

Substance Misuse Operations Manager 0.5 WTE

Manager Holly Road 1.0 WTE

Team Manager 0.5 WTE (Covered by Senior Prac.)

Senior Social Worker (AMHP) 1.0 WTE

Senior Practitioner (AMHP) 0.5 WTE

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Administrator 1.0 WTE

Senior Social Worker (AMHP) 1.0 WTE

Senior Social Worker 1.0 WTE

Social Worker 1.0 WTE

AREA OF RESPONSIBILITY Inclusion Drug Alcohol Services

Inclusion Service Manager

Nurse Team Leader Lead Prescriber

Specialist Prescriber

Nurses

Health and Social Care Workers

Reception and administration for the Centre of Excellence and ensuring that the unit runs efficiently Provision of specialist medical care to service users

Providing specialist psychological interventions and provision of action research within the unit to provide continuous improvement Provision of low range psychological interventions and undertaking core action research activities

Round the clock nursing care to service users undergoing detoxification or stabilisation

Moving Forward

Assistant Psychologist Practitioner

Responsible for the high standards of clinical practice and service user safety within the unit

The Treatment

Principal Clinical Psychologist

Responsible for ensuring that service user care and the team are fully supported

Accessing services

Administrator

Day to day management of the clinical services and ensuring the highest levels of clinical practice is maintained

The Centre of Excellence

Nurse Team Manager

Overall responsibility for the units operation, partnerships and strategic development

The Partnership

ROLE

Introduction

Roles and Responsibilities

Responsible for day to day social support and activities within the centre

Phoenix Futures Administrator Service Manager

Team Manager

Rehabilitation Workers

Reception and administration for the Centre of Excellence Ensuring that leadership and management of the rehabilitation treatment services, in conjunction with our partners, are provided to the highest possible standards and ensure that the treatment approaches and interventions are appropriate, innovative and fully meet the needs of both clients and stakeholders Management of the multi-disciplinary team responsible for the delivery of a comprehensive rehabilitation programme with emphasis on assisting residents transition back into independent living within the community Responsible for the delivery, development, and evaluation of the core therapeutic programme make sure that residents' care plan targets are met ensuring a smooth transition into independent living Rehabilitation and After Care Team

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Responsible for the initial assessment into the Rehabilitation Programme to ensure Community Care Act/FACS Banding & Financial compliance. Undertaking a 28 day review and involvement in the Discharge Planning Review. Responsible for After-Care Planning, providing Care Co-ordination following completion of residential treatment

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Social Workers

Moving Forward The Treatment

Accessing services The Centre will work closely with treatment providers, service users, their families and carers to share knowledge and understanding on treatment criteria, access into treatment, treatment interventions

Accessing services

ensure that information is readily available and accessible to the

The Centre of Excellence

and activities. This will be achieved by using digital media to

This approach is intended to increase the knowledge of the

widest audience. In conjunction with this there will be stakeholders and service user’s involvement workshops, where they can participate in the shaping of the Tier 4 centre and its services.

Tier 4 service to referring agencies and service users. We are currently filming activities that will form part of

Introduction

The Partnership

the website to distribute the programme to all.

Referral and Assessment

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Processes must be adequate and streamlined to unlock resources and produce efficiency savings. Key to this is ensuring that clinicians and service users are informed about Tier 4 criteria and the programme. Considerable resources in terms of people and paperwork can be expended on inappropriate referrals and duplication of processes leading potentially to blockages, an unsatisfactory service user experience and inter agency tensions.

In order to minimise delays in processing referral forms, treatment providers will need to ensure that the following documentation is provided:

The flowchart on the next page illustrates how the referral process will enable treatment providers to access the Tier 4 service.

• risk assessment

All referrals from professionals will be accepted for assessment. The service user will have a lead care coordinator in the community.

• ‘continuity of care’ plan for detox service users.

• comprehensive assessment • current care plan • a relapse plan

Introduction

Providers referral to unit

Inclusion medical assessment

Integrated assessment by Phoenix Futures and RACT

The Centre of Excellence

Service user screening and information session

Not suitable for unit â&#x20AC;&#x201C; referred back to treatment provider

The Partnership

Referral and Assessment Flowchart

Accessing services

Intake Multi disciplinary meeting

Stabilisation

Rehabilitation

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Refer to continual care

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Detox

Prior to referral the treatment provider will need to ensure that they have identified a continual care plan and have contingency arrangements in place should the service user be discharged before treatment completion. This is crucial to managing risk for service users referred. Monitoring of the quality of referrals and level of additional information supplied will be recorded and fed back to commissioners and senior managers within treatment services to engender continuous improvement. On receipt of all the referral and appropriate information, service users will be invited to the preassessment clinic. Stabilisation referrals will automatically be deemed high risk and therefore fast-tracked to assessment and will not be expected to attend pre-assessment sessions. The pre-assessment clinic will be delivered by staff and peer supporters. It will act as a screening facility for the Tier 4 service and provide an opportunity for the service user to tour the facility and find out more about the treatments available and the expectations of treatment. During the visit service users will be given the opportunity to book assessment appointments. The residential assessment will be conducted by a multi-disciplinary team and include a medical and psycho-social assessment. A care plan will also be developed with the service user during this meeting identifying both the preparation and treatment needs of the individual. The assessing member of staff, in collaboration with the service user will agree the best package of care to meet the service userâ&#x20AC;&#x2122;s needs. A multi disciplinary team will decide on admission priority. The assessor will retain care-coordination responsibility of the service user throughout their treatment within the Centre in conjunction with the referral agency, who will retain overall care-coordination during the service userâ&#x20AC;&#x2122;s treatment journey, through to continuing care when they leave the Centre. P A G E 1 3

Moving Forward The Treatment Accessing services The Centre of Excellence The Partnership Introduction

The Treatment The drug and alcohol stabilisation and detoxification programmes go beyond medical or psychological treatment. Our aim is to facilitate social reintegration by providing a range of daily physical and cognitive activities that the service user can participate in whilst being stabilised and or detoxified. The rehabilitation programme will be flexible to accommodate residential or community based service users. It offers a short stay intensive therapeutic based service that will address self responsibility, self management, self understanding and self effectiveness to achieve an outcome of abstinence recovery from substance dependence. Detoxification This is a medical process which enables the body to become drug/alcohol free. All individuals are managed on a 24-hour basis by supervised and qualified staff. The time taken to complete this treatment is variable depending on the severity of problems and the profile of drugs the individual is trying to come off.

Stabilisation

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Stabilisation is a medically managed process for individuals in medical and psychological crisis, and who need structured medical care within a period of effective assessment and monitoring. All individuals are managed on a 24 hour basis by supervised and qualified staff. This process can take up to a week.

Preparation for Rehabilitation The aims of the preparation for rehabilitation are as follows: • Encourage service user responsibility for their rehabilitation plan and work with services in partnership to achieve this outcome. • One preparatory session which focuses on maximising service user responsibility by exploring their needs both during rehab and exiting rehab into recovery. • Within the above session the boundaries, house rules and disciplinary procedures are discussed and explained. The management of boredom is also explored with the service user. • This session covers the journey from rehab into recovery with a ‘what happens next’ which allows the service user to consider an alternative lifestyle free form substance misuse.

Rehabilitation The process of rehabilitation enables the individual to overcome social and psychological barriers to prevent reusing drugs and/ or alcohol. This includes learning about overcoming triggers and cravings, providing peer support and treatment provision in the prevention of relapse. This also includes facilitating entry into employment and training and most importantly identifying suitable accommodation and housing related support. Rehabilitation is a more complex psychological and social change that will typically continue long after the person has stopped experiencing physical effects and is the supportive process of protecting ex-substance users against the risk and temptation of relapse. The therapeutic model aims to fulfil a range of needs and provide a joined up ‘wraparound’ intervention.

Introduction The Partnership The Centre of Excellence

They will have maintained contact with their care-coordinator who made the referral. This will assist in the transition from Tier 4 to continuing aftercare. Structured pathways into supported housing facilities and floating support funded by Supporting People will be developed in partnership between the Tier 4 Centre and other providers to assist the transition for service users from Tier 4 into continuing care. The Centre will have its own peer support network, including a network for parents and carers of service users.

Moving Forward

Following treatment at the Centre service users will have planned departures into continuing supported treatment which will have been devised as part of their initial care plan.

The Treatment

Continuing Care

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Moving Forward

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PA R K H O U S E , 1 5 PA R K R O A D S O U T H , H O C K L E Y B 1 8 5 Q L

Tel: 0121 523 5940 Fax: 0121 523 5942

adults and communities Ending dependency, transforming lives

Birmingham Drug and Alcohol Action Team. Contact Mike Quinn â&#x20AC;&#x201C; telephone 0121 465 4980 working in partnership with service users

www.bdaat.co.uk South Staffordshire and Shropshire Healthcare NHS Foundation Trust