nta recovery presentation 22/10/10 leeds/ cvh1 recovery in north lincs. presented by charlotte...

Nta recovery presentation 22/10/10 leeds/ CVH

1

Recovery in North Lincs.

Presented by Charlotte Harrison & Helen Kirk

from the Junction.

Supported by Ben Gow and Stephen Storrs


2

The Junction North Lincolnshire Legal partnership between RDASH and ADS.

Employ 24 staff of mixed disciplines Nurses, councillors, structured day programme workers, social

worker. Links to DIP, MH, BBV nurses, midwife, housing, probation,

Provide services for Core specialist drug treatments. Shared care within 9 satellite bases or GP surgeries

Support Multi disciplinary multi agency working within the locality


3

Background to pilot Largest shared care practice supported by experienced GP’s

supported by practice and Junction. Locality and commissioners refocusing on throughput. Staff energised by ITEP/ recovery training. Prime opportunity to respond to several drivers for progress and

change form strategic, local and staff level Proposal put to commissioners using the flexibility of the smaller

team at shared care – pilot agreed, naturally the next step for stable service users

Ongoing consideration to larger team, a service redesign was running concurrently in the core service.


4

What was the pilot?

Weekly clinic 1;1 work Key worker led To motivate service users to support teir aspirations and capabilities Small start planned to not be to resource intensive. Opportunity to trial ITEP mapping tools Specific recovery care plan for individualised needs Criteria used to identified clients initially. Contract devised in conjunction with service user panel


5

What did we offer?

Individualised care plans and named key working- one size does not fit all

Initial recovery capital assessment Flexible negotiated reductions for planned detoxification from

medication. Agreed plan for unmet needs. Sign posting, onward referral,

advocacy, accompany, peer mentoring. Involvement of significant others and family in planning, and

appointments and support.


6

What are the outcomes? Completed treatments month. Initial target for project 8 completed

discharges

Attendance figures 100% in q1 95% in q2

Numbers on pilot 20 at start now 50

Completed treatments

Planned discharges

Quarter 1 3Quarter 2 1Quarter 3 4+3 OCT


7

Service user feed back

“the worker really believed in me.” “the dentist referral is so important- your smile is

your face and everyone knows your past when your teeth are bad”

“please come to my house to meet my family- you have only seen me in your clinic and I am proud of what I have achieved”


8

Key findings – so far.

Therapeutic relationship is crucial to role- service users need to feel supported and empowered by worker.

Everyone has some recovery capital but the treatment approach needs to recognise where the service user is and adapt the intervention

Recovery is infectious- use successes to motivate other in to believing they can do it too Recovery champions Peer mentoring

Recovery needs to be introduced at the start of the treatment journey


9

Activity.

The next slide will be a model many people will be familiar with that explains how people develop, learn and achieve their own potential. It also suggests that this process will not the completed if there are deficits.

This model can be considered for service users journey and shows recovery is supported be research in many formats


10

Maslow model

What needs to be

In place for recovery


11

Do flip chart exercise

What needs to be in place for recovery?


12

Maslow model

What needs to be In place for recovery

Becoming a recovery championHope. Self belief, acceptance, hope.

detoxificationSupport, family, NA, AA Honesty. Daily activity with

purposeScript / abstinence from illicitHousing, prescribing, benefits.


13

Inclusion in treatment model

Concurrent review of service model allowed inclusion of 3 addition staff with relevant training in to the programme delivery

Staff with recovery experience have been linked to other disciplines as new model developed

Senior Recovery practitioner to support all staff through MDT process in locality for consistency.

Work in progress with commissioners to develop this further in other shared care clinics


14

Our ModelJUNCTION NEW CLIENT (see pathways induction and script initiation completed recovery concept is introduced and discussed throughout the treatment journey)

MDT Process Used to Design Holistic Care/ Recovery Plan for Phase of Treatment (Stabilisation, maintenance, recovery)Care/recovery plan to support progress to next phase e.g. Stabilisation to maintenance or recovery, incorporating where appropriate multi agency work, family and carer’s etc

RELAPSE (re assess)

Care co-ordinator ensures individual is linked in with Counselling / Prescribing/ Recovery Leads partner agencies etc as appropriate to their needs to enhance recovery capital and support progress to the next treatment phase

focus of care planning to increase recovery capital

Ready for RecoveryHighest recovery Capital reduced risk, may have progressed through treatment phases or short history of substance misuse

Maintenance Service user has a significant level of stability

states wants to be maintained at this point in time. Those in maintenance will have recovery re-discussed 6 monthly

StabilisationHighest risk, most complex needs, lower recovery capital needs intensive support to build confidence and recovery capital

Intensive recovery support Planned reduction regime If suitable for subutex or symptomatic detox support with this

OutcomesGood client experienceImproves family, and social networkingGrowth to community benefitLowering or stigma and increasing integrationChange in attitudes and outlookEnhanced Aspirations

Planned Treatment Exit

Referral to Shared Care Recovery


15

Most complex needs

Most complex. Dual needs Multi agency working Highest risk life style Ongoing chaotic drug use Limited capacity for recovery

at this point

Workers need to Aim to achieve stability and increase recovery capacity.

Assertive engagement Interagency working. Outreach, home visits Maintaining script whilst

addressing deficits in recovery capacity


16

Previously maintenance

Considered maintenance Some evidence of stability,

client may considers progress adequate.

Unwilling to consider prescription change

Fearful of change Entrenched behaviours that

prevent progress. Some unmet needs

Change achieved by Care plan for unmet needs as

specific goals. Engage in alternative context to

challenge perception, ie. motivational interviewing. ITEP

Recognise and build on success, ie, family support.

Use of recovery champion, peer mentoring , group support.


17

New in to treatment / detoxing

New entry clients- short drug using histories or detoxing currently

Low level use Not in treatment previously Previous successful treatment

exits Planned reductions

Consider subutex, or symptomatic detox,

Introduce recovery from inductions 1.1 support

Family support programme Plan time limited prescribing

by negotiation Maximise recovery potential Relapse prevention


18

Future development

Staff training Development of the recovery champion role Visioning with commissioners for future planning Measuring outcomes Celebrating successes Raising the profile of success – Promoting the development of recovery champions in to recovery

groups.


19

Thanks for your time…

Any Questions??

nta recovery presentation 22/10/10 leeds/ cvh1 recovery in north lincs. presented by charlotte...

Documents

recovery slide

nta recovery presentation

recovery experience

intervention recovery

recovery concept

leeds cvh1 recovery

recovery carerecovery

itep recovery training