daap agm 30 november 2005

NTAMore treatment, better treatment, fairer treatment

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DAAP AGM 30 November 2005

Models of Care for Alcohol MisusersTrevor McCarthy

Senior Policy Officer: Alcohol


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Alcohol: It’s a drug Jim, but not as we know it.

Alcohol:It’s a drug Jim, but not as we know it.


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Treatment for Problem Drinkers

A. Physical health

B. Psychological adjustment

C. Vocational adjustment

D. Social adjustment

E. Interpersonal adjustment

F. Legal status and criminal activity

G. Poly-drug use, where relevant

H. HIV / Hepatitis risk taking, where relevantRaistrick D & Heather N 1998:

Review of the effectiveness of Treatment for Alcohol Problems. Unpublished report for DoH. Commissioning Standards. SMAS.1999


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National Alcohol Harm Reduction Strategy for England: 4 strands

1. Improved, better-targeted, education and communication

2. Better co-ordination and enforcement of existing powers against crime and disorder

3. Encourage industry to promote responsible use & take a role in reducing alcohol-related harm

4. Better identification & treatment of alcohol problems


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NTA Work to supportAlcohol Harm Reduction Strategy for England

Consult & develop Models of Care for Alcohol Misusers (MoCAM) – informed by national key stakeholder group

Commission ‘Review of the Effectiveness of Treatment for Alcohol Problems’ (includes BI & cost effectiveness)

Ambition: in partnership with Healthcare Commission develop criteria congruent with NHS standards for new review & inspection function

Complementary work e.g. Alcohol Needs Assessment Research Project (ANARP) and local Toolkits [DH]

Develop draft implementation strategy with DH


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What is MoCAM?

A framework describing what should be commissioned in each local area

Evidence based guidance Consensus based: professionals and service users Mainstreaming alcohol interventions to develop

integrated local alcohol treatment systems


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What is different?

Alcohol is more pervasive: higher levels of prevalence than drugs & more front line contact

No significant new money allocated Regional performance management not yet defined Links to crime and disorder qualitatively different UKATT isn’t NTORS – different evidence base Alcohol’s profile is on the rise


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Typology of drinkers

Severely-Dependent Problem Drinkers

Moderately-Dependent Problem Drinkers

Harmful Drinkers

Hazardous Drinkers

Low-Risk Drinkers

Abstainers

N.B. ‘Drinking patterns are not fixed for life’: Strategy Unit Interim Report 2004N.B. ‘Drinking patterns are not fixed for life’: Strategy Unit Interim Report 2004


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What is in Models of Care for Alcohol Misusers

4 Tiered model: following Models of Care Local systems for screening and assessment Adopting a stepped care approach Emphasis on care plans in structured care More explicit co-ordination of care for people with

multiple issues e.g. mental health, drug problems, homeless, domestic violence (young people)


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Stepped care approach to alcohol treatment

the least intrusive and expensive intervention that is likely to be effective is the first line of treatment, and more intensive services are offered only if the initial step proves inadequate

Sobell & Sobell 2000

Stepped care as a helpful concept which: Broadly describes existing service organisation Can inform commissioning strategies Applied flexibly would allow service users choice


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Alcohol Treatment System The 4 Tiers

Tier I: Mainstream Targeted screening Information and brief advice Referral “Shared care”

Tier 2: Mainstream or Specialist Open access or outreach Brief interventions & treatment assessment and referral “Shared Care”

Tier 3: Community Specialist Comprehensive assessment Care planned treatment Managed withdrawal Psycho-social treatments

Tier 4: Residential Specialist In-patient managed withdrawal

& psycho-social treatment Residential rehabilitation


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Implications for Tier 1: all frontline workers

Capacity building for Tier I: all staff enabled to:

Identify hazardous & harmful drinkers & those drinking over sensible limits

Provide information on low risk drinking Provide brief advice to reduce alcohol harm Make referrals for more intensive treatment


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Alan Cartwright. 1999.NDSAG Conference.

Role AdequacyRole Adequacy Role SupportRole Support

Therapeutic Therapeutic CommitmentCommitment

Therapeutic Therapeutic ProcessProcess


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Alan Cartwright. 1999.

NDSAG Conference.

Non Facilitative Non Facilitative BehaviourBehaviour

ResistantResistantService UserService User

Role Role InsecurityInsecurity

Poor Poor AllianceAlliance


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New Quality requirementscould look like …

Quality Criteria for Commissioners & Providers, ideally

to be reviewed or inspected by Healthcare Commission

New Commissioning Alcohol Treatment Systems Criteria

Commissioning Performance monitoring Meeting needs of a diverse population


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Quality requirements for providers could be …

Screening & Brief Interventions Assessment Care planning Evidence-based treatment Meeting needs of people with complex needs Exiting treatment: aftercare and support Managing alcohol services

In line with NHS Standards for Better Health 2004


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Which Drinkers?

NSFs Mental Health; Coronary Heart Disease; Older People; Diabetes & the Cancer Plan

Mental Health (Dual Diagnosis Good Practice Guide 2002; National Suicide Prevention Strategy)

Sexual Health (young people and risk)

Health Inequalities (HImPs, LSPs)


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MoCAM consultation

Phase 1: over 100 responses January 2005 Phase 2: over 100 responses – including key

stakeholders and series of events: providers, commissioners, users and carers

Most responses very favourable to MoCAM draft overall Most responses tended to have one main area where

they wanted more focus; some consensus emerged Concern expressed about availability of resources for

service provision and enhancement


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Consultation responses

Considerable variation from one liners to erudite essays – most completed pro-forma response sheet

Significant consensus for increased emphasis for family members and others affected and Domestic Abuse

Understandable concern about resources to enhance service provision and delivery

Evident that most of the responses represented a considerable amount of work, frequently involving several contributors


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Essential equipmentfor Commissioners:


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Commissioners’ In-Tray late 2005 / early 2006:

MoCAM – final text MoCAM Alcohol Treatment Pathways guidance Review of the Effectiveness of Treatment for

Alcohol Problems Summary of the Review ANARP Toolkit


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What next ?

Implementation strategy will be crucial Small amounts of new monies until 2008 / 2009 Defend existing alcohol treatment services Prioritisation or resources in next Spending Review Build commissioning structures and monitoring Increase alcohol competence in mainstream workforce Build support for families and users Encourage local alcohol champions

Pssst. Don’t tell anybody we told you this but …Tackling alcohol misuse will improve health.


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Do you need Glasses?

There are, it has been said, two types of people in the world. There are those who, when presented with a glass that

is exactly half full, say: this glass is half full. And then there are those who say:

this glass is half empty.

The world belongs, however, to those who can look at the glass and say:

‘What’s up with this glass? Excuse me? Excuse me? Excuse me? This is my glass? I don’t think so. My glass was full! And it was a bigger glass!’

TERRY PRATCHETT: The Truth


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Principles for Strategic Implementation of MoCAM

““Brains first Brains first and then and then Hard Work.”Hard Work.”

THE HOUSE AT POOH CORNERA. A. Milne

London 1928


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Here’s hoping…

““Help me to hope. But help Help me to hope. But help me not to hope too much”me not to hope too much”

MAGGIE GEE: My Cleaner. Saqi 2005

In 1969 I gave up In 1969 I gave up women and alcohol women and alcohol

and it was the and it was the worst 20 minutes worst 20 minutes

of my life.of my life.

Teenage Dreams So Hard To BeatTeenage Dreams So Hard To BeatTeenage Kicks – The UndertonesTeenage Kicks – The Undertones

daap agm 30 november 2005

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