hse addiction services

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HSE Addiction Services HSE Addiction Services Northern Area: Northern Area: LHO, Dublin Central. LHO, Dublin Central. LHO, Dublin North West, LHO, Dublin North West, LHO, Dublin North East LHO, Dublin North East Dr.Siobhan Rooney: Dr.Siobhan Rooney: Consultant Psychiatrist Consultant Psychiatrist in Addictions in Addictions Dr.Des Crowley: GP Co- Dr.Des Crowley: GP Co- Ordinator Ordinator

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Page 1: Hse addiction services

HSE Addiction Services HSE Addiction Services Northern Area:Northern Area:

LHO, Dublin Central.LHO, Dublin Central.LHO, Dublin North West,LHO, Dublin North West,LHO, Dublin North EastLHO, Dublin North East

Dr.Siobhan Rooney: Consultant Dr.Siobhan Rooney: Consultant Psychiatrist in AddictionsPsychiatrist in Addictions

Dr.Des Crowley: GP Co-OrdinatorDr.Des Crowley: GP Co-Ordinator

Page 2: Hse addiction services

Content.Content.

• IntroductionIntroduction• Historical Development of Addiction Services Historical Development of Addiction Services

and the Numbers attending the Addiction and the Numbers attending the Addiction Services in the Northern Area over the years.Services in the Northern Area over the years.

• Current Services and numbers attending.Current Services and numbers attending.• 4 Tier Service4 Tier Service• Service User’s Pathway and Services availableService User’s Pathway and Services available• Current ChallengesCurrent Challenges

Page 3: Hse addiction services

Historical Development of Addiction Historical Development of Addiction Services.Services.

Developed as a harm reduction service in Developed as a harm reduction service in response to HIV epidemic in Dublin in the response to HIV epidemic in Dublin in the late eighties/early ninetieslate eighties/early nineties

Enormous community opposition to the Enormous community opposition to the development of services.development of services.

Services developed in an Ad hoc Services developed in an Ad hoc bases/facilities often no suitable for bases/facilities often no suitable for purpose /purpose /

Page 4: Hse addiction services

Numbers registered on the Central Treatment Numbers registered on the Central Treatment List:List:

1994 - 20091994 - 20091994 1995 1996 1997 1998 1999 2000 2001

15291529 22382238 29482948 42154215 54985498 54335433 61456145 71077107

2002 2003 2004 2005 2006 2007 2008 2009

75967596 81558155 83648364 89628962 94289428 97609760 1021310213 1066810668

Page 5: Hse addiction services

Numbers registered on the Central Treatment Numbers registered on the Central Treatment List:List:

1994 - 20091994 - 2009Numbers in Treatment: 1994-2009

0

2000

4000

6000

8000

10000

12000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Years: 1994-2009

Nu

mb

ers

Page 6: Hse addiction services

Current Services and Numbers Current Services and Numbers attendingattending

6 Drug Treatment Centres, 1 Mobile Clinic and a Central Pharmacy6 Drug Treatment Centres, 1 Mobile Clinic and a Central Pharmacy 13 Satellite Clinics. 13 Satellite Clinics. CTL: CTL: August 2010August 2010: : 2040 methadone2040 methadone patients attending with patients attending with 1997 1997

registered at the end of this period. 7 new cases registered.registered at the end of this period. 7 new cases registered. Waiting List: 9Waiting List: 9

LHO AreaLHO Area Dublin North WestDublin North West Dublin North Dublin North CentralCentral

Dublin North EastDublin North East

Attending DTCs, Attending DTCs, satellite clinics etc.satellite clinics etc.

631631 916916 493493

Attending GPs: Attending GPs:

(65 GPs: Level 2: (65 GPs: Level 2: 18, Level 1: 47)18, Level 1: 47)

197197 453453 285285

Total: 935Total: 935

Community Community Pharmacists: 93Pharmacists: 93

591 (29 591 (29 Pharmacies)Pharmacies)

541 (n=25)541 (n=25) 584 (n= 39) 584 (n= 39)

Total: 1716Total: 1716

Page 7: Hse addiction services

Graph 1. Illustrates the number of Service Users attending the Graph 1. Illustrates the number of Service Users attending the DTC’s (Drug Treatment Centres) in the different area HSE.DTC’s (Drug Treatment Centres) in the different area HSE.

Number of Service Users attending DTC's

568

654

148

0

100

200

300

400

500

600

700

Dublin NorthWest

Dublin NorthCentral

Dublin North

Dublin North West

Dublin North Central

Dublin North

Total: 1370

Page 8: Hse addiction services

Graph 2. Illustrates the number of Service Users Graph 2. Illustrates the number of Service Users attending the Satellite Clinics.attending the Satellite Clinics.

Number of Service Users attending Satelite Clinics

63

261

319

0

50

100

150

200

250

300

350

Dublin NorthWest

Dublin NorthCentral

Dublin North

Dublin North West

Dublin North Central

Dublin North

Total: 643

Page 9: Hse addiction services

The Drug Treatment Centre BoardThe Drug Treatment Centre Board

Tertiary Service.Tertiary Service. Patients: Patients:

Dual Diagnosis / Co-morbid Psychological morbidity: Dual Diagnosis / Co-morbid Psychological morbidity: Anxiety and depressive disorders, PTSD, Personality Anxiety and depressive disorders, PTSD, Personality Disorders. Psychotic Disorders, Major Mental IllnessDisorders. Psychotic Disorders, Major Mental Illness

Challenging and aggressive behavioursChallenging and aggressive behaviours HomelessHomeless Service provision for areas not covered in the Service provision for areas not covered in the

community by DTCs / Satellite Clinicscommunity by DTCs / Satellite Clinics Young Person’s ProgrammeYoung Person’s Programme

Page 10: Hse addiction services

CCACCA GenderGender During During PeriodPeriod

End of End of periodperiod

NewNew

66 mm 5858 5454 11

LHO Dublin ff 3434 3232 00

North West Total 92 86 1

77 MM 7777 7171 11

LHO Dublin ff 3737 3333 00

Central Total 114 104 1

88 MM 3333 3030 00

LHO Dublin ff 1010 99 00

North East Total 43 39 0

Summary Total

MM 168168 155155 22

FF 8181 7474 00

Total 249 229 2

Numbers attending the DTCB, September 2010

Page 11: Hse addiction services

Services:Services: Primary Care Services:Primary Care Services: Level 1 and 2 GPs, Community Pharmacies Level 1 and 2 GPs, Community Pharmacies Specialist Multidisciplinary Teams:Specialist Multidisciplinary Teams:

Drug Treatment Clinics, Satellite clinics, DTCBDrug Treatment Clinics, Satellite clinics, DTCB SASSY TeamSASSY Team Needle ExchangesNeedle Exchanges

Rehabilitation ServicesRehabilitation Services Talbot CentreTalbot Centre Soilse.Soilse.

Inpatient Residential ServicesInpatient Residential Services Inpatient Drug Treatment Units: Cuan Dara / St.Michaels Ward, Inpatient Drug Treatment Units: Cuan Dara / St.Michaels Ward,

Beaumount Hospital.Beaumount Hospital.• Stabilisation ProgrammesStabilisation Programmes• Detoxification ProgrammesDetoxification Programmes

Residential Rehabilitation Unit:Residential Rehabilitation Unit: Keltoi Keltoi

Page 12: Hse addiction services

Framework Concepts

• 4 - Tier Model of Interventions

– Service users may receive interventions from 1 of all tiers over the course of their rehabilitation

TIER 1Interventions where

main focus is not drug treatment

TIER 2Drug-relatedInterventions

TIER 3Specialist Drug-related

Interventions

TIER 4Specialist Dedicated

Inpatient or ResidentialUnits or Wards

Family Support Social Care

Pharmacies CommunityBased

Job Prison Community EducationSeeking Setting Setting Services

Skills

Primary Care Outreach

Hospital Setting

Specialist AddictionServices

Vocational Criminal Justice Training & Probation

Services

General Healthcare Setting

Page 13: Hse addiction services

Services:Services: PreventionPrevention ++ Treatment Treatment + + RehabilitationRehabilitation Educational Officers:Educational Officers:

Interagency CollaborationInteragency Collaboration Primary Prevention , Harm Reduction, Tertiary Prevention Primary Prevention , Harm Reduction, Tertiary Prevention 4 Health Promoting Settings.4 Health Promoting Settings.

• Schools and YouthSchools and Youth• CommunityCommunity• WorkplaceWorkplace• Addiction Service.Addiction Service.

Page 14: Hse addiction services

Client Referral and Pathways: Drug Treatment Client Referral and Pathways: Drug Treatment Clinic in the communityClinic in the community

Service User: Opiate / Cocaine

Initial Assessment: Nurse, Counsellor, GP,

CWO, Urinalysis

Discussion at clinical team meeting:

Referrals to other members of the team and external

referrals

Referral to Other HSE Addiction Rehabilitation Services:Talbot Centre, Soilse.Residential Inpatient + Rehabilitation Services

Referrals: Self, Family +Friends, GPs, Social Services, Statutory, Community Services, Outreach, Prisons, Hospitals, Psychiatric services, Maternity Services

Referral to other services: i.e. SASSY Team, Addiction

Psychiatry

MDT Team: GPs, Nurse, Counsellors, Consultant Psychiatrist, Rehabilitation Integration Service, Outreach, CWO, Hepatitis C Nurse, Liaison Mid-wife,

Sen.GA, Pharmacists

Page 15: Hse addiction services

““Menu of Services” Menu of Services” Biological:Biological:

Medications / Substitution Treatments. Maintenance and Medications / Substitution Treatments. Maintenance and detoxification programmesdetoxification programmes

UrinalysisUrinalysis Viral screening and vaccinations,.Viral screening and vaccinations,.

Psychological: Psychological: Comprehensive Psychiatric assessment and Treatment Plan Comprehensive Psychiatric assessment and Treatment Plan Counselling and evidence based counselling interventions.Counselling and evidence based counselling interventions. Psycho-Social and RehabilitationPsycho-Social and Rehabilitation Rehabilitation Integration Services: Comprehensive assessment Rehabilitation Integration Services: Comprehensive assessment

and Care –plan: Focusing on rehabilitation i.e. training schemes, and Care –plan: Focusing on rehabilitation i.e. training schemes, CEE schemes, accommodation issues, support in preparation for CEE schemes, accommodation issues, support in preparation for detoxification and residential treatment and rehabilitation. detoxification and residential treatment and rehabilitation.

CWO: in 1 LHO area: Advising on benefits and advocating for CWO: in 1 LHO area: Advising on benefits and advocating for clients in being able to access benefits.clients in being able to access benefits.

Greater need for family involvementGreater need for family involvement

Page 16: Hse addiction services

Client Referral and Pathway:Client Referral and Pathway:Soilse: Soilse: Rehabilitation Day Programme: Rehabilitation Day Programme:

Goals: Stabilisation of Drug Use and Detoxification.Goals: Stabilisation of Drug Use and Detoxification.

Service User

Team + Activities: Keyworker, Educators,

counsellors, Career Guidance, Literacy, Health+Fitness, Art,

Drama, creative pursuits

Comprehensive assessment: Appointed Key worker and development of Care-plan.

Preparation for detoxification, Personal development. 1:1 and

Group work

Interagency Working Rehabilitation Integration Services, residential drug

treatment units and residential rehabilitation Units.

Partnership: Soilse: Rutland

Referral: Self, rehabilitation Integration Services, Treating clinic team, Probation etc as per

treatment clinic.

Page 17: Hse addiction services

The Talbot Centre:The Talbot Centre: is a dedicated Prevention service for children, young people is a dedicated Prevention service for children, young people and their families whose lives have been affected by drugs / alcohol in the North Inner and their families whose lives have been affected by drugs / alcohol in the North Inner

City.City.

Client / Service User/ Family

Team: 1 Education Officer, Project Leaders

x 2 (1WTE)3 Project Workers

Comprehensive assessment

Allocated Keyworker and development of

Care-Plan

Collaboration, Interagency Working. Case -managementEducational: PreventionAdvocacy, Counselling, Family Therapy, Outreach

Referrals: Family, community groups, SASSY Team, Social

Workers, Crinian Project, JLOs. Courts, residential Care Centres, Family Support Network, LDTFs

Page 18: Hse addiction services

S.A.S.S.Y. (S.A.S.S.Y. (SSubstance ubstance AAbuse buse SService ervice SSpecific to pecific to YYouthouth) Team) Team

1 1 psychiatristpsychiatrist + 0.6 + 0.6 counsellorcounsellorLack of staff severe Lack of staff severe Cover Cover all North Dublinall North Dublin city & city &

countycounty Assess and treat Assess and treat all U-18all U-18 drug drug

and /or alcohol users from and /or alcohol users from catchment area (all drugs)catchment area (all drugs)

Do Do notnot need to be drug free to need to be drug free to attendattend

Assess Assess mental healthmental healthOffer 1:1 Offer 1:1 psychotherapypsychotherapyMedicationMedication if required if requiredAdvise re risky behavioursAdvise re risky behaviours

CBT / MI approachCBT / MI approach Multi-agency liaisonMulti-agency liaison Worked with Worked with 136136 last year last year 1 1 prison clinicprison clinic per week per week 2 sessions at 2 sessions at YPP DTCBYPP DTCB Advice & education role- often Advice & education role- often

country wide via phonecountry wide via phone High risk groupsHigh risk groups in care in care Early interventionEarly intervention for for

tomorrow’s problemstomorrow’s problems

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Inpatient Drug Treatment Units: Beaumount Hospital Inpatient Drug Treatment Units: Beaumount Hospital and Cuan Dara, Cherry Orchard Hospitaland Cuan Dara, Cherry Orchard Hospital

Stabilisation Programmes:Stabilisation Programmes: Maintain on methadone maintenanceMaintain on methadone maintenance Detox. from other drug / alcohol useDetox. from other drug / alcohol use

Detoxification ProgrammesDetoxification Programmes:: Detoxification from Methadone 40mg / 50mgDetoxification from Methadone 40mg / 50mg Has attended for counselling and has aftercare planHas attended for counselling and has aftercare plan St.Michael’s Ward: 4 weeksSt.Michael’s Ward: 4 weeks Cuan Dara: 6 weeks: 3 weeks medical detoxification, Cuan Dara: 6 weeks: 3 weeks medical detoxification,

3 weeks Drug Free3 weeks Drug Free 1:1 Counselling, Group Work1:1 Counselling, Group Work

Page 20: Hse addiction services

Keltoi: HSE Residential Rehabilitation Unit: Keltoi: HSE Residential Rehabilitation Unit: Drug Free, 8 Week Programme:Drug Free, 8 Week Programme:

Service User

Comprehensive assessment process:

Pre-admission group and urinalysis: Drug Free

Team and Supports: Manager, Keyworkers, residential care workers, counsellors, family

therapy, catering tutor (vacant),CWO, Educational

supports: VEC, Literacy, Fitness, gardening.

Allocated Keyworker and development of

care-plan:Living Skills and capacity building

Referrals: Self, Residential detoxification Units, Rehabilitation Day

Programmes, Rehabilitation Integration Services and

clinical teams, Community GPs

Aftercare: 2 years, 1:1 counselling. Supportive housing / step down facilities, Day Programmes. Ongoing liaison with other services

Page 21: Hse addiction services

Keltoi: Residential Drug Free Keltoi: Residential Drug Free Rehabilitation Unit.Rehabilitation Unit.

Feb. 2001 to Dec. 2009. Feb. 2001 to Dec. 2009. Total admissions: Total admissions: 414414, Total completed treatment: , Total completed treatment: 314314 Total No. of assessments:Total No. of assessments: 1278 1278

Since 2007: 90% Completion rateSince 2007: 90% Completion rate

Outcomes at 1-3 years and compared to other research.Outcomes at 1-3 years and compared to other research.

ResearchResearch Smyth et. al. Smyth et. al. (n=113, (n=113, Cuan Dara, inpatient Cuan Dara, inpatient detoxification unit)detoxification unit)

Rosie Study Rosie Study (Residential (Residential rehabilitation rehabilitation nationally: N=81)nationally: N=81)

Keltoi (Residential Keltoi (Residential rehabilitation n=85)rehabilitation n=85)

OutcomesOutcomes 23% free of opiates 23% free of opiates at 2-3 yearsat 2-3 years

41% free of all drugs 41% free of all drugs except alcohol at 1 except alcohol at 1

yearyear

60% free of all drugs 60% free of all drugs except alcohol except alcohol between 1 and 3 between 1 and 3 yearsyears

Page 22: Hse addiction services

The Continuum of Care

DetoxificationCuan Dara

LanternSt.Michaels

Education/training Community employmentBridge to the workplace

Harm Reduction /Stabilisation

SoilseC.D.T.sClinics

Residential rehabilitationKeltoi

CoolmineHigh ParkRutland

Day programmesSoilse

CoolmineA.C.R.G

AccommodationGeorges Hill

Peter Mc VerryGranby

Page 23: Hse addiction services

Future ChallengesFuture Challenges

Drug Treatment Clinics: Drug Treatment Clinics: Development of a Comprehensive Development of a Comprehensive

assessment assessment Key Worker assigned Key Worker assigned Development of a care plan.Development of a care plan.

Case Manager and case management if Case Manager and case management if required.required.

Greater Interagency Working grounded by Greater Interagency Working grounded by Interagency ProtocolsInteragency Protocols

Page 24: Hse addiction services

National Drug Rehabilitation Implementation Committee: Framework DocumentNational Drug Rehabilitation Implementation Committee: Framework Document

Aftercare

Transition Programmes

(e.g. structured

pre-induction)

Budgeting & Money

Management

FamilySupport &Childcare

Justice, Law and Criminal Issues

Support

Education&

Training,Personal

Development

Housing& Tenancy Support &

independent Living

Community Integration,

Social & Recreational

Activities

Employment (including

community employment),

Work Placements

General Health Services,

Health Promotion,

Mental, Physical and Intellectual

Disability etc

Drug SpecificInterventions

Service User

Page 25: Hse addiction services

Future ChallengesFuture Challenges

Change of PhilosophyChange of Philosophy Negative Public Image of servicesNegative Public Image of services Changing Needs of Service UsersChanging Needs of Service Users Financial Pressures and pressures of the Financial Pressures and pressures of the

MoratoriumMoratorium Homeless Strategy and impact on servicesHomeless Strategy and impact on services Reconfiguration of ServicesReconfiguration of Services

Page 26: Hse addiction services

Aims of ServicesAims of Services

To support Service users in services To support Service users in services based in their locality and at a Tier that based in their locality and at a Tier that meets their needs.meets their needs.

To promote stabilisation and detoxification To promote stabilisation and detoxification and transfer of service users to primary and transfer of service users to primary care services.care services.

Page 27: Hse addiction services

Thank YouThank You

QuestionsQuestions