ost capacity building, monitoring and mentoring
TRANSCRIPT
Additional Professor, NDDTC, AIIMS, New Delhi
Member: Strategic Advisory Group, IDU and HIV, United Nations
Member: Technical Resource Group, IDU - HIV, NACO, Govt. of India
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
What’s so special about OST?0 A Medical intervention 0 Involves providing a medication which
0 Has abuse liability of its own 0 Is controlled under the regulations
0 More technically intensive than other interventions 0 More resource intensive than other interventions
……Adequate capacities of service providers and adequate standards of services are critical
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Case study0 NACO OST Programme for IDUs (as HIV prevention)
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
NACO OST Programme: NGO ‘TI’ model
Govt. HOSPITAL
NGO TIDelivery of various harm reduction services: including NSEP and OST
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
NACO OST Programme: GO-NGO model
Govt. HOSPITALwith OST
NGO TIDelivery of various harm reduction services: including NSEP
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Case study0 NACO OST Programme for IDUs (as HIV prevention)0 Two models
0 NGO TI model 0 GO-NGO collaborative model
0 Human resources: Doctor, Nurse, Counselor, managerial staff
0 Critical requirements: 0 Capacity Building0 Quality Assurance
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
NACO OST Programme: Mechanisms for building capacities and ensuring quality
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Induction Training on OST0 A five day training programme 0 Conducted soon after recruitment of staff 0 Conducted for a mixed group of staff (nodal officers,
doctors, nurses, counselors, data managers, programme managers and outreach workers)
0 Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component
0 BASED UPON A MANUAL 0 Outcome:
0 Trained staff who begin service delivery after receiving a certificate
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Induction Training on OST0 A five day training programme 0 Conducted soon after recruitment of staff 0 Conducted for a mixed group of staff (nodal officers,
doctors, nurses, counselors, data managers, programme managers and outreach workers)
0 Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component
0 BASED UPON A MANUAL 0 Outcome:
0 Trained staff who begin service delivery after receiving a certificate
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Organization of the manual
Rajat Ray, Anju Dhawan, Atul Ambekar (2011), Implementing OST : A Training manual for service providers, NACO, Government of India, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
0Organization of the manual0Content 0Format
Organization of the manual
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Areas covered in the trainingDrugs, Drug Dependence, Harm Reduction, Principles of drug treatment, OST:
• Basic knowledge (and attitude)
Assessment and Diagnosis:
• Clinical skills
OST (induction, maintenance, dispensing):
• Clinical skills
Psycho-social interventions:
• Clinical skills
Exposure to a functioning OST centre
Programme management: Dispensing, record maintenance, stock keeping, reporting, referral and linkage:
• knowledge , attitude and skillsPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training sessions Day Sessions
Day 1
Introduction exercise: meeting strangers and building a rapportBasics of Drugs: Overview of drugs and drug use disordersDrug-related problems and harmsLocal drug abuse scenario – GROUP ACTIVITYGeneral principles of drug treatment and harm reduction
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day 2
Opioid substitution therapy – overview
Assessment and diagnosis
Assessment and diagnosis: ROLE-PLAY AND CASE DEMONSTRATION
Buprenorphine- pharmacology
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day 3
Implementing OST with buprenorphine: induction, stabilisation, discontinuationSpecial clinical situations – adolescents; women; HIV; other medical conditions, dual diagnosisPsychosocial interventionsROLE-PLAY / DEMONSTRATION OF PSYCHOSOCIAL INTERVENTIONSScheme for implementing OST in Government centres: an overview
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day 4
Exposure to the OST clinic, including demonstrationDEBRIEFING AND EXPERIENCE SHARING
Programme management–I Procurement and suppliesProgramme management–II Record maintenance and reporting
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day5
Programme management-III Referral and networking, engaging civil societyProgramme management-IV Minimum standards of care, reportingOpen session
Working together: meeting between stakeholders
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Content of each session
0Objectives 0Materials and method0Steps 0Highlights (as box items)0Contents of the presentation
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
0Organization of the manual0Content0Format
Organization of the manual
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Format
0 The manual has been designed to be available in two versions: 1. Hard copy:
0Description of all the sessions0Handouts of slides along with ‘notes’ for the
facilitator
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Format
0 The manual has been designed to be available in two versions: 1. Hard copy:
0Description of all the sessions0Handouts of slides along with ‘notes’ for the
facilitator 2. Digital version: (available as a CD or online)
0The manual proper as a pdf file0Power point presentations as hyper links
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Highlights of the manual 0 Developed as a ‘guide’ for facilitators
0 Not a substitute for practice guidelines or operating procedures
0 Flexibility for facilitators for local adaptation 0 Applicable to a variety of OST settings 0 Entire training programme has been designed to be
participatory in nature0 Strives to address all three components – knowledge,
attitudes and skills0 Manual encourages training programmes for mixed group
of participants
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training on OST in India
0 Induction Training: Just after staff is recruited, before beginning the service delivery
0 Refresher training: about six months after beginning of services
0 Conducted by Psychiatrists from academic institutes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
A pool of trainers has been created through
Training of Trainers (TOT) programmes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Coming soon…
Online Training programme on OST0 Course content similar to existing training programme 0 Could be received by the registered participant at any
time and any place 0 Being developed by:
NDDTC AIIMS
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Quality Assurance of OST0 In the form of ‘visits’ by OST experts /
mentors 0 Visits aimed at:
0 Assessment of the quality of services0 Interaction with and guidance to the staff on
ensuring adequate quality 0 Mentors / experts: Psychiatrists; experience /
expertise in OST; trained on QA guide0 Outcome:
0 Staff receives hands-on guidance; 0 Authorities receive a report on performance Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Quality Assurance of OST0 In the form of ‘visits’ by OST experts /
mentors 0 Visits aimed at:
0 Assessment of the quality of services0 Interaction with and guidance to the staff on
ensuring adequate quality 0 Mentors / experts: Psychiatrists; experience /
expertise in OST; trained on QA guide0 Outcome:
0 Staff receives hands-on guidance; 0 Authorities receive a report on performance Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Atul Ambekar, Ravindra Rao, Alok Agrawal, Anju Dhawan, Rajat Ray, (2013), Quality Assurance of OST in India: A reference guide for mentors, NDDTC, AIIMS and NACO, Government of India, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
QA Guide: Contents
0 Introduction / About the Reference Guide 0 Conducting a Quality Assurance Visit0 Preparing a Quality Assurance Visit Report0 Tool for OST Quality Assurance Visit0 OST Quality Assurance Visit Report - Proforma0 Annexures: List of common problems and
their solutions; Steps for Planning and Managing QA Visits,
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Conducting a QA visit0 Inform the centre staff and concerned SACS prior to visit 0 During visit
0 Observation of the centre, including functioning of the staff and service delivery processes
0 Review of records0 Interaction with
0 Staff – OST centre0 Staff – linked IDU TI 0 Beneficiaries0 Other stakeholders
0 Use the prescribed format to conduct the visit 0 Use the prescribed format to report the visit
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Tool for OST quality assurance visit
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Section 1: Background information
Section 2: Details of the OST centre
Section 3: Staff-related Details
Section 4: Implementation Of OST
Section 5: Record Keeping-related Details
Section 6: Feedback from Clients and their Families
Section 7: Stock Maintenance & Programme Management
Section 8: Gaps Identified and Addressed
Section 9: Impression on Quality of OST Centre
Tool for OST quality assurance visit
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Impression on Quality of OST centre
0 16 - item scoring scale 0 Each item can be scored 1, 2 or 3 0 Option for giving remarks for each item0 Quality grading depends upon the total %
score obtained
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Item 1: OST uptake
Item 2: Recruitment and training of staff
Item 3: Knowledge and confidence of staff on OST issues
Item 4: Role clarity
Item 5:Initial assessment of clients before OST initiation
Item 6: Stabilisation dose of buprenorphine
Item 7:Follow-up of OST clients
Item 8:Changes in dose of buprenorphine
Impression on Quality of OST centre
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Item 9:Duration of maintenance phase of treatment
Item 10:Follow-up of LFU/irregular clients in the field
Item 11:Dispensing-related protocols
Item 12:Record maintenance
Item 13:Stock management
Item 14:Satisfaction of clients and family members
Item 15:Client retention
Item 16: Treatment adherence and compliance
Impression on Quality of OST centre
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST Quality Assurance visit report
0Observations/findings and specific recommendations on specific areas of OST implementation
0Other specific inputs provided0Issues for consideration by the
authorities
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Annexures
0List of common problems and possible solutions
0Planning and managing the OST QA visits
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Accreditation 0 All OST centres expected to undergo Accreditation 0 Conducted by an independent agency: National
Accreditation Board for Hospitals (NABH) 0 Through trained team of two experts
0 Technical expert – a psychiatrist 0 Programme expert – a civil society member
0 Using a especially prepared tool 0 Report provides
0 Scores0 Qualitative / descriptive information
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Accreditation 0 All OST centres expected to undergo Accreditation 0 Conducted by an independent agency: National
Accreditation Board for Hospitals (NABH) 0 Through trained team of two experts
0 Technical expert – a psychiatrist 0 Programme expert – a civil society member
0 Using a especially prepared tool 0 Report provides
0 Scores0 Qualitative / descriptive information
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
The Accreditation Tool0 In the form of an excel sheet 0 Filled by both the experts through observations and
interaction
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
The Accreditation Tool0 In the form of an excel sheet 0 Filled by both the experts through observations and
interaction0 Sections
0 Infrastructure 0 Staff 0 Service Delivery Process 0 Performance 0 Qualitative information 0 “Essential Items”
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Accreditation: Essential items Infrastructure Storage of Medications
Staff DoctorOST Nurse
OST Service Delivery Processes
Regularity of functioningAdherence to DOTSDosage ChangeDispensing RecordsStock records
Mechanisms to check diversion
Programme Performance Service utilization
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Resource Materials developed for Capacity Building and Quality Assurance
1. Training Manual
2. SOPs 3. Practice Guidelines
4. QA GuidePresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Facebook Group: “OST Experts, Service Providers and Advocates“
https://www.facebook.com/groups/OST.experts.India/
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Upcoming resource hub:“http://aiimsost.org/“
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Conclusion
0 OST is a specialized psychiatric intervention 0 Psychiatrists are in a unique position as
0 Service Providers 0 Teachers and Trainers 0 Evaluators 0 Prgramme planners 0 Advocates
0 We need to enhance our own capacities to help others enhance their capacities
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
[email protected] fb.com/atul.ambekarPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi