models

Here’s to Healthier DrinkingNorth East Alcohol Conference 2006 Stadium of Light, Sunderland: 7 February 2006: 

Here’s to Healthier Drinking North East Alcohol Conference 2006 Stadium of Light, Sunderland: 7 February 2006 Models of Care for Alcohol Misusers: MoCAM Trevor McCarthy Senior Policy Officer: Alcohol

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

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

Treatment for Problem Drinkers (what we knew already): 

Treatment for Problem Drinkers (what we knew already) Physical health Psychological adjustment Vocational adjustment Social adjustment Interpersonal adjustment Legal status and criminal activity Poly-drug use, where relevant HIV / Hepatitis risk taking, where relevant Raistrick D & Heather N 1998: Review of the effectiveness of Treatment for Alcohol Problems. Unpublished report for DoH. Commissioning Standards. SMAS.1999

National Alcohol Harm Reduction Strategy for England: 4 strands: 

National Alcohol Harm Reduction Strategy for England: 4 strands Improved, better-targeted, education and communication Better co-ordination and enforcement of existing powers against crime and disorder Encourage industry to promote responsible use & take a role in reducing alcohol-related harm Better identification & treatment of alcohol problems

NTA Work to supportAHRSE : 

NTA Work to support AHRSE 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

Reminder:What is MoCAM?: 

Reminder: 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

What’s different?: 

What’s 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

Typology of drinkers : 

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 2004

What is in Models of Care for Alcohol Misusers: 

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)

Stepped care approach to alcohol treatment: 

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

Implications for Tier 1: all frontline workers: 

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

Alan Cartwright. 1999.NDSAG Conference.: 

Alan Cartwright. 1999. NDSAG Conference. Role Adequacy Role Support Therapeutic Commitment Therapeutic Process

Slide13: 

Alan Cartwright. 1999. NDSAG Conference. Non Facilitative Behaviour Resistant Service User Role Insecurity Poor Alliance

New Quality requirements: 

New Quality requirements New Commissioning Alcohol Treatment Systems Criteria Commissioning Performance monitoring Meeting needs of a diverse population

Quality requirements for providers …: 

Quality requirements for providers … 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

Targeting –Which Drinkers?: 

Targeting – 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)

MoCAM consultation: 

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

Consultation responses: 

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

Essential equipmentfor Commissioners:: 

Essential equipment for Commissioners:

Commissioners’ In-Tray early 2006:: 

Commissioners’ In-Tray 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

Do you need Glasses?: 

Do you need Glasses?

Principles for Strategic Implementation of MoCAM: 

Principles for Strategic Implementation of MoCAM “Brains first and then Hard Work.” THE HOUSE AT POOH CORNER A. A. Milne London 1928

What next?: 

What next? Implementation strategy will be crucial Small amounts of new monies 2007 / 2008 Encouragement to defend existing provision Prioritisation of resources in next Comprehensive Spending Review Build support for families and users Encourage local alcohol champions

Early 2006: 

Early 2006 Regional dissemination Identify investment savings (e.g. A&E; liver units) Existing alcohol partnerships – strengthen commissioning & monitoring support Capacity building for mainstream workforce Making the case for the Comprehensive Spending Review

Here’s hoping… : 

Here’s hoping… “Help me to hope. But help me not to hope too much” MAGGIE GEE: My Cleaner. Saqi 2005

Fortune telling …: 

Fortune telling … I never predict nothing - and I never will do. GAZZA: Paul Gascoigne

Slide27: 

251 goals in 274 games for Middlesbrough & Sunderland Brian Howard Clough: 1935 – 2004 “I’m dealing with my drinking problem and I have a reputation for getting things done.”