suffering from problems caused by hepatitis C infection) in Models of Care 2002 are re-designated as Tier 1 in Models of Care: Update 2006.
Tier 2 drug interventions Consultation on Models of Care has suggested the need for a wider recognition of the valuable role of open access Tier 2 drug interventions that may just stop short of being classified as structured drug treatment. In keeping with this, Models of Care: Update 2006 advocates that Tier 2 interventions should be strengthened. Within a local system, Tier 2 interventions should include:
Interventions to engage people into drug treatment
Interventions to support people prior to structured treatment
Interventions to help retain people in the treatment system
A range of drug misuse harm reduction interventions
Interventions to support active drug users who may not want or need intensive structured drug treatment at that point in their lives.
These interventions can include health interventions to meet clients’ immediate health needs and a range of brief interventions targeted at engaging clients in treatment. It is important that the interventions are simple and can be provided quickly. Clients can also be engaged in treatment through outreach services, which can also seek to re-engage former service users who have dropped out of treatment.
There is some perception that Tier 2 interventions have focused solely on those who are still actively using illegal drugs. Models of Care: Update 2006 recommends that Tier 2 open access interventions should also be delivered to those who are drug-free (and wish to remain so). Tier 2 interventions can be a component of aftercare. Aftercare is described as:
Drug-related support, such as relapse prevention, support groups and individual support for those wishing to remain drug-free, and access to user groups and advocacy mechanisms (such as Narcotics Anonymous or equivalent)
Non-drug-related support, such as access to education or training, support from advisory services, helping develop social networks and employment support.
Such aftercare follows the completion of care-planned drug treatment.
It is expected that both interventions with an explicit abstinence oriented approach and those that target active drug users are commissioned locally. These interventions may be provided on the same or different service sites. How these services are delivered is a local treatment planning decision.
Models of care for treatment of adult drug misusers: Update 2006
Community-based Tier 2 and Tier 3 interventions Some consultation responses called for the creation of “tier two- and-a-half”, in recognition of work that practitioners undertake with clients that does not quite reach the threshold for care- planned treatment (e.g. two or three “sessions” of brief interventions). Rather than create a new tier, Models of Care: Update 2006 advocates a more careful consideration of whether Tier 2 or Tier 3 interventions are being provided and a recognition that providers can and do provide a range of interventions at different tiers.
The main difference between Tier 2 and Tier 3 interventions is that Tier 3 refers to the provision of care-planned interventions that meet the threshold for structured drug treatment, determined following comprehensive assessment. The definitions of care planning and of the various forms of structured treatment have been amended and updated to aid clarity in Models of Care: Update 2006. There are additional reporting requirements for Tier 3 interventions, including the completion of National Drug Treatment Monitoring System (NDTMS) returns.
It is recognised that, in reality, the differences in some cases between more structured forms of Tier 2 support and simpler forms of Tier 3 interventions can be subtle. While care planning is a requirement of structured treatment, it can also be used, if appropriate, for some Tier 2 interventions (e.g. planned brief motivational interventions). Some brief interventions, for example for alcohol or cannabis use, may be provided in both tiers. In this, and other equivocal cases, it will be the degree of structure of the care plan and of the treatment intervention that will usually be the best guide to determine the tier of intervention being provided. If a service provider is delivering care-planned structured treatment following comprehensive assessment, the interventions provided should be classified as Tier 3.
Tier 2 interventions may not require the same degree of commitment from the client. The level of assessment may be lower (although there may be some). Tier 2 interventions may not require the same degree of consent as for a planned course of treatment and they often will not have the same level of duty of care for the practitioner (though they should still carry some). Therefore, there are different reporting requirements. Care plans should be used, if appropriate, for Tier 2 interventions.
To maximise engagement and motivation following assessment, all DATs and CJITs have been funded to build Tier 2 treatment capacity to facilitate access to structured drug treatment.
If a service provider is providing care-planned care following comprehensive assessment, the interventions provided should be classified as Tier 3. Tier 3 interventions comprise care-planned treatment, where an individual assessed has been found in need of structured treatment and has a care plan, which involves the client consenting to treatment. The client then receives drug treatment and other interventions (sequentially or concurrently)