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National Treatment Agency for Substance Misuse - page 14 / 52





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Models of care for treatment of adult drug misusers: Update 2006

according to the care plan drawn up with the keyworker, together with scheduled keyworking sessions, and any co-ordination of care or case management required.

The most appropriate guide to deciding whether interventions are Tier 2 or Tier 3 is whether interventions are provided in the context of a comprehensive care plan, following a comprehensive assessment. Models of Care: Update 2006 contains a range of definitions to help clarify the process of decision making, including care planning, keyworking, the treatment interventions and how they fit together.

All substitute prescribing interventions are Tier 3 Clinical experience, supported by consultation responses, has indicated that all substitute prescribing interventions, including those previously described as “low threshold” in Models of Care 2002, should be redefined as Tier 3 interventions, including those delivered by prison healthcare This is because they require comprehensive assessment, should be care planned and carry a high duty of care for the clinician prescribing controlled drugs.


The Drug Interventions Programme (DIP)

The Drug Interventions Programme (DIP) provides an enhanced Tier 2 service by offering the client ongoing support, through the case management arrangements, in order to facilitate engagement in structured treatment.

One of the key drivers for the development of the DIP was the need to bridge the gap between assessment and referral from the criminal justice system and effective engagement into structured treatment. Evidence from the arrest referral scheme evaluations (July 2002) consistently recorded high levels of attrition for clients referred to drug treatment from the criminal justice system, with an engagement rate of 20–25 per cent.

Criminal justice integrated teams (CJITs) are the key local delivery mechanism of the DIP. They are established by the DATs as multi- agency partnerships, comprising members from a range of disciplines with a range of competences and skills. There is no one model but a typical team might include drug workers based in police custody suites or courts; case managers; those with specialist knowledge of housing issues, mental health, education, training and employment, and family support; outreach workers working in the community, and dedicated prolific and persistent offender (PPO) case managers.

Improving continuity of care for the individual is reliant upon seamless case management through the effective provision and communication of the right information at the right time to the right people, throughout the “journey” of the drug misuser. Case management should reflect the key elements of keyworking and care planning. This process is facilitated through the use of the Drug Interventions Record (DIR) by CJIT workers in the


community and CARATS or healthcare in prisons. The DIR has three main roles. They are:

  • To facilitate and improve standards of continuity of care for drug users, and minimise duplication of assessments, especially when they are moving between custody and community but also when information is passed between case managers and/or treatment providers

  • To support the monitoring and research functions around the Drug Interventions Programme, in line with the programme’s, and other related, Performance Management Frameworks

  • To be the form on which substance misuse triage assessment is recorded in prison, whether or not the individual agrees to the sharing of information with the CJIT for continuity of care purposes.

Where a client is assessed by a CJIT worker following a triage level assessment, the worker will use the DIR to record the summary and outcomes from the assessment. Where clients require structured treatment, they will be taken onto the CJIT caseload and allocated a case manager or keyworker. Initial care plans are then agreed with clients to identify what steps need to be taken to engage them in treatment and what support can be provided in the interim. This might involve ongoing contact with the case manager to maintain the client’s motivation and address social support needs, such as housing, employment and training.

The transition to structured treatment (Tier 3) is achieved when a comprehensive assessment, followed by a full care plan, is completed by the treatment provider. The CJIT worker who is the case manager, with the client’s informed consent, can contribute to this process and will continue to work with the client until they are actively engaged in treatment with the Tier 3 provider.


Drug treatment based in prisons

A comprehensive framework of drug treatment services, spanning Tiers 1–4, should be available in prisons to address the varying needs of drug misusers. In principle, delivery of drug treatment in prisons is very similar to providing treatment in the community. However, there are specific factors that need to be taken into account, given the different environment in which prison treatment is provided.

As with any drug treatment, prisoners must be provided with continuity of care both in custody and on release. It is vital that any drug treatment, especially relapse prevention and release planning, takes into account the differences that exist within prison and community environments, in order to best prepare prisoners for release.

There are three main types of drug treatment within prisons.

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