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

to maximise the benefits of treatment and to reduce risk of relapse and fatal overdose.

The commissioning of all Tier 4 interventions requires improvement. Some of the services (mainly residential rehabilitation units) providing these interventions have national catchment areas, and can be particularly vulnerable if they are continually “spot purchased”. It is important to note that these interventions can be purchased using pooled treatment budget funding, community care funding, mainstream health funding, or some combination of these. The commissioning of inpatient and residential rehabilitation services should be undertaken within an integrated care pathway approach that is embedded within local strategic annual treatment planning process and joint commissioning systems. These pathways should be commissioned with clear routes into inpatient services, which lead to residential rehabilitation (if required) followed by a substance misuse support package, including housing if necessary.

From 2006, new regional or sub-regional commissioning arrangements will be developed, which will require working across strategic partnerships on a regional or sub-regional basis to strategically plan and commission Tier 4 treatment.

Initial guidance for commissioning Tier 4 treatment33 was issued in February 2006 (further guidance is planned for later in 2006). This guidance emphasises the need to increase inpatient and residential rehabilitation provision to create more planned exits from drug treatment for those who want it, in line with the Treatment Effectiveness strategy. It focuses on:

  • The effectiveness of Tier 4 treatment

  • The importance of commissioning integrated care pathways for Tier 4 treatment

  • Commissioning based on assessment of need for Tier 4 treatment

  • Using a mixed economy to purchase or commission Tier 4 treatment. In particular, sole reliance on community care funding for residential rehabilitation will not be enough, and other funding arrangements should also be used

  • A mixture of block and spot purchasing of residential rehabilitation places

  • A move towards contracting with preferred providers who demonstrate quality

  • Improved performance management arrangements (including standard contracts and NDTMS compliance).

Future guidance is planned which will further emphasise strategic regional and sub-regional commissioning of Tier 4 treatment.


Greater emphasis on aftercare

Models of Care: Update 2006 seeks to clarify and describe aftercare as both drug related and non-drug related support (see


section 9.10 for more details). To aid effective and well co- ordinated commissioning, drug-related aftercare provision (i.e. support to specifically address a person’s drug dependency issues) should be commissioned through inclusion in DAT partnership annual treatment plans. Non-drug related aftercare support (i.e. support that does not directly address drug dependence) is provided by partner agencies and is not usually directly commissioned through drug treatment plans. Commissioners should ensure that necessary local partnership arrangements are in place to enable adequate service provision for clients leaving drug treatment.

Aftercare is increasing in importance as more drug users are entering and going through treatment programmes. This raises the need for both drug-related and non-drug related aftercare support to be in place when they leave treatment, so that positive changes they have achieved in drug use – criminal activity, health and social functioning – are maintained. In strategic planning and commissioning of aftercare services, it is important that commissioners give consideration to the following areas, which can also be key to client engagement and retention:

  • Ensuring continuity of care for those leaving treatment, finishing a community sentence or moving between the community and custody

  • Making clear links to housing provision through local authority homelessness strategies

  • Establishing access and links to local and mainstream programmes for wraparound support (such as housing, employment, training and education)

  • Establishing links to other services (such as alcohol and mental health services) as appropriate

  • Developing relapse prevention support (outside existing treatment provision), support for families, peer support for drug users leaving treatment, and providing mentors.

It is particularly important that housing and support services are in place, where required, for people leaving inpatient treatment and residential rehabilitation. Agencies providing Tier 4 interventions need to have good connections with social care and other services that can provide, or can facilitate provision of, the aftercare a client needs when they leave treatment. Guidance has been issued by ODPM and the Home Office,34 which emphasises that Supporting People funding should be considered in tandem with other funding streams, such as the drug pooled treatment budget and the DIP main grant, and in line with the drug action team treatment plans, local homelessness strategy and Supporting People strategy, to provide the basis for a locally joined-up approach. The Home Office and ODPM have also issued a briefing outlining further examples of joint working and practice.35

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