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

Tier 2 interventions

Definition

Tier 2 interventions include provision of drug-related information and advice, triage assessment, referral to structured drug treatment, brief psychosocial interventions, harm reduction interventions (including needle exchange) and aftercare.

Interventions

Tier 2 interventions that should be commissioned in each local area include:

  • Triage assessment and referral for structured drug treatment

  • Drug interventions which attract and motivate drug misusers into local treatment systems, including engagement with priority groups, such as pregnant women, offenders and stimulant users

  • Interventions to reduce harm and risk due to BBVs and other infections for active drug users, including dedicated needle exchanges and the support and co-ordination of pharmacy-based needle exchanges

  • Interventions to minimise the risk of overdose and diversion of prescribed drugs

  • Brief psychosocial interventions for drug and alcohol misuse (including for stimulants and cannabis problems if it does not require structured treatment)

  • Brief interventions for specific target groups including high-risk and other priority groups

  • Drug-related support for clients seeking abstinence

  • Drug-related aftercare support for those who have left care-planned structured treatment

  • Liaison and support for generic providers of Tier 1 interventions

  • Outreach services to engage clients into treatment and to re-engage people who have dropped out of treatment

  • A range of the above interventions for drug-misusing offenders.

Settings

Tier 2 interventions may be delivered separately from Tier 3 but will often also be delivered in the same setting and by the same staff as Tier 3 interventions.

Other typical settings to increase access are through outreach (general detached or street work, peripatetic work in generic services or domiciliary (home) visits) and in primary care settings.

Pharmacy settings are important due to their unique role in pharmacy based needle exchange schemes and their role in supervised consumption of prescribed drugs.

Criminal justice settings – including initial contact and assessment by CJIT workers in police custody suites, magistrates courts and crown courts – working closely with probation as well as CARATs and prison healthcare provision within the prisons estate.

Drug treatment interventions for offenders may be delivered in the community by CJIT workers and in prison by CARATs and some drug treatment programmes.

Competency

Tier 2 interventions require competent drug and alcohol specialist workers who should have basic competences in line with DANOS.39

Competency also depends on what cluster of services are provided. Normally, frontline staff would have competence in motivational techniques and drug and alcohol brief interventions. Those advising on injecting techniques should be DANOS competent with, as best practice, some members of the team having nursing or

medical qualifications.

Those providing extended pharmacy-based services for drug misusers, including interactive needle exchange and supervised consumption services, would normally have drug specific competence, may have specific contractual arrangements with drug treatment commissioners and work in partnership with other community-based drug services.

Tier 2 interventions: Open access, non-care-planned drug-specific interventions

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