Models of care for treatment of adult drug misusers: Update 2006
Tier 3 interventions
Tier 3 interventions include provision of community-based specialised drug assessment and co-ordinated care- planned treatment and drug specialist liaison.
Tier 3 interventions that should be commissioned in each local area include:
Comprehensive drug misuse assessment
Care planning, co-ordination and review for all in structured treatment, often with regular keyworking sessions
• • •
as standard practice Community care assessment and case management for drug misusers Harm reduction activities as integral to care-planned treatment
A range of prescribing interventions, in the context of a package of care and in line with Drug Misuse and
Dependence – Guidelines on Clinical Management,21
known as “the clinical guidelines”. This will be updated
alongside the relevant forthcoming National Institute for Clinical Excellence (NICE) guidelines and technology appraisals, and in line with other evidence-based clinical standards with specific interventions, including: prescribing for stabilisation and oral opioid maintenance prescribing; community based detoxification; injectable maintenance prescribing, and a range of prescribing interventions to prevent relapse and ameliorate drug and alcohol-related conditions
A range of structured evidence-based psychosocial interventions to assist individuals to make changes in drug and alcohol using behaviour
Structured day programmes and care-planned day care (e.g. interventions targeting specific groups)
Liaison services for acute medical and psychiatric health services (e.g. pregnancy, mental health and hepatitis services)
Liaison services for social care services (e.g. social services (child protection and community care teams), housing, homelessness)
A range of the above interventions for drug-misusing offenders.
Tier 3 interventions are normally delivered in specialised drug treatment services with their own premises in the community or on hospital sites. Other delivery may be by outreach (peripatetic work in generic services or other agencies or domiciliary or home visits). Tier 3 interventions may be delivered alongside Tier 2 interventions.
Some of the Tier 3 work is based in primary care settings (shared care schemes and GP-led prescribing services), as well as pharmacies, but drug specialist-led services are required within the local systems for the provision of care for severe or complex needs and to support primary care.
Drug treatment interventions for offenders may be delivered in prison settings by CARATs and some drug treatment programmes
Community criminal justice programmes, such as DRRs, are delivered in contracted community drug treatment services (statutory or voluntary) or in-house by probation staff on probation premises.
Tier 3 services require competent drug and alcohol specialised practitioners who should have competences in line with DANOS.39 The range of competences required will depend upon job specifications and remits.
Medical staff (usually addiction psychiatrists and GPs) will require different levels of competences depending on their roles in drug treatment systems and the needs of the client, with each local system requiring a range of doctor competences (from specialist to generalist) in line with joint guidance from the Royal College of General Practitioners and the Royal College of Psychiatrists.30
Tier 3 interventions: Structured, care-planned drug treatment