Models of care for treatment of adult drug misusers: Update 2006
Substance misuse assessment
Substance misuse assessment is a process to establish the nature and extent of drug and alcohol misuse, what level of need an individual may have and what interventions are required. Assessment varies in its depth and level of detail, depending on the purpose and anticipated outcome of the assessment process. Models of Care 2002 identified three levels of assessment: screening, triage and comprehensive assessment, and provides a detailed description of each level of assessment. The majority of respondents to the consultations found the different levels in Models of Care 2002 to be meaningful and useful. These are reiterated here.
Screening assessment is a brief process that aims to establish if an individual has a drug and alcohol problem, related or co- existent problems and whether there is any immediate risk for the client. The assessment should identify those who require referral to drug treatment services and the urgency of the referral. Screening assessment may include an element of brief opportunistic intervention aimed at engaging or preparing the client for treatment. Screening assessment is likely to be carried out in generic settings.
Triage assessment usually takes place when a drug misuser first contacts specialist drug treatment services. The aim of triage assessment is to determine the seriousness and urgency of a client’s problems and the most appropriate type of treatment for the client. It involves a fuller assessment of the individual’s drug and alcohol problems than is conducted at screening, as well as assessment of a client’s motivation to engage in treatment, current risk factors and the urgency of need to access treatment. As a result of a triage assessment, a client might be offered services within the assessing agency or onward referral to another service. A further outcome of triage assessment is that, where appropriate, work is undertaken to further engage and prepare the client for treatment.
4.2.1 Assessment in the Drug Interventions Programme
Assessments of clients seen by CJIT workers in the community and CARAT teams in prison are to be carried out within the Models of Care framework.
A summary of the information from the assessment is collected on the Drug Interventions Record (DIR). An effective DIR-based assessment addresses the range of the client’s presenting needs and covers health and social issues as well as drug use.
In the context of the DIR, the assessment is the key step towards the development of an initial care plan and is also the first
important stage in gathering together, in a consistent way, the information that will facilitate effective continuity of care for drug users in the community and between community and prison.
Criminal justice integrated teams (CJITs) should all be able to undertake assessments up to triage level and should have resources available to the team to carry out more complex and comprehensive assessments. It is important that practitioners only carry out assessments according to their qualifications or competence, and use the expertise of colleagues when necessary.
Initial care plan
Following triage-level assessment, it may be good practice to produce an initial care plan for clients. For clients taken onto the CJIT caseload this will be essential, but it may also be useful in other treatment services, particularly for clients who are identified as at high risk, who have complex drug-related problems or are likely to be hard to engage. Within prisons, initial care plans may be appropriate for prisoners in the very early days of custody, or those who are due to be released shortly after the triage is undertaken.
The initial care plan is to facilitate a focus on a client’s engagement in the treatment system, to ensure their immediate needs are met, to build a therapeutic alliance and to ensure appropriate support if they are waiting to undergo comprehensive assessment. Not all clients will be required to undergo a comprehensive assessment, and some may remain on their initial care plan and be reviewed until they are discharged from treatment.
The initial care plan is particularly relevant to CJIT/CARAT clients, all of whom will receive an initial care plan after triage-level assessment if taken onto the caseload. The initial care plan is set at Tier 2 interventions level. If an initial care plan identifies the need only for Tier 2 interventions, this will need to be reviewed with the client at regular intervals. If the presenting needs increase, the client may have to be referred for a comprehensive assessment.
Where a prisoner is in custody for a short period of time – up to 28 days – and there is insufficient time to progress to a comprehensive assessment and care plan, an initial care plan may be drawn up to ensure their immediate and throughcare needs are met.
Comprehensive assessment is targeted at drug misusers with more complex needs and those who will require structured drug treatment interventions. The assessment aims to determine the exact nature of the client’s drug and alcohol problems, and co- existing problems in the other domains of health (mental and physical), social functioning and offending. A full risk assessment