Models of care for treatment of adult drug misusers: Update 2006
This section should be read alongside the Care Planning Practice Guide,5 which contains more detailed information and guidance on care planning.
The need for good-quality care planning and co-ordination of care
In Models of Care: Update 2006 there is a stronger focus on care planning as central to drug treatment and a defining characteristic of structured treatment. The Audit Commission report Drug Misuse 2004 outlines the good progress that has been made since 2002 to meet the recommendations of the 2002 report. However, one of the areas that Drug Misuse 2004 highlights as needing improvement is consistency in the quality of care planning. The report concludes that care planning is frequently ad hoc and should be a routine activity monitored by local drug partnerships, in order to deliver the vision of integrated care envisaged in current national guidance. It also recommends that there should be performance indicators that focus on effective care planning and aftercare outcomes.
The NTA has identified care planning as a key tenet in its Treatment Effectiveness strategy, recognising that the combination of good care planning, good co-ordination of care and frequent reviews of care plans with service users, is the vehicle to deliver improvements to individuals’ health and social functioning and reduce the public health and crime risk they pose to others. The NTA’s Business Plan 2005/0625 sets an objective that, by 2008, all individuals in treatment have an identifiable written care plan, which tracks their progress and is regularly reviewed with them.
Care planning in Models of Care: Update 2006
This section sets out key principles for care planning and co- ordination of care, and a summary of the process as it relates to a client’s treatment journey. Further details on the NTA’s recommendations for care planning are contained in the NTA Care Planning Practice Guide. Consultation confirmed that people in the drugs field wanted to see more emphasis on clients achieving treatment goals through the delivery of a care plan and the client treatment journey. Therefore, although the key principles of care planning and the co-ordination of care set out in Models of Care 2002 remain the same, there are some differences in focus, which are consistent with the overall greater focus on the client’s treatment journey. These are:
The care planning process as the essential component of the client treatment journey
The importance of all clients receiving keyworking as a crucial element of care-planned treatment
A greater focus on clients’ participation in the care planning process, where they are involved in producing and agreeing their care plans. This is consistent with the consultation response where an overwhelming majority of respondents wanted to see more service user involvement in care planning and review
Ensuring the care plan actively covers meeting client needs in the four key domains of – substance misuse, health (physical and psychological), social functioning (including employment and education), and offending behaviour. This will require providers to work together to meet these multiple needs and greater co-ordination of elements of the care plan
The focus in care plans and keyworking on the main elements in the treatment journey: engagement, delivery, and completion or maintenance.
5.2.1 Care co-ordination
The previous levels of “standard” and “enhanced” care co- ordination are no longer referred to in Models of Care: Update 2006. It is clear that clients have a range of needs, from simple to highly complex, and this must be reflected in the care plan and the intensity of care co-ordination. It is expected that the keyworker would co-ordinate care in most cases. External care co-ordination may be required where a client has multiple needs or is under statutory obligations via the criminal justice system, Care Programme Approach (CPA) etc. This enables services to reflect on case mix in a more flexible way taking into account the staff competences, client characteristics and client needs, as well as the systems of multidisciplinary working that are in place.
The care planning process
Care planning is a process for setting goals based on the needs identified by an assessment and planning interventions to meet those goals with the client. Care planning is a core requirement of structured drug treatment.
5.3.2 The care plan
A care plan is an agreement on a plan of action between the client and service provider. It should be a paper document which is available to the client and kept on the client’s file. Care plans should document and enable routine review of client needs, subsequent goals and progress across four key domains:
Drug and alcohol misuse
Health (physical and psychological)
Social functioning (including housing, employment and