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National Treatment Agency for Substance Misuse - page 33 / 52





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Integrated care pathways


Commissioning integrated care pathways

An integrated care pathway (ICP) describes the nature and anticipated course of treatment for a particular client and a predetermined plan of treatment. A system of care should be dynamic and able to respond to changing individual needs over time. It should also be able to provide access to a range of services and interventions that meet an individual’s needs in a comprehensive way. Previous consultation has shown that the majority of respondents found that the ICPs set out in Models of Care 2002 had been useful to them in their work.

ICPs should be developed for drug and alcohol misusers for the following reasons:

  • Drug and alcohol misusers often have multiple problems that require effective co-ordination of treatment

  • Several specialist and generic service providers may be involved in the care of a drug and alcohol misuser simultaneously or consecutively

  • A drug and alcohol misuser may have continuing and evolving care needs requiring referral to services providing different tiers of intervention over time

  • ICPs ensure consistency and parity of approach nationally (i.e. a drug misuser accessing a particular treatment intervention should receive the same response wherever they access care)

  • ICPs ensure that access to care is not based on individual clinical decisions or historical arrangements.

Models of Care 2002 Part 2 encouraged commissioners and providers to develop and publish local ICPs by March 2004. ICPs may need to be revised in the light of this update and in the light of changes in treatment systems (particularly in relation to offenders), changes for clients requiring Tier 4 treatment and for those requiring active interventions for prevention or management of blood-borne virus infection.


Elements of integrated care pathways

Commissioners should ensure that each drug and alcohol treatment intervention should have an ICP, which should be agreed with and between local providers, and built into service specifications and service level agreements. Integrated care pathways should contain the following elements:

  • A definition of the treatment interventions provided

  • Aims and objectives of the treatment interventions

  • A definition of the client group served

  • Eligibility criteria (including priority groups)

  • Exclusions criteria or contraindications


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

  • A referral pathway

  • Screening and assessment processes

  • Development of agreed treatment goals

  • A description of the treatment process or phases

  • Co-ordination of care

  • Departure planning, aftercare and support

  • Onward referral pathways

  • The range of services with which the interventions interface.

These elements are designed to provide clarity as to the type of client the drug treatment intervention caters for, what the client can expect treatment services to provide, and the roles and responsibilities of the service within the integrated care system and towards the individual client.


ICPs and the treatment journey

An ICP will not necessarily be the whole description of a person’s treatment journey. An individual ICP will be focused on one treatment intervention in a client’s care plan, within which a client may receive a range of interventions. Therefore, it is important that the development of local ICPs takes into account the client treatment journey through care-planned treatment and represents it in a way that clients can understand and see their experience reflected.

Figure 2 sets out an overall representation of client’s journey through treatment. This can assist with the planning of ICPs. However, this figure and the ICPs for drug treatment described in Models of Care 2002: Part 2 are illustrative rather than prescriptive. Local ICPs should describe the structure and content of drug treatment interventions, but these should be adapted to local needs and drug treatment providers as appropriate.

As well as ICPs for specific treatment types, there will also need to be local ICPs developed for specific client groups, particularly excluded groups of service users who may have difficulty in gaining access to treatment because they have complex needs and because they are vulnerable. Models of Care 2002: Part 2 has some examples of these (e.g. ICPs for drug and alcohol misusing parents and pregnant drug users). Again, these must be developed using the above principles to fit in with local need.

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