harm reduction, interventions for blood-borne viruses and psychosocial interventions.
9.4.2 Specialist prescribing
Specialist prescribing is community prescribing for drug misuse in a specialist drug service setting, which normally comprises a multidisciplinary substance misuse team. Specialist prescribing interventions normally include comprehensive assessments of drug treatment need and the provision of a full range of prescribing treatments in the context of care-planned drug treatment. The specialist team should also provide, or provide access to, a range of other care-planned healthcare interventions including psychosocial interventions, a wide range of harm- reduction interventions, BBV prevention and vaccination, and abstinence-oriented interventions.
The client group should be comprised of drug misusers whose problem level is mostly moderate to severe.
The teams include specialist doctors who are usually consultant addiction psychiatrists “with a Certificate of Completion of Training (CCT) in psychiatry, with endorsement in substance misuse working exclusively to provide a full range of services to substance misusers”. Such teams sometimes have other specialists including:
Consultants in general psychiatry with a special interest in
Consultants in general psychiatry
Other doctors on the specialist register (associate specialists)
Senior clinical medical officers (see Roles and Responsibilities)
Doctors in training.
Since the specialist team should provide or enable access to other drug-related interventions identified in the client’s care plan, the team may contain a range of staff including clinical psychologists, counselling psychologists, general and psychiatric nurses, pharmacists, social workers and drug workers.
Specialist prescribing services may also be supported by non- medical prescribers, such as nurses and pharmacists). For more information on nurse prescribing, see Nurse Prescribing in Substance Misuse (NTA, 2005)52 – this will be updated in 2006 to include pharmacists and will issued as guidance on non-medical prescribing in substance misuse. Further guidance on prescribing for pharmacists is available in the RPSGB’s Clinical Governance Framework for Pharmacist Prescribers and Organisations Commissioning or Participating in Pharmacist Prescribing.53
Structured day programmes
The term “structured day programmes” replaces the old term “structured day care” and will be the intervention name used for NDTMS monitoring from April 2006. Introduction of an additional
Models of care for treatment of adult drug misusers: Update 2006
category of “other structured treatment” can be used for less extensive or less structured “day care” provided in the context of a structured care plan (see section 9.7 for further discussion).
Structured day programmes (SDPs) provide a range of interventions where a client must attend 3–5 days per week. Interventions tend to be either via a fixed rolling programme or an individual timetable, according to client need. In either case, the SDP includes the development of a care plan and regular keyworking sessions. The care plan should address drug and alcohol misuse, health needs, offending behaviour and social functioning.
SDPs usually offer programmes of defined activities for a fixed period of time. Clients will usually attend the programme according to specified attendance criteria, and follow a set timetable that will include group work, psychosocial interventions, educational and life skills activities. Some clients may be attending the SDP as a follow-on or precursor to other treatment types, or may be attending as part of a criminal justice programme supervised by the probation service (e.g. DRR), or community rehabilitation.
Settings: SDPs are normally community-based services, set in centres that have been specifically designated for the programme (purpose-built or converted) and have rooms designated for specific parts of the programme (e.g. group work and life skills). They may be attached to other drug treatment services if they are part of a larger treatment agency. Structured day programmes are also used in prisons, and in prisons the majority of drug treatment programmes would fall into this category.
Structured psychosocial interventions
The term “structured psychosocial interventions” replaces the old term “structured counselling” and has been the intervention name used for NDTMS monitoring since April 2006. Introduction of an additional category of “other structured treatment” allows use of this term for less clearly defined counselling in the context of a structured care plan (see the relevant section below for further discussion).
Structured psychosocial interventions are clearly defined, evidence-based psychosocial interventions, delivered as part of a client’s care plan, which assist the client to make changes in their drug and alcohol using behaviour. These interventions are normally time limited and should be delivered by competent practitioners. Competent practitioners will have adequate training, regular clinical supervision to ensure adherence to the treatment model and be able to demonstrate positive client outcomes.
Structured psychosocial interventions should be identified within a care plan. These interventions can be delivered in individual or group settings, and by any practitioners who have appropriate training and supervision. A number of these interventions can be