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abstinence as part of the care plan (prior to referral on or provision of aftercare arrangements), and is also receiving harm reduction interventions and help to deal with health needs

  • An uncomplicated problem cannabis user who is receiving a short period of care-planned regular brief interventions to deal with problem cannabis use

  • Clients who are not assessed as needing “structured psychosocial interventions” for their problem drug use, but who receive sessions with keyworkers to address their social needs and offending behaviour.

“Other structured treatment” can describe regular sessions with a keyworker, delivered in order to keep a client engaged in the treatment system while they are waiting to start receiving another care-planned intervention (e.g. GP prescribing), if the structured interventions are outlined in an initial care plan following a triage assessment.

Clients receiving “day care” rather than a structured “day programme”, as part of a care plan, may be recorded as “other structured treatment”. Day care is distinct from structured day programmes, because it has a lower requirement to attend than structured day programmes (usually 1–2 days). Some clients may have a care plan that specifies regular attendance at day care with regular sessions with keywork. As part of the care-planned day care they may receive a range of interventions and support including emotional and psychological support, educational and life-skills work and related activities, advice and information, harm reduction support, further assessment and subsequent referral to alternative structured treatment. This may be particularly relevant for clients who have co-existing mental health problems.

A client should not be recorded as receiving “other structured treatment” if the interventions are not being delivered as part of a care plan. It is also important to note that “other structured treatment” requires a more rigorous approach to “keyworking”. As good practice, keywork involves the building of a therapeutic relationship with the client, which should include:

  • Following triage, drawing up an initial care plan if required to address immediate needs (e.g. providing information and advice on drug and alcohol misuse)

  • Harm reduction interventions

  • Motivational interventions to enhance retention

  • Developing and agreeing the care plan with the client and ensuring implementation of the care plan – with interventions relevant to each stage of the treatment journey and regular care plan reviews.

Other structured treatment involves the delivery of a package of structured interventions that are beyond the level that would be required for Tier 2, but do fall into the other categories of structured interventions described in this section.

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

Settings: Other structured treatment could take place in a wide variety of different treatment settings, including settings that may normally be known for delivering Tier 2 interventions.

9.8

Inpatient drug treatment

Inpatient drug treatment interventions usually involve short episodes of hospital-based (or equivalent) drug and alcohol medical treatment. This normally includes 24-hour medical cover and multidisciplinary team support for treatment such as:

  • Medically supervised assessment

  • Stabilisation on substitute medication

  • Detoxification/assisted withdrawal from illegal and substitute

drugs and alcohol in the case of poly-dependence

  • Specialist inpatient treatments for stimulant users

  • Emergency medical care for drug users in drug-related crisis.

The multidisciplinary team can include psychologists, nurses, pharmacists, occupational therapists, social workers, and other activity and support staff.

Inpatient drug treatment should be provided within a care plan with an identified keyworker. The care plan should address drug and alcohol misuse, health needs, offending behaviour and social functioning.

Care-planned inpatient treatment programmes may also include a range of additional provisions such as:

  • Preparing the client for planned admission to inpatient treatment (if this is not carried out by a suitably competent community worker as part of the agreed care plan leading to admission)

  • Psychosocial interventions, including relapse prevention work

  • Interventions to tackle excessive levels of drinking

  • Appropriate tests or vaccination (if appropriate) for hepatitis B, C and HIV

  • Other harm reduction interventions

  • Educational work

  • Physical and mental health screening

  • Linking inpatient treatment to post-discharge care, which may involve preparation for referral to residential rehabilitation or community treatment, aftercare or other support required by the client.

Inpatient drug treatment is an important intervention for enabling adequate assessment of complex needs and for supporting progression to abstinence.

It is very important to have effective discharge care planning, and to ensure appropriate referrals to mainstream medical services (e.g. liver clinic and psychiatric services) or social and community

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