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NTA Residential Rehabilitation Event. Welcome Baroness Massey of Darwen. Building Recovery Realising the potential of residential rehabilitation. Paul Hayes Chief Executive, NTA. Radical. National vision Local delivery Individual choice Rewarding success. Architecture.

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NTA Residential Rehabilitation Event

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NTA Residential Rehabilitation Event

Welcome

Baroness Massey of Darwen


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Building RecoveryRealising the potential of residential rehabilitation

Paul Hayes

Chief Executive, NTA


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Radical

  • National vision

  • Local delivery

  • Individual choice

  • Rewarding success


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Architecture

  • Public Health England

  • Local Authorities

  • Service Users

  • Providers


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2011/12 from “Treatment system” to “Recovery system”

  • BRiC

  • Successful completions

  • Patient Placement Criteria

  • PbR

  • Skills

  • Recovery networks

  • Families

  • Jobs / houses

  • Prison / community


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Rehab – an underused resource

  • Dialogue

  • Respect

  • Understanding

  • Shared vision

  • Working market

  • Choice

  • Outcomes

  • VFM

  • Sustainability


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Key themes for Commissioners & Providers

March 2011

Mark Gillyon

Head of Delivery - North


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MoC 3  Building Recovery in Communities

2007 Clinical Guidelines

Integrated Drug Treatment System (IDTS)

Recovery

Mutual Aid, successful completions, the supportive role of families, the importance of housing and employment

Support through the system

User choice and responsibility

Families and safeguarding

Targeting the right interventions, to the right people, at the right time.


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The new framework

The over arching aim of the new framework is to support local areas in developing their systems and services to become recovery focused, highly ambitious and offer a real opportunity for sustainable recovery.


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The sector is changing...

Different models of delivery

‘Traditional’

Locally commissioned and locally provided

‘Quasi-residential’


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The commissioning environment is changing...

Funding in 2011/12

Funding in 2012/13

Funding from 2013 onwards

Outcome-based systems, Payment by Results, and the leadership of Directors of Public Health / Health & Wellbeing Boards


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Other things will change...

Successful completions

The number of people leaving drug treatment free of their drug(s) of dependency

Payment by results

Model / length focus vs. specific required outcomes

Data

About 2/3 report to NDTMS

New models / new data problems

The future of PTB

Within Public Health ring-fence, for Health & Wellbeing Boards


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Data support

NDTMS Regional Teams

Data collection, support, training, analysis

Rehab Online

Marketing

Testimonials

Vacancies

Evidencing outcomes and value


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Future developments

Colin Bradbury

Residential Rehabilitation Event

29th March 2011


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Contents

Payment by Results

Case Mix Adjustment

Residential Rehabilitation Outcomes


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Payment by Results - Background

A recovery programme, not a treatment programme

Around 6 pilot local authority areas

April – Sep 2011: co-design, running 2011-2013

Independent evaluation

4 outcomes (interim & final) identified:

Leaving treatment free from drug(s) of dependency

Re/Offending

Employment

Health & Wellbeing (interim only)

Payment by Results


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Opportunities and challenges

Moving away from process/ front end targets

Giving providers freedom and flexibility to innovate and sub-contract what they need

Letting the market show “what works”

Encouraging new providers to enter the market

Developing a single point of contact model

A need to avoid perverse incentives

Delivering more outcomes with the same money

Ensuring small/ new providers are able to compete

Payment by Results


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Case Mix

Using treatment and re-presentation data to predict outcome for new treatment entrants

Push and pull factors for recovery

Allowing comparisons of outcomes in similar areas and services – segmenting on the basis of probability of recovery

Limited to the data we have

Says something about an individual’s chances, but nothing about how best to help them...

Case

Mix


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RR outcome research

a prospective outcome study of publicly funded providers of drug and alcohol residential rehabilitation

expert academic and provider advisory group

Peer reviewed academic journal

Consult on which sort of models should be included

Rehabilitation Outcomes


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In summary...

How might we further incentivise recovery, moving beyond the existing evidence base?

Payment by Results

How can we ensure accurate tariffs are set and there is a level playing field?

Case Mix Adjustment

How could we ensure people get the right treatment at the right time?

Patient Placement Criteria

What role can residential rehabilitation play in this?

Outcomes Study


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“Patient Placement Criteria”

John Marsden

NTA Senior Academic Advisor

Reader in Addiction Psychology, Institute of Psychiatry, KCL

National Residential Rehab Events - London

29th March 2011


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Background

No “one size fits all” recovery pathway

Some people have strong preferences about their care

Wide differences in treatment needs

Evidence for layered or combination interventions

Single prescribing or psychosocial interventions

Combination prescribing and/or psychosocial packages

Evidence from the adaptive continuing care literature

Principle of changing direction if no therapeutic benefit


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PPC expert sub-group

David Best UWS (chair)

Nicola Adamson Worcestershire Commissioning

Karen Biggs Phoenix Futures

Jayne Bridge Mersey Care

Wendy Dawson Ley Community

Ed Day Uni of Birmingham

Vivienne Evans Adfam

Jason GoughYorks. & Humber Service User Forum

Kate Hall GMW

Linda Harris Wakefield & RCGP

Dave Knight RCN

Tom Kirkwood TTP

Tim Leighton Action on Addiction

Peter McDermott The Alliance

DH observers: Mark Prunty &

NTA project team

International correspondents: William White, Alexandre Laudet, Arthur Evans, Mike Dennis, Robert Ali, Steve Shoptaw, Min Zhou


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Goal

Better matching of individuals to treatment packages

Promote clinical expertise and personal preference

Progressive treatment system; recovery-oriented

A wider array of evidence supported interventions


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“PPC” in practice

Resource for personalising and optimising treatment

Screening for risk, need and preference

Adaptive care criteria (sequencing and layering)

Criteria for judging therapeutic response

Justification for specific intervention or continuing care


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PPC – adaptive care criteria

Screening process

4 individual specifiers:

1. Current recovery/treatment status

2. Substance use

3. Positive intervention preferences

4. Contra-indications


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PPC individual specifiers

Treatment Preferences

☐ Stay in local community

☐ Medication-assisted recovery

☐ Active involvement of social network in recovery plan

☐ Inpatient detoxification

☐ Intensive shorter or longer-term residential treatment in local area (1-12 months)

☐ Intensive shorter-term residential treatment away from locality (1-6 months)

☐ Intensive longer-term residential treatment away from locality (6-12 months)

☐ Preference to continue to work on recovery goals at same or different level of care


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PPC individual specifiers

  • Contra-indications

  • ☐ Significant risk of domestic violence

  • ☐ Lack of drug-free partner/spouse

  • ☐ Significant cognitive impairment or learning difficulties

  • ☐ Active hepatitis or abnormal liver parameters

  • ☐ Unwilling/able to sustain the regularity of attendance required

  • ☐ Unwilling/able to comply with conditions of residence

  • ☐ Current or previous experience of psychosis

  • ☐ Unlikely to be able to maintain 24 hour abstinence in a day programme setting

    • ☐ In education, training or employment which is best maintained during treatment

    • ☐ Has dependants, no arrangements for care can be made or are inappropriate


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PPC – adaptive care criteria

3 domains

1. Severity(dependence, health, risk, neglect)

2. Complexity(response, environment)

3. Strengths(personal, social, economic)


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18 PPC Dimensions

Severity and complexity

☐Physiological dependence

☐Psychological dependence

☐Overdose risk

☐Relationships and communication

☐General medical conditions

☐Psychological disorders

☐Personality factors

☐Trauma and stress

☐Criminal involvement

☐Risk and neglect

☐Treatment and recovery history

☐Recovery environment

Strengths (recovery capital)

☐Change motivation and therapeutic alliance

☐Quality of living situation

☐Supportive social network

☐Roles and responsibilities

☐Vocational skills and independence

☐Coping and outlook


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PPC – taking it forward

  • Further development with field

  • Pilot testing

  • Monitoring and refinement

  • Does using produce better outcomes?

  • Incorporate outcome risk adjustment

  • Adjust for push and pull factors


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