Nta residential rehabilitation event
1 / 33

NTA Residential Rehabilitation Event - PowerPoint PPT Presentation

  • Uploaded on

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.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'NTA Residential Rehabilitation Event' - melina

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Nta residential rehabilitation event l.jpg

NTA Residential Rehabilitation Event


Baroness Massey of Darwen

Building recovery realising the potential of residential rehabilitation l.jpg

Building RecoveryRealising the potential of residential rehabilitation

Paul Hayes

Chief Executive, NTA

Radical l.jpg

  • National vision

  • Local delivery

  • Individual choice

  • Rewarding success

Architecture l.jpg

  • Public Health England

  • Local Authorities

  • Service Users

  • Providers

2011 12 from treatment system to recovery system l.jpg
2011/12 from “Treatment system” to “Recovery system”

  • BRiC

  • Successful completions

  • Patient Placement Criteria

  • PbR

  • Skills

  • Recovery networks

  • Families

  • Jobs / houses

  • Prison / community

Rehab an underused resource l.jpg
Rehab – an underused resource

  • Dialogue

  • Respect

  • Understanding

  • Shared vision

  • Working market

  • Choice

  • Outcomes

  • VFM

  • Sustainability

Key themes for commissioners providers l.jpg

Key themes for Commissioners & Providers

March 2011

Mark Gillyon

Head of Delivery - North

Moc 3 building recovery in communities l.jpg
MoC 3  Building Recovery in Communities

2007 Clinical Guidelines

Integrated Drug Treatment System (IDTS)


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.

The new framework l.jpg
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.

The sector is changing l.jpg
The sector is changing...

Different models of delivery


Locally commissioned and locally provided


The commissioning environment is changing l.jpg
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

Other things will change l.jpg
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


About 2/3 report to NDTMS

New models / new data problems

The future of PTB

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

Data support l.jpg
Data support

NDTMS Regional Teams

Data collection, support, training, analysis

Rehab Online




Evidencing outcomes and value

Future developments l.jpg

Future developments

Colin Bradbury

Residential Rehabilitation Event

29th March 2011

Contents l.jpg

Payment by Results

Case Mix Adjustment

Residential Rehabilitation Outcomes

Payment by results background l.jpg
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



Health & Wellbeing (interim only)

Payment by Results

Opportunities and challenges l.jpg
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

Case mix l.jpg
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...



Rr outcome research l.jpg
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

In summary l.jpg
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

Patient placement criteria l.jpg

“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

Background l.jpg

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

Ppc expert sub group l.jpg
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

Slide26 l.jpg

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

Ppc in practice l.jpg
“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

Ppc adaptive care criteria l.jpg
PPC – adaptive care criteria

Screening process

4 individual specifiers:

1. Current recovery/treatment status

2. Substance use

3. Positive intervention preferences

4. Contra-indications

Ppc individual specifiers l.jpg
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

Ppc individual specifiers30 l.jpg
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

Ppc adaptive care criteria31 l.jpg
PPC – adaptive care criteria

3 domains

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

2. Complexity(response, environment)

3. Strengths(personal, social, economic)

18 ppc dimensions l.jpg
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

Ppc taking it forward l.jpg
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