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DH West Midlands Developing and Implementing Local Alcohol Treatment Pathways Workshop - 18th January 2009

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Title: DH West Midlands Developing and Implementing Local Alcohol Treatment Pathways Workshop - 18th January 2009


1
DH West MidlandsDeveloping and Implementing
Local Alcohol Treatment PathwaysWorkshop -
18th January 2009
Steve Arnold David Monk
2
Alcohol Treatment Pathways Workshop Programme
3
Developing and Implementing Local Alcohol
Treatment Pathways 18th January 2010 Government
Office for the West Midlands Birmingham Damian
Mitchell Alcohol Improvement Programme Department
of Health
4
(No Transcript)
5
National Alcohol Improvement Programme
NHS
Planned delivery on RA-RHAs
Start delivering RA-RHAs
Receive priority support from AIIC Implement
High Impact Changes
Implementation
Early Implementation PCTs
PCTs (Unplanned) delivery on targets through
implementation of elements of the high impact
actions
learning
learning
learning
Support Influence
Review Support
Priority access
learning
NST(DH) Supports 18 struggling PCTs
P.A. Strategic reports follow-up visits
Regional co-ordinators (DH/SHA) Responsibility to
ensure delivery of targets
Support
learning
DH Policy Team Role Work with outside bodies to
facilitate frontline delivery. Develop policy,
Develop Guidance, Commission, co-ordinate and
contract manage support projects and channel
expertise
Social Marketing Insight, evidence, products and
interventions
NWPHO Provide local data on need and key evidence
Trailblazers (SIPS), ANARP Effectiveness review,
HES data,etc
Evidence
6
http//www.alcohollearningcentre.org.uk/
7
http//www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_1104
23
8
Developing Alcohol Treatment Pathways
Introduction (1)Don Lavoie DH Alcohol Policy
Team
  • Alcohol Treatment Pathways (ATPs) are locally
    agreed templates for best practice
  • They map out the local help available for
    alcohol-related problems at the various stages of
    a treatment journey.
  • They are commonly made up of a flow diagram
    showing the particular pathway and decision
    points
  • Alongside the diagram is background documentation
    giving explanatory narrative and clarifying
    details
  • This allows for a wide variation in size, scope
    and detail.

9
Developing Alcohol Treatment Pathways
Introduction (2)Don Lavoie DH Alcohol Policy
Team
  • Builds on locally agreed protocols and developed
    treatment guidelines
  • Supports more standardised local practice
  • Provides practical help and guidance to less
    experienced workers.
  • An ATP is not a substitute for management,
    supervision and training,
  • But an ATP does offer a means to help ensure
    consistently high standards of treatment and
    care.

10
Developing Alcohol Treatment Pathways -
ChecklistDon Lavoie DH Alcohol Policy Team
  • ATPs should be
  • agreed and developed locally, taking account of
    local service configuration and priorities
  • evidence-based
  • client-focused and
  • agreed and championed so as to ensure ownership
    by managers, practitioners and the key
    stakeholder who can influence success

11
Developing Alcohol Treatment Pathways Key
ElementsDon Lavoie DH Alcohol Policy Team
  • Reviewing the existing documentation, and the
    processes and pathways currently in use
  • Developing or revising local treatment guidelines
    and protocols
  • Deciding on the content of the ATP document
    what we need to know and what would be helpful to
    know and include
  • Producing clearly written documents that are easy
    to understand and are user-friendly
  • effective editorial control from the ATP lead or
    champion is needed
  • alongside involvement of all stakeholders on
    drafts and
  • Comparing new drafts with existing paperwork,
    removing duplication and including essential new
    content.

12
Developing Alcohol Treatment Pathways Narrative
(1)Don Lavoie DH Alcohol Policy Team
  • Purpose
  • Provides clarity as to the type of client the
    alcohol treatment intervention caters for
  • States what the client can expect treatment
    services to provide including important
    detailed practical arrangements when appropriate
  • Sets out the roles and responsibilities of the
    service within the integrated care system towards
    the individual client.

13
Developing Alcohol Treatment Pathways Narrative
(2)Don Lavoie DH Alcohol Policy Team
  • Content
  • Definition of the treatment interventions
    provided (referencing any key guidance or
    guidelines)
  • Aims and objectives of the treatment
    interventions
  • Definition of the client group served
  • Eligibility criteria (including priority groups)
  • Exclusion criteria or contraindications
  • Referral, screening and assessment processes
  • Process for agreeing the treatment goals
  • Description of the treatment process or phases
  • Description of the co-ordination of care
  • Nature of departure planning, aftercare and
    support
  • Relevant onward referral pathways
  • Description of the range of services/agencies
    with which the interventions interface

14
Developing Alcohol Treatment Pathways Exemplars
(1)Don Lavoie DH Alcohol Policy Team
  • Five specimen template alcohol treatment pathway
    diagrams. The diagrams will rarely make complete
    sense out of the local context
  • The aim of the examples is to identify the shape
    of some typical ATPs whilst recognising the scope
    and level of detail will vary markedly from place
    to place
  • They are not intended to be prescriptive but
    rather to be illustrative of issues that may be
    of relevance in developing different ATPs
  • In addition to the diagrams, some narrative
    commentary is given for each pathway, pointing
    out some issues that may need to be considered or
    addressed

15
Developing Alcohol Treatment Pathways Exemplars
(2)Don Lavoie DH Alcohol Policy Team
  • Currently available
  • Identification and brief advice (IBA)
  • Community based services - assisted alcohol
    withdrawal
  • Assisted alcohol withdrawal inpatient-based
  • People with combined alcohol and mental health
    problems
  • Homeless people who need alcohol treatment
  • For further consideration
  • Residential rehabilitation
  • People with alcohol problems who also experience
    domestic abuse
  • Service users in drug treatment who also have
    alcohol problems

16
Primary Care - Alcohol Care Pathway
Adults 16-64 visiting GP
Requesting help with alcohol problem
New Registration
Other health complaint
SASQ
FAST
AUDIT - C
AUDIT - PC
Initial Screening Tools
PositiveResult
NegativeResult
Full Screen AUDIT
No action
AUDIT Score 8-15 Increasing-risk
AUDIT Score 16-19 Higher-risk
AUDIT Score 20 Possible Dependence
AUDIT Score 0-7 Lower-risk
Consider Referral to Specialist Services
Extended Brief Advice
Brief Advice
Full Assessment
17
ATP 1
18
ATP 2 Part 1
19
ATP 2 Part 2
20
ATP 3
21
ATP 4
22
ATP 5 Part 1
23
ATP 5 Part 2
24
Developing Alcohol Treatment Pathways Final
thoughtsDon Lavoie DH Alcohol Policy Team
  • The way in which ATPs are developed locally will
    depend on the issues that have been identified as
    most important for which the development of ATPs
    are considered a useful contribution
  • Planning the development of ATPs over a sensible
    timeline will be needed in order to ensure that
    high quality and robust ATPs are developed rather
    than simply quickly achieving a comprehensive but
    superficial coverage of topics
  • It is important for all the key contributors to
    the care described in any particular ATP to be
    engaged in the development of that care pathway,
    at least at key development points and for final
    sign-off
  • Establishing effective treatment pathways can
    therefore also involve developing and
    strengthening partnerships between relevant local
    organisations
  • ATP development can be a helpful mechanisms to
    involve service users and carers in governance
    processes

25
Developing Alcohol Treatment PathwaysWhat Else
Might be Useful?
  • Access to good data and combined intelligence
  • PH/quality observatory
  • Benchmarking capability
  • NI 39 groups
  • Learning sets
  • Gaining collaborative advantage
  • Using map of medicine getting alcohol pathways
    on this resource
  • The Royal Colleges - expert power message
  • Better local modelling
  • Consistency of the science social market
    messaging e.g. pregnancy
  • Balance between crime and health consequences
    in the marketing imagery
  • A minimum unit price
  • National Minimum Dataset for AE to include
    Alcohol related diagnoses

26
Developing Alcohol Treatment PathwaysWhat Else
Might be Useful?
  • QOF requirement DH to lobby
  • Positioning of alcohol advertising (NB new
    campaign form February 2010)
  • CQUIN requirements national, regional and local
    incentives
  • QIPP/QaP
  • Innovation funds available through SHAs
  • Links to other initiatives, e.g.
  • Links to the Quality agenda advancing quality
    via Pathway Metrics, Clinical engagement and User
    experience
  • Need to lobby for Alcohol awareness across all
    services (similar to e.g. work on Medically
    Unexplained Symptoms)
  • Mental Health service use of GPs with a special
    interest in Psychiatry

27
Developing Alcohol Treatment PathwaysLocal
Experience in the West Midlands (1)
  • Sandwell (Neil Parkes)
  • Overview pathway supported by specific pathways
    for
  • GP/Self Referral to Tier 2 Services
  • Tier 2 services (designated provider)
  • Referral to Tier 3
  • AE Referral and AE Attendance
  • Generic inpatient services
  • Tier 3 service (designated provider)
  • Framed around the NHS but other agencies provide
    support
  • Interagency Alcohol group established from
    January 2010 will help to formalise work done
    so far
  • SLA in place for Tier 2 services under
    development in respect of Tier 3
  • The Pathway is not the only output improving
    the process of working together through
    experience is a key deliverable

28
Developing Alcohol Treatment PathwaysLocal
Experience in the West Midlands (2)
  • North Staffordshire (Tim McGreggor) - new model
    for commissioning services to reduce alcohol
    related harm in the South Staffordshire
  • Build on recent needs assessment and utilise the
    DH Ready Reckoner and Rush Model tool
  • Bring together key players to achieve ownership
  • Invest time with Practice Based Commissioners to
    ensure PCT ownership
  • Integrated pathways reflect the DH Local pathways
    document
  • ICPs need to go through PCT PECs
  • Difficult to move investment out of mental health
    trusts as it is part of a bigger lock contract
  • Need to work very closely with drug commissioners
    to check for impact or disinvestment in drug
    treatment services
  • Inpatient detox needs to addressed at a regional
    level

29
Developing Alcohol Treatment Pathways Generic
Approach (1)
Knowledge of people needing
services 1.Quality of Information Signposting Eas
e of entry
2.The Assessment Process Right 1st
time Dynamic
3.The Delivery Experience Personalised
care packages
4.Information Planning Signposting Eas
e of Exit
5. Care Coordination Navigation and Advocacy
Segmentation
Care Currency
Access, Entry Re-entry
Formulation
D I A G N O S I s
C L U S T E R S
Exit Aftercare
Currency
Currency
Currency
Currency
30
Developing Alcohol Treatment Pathways Generic
Approach (2)
Innovation
Clear objectives
Barriers
Review (local context)
A clear strategy
Enablers
The evidence
31
Developing Alcohol Treatment Pathways Generic
Approach (3)
  • Clarity about population targeted
  • A good case behind choices
  • Strategic analysis
  • Knowledge of stakeholders
  • High level health economic case well made and
    understood
  • Understand the policy competition
  • Innovation (and funds)
  • Evidence of what works
  • Quality of assessments
  • Choosing the right intervention

32
Developing Alcohol Treatment Pathways Local
Treatment Pathways Group work - Briefing
  • Working in designated groups
  • Identify any key local implementation issues
  • Begin the preparation of a local action plan
  • Consider further action beyond the workshop, inc
    any joint working and external support required
  • Keep written notes of the key points
  • Summarise the 3 key messages

33
Developing Alcohol Treatment Pathways Local
Treatment Pathways Group work Summary of Key
Messages (1)
  • Starting with a Simple pathway makes sense the
    basis for a sensible dialogue with stakeholders
  • Learn from experience create the environment to
    share knowledge
  • Up our game on information, data and its utility
    - better metrics - better Commissioning'

34
Developing Alcohol Treatment Pathways Local
Treatment Pathways Group work Summary of Key
Messages (2)
  • Better stakeholder buy in right people engaged
    at right time - a clear business case
  • Understand the resource implications in more
    detail understand demand and the time it takes
    (time-lag) to realise a return
  • Realism in the pathway - linking with other
    pathways where it makes sense e.g. Sexual health
    pathways

35
Developing Alcohol Treatment Pathways Local
Treatment Pathways Group work Summary of Key
Messages (3)
  • Leadership vital on the payroll and driving the
    issue - Alcohol champions across partners
  • Good local needs assessment driving commissioning
    and better benchmarking
  • Learning exchanges more sharing roll for
    the RAM to match make

36
Developing Alcohol Treatment Pathways Local
Treatment Pathways Action
  • PCTs to consider options for joint working on the
    further development of ATPs e.g.
  • Region-wide user support group
  • Sub-regional geographic groups
  • PCTs at the same stage of preparation work
    together
  • Initial assessment of current position in each
    PCT to be undertaken to inform the process
    Deryn B to lead, using the recently developed PCT
    self-assessment tool or similar
  • Regional support to continue for local
    initiatives via Deryn B
  • The ALC team to provide dedicated website space
    for the West Midlands, enabling storage of
    locally developed pathways
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