Recovery-orientated drug treatment - National Treatment Agency for

Recovery-orientated drug treatment - National Treatment Agency for
“In 2010, the NTA asked me to chair
a group to provide guidance to the
drug treatment field on the proper
use of medications to aid recovery…”
recovery-orientated drug
treatment an interim report
by professor john strang,
chair of the expert group
NTA 2011
Recovery-Orientated Drug Treatment
An interim report by Professor John
Strang, chair of the expert group
Background
In August 2010, the NTA – on behalf of the
Department of Health – asked me to chair a group to
provide guidance to the drug treatment field on the
proper use of medications to aid recovery and on how
the care for those in need of effective and evidencebased drug treatment is more fully orientated to
optimise recovery. This work would also address the
critical observation, subsequently highlighted in the
2010 Drug Strategy1, that “for too many people
currently on a substitute prescription, what should be
the first step on the journey to recovery risks ending
there.” As an example of the recovery orientation,
the strategy expected that “all those on a substitute
prescription engage in recovery activities”.
The group’s task would be to provide guidance to
clinicians about the more effective provision of
recovery-orientated opioid substitution and other drug
treatments as part of broader personalised recovery
plans. For some individuals with heroin addiction, the
best treatment may include substitute medication, while
for others this may be inappropriate or unnecessary. In
all instances, the objective is to enable individuals to
achieve their fullest personal recovery. The expert group
would develop clinical protocols to guide clinicians and
agencies so they can help individuals make progress
towards this objective, improve support for long-term
recovery, and avoid unplanned drift into open-ended
maintenance prescribing.
whose working practice includes prescribing
medications for addiction treatments in primary and
secondary care settings. Experts also came from a
range of other clinical and rehabilitative settings, often
bringing a breadth of knowledge and experience of
recovery-orientated programmes. The group included
colleagues who have voiced criticisms of the current
system, and others who brought experience of driving
improvements in the recovery focus of addiction
treatments.
The group was joined by observers from government
departments and the NTA, which also provided its
secretariat. We also have the benefit of a number of
experts from across the world who have kindly agreed
to provide advice by correspondence.
The group’s agreed terms of reference are appended.
Since the group was convened in October 2010 we
have met six times and covered much ground. Further
work has taken place outside the full meetings,
including that of sub-groups (reported below). We
still have more to do and we expect to produce a
substantial product which reports conclusions and
recommendations early next year. In the meantime,
I am able to provide some early observations about
where we have found common ground, how
treatment services and systems can immediately
improve the treatment they offer to patients*, and a
vision for recovery-orientated drug treatment.
This project was a central plank of the NTA’s business
plan for 2010-112.
I selected a wide group of experts from across the
country. Many of these were experienced clinicians
*I have used the term ‘patient’ throughout, in part because of the clinician
orientation of this document, but we are aware others may prefer different terms.
Whatever the terminology and framework, we are looking to ensure an orientation
of nurturing recovery and a style of working with people to help them recover.
Gateway number: 16329
The National Treatment Agency for Substance Misuse, 6th Floor, Skipton House, 80 London Road, London SE1 6LH
T:020 7972 1999 F: 020 7972 1997 E: nta.enquiries@nta-nhs.org.uk W: www.nta.nhs.ukJuly 2011
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2011
Common ground
The group noted the remarkably strong body of
research evidence for the effectiveness of opioid
substitution treatment (OST), albeit mostly from
other countries. When delivered correctly to the right
individuals at the right time, OST retains patients in
treatment, supports improvements in health and
social functioning, reduces crime and illicit drug
use, prevents the spread of blood-borne viruses and
protects against overdose.
We need to hold on to what is good, and use it as
a platform from which to achieve more. We have
listened and heard evidence from drug users and
colleagues around the country that, too often, people
with addiction problems could be better supported
in their recovery, and that there could be greater
ambition for and focus on their potential to make
further progress.
There has been a growing recognition of imbalance
within the system over the last few years. The reexamination of drug strategy following the election
of the coalition government in May 2010 was the
catalyst for the review we are currently undertaking.
The group also noted the diversity and complexity of
both drug misuse and the needs of those who use
drugs. It has rarely been the case that a problem with
a single drug requires a single, simple solution; many
people in need of treatment have complex physical,
mental health and social problems requiring complex
interventions.
The drive in recent years to reduce waiting lists
and retain people in treatment has generally been
successful with the result that much larger numbers of
patients with addiction problems now enter treatment.
This has undoubtedly been accompanied by significant
benefits for many patients and the communities in
which they live.
However, the desire of clinicians to secure these
benefits has led, in some instances, to over-reliance
on medication and patients being allowed to drift into
long-term maintenance. As a consequence, insufficient
attention may have been paid to reviewing the actual
benefits gained, reconsidering alternative methods
to maximise the prospect of personal recovery, and
adjusting treatments so that greater recovery could be
achieved.
The prescribing of any medication (and perhaps
especially of OST) must not be allowed to become
detached and delivered in isolation from other crucial
components of effective treatment. Other elements
of overall care need also to be considered, including
individual recovery care planning, psychosocial
interventions and integration with mutual aid and peer
support. All of these, in different combinations with
different patients, and adjusted over time, can and do
support recovery.
Services have grown significantly during the sector’s
rapid expansion, which has been a time of greater
reliance on medication. Staff working in these services
may need additional training and support to gain the
competences to improve the quality of regular review
and restructuring of personalised care to support
recovery.
We already have considerable experience and
expertise within the UK available to us, and we also
have good international links so we can learn from
the best practitioners and researchers in the world.
Consequently we are in a strong position to deliver
any changes that, as a result of our review, we
consider necessary.
Existing guidance, and the extensive
evidence on which it is based, already
describes much of what is best practice
In its initial deliberations the group reconsidered some
of the key elements of effective drug treatment and
concluded that to a large extent they were already
described in existing clinical and other guidance,
although not always followed in practice. The
previously identified extensive research evidence base
had also been further strengthened.
A comprehensive assessment of need is an
essential early (and ongoing) step in the planning
of personalised treatment and it should also be an
integral part of the therapeutic process. Assessment
should not be a process that happens to someone but
one in which they are actively involved, to the fullest
appropriate degree, and about which they develop
their own understanding of their situation alongside
the understanding provided by the clinician.
The recovery care plan that results from this
assessment, and subsequent revisions when progress is
reviewed, must be developed collaboratively so that it
is personally relevant and ‘owned’ by the patient. This
will increase the likelihood that they commit to, and
are motivated by, a personal recovery care plan that is
meaningful to them.
The construction of a recovery care plan should be built
around the individual patient. Pre-existing packages
of care may be used, but they must be carefully and
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deliberately chosen to support the individually relevant
personalised treatment that is essential to ensure an
individual response based on need.
The provision of a prescription alone should not be
considered to constitute the totality of treatment.
Previous guidance3 has made it abundantly clear that
better results can generally be achieved by the proper
incorporation of psychosocial interventions within a
comprehensive OST programme. However it needs to
be noted that even OST with minimal psychological
input can reduce injecting and drug-related deaths.
In our opinion, while the gains from the medication
component of treatment can be significant, there
would be benefit from incorporating more of these
non-medication elements of treatment and from
aiming for higher achievement from such treatments.
The competent provision of the medication element of
the treatment – and tailoring it to the individual – may
be important, but it is still only the medication element.
Medication can valuably support individuals to
make changes to harmful behaviour, just as nicotine
replacement treatments can help individuals to quit
their previous smoking; but in such cases, active
commitment and effort is required from the individual
in order to maximise the impact of the medication.
Regular reviews of progress enable the clinician and
patient to assess continuing and changed need, and
appropriate responses. The Treatment Outcomes
Profile (TOP) has been specifically developed and
validated4 for use in reviewing progress, and has been
widely adopted on a routine regular basis by many
treatment agencies.
We have considered criticisms of the TOP as a tool
and of its intrusion into clinical practice. There may be
room for improvement – and the NTA is addressing
this – but it is essential that a culture of regular use
of common validated measures becomes part of
our clinical practice. This includes tracking progress
as evidenced by change over time, and ensuring
widespread use of the same (or directly comparable)
measures across clinicians and services.
Repeated reviews should result not only in a
personalised assessment but also the optimised
treatment for the individual. This should include – but
certainly not be limited to – attention to elements
of the medication component of treatment. If an
individual is deriving little or no benefit from an
intervention, then it should be modified and tailored
in partnership with the patient so that the provision of
the treatment delivers identified and valued benefit.
The total package may appear complex
and will follow, but this is what can
already be done
The total package for delivering recovery-orientated
drug treatment is likely, in its full description, to be
complex. It may take time for some treatment services
and systems to fully re-orientate to achieve the best
balance between reduction of negatives and accrual
of positives. Our full report, described on page 7, will
cover this balance in more detail.
In the meantime, there are some immediate steps
that can be taken to improve the recovery orientation
of treatments that include prescribing, and to ensure
there is appropriate support for patients to achieve the
best secure gains:
1.
Conduct an audit of the balance in your service between overcoming dependence and reducing harm to ensure that both objectives properly co-exist; and that individual clinicians understand and apply a personalised assessment for each patient, repeat it at regular intervals, and on the basis of its findings re-examine and adjust the treatment plan jointly with the patient
2.
Review all your patients to ensure they have achieved abstinence from their identified problem drug(s) or are working actively to achieve abstinence. Patients should also be offered the opportunity to come off medication after appropriate careful planning, when they are ready
3.
Consider whether to change the current balance between promoting overcoming of dependence and promoting reduction of harms, with the aim of actively encouraging more patients to take opportunities to recover. Although no clinician
should take unwarranted risk, neither should they protect patients to the extent that they are not encouraged and enabled to get better. This must always be undertaken in a way that supports each patient to make an informed choice that is relevant to their personal situation and is based on an accurate description of the available options
4.
Ensure exits from treatment are visible to patients from the minute they walk through the door of your service. This means giving them enough information to understand what might comprise a treatment journey, even if their eventual exit appears to some way off. And make visible those people who have successfully exited by explicitly linking your service to a recovery community, or employing ex-service users or using them in a volunteer capacity as recovery mentors and coaches
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5.
If agonist or antagonist medications are being prescribed, then review, jointly with each patient and with input, as appropriate, from relevant third parties, the extent of benefit still being obtained
6.
For patients who have achieved stability while on medication and who choose to reduce and/or stop the medication, ensure that support mechanisms are in place to support this transition, and also ensure that rapid re-capture avenues are in place and are understood and acceptable to the patient, in the event of failure of the transition
7.
Check that all treatment is optimised so patients are receiving the range and intensity of
interventions that will give them the best chance of recovery. This may include optimised doses of appropriate medications; the reintroduction, reduction or dropping of supervised consumption as appropriate; active keyworking, including case management and psychosocial interventions that keyworkers are competent to provide; access to other psychosocial interventions requiring additional competences; etc. As a first step, audit the availability of key NICE-recommended psychosocial interventions5, using the audit tool in the NTA/BPS Toolkit6
8.
Strengthen or develop patients’ social networks, involving families where appropriate and facilitating access to mutual aid by, for example, providing information, transport, or premises for meetings, and by bringing local recovery champions into the service to meet patients
9. Establish opportunities to accrue ‘social capital’ via work experience placements or employment, training opportunities, volunteer work, etc
10.Ensure all keyworkers are trained and supervised to deliver psychosocial interventions of a type and intensity appropriate to their competence. Effective keyworking entails not only recovery care planning, case management, advocacy and risk management, but also collaborative interventions designed to raise the insight and awareness of patients and help them plan and build a new life. This will often involve attention to employment and housing
11.Review the quality of your service’s recovery care planning and take steps to improve it, wherever possible. Recovery care plans should be personally meaningful documents, developed over a period of comprehensive assessment, and reviewed and adapted regularly, so that they are important to and owned by the patient
12.Ensure your service works with local housing and employment services, and in partnership with commissioners, to ensure there is supported and integrated access to relevant provision.
We will need a renewed emphasis on
improving people’s recovery
The new agenda is about more than business as usual
(or even business as it should have been). The new
emphasis on recovery will often best be addressed by
recourse to constructing personalised recovery care
plans which include reintegration and peer support.
While not losing the benefits from reduction of
the harms associated with drug use and addiction,
the new emphasis will probably also require more
prominent attention to efforts to obtain the positives,
by embracing a more proactive and aspirational
approach, identifying strengths and increasing
ambition to make important behavioural changes.
For the future, we envisage a much stronger and
more explicit focus on supporting the individual to
reintegrate within mainstream society. Not only does
this bring advantages and responsibilities, but it is
also as ‘therapeutic’ in its own right, with discernible
positives for the individual themselves as well as for
society at large. Drug treatment services, working
in conjunction with individual patients, will need to
establish mechanisms of joint working with the wide
range of services that can support someone to get a
job, housing, healthcare, etc.
We are exploring the extent to which a greater
emphasis on peer-led recovery (e.g. greater
incorporation of, and reliance on, peer-support and
mutual aid) may be beneficial, at least for some
patients and at some particular stages of treatment
and rehabilitation. This may require clinicians to
recognise the strengths brought by our patients and
their peers to enable one another to achieve and
sustain recovery, and to give them greater control over
how and where treatment and recovery occur.
Our work has begun to address four
key areas, and marked two more as
needing future attention
The group identified gaps or a lack of consensus in
four main areas, one of which has already been the
subject of a formal sub-group reporting to the main
group, and three of which have been the subject of
attention from subsets of the main group.
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The area immediately delegated to a sub-group was
around understanding the proportion of patients who
might be expected to rapidly recover with no or limited
substitute prescribing and what proportion will need
long-term care, including substitute prescribing. A subgroup chaired by Dr David Best was asked to develop
thinking on “patient placement criteria” (see below).
The sub-group’s terms of reference are appended.
Patient placement criteria
The sub-group commissioned to examine patient
placement criteria developed in two areas:
1. Segmentation locality assessment
Developing models for dividing up treatment and
recovery populations to allow for an understanding
of differential rates of recovery probability
2. Treatment and recovery indicators
Developing a set of indicators that can be used by
keyworkers at assessment and review to identify
treatments and specific interventions from which
clients may be most likely to benefit.
The PPC sub-group is still busily engaged in
its work. It heard the initial outcomes of the
Segmentation Locality Assessment work in April
and plans to follow this with an initial tool for
testing the treatment and recovery indicators.
All of this work will first come to the full RODT
group for consideration and incorporation (as
appropriate) and, while it is ongoing, forms no
further part of this interim report.
B. Determining how progress in treatment and the
accumulation of ‘positive capital’ can be measured
Monitoring the benefits from, and progress of,
treatment is an essential element of good clinical
practice. The work in this second area has been to
consider how recovery capital and its accumulation
can best be measured in treatment. We are
considering the potential contribution of various
possible measures of such recovery capital. We are
mindful of the wide current use of the Treatment
Outcomes Profile (TOP) which has been central to the
NTA’s recent work in this area, but it has been agreed
that the measurement of recovery (what we have
taken to calling ‘recoverometry’) will require greater
attention to the dimensions of recovery identified in
the first area of work.
C. Developing an understanding of how
interventions can be layered and sequenced to
support a personally-relevant and evolving journey
of treatment and recovery.
Bringing the previous two areas together, the third
area of work is then concerned with how treatment
interventions and the systems in which they are
provided can be better sequenced and/or layered:
an analysis of who gets what when, and how it is
best delivered. We are exploring how, through a
closer definition of the components of treatment and
organising them into varying intensities and phases,
it may be possible for there to be more effective and
more efficient deployment of available resources
in such a way as to maximise overall individual and
societal benefit.
The two areas requiring future attention are:
The next three areas settled on by the main RODT
group as needing further attention were:
A. Understanding the dimensions of recovery and
how these fit into a conceptual framework
As the first step on the road to recovery, treatment
needs to focus not only on preventing immediate and
longer-term harm but also on helping patients to build
the resources they will need to sustain that recovery:
‘recovery capital’. The 2010 Drug Strategy gives us
a framework for recovery and the work in this first
area focussed on the implications of that framework
for prescribing practice. Sometimes clinicians may
be too ready to accept the reduction of negatives
which can occur rapidly with prescribing interventions
as sufficient impact of the treatment, and they may
consequently fail to work with their patient on the
accrual of positives, with the involvement in treatment
acting as a platform for increasing someone’s social,
physical, human and cultural recovery capital.
••How to optimise opioid substitution therapy, which may involve different intensities and need targeted phases of treatment
••The potential wider future use of a range of medications (existing and in development, and also considering new emerging technologies) in a range of treatment and recovery settings.
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a vision for the future
The group’s full report
Our vision for the future is a system:
Our full report later this year is expected to cover:
••In which the valuable role of prescribing continues ••A summary of the key evidence for medication factors important in promoting recovery
to be recognised, though it is not an end in itself but a component of a phased, integrated package of treatment that minimises risk while being ambitious for each individual patient’s recovery
••That develops and supports staff to adopt recovery-orientated practice and in which they are trained to deliver evidence-based psychosocial interventions alongside medical interventions
••In which everyone entering treatment is enabled to see and understand the range of treatment and recovery options open to them, the trajectories of the journey on which they are embarked, and the possible destinations of that journey
••That seeks to maximise what individuals can achieve, with a clear overall sense of movement and progress for patients, even during those periods when they are appropriately allowed to settle and stabilise
••That recognises the real achievement of preventing the deterioration that would otherwise have occurred to more severely damaged patients
••A conceptual framework of recovery which specifically examines how benefits of medication can be harnessed to best effect
••Guidance on measuring treatment benefit to support progress
••A description of how to optimise both opioid substitution therapy and also the accompanying psychological and psychosocial treatments, which, for both, may involve different intensities and need targeted phases of treatment
••Strategies to encourage greater constructive use of peer role-models and peer support
••Guidance on how it might be possible to open up new opportunities for patients making progress in their personal recovery to be supported further with employment opportunities and other ways of accruing ‘social capital’
••The potential for the use of a range of medications in treatment and recovery settings.
••That closely involves families and carers in patients’ treatment, and supports them in their own right
••That has close links to its community, that works alongside other systems to facilitate access to a broad range of reintegration and recovery support
••In which there are well-defined roles for current and future medications in stabilising, maintaining and detoxifying patients, and preventing relapse in different settings.
Professor John Strang is a consultant psychiatrist,
director of the National Addiction Centre, and head of
the Addicitions Department at King’s College, London
References
HMGovernment (2010) Drug Strategy 2010 ‘Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life’.
London: H M Government
1
NTA (2010) NTA Business Plan 2010-11. London: National Treatment Agency for Substance Misuse
2
E.g. Department of Health (England) and the devolved administrations (2007) Drug Misuse and Dependence: UK Guidelines on Clinical
Management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive, and
the NICE suite of 2007 drug misuse guidance on which the Clinical Guidelines draw
3
Marsden J, Farrell M, Bradbury C, Dale-Perera A, Eastwood B, Roxburgh M & Taylor S (2008). ‘Development of the Treatment Outcomes Profile’.
Addiction, 2008; 103 (9): 1450–1460
4
NICE (2007) ‘Drug Misuse: Psychosocial Interventions’. NICE clinical guideline 51. London: National Institute for Health and Clinical Excellence
5
Pilling S, Hesketh K & Mitcheson L (2010) ‘Routes to Recovery: Psychosocial Interventions for Drug Misuse. A Framework and Toolkit for
Implementing NICE-recommended Treatment Interventions’. London: National Treatment Agency for Substance Misuse & British Psychological Society
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Appendix A
terms of reference for the expert
group
The Group’s task
Background
During 2010-11 the NTA will work to reposition the
treatment system to focus on safe and sustained
recovery, and to demonstrate transparent outcomes,
while consistently providing more for less. As part
of this work the NTA is convening an expert group
of clinicians and other interested parties to develop
clinical guidance and tools in two closely related areas.
Firstly, the NTA is committed to exploring the
principle that open-ended substitute prescribing in
the community should only be used in exceptional
circumstances and only on the basis of a rigorous,
multidisciplinary review of a patient’s ongoing needs.
The objective is to make the system more dynamic.
We do not want to allow service users to drift into
long-term maintenance prescribing without effort
being made to promote beneficial change in their
lives. Sound, evidence-based clinical judgement
endorsed by clinical governance will be able to identify
cases where the approach would not be appropriate,
but the intent is to see a fundamental shift in
the balance of treatment for opiate dependence,
away from the unreviewed provision of long-term
maintenance towards supporting individuals to
overcome dependence and to recover fully.
The expert group will develop a clinical consensus and
resultant protocols that focus practitioners and clients
on supporting long-term recovery as the desired
outcome of treatment and prevent unplanned drift
into long-term maintenance.
Secondly, we wish to develop patient placement
criteria to maximise access to recovery-focused
pathways, ensure a consistent and transparent
approach to the commissioning of community and
residential rehabilitation, and achieve a cost-effective
balance between different types of treatment. This
will be based on a consensus on which individual
drug users would benefit most from which treatment
service models. This would distinguish between
those requiring long-term treatment and those who
can safely and quickly overcome their dependence
and achieve long-term recovery. The expert group
will advise on the development of a model to match
individual clinical need as closely as possible to the
location, intensity and duration of the treatment that
is most likely to be effective at promoting recovery
including indicating those who are likely to benefit
from residential treatment.
These tasks, and the expert group’s deliberations, are
expected to feed into the NTA’s development of an
explicit, recovery-orientated vision for the treatment
system to replace the current framework, Models
of Care for Treatment of Adult Drug Misusers, last
updated in 2006. The document and accompanying
implementation will facilitate the transformation
of local treatment systems to enshrine that greater
ambition, and ensure that achieving sustained recovery
from addiction is the basis of all local commissioning
and service delivery in prison and community settings.
Proposed work
The proposal is therefore that an expert working
group should:
Develop, for and with the National Treatment
Agency, clinical consensus and appropriate clinical
protocols for substitute prescribing, and a model for
the segmentation of the treatment population and
suitable treatment placement indicators, both in the
context of the developing recovery framework.
It is likely that sub-groups may be needed to work on
specific aspects of this wide-ranging task.
Status
The process of development by a respected expert
group, with NTA and Department of Health support,
will ensure the protocols and models are accepted as an
important guide to best practice by the drug misuse
treatment field and relevant professional bodies.
Coverage
The work relates to England only.
Composition
Membership
Professor John Strang (chair)
Mike Ashton – Findings
Dr Alison Battersby – Psychiatrist, Plymouth
Dr James Bell – Physician, SLAM
Dr David Best – University of West Scotland
Dr Owen Bowden-Jones – RCPsych addictions faculty
chair
Jayne Bridge – Nurse, Mersey Care NHS Trust
Anne Charlesworth – Commissioner, Rotherham
Professor Alex Copello – Birmingham
Dr Ed Day – Psychiatrist, Birmingham
Selina Douglas – Commissioner, Westminster
Vivienne Evans – Adfam
Dr Eilish Gilvarry – Psychiatrist, NTW
Jason Gough – Service user voice, Sheffield
Kate Hall – NHS service director, GMW
Dr Linda Harris – RCGP substance misuse unit director
Dr Michael Kelleher – Psychiatrist, SLAM
Dr Brian Kidd – Psychiatrist, Scotland
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Tim Leighton – Action on Addiction (residential sector)
Peter McDermott – Service user voice, The Alliance
Professor Neil McKeganey – University of Glasgow
Dr Luke Mitcheson – Psychologist, SLAM
Dr Gordon Morse – GP Somerset
Morag Murray – NHS service director, Sussex
Noreen Oliver – BAC O’Connor
Professor Steve Pilling – NICE and NCCMH
Dr Roy Robertson – University of Edinburgh
Ian Wardle – Lifeline
Observers/secretariat
Department of Health Substance Misuse team
Department of Health Offender Health team
Home Office drugs strategy team
National Treatment Agency (observers and secretariat)
Corresponding members
Dr Laura Amato – Cochrane Drugs and Alcohol
Group, Department of Epidemiology, Rome, Italy
Professor Wayne Hall – National Health and Medical
Research Council, Australia
Professor Keith Humphreys – Stanford University
School of Medicine, USA
Professor A Thomas McLellan – University of
Pennsylvania and Treatment Research Institute, USA
William L White – Chestnut Health Systems, USA
Declaration of interests
Members will be required to declare any potentially
conflicting interests in line with established DH policy
and procedures.
Timetable
It is proposed that the initial meeting of the expert
group will take place in September 2010; that the
subsequent meeting schedule will be determined by
the work plan of the group, and that sub groups may
meet more frequently. Meetings will usually be a half
or full day and mostly held in London.
The final publications are expected in 2011-12, with:
••An interim report on options for clinical protocols for substitute prescribing planned for quarter 4 2010-11
••National consultation on treatment placement indicators scheduled for quarter 3 2010-11. Piloting of the approach in selected parts of the country to refine their effectiveness is scheduled for quarter 4 2010-11.
Outputs
••The publication of clinical protocols for substitute prescribing
••A model for segmentation of the treatment population and suitable treatment placement indicators.
Inputs
Support and costs
The expert group will be serviced and supported by
the NTA, which will also fund meeting costs including
travel costs for working group members.
Working group members will be able to claim hotel
expenses for one night if necessary/appropriate.
Expenses will be reimbursed on production of
appropriate receipts and completed claim forms,
according to NTA financial procedures.
Appendix B
the PPC sub-group terms of reference
nb. These terms of reference should be read with
reference to the terms of reference of the main RODT
expert group.
The sub-group’s task
Background
The NTA wishes to develop patient placement
criteria to maximise access to abstinence-focused
pathways, ensure a consistent and transparent
approach to commissioning community and residential
rehabilitation, and achieve a cost-effective balance
between different types of treatment. This will be
based on a consensus on which drug users would
benefit most from which service models and recoveryoriented pathways. This would distinguish between
those requiring long-term treatment and those who
could be safely and quickly moved to abstinence, and
indicate those who are likely to benefit from residential
treatment. The expert sub-group will advise on the
development of a model to match individual clinical
need as closely as possible to the location, intensity
and duration of the treatment that is most likely to
effectively promote recovery.
This is a sub-group of the RODT expert group, whose
aim is to:
“Develop, for and with the National Treatment
Agency, clinical consensus and appropriate clinical
protocols for substitute prescribing, and a model for
the segmentation of the treatment population and
suitable treatment placement indicators, both in the
context of the developing recovery framework.”
The chair of the sub-group, David Best, will report
back to the RODT group and will act as the link
between the groups.
Proposed work
The proposal is that an expert sub-group should:
Develop, for and with the National Treatment Agency,
a model for the segmentation of the treatment
population and the ‘at-need’ group not currently
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engaged in treatment, in terms of their likely recovery
pathways and journeys. This will prepare the way for
matching to suitable treatment placement indicators,
in the context of the developing recovery framework.
Overall, the aims of the group are to agree a process
for meaningful segmentation and to utilise this as
a way of identifying matching criteria for treatment
journeys and ongoing recovery pathways.
Dr John Marsden – NTA & IoP
Christopher Whiteley – NTA and East London NHS
Trust
The work of the group will be to focus on initial
assessment and the decision-making at different
stages of recovery journeys, and will examine wider
needs, including populations whose needs may be
met without recourse to formal treatment.
Corresponding members
William White
Alexandre Laudet
Arthur Evans
Mike Dennis
Robert Ali
Steve Shoptaw
Min Zhao
Status
The process of development by a respected expert
group, with NTA and Department of Health support,
will ensure the protocols and models are accepted as an
important guide to best practice by the drug misuse
treatment field and relevant professional bodies.
Coverage
The work relates to England only.
Composition
Membership
Members will primarlily be drawn from the main RODT
expert group but supplemented by the co-option of
other key individuals.
RODT
Dr David Best (chair) – University of the West of
Scotland
Jayne Bridge – Mersey Care NHS Trust
Dr Ed Day – University of Birmingham
Vivienne Evans – Adfam
Jason Gough – Service user voice
Kate Hall – Greater Manchester West
Linda Harris – Wakefield & RCGP
Tim Leighton – Action on Addiction
Peter McDermott – The Alliance
Co-opted
Nichola Adamson – Worcestershire DAAT
Karen Biggs – Phoenix Futures
Wendy Dawson – The Ley Community
Tom Kirkwood – Trust the Process
Dave Knight – RCN
Dr David McCartney – LEAP
Observers/secretariat
Department of Health Substance Misuse team –
Dr Mark Prunty, Amy Edens
National Treatment Agency, secretariat – Steve Taylor
Declaration of interests
Members will be required to declare any potentially
conflicting interests in line with established DH policy
and procedures.
Timetable
The initial meeting of the main expert group will take
place in December 2010, when consideration will be
given to the frequency and timings of meetings of the
sub group.
Outputs
••An outline of segmentation methods and categories for drug users in and out of treatment
••A model for segmentation of the treatment population and suitable treatment placement indicators.
Inputs
Support and costs
The sub-group will be serviced and supported by the
NTA, which will also fund meeting costs including
travel costs (if needed) for members.
Working group members will be able to claim hotel
expenses for one night if necessary/appropriate.
Expenses will be reimbursed on production of
appropriate receipts and completed claim forms,
according to NTA financial procedures.
PPC Project Team
Colin Bradbury – NTA
Pete Burkinshaw – Skills and Development Manager
Alison Keating – NTA regional manager
Dr Michael Kelleher – NTA & SLAM
10
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