Invitation to Tender for Wandsworth Integrated Drug and Alcohol Treatment and Recovery Service. Reference: WAND-Q0157 Attachment 3: Specification

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1 Invitation to Tender for Wandsworth Integrated Drug and Alcohol Treatment and Recovery Service Reference: WAND-Q0157 Attachment 3: Specification

2 PURPOSE The Aims of the Integrated Drug and Alcohol Treatment Service To offer personalised opportunities for those using drugs and / or alcohol to move towards sustained recovery To reduce the harm caused by drug and alcohol use on the local community including contributing to a reduction in crime and anti-social behaviour To ensure that the principles of harm minimisation underpin the delivery of all interventions in order to improve the health and well-being of service users To deliver a non-judgemental and inclusive service which treats service users with dignity, respecting gender, sexual orientation, age, physical or mental health ability, religion, culture, social background and lifestyle choice To deliver services which are accessible, responsive and offer greater service user choice To improve the outcomes for children of service users by reducing the impact of drug and alcohol related harm on family life and to promote positive family involvement in treatment To facilitate a co-ordinated and holistic approach to recovery which emphasises the inclusion, or re-entry into society of service users by working with a range of local partner agencies To reduce the impact of drug and alcohol misuse on the wider public sector economy by promoting effective treatment and harm reduction responses in a range of settings including primary and community health care, mental health and criminal justice services To identify and safeguard vulnerable adults and children of adults who use the services SERVICE SCOPE Service Users The Integrated Substance Misuse and Alcohol Service is a service for Wandsworth residents 18 years and over, their families and significant others who are experiencing issues with drug and / or alcohol use. Priority groups are: Pregnant women P a g e 2

3 Individuals whose children are categorised as in need under the Children s Act 2004 or have been subject to a Common Assessment Framework (CAF) or Team Around the Family (TAF) Individuals with a co-morbid physical and / or mental health diagnosis where their drug or alcohol use exacerbates this diagnosis Individuals whose drug and / or alcohol use puts them at immediate risk of homelessness Individuals who have recently been discharged from prison Individuals subject to Multi Agency Public Protection Arrangements (MAPPA) Individuals subject to a court requirement to engage in treatment Perpetrators and victims of domestic violence The service is not for individuals under the age of 18* *It will be the responsibility of the provider to deliver clinical interventions to individuals under the age of 18 with an identified prescribing need in the event this should occur. 1. Assessment The vision for Wandsworth is for a single client assessment and information system to underpin a fully integrated treatment system. This will facilitate a multi-disciplinary working and provide accountability and information sharing within the wider context of client confidentiality and clinical governance. 1.1 The provider will be responsible for the development of a universal assessment framework which will be used with both drug and alcohol clients 1.2 In line with Models of Care and Models of Care for Alcohol Misusers, the assessment framework will include a screening tool, a triage tool and a full comprehensive assessment. It will adopt a holistic approach and include the Alcohol Use Disorder Identification Test (AUDIT) and the Severity of Alcohol Dependency (SAD) questionnaire for all individuals using alcohol 1.3 It is expected that every new service user entering the service will receive a triage assessment on their first contact with the service and a comprehensive assessment prior to starting tier 3 structured treatments P a g e 3

4 1.4 The maximum waiting time between a triage and a comprehensive assessment for those ready and willing to engage in structured treatment will be one week. For priority groups of individuals or who may present as being at immediate risk of harm the maximum waiting time will be 72 hours 1.5 The comprehensive assessment will fulfil requirements of drug and alcohol minimum data sets and include as a minimum: Drug and / or alcohol use Physical health A mental health screening tool Housing needs Emotional needs Social networks including family life and relationships Personal and life skills Future aspirations and beliefs around recovery The minimum data set can be seen at: 1.6 The assessment framework will include a screening for blood borne viruses, smoking cessation, nutrition, sexual health and domestic violence 1.7 The assessment framework will be used to inform a recovery plan which will be reviewed and updated at a minimum of every three months and according to changing needs and circumstances 1.8 Where additional needs are identified, where appropriate and with client consent a referral will be made and followed up with local health and social care services 1.9 All service users will have a single case file throughout their recovery journey. Initial and comprehensive assessment will be updated, but not duplicated as the service user moves between different settings and modalities 1.10 The provider will ensure that every service user receives a full explanation of confidentiality and reasons why it might be broken before the assessment process begins 1.11 Where service users are not registered with a GP they will be supported to identify and register with one P a g e 4

5 1.12 A risk assessment will be completed for every new service user including their level of risk awareness. Where risks are identified, a risk management plan will be developed, implemented and linked to the service user s recovery plan. This must be subject to regular review. Information relating to risk will be shared and acted upon according to the local risk assessment framework 1.13 In line with Hidden Harm and the whole family approach, the assessment will identify those service users who are parents and / or who come into regular contact with children. For these service users, a specific child needs assessment will be completed capturing at a minimum the following information: The name of the main carer/s for children The age of children The name of health visitor if applicable Is there a CAF open? Is there a child protection plan or has there been one open in the past? 1.14 Where children are identified, the provider will have mechanisms in place to be able to appropriately respond to the multi-agency Common Assessment Framework (CAF) if applicable 1.15 In line with Supporting and Involving Carers, (NTA 2008) family members and significant others will be given the option to be involved in assessment, where appropriate and with the consent of the service user. Where family members and significant others are identified as fulfilling a caring role they will be signposted and or referred as appropriate into local carer services 1.16 Assessment will be available in a range of settings to suit the needs of the service user, their family and the wider strategic priorities including specialist, primary and secondary care settings 2. Case Management and Care Co-ordination A single case management system will underpin the treatment system and will be used to promote systematic review and on-going service user engagement. 2.1 Recovery planning and review will be a dynamic and empowering process involving the service user and where appropriate professionals from partner agencies involved in the service user s on-going recovery. This will include the service user s family and / or significant others where appropriate and with service user consent P a g e 5

6 2.2 The Provider will ensure that the treatment outcome profile (TOP) is routinely completed for all drug users at treatment entry, at recovery plan review (which shall take place at least once every six months) and on planned exit from treatment. A minimum threshold of 80% completion at all of these stages will be achieved every month 2.3 All recovery plans will be specific, measurable, attainable, realistic and time-bound and will incorporate the TOP process for drug users 2.4 The provider will take particular measures to promote accurate and meaningful completion of all TOPS treatment questions including those which relate to offending 2.5 It is expected that where possible one allocated key-worker will assume responsibility for the co-ordination of the service user s recovery journey across all elements of tier 3 and tier 4 treatment and between a range of partners 2.6 Every service user will be allocated a key-worker / case manager within 5 working days of comprehensive assessment 2.7 The provider will ensure that the intensity of case management corresponds to each service user s initial and on-going assessment of need and risk. This approach will be used to maximise the retention of service users in treatment, specifically those individuals assessed as having high levels of risk and need and / or poor levels of engagement. The provider is asked to indicate the frequency of expected intervention at each level of need 2.8 The provider will work in partnership with service users to ensure that pro-active exit planning is part of the on-going recovery planning process 3. Information Privacy and Access Issues The use of robust case management and information management tools will enable controlled but wide sharing of information and ensure that the data collected is accurate, reliable and will support the continual assessment of drug and alcohol related needs in Wandsworth. The aim of a borough- wide information management system is to allow professionals to work more effectively with each other and minimise the duplication of assessment, care planning and treatment provision across the treatment system P a g e 6

7 The DAAT currently holds a contract with the Gallery Partnership for a web-based case management system (ODM) which is used by the major voluntary sector providers whilst the statutory providers use RIO. The contract for ODM expires on 17 December Further details of the system and contract will be made available to bidders on request. The Provider may in the short term take over responsibility for this contract or may choose to use its own system from the start of the contract 3.1 Whilst it is a requirement that a single case management system forms a core part of the new contract, the provider will be expected to demonstrate that considerations raised by a privacy impact assessment governs how this is implemented 3.2 The DAAT will act as data controllers in respect of all personal information processed and shared for the purpose of service delivery and the provider will act as data processors 3.3 The provider (and any other third parties) will be expected to demonstrate accountability for the appropriate assurance of privacy issues involving the processing and sharing of service user s personal and sensitive information 3.4 The provider (and any other third parties) will be expected to demonstrate that all processes and systems for information processing and sharing are informed by NHS Information Governance requirements (http://www.ico.gov.uk/ and 3.5 The provider shall comply at all times with NHS information rights-related legislation and shall not perform its obligations under this contract in such a way as to cause NHS Wandsworth to breach any of its obligations under this legislation The current local information sharing protocols can be seen at Performance Monitoring and Analysis 3.6. The provider will work with the DAAT to provide accurate and timely performance reporting allowing for continuing development of the treatment system for the benefit of all service users. This will include NDTMS, TOPs and Home Office submissions 3.7. The provider will use performance information to monitor how effectively resources are being used across the whole treatment system including the identification of unmet needs 3.8. The provider will monitor data consistency and quality and will assist the DAAT in any data audits P a g e 7

8 4. Open Access and Tier 2 Interventions For many clients open access and Tier 2 services are the gateway into the wider treatment system providing an initial point of assessment and advice, and where required referral on into more structured interventions. NHS Wandsworth commissions well established open access services for drug users and would like to extend some elements of this to problematic drinkers specifically those who are hard to engage in more structured treatment The priorities for the further development of open access services are: a) To increase the presence of open access services in each locality across the borough. These locations will be identified through consultation with general practitioners, community groups, the police and other stakeholders operating in each of the locality areas in Wandsworth b) Interventions targeted to those with the most chaotic patterns of drug and or alcohol misuse who have high levels of complex and unmet needs and poor levels of engagement with treatment services 4.1 At least 20 hours of open access provision per week will be offered to potential service users with opening times and locations that reflect their lifestyles and circumstances 4.2 The provider will work with service user groups to identify a range of incentives that will encourage service users to access the service. This could include washing facilities, hot meals, IT support, and access to complementary therapies 4.3 Open access will be a safe space for drug and alcohol users to access information, support and motivational interventions. The provider will signpost and refer individuals into related agencies and appropriate treatment depending on their needs including advice clinics on areas such as housing access and benefits 4.4 The provider will ensure that harm minimisation advice, information on treatment options and information around health and lifestyle for example nutrition, sexual health and smoking cessation are offered in a variety of methods and languages according to need 4.5 This will include Identification and Brief Assessments and Extended Brief Assessments for those individuals using alcohol and ongoing monitoring for those who are identified as having early signs of alcohol related harm to health P a g e 8

9 Blood Borne Virus Service NHS Wandsworth currently commission a blood borne virus service (comprising 1 full time nurse) to provide blood borne virus screening and immunization for service users in a range of DAAT sites across the borough. The current contract for this expires on 31st March 2012 after which time NHS Wandsworth will work with the provider to integrate these functions into core service delivery within year one of the contract. 4.6 The Provider will deliver screening for hepatitis A, B, C, HIV, chlamydia, syphilis and other sexually transmitted infections 4.7 It is expected that with the service user s consent nurse-led referrals are made to hepatology and immunology services for all service users testing positive with hepatitis B or C and / or HIV / AIDS 4.8 The Provider will deliver immunizations against hepatitis A, B, diphtheria typhoid tetanus and seasonal influenza Fixed-site Needle Exchange: Garratt Lane Due to its location and uptake the fixed-site needle exchange will continue to be delivered from the Garratt Lane tier 2 building. A map of all the DAAT treatment service sites in the borough can be seen at: The aim of this service is to provide intra-venous drug users with access to sterile injecting equipment and information to service users to reduce the risks associated with such high risk behaviour including overdose prevention, blood borne viruses and safer injecting practices 4.9 The fixed-site needle exchange will provide access to information on primary health care services including local GPs, pharmacies and related services and deliver important physical, psychological and sexual health messages to those not currently engaged in services 4.10 The fixed-site needle exchange will offer the delivery of clinical venepuncture skills and wound management where appropriate 4.11 The fixed site needle exchange will provide a dedicated response for working with users of steroids and performance and image enhancing drugs 4.12 The provider will work with the needle exchange facilitator to maximise the returns rates of used needles and paraphernalia P a g e 9

10 5. Street Outreach Over the past year Wandsworth has seen a newly emerging street homeless population, combined with growing numbers of Eastern European individuals with little or no prior engagement with services. Local evidence suggests that many of these individuals have frequent contact with a range of services including neighbourhood police teams, the ambulance services and local accident and emergency services. NHS Wandsworth is working with its strategic partners to develop a coordinated response to these needs. Outreach activity will contribute to this by providing a supported pathway into treatment services 5.1 The provider will deliver a flexible street outreach service to specifically target chaotic street-based drug and alcohol users who are not willing or able to access building based provision. This will involve street shifts outside of office hours according to local need 5.2 The provider will lead a partnership-wide contact and engagement strategy which will facilitate a multi-agency case management approach for street based drinkers and drug users with a history of poor engagement with treatment services 5.3 The service will tailor its level of contact according to the needs of the client and may need to take a more assertive approach with a limited number of clients identified as particularly vulnerable or high need 5.4 The provider will work in partnership with local police, criminal justice and community services to ensure that street outreach is co-ordinated across the borough and targets particular areas identified as hot spots where problematic drug and / or alcohol use may be perceived as anti-social within the local community The street outreach sessions will deliver the following interventions on a street level: Harm minimisation and health promotion advice The distribution of harm reduction and health promotion materials (according to local needs) Motivational engagement and information on local treatment options Brief street based triage assessments where appropriate and escorts Support to re-engage ex-service users who may have dropped out of services 5.5 The provider will work closely with the pharmacies hosting needle exchange in the borough, as they often come into contact with groups of drug users who are not engaged in treatment services P a g e 10

11 5.6 The provider will ensure that policies on risk assessment, escorting service users and lone working if appropriate govern the delivery of street outreach sessions 6. Psycho-Social Interventions and Counselling Psychosocial interventions will form a core part of the service user s move towards recovery and will be offered to service users in both one to one and group-work sessions. Where a service user is receiving more than one intervention, all modalities will be integrated into a co-ordinated package of care 6.1 All psychosocial interventions and counselling will be delivered in line with NICE guidelines and other best practice guidelines 6.2 A range of psychosocial interventions will be offered to each service user according to need and changing circumstances. These will include: Motivational interviewing Solution focused brief therapy Cognitive behavioural therapy International treatment effectiveness project (ITEP) 6.3 Psychosocial interventions will be available to all service users at all stages of their recovery journey including pre-contemplation, contemplation, active change and relapse prevention 6.4 Psychosocial interventions will support a range of needs including: Drug and alcohol use including poly and cross use Motivation to change and aspirations for recovery Personal and life skills Positive support and relationships Dual diagnosis Anger management Positive parenting 6.5 The specific needs associated with stimulant use are often different to those using other drugs, so the provider will ensure that interventions specific to these needs are available and incorporated into the recovery planning process P a g e 11

12 6.6 All staff who deliver group-work will have received appropriate level group-work skills training and on-going specific support Structured Counselling 6.7 The level and duration of counselling support provided will be based on comprehensive assessment of need. It is anticipated that this will be between six and twelve sessions 6.8 Where longer term counselling support is identified in relation to issues such as childhood trauma and bereavement, the provider will endeavour to identify and refer to alternative specialist services 6.9 The counselling service will utilise both accredited and volunteer counsellors (who are working towards their accreditation) with the provider ensuring that robust systems are in place for on-going training and supervision 6.10 Access to couples counselling will be available where a need is identified 6.11 Counselling will be offered in a range of locations including general practices according to identified need 6.12 Home visits for initial assessment and / or counselling should be available within a clearly defined protocol 7. Structured Day Programme for drug use* The structured day programme for drug users will provide a more intensive opportunity for individuals to explore their drug use and related behaviour within high and medium levels of intensity. *Wandsworth DAAT commissions a separate structured day programme for those recovering from alcohol use which is not included in this procurement process 7.1 The provider will deliver a modular programme of support which reflects the diverse needs of drug users including for example stimulant specific interventions, female specific interventions, parents and offenders. It will also deliver distinct options for those still choosing to use drugs and those who are abstinent / stable on prescribed medication 7.2 The programme will address practical as well as psycho-social needs for example the development of IT skills, the promotion of positive social and leisure activities and service user led support. It will also promote access to external 12 step support such as narcotic and cocaine anonymous P a g e 12

13 7.3 The programme will promote generic health interventions for example nutrition, exercise, smoking cessation and sexual health 7.4 The programme will deliver at least one module per week in which family members and affected others are invited to attend the structured day programme with service users 7.5 The programme will work in partnership with the probation service to support the rehabilitation of offenders including those on Drug Rehabilitation Requirements (DRR) and therefore will include drug testing for these individuals 7.6 The programme will include separate provider-led provision for those who have successfully exited structured treatment in which service users will be encouraged to attend for as long as they need to 7.7 The provider will develop working links with providers of Tier 4 services and will contribute to a more efficient use of social care funding through supporting a coordinated step-down approach from residential rehabilitation 7.8 It is anticipated that service users will engage with the programme for up to 12 week duration 8. Education, Training and Employment Interventions The Wandsworth Service User Consultation 2010 indicated that employment is often a key objective in an individual s recovery however for many this will be a medium to long term goal. The aim in Wandsworth is for access to education, training and employment (ETE) opportunities to become an integrated part of an individual s recovery journey NHS Wandsworth believes that a more comprehensive range of education and employment related interventions can be offered within the current service by restructuring and streamlining existing resources. NHS Wandsworth will work with the provider to implement a comprehensive employment pathways strategy and delivery plan in year one of the contract 8.1 The provider will implement an employment pathways strategy and delivery plan which will reflect: An understanding of the aspirations of service users in relation to employment and education An understanding of potential barriers to employment Opportunities for developing work experience options which should include supported employment and intermediate labour projects Possible opportunities for funding employment focused schemes Potential local partners and business champions to promote employment pathways for service users P a g e 13

14 8.2 The provider will offer assessment of education, training and employment needs to all service users including numeracy and literacy, employment history and career aspirations 8.3 The provider will deliver a range of interventions designed to support to service users to increase their practical skills and experience to enable them to become job-ready 8.4 The provider will compile a database of local education, training, employment opportunities including volunteer placements by developing links with local agencies, employers, community groups and the Wandsworth Volunteer Bureau 8.5 The provider will co-ordinate and map service users into ETE opportunities according to their needs, and provide on-going one to one support for these service users. This will include a single point of contact for all volunteer, training or supported employment placements 9. Criminal Justice Services Whilst the current Drug Intervention Programme (DIP) is limited to class A drug users, alcohol has a considerable local impact on crime and anti-social behaviour. As part of the vision for an integrated treatment system which is responsive to the needs of the local community, NHS Wandsworth are looking for providers to demonstrate an inclusive approach to incorporating alcohol users who come into contact with criminal justice services. It is recognised that the lack of legislative framework will require local innovation and flexibility 9.1 The provider will ensure that all interventions are available to those who enter via the criminal justice system 9.2 The provider will ensure that the full range of DIP interventions are delivered in line with the Drug Intervention Programme Handbook, the 2010 National Drugs Strategy and Drug Misusing Offenders, Continuity of Care between Prison and the Community Single Point of Contact 9.3. The provider will act as a single point of contact for all DIP referrals from every part of the criminal justice system, CARAT teams and other relevant agencies 9.4. The provider will ensure that a phone line or alternative out-of-hours arrangement particularly targeted at new and / or service users leaving custodial establishments and / or treatment is accessible twenty four hours a day and seven days per week P a g e 14

15 Arrest Referral 9.5. The provider will maintain a presence within agreed times in the principal custody suites in the borough to carry out initial assessments for offenders testing positive for opiates and / or crack cocaine following a trigger offence 9.6. Where individuals test positive outside of these hours the provider will aim to complete an assessment before the individual leaves custody. Where this cannot be achieved, the appointment will be within 24 hours for those arrested locally and within 48 hours for those referred from another borough or police force area 9.7. The Provider will ensure that harm minimisation advice and information on local treatment options is delivered to encourage voluntary referrals into treatment. This includes alcohol users and non-pdu users 9.8. In partnership with the police all drug tests will be completed in line with Tough Choices (Drugs Act 2005) and reported accurately to ensure a match between the identifiers used by the police and used by the provider 9.9. Immediate efforts will be made to contact the individual in the event they refuse or fail to attend their appointment. The provider will report any breaches associated with initial and / or follow up assessments including out of borough residents to the police within 5 working days In partnership with the police the provider will establish mechanisms to identify and screen a target group of individuals arrested for alcohol related offences in custody including: Individuals arrested for alcohol-related domestic violence and Individuals who have been arrested 3 or more times for alcohol related offences in a 6 month period 9.11 The provider will deliver Identification and Brief Assessments (IBA) to those who are in custody for alcohol related offences and refer where appropriate for further treatment Court Service 9.12 The provider will maintain a presence at South Western Magistrates Court during weekdays in order to: Complete assessments for individuals eligible for Restrictions on Bail (ROB) Report those who are suitable to the court Deliver harm minimisation and information on local treatment options to individuals in the waiting rooms and cells 9.13 The provider will provide support and necessary interventions to the individuals on the scheme in order for them to comply with their ROB conditions P a g e 15

16 9.14 The provider will make immediate efforts to re-engage individuals who do not comply with ROB requirements, and if unsuccessful the breach procedure will be followed Prison Link 9.15 The provider will identify and track Wandsworth s drug using offenders through the prison system, and where possible the list of priority alcohol misusing offenders 9.16 Following an offender s entry into custody the provider will refer all drug intervention records (DIR) according to the timescales set out by the national continuity-of-care protocols 9.17 The provider will accept and respond to all CARAT referrals within 24 hours 9.18 The provider will establish and maintain robust and effective working links with the relevant CARAT teams including regular liaison, pre-release planning and where possible prison visits in order to ensure continuity of care into the community 9.19 Where possible appointments will be provided to those leaving prison on their day of release. Where this is not possible, the provider will demonstrate a flexible response to maximise the engagement of early or unplanned releases 9.20 The provider will have responsibility for Wandsworth DAAT s prison gate office and will work with other providers with significant numbers of clients in HMP Wandsworth to provide support and direction to prisoners at the point of their release from HMP Wandsworth Offender Management 9.21 The provider will case manage to a specified number of drug using offenders and a specified number of alcohol using offenders identified as part of the integrated offender management scheme 9.22 The aim of this scheme is to promote access to support and treatment to these offenders in order to reduce their offending behaviour and minimise the harm their drug use may cause to themselves and communities 9.23 The provider will work with local partners to contribute to the borough s Reducing Reoffending Strategy 9.24 The provider will utilise a range of methods including assertive outreach, to promote the engagement of individuals within the integrated offender management scheme 9.25 The provider will be responsive to changes in the scheme and developments agreed by the strategic group P a g e 16

17 9.26 The Provider will deliver assessment and assertive case management for service users on the Wandsworth Family Recovery Programme (FPR) and work in a collaborative way with partner agencies within the team around the family (TAF) 9.27 This particular service will operate within the context of the FRP information sharing protocol Drug Rehabilitation Requirements 9.28 The provider will work in partnership with the Probation Service to support the delivery of Drug Rehabilitation Requirements (DRR) in Wandsworth 9.29 The provider will work in a variety of settings including East Hill Probation Service, South Western Magistrates Court, local prisons and drug treatment services 9.30 The provider will assess all offenders referred for a DRR as suitable according to a comprehensive assessment of need. Where offenders are assessed as not suitable appropriate information will be provided to encourage voluntary referrals into treatment 9.31 The provider will work with all suitable offenders to prepare and co-ordinate a recoveryfocused treatment plan based on their assessment of need and where possible service user choice 9.32 The provider will support delivery in line with local DRR targets 9.33 The provider will report to the probation service or court as required on the progress and compliance of clients subject to a DRR including, where appropriate, supplying evidence to support breach or revocation proceedings 9.34 The provider will work in partnership with the probation service to promote access to structured treatment for individuals subject to an alcohol treatment requirement P a g e 17

18 10. Clinical Interventions Service for Drugs and Alcohol NHS Wandsworth currently has a well resourced prescribing service for drug users and is committed in line with the National Drug Strategy to provide equivalent levels of access to alcohol users Clinical services for drug use in Wandsworth have benefited from substantive year on year investment including the expansion of the primary care liaison service and a specialist dual diagnosis service The current structure of clinical services for drug and alcohol misuse consists of seven individual components which can be seen at: Clinical Standards 10.1 All clinical interventions will be delivered in accordance NICE guidelines, Drug Misuse and Dependence UK Guidelines on Clinical Management and RCGP Guidelines for Practice and Effectiveness in the Prevention and Treatment of Drug and Alcohol Misuse 10.2 The provider will ensure that all practitioners involved in the delivery of the clinical services are competent, appropriately qualified, and have access to mechanisms to maintain continuous professional development 10.3 All clinical interventions will be based on comprehensive clinical assessment and on- going review and will be delivered as an integrated part of the wider recovery focussed approach 10.4 In consultation with NHS Wandsworth and local needs, the provider will ensure that all clinical interventions offer comprehensive service user choice in available clinical treatment options including: Methadone Buprenorphine Buprenorphine - Naloxone ( suboxone ) Benzodiazepines (for benzodiazepine withdrawal only) Naltrexone Librium Antabuse Acamprosate P a g e 18

19 10.5 All service users will be fully informed about the treatment options available to them, as well as the processes and any relevant risks associated with each. This information should be provided in both verbal and written form 10.6 The provider will promote the development of GP and nurse prescribing. More specialist clinical input will be focused only on the management of those presenting with more acute and complex levels of need Access 10.7 The provider will provide prompt and accessible clinical assessment and prescribing service to all those who need it within a maximum of 72 hours of receipt of referral. Where possible low threshold fast track prescribing will be offered within 24 hours to those who demonstrate clinical need and / or are at significant risk of harm 10.8 It is anticipated that prescribing and other clinical services will operate from a range of settings in addition to core drug and alcohol treatment sites. In addition to supporting the development of treatment delivery in general practices it is anticipated that some clinical interventions will be incorporated into the developing poly-systems 10.9 The provider will ensure that clinical interventions operate to hours which reflect the needs of those who may require access to them including working adults, those recently released from prison and to support GP extended hours The provider will develop clear criteria for the management of individuals in specialist drug, specialist alcohol and primary care settings across the borough to ensure service users are treated in a setting suited to their needs This criteria will be regularly reviewed with service users in the context of the wider recovery focussed approach and robust mechanisms will be implemented to ensure the effective transfer of appropriate service users into primary care Delivering an Effective Treatment Response The clinical intervention service will support drug and alcohol treatment through: a) The direct provision of clinical interventions b) Enabling the effective treatment of drug and alcohol misuse in other health care settings P a g e 19

20 a) The direct provision of clinical interventions NHS Wandsworth s intention is that where possible treatment for drug and alcohol misuse should be integrated in to the wider health-care system, allowing specialist services to focus on the clinical management of those who present with the most acute and complex levels of need and risk The clinical interventions service will provide: Clinical assessment for those with co-morbid physical and / or mental health needs within 24 hours of receipt of referral Clinical assessment for those referred from criminal justice settings within the DIP framework within 24 hours of receipt of referral Clinical assessment or continuity of clinical care to those recently discharged from prison within 24 hours of receipt of referral Clinical assessment and age-appropriate treatment for children under the age of 18 referred by Children and Young People s Services * A single point of contact for GP s requiring advice on appropriate treatment regimes A single point of contact for the transfer of service users from primary care who may require short-term stabilisation / more intensive management due to relapse *The incidence of children referred for prescribing is approximately 1-2 per year. Any prescribing for children will be delivered in partnership with Young People s Service b) Enabling the effective treatment of drug and alcohol misuse in other health care settings The clinical interventions service will deliver treatment to drug and alcohol users in a range of settings: Primary Care The provider will work in partnership with the Primary Care Co-ordinator at NHS Wandsworth to deliver the clinical intervention service from GP surgeries via the locally / nationally enhanced service contracts The provider will work with individual practices to design local frameworks to improve the identification and management of drug and alcohol misuse in the primary care setting. This will include: Implementing a borough-wide programme of targeted screening for alcohol use disorders and where appropriate, the delivery of brief interventions P a g e 20

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