Drug and Alcohol Recovery Payment by Results Wakefield Model. Carrie Abbott, NHSWD Jo Rowe, Turning Point Emil Brown, Recovery 4EM

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1 Drug and Alcohol Recovery Payment by Results Wakefield Model Carrie Abbott, NHSWD Jo Rowe, Turning Point Emil Brown, Recovery 4EM

2 Wakefield Characteristics One of 5 districts within West Yorkshire Population est. 323,900 High levels of multiple deprivation Life expectancy for both males and females below national average 2010/11 Prevalence estimate 2492 Drug users in treatment 1960 Alcohol users in treatment 567

3 Wakefield Model In scope (tier 3 services) Out of scope (tier 2, tier 4 services, dual diagnosis services, prison based services) LASARS function to be delivered by existing providers Integrated nature of service provision does not lend itself to gaming LASARS Audit Tool commissioned to assure independence, to be applied by commissioners as part of contract monitoring process Contractual issues covered by a Contract Variation and signed off by PCT CEG Oct 11 to Mar 12 shadow to test model and transfer all clients Apr 12 to Mar 14 live

4 Financial Incentives Initial model 100% payment on outcome Revised model 20% of tier 3 contract value to be paid on outcome Year 1 Drugs outcome payment 549,008 Year 2 Drugs & Alcohol payment 632,525* Total 1,181,533

5 Financial Modelling Used central NDTMS modelled data, supplemented by local up to date JSNA and NDTMS data Used the NTA Outcome Payment Tool Understand the limitations of the data Weighting set according to areas of performance that commissioners wanted to incentivise Included a local employment metric Sign off of financial modelling and prices is a partnership process

6 PbR Providers Operational Perspective Freedoms and Responsibilities Opportunities and Risks Effectiveness and Efficiency Innovation and the Deliverables Working with Commissioners Partnership

7 Outcome focussed care Track record of working together to deliver shared outcomes (WISMS Integrated Care Organisation Pilot) Willingness to redesign and transform integrated care pathways to deliver recovery oriented drug treatment with a focus on improving planned exits from treatment PBR pilot seen as a means of building on work already started to measure steps toward citizenship, wellbeing, and community benefit - crime reduction, reduced hospital admissions, functional family life LASAR seen as an opportunity to develop an integrated assessment tool that is validated, transferable measuring social/recovery capital as well as psychosocial needs

8 LASARS completed (Local Area Single Assessment and Referral Service) New TOPS & Christo completed Data from Christo & TOPs inputted to PbR Clustering tool to identify Appropriate cluster Final clustering entered onto the tool, recording any set reasons for Disputing the set cluster (these to be agreed via your Team Leader) Disputed clusters to be analysed at Panel meetings

9 Clustering Use the comprehensive assessment and validated tools (TOPS and Christo Inventory) to help inform the cluster and interventions required. The Cluster is based on complexity and recovery capital linked to areas of need requiring interventions, support and onward referral. All existing service users have been clustered prior to 31 st March and all new service users are being clustered on entry to the treatment system 4 clusters have been identified All service users receive a CORE offer and then enhanced options as required

10 1 Low complexity, high capital Recovery Through Flow Low complexity, moderate capital High complexity, moderate capital High complexity, low capital EXIT Complexity = the level of needs, difficulties or problems an individual presents with. Capital = the resources, assets and support that an individual has that are both tangible and in-tangible.

11 Clusters Key working with skills development B Clusters Step down / Step up Intensive High Resource (Enhanced) A S S E S S M E N T Low 1 Complexity High Capital 1-5 CISS Low 2 Complexity Moderate Capital 6-9 CISS High 3 Complexity Moderate Capital CISS High 4 Complexity Low Capital CISS C O R E O F F E R 1A Detox ready- 1B Not ready for Detox Core interventions plus 1A or 1B 2A Employment Issues/ wants to work/train 2B Social Satisfaction issues Key working with skills development Health issues plus 3A Employment 3B Housing 3C Mixed & orfamily/ includes offending Resistance to treatment or ambivalent, no support network, enduring mental health issues U I L D I N G R E C O V E R Interventions CORE and ENHANCED Pathways DETOX HWB PSI DIP/DRR SHARED CARE ETE Re-cluster Current offending issues Y

12 Core offer Evidence based interventions including harm reduction and health advice, Hep B vaccinations, medical support/ prescribing, low intensity PSI, OD prevention, brief interventions for alcohol and signposting to community support and other services. Group work. Enhanced offer high intensity treatment including rapid detoxification, enhanced Health and wellbeing or PSI work dual diagnosis,intensive group work, Criminal Justice interventions, safeguarding Regular review of the cluster to monitor progress and refer back to operational panel when there is a concern regarding progress.

13 Interventions Crisis management Signposting PSI low intensity Methadone maintenance Methadone reduction Buprenorphine maintenance Buprenorphine reduction Lofexidine prescribing Naltrexone prescribing Detox preparation Stimulant intervention Cannabis intervention Benzodiazepine detox Alcohol brief intervention Mental health assessment Complementary therapies Child protection Pregnancy support Re-engagement SOVA management Domestic violence support Family support PSI medium intensity Accommodation support Rapid detox Inpatient detox Residential rehab Short term maintenance Group work non accredited Meaningful activity ARC ETE Intensive offender management Mentoring Mutual aid Service user representative

14 Service User Involvement Recovery4EM Emil Brown Here as rep for over 2500 people! Many of whom have been consulted as part of PbR process Here to explain how service users shaped the service model Here to show how service users contributed through PbR to make sure we get the best outcomes for service users in the long term Here to explain how we made sure that PbR developed Recovery Capital

15 The Consultation Process How we did it: Planning Meeting Participatory Appraisal Tools Visited each site Developed the model Consistent Approach Consultation sites: Wakefield Castleford South Kirkby Shared Care Saviours Trust Soup Kitchens

16 Key findings: Service users were very specific regarding perceived barriers within the system can already see results Service users were very concerned that PbR did not just result in pressure to reduce substitute prescribing levels Service users welcomed the opportunity to contribute to development of more recovery based interventions Service users emphasised the need for interventions that build recovery capital and give them the tools to move forward to develop skills, knowledge and qualifications to take away

17 How we delivered our findings: Service User led Presentation to the PbR Board SMCG Board Presentation has been delivered within the broader service user forum Service User Forum has ongoing representation on the PbR Board

18 Examples of some of the feedback from service users on how to improve outcomes: More to help skilling up for employment More basic skills to help employment. More skills training for service users when reducing off drugs. People need help with bus fares to get places to help find employment. A place to go after treatment like a stepping stone

19 Changes that we can already see: Structured Day Services that are focussed on developing skills, confidence and employability Interventions designed as stepping stones to recovery that build capital (ABLE) Better access to accredited training courses and access to Adult education (ARC & Northern College) More capacity to shape the system

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