Blackpool Harm Reduction Strategy Team

Transcription

1 Blackpool Harm Reduction Strategy Team Alcohol Care Pathways (Draft v0.03) This web/document is intended to present current care pathways relating to treatment to patients targeted by the Alcohol Harm Reduction Programme The web/document is interactive in that it contains hyperlinks linking three levels of detail. These levels are Top Level Map this level shows all of the pathways that have been identified and documented to date. In itself, it does not give much detail, but simply shows high-level links between the pathways. Clicking on a pathway in the diagram will take the document to the mid level of detail Mid-level Map This level focuses on the pathway selected in the Top Level Map. It shows the pathway together with only the pathways that are linked to it. It is possible to trace the links and follow a patient route through the entire pathway. The pathway chosen from the Top Level Map will be highlighted and by clicking on this box, you will be taken to the care pathway detail map Detail Map This diagram shows the detailed process followed when a Service Provider deals with the patient. Navigation through the pathways is made by simply selecting the route. Return through the pathways is controlled by the symbol, clicking will take you back up through the pathway map structure. Go to the Top Level Map

2 Alcohol Care Pathways Start Tier 1 Community Mental Health Services (T1) to Substance Misuse Services (T2,T3 and T4) Access to Alcohol Treatment via Homeless Team and Organisations Employment and Training Peer Support (AA) Tier 2 Alcohol Liaison Nurse Specialist referral to Mental Health Team Primary Care Alcohol Service Acute Trust Alcohol Liaison Nurse Specialist Tier 2 Alcohol Community Brief Intervention Tier 2 Pathway Assertive Alcohol Outreach Services Tier 2/3 Arrest Referral Working for Alcohol Clients Tier 3 ADS to - Alcohol Assertive Outreach Project - to ADS Alcohol Treatment Requirement - PreSentence Alcohol Treatment Requirement - PostSentence Tier 3 Pathway T3 Dependent Drinkers Alcohol Service Alcohol Users Accessing COAST Community Rehabilitiation Programme from Tier 3 Services Single Point of Contact Tier 3 Dependent Drinkers to Assertive Outreach Team Tier 3 Alcohol Aftercare Service Dependent Drinkers Service to Community Detoxification Tier 3/4 Dependent Drinkers Service to Inpatient Detoxification Tier 4 Leaving Tier 4 Assisted Withdrawl and Stabilisation Inpatient Facility Tier 4 Pathway Dependent Drinkers Service to Residential Rehab Entering Tier 4 Inpatient Facility Dual Diagnosis Patients in Mental Health inpatient units (LCFT) to Community Alcohol Services (CAS) Inpatient Services to Substance Misuse Exit NODE: A0 TITLE: Alcohol Harm Reduction Programme - Care Pathways NO.: 1

3 Tier 1 Access to Alcohol Treatment via Homeless Team and Organisations A0 A1 Tier 2 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4 A0 NODE: A1 TITLE: Access to Alcohol Treatment via Homeless Team and Organisations NO.:

4 Tier 1 Community Mental Health Services (T1) to Substance Misuse Services (T2,T3 and T4) Tier 2 Alcohol Liaison Nurse Specialist referral to Mental Health Team Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4 A0

5 Tier 1 Employment and Training Tier 2 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4

6 Tier 1 Peer Support (AA) Tier 2 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4 A0

7 Tier 1 Tier 2 Primary Care Alcohol Service A0 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4 A0

8 Tier 1 Community Mental Health Services (T1) to Substance Misuse Services (T2,T3 and T4) A0 A2 Tier 2 Alcohol Liaison Nurse Specialist referral to Mental Health Team A0 Acute Trust Alcohol Liaison Nurse Specialist A0 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4 A0

9 Tier 1 Tier 2 Alcohol Liaison Nurse Specialist referral to Mental Health Team Acute Trust Alcohol Liaison Nurse Specialist Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4

10 Tier 1 Tier 2 Tier 2 Alcohol Community Brief Intervention Tier 2 Pathway Tier 2/3 Tier 3 Tier 3/4 Tier 4

11 Tier 1 Tier 2 Tier 2 Alcohol Community Brief Intervention Tier 2 Pathway Tier 2/3 Tier 3 Tier 3 Paathway Single Point of Contact Tier 3/4 Tier 4

12 Tier 1 Tier 2 Assertive Alcohol Outreach Services Tier 2/3 Tier 3 ADS to - Alcohol Assertive Outreach Project - to ADS Single Point of Contact Tier 3/4 Tier 4

13 Tier 1 Tier 2 Tier 2/3 Arrest Referral Working for Alcohol Clients Tier 3 Alcohol Treatment Requirement - PreSentence Alcohol Treatment Requirement - PostSentence Single Point of Contact Tier 3/4 Tier 4

14 Tier 1 Tier 2 Tier 2/3 Assertive Alcohol Outreach Services Tier 3 ADS to - Alcohol Assertive Outreach Project - to ADS Tier 3 Paathway Tier 3 Dependent Drinkers to Assertive Outreach Team Tier 3/4 Tier 4

15 Tier 1 Tier 2 Tier 2/3 Arrest Referral Working for Alcohol Clients Tier 3 Alcohol Treatment Requirement - PreSentence Alcohol Treatment Requirement - PostSentence Alcohol Users Accessing COAST Community Rehabilitiation Programme from Tier 3 Services Tier 3/4 Tier 4 Leaving Tier 4 Assisted Withdrawl and Stabilisation Inpatient Facility

16 Tier 1 Tier 2 Tier 2/3 Arrest Referral Working for Alcohol Clients Tier 3 Alcohol Treatment Requirement - PreSentence Alcohol Treatment Requirement - PostSentence Tier 3/4 Tier 4 Leaving Tier 4 Assisted Withdrawl and Stabilisation Inpatient Facility

17 Tier 1 Tier 2 Tier 2 Pathway Tier 2/3 Tier 3 ADS to - Alcohol Assertive Outreach Project - to ADS Tier 3 Pathway T3 Dependent Drinkers Alcohol Service Single Point of Contact Tier 3/4 Tier 4

18 Tier 1 Tier 2 Tier 2/3 Tier 3 Tier 3 Pathway T3 Dependent Drinkers Alcohol Service Single Point of Contact Tier 3 Dependent Drinkers to Assertive Outreach Team Dependent Drinkers Service to Community Detoxification Tier 3/4 Tier 4

19 Tier 1 Tier 2 Tier 2/3 Tier 3 Alcohol Treatment Requirement - PreSentence Alcohol Users Accessing COAST Community Rehabilitiation Programme from Tier 3 Services Single Point of Contact Tier 3/4 Tier 4

20 Tier 1 Tier 2 Tier 2/3 Tier 3 ADS to - Alcohol Assertive Outreach Project - to ADS T3 Dependent Drinkers Alcohol Service Tier 3 Dependent Drinkers to Assertive Outreach Team Tier 3/4 Tier 4

21 Tier 1 Tier 2 Tier 2/3 Tier 3 Single Point of Contact Tier 3 Alcohol Aftercare Service Tier 3/4 Tier 4

22 Tier 1 Tier 2 Tier 2/3 Tier 3 T3 Dependent Drinkers Alcohol Service Single Point of Contact Dependent Drinkers Service to Community Detoxification Tier 3/4 Tier 4

23 Tier 1 Tier 2 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Dependent Drinkers Service to Inpatient Detoxification Tier 4 Tier 4 Pathway

24 Tier 1 Tier 2 Tier 2/3 Tier 3 Alcohol Treatment Requirement - PreSentence Alcohol Treatment Requirement - PostSentence Single Point of Contact Tier 3/4 Tier 4 Leaving Tier 4 Assisted Withdrawl and Stabilisation Inpatient Facility Inpatient Services to Substance Misuse

25 Tier 1 Tier 2 Tier 2/3 Tier 3 Tier 3/4 Dependent Drinkers Service to Inpatient Detoxification Tier 4 Tier 4 Pathway Dependent Drinkers Service to Residential Detox Entering Tier 4 Inpatient Facility Dual Diagnosis Patients in Mental Health inpatient units (LCFT) to Community Alcohol Services (CAS)

26 Tier 1 Tier 2 Tier 2/3 Tier 3 Tier 3/4 Tier 4 Tier 4 Pathway Dependent Drinkers Service to Residential Rehab

27 Tier 1 Tier 2 Tier 2/3 Tier 3 Tier 3/4 Tier 4 Tier 4 Pathway Entering Tier 4 Inpatient Facility Inpatient Services to Substance Misuse

28 Tier 1 Tier 2 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4 Tier 4 Pathway Dual Diagnosis Patients in Mental Health inpatient units (LCFT) to Community Alcohol Services (CAS)

29 Tier 1 Tier 2 Tier 2/3 Tier 3 Single Point of Contact Tier 3/4 Tier 4 Leaving Tier 4 Assisted Withdrawl and Stabilisation Inpatient Facility Entering Tier 4 Inpatient Facility Inpatient Services to Substance Misuse

30 Start Tier 1 Community Mental Health Services (T1) to Substance Misuse Services (T2,T3 and T4) Access to Alcohol Treatment via Homeless Team and Organisations Employment and Training Peer Support (AA) Tier 2 Primary Care Alcohol Service Acute Trust Alcohol Liaison Nurse Specialist Tier 2 Pathway Assertive Alcohol Outreach Services Tier 2/3 Arrest Referral Working for Alcohol Clients Tier 3 Tier 3 Pathway T3 Dependent Drinkers Alcohol Service Alcohol Users Accessing COAST Community Rehabilitiation Programme from Tier 3 Services Single Point of Contact Tier 3 Alcohol Aftercare Service Dependent Drinkers Service to Community Detoxification Tier 3/4 Dependent Drinkers Service to Inpatient Detoxification Tier 4 Leaving Tier 4 Assisted Withdrawl and Stabilisation Inpatient Facility Dual Diagnosis Patients in Mental Health inpatient units (LCFT) to Community Alcohol Services (CAS) Inpatient Services to Substance Misuse Exit

31 Community Mental Health Services (T1) to substance Misuse Services (T2, T3 and T4) Service User (SU) admitted. Screen on admission for illicit drugs & Alcohol. Determine dependency level (refer to admission pathway). If SU refuses to provide prescriber information, then review risk issues and purpose of admission. SU known? Admitting nurse verify any medication dose; request safety profile. Inpatient services OR Reid House cancel any prescriptions at community pharmacy, whichever is sooner. Determine SU motivation to engage in drug or alcohol treatment at T3. SMS may offer assessment re: motivation. If client not motivated for T3, then liaison working advice and management of symptoms Determine SU motivation to engage in drug or alcohol treatment at T3. SMS may offer assessment re: motivation. If client not motivated for T3, then liaison working advice and management of symptoms Inpatients schedule MDT/CPA review and invite all agencies involved in care plan. Allocate C/C if client unknown to MH services. Prepare for discharge planning and allow time for SMS to arrange to continue prescription Tirate using Orange Guidelines; observe for given period especially if leave permitted soon after admission. Agree intervention with SMS during admission and upon discharge. Outcome? Outcome A SMS provide guidance on management of symptoms where needed and offer intervention if client consents or treatment is ordered via criminal justice system Outcome B Refer to Tier 2 servcies Jarman Centre, Blackburn and/or Inward House Outcome C Refer to Tier 4 services Options - Kenyon House, Inward House, Drugs NW or Wentworth Houses. If client not known to Reid House via social services customer care officer Outcome A1 Refer to DIP service for treatment as above Further input needed upon discharge. AT MDT/SMS team meeting discuss case so decisioncan be made as to which team is best placed to meet Service User's identified needs. Adopt liaison model of working with other service as needed. At pre-dischrge meeting determine joint working arrangements between SMS/CAT and MH services. MH arrange to see client within 7 days as per CPA policy. SMS arrange to see client as per care plan. Safety Profile to accompany discharge NODE: TITLE: Community Mental Health Services (T1) to substance Misuse Services (T2, T3 and T4) NO.:

32 Primary Care Alcohol Service Referral received at SPOE Appointment given at appropriate GP surgery for Triage Dependent Triage Pre-Dependent Refer to Dependent Drinkers Service to initiate care plan. 4-6 sessions of Brief Intervention work to address lifestyle changes and reduction to safe levels Refer to Aftercare Service for additional support Treatment complete - Discharge

33 Tier 2 Alcohol Community Brief Intervention Access is available without referral at any ADS community venue. Information regarding dates and times from media or by telephoning Information and screening session lasts approximately 1 hour Wish to access service? Triage assessment undertaken Self help material and Information Pack given Client Dependent Drinker refer to Dependent Drinkers Service, Cookson Street, to initiate care plan Client Pre-dependent 4-6 sessions of Brief Intervention work to address life-style changes and reduction to safer levels Aims To reduce health inequalities across Blackpool caused by alcohol misuse To contribute to reducing the amount of Alcohol related crime, including violent crime. Support alcohol integrated care pathways, providing swift assessment and client referral on to Tier 3 service where the threshold of need is beyond the remit of Tier 2 Services. Increase in the number of Blackpool residents registered with a Blackpool GP accessing treatment To assist in providing alcohol harm reduction information Who is this pathway for? Clients who misuse alcohol and their family and friends who may be in need of support Anyone who would like more information or advice on alcohol related matters Who is suitable for this pathway? Any client referred to ADS by a professional agency or GP surgery for assessment Refer to Aftercare Service, Cookson Street, for additional support Treatment Complete - Discharge Any concerned other. Who is not suitable for this pathway? Anyone who drinks dependently or harmfully

34 Alcohol Liaison Nurse referral to Mental Health Team Patient admitted to Acute Trust (A&E, A&E Obs Ward Medical Admissions Unit) A part of medical assessment, alcohol screens tool is completed by triage nurse Alcohol issue? further action Nurse discusses alcohol liaison service with patient Patient accepts? Nurse contacts alcohol liaison service Inpatient appointment made or Alcohol Liaison Nurse attends to conduct full assessment, inc. Mental Health screening Mental Health issue? Follow Dual Diagnosis Pathway Full MH assessment and diagnostics reveal level of intervention following Dual Diagnosis Pathway Patient suitable for this modality as per Dual Diagnosis Pathway Detox needed? Detox included on and provided as part of care plan Detox supervised by ALS over critical period Psychosocial therapy begins Patient has discharge plan Patient agrees to outpatient intervention Referral to outpatient clinic at point of discharge Patient attends outpatients clinic? 3 x weekly appointments Patient content with outcome Patient request further intervention community alcohol services are discussed Referral made to CAS Assertive multiagency follow up Client attends Successful? Exit

35 Inpatient Services to Substance Misuse Service User (SU) admitted. Screen on admission for illicit drugs & Alcohol. Determine dependency level (refer to admission pathway). If SU refuses to provide prescriber information, then review risk issues and purpose of admission SU known? Admitting nurse verify any medication dose; request safety profile. Inpatient services OR Reid House cancel any prescriptions at community pharmacy, whichever is sooner. Determine SU motivation to engage in drug or alcohol treatment at T3. SMS may offer assessment re: motivation. If client not motivated for T3, then liaison working advice and management of symptoms Determine SU motivation to engage in drug or alcohol treatment at T3. SMS may offer assessment re: motivation. If client not motivated for T3, then liaison working advice and management of symptoms Inpatients schedule MDT/CPA review and invite all agencies involved in care plan. Allocate C/C if client unknown to MH services. Prepare for discharge planning and allow time for SMS to arrange to continue prescription Tirate using Orange Guidelines; observe for given period especially if leave permitted soon after admission. Agree intervention with SMS during admission and upon discharge Outcome? Outcome A SMS provide guidance on management of symptoms where needed and offer intervention if client consents or treatment is ordered via criminal justice system Outcome B Refer to Tier 2 servcies Jarman Centre, Blackburn and/or Inward House Outcome C Refer to Tier 4 services Options - Kenyon House, Inward House, Drugs NW or Wentworth Houses. If client not known to Reid House via social services customer care officer Outcome A1 Refer to DIP service for treatment as above Further input needed upon discharge. AT MDT/SMS team meeting discuss case so decision can be made as to which team is best placed to meet Service User's identified needs. Adopt liaison model of working with other service as needed. At pre-discharge meeting determine joint working arrangements between SMS/CAT and MH services. MH arrange to see client within 7 days as per CPA policy. SMS arrange to see client as per care plan. Safety Profile to accompany discharge

36 Tier 2 Primary Care Alcohol Service Referral received at SPOE Dependent Appointment given at appropriate GP surgery for Triage Triage Pre-Dependent Aims... To reduce health inequalities across Blackpool caused by alcohol misuse To contribute to reducing the amount of Alcohol related crime, including violent crime. Support alcohol integrated care pathways, providing swift assessment and client referral on to Tier 3 service where the threshold of need is beyond the remit of Tier 2 Services. Increase in the number of Blackpool residents registered with a Blackpool GP accessing treatment To assist in providing alcohol harm reduction information. Who is this pathway for? Clients who misuse alcohol and their family and friends who may be in need of support Who is suitable for this pathway? Any client referred to ADS by a professional agency or GP surgery for assessment. Any concerned other. Who is not suitable for this pathway Anyone who drinks dependently or harmfully. Refer to Dependent Drinkers Service to initiate care plan. 4-6 sessions of Brief Intervention work to address lifestyle changes and reduction to safe levels Refer to Aftercare Service for additional support Treatment complete - Discharge

37 Tier 2 Alcohol Community Brief Intervention Service Access is available without referral at any ADS community venue. Information regarding dates and times from media or by telephoning Information and screening session lasts approximately 1 hour Wish to access service? Aims To reduce health inequalities across Blackpool caused by alcohol misuse To contribute to reducing the amount of Alcohol related crime, including violent crime. Support alcohol integrated care pathways, providing swift assessment and client referral on to Tier 3 service where the threshold of need is beyond the remit of Tier 2 Services. Increase in the number of Blackpool residents registered with a Blackpool GP accessing treatment To assist in providing alcohol harm reduction information Triage assessment undertaken Self help material and Information Pack given Who is this pathway for? Clients who misuse alcohol and their family and friends who may be in need of support Anyone who would like more information or advice on alcohol related matters Who is suitable for this pathway? Any client referred to ADS by a professional agency or GP surgery for assessment Any concerned other. Who is not suitable for this pathway? Anyone who drinks dependently or harmfully Client Dependent Drinker refer to Dependent Drinkers Service, Cookson Street, to initiate care plan Client Pre-dependent 4-6 sessions of Brief Intervention work to address lifestyle changes and reduction to safer levels Refer to Aftercare Service, Cookson Street, for additional support Treatment Complete - Discharge

38 Community Mental Helath Servcies (T1) to substance Misuse Services (T2, T3 and T4) Service User (SU). Screen on presentation for illicit drugs. Determine dependency level SU known? Verify care plan and any medication dose; request safety profile Triage and determine the SU's motivation to engage in treatment. Refer to appropriate Tier MH C/C schedule MDT/CPA review and invite all agencies involved in care plan. Modify care plan according to which team is best placed to continue care, based on SU identified need. If motivated and appropriate at T3, remain here. SMS titrate using Orange Guidelines. Confirm treatment plan and share info with MH Agree intervention Outcome A Refer to and liaise with T2 services. T2 provide guidance on management of symptoms where needed and offer intervention if client consents or treatment plan is ordered via criminal justice system Outcome B Refer to and liaise with T3. T3 to provide guidance on management of symptoms where needed and offer intervention if client consents or treatment plan is ordered via criminal justice system Outcome C Refer to and liaise with T4 services. If client not known then refer vial social services customer care officer Determine if further input needed between both services. At team meeting discuss case so decision can be made as to which team is best placed to meet SU identified needs. Transfer needs to care plan. Adopt liaison model of working with other service as needed. Both services jointly manage care plan as needed

39 T3 Alcohol Aftercare Service Referrals recieved at SPOE, Cookson Street from T2, T3 and T4 Alcohol Services Care Plan Induction session carried out to identify most suitable options for individual client. Client accesses 6 month programme and attends, as appropriate, any of a variety of ITEP workshops on health, relapse avoidance, coping skills, mind and body, alcohol education. also Support Groups, Basic Skills Classes, Holistic Therapies, Social Interaction Dropin Groups, Arts and Crafts, Camera Club, Confidence Building courses and Clinics run by outside agencies such as Positive Steps and Volunteer Centre Six weekly reviews to ensure that client gets the best possible interventions for his/her needs and to assess further interventions required or not. Required?? Further work planned 6 week review as required until 6-9 months completion Aims... To reduce health inequalities across Blackpool caused by alcohol misuse To contribute to reducing the amount of Alcohol related crime, including violent crime. Support alcohol integrated care pathways, providing additional support to those clients post treatment for alcohol abuse To prevent relape of Alcohol misuse by those leaving T3 and T4 treatment options T o assist in the rehabilitation of clients who have suffered from alcohol misuse and help them to return to education or employment Who is this pathway for? Clients who have completed T3 and T4 treatment options and are either stable in controlled drinking or abstinent, whichever their treatment goal obtained Concerned others who require additional support and understanding regarding alcohol issues Who is suitable for this pathway? Any client referred from T2, T3, T4 services whoa have attained their treatment goal and who require additional support to help them maintain this status. Any concerned other. Accepted Peer support training offered Declined Who is not suitable for this pathway Anyone who drinks dependently or harmfully. Training completed and Peer Supporting starts End of Programme Discharge Referral to ex-clints peer support group if required

40 Dependent Drinkers Alcohol Service Referal received at SPOE Cookson Street Appointment given for information session at Cookson Street to explain treatment pathway to allow client to make an informed decision as to whether they wish to access treatment at this time Self-help material given and discharged to return when appropriate Treatment wanted Triage Client Pre-dependent Refer to PHC for Brief Intervention work Client Dependent Drinker Comprehensive assessment and Care Plan completed Client abstinent Refer to Aftercare if required Identify rehabilitation and complete paperwork Rehab. type Home Detox Refer to CPNs and continue Key Work sessions Inpatient Detox Refer to pre-detox group and also appropriate detox unit. Review regularly to ascertain commitment Reduction Continue 10 sessions of Key working Detox completed Rehab reqd? Enter Rehab Stable on Safe Limits or Abstinent Referral to Aftercare required? Aftercare Discharge

41 Tier 2 Pathway Referral from Self, GP or Other Professional Screening Primary Care Alcohol Service Counsellors in Primary Care (Triage) Dependent Drinker? Discharge from T2 Refer to T3 Brief Intervention 1-to-1 Alcohol Therapy max 4 sessions Dropout? Outreach Care Plan met? Discharge from T2

42 Tier 3 Pathway Referral from Tier 2 Comprehensive Assessment including Detoxification Assessment, Mental Health screening and Care Plan Mental Health issues? Follow Dual Diagnosis pathway Dual Diagnosis pathway not yet done Suitablefor Community Detox? Suitable for Inpatient detox? Revise Care Plan to????? pathway Follow Community Detox Pathway Follow Tier 4 Pathway Detox completed to Care Plan Engagement with day/ evening care and structured relapse prevention Referral to peer support, Service User groups, self help (AA and Aftercare Pharmocatherapies Exit

43 Tier 4 Pathway Referral from Tier 3 Tier 4 Providers ensure that aftercare provision has been prearranged and a robust care plan covering domains of housing, Mental Health, Social Functioning and Alcohol Consumption Accepted to Tier 4? Client re-engages with Tier 3 - either community detox or reduction Client continues engagement with Tier 3 service until Tier 4 placement available - using evidence-based therapies and regular sessions against agreed care plan Detoxification completed to Care Plan Engagement with Day/Evening and Structured Relapse Prevention and Aftercare worker (differennt to Tier 3 workers) Refrral to Peer Support, Service User Groups, Self Help (AA and Aftercare Pharmocatherapies) Exit

44 Entering Tier 4 Inpatient Facility Client need for admission to tier 4 facilities is identified as a result of a comprehensive clientcentred assessment process 1 that highlights the client s needs and outlines options for access to a range of tier 4 services. All documentation sent to tier 4 service providers at this point What is the aim of this pathway? The aim of this pathway is to provide a smooth transition for clients between the community-based tier 3 services and tier 4 inpatient facilities Who is this pathway for? This pathway is for clients already within the alcohol treatment system who intend to undergo an inpatient assisted withdrawal and stabilisation process What other pathways does this one connect with? The coloured boxes on the flow chart below show which other pathway(s) connect to this one. Client referred to tier 4 to await admission 2 Once a person has been referred to the in patient services, the precise nature of the package of treatment and care to be provided is decided based on the detailed assessment of their needs and wishes together with specialist clinical advice and guidance. The exact nature of the support and/or treatment provided will differ from person to person, so each subsequent pathway followed will be in line with their changing needs. tes An admission plan is devised together with the client 3 The tier 3 service provider continues to support the client until the admission date is reached 4 1 A common tool for this assessment process should be agreed. The assessment is an interactive one and follows the client through modalities and services. It includes risk assessment, care plan development (or initiation if one is not already in place on entry to tier 3), and discharge planning. The usual expected stay in assisted withdrawal programme will be 10 to 21 days. 2 At this stage the tier 4 team will discuss each referral at a weekly review meeting and agree an admission date for the client. 3 The admission plan includes an aftercare/discharge plan Admission to tier 4 facility as an in patient 5 The key worker (care co-ordinator) at tier 3 remains in contact and involved during the in patient stay 4 The care plan should be updated to reflect any changes in the client s circumstances whilst awaiting admission 5 The tier 4 service providers will usually undertake additional assessment of client on arrival to explore underlying complex issues including risk assessment, physical and mental health. 6 Treatment completion is defined in this context as: When the client has completed the planned programme of assisted withdrawal within a tier 4 setting 7 A simple protocol is advised at this point for the management of unplanned discharges. This explains the necessary communication that should occur. Treatment completion 6 Planned discharge Treatment episode termination 7 Unplanned discharge

45 Leaving the Tier 4 Assisted Withdrawl and Stabilisation Inpatient Facility Assisted withdrawal and stabilisation programme completed 1 Client departs from programme prematurely 2 Implement unplanned discharge protocol What is the aim of this pathway? The aim of this pathway is to provide a smooth transition for clients when they leave the assisted withdrawal and stabilisation programme and return to community services. Who is this pathway for? Clients who have completed, or departed prematurely, from the assisted withdrawal and stabilisation process The care co-ordinator at tier 3 is informed (as routine). Client care plan updated Other individuals/agencies informed in accordance with the care plan What other pathways does this one connect with? The coloured (blue) boxes on the flow chart below show which other pathway(s) connect to this one. The exact nature of the support and/or treatment provided will differ from person to person, so each subsequent pathway followed will be in line with their changing needs. tes 1 The definition of programme completion is as follows: An appointment is pre-arranged with the care co-ordinator to ensure all the components of an aftercare plan are in place and to review client needs 3 When the anticipated care plan has been successfully delivered and the client is aware of relapse prevention strategies to support longer term recovery. The usual expected stay in assisted withdrawal programme will be 10 to 21 days. 2 This may be for a number of reasons including: physical health status severity of withdrawal symptoms mental health state 3 This appointment is seen as critical in terms of continuity of care for the client. The admission plan for the client will have included an aftercare/ discharge plan and this should now be revisited and reviewed in light of experience in assisted withdrawal programme. Episode of care ends with successful community reintegration 4 Client relapses and requires reassessment for re-entry to treatment journey 4 Extract from Care Planning Guidance regarding community reintegration

46 Dual Diagnosis Patients (alcohol) in Mental Health Inpatient Units (LCFT) to Community Alcohol Services Inpatient is identified as having an alcohol use disorder during their admission to mental health inpatient unit Full Blood Profile and Liver Function Tests completed on the unit Aim To ensure that mental health inpatients with co-morbid alcohol use disorders receive appropriate help and support for this in the community following their discharge from hospital. Who is this pathway for? Adult Blackpool residents receiving mental health inpatient treatment who have co-existing alcohol use disorders Inpatient staff refer patient to?????? for AUDIT assessment/triage on the unit Who is this pathway not suitable for? Inpatients who have not been fully assessed Individuals with a primary problem of drug dependency Individuals who are already in receipt of Community Alcohol Services support?????? triage assess the patient using AUDIT and refer to ADS (predependent) or LCFT Alcohol Nurses (dependent) ADS or LCFT CAS staff complete comprehensive assessment and draw up care plan with client

47 Alcohol Treatment Requirement - Pre-Sentence ATR referrals can only be made from probation. ATR - (available for Blackpool offenders only not for Fylde offenders at this time) Offender is High seriousness CO or SSO.Alcohol misuse identified prior to or during interview. Offenders will have a link between their dependence on alcohol and their offending. Offender Managers should consider an ATR for offenders who have: committed offences involving emotional, psychological, physical or sexual violence; a Section 9 OASys score of 4 or above; an AUDIT screening tool score of 20 or above. Alcohol misuse and other interventions for offenders, who do not meet these criteria, should be through a Supervision Requirement, other appropriate Requirements and, where appropriate, referral to other agencies in the community. A formal treatment provider assessment, by a Substance Misuse worker from Addaction Blackpool is required for all cases prior to confirmation of suitability. This will also include an assessment of the range, type and availability of the treatment and intervention(s) required. Offender Managers will provide the substance misuse worker with a completed AUDIT screening tool and information concerning risk of serious harm. SDR writer completes AUDIT Score >= 20 High seriousness violent offence and OGRS of 76+ Given the target group for an ATR it will, in all cases, be imposed alongside a Supervision Requirement and, if appropriate, other Requirements within a Community/Suspended Sentence Order to meet the overall restriction on liberty commensurate with the seriousness of offence(s), risk of serious harm, purposes of sentencing and likelihood of reoffending. Score < 20 Aim To reduce and eliminate alcohol dependency and reduce the likelihood of offending. The Probation Service, in partnership with Addaction will deliver appropriate treatment, supervision and interventions that are intended to meet the needs of punishment and address the critical issues of alcohol dependency and reducing the offender s likelihood of reoffending and risk of harm to the public. Unsuitable for ATR Assessment Report prepared stating reason and /fax to OM ATR Assessment determines suitability Suitability For offenders aged 18 and over who must be assessed as suitable. This includes: offender has committed a violent offence offence is alcohol related evidence of entrenched pattern of alcohol dependency evidence that the offender is susceptible to treatment The offender needs to express a willingness to comply with the requirement. To address alcohol issues, PSR writer consider proposing Community or Suspended Sentence Orders with Supervision and ASRO (OGRS 51+) DIDs, CALM, CDVP OR If OGRS< 51 Community or Suspended Sentence Orders with Supervision Requirement. Treatment provider completes Assessment report based on Tier 3/4 interventions eg individual sessions Community detox In patient detox Residential rehab (Tier 4 and also Clients Outcomes Offenders who complete the Alcohol Treatment Requirement will have: examined their dependency, behaviour and issues of self-control acknowledged the harmful impact of their behaviour on victims, community and self learned new skills to help them lead constructive and law-abiding lives Requirements The offender will be subject to the following: Community Order + ATR proposed for 6 months. Supervision Requirement will also be standard condition. Any additional Requirements will depend on OASys assessment of criminogenic need. NB consider length of Supervision Req t if CDVP included. Supervision in accordance with Probation Service National Standards Community based interventions will focus on a range of issues including alcohol use, psychological well-being, offending behaviour and life skills Required to lead a law-abiding lifestyle. Attend all appointments as required by the Offender Manager, including appointments with treatment provider and other agencies being returned to Court promptly for failure to comply Making the Requirement Minimum period is 6 months with a maximum of 3 years. Standard ATR length should be 6 months Treatment intervention can include: Community Care Planned treatment: This can include a range of structured, specialist and evidence based prescribing interventions, psychosocial therapies focussing on alcohol misuse; brief interventions; health improvement and the amelioration of alcohol related health problems; psychological well-being; offending behaviour; life skills, accommodation issues; and social functioning. If appropriate, it can also include medically assisted alcohol withdrawal in the community (detoxification) and prescribing interventions to reduce risk of relapse. Treatment and interventions will be delivered and managed through a written individual Care Plan. Structured Day Programme: a formal care planned programme of day care focusing on issues including offending, relapse prevention, personal development, life skills, problem solving and other practical and emotional support. Inpatient and Residential Structured Care Planned Treatment: including medically assisted alcohol withdrawal, stabilisation, rehabilitation and pharmacotherapy (medication) requiring specialist residential or inpatient treatment Referrals to ADS. Additionally, under the ATR, motivational work and solution focused interventions to improve or resolve an offender s accommodation, attendance at mutual support e.g. Alcoholics Anonymous (AA) (if attendance can be confirmed), education, training or employment can be counted as contact providing it is included in the Sentence Plan and there is a clear audit trail. All interventions in the ATR will be guided by a formal Care Plan written by the Substance Misuse worker in consultation with the offender. All aspects of treatment outlined above will be covered by the ATR, which means that there is no need to include a Residence Requirement if an offender is to undertake residential treatment as a component of any care planned intervention(s) detailed in the court report.

48 Alcohol Treatment Requirement - Post-Sentence ATR referrals can only be made from probation. Community/Suspended Sentence Order + ATR imposed at Court Court staff phone Probation and Substance Misuse Worker to confirm that CO/SSO+ATR has been made and confirm initial appointments ATR - (available for Blackpool offenders only not for Fylde offenders at this time) Offenders will have a link between their dependence on alcohol and their offending. Offender Managers should consider an ATR for offenders who have: committed offences involving emotional, psychological, physical or sexual violence; a Section 9 OASys score of 4 or above; an AUDIT screening tool score of 20 or above. Alcohol misuse and other interventions for offenders, who do not meet these criteria, should be through a Supervision Requirement, other appropriate Requirements and, where appropriate, referral to other agencies in the community. A formal treatment provider assessment, by a Substance Misuse worker from Addaction Blackpool is required for all cases prior to confirmation of suitability. This will also include an assessment of the range, type and availability of the treatment and intervention(s) required. Offender Managers will provide the substance misuse worker with a completed AUDIT screening tool and information concerning risk of serious harm. Given the target group for an ATR it will, in all cases, be imposed alongside a Supervision Requirement and, if appropriate, other Requirements within a Community/Suspended Sentence Order to meet the overall restriction on liberty commensurate with the seriousness of offence(s), risk of serious harm, purposes of sentencing and likelihood of reoffending. Aim To reduce and eliminate alcohol dependency and reduce the likelihood of offending. OM contacts Substance Misuse Worker to confirm details of the treatment plan prior to completion of the initial sentence plan The Probation Service, in partnership with Addaction will deliver appropriate treatment, supervision and interventions that are intended to meet the needs of punishment and address the critical issues of alcohol dependency and reducing the offender s likelihood of reoffending and risk of harm to the public. Suitability For offenders aged 18 and over who must be assessed as suitable. This includes: offender has committed a violent offence offence is alcohol related evidence of entrenched pattern of alcohol dependency evidence that the offender is susceptible to treatment The offender needs to express a willingness to comply with the requirement. OM completes sentence plan within required timescales and provides copy to Substance Misuse Worker within one day of completion. OMs should provide OASys screening for low and screening and summary for medium and high risk Substance Misuse Worker confirms attendance, in writing/ , following each appointment. Witness Statements, using agreed pro-forma, will be required for all FTAs. Outcomes Offenders who complete the Alcohol Treatment Requirement will have: examined their dependency, behaviour and issues of self-control acknowledged the harmful impact of their behaviour on victims, community and self learned new skills to help them lead constructive and law-abiding lives Requirements The offender will be subject to the following: Supervision in accordance with Probation Service National Standards Community based interventions will focus on a range of issues including alcohol use, psychological well-being, offending behaviour and life skills Required to lead a law-abiding lifestyle. Attend all appointments as required by the Offender Manager, including appointments with treatment provider and other agencies being returned to Court promptly for failure to comply Making the Requirement Minimum period is 6 months with a maximum of 3 years. Standard ATR length should be 6 months Treatment intervention can include: Community Care Planned treatment: This can include a range of structured, specialist and evidence based prescribing interventions, psychosocial therapies focussing on alcohol misuse; brief interventions; health improvement and the amelioration of alcohol related health problems; psychological well-being; offending behaviour; life skills, accommodation issues; and social functioning. If appropriate, it can also include medically assisted alcohol withdrawal in the community (detoxification) and prescribing interventions to reduce risk of relapse. Treatment and interventions will be delivered and managed through a written individual Care Plan. If the Substance Misuse Worker rearranges any appointments with the offender, these must be notified to the OM in advance or at the latest on the day of the original appointment OM to convene Care/Sentence Plan meeting within 10 working days of sentence. Includes OM, offender and Substance Misuse Worker. Review meetings should be convened at a minimum of every 14/16 weeks until ATR completion Structured Day Programme: a formal care planned programme of day care focusing on issues including offending, relapse prevention, personal development, life skills, problem solving and other practical and emotional support. Inpatient and Residential Structured Care Planned Treatment: including medically assisted alcohol withdrawal, stabilisation, rehabilitation and pharmacotherapy (medication) requiring specialist residential or inpatient treatment Referrals to ADS. Additionally, under the ATR, motivational work and solution focused interventions to improve or resolve an offender s accommodation, attendance at mutual support e.g. Alcoholics Anonymous (AA) (if attendance can be confirmed), education, training or employment can be counted as contact providing it is included in the Sentence Plan and there is a clear audit trail. All interventions in the ATR will be guided by a formal Care Plan written by the Substance Misuse worker in consultation with the offender. All aspects of treatment outlined above will be covered by the ATR, which means that there is no need to include a Residence Requirement if an offender is to undertake residential treatment as a component of any care planned intervention(s) detailed in the court report. If the offender is returned to court in breach of their order the Substance Misuse Worker may be required to attend to give evidence.

49 Dependent Drinkers Service to Community Detoxification Comprehensive Assessment Identifies need Care Plan Agreed Application forms completed with Key worker and forwarded to NHS Nurses for assessment process NHS Nurses carry out a suitability assessment with the client t Suitable NHS Nurses inform Keyworker. Care plan reviewed and alternative options explored Suitable Key Worker arranges medication with GP. Informs NHS nurse this is available and continues 1-1 support until detox is available The aims of accessing of community based detoxification are: To reduce health inequalities across Blackpool caused by alcohol misuse Contribute to reducing the amount of Alcohol related crime, including violent crime. To reduce the number of hospital admissions due to the misuse of Alcohol. To prevent the death of clients through alcohol withdrawals. Who is this pathway for? Clients who are physically dependent on alcohol Completed Detox. is carried out with Nurses attending daily for five days t Completed Clients who fit the criteria for community detoxification Clients whom the GP is willing to prescribe appropriate medication. Who is suitable for this pathway? Clients who wish to become abstinent. Clients who have adequate support at home to undertake the risk involved of withdrawing with minimal supervision. Who is not suitable for this pathway? Anyone who is not physically or psychologically dependent on Alcohol. Key worker sessions recommence and care plan reviewed to explore next steps Key worker sessions resume care plan reviewed and other options explored. Anyone who has health problems which might prevent them withdrawing safely from alcohol with medication.

50 Dependent Drinkers Service to Inpatient Detoxification Comprehensive Assessment Identifies need Care Plan Agreed Application Forms completed with Key Worker and forwarded to Detoxification unit. Client enters Pre-detox group while awaiting acceptance by Detox Unit t Accepted Key worker reviews Care plan and explores alternative options with client Accepted The accessing of Inpatient detoxification aims are: To reduce health inequalities across Blackpool caused by alcohol misuse Completed Detoxification Client remains in Pre-detox group until bed is ready in detox unit. Enter unit when appropriate t Completed Contribute to reducing the amount of Alcohol related crime, including violent crime. To reduce the number of hospital admissions due to the misuse of Alcohol. To prevent the death of clients through alcohol withdrawals. Who is this pathway for? Clients who are physically dependent on alcohol Return to ADS keyworker and review care plan exploring alternative options Return to ADS Key worker. Care Plan reviewed exploring further support needed. Agree next steps Clients who do not fit the criteria for community detoxification either due to physical health, adverse reaction to withdrawal symptoms or who do not have adequate support at home to safely withdraw whilst on medication Who is suitable for this pathway? Clients who wish to become abstinent. Clients who are not suitable for community based detoxification but who require medication to withdraw safely. Who is not suitable for this pathway? Anyone who is not physically dependent on Alcohol. Anyone who has health problems which might prevent them withdrawing safely from alcohol with medication.

51 ADS to Alcohol Assertive Outreach Project - to ADS Client fails to attend 2 appointments consecutively at ADS and does not respond to letters. File photocopied and passed to AAO project Aim The aim of the pathway is to ensure that dropped out clients who have ceased to engage with alcohol treatment are re engaged via the Alcohol Assertive Outreach Project, Drugline Blackpool. Who is this pathway for? Clients who are experiencing high levels of dependency or harm due to alcohol consumption Clients who have been a client of ADS in the last 6 months Clients who have been triaged and assessed by ADS Clients who are involved with other substances but alcohol the main substance Contact client within 48 hours by letter, text phone or outreach and organise face 2 face within 1 week. Who is the pathway not suitable for? Clients who are under 18 yrs for ADS and 19yrs for Drugline Clients who are at poscodes FY5 FY8 as beyond the geographical boundary for AAO outreach work. Client responds? Maintain contact for period of 3 months to motivate client back into Tier 3 treatment Client responds and re engagement process begins with AAO project worker solving problems that have caused dis engagement from Tier week ICP planned Re referral to ADS. Support client through information session, assessment and allocation of key worker. AAO project worker closes case at this point Client returns to treatment Close client as a refusal to engage with treatment though will accept as a re referral in the future or as a treatment naïve client

52 Access to Alcohol Treatment via Homeless Team and Organisations Oasis Night Shelter Comfort Zone The Bridge Project Homeless Project Drugline South King Street SORT Team Street Life Client with significant alcohol problem (reason for being homeless, life being socially, mentally, economically and financially adversely affected by alcohol consumption) for ADS (Tier3) and 19+ for Drugline AAO(Tier 2). Following assessment of needs dual referral made to ADS and AAO project or single referal to ADS or AAO project. Assessment Aim The aim of the pathway is to ensure that homeless people experiencing significant alcohol problems are able to access alcohol treatment Who is this pathway for? Clients who are experiencing high levels of dependency or harm due to alcohol consumption Clients who are homeless or experiencing problems with accommodation Clients who access these services for support Clients who are involved with other substances but alcohol the main substance Who is the pathway not suitable for? Clients who are under 18 yrs for ADS and 19yrs for Drugline Clients who are at poscodes FY5 FY8 as beyond the geographical boundary for AAO outreach work. Referral to ADS if client is stable drinker who is able to cope and remain stable during waiting time (4 week period). Referral to ADS and AAO if client is naïve or dropped out with a history of non engagement with services. AAO workers will support in getting client into ADS via Outreach Referral to AAO project if client has significant difficulties/barriers preventing them from engaging in Tier 3 alcohol services Completion of triage and assessment, allocation of keyworker. Access and gateway to Tier 2, 3 and 4 12 week wraparound service, provided outreach support to clients to achieve some stability, in order to (re) introduce to and maintain in Tier 3 services

53 Acute Trust Alcohol Liaison Nurse Specialist Patient Admitted to Acute Trust (A & E, CDU, General wards, Pre-Op Assessment, Clinics) As part of medical assessment, Alcohol Screening Tool is completed by triage nurse Alcohol Issues Alcohol Intervention needed further action Alcohol Issues Identified Nurse discusses Alcohol Liaison Service with patient Patient Declines Alcohol Harm Reduction Information Given Patient Accepts Nurse bleeps alcohol liaison service Inpatient or Outpatient Inpatient Inpatient appointment made Outpatient Alcohol Liaison Nurse attends to conduct full assessment, inc Mental Health screening Mental Health issues? Follow Dual Diagnosis Pathway Full MH assessment and diagnostics reveal level of intervention following Dual Diagnosis pathway Detox required? Detoxification included on and provided as part of care plan Detoxification supervised by ALNS over critical period Brief Intervention Therapy begins Patient has discharge plan Patient agrees to outpatient intervention Referral to outpatient clinic at point of discharge Patient attends outpatient clinic 3 outpatient appointments Patient content with outcome Patient requests further intervention - Community Alcohol Services are discussed Patient agrees Referral made to CAS Client attends? Exit Assertive multi-agency follow up

54 Arrest Referral Working for Alcohol Clients Client offered contact with an arrest referral worker Client accepts contact Leaflet for ADS and for Alcohol Assertive Outreach Team at Drugline given to client Triage assessment carried out with client Brief intervention carried out Audit? - Harm reduction advice given. - Written information given. - Immediate needs prioritised and client referred on appropriately e.g urgent housing needs, physical health needs etc The focus of arrest referral working is to reduce drug and alcohol related crime by engaging with users at point of arrest, offering immediate support and screening, and moving them into appropriate treatment and support in the community Aims To identify individuals with an alcohol issue brought into custody at Blackpool Police Station To provide screening at point of arrest. To provide alcohol specific information, harm reduction advice, brief interventions and support. To facilitate onward referral for those requiring more structured alcohol treatment Appointment made for client with Alcohol Assertive Outreach Team at Drugline Criteria Any Individual with an alcohol issue in custody at Blackpool Police Station Exclusion criteria would include those whose behaviour in the station presented a risk to arrest referral workers safety e.g violent behaviour and those heavily under the influence of alcohol who were unfit to be seen by a worker. Contact maintained with client until effectively engaged with alcohol services, including support offered with Initial attendance

55 Alcohol Users accessing the COAST Community Rehabilitation Programme from Tier 3 Services Before the referral takes place care coordinators need to establish that the service user is alcohol and drug free and will benefit from an intensive community based rehabilitation programme. Initial referral is made to the Open Access service at Drugline from Tier 3 treatment agency. This referral should include copies of the latest comprehensive assessment and the care plan Client attends OA service Able to contact client? Send letter/ text/ call and offer 2 nd appointment. Contact referring agency Client attends suitability Open Access: Client and worker discuss expectations Care plan review takes place Risk assessment updated Conf/Info Sharing updated TOP completed (if appropriate) Pre-CAF completed / full CAF completed if appropriate Assessor becomes CC for 12 week period, volunteer support offered from point of assessment also for 12 week period. Contact referring agency case suspended Aim The aim of the pathway is to ensure access to treatment and support for service users who are abstinent from Alcohol and other illicit abd dependence forming substances. Who is this pathway for? Service users who are abstinent / drug free and will benefit having from accessing the COAST community rehabilitation programme. Who is the pathway not suitable for? Client is suitable and drug / alcohol free? Contact referring tier 3 agency and /or referral to tier 2 treatment services in line with treatment plan. Referral to other support services e.g. benefits, housing etc. CC to liaise with and update care plan. For clients who are alcohol and drug free (abstinent) and are able to attend an intensive (five days a week) community rehabilitation programme lasting between twelve and twenty four weeks. Glossary of terms used CC Care co-ordinator DNA Did not attend TOP Treatment outcome profile OA Open Access Vol Volunteer worker Coast is full? COAST is full. Client enters pre-coast group and counselling A space is available client enters COAST programme Client relapses? Activate reengagement policy, inform referring agency or Re-referral made to tier 3 treatment service or Suspended from programme Client completes coast. Care plan complete / treatment complete or Client ends lapse becomes abstinent - return to COAST Referral made to Academy and post-coast support group

56 Assertive Alcohol Outreach Service Client referred either treatment naïve, drop out or self referral Letter sent (within 48 hrs) offering an appointment (within one week of referral) Attends appointment? Joint home visit conducted Client engages with service? Client attends triage assessment completed/ updated inc info consent, risk assessment, care plan developed/ updated, Pre-CAF completed. > 3 attempts? Exit Allocation within AAO project. Worker acts as CC Aim The aim of the pathway is to ensure access to treatment and support for service users with alcohol misuse problems in Blackpool whoare either treatment naive or eho have droped out of treatment. Who is this pathway for? Case work begins, referal to ADS and or other agencies completed. Service users who are having significant problems with their alcohol misuse and are either treatment naive or who have droped out of treatment. Who is the pathway not suitable for? Those clients who solely experience problems with drug use or who are under 18 years of age Glossary of terms used Handover to Tier 3 service within 12 weeks of assessment. Case closed to AAO CC Care co-ordinator DNA Did not attend TOP Treatment outcome profile OA Open Access Vol Volunteer worker AAO Assertive Alcohol Outreach CAF Common Assessment Framework ADS Addiction dependancy solutions A Risk Assessment will be carried out at the start of client contact and at the Care Plan Review stage and at any other point of contact with the client when the worker or client considers it appropriate. If a risk issues arises or a child protection issues arises then a risk management plan / child protection procedures will be followed. A CAF maybe completed with the consent of the parent if the family will benefit from extra support.

57 Pathway from Dependent Drinkers Service to Residential Rehabilitation Comprehensive Assessment Identifies need Care Plan Agreed Application forms completed with Key worker and forwarded to Rehabs. A choice is available to ensure client need is addressed. Visit rehabilitation centres for assessment and to ensure client is comfortable with the centre programme Detox Required? Application completed for appropriate detox either home or inpatient. Co-ordinating, to be seamless with when rehab bed is available. If accepted for Rehab treatment programmes client makes a choice from those offered, Detox Completed? Accepted? Funding Application completed and forwarded to NHS for approval Client enters Rehabilitation Centre for a period of three to six months. Review at 10 weeks if required. Approved? Completed? Key worker sessions resume care plan reviewed and other options explored. Key worker sessions recommence and care plan reviewed to explore next steps and aftercare provision

58 Tier 3 Dependent Drinkers Service to Assertive Outreach Team - Drugline Client is engaged with Dependent Drinkers Service at ADS The aims of accessing the Assertive Outreach team are: To reduce health inequalities across Blackpool caused by alcohol misuse Contribute to reducing the amount of Alcohol related crime, including violent crime. To reduce the number of hospital admissions due to the misuse of Alcohol. Client DNA s appointment with ADS staff. ADS retention procedures and protocols are followed to try to ensure client stays in treatment To prevent the death of clients through alcohol withdrawals. To re-engage those clients who have dropped out of T3 alcohol treatment services. Who is this pathway for? All clients who have given permission at Triage for referral to the outreach team should they drop out of treatment Who is suitable for this pathway? Clients who drop out of T3 treatment and are not habitual revolving door clients. Successful? Who is not suitable for this pathway? Anyone who is not physically or psychologically dependent on Alcohol. Treatment continues. Assuming client has given permission in information sharing, documentation is prepared and given to Assertive outreach team staff to make contact.

59 Pathway available yet

60 Pathway available yet