Midland Regional Addiction Services Prepared By: Belinda Walker and Eseta Nonu-Reid Context To provide MRCGN with an understanding of what services Midland funds regionally for future investment strategies The regional beds are just one part of the wider Addiction continuum. Local DHBs purchase a range of services that support the regional beds. To determine effectiveness and value for money we need to determine evidence of outcomes e.g. how many clients completed programmes. Are there more? 1
Discharge Graphs Te Utuhina Manaakitanga Discharge Types 2010-YTD Still in Programme Transferred Self Discharge Service Discharge Completed Completed Service Discharge Self Discharge Transferred Still in Programme 2010/11 36 16 17 0 12 2011/12 37 20 14 4 17 2012/13 30 20 8 6 7 Discharge Graphs Cont Nova Trust Discharge Types 2010-YTD Still in Programme Service Discharge Organised Organised Service Discharge Still in Programme 2012/13 4 2 5 2011/12 8 1 4 2010/11 8 2 1 2
Salvation Army What is funded: 5 FTE non clinical 2 FTE clinical 13 beds Intensive AOD with accommodation (fee for service based) 730 bed days (2 beds) Managed withdrawal home community (fee for service based) Total Potential AOD Residential contract value in 2012/13 - $878,215 What is unique to Salvation Army: National provider of addiction services Seven fundamental values underlie services provision: Humanity, Service, Spirituality, Identity, Partnership, Transformation and Social Action Service available to Waikato, Bay of Plenty, Lakes and Tairawhiti populations Two Hamilton based facilities, one for Residential treatment and one for social detox Men and women accommodated in separate areas of each facility Ability to increase and decrease service according to demand between two facilities Structured visiting times but specific visiting arrangements are made for family that are travelling some distance Salvation Army Cont. Intensive AOD with accommodation service: 8 week structured programme, with option for an additional week Provided from a semi-rural 13 bed facility in Baverstock Road, Hamilton. The programme is recovery orientated around the SA Model of Treatment that has four distinct components that include: Community Reinforcement Approach Focus on the clients personal plans, Preparation for returning clients to their community and Reinforcement of good habits for sobriety Programme includes a partnership agreement with client in regard to: Pathway, Mutual work, Relationships, Context Programme also has a 12 step recovery journey that includes stages of Healing, Peace, Freedom and Growth Managed Withdrawal home community: Social detox service - that is used on occasion as a step-down detox service from the medical detox bed at Health Waikato. Provided from a 5 bed house (facility) in Dalgleish Avenue, Hamilton. Can supply 'detox only' on demand Where detox phase has to dovetail with treatment there is a wait-time 3
Salvation Army Cont. Salvation Army Managed Withdrawal (Detox) Utilisation 2010-YTD by DHB Utilisation Waikato Taranaki Tairawhiti Lakes BOP BOP Lakes Tairawhiti Taranaki Waikato 2010/11 115 72 7 445 409 2011/12 175 35 15 0 445 2013/12 105 47 55 0 248 Salvation Army Cont. Salvation Army Intensive AOD Utilisation 2010-YTD by DHB Waikato Taranaki Tairawhiti Lakes BOP BOP Lakes Tairawhiti Taranaki Waikato 2010/11 1022 533 72 0 1720 2011/12 1012 272 126 0 2350 2013/12 439 185 164 0 1377 4
Salvation Army Cont. Salvation Army Managed Withdrawl (Detox) 2010-YTD Available/Used Beds 2010/11 603 730 2011/12 670 732 Used Available 2013/12 455 730 0 100 200 300 400 500 600 700 800 Salvation Army Cont. Salvation Army Intensive AOD 2010-YTD Available/Used Beds 3347 2010/11 4745 2011/12 3760 4758 Used Available 2013/12 2165 4745 0 1000 2000 3000 4000 5000 5
Te Whare Oranga Ngako What s funded: 5 FTE non clinical 2 FTE clinical 15 beds Intensive AOD with accommodation (fee for service based) Total potential contract value in 2012/13 - $571,192.31 What s unique to Te Whare Oranga Ngako Kaupapa Maori service delivery Will accept people with CEP and/or justice referred 2 MoH funded methamphetamine beds (inclusive of social detox) Men and women accommodated on separate properties Rolling 12 week therapeutic program delivered from Marae Whanau Ora worker through Te Ao Auahatanga funding Bed based funding and TUMT budget purchases a further 2.5 clinical FTE and 3 non clinical FTE to operate the 24/7 roster and therapeutic programs Cont.. Intensive AOD with accommodation service: 12 week structured programme The aim is to positively impact on the resident's thoughts and perceptions, emotional self-regulation, spiritual strengths and pro-social skills and behaviours. The programme is integrated into a 'therapeutic community of whanau' who have input into a continual unfolding of quality interventions in an overall environment of safety, respect and learning. Based on the Poutama model the programme whanau also attend 12 step recovery hui in the community which can also support their recovery post treatment Whanau engagement is also encouraged via a Whanau Practitioner and Whanau Ora Worker 6
Cont.. Intensive AOD with accommodation service: Intensive group work and one to one counseling. Whaiora learn about relapse prevention, interpersonal behavioral patterns, distress intolerance, anger/stress management, communication skills, gender issues, spiritual /cultural awareness, family systems and self nurturing and coping skills, ko wai au, whakapapa, tikanga, kapa haka, karakia, research and presentation skills Hosts a multidisciplinary team inclusive of a Registered Nurse, Whanau Practitioner, Whanau Ora Worker and practitioners with 10+ years experience in AOD/MH TWON have access to post treatment beds/community support in the Taranaki, Lakes, Waikato region Staff regularly visit the Midland regional providers to ensure whanaungatanga is up held The ADOM tool is utilised to follow up whaiora 12 week post treatment Cont. Te Utuhina Manaakitanga Trust Utilisation 2010-YTD by DHB Waikato Taranaki Tairawhiti Lakes BOP 0 200 400 600 800 1000 1200 1400 1600 BOP Lakes Tairawhiti Taranaki Waikato 2010/11 1051 1,271 0 790 1,593 2011/12 1023 781 186 873 1,498 2013/12 726 462 282 239 1,434 7
Bed Utilisation 2010- YTD Te Utuhina Manaakitanga Trust 2010-YTD Available/Used 2010/11 4705 5475 2011/12 4361 5490 Used Available 2013/12 3143 5475 0 1000 2000 3000 4000 5000 6000 Springhill What s funded 3 residential beds (1095 bed nights per annum) At a cost of $124,488.00 per annum What s unique to Springhill Structured, 8 week residential environment for motivated adults committed to overcoming mental health and addiction issues. Holistic approach to recovery featuring psycho-educational, behavioral and psychotherapeutic interventions. Intensive group work and individual support. In groups the clients learn about relapse prevention, interpersonal behavioral patterns, distress intolerance, anger/stress management, communication skills, gender issues, spiritual /cultural awareness, family systems and self nurturing and coping skills. Evidence based practice that includes a range of talking therapies i.e. cognitive behavioral therapy, dialectical behavioral therapy, motivational interviewing, mindfulness, person centered practice, acceptance commitment therapy etc. 8
Springhill cont What s unique to Springhill Springhill provides a clear referral process in screening and selecting its clients that are suited to the unique service that Springhill provides. The intention is to maximise the client s potential for success whilst in residential treatment. Comprehensive recovery action plans are implemented upon entry and is reviewed in week six with the client, whanau and professional supports. This review explores discharge planning by examining the client s strengths, goals, risks and ongoing support that will enable a smooth transition back to their community to ensure recovery maintenance. Psychiatric and medical consultations and assessments. Family and couples sessions. 12 step community meetings. Do not accept justice or court referred clients or clients under the AOD Act Springhill adequately measures clinical outcomes by using the ADOM tool Springhill cont What s unique to Springhill There is the expectation of 6 month post discharge with follow up support and counselling by referral agency or other identified community agency. Springhill is fortunate to have a multi disciplinary team with the total of 11 full time equivalent (FTE) health professionals including psychotherapists, social workers, registered nurse and night time/weekend supervisors. Springhill also has regular support and input from senior management, medical officer and a consultant psychiatrist. Clinical governance model has been set up to provide a framework that reviews current practice standards that align with DHBs ethics, regulations, polices and Ministry of Health s derived KPI s. The clinical governance group meets bimonthly which consists of a Clinical Nurse Manger, Associate Manger and Clinical Coordinator. 9
Cont. Springhill Utilisation 2010-YTD by DHB Waikato Taranaki Tairawhiti Lakes BOP BOP Lakes Tairawhiti Taranaki Waikato 2010/11 173 385 112 64 179 2011/12 332 167 109 226 331 2013/12 385 258 0 87 217 Bed Utilisation 2010-YTD Springhill 2010-YTD Available/Used Beds 2010/11 913 1095 2011/12 1098 1165 Used Available 2013/12 947 1095 0 200 400 600 800 1000 1200 10
Nova Trust What s funded 4 residential beds (1,464 per annum) At a cost of $143,545.20 per annum What s unique to Nova Nova accepts residents under the Alcohol and Drug Addiction Act, on Probation Supervision and/or Bail sentences or conditions Nova aims to provide a special environment where the benefits of counselling are combined with a new sense of self worth. Such a place exists at Nova Lodge, a unique residential facility that works hard to assist chronic dependent people to re-establish themselves as responsible members of society. Nova aims to provide a quality and professional therapeutic programme through maintaining staff qualification level, experience and knowledge to a high standard. Nova will maintain an excellence level of attainment for Certification under Health and Disability Certification Service Standards. Through case management sessions, staff strive to provide a holistic approach to recovery by including cultural, social and spiritual needs leading to empowering the clients to enable their recovery. Treatment is designed around client focused needs and to address health recovery. Cont.. Nova Trust provides a 24 hour residential service with a programme length of 6 months. Opportunity to remain longer may be given. Work therapy is the major activity of the programme. Work therapy focuses on developing regular work habits and new skills. Nova Trust is primarily a work-based programme but accepts there is a need for counseling in its programme. The service delivery is focused on providing coping strategies to abstain from alcohol/drug dependence, cannabis, and minor tranquillisers. This is supported with initial and ongoing assessments of the residents needs and a coordinated programme that includes individual counseling and group therapy. All Nova staff are working toward the same purpose, to provide the resident with a balanced life-style to enable them to make appropriate and informed choices about their future. Nova Lodge believe it is the integration of the work therapy and the holistic approach to the individual that makes the Nova programme successful. Individual counselling combines a resident centred counselling model with motivational counselling. Incorporated into this is the development of selfesteem, and personal skills. Residents are allocated a Case Manager/Counsellor after initial assessment. 11
Cont. Nova Utilisation 2010-YTD by DHB Waikato Taranaki Tairawhiti Lakes BOP BOP Lakes Tairawhiti Taranaki Waikato 2010/11 303 735 0 1 484 2011/12 257 202 0 152 783 2013/12 310 0 149 31 577 Average Utilisation Nova 2010-YTD Available/Used Beds 2010/11 1523 1460 2011/12 1394 1464 Used Available 2013/12 1067 1460 0 200 400 600 800 1000 1200 1400 1600 12
Summary What outcomes need to be collected going forward? How the future service configuration will be compliant to the AOD Compulsory Treatment Act requirements? How to manage access to beds going forward? What after-care processes are in place and are there any known concerns? 13