Wear Recovery. Sunderland Integrated Drug & Alcohol Services

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1 Wear Recovery Sunderland Integrated Drug & Alcohol Services

2 Partnership Presentation Introduction to individual organisations NTW DISC Changing Lives Introduction to the Model Pathway Phasing and Layering Support Requirements Service Location and Facilities Referrals

3 Introduction to Northumberland, Tyne and Wear NHS Foundation Trust (NTWFT) David Muir Directorate Manager, Specialist Adult Services

4 Northumberland, Tyne and Wear NHS Foundation Trust (NTWFT) One of the largest mental health and disability trusts in England 6,000 plus staff 60+ sites including main hospital and smaller units Income budget 300 million + Serve population of 1.4 million Covering 2,200 square miles Formed in 2006, becoming a Foundation Trust in 2009

5 NTWFT Services... Mental Health, Learning Disability & Neuro Rehabilitation Services Services provided in peoples homes, hospitals and community based premises A range of services are also provided on a wider regional and national basis Community Inpatients Specialist

6 More about how Specialist Adult Directorate is organised... Forensic Services Specialist Services Neurological Services Specialist Adult

7 How can I find out more? Available at:

8 Introduction to DISC Ted Haughey DISC Operations Director

9 About us Established over 30 years ago Now a leading Northern Charity Working with the most disadvantaged and complex needs Currently over 450 staff & 23M turnover Strong focus on partnership working to meet local needs

10 DISC What we do Accommodation & Housing Support Children, Young People & Families Drug & Alcohol Services Skills, Employment & Training

11 Introduction to Changing Lives James Ward

12 Who We Are Changing Lives is a national, registered charity which provides specialist support for thousands of vulnerable people and their families, every month. Through our pioneering and innovative work we help people to make positive, lasting changes in their lives. Our aim is to support people to change their lives together

13 What We Do We deliver services in 7 key areas: Direct access services from larger hostels through to smaller supported accommodation A range of services which reach out and support people out in the community A variety of centres which provide support at every stage of the recovery journey Our team dedicated to jobs and preemployment training Specialist services across the UK dedicated to women and girls Activities supporting parents and children to manage family change better Supporting our charitable work; TCUK Property Services, FareShare North East & York, and retail

14 Model Overview Margaret Orange Treatment Effectiveness and Governance Manager (Addictions) NTWT

15 Model Overview SPOC

16 Service Description The Sunderland Integrated Substance Misuse Treatment and Harm Reduction Service is divided into three broad areas of activity: A recovery focused model of structured treatment based on a Behaviour Change Model Specialist Harm Reduction Specialist Liaison Functions

17 Engagement Single Point of Contact SPOC Multiple points of access Effective screening, assessment and brief intervention Access to short, intensive programmes and longer term recovery coordination depending on need and complexity Comprehensive assessment and Recovery Plan (RP) Recovery coordinator (RC) will be the first face-to-face contact following SPOC refer and accompany.

18 Preparation SPOC Intensive Induction RC will facilitate comprehensive ITEP assetbased assessment Single, shared Recovery Plan (RP) Peer Mentor (PM) Individual recovery capital (social, physical, human and cultural)

19 Change Assessment and Engagement Team <16 weeks SPOC Recovery Co-ordination > 16 weeks+ On-going Recovery Coordination Peer Mentor support Psychosocial, Clinical and Pharmacological interventions combinations of interventions Oaktrees Model

20 Completion SPOC Exit planning Lapse Contingency plans Re-engagement plan Recovery Capital to sustain recovery before exiting service including: Suitable Accommodation Sustainable Recovery Networks Employment, Training, Education opportunities Friends and Family Networks Engagement in Meaningful Activity Relapse Prevention plans and skills Aftercare service

21 Referrals: Universal Services, GP, Secondary Care, Hospital, Self, Carer Wear Recovery - Pathway Disc (<16 wks) YES Disc Via Assessment and Engagement Team Treatment Complete? YES Single Point of Contact (SPOC) TRIAGE Consent gained Initial assessment Risk Screen Offer: YES Suitability for treatment? NO Self-help information, Brief advice and referral back to GP/Referrer. Inform Referrer. ROUTINE? Who complete comprehensive assessment? Complex/ High Risk? YES Via Assessment and Engagement Team Also book Welcome Meeting for all service users via changing Lives NTW Via Clinical Team At any point based on need Disc (>16wks) Via Recovery Coordination Team If Risk level changes NTW High risk Recovery coordination - NTW Clinical activity Recovery Coordination via DISC Access to all Groups and Recovery Support via changing Lives to include volunteering, outreach, peer support, capital building NO Treatment Complete? Treatment Complete? YES YES 3 month standard Recovery support via Changing Lives Sub Pathways: Guidance: Guidance: Criminal Justice Pathway Alcohol Pathway OST Pathway Hospital Liaison Pathway Pregnancy Pathway Dual Diagnosis Pathway Oaktrees Pathway Aftercare Pathway Access to Groups/Recovery Pathway Testing Engagement and non-attendance Challenging Behaviour Naloxone Carer engagement Transfer of Keyworker Needle Exchange Triage completion High risk and complexity criteria Welcome Group/Package Access to groups

22 Layers Phases Engagement and Stabilisation Preparation For Change Active Change Sustained Recovery LIFE Completion Keywork interventions/ Standard Treatments All engagement interventions will be used throughout all phases/layers as appropriate Harm Reduction/NX BI/EBI Breakfast Clubs SPOC Triage NPS/YAI Pharmacies BI Training Meet and Greet Opioid substitution treatment Community Alcohol interventions Proactive/facilitated referral to mutual aid Mental health assessment, monitoring and integrated access to appropriate mental health services Physical examination and access to healthcare Low intensity PSI Comprehensive assessment Recovery Plan Recovery Co-ordination Harm Reduction Physical investigations Medically Assisted Recovery Harm Reduction Pre-detox SADQ Carer engagement PSI MI MET SMART Behavioural self-control Family Carer Recovery planning Recovery co-ordination Family/care Ongoing assessment including risk Medically Assisted Recovery Relapse Prevention Physical and mental health care Community Detoxification PSI Non-residential rehabilitation ITEP Community reinforcement CBT Mindfullness Aftercare Mutual Aid reengagement Family/carer Relapse prevention Volunteering Employment Training Cognitive Behavioural Relapse Programmes Structured Aftercare Self help Keywork+/ Enhanced Treatments Assertive outreach Optimised prescribing Community detox Enhanced PSI Health/mental health monitoring *4 year +/recovery plan and coordination Criminal Justice Dual diagnosis input *4year + / recovery plan and co-ordination Criminal Justice DRR/ATR Clinical assessment Recovery pathways Follow up support High Intensity/ Intensive Treatments Inpatient assessment and treatment GAD/Assessment tools Dual diagnosis input Safeguarding Pregnancy pathway Increased frequency PSI Residential Rehabilitation assessment Inpatient detoxification Access to residential rehabilitation Complexity can be defined by a range of factors and includes: Mental Health/Co-morbidity, Pregnancy, Physical Health, Overdose, Multiple vulnerabilities, Safeguarding, Public Protection, lack of progression in treatment.

23 Support Requirements Complexity High Complexity Medium/Low Complexity Low Complexity Advisory Intervention Only Support Requirement Requires intensive support Requires 16+ weeks support Requires < 16 weeks support Opportunistic / When contacted Key Worker Allocation Clinical coordination Recovery Coordinator / Clinical Support Assessment &Engagement SPOC / Assessment & Engagement

24 Service Location and Facilities Services provided within all localities of Sunderland via both permanent bases and use of appropriate local facilities: Coalfield Area (estimated 300 Service Users) East Sunderland Area (estimated 600 Service Users) Washington Area (estimated 350 Service Users) Sunderland Royal Hospital Northumbria Police within Sunderland area command

25 Delivery Locations In addition to utilising local community resources the service will be delivered from three key Recovery Hubs. Each Hub will offer the full range of service including clinical, coordination and psychosocial interventions.

26 Washington, Concord Sunderland Central/East Houghton le Spring Newbottle St.

27 Empire House, Newbottle St. Houghtonle-Spring, DH4 4AJ Recovery Hub & SPOC telephone service Vermont House, Concord, Washington, NE37 2SQ Recovery Hub & Oaktrees Sunderland Central/East: 4-6 Mary St. Sunderland SR1 3NH Needle Exchange remaining at Saville Place

28 Referrals The new service is available for those who: misuse alcohol and/or drugs 18 years+ are registered with a GP in Sunderland want to address their substance misuse We welcome referrals from any source including, self-referral, GP s, friends and families and other professionals.

29 Referrals cont. Referrals can be made through the existing number free from landlines and mobiles 10am-8pm Mon-Fri and 10am-2pm Sat, Sun and bank holidays. The harm reduction service at 3 Saville Place, Borough Road, Sunderland, SR1 1PA will remain in place whilst harm reduction provision is reviewed by the new service. If you require further information prior to the 1st July please ssmsinfo@ntw.nhs.uk

30 Thank you Any Questions?

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