MATRIX MODEL: INTENSIVE OUTPATIENT AOD TREATMENT SERVICE SOUTH EASTERN MELBOURNE PHN 5 FEBRUARY 2018

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Louisa Nash
5 years ago
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1 MATRIX MODEL: INTENSIVE OUTPATIENT AOD TREATMENT SERVICE SOUTH EASTERN MELBOURNE PHN 5 FEBRUARY 2018

2 Agenda 9:30-09:45 Welcome and Acknowledgment 9:45-10:00 AOD Funding and SEMPHN s Vision 10:00-10:15 AOD Catchment Data 10:15-10:30 Morning Tea 10:50-11:15 Matrix Model Evidence and Brain Model 11:15-11:30 Matrix Program Structure 11:30-11:40 EOI and Next Steps 11:40-12:10 Q&A Panel

3 WELCOME

4 3000 km2 10 LGAs 1.5 million residents Very diverse communities 2000 GPs, 450 practices 12 major hospitals

5 AOD & SEMPHN identify and address system integration and capacity issues to ensure a wellcoordinated and functional AOD service system capable of responding to the needs of the community

6 SEMPHN PROGRAMS (Approx $46 mill)

7 2016/2017 AOD Projects Focus Location Agency School-based program to reduce adolescent use of alcohol (years 8-10), plus parent/teacher info sessions Improve service access to AOD treatment options and drug use improved referral pathways, discharge planning, and counselling Address Hepatitis C rates by build capacity among GP clinics and AOD services Bayside, Cardinia Mornington Peninsula Port Philip Greater Dandenong Port Phillip, Frankston, Greater Dandenong Taskforce Community Agency Taskforce Community Agency Alfred Health Carer Services

for networking and professional development work with AOD services for improved service integration

8 SEMPHN and A4 Pharmacotherapy Network support GPs to manage patients with opioid dependence; support pharmacists to provide pharmacotherapy (education and training) build Communities of Practice (CoP) for networking and professional development work with AOD services for improved service integration increase awareness of opioid dependence, treatment options and referral pathways (visits, communications)

South Eastern Consortium of Alcohol and Drug Agencies - SECADA consortium of six organisations in Melbourne s South East contracted to provide specialist alcohol and

9 South Eastern Consortium of Alcohol and Drug Agencies - SECADA consortium of six organisations in Melbourne s South East contracted to provide specialist alcohol and drug (AOD) services for voluntary and correctional clients SEMPHN is the lead agency with services in Dandenong, Springvale, Narre Warren, Pakenham and Cranbourne areas.

10 AOD IN SEMPHN

11 Service use Who is using AOD services in SEMPHN

12 Age Distribution Relatively few people over the age of 45 accessed AOD services Relatively high rates of AOD service use among people under 24 years of age Source: AODTS NMDS, 2014/15

13 Gender distribution 44% 56% Females Males Most episodes of care are for males but it s fairly even Average episode length for males (3.5 months) and females (3.6 months) is similar Source: AODTS NMDS, 2014/15

14 Indigenous status 6% 5% 89% Aboriginal or Torres Strait Islander Non-Indigenous Not stated The Indigenous population within the SEMPHN region comprises 0.5% of the total population, yet 5% of all AOD episodes of care involved Indigenous clients. This indicates that the Indigenous population was 10 times over represented in AOD service use Source: AODTS NMDS, 2014/15

15 Country of birth 6% 11% Australia English speaking countries Predominantly non-english speaking countries 83% 61% of SEMPHN residents were born in Australia, yet 83% of episodes of care involved Australian born clients Data from the National Drug Strategy Household Survey (2013) indicates that people from non- English speaking backgrounds (22% in SEMPHN) were less than half as likely to report illicit drug use and risky alcohol consumption Source: AODTS NMDS, 2014/15

16 Principal drug of concern In the National Drug Strategy Household Survey (2013), the self-reported rates of recent drug use were: Cannabis (10.2%), Ecstasy (2.5%), Meth/amphetamines (2.1%), Cocaine (2.1%) & Heroin (0.1%) Other includes: Benzodiazepines (2%), Methadone (1%), Nicotine (1%), Codeine (0.5%), etc Source: AODTS NMDS, 2014/15

17 Source of referral Most episodes of care were for clients who had sought treatment themselves Relatively large proportion of referrals are from AOD services to other AOD services Few referrals from GPs and family members/friends Source: AODTS NMDS, 2014/15

18 Treatment type Most episodes of care were for counselling and withdrawal management Average length of episode was longest for pharmacotherapy Source: AODTS NMDS, 2014/15

19 Treatment setting Most episodes of care were for services delivered in non-residential treatment facilities Source: AODTS NMDS, 2014/15

20 Service mapping Clusters of services around St. Kilda, South Yarra, Dandenong & Frankston High rates of alcohol related hospitalisation in the Inner-South (Bayside, Port Phillip & Stonnington) as well as the South East (Greater Dandenong & Frankston) Source: VAED 2014/15, Connetica, 2016

21 AOD Outcomes A closer look at where services are provided and where they are needed

22 Episodes of Care - Alcohol Alcohol Episodes of care rate per 10,000 by LGA and Year Victoria Bayside Cardinia Stonnington Port Phillip Casey Frankston Mornington Peninsula Glen Eira Kingston Greater Dandenong 2010/ / / / /15 Source: Turning Point

23 Episodes of Care Amphetamine (all) Source: Turning Point

24 Ambulance Attendance - Alcohol Alcohol Only Ambulance Attendance Rate by LGA and Year Stonnington Port Phillip Victoria Bayside Cardinia Casey Frankston Mornington Peninsula Glen Eira Kingston Greater Dandenong Source: Turning Point 2011/ / / / / /17

25 Ambulance Attendance Crystal Methamphetamine Source: Turning Point

26 Ambulance Attendance Amphetamine (all) Source: Turning Point

27 Alcohol Offences Alcohol Assault Rate per 100,000 by LGA and Year Stonnington Bayside Cardinia Port Phillip Casey Mornington Peninsula Frankston Kingston Glen Eira Greater Dandenong 2010/ / / / /15 Source: Turning Point

28 Methamphetamine Offences Methamphetamine Offences per 100,000 by LGA and Year Stonnington Port Phillip All Victoria Bayside Cardinia Casey Frankston Mornington Peninsula Glen Eira Kingston Greater Dandenong Source: VicPol Crime Data

29 Morning Tea

30 Matrix Model: The Evidence Evidence-based Intensive outpatient treatment Developed in the US in the 1980s in response to the cocaine and meth epidemic Addresses issues relevant to clients who are dependent on methamphetamine Incorporates elements of relapse prevention, CBT, psychoeducation, family sessions, social support, and 12-step/SMART Recovery support Highly Evaluated Program

31 Matrix Model: Approach Takes a motivational interviewing approach Significance of desired change is recognised Social support and education seen as key success factors Readiness for change is understood as an incremental process

32 Matrix Model: Approach Highly structured program Group work is educative rather than therapeutic Changing behaviours and brain chemistry are key tenets

33 Matrix Model: Approach Forming a strong therapeutic relationship between client & therapist Teaching structured and healthy lifestyle through time management Conveying immediate and long-term effects of substance withdrawal & cravings Creating opportunities to learn and apply coping techniques incl. relapse prevention Involving family & primary supports Encouraging participation in peer-led support groups Program and client safety - random urine drug testing & breath analysis

34 The Brain Model

35 Recovery Stages Stage 1: Withdrawal Stage 2: Early Abstinence ( Honeymoon ) Stage 3: Protracted Abstinence ( the Wall ) Stage 4: Adjustment/Resolution

36 Stage 1: Withdrawal Physical detoxification Cravings Depression/anxiety Low energy Irritability Exhaustion Insomnia Paranoia Memory problems Intense hunger 5-36

37 Stage 2: Early Abstinence Increased energy and optimism Overconfidence Difficulty concentrating Continued memory problems Concern about weight gain Intense feelings Mood swings Other substance use Inability to prioritize Mild paranoia

38 Stage 3: Protracted Abstinence Continued lifestyle changes Anger and depression Isolation Family adjustment Positive benefits from abstinence Emotional swings Unclear thinking

39 Protracted Abstinence Relapse Risk Factors Increased emotionality Behavioral drift Decreased ability to feel pleasure Low energy/fatigue Secondary drug use Breakdown of structure Interpersonal conflict Loss of motivation Insomnia Paranoia Relapse justification Matrix IOP 5-39

40 Protracted Abstinence Relapse Justification The addicted brain attempts to provide a seemingly rational reason (justification) for behavior that moves a person in recovery closer to a slip.

41 Relapse Justification Other People Made Me Do It My wife used so I was doing fine until he brought home I went to the beach with my sister and My brother came over for dinner and brought some I wanted to see my friend just once more, and he offered me some

42 Relapse Justification I Needed It for a Specific Purpose I was getting fat again and needed to control my weight, so I I couldn t get the energy I needed without I can t have fun without Life is too boring without I can t be comfortable in social situations or meet people without

43 Relapse Justification I Was Testing Myself I wanted to see whether it would work better now that I ve been clean awhile. I wanted to see my friends again, and I m stronger now. I needed a little money and thought I could sell a little without using. I wanted to see whether I could use just a little and no more. I wanted to see whether I could be around it and say no. I thought I could drink without using.

44 Relapse Justification It Wasn t My Fault It was right before my period, and I was depressed. I had an argument with my spouse. My parents were bugging me. My partner was intimate with another person. The weather was gloomy. I was only going to take a hit and

45 Matrix Program Structure

46 Matrix Program Structure Pre-treatment sessions including assessment (1-2 sessions) 1-hour/session Individual/Conjoint Counselling sessions (3 sessions minimum) 1-hour/session Early Recovery Skills group sessions (8 sessions) 1-hour/session Relapse Prevention group sessions (32 sessions) 1.5 hours/session

47 Matrix Program Structure Family Education group sessions (12 sessions) 1.5 hours/session Social Support group sessions (16 sessions) 1.5 hours/session Weekly mandatory (random) urine drug testing (16 weeks) Once per week Continuing Care (35 Sessions) 1.5 hours/session 12-Step (AA/NA) or SMART Recovery Throughout the program

48 Matrix Program Structure sample program schedule

49 Matrix Workforce Successful service Providers will be required to have A dedicated Matrix Program Manager certified as a Key Matrix Supervisor Therapists, Family Therapists, and Support Coordinators certified as a Matrix Practitioners Note: The term therapist may be adapted to suit Australian context

50 Workforce Capacity Building Matrix requires a high level of fidelity to implementation and delivery and only certified practitioners will be eligible to deliver the Matrix program. SEMPHN and the Matrix Institute will host two phases of comprehensive training to enhance workforce capacity: Sector-wide Capacity Building Provided to the sector to enhance understanding and build capacity for service delivery Provider Certification Specialist certification training for successful tenderers. This will include Matrix practitioner certification and Matrix key supervisor certification

51 Matrix EOI and Next Steps

52 EOI Process Timelines Closing Date for Questions: 12 February 2018 Closing Dates for Responses: 3:00pm 16 February 2018 Evaluation of Responses: Early March Outcome advised: Early March Notification of RFT Process Timelines: Early March

53 Provider Organisation Eligibility Criteria Established provider for a minimum duration of 2 years Deliver within catchment boundaries Commence services on: 1 August 2018 Financial statements Current accreditation 2 referees

54 Provider Organisation Eligibility Criteria PART C Conditions of Contract Reporting obligations Contractor Work and Evaluation Plan development Matrix Operational Guidelines Authority for SEMPHN to publish outcomes ehealth initiatives My Health Record

55 Response Process Downloading, reading and understanding all Request documents Completing and uploading the Response Form(PART D) Qualification of Responses Evaluation of Responses

56 Evaluation Criteria All questions must be answered Failure to answer = non compliant Indicative word limits have been provided Weightings have been provided where applicable

57 Evaluation Criteria Criterion 1 What has motivated your interest in delivering this service? Criterion 2 As a prescribed/manualised treatment model, the Matrix programme requires a high level of fidelity to implementation and delivery. Please describe your willingness to work with the PHN to achieve fidelity to the model. For guidance, please refer to Section 4 of Part B Specification document. Criterion 3 Please describe the infrastructure to which you have access (including milieu and fit-out) to accommodate and facilitate all aspects of service delivery for this program as outlined in section 5.2 of Part B Specification document.

58 Evaluation Criteria Criterion 4 Please explain (through specific examples) your understanding of the existing complementary services within the LGA and the process by which referral pathways into the Matrix program will be developed. Criterion 5 Please indicate how you will engage with the PHN to resource and build the capacity of the workforce required to deliver all aspects of this program. Criterion 6 Please identify the representative from your organisation who attended the Mandatory Information Session on 5 February 2018

59 Unscored Criteria Previous performance Eligibility mandatory

60 Next Steps Completing and uploading response template Qualification of responses Evaluation of responses All questions posted on Tenderlink in the Forum by 12 February.

61 Appendix A: FTE Requirements per location. Year 1 Number of clients 220 Program Manager 1 Therapist 2 Support Coordinator 1 Family Therapist 0.5 Admin support 0.5

62 Appendix B: Sample Therapist Schedule

Primary Health Networks

Primary Health Networks Drug and Alcohol Treatment Activity Work Plan 2016-17 to 2018-19 South Eastern Melbourne PHN When submitting this Activity Work Plan 2016-2018 to the Department of Health, the PHN