Integrating ITEP BETI across services

Transcription

1 Integrating ITEP BETI across services Luke Mitcheson, Clinical Team, National Treatment Agency Optimising i i Treatment t Effectiveness, KCA, London 30th November 2009

2 Structure What is ITEP / BTEI? Why might we want to adopt and implement these approaches? Implementation challenges The role(s) of key-working What do we know about adopting new practices? Where are we now with ITEP and next steps

3 Origins Ideas developed by Dwayne Simpson at TCU Brought to UK by the NTA as central to the treatment effectiveness strategy and branded as ITEP Piloted in 3 regions and evaluated in NW and West Midlands In West Midlands branded as BTEI (Birmingham Treatment Effectiveness Initiative) ITEP and BTEI manuals on NTA website

4 3 Key components 1. Mapping and manuals Visual maps to enable focused topic specific conversations with clients. 2.Organisational assessments The Organisational Readiness to Change questionnaire (ORC). Enables services to evaluate themselves on a number of parameters related to organisational health and functioning. 3. Service User Feedback Measures The Client Evaluation of Self in Treatment (CEST) evaluative tool. Provides feedback on clients experience of treatment and provides a basis for targeted intervention as well as feedback on service changes.

5 IBR IBR HOME PAGE MANUALS FORMS EVIDENCE ABOUT IBR-TCU STAFF PUBLICATIONS PRESENTATIONS PROJECTS NEWSLETTERS OTHER LINKS WHAT S NEW SITE GUIDES: Evidence-Based Treatment Model Readiness Training Patient Patient Severity Readiness Program Staff Resources Climate Program Interventions Behavioral Strategies Early Engagement Program Participation Therapeutic Relationship Cognitive Strategies Family & Friends Early Recovery Behavioral Change Psycho-Social Change Social Skills Training Simpson, 2001 (Addiction) Personal Health Services Sufficient Retention Supportive Networks Drug Use Crime Social Relations Posttreatment Social Support Services DATOS Selected Presentations A National Research Center for addiction treatment studies in community and correctional settings (over 600 free resource files available) Overviews of TCU Treatment System & Conceptual Models Guide for Selecting from 20 Intervention Manuals Guide for Selecting from 80 Assessment Forms Project Updates & Summaries New Publications (Abstracts), Presentations, ti Newsletters EVIDENCE SUMMARY Treatment Process Counseling Manuals TCU Mapping- Enhanced Counseling Corrections- Based Treatment National Evaluations Organizational Readiness Assessment Fact Sheets (with norms) Visitors 600/day 30 mins

6 2009

7 Adaptive Treatment Assessments of Client Needs/Progress Treatment Readiness: Needs-Risk Severity Motivation s s) ferrals eds/risks Ref (Nee Client Recovery Stages in Treatment Early Engagement Retention & Participation Continuing Change Therapeutic Relationship Early Recovery Changes in -- Thinking Acting Other Treatments or Support Networks Follow-up Outcomes Drug use Crime Social Functions Interventions (Behavioral & Cognitive) Simpson, 1995, 2001, 2004,

8 TCU Mapping Interventions for Adaptive Treatment Process Stages of Treatment Treatment Readiness: Needs-Risks Severity Motivation Early Engagement Participation Therapeutic Relationship Early Recovery Changes in Thinking Acting Retention & Change Orientation Treatment A Treatment B Re-Entry BTEI ITEP Getting Motivated Preparing for Change Reducing Anger Unlocking Thinking Better Comm Building Networks HIV Risk Reduction Using Client Assessments Mapping Care Plans Mapping Journey CM/Reward Strategies Workshop for Women Workshop for Men Parenting Skills Downward Mapping Spiral 12 Steps TCU Mapping-Enhanced Counseling Transition to Re-entryentry 2009

9 What is mapping? Presents visual and spatial relationships between ideas and tasks Uses simple cognitive principles i and problem solving techniques Not a new theoretical technique but a way of recording and communicating ones that already exist e.g. motivational interviewing and relapse prevention principles Not prescriptive, offers substantial key worker and client freedom A way to structure and review sessions

10 Mapping: A Visual Representation Strategy 2007

11 Health and Physical Social Relationships Problem Solving Emotions/Temperament What are your strengths? Values and Beliefs Work or Avocation How will these strengths help you succeed in your treatment journey?

12 Provide a workspace for exploring problems Improve Therapeutic Alliance Focus attention on the topic at hand Train clearer and more systematic thinking BENEFITS OF MAPS Provide easy reference to earlier discussions Create memory Provide a method Useful structure aids for client and for getting for clinical worker unstuck supervision

13 UK programme evaluation Positive outcomes in terms of acceptability and usage Services where more mapping was implemented had clients who reported significantly higher levels of rapport with key-workers, better levels of participation in treatment, and better peer support. 3 months post-training - Mapping maintained, Changing your thinking patterns falling away Campbell A, Finch E, Brotchie J, and Davis P (2007) The international p,,, ( ) treatment effectiveness project: Implementing psychosocial interventions for adult drug misusers. NTA.

14 Lessons from ITEP / BTEI implementation a virtuous circle? Clients better engaged, more satisfied with treatment Management more effective, clearer mission Workers less stressed, more motivated

15 Why? The broader context Drug strategy: t Recovery, social inclusion i and reintegration ti Be more ambitious for service users Centrality of psychosocial interventions Workforce development

16 Why? The role of psychosocial interventions Pharmacological treatments for cannabis and stimulant misuse are not well developed, and therefore psychosocial interventions are the mainstay of effective treatment. t t (NICE 2007) Treatment for drug misuse should always involve a psychosocial component. (DoH 2007) Psychological treatment has a role as important as substitute prescribing in treating opiate-dependent p clients. (NTA 2005) Both pharmacological interventions and psychosocial treatment are more effective when they work together in an integrated and harmonised manner. (DoH 2006)

17 Why? Lessons from the Treatment Effectiveness Programme Mapping is a useful service user engagement tool Can become a mainstream treatment approach and be adopted as a core skill set Focuses on key-working and on psychosocial component of treatment Potential to support a recovery orientation to treatment delivery and personalisation self directed support Platform for other evidence-based approaches (NICE) CEST can help with client engagement and help measure progress ORC can provide an analysis of the strengths and needs of treatment services

18 General challenges to implement psychosocial interventions Key-work Rapid expansion of workforce Very variable: also more often not Orange; 80% chat Variable clinical supervision Formal psychosocial programmes Many types uncommon in addiction Training rarely delivered to achieve competence Lack of leaders, protocols and `how to guides Geographical variations in access to formal psychological treatment Not enough intervention specific supervisors Need drug services to have `learning and problem solving cultures` to be able to implement new techniques Commissioning Careful systems do not have standard treatment for all Understanding of psychosocial approaches

19 Tasks of key-working Engagement Strategies Assessment skills Therapeutic Relationship Attitudes Structure Intervention skills Care-planning and reviews, TOP

20 Implementing change Implementation is the least researched component of translating evidence-based approaches into practice (Gotham, 2004) Some ingredients for successful process improvement: Understand and involve the customer (e.g. client, families, community) Fix the key problems (e.g. TOP completion?) Pick a powerful change leader Get ideas from outside the organisation Use rapid-cycle testing to establish effective changes (implement one small change and see how it works)

21 Implementing change 5-steps: Pre-planning Planning Implementation Evaluation Sustainability Implementing change in substance abuse treatment programmes (TAP31) 2009

22 3 groups of products 1. Psychosocial interventions in drug misuse: a framework and toolkit for implementing NICE-recommended interventions: 2. Psychosocial Interventions Resource Library (PIRL): 3. ITEP and BTEI ITEP introduction: ITEP manual: nhs routes to recovery part2 pdf BTEI introduction:

23 Psychosocial interventions in drug misuse: a framework and toolkit for implementing NICE-recommended treatment interventions Structure and interventions High Intensity Formal therapies delivered by a specialist psychological therapist Behavioural Couples Therapy CBT for specific co-existing psychological problems (anxiety / depression) Low Intensity Delivered by key-workers, may have an aspect of self-help Motivational interviewing and contingency management Guided self-help and behavioural activation for anxiety and low y mood

24 Elements of toolkit Competencies of staff to undertake specific interventions; generic, basic, specific techniques and meta-competencies Training curricula Supervision competencies Example protocols Adherence measures Audit tools for implementation

25 PIRL Resource Locator Drug misused: Alcohol Cannabis Stimulants Client group: Adolescents Adults Families Parents Intervention: 12 step facilitation CBT Community reinforcement Contingency management Family interventions ITEP/BTEI Motivational interviewing Relapse prevention

26 Skills Consortium PURPOSE To support the drug treatment sector to identify the knowledge attitudes and skills required to promote and sustain beneficial treatment outcomes for service users and their communities Support employers to equip their practitioners i and managers with the requisite i skills Core group taking forward the development of a constitution and work-plan priorities Skills framework Define effective and evidence based practice, support organisational development initiatives and early adopters for psychosocial interventions Skills development Define a framework and mechanisms to connect training to this framework Intelligence / influence Advice to sector, policy development and responding to new initiatives

27 Issues to address in implementing ITEP / BTEI Is it a clinical tool, the clinical tool or a quality improvement system? Branding (more than ITEP / BTEI) Different versions of maps and manuals in circulation Data management resources Potential for research not yet realised More work on translating into clinical practice

28 Next steps Further pilots (IDTS) Branding. Recovery, engagement and life-skills. Product differentiation Skills consortium to define and endorse a programme that ensures leadership, of work and sharing of knowledge across the treatment sector Mapping Integrate with assessment, care-planning and the TOP. Further training and investigation of training impact Develop a recovery manual Client feedback and organisational assessment tools Find cost effective ways to collate and report data Make it more useful for clinical practice NTA website developments Library of materials Share implementation information

29 Conclusions: Bridging g the gap between guidelines and practice Clinical Guidelines Facilitative organisation Clinical leadership Workforce competencies Manuals, protocols, care-pathways, training, supervision, quality assurance systems IMPLEMENTATION OF EVIDENCE-BASED PRACTICE

30 Conclusions: Principles of implementing organisational change No single model for or approach to implementing organisational change Needs to be individualised to accommodate specific needs, goals, culture and readiness to change Change is not a linear process Change is ongoing The ultimate goal is to create changes that can be sustained over time

31 All resources can be accessed at: nhs Thank you for your attention