Service Specification: Bristol and South Gloucestershire Specialist Substance Misuse Treatment Service January 2016

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April Palmer
5 years ago
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1 This specification is an annex to the Service Specification for the provision of Child and Adolescent Mental Health Services. It must be read along with the overarching specification which applies to all services 1. Population Needs 1.1 National / local context and evidence base This service should operate within the context of the Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery. The aim of this Strategy is to support people to live a drug free life through a whole-life approach to preventing and reducing the demand for drugs that will: Break inter - generational paths to dependency by supporting vulnerable families. Provide good quality education and advice so that young people and their parents are provided with credible information to actively resist substance misuse. Intervene early with young people and young adults. The focus for all activity with young drug or alcohol misusers should be preventing the escalation of use and harm, including stopping young people from becoming drug or alcohol dependent adults. Drug and alcohol interventions need to respond incrementally to the risks in terms of drug use, vulnerability and, particularly age. 1.2 Local Needs The most recent Bristol needs assessment was done in 2009/10. A new needs assessment is due to be carried out in 2015 and will inform the Provider commissioning process. 2. Outcomes 2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely Domain 2 Domain 3 Domain 4 Domain 5 Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill-health or following injury Ensuring people have a positive experience of care Treating and caring for people in safe environment and protecting them from avoidable harm Page 1 of 7

2 Public Health England Health Behaviours in Young People- What About YOUth Indicators Domain 2 Smoking Drinking and Drugs 2.2 Local defined outcomes The following outputs and outcomes will be reported quarterly and data entered on Theseus (or equivalent agreed monitoring system) Activity Output/outcome Young people from Bristol are entitled to 90% of the delivery of this service and South Glos are entitled to 10%. This can be interpreted flexibly by the service and may not necessarily refer to the number of clients seen. It could, for example, also incorporate the complexity of need or length of time in the service. Number of young people who are new journeys who have had previous contact with treatment service in < 8% last 6 months Proportion of young people who are offered an appointment in less than 3 weeks to start first 100% intervention Proportion of young people who have care plan developed within 10 working days of beginning of 100% intervention Proportion of young people engaged and showing improvement in Young People Outcome Record at 80% first review Proportion of clients assessed as appropriate who receive information and advice about Hep B 100% vaccination Proportion of clients assessed as appropriate who 100% receive information and advice about Hep C testing Percentage of young people achieving a planned exit 80% drug free Percentage of young people achieving a planned exit who are occasional users should be recorded but N/A there is no target set for this Percentage of young people leaving service in a planned way who met the goals agreed on their care 80% plan at exit. The following outcomes are applicable to all services for very vulnerable children and young people Do not attend rate (DNA) for all appointments 5.5% or less Page 2 of 7

3 3. Scope 3.1 Aims and objectives of service Aim To enable young people with complex needs, including poor mental health, and substance misuse problems, to overcome their substance misuse problems and to promote healthy lives through the provision of a range of physically, psychologically and culturally accessible services in a way that is acceptable to potential clients and consistent with the national Drug Strategy. Objectives Deliver a Child and Adolescent Mental Health Service (CAMHS) based, consultant led, specialist substance misuse treatment service for young people up to their eighteenth birthday as part of a comprehensive treatment / care plan. Provide a multidisciplinary service offering interventions appropriate to the young person s personal and individual needs. Work with young people using approaches which promote resilience. Provide a full range of evidence based interventions including Pharmacological, Psychosocial, Harm reduction and Multi agency working, and to record the interventions for each young person on the National Drug Treatment Monitoring Service (NDTMS) database. Ensure equity of access for all groups in the community including those who otherwise would be hard to engage. Increase year on year proportion of young people who successfully complete substance misuse treatment programmes. Offer a service that meets the cultural needs of the clients and their carers/families, taking account of gender, sexuality, disability and any religious beliefs. Monitor performance and report to the service commissioner, and to the National Drug Treatment Monitoring Service in accordance with agreed measures. Foster and promote a culture good practice that demonstrably contributes to the treatment evidence base. Support the development of good physical health by encouraging referral to support for improving diet and exercise. Assess and refer to appropriate services for other needs which impact on good physical and mental health for example Page 3 of 7

4 communication skills. The Service will develop, share and implement good practice through participation in regional and national networks as appropriate. 3.2 Service description / care pathway This service delivers evidence based treatment interventions to young people with complex needs and problematic drug and alcohol use. Any professional working with young people can refer into this service including other substance misuse services, primary and mental health services, education, youth justice services and housing support services. The service should be flexible and able to work with young people in a way which reflects changing patterns on substance use and polydrug use. The service will have a transition pathway in place to ensure that where young people aged 17 are still in need of a service they are referred to the transition lead within adult drug treatment services and a joint plan is developed. The Criteria for referral into this service are: Any young person who is involved in the following high risk drug or alcohol using behaviour: Early onset of substance misuse. Injecting any substance. Using opiates. Using crack cocaine. High risk alcohol use. Polydrug use. Weekly of more frequent use of any substance. Physical dependence. Who also has complex needs, which might interact negatively with any drug and alcohol, use including the following: a) Mental health needs e.g. Depression, psychosis, anxiety disorder, suicidal thoughts or other mental health problem, including a history of any of these Page 4 of 7

5 o Self-harming behaviour o Eating disorder o Isolation o ADHD b) Other vulnerabilities e.g. o Pregnant* o Child in need* o Looked After Child* o Not in Education Employment or Training *Bristol Children in Need and Looked After Children would normally be referred to the Drugs and Young People Project in the first instance (see 3.5 below). Care of pregnant drug users should be managed jointly with the substance misuse midwife and / or teenage pregnancy midwife. c) Other high risk behaviour: o Involved in criminal activity* o Involved in excessive violence and aggression o At risk of sexual exploitation *Bristol young people who are engaged with the Youth Offending Team (YOT), should be referred into the YOT drug treatment service d) High risks home environment e.g. o Homeless or at risk of homelessness o Their home environment is chaotic o Affected by others substance misuse 3.3 Population covered This service is provided for young people who are normally resident in the Bristol local authority area. A service will also be provided for young people normally resident in the South Gloucestershire area up to an agreed activity threshold (to be agreed annually, currently six places per year). A place is defined as a young person achieving a planned exit from the service. Subject to there being sufficient capacity in the service, interventions may also be provided to additional young people from South Gloucestershire and North Somerset charged to the relevant commissioner on a cost per case basis. Page 5 of 7

6 3.4 Any acceptance and exclusion criteria and thresholds This service is for young people with severe and complex substance misuse problems. Young people who do not meet this threshold should be referred to Bristol Youth Links Early Intervention Project (or equivalent). 3.5 Interdependence with other services / providers In addition to the interdependences section in the overarching specification: The service will have a care pathway in place for accepting referrals from A&E within an agreed timeframe. The service will have a care pathway in place to accept referrals from and make referrals into Early Help and First Response Service in both Bristol and South Gloucestershire. The service will ensure that there are close working relationships with other substance misuse services for young people. Where a young person meets the criteria for accessing more than one service they will negotiate which service will best meet the needs of the young person. These services currently include: o Early intervention service (currently delivered by Bristol Drugs Project through Bristol Youth Links commission) o Bristol Youth Offending Team Substance Misuse team - for young people engaged with the YOT o Drugs and Young People Project for young people who have a social worker, o Substance Misuse Midwives (North Bristol Trust and UHB) for young women who are pregnant o Transitions service into adult substance misuse treatment (AWP) The service will ensure close working relationships with other services for vulnerable young people (for example Bristol Against Sexual Exploitation (BASE) young homeless project, Family Nurse Partnership). Where children have other health needs including long term conditions, the service should ensure that joint planning is in place with the young person s GP or Secondary Care Consultant. 4. Applicable Service Standards 4.1 Applicable national standards (e.g. NICE) This service will operate in line with the appropriate NICE Guidance. Page 6 of 7

7 The current guidelines apply: PH4 Interventions to Reduce Substance Misuse Among Vulnerable Young People (2007). PH24 Alcohol Use Disorders: Preventing Harmful Drinking (2010). PH52 Needle and Syringe Programmes (2014). CG 51 Drug Misuse Psychosocial Interventions (2007). CG 52 Drug Misuse Opioid Detoxification (2007). CG120 Psychosis with coexisting substance misuse (2011). Specialist substance misuse treatment for young people in England (PHE, 2015). Drugs and Alcohol (Young people) (NTA) Applicable standards set out in Guidance and / or issued by a competent body (e.g. Royal Colleges) Practice standards for young people with substance misuse problems, Royal College of Psychiatrists Centre for Quality Improvement (2012) 4.3 Applicable local standards Safeguarding standards as set out in the overarching specification 5. Applicable quality requirements and CQUIN goals 5.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D]) The service will have and maintain Young People Friendly accreditation 5.2 Applicable CQUIN goals (See Schedule 4 Part [E]) Page 7 of 7

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