key worker guidelines (ads)€¦ · web viewchhs16/079 doc number version issued review date area...

CHHS16/079

Canberra Hospital and Health ServicesClinical GuidelineAlcohol and Drug Services - Key Worker Support Program Guideline for StaffContents

Contents....................................................................................................................................1

Introduction..............................................................................................................................2

Scope........................................................................................................................................ 2

Background............................................................................................................................... 2

Key Objectives...........................................................................................................................4

Section 1 – Assessments...........................................................................................................4

Section 2 – Person Centred Care Planning................................................................................5

Section 3 – Key Worker Roles...................................................................................................6

Section 4 – Contact with People...............................................................................................6

Section 5 – Identifying People, Referrals and Engagement.......................................................7

Section 6 – Recording Contact Information..............................................................................7

Section 7 – Difficulty Contacting Person/DNA...........................................................................8

Section 8 – Numbers/types of persons per Key Worker...........................................................9

Section 9 – Indications for support...........................................................................................9

Section 10 – Crisis Identification and Suicide Intervention.....................................................10

Section 11 – Intensive & Ongoing Psychosocial Support.........................................................11

Section 12 – Child Protection Reports.....................................................................................11

Section 13 – Transition Planning.............................................................................................11

Section 14 – Staff Meetings.....................................................................................................12

Section 15 - Clinical Supervision..............................................................................................12

Section 16 – Staff Leave and Clinical Handover.......................................................................12

Section 17 – Structure and Management of Program Performance.......................................13

Implementation...................................................................................................................... 13

Related Policies, Procedures, Guidelines and Legislation.......................................................13

References.............................................................................................................................. 13

Definition of Terms................................................................................................................. 14

Attachments............................................................................................................................15

Doc Number Version Issued Review Date Area Responsible PageCHHS16/079 1 22/06/2016 01/06/2019 MHJHADS 1 of 17

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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Introduction

The purpose of this guideline is to outline the standard practice of the Key Worker (KW) Support Program. The KW Support Program provides Tier 1 OTS (Opioid Treatment Service) people with individual support through the allocation of a KW. KWs support people’s ongoing pharmacological treatment of opioid dependence at the Opioid Treatment Service.

Scope

This guideline applies to all OTS staff who undertake direct person contact as a KW. KWs include nursing staff, counsellors, and case managers. This guideline supports the implementation of the KW support program and is supported by Alcohol and Drug Services (ADS) policies, business plan and procedures. This document outlines the processes and roles.

Background

In December 2008 the ADS OTS implemented a quality improvement project, The Case Management Project, later renamed the Key Worker (KW) Support Program. The KW Support Program provides Tier 1 OTS persons with structured monthly individual support through the allocation of a KW.

ADS OTS is a public outpatient clinic located in the division of Mental Health, Justice Health & Alcohol and Drug Service. The clinic currently provides access to opioid maintenance pharmacotherapies, psychological support and specialist addiction medicine support to dependant people. Services are delivered through a range of health staff including Nursing Staff, Medical Officers, Psychiatrists, Social Workers, Psychologists and related disciplines.

The OTS KW Program is underpinned by the National Drug Strategy and was developed from the ACT Alcohol, Tobacco and Other Drug Strategy 2011-2014. The Strategy aims to: reduce the supply and use of illicit drugs in the community reduce the risks to the community of criminal drug offences and other drug related

crime, violence and antisocial behaviour reduce risk behaviours associated with drug use reduce drug-related harm for individuals, families and communities reduce the personal and social disruption, loss of life and poor quality of life, loss of

productivity and other economic costs associated with harmful drug use increase access to a greater range of high-quality prevention and treatment services increase community understanding of drug-related harm promote evidence-informed practice through research, monitoring drug-use trends,

and developing workforce organisation and systems strengthen existing partnerships and build new partnerships to reduce drug related

harmDoc Number Version Issued Review Date Area Responsible PageCHHS16/079 1 22/06/2016 01/06/2019 MHJHADS 2 of 17


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develop and strengthen links with other related strategies.

People accessing Tier 1 ADS opioid maintenance are required to access prescribed opioid maintenance pharmacotherapy daily at the clinic until stabilised. They often present with complex needs and psychosocial issues. Some of these include: homelessness financial issues and/or poverty high rates of co morbid substance use and mental health issues breakdown in social supports polydrug use fatal and non-fatal opioid overdose transmission or presentation of blood borne viruses legal and criminal issues high risk behaviours associated with problematic substance use.

The Opioid Treatment Service- Key Worker Program In 2009 the clinic started the KW Program as a standard service for new and returning people to the clinic. KWs are nurses, counsellors or case managers from the clinic who can help the person with things that the person decides are important to their health and wellbeing.

A KW is the point of contact for any enquiries about a person’s treatment, as well as assisting a person with issues which may impact the person’s ability to participate in the program. At a minimum, a KW will contact a person by phone on a monthly basis to discuss the progress of the person’s treatment and to offer assistance. The person can contact their KW at the clinic if it is convenient for the person. KWs offer support and encouragement to the person to assist them to get the most out of their treatment.

The principal supports provided by KWs are: General Support & Providing Information regarding Alcohol and Drug Program Services

and how to get the most out of treatment including getting the right dose, what works, treatment planning, relapse prevention strategies

Advocacy or support in areas such as housing assistance, Centrelink and employment, and other issues that may affect a person’s well-being or with issues that may impact upon a person’s ability to participate with the OTS Program

Referral to internal Alcohol and Drug Program Services Crisis Counselling, Sexual Health Clinics, Women’s Health Clinics, Pregnancy & Parenting Support, Alcohol and Drug Counselling, Psychiatry and referral to external services in the community and private sector. Referrals may take the form of phone calls, emails, education and information provision.

Back to Table of Contents

Key Objectives

The KW model of support adopts a proactive approach by implementing the following:



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seeking to develop the person’s capacity for self-management adopting a strengths-based approach that seeks to help people identify and use their

strengths, assets, and abilities using a team approach to maximising positive health and social outcomes


Section 1 – Assessments

KW Assessments are holistic outlines of the person’s current needs and situation. In conjunction with the person, the multi-disciplinary assessment team (Key Worker, Case Manager, Counsellor, Registered Nurse and Medical Officer) will document the needs the person wishes to address as the basis for developing a person directed care plan. After assessment people are allocated an Alcohol & Drug Services (ADS) KW as the ongoing point of contact within the service.

The initial KW assessment appointment is a requirement to proceed to an appointment with ADS medical staff. This initial appointment should occur as close as possible to the initial period of contact with the service to facilitate entry into the program, and actively focus on interventions to reduce the harms associated with substance use.

A standard assessment appointment is conducted in person for 60 minutes prior to the initial induction with an ADS medical officer. If these appointments are not conducted prior to the day of commencement, that is if the person Does Not Attend (DNA) or Failure To Attend (FTA), an additional time for assessment can be arranged prior to the day of the medical appointment. If the KW’s initial assessment appointment is unsuitable or creates a block in access to treatment, alternative arrangements are to be made within seven days of commencing or recommencing on OTS.

Assessments can be conducted by an ADS Counsellor/case worker or a trained member of Alcohol and Drug Services. The ADS KW Program Psychosocial Assessment form will be used or an assessment conducted as part of inpatient admissions can be utilised as the KW assessment. When the person presents, the following information needs to be taken into account:

Case presentation format1. Identification

Name, gender, age/life stage Family geno gram if appropriate Impressions from mental status examination and ongoing engagement

2. Background information the person’s understanding of the problem and expectations for treatment Initial assessment information: substance use, physical and mental health, family and

social functioning, education and employment, legal issues KW engagement: frequency, length and number of sessions



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3. Formulation Assessment of what cannot be changed for example, genetic, congenital and medical

conditions with direct psychological effects, irreversible consequences of head trauma, illness and toxicity, unchangeable physical realities, unchangeable life circumstances (for example, loss, past trauma)

Psychological and social developmental issues, coping strategies, emotional style: range of affect, emotion and mood, ability to tolerate and regulate affect, relational patterns, self-esteem, pathogenic beliefs, possible diagnoses

Treatment Attendance and dosing history, engagement with staff, pharmacotherapy, keeping/missing appointments

4. Treatment plan

Persons plan for treatment Theoretical and clinical approach Criteria for change

5. Treatment to date Strategies and interventions: aims, effectiveness Key worker relationship: impact on interventions Evaluation to date


Section 2 – Person Centred Care Planning

Care plans are a person directed process where personal goals and agreed strategies are documented on the alcohol and drug service management plan. These plans reflect the priorities and planned action agreed upon between the person and ADS services involved in the person’s treatment and support. Care planning begins at the commencement of a treatment episode and continues monthly until the person has transferred to Tier 2 or FTA.

The KW assists the person in the planning, implementing, monitoring and review of this care plan. Care plans are dynamic, flexible documents, responsive to changing needs and circumstances. The care plan is found on the reverse side of the management plan. These people are to receive a copy of the care plan with a copy to be placed on their file. The management plans are to be review every three months to ensure care provided is appropriated and person centred.


Section 3 – Key Worker Roles

KWs are ADS staff members including Nurses, Social Workers/counsellors who provide direct support to people in the KW Program. The quality of the relationship established between the person and the KW is an essential focus for KWs. The therapeutic relationship will be



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underpinned by empirically supported treatment processes and continuing professional education. This relationship is the vehicle for developing the person’s self efficacy, empowering the person to feeling competent and hopeful about improving their circumstances and building a person’s’ knowledge about treatment and healthcare utilisation.


Section 4 – Contact with People

KWs are required to make contact with each of their people on a minimum of one occasion per month. Refer to Appendix A for how to proceed from first contact. This contact can occur in the form most appropriate for the person including by telephone, letter or with a face-to-face meeting at Building 7 OTS. KWs are allocated blocks of time to carry out the KW role each month. This time is allocated on the staff rosters and may be subject to change due to staffing levels and availability. People can contact their KW outside of this time and as required to support positive treatment outcomes.

During contact, the KW and the person work collaboratively to assess presenting needs and goals. The three main strategies for KWs to meet the need of persons include: General support and provision of information regarding ADS, health information, harm

minimisation information, and treatment information Advocacy or support in areas such as housing assistance, Centrelink and employment

issues and other issues that may affect the well-being of the OTS person and impact on their ability to participate within the OTS Program

Referral to internal ADS Services, crisis counselling, counselling and psychotherapy services, Sexual health nurses, NRT Clinic, women’s health clinics, Midwife, Blood Bourne Virus screening, Liver clinic referrals, ADS psychiatry registrar reviews; and Referral to external services in the community and private sector- referrals may take the form of phone calls, emails and information provision.

Each contact with a person is based upon: developing an ongoing therapeutic relationship with the person/s gathering information pertinent to treatment and clinical decision making working collaboratively towards building upon a person’s strengths, abilities and

capacity for self management create opportunities to further build on psychosocial stability and positive treatment

outcomes.

Each month when a KW initiates contact with allocated people, the KW is expected to make a brief annotation in person’s files regarding observed participation in treatment and issues identified by the person. This includes updating the management plan if a person’s goals change. If a KW experiences difficulty in contacting the person directly the KW must make an annotation regarding attempts to contact the person, presentation at clinic, dosing history from dosing system as per the following documentation guidelines.



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Section 5 – Identifying People, Referrals and Engagement

Each KW has a profile on ACTPAS each new/returning person will have an active referral made to their KW. A new referral notification will appear upon entering the ACTPAS system to alert the clinician of the new referral. Upon receipt of this referral the KW must contact the person within one week to introduce themselves as the person’s KW.

If a KW identifies issues that require specialist attention and if a person would benefit from additional team support, a KW can refer the person to the most appropriate resource.

KWs are responsible for the management of referrals for allocated people including: Once a person has started on the program the KW is responsible for changing the initial

medical referral from a ADS Gold referral (ADS Medical Review) to a ADS Red referral (this reflects commencement on Tier 1 program)

When a person is transferred to Tier 2 the ADS Red referral is to be changed to an ADS Green, (reflecting commencement at community pharmacy).


Section 6 – Recording Contact Information

Information recorded in file notes inform the ADS multidisciplinary treating team as to recent contacts and assist the multidisciplinary team’s clinical decision making. Documentation can be brief or as extensive as required. Monthly KW documentation in a person’s file should reflect the following: Pharmacotherapy: current pharmacotherapy/ dose, any fluctuation in dose, people’s

perception of treatment effectiveness (dosage, frequency physiological symptoms). Presentation at clinic: frequency of attendance over the last month, physical

presentation, attendance while intoxicated, refused doses due to intoxication, erratic behaviour, or other indicators of treatment instability as outlined in guideline, reason and strategies people have initiated for missed days (for example, using AOD, relapse prevention).

Psychosocial & Alcohol Tobacco and Other Drug (ATOD) issues: brief summary of psychosocial circumstances of the person, any issues that impact treatment or psychosocial stability including current substance use

Outcomes: direct actions from contact with the person or organisational actions/ intended actions.

KWs continue to contact the person for three months of ongoing support once transferred out of OTS Tier 1. During this period some of this information will not be directly observable. KWs can utilise the person self reports or reports from the pharmacy for the purpose of reporting during this transition period.



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KWs will be required to readminister Severity of Dependence Scale (SDS) including a current drug history every six months and prior to person’s transition to Tier 2 (See appendix B). The SDS has five questions that when completed will provide a score indicating the severity of dependence on opioids. Each of the five questions is scored on a 4-point scale (0-3). The total score is obtained through the addition of the 5-item ratings. The higher the score the higher the level of dependence In addition, clinicians are expected to administer the suicide assessment part A every three months as part of their ongoing contact with the person.

Example:

Date Note16/08/201017:00 HRS

KW Program - Contact with Joe Bloggs: Currently on 85mg methadone, quickly reduced 120mg to 35mg since last

month. Joe states he wants to jump off program to get kids back Presentation: dosing 28/30 days on days when not dosing has used

heroin 1/4gr that day. Presents in significant withdrawal after reducing down or missing days

Attended clinic on 15/8/10 with BAL 0.04, half dosed due to Etoh use Psychosocial stressors: family court hearing in one month Carried out motivational interview and education about additional Opioids

effect on treatment. Person seemed open to information. Referred person to ADSMO for review

(Name)Bill Smith (Position) OTS RN (signature) …………..

In addition to notations made in the paper file, clinicians contacts are expected to be logged into ACTPAS corresponding to the time and date indicated in the paper file.


Section 7 – Difficulty Contacting Person/DNA

KWs who experience difficulties in contacting the person directly are to make an annotation regarding the attempts to contact the person, presentation at clinic and a summary of dosing history from the computerised pharmacotherapy dosing system as per following above guidelines.

A request can be made to move a person to an alternative clinical if the person is difficult to engage. Clinicians are expected to gain support (from managers, supervisors or allied health disciplines) to develop engagement opportunities and skills prior to this occurring. Requests for transfer of KW are made at the weekly meetings. If people are unable to be engaged, at a minimum, a dosing nurse should be allocated to the person to observe and regularly develop rapport with the person.




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Section 8 – Numbers/types of persons per Key Worker

Nursing staff will be allocated a number of people based upon their routine work hours at the clinic. A full time clinician should have approximately 20 people to contact over the period of a month. A pro rata reduced rate will apply to the staff members actual work hours .5fte/month = 10 people. Dosing clinic staff will act as the main bulk of KWs. It is expected that complex needs are addressed by the senior allied health officers, Aboriginal liaison officers and case managers.


Section 9 – Indications for support

Included within the proactive role of KWs is an active screening for indicators for support, which if left, may lead to sentinel events. Proactive engagement by KWs must focus on support with the aim of building on the person’s strengths, resources, abilities and capacity for self management (resilience). KWs proactively contact the person if there is an indication of concern about the person’s progress. This follow up is aimed at supporting the person through challenging periods to remain in the program and is not in any way meant to be punitive.

Indicators for proactive support by KWs include: a general decline in the person’s participation on the program such as missed doses or

erratic periods of dosing, ceasing dosing altogether, erratic behavioural changes indicative of stress

Urine Screening Results indicating continued poly drug use or persons states additional drug use

ADS medical officer, nurse or counsellor feedback Pharmacists or community pharmacy staff concerns about person’s progress at the

pharmacy resulting in transfer back to daily dosing at the clinic information provided by other ADS services such as Diversion, Consultation Liaison, The

Counselling and Psychotherapy Centre Advice from General Practitioners Concerns raised by close family members or friends of the person Person’s risk to self and others (self harm, suicide and mandatory reporting).


Section 10 – Crisis Identification and Suicide Intervention

If a person is identified as experiencing a crisis or with increasing complex risk factors, the person is referred to the OTS multi disciplinary team KW or counsellor for follow up with additional psychosocial interventions. Once any crisis and complex issues have been addressed, and recorded, the KW support team should be notified of outcomes at the next staff meeting.



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People with possible suicidal behaviour must be managed in an integrated and coordinated way. The overarching policy of the division is: Mental Health, Justice Health, Alcohol and Drug Services (MHJHADS) Standard Operating Procedure Suicidal Behaviour: Risk Assessment, treatment and care of Consumers.

A thorough, well-documented psychosocial assessment should be conducted that includes a suicide risk and psychiatric assessment of the person. The assessment should identify mental health problems or illnesses, suicide risk, social crises, and the presence of co-existing problems.

A thorough, ongoing assessment of the person’s mental state must be conducted. This includes completion of Suicide A Risk Assessment. Where suicide risk is high, the clinical situation for the person is treated as an adverse incident and the Suicide B Risk Assessment must be completed. In the case of aperson presenting with deteriorating mental health, including active psychosis, suicidal ideation, disclosing plans to attempt suicide, active self harming the Mental Health Crisis Assessment and Triage Team (CATT Team) should be notified on (02) 6205 1065. Alternatively the Police can be contacted on 000 for situations where harm to others is identified or an urgent Response is needed to ensure the safety of the staff, person or members of the community.

If a reasonable clinical decision could be made about the safety of the person due to the person leaving the premises, the same steps can be utilised in combination with team consultation.

Procedures: Support: support person once disclosure made, counsel person if possible or refer to

counsellor Consultation & Intervention Planning: inform and consult with OTS team regarding the

person’s disclosure (OTS counsellor, CNC or medical officer, nursing team), and develop strategies to contain or manage the situation

Intervention: notify appropriate statutory organisations such as the CATT team or police, ambulance

Documentation: document a person’s disclosure in a person’s file when appropriate, Riskman if required at appropriate time

Follow up: once the crisis situation is managed and then reported back to the OTS Team, steps must be identified and taken to further enhance treatment and psychosocial stability.


Section 11 – Intensive & Ongoing Psychosocial Support

The OTS social workers, counsellors and case managers are able to provide an intensive follow up service for complex clinical cases. This includes peopel with complex psychosocial issues, co morbid mental health, alcohol and other drug issues. Intensive support is in the form of a three month solutions focussed approach or alternatively as a longer therapeutic



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modality. KWs can refer people into the service as an addition to services delivered by individual KWs.


Section 12 – Child Protection Reports

If a report needs to be made to Child Protection the report should be made in line with the ACT Health Child Protection Policy 2007 and the ADS Child Protection operating procedure. This policy is available on the Health directorate Intranet policy register ACT Health Child Protection Standard Operating Procedure (SOP).

When a report has been made staff are required to inform the Impact Coordinator and the OTS Team of the report being lodged. A referral to a counselling team member can be offered to the person to assist with any psychosocial issues.


Section 13 – Transition Planning

The purpose of transition planning is to implement a consistent quality of care post discharge from OTS Tier 1 Services to the community. Planning interviews are to be carried out with the person, KW, medical officer or counsellor. This interview will focus on connecting the person with local resources that will support needs identified within the care plans.

Transition planning is required when: ADS clinic person wish to transfer to Pharmacy dosing The person’s wish to reduce off opioid maintenance pharmacotherapies A person’s life is in transition and they are readjusting and attempting to engage in a less

marginalised life style, for example, if a person is re-entering the labour market or re-establishing relationships.

KWs continue to contact the person for three months of ongoing support once transferred out of OTS Tier 1. This is to ensure that the person is supported through the transition to pharmacy dosing. The Person transitioning out to pharmacy will also be given a referral to the Tier 2 social worker/counsellor. The Tier 2 counsellor is based at building 7 The Canberra Hospital, and provides counselling, assessment and referral to ADS and non government sector services. This service is a short term solution focussed approach to ATOD or psychosocial issues. The person can access this worker via telephone, outreach or by making an appointment to meet with the worker in person.


Section 14 – Staff Meetings



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KW staff meetings occur for forty five minutes once a week. The venue will be Building 7, Conference Room, or within the Wruwallin clinic. At the KW meeting staff have the opportunity to offer feedback and participate within the planning and development of the program. The format of the meetings will follow a set agenda but will be flexible enough to capture current issues and concerns.

A key component of this meeting will be Key Worker Case reviews.


Section 15 - Clinical Supervision

Clinical supervision is an important process of ongoing professional development, self care and development of the KW team. KWs also have the opportunity for one-on-one clinical supervision with an ADS CNC or ADS Counsellor, ADS Clinical supervisor or by peers in a group format. KWs are expected to meet their disciplines minimum requirements for professional supervision by the ACT Health Directorate and the ADS. For Critical Incidents immediate debriefing can be done in the form of team or individual debriefing with a trained critical incident counsellor. ADS have a trained counsellor/s based in Moore Street, Canberra City, to use for debriefing and management in the case of critical incidents occurring. If out of hours staff can access the current EAP provider.


Section 16 – Staff Leave and Clinical Handover

To ensure a continuity of care when a staff member takes leave, the person will be notified that for the duration of the leave another staff member will act as the KW. KWs facilitate this discussion and planning prior to commencement of their leave. It is expected that KWs will inform their person about alternative arrangements for the duration of leave. During extended leave the person is to be transferred to other KWs and this is to be discussed with the manager and at the weekly meeting prior to transfer. This will include a formal clinical handover process.


Section 17 – Structure and Management of Program Performance

The KW program operates within the current staffing structure arrangements. Each KW is directly accountable to their pre-existing line manager. For nurses acting as KWs the Manager of Clinical Services is the direct line manager. Members of staff from an allied health discipline of Counselling, Social Workers or Psychologists are managed by the current team leader and Manager of Clinical Services.


Implementation



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This guideline will be implemented through annual review.


Related Policies, Procedures, Guidelines and Legislation

ACT Health Consent to Treatment Policy - CED06-010 – 2006 (Under review 2007/8) ACT Health Privacy and Confidentiality Policy ACT Health Risk Management Policy and Framework Oct 2007 ADS Guiding Principles to Documentation ADS Business Plan 2012-2015 ACT Opioid Maintenance Treatment Guidelines ACT Alcohol, Tobacco and Other Drug Strategy 2010-2014 Mental Health, Justice Health, Alcohol and Drug Services (MHJHADS) Standard Operating

Procedure Suicidal Behaviour: Risk Assessment, treatment and care of Consumers. Children and Young People Act 2008 ACT Health Child Protection Standard Operating

Procedure (SOP) The 10 National Care Standards will also be applied to this guideline. Mental Health Act 2015


References

ACT Health (2004) ACT Alcohol, Tobacco and Other Drug Strategy 2010-2014, ACT Health Alcohol and Drug Policy Unit, Canberra, Australia 2004

Australian National Council on Drugs (2001), Evidence Supporting Treatment- the effectiveness of interventions for illicit drug use, Australian National Council on Drugs Canberra, Australia 2001

Australian Council on healthcare standards, (2007) EQuIP4 Risk Management and Quality Improvement Handbook, Sydney Australia 2007.

Case Management Society of Australia (2004), The National Standards of Practice for Case Management September, Melbourne.

Grinnel, R M. Unrau, Y A. (2005) Social Work Research and Evaluation- Quantitative and Qualitative Approaches, Oxford University Press

Meadows, G. Singh, B. Grigg, M. (2007) Mental health In Australia Collaborative Community Practice. Oxford University Press, Second Edition.

Nucleus Group (2005) ACT Health, Case Management Across the Alcohol and Other Drug Sector, Commissioned by ACT Health, Canberra, Australia 2005

Nucleus Group (2005) Brief Review of Approaches to Case Management for the ACT ADS, Commissioned by ACT Health, Canberra, Australia 2005

Sarantakos, S. (2005) Social Research, Palgrave MacMillian Publishers, Third Edition


Definition of Terms



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ADS: Alcohol and Drug ServicesOTS: Opioid Treatment ServiceKW: Key Worker TCH: The Canberra Hospital Tier 1: The person’s prescriber for pharmacotherapy is an ADS medical officer; persons are required to access pharmacotherapy at the ADS OTS building 7 TCH Tier 1a: The person ais prescribed pharmacotherapy by a GP in the community and dose at the OTS Building 7 TCH.Tier 2: The person’s prescriber for pharmacotherapy is an ADS medical officer; the person access pharmacotherapy through community pharmacies.Tier 3: The person is prescribed pharmacotherapy by a GP in the community and dose at a community pharmacy.




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Attachments

Appendix A – Opioid Treatment Service Key Worker Program Flow ChartAppendix B Page 2 – Severity of dependence Scale for outcomes monitoring

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair



Centralised Assessment Initial Psychosocial Assessment to be conducted by OTS Allied Health, or designated Key Worker Prior to first Medical Appointment. Initial Planning: Assessment, Consent and Confidentiality, Treatment and personal Goals Negotiated Allocation to a Key Worker ADS Medical Appointment Initial Assessment, Treatment Planning, and Induction on to Pharmacotherapy treatment

Key Worker TeamKey Worker Team is responsible for the Implementation, monitoring and review of the goals set out in the initial Assessment.Tasks of Key Worker Role: Minimum 1 contact per month with person. Worker and person collaborate to assess Needs, Goals and tasks while on T1 services. Three main strategies for Key Workers to meet the need of persons include:Referral to internal ADP services or Referral to external services Provision of Information & General SupportAdvocacyIncluded within the monitoring role is the active screening for Risk indicators, which in turn may lead to sentinel events.Crisis/Concern IdentificationPotential Sentinel Event IdentifiedReferral to:Crisis counselling (ADS), Health & MHAnd external community providersNotification made in notes & co-ordinator - staff team advised in OTS clinical meeting of outcomeADS Medical Specialists Addiction Medicine Specialist ServicesInitial Assessment, Treatment Planning, Reviews of Pharmacotherapy Psychiatry Registrar OTS Counselling TeamCrisis Counselling ServicesOngoing Psychosocial Support & AOD CounsellingComplex needs servicesIntensive Case Management

OTS Administration- Eligibility Determined; Commencing or Recommencing onto OTS T1 Services. Person is Identified as having complex needs or Voluntary basis)Appointment for initial Psychosocial Assessment BookedAppointment for ADS Medical Officer booked

First Contact- ADS Intake Line Assessment of persons needs Referral Generated to Opioid Treatment Service (ADS RED referral & ADS KWP)

Transition & ExitStability Achieved on T1 transfer to T2- Key Worker to follow up for three months on T2.Maintenance / Reduction in PharmacotherapyExit Planning interview with Key Worker and counsellor Referral to Tier 2 ADS Community Social Worker

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Appendix A – Opioid Treatment Service Key Worker Program Flow Chart



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Appendix B Page 2 – Severity of dependence Scale for outcomes monitoring

Severity of Dependence Scale – measures psychological construct of dependence as defined in DSM-IV IIILead in questions; “This questionnaire is going to ask you five questions about how you have felt about your drug use over the last twelve months. For each of the five questions we want you to pick the most appropriate answer for each drug you have used in the last 3 months”.

NeverAlmost never-

0Sometimes- 1 Often- 2

Always, Nearly always-3

Do you think your use of (named drug)was out of control?

Does the prospect of missing a fix (or dose) make you anxious or worried?

Do you worry about your use of(named drug)?

Do you wish you could stop

How difficult do you find it tostop or go without (name drug)?

Not Difficult - 0 Quite Difficult -1

Very Difficult -2

Impossible-3

Total Score out of 15 for current substances.

Indicators of presence of DSM-IV III dependence; Alcohol 3>, Amphetamine 4> , Heroin 5> , Cannabis and benzodiazepine 6>higher scores above cut off points indicate higher likelihood of dependence

Source: Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W., Strang, J. (1995), The Severity of Dependence Scale (SDS): Psychometric Properties of the SDS in English and Australian Samples of Heroin, cocaine, and amphetamine users’, Addiction. Vol. 90. pp607-614.Dawe, S., Loxton, N., Hides, L., Kavanagh, D., Mattick, R (2002), Review of diagnostic screening instruments for alcohol and other drug use and other psychiatric disorders 2nd Edition, Commonwealth Department of Health and Ageing, Canberra.Lawinson, P., Copeland, J., Gerber, S., Gilmore, S. (2007),

Determining a cut-off on the Severity of Dependence Scale (SDS) for

alcohol dependence, Addictive Behaviours, 32, pp1474-1479.



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