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Chapter 1: Integrated Care for Drug or Alcohol Users: Principles and Practice Update 2008
Introduction
In October 2002 the Effective Interventions Unit ( EIU) published, Integrated Care for Drug Users: Principles and Practice which set out the definitions and concepts of integrated care for drug misusers. It also set out the key principles underpinning an integrated care approach and provided detailed evidence of effective practice under each of the six key elements of the integrated care process.
Since then a number of developments have taken place within the substance misuse field and health and social care organisations have been re-structured to accommodate better joint working: for example, the development of Community Health (and Social Care) Partnerships in each NHS Board area and Community Justice Authorities.
The specific guidance produced by Scottish Intercollegiate Guidelines Network ( SIGN) on the Management of harmful drinking and alcohol dependence in primary care ( SIGN 74, 2003) and the Health Technology Assessment ( HTA) Report 3: Prevention of Relapse in Alcohol Dependency (Slattery et al, 2003) suggest that a range of interventions should be employed, not only in specialist alcohol services, but also in primary care, lay services (local councils on alcohol, AA) and in other settings, such as A&E Departments, hospital wards, criminal justice and community care services.
It is important to note that although some of the interventions provided in the treatment of drug misuse differ from those in alcohol misuse the concept of integrated care and the key elements of effective practice contained in this document are common to both.
In addition, substance misuse services (drug and alcohol) and mental health services, in many areas of the country, have been better aligned to allow for the development of closer working relationships.
The introduction of the Single Shared Assessment ( SSA) process has created an opportunity for dialogue between care and treatment providers in each area on issues such as levels of assessment, core data sets and information sharing.
Purpose of this Document
From the feedback received from Alcohol and Drug Action Teams ( ADATs), service provider organisations and individual service managers and practitioners it is clear that since the publication of Integrated Care for Drug Users: Principles and Practice, integrated care has developed at different rates across the substance misuse field in Scotland.
This document has been produced as part of the work of the Scottish Advisory Committee on Drug Misuse ( SACDM) Working Group on Integrated Care in order to provide further guidance and information on what integrated care should look like and what it should deliver for service users. It should be read in conjunction with the guidance on Essential Care: a report on the approach required to maximise opportunity for recovery from problem substance misuse in Scotland (Scottish Government 2008) in order to identify the way in which a wide range of health, social care and wider community support structures should work together to meet the identified needs of an individual person who is experiencing problems with alcohol or drugs.
This update builds on the guidance provided in the original document by summarising the evidence, identifying key principles of good practice and setting this in a modern context, taking account of the way in which services are now aligned and delivered.
It draws on the experiences of health and social care organisations in developing partnership working and, wherever possible, draws on examples of good practice from the drug and alcohol field.
It provides further evidence and examples of effective practice in providing integrated care and sets out action points for service commissioners, service managers and practitioners to consider in the planning and delivery of services.
The document should be read alongside the National Quality Standards for Substance Misuse Services published in 2006 by the Scottish Executive. The standards have a number of key aims.
- To improve the consistency and quality of substance misuse service provision in Scotland.
- To form the foundation of a framework that is intended to enable service providers to examine and continuously improve their service delivery.
- To increase accountability of service providers and commissioners to the general public and specifically service users and their families.
- To assist service commissioners to make informed funding and contract decisions.
All eleven standards apply to all services involved in supporting people affected by substance misuse - they do not apply solely to 'treatment services'. The difference occurs in the "evidence" that service providers, commissioners and partnerships use to demonstrate how they are meeting the standards. Thus, examples of written personal plans may well vary in their detail and comprehensiveness depending on the intensity of support available from that service. However, the same principle applies, in that if you use a service, whether as a 'client', 'patient' or 'service user', you should be involved in your care, know what the service is offering to support you and know what part you play in ensuring such support is effective.
Service providers should not operate in isolation of each other. Many individuals and families affected by substance misuse will require the support of more than one service. Sometimes they will require the support of more than one service at the same time. It is therefore critical that the planning, delivery, and evaluation of service provision is both integrated and co-ordinated. It is unlikely that this co-ordination role will be the responsibility of any one service provider, hence the wording of Standard Statements 9, 10 and 11.
When using this manual you may find it helpful to refer to documents written to support the implementation of the National Quality Standards.
- Baseline exercise report
- Regional Roadshows report
- User involvement
- Guidance Manual ( to be published)
The full document can be downloaded at http://www.scotland.gov.uk/Resource/Doc/149486/0039796.pdf
Structure of the Document
The subsequent chapters follow the structure of Integrated Care (2002) focusing on the key elements of integrated care: accessibility, assessment, planning and delivery of care and information sharing.
Each chapter highlights recent changes in relevant policy, guidance and practice; identifies the key principles against which service delivery should be measured; and draws out the actions required locally to ensure that these issues are being addressed.
These action points are generalised in order to ensure that they are applicable to all areas. Each ADAT and service provider should apply these to their area of responsibility and identify their own areas of strength and weakness. This process should allow the development of a local action plan aimed at addressing identified weaknesses or gaps with clear, locally relevant performance measures.
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