Tailoring programs and services to methamphetamine (Nov 15)

Tailoring programs and services to methamphetamine (Nov 15)

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  Tailoring programs and servicesto Methamphetamine Laurence Alvis & Rose McCrohan APSAD Perth 2015
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  Who are we? UnitingCareReGen is a not for profit agency with over 45 years experience of providing AOD treatment & education in Victoria. ReGen is a leading provider of treatment services in Victoria. ReGen has piloted Non Resi Rehab Day Programs in Victoria since 2009
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  First choice of substance 2010-2015 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 2007/082008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 YTD 13% 14% 10% 7% 7% 7% 7% 4% 9% 44% 39% 40% 45% 39% 42% 41% 38% 33% 22% 32% 32% 30% 29% 22% 20% 19% 17% 8% 6% 5% 6% 12% 12% 17% 20% 30% 13% 9% 13% 12% 13% 16% 15% 19% 11% Major Presenting Drug Types 2007 to 2016 Heroin Alcohol Cannabis Ampetamines (Includes Ice) Other
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  What was the problem? In2012/13 • Over 40% of clients were reporting methamphetamine as their 1st or 2nd drug of choice • Poor retention in adult withdrawal 48% compared to 90% in youth service • Poor program participation & hostility that impacted on client-staff relationships • Early discharge and poor treatment experience • Increasing serious incidents
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  What did we do? •Residential Unit staff raised issues that treatment wasn’t working for meth clients • File audit, client feedback - recommended program changes • Staff forum – focus on staff & client care • Implemented program changes from 01.01.13 • Relax program expectations first 72 hours; rest, minimise stimulation, support & reassurance • Monitoring (mental state, fluid intake, vital signs) & withdrawal state (Amphetamine Cessation Symptom Assess) • Extended stay from 7 to 10 days (acute withdrawal phase)
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  During the trial • Retentionincreased from 48% to 60%, higher now. • Client staff relationships improved • Number and severity of incidents declined in the final 3 months of the trial and continued to decrease • Clients still reported low - moderate withdrawal symptoms at discharge • Over 50% of clients had experienced no decrease, or an increase of withdrawal symptoms on discharge from residential withdrawal (7 days)
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  What is stepped care Steppedcare • Support to engage and access treatment • Support to reduce drug use prior to residential withdrawal • Crash at home if appropriate • Assertive follow up and support post withdrawal
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  Lessons • Extended withdrawal duration(for some) • Support to access treatment before and after withdrawal (stepped care). Easier to do step down care • Post withdrawal programs that cater for these clients (not just NRW) • Maintain relationship with the participant throughout treatment • Priority access to the Torque Program • Aboriginal inclusion
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  What is Torque? •Torque is an evidence based structured day non residential rehab program comprising of a range of individual and group interventions • Torque is for people involved in the justice system, and is modeled on the ReGen Catalyst program • It is a 6 week non-residential rehabilitation program for people who have made a decision to stop use. The program operates from Monday to Friday with a maximum 12 participants per group • The model is designed as an alternative treatment option for Victorians involved in the justice system for whom residential services are inaccessible or unsuitable post withdrawal, but who require more intensive support than individual counselling • Suitable participants need to be capable of self-management and have at least a moderate level of intellectual functioning
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  Torque Program • Basedon Cognitive Behavioral Therapy and motivational enhancement • Completion of program: 80% of the total hours of the compulsory sessions • 4 x Motivational enhancement sessions (Individual counselling sessions) • 10 x Cognitive behavioral coping skills training • 4 x Mood management sessions (Anxiety, depression and anger) • 4 x Skills practice sessions • 18 x Check In & Outs
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  Electives • The programalso offers a range of educational, complimentary and therapeutic session that supports retention and specific needs • Physical activity (Gym) • Yoga & meditation • Nutrition • Family strengthening • Art therapy • Music & drumming • Financial Counselling • Employment support
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  Results Substance Use • At3 month follow-up sustained abstinence from heroin, and reductions in cannabis and methamphetamine use still evident • Reduced rates of substance use at program completion & significant increases in confidence to manage high risk situations Offending behaviours • Decreased prevalence of past month property, drug dealing, fraud and/or violent offending – example -9 clients reduced to 3 in week 6 Quality of Life (QOL) • Overall improved QOL, health & life satisfaction, sustained or further improved at three month follow-up Evaluation of Torque –LeeJenn Health Consultants January 2015
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  Key Learnings • Keepingpeople engaged while they move through treatment options • Person centred • Evidence based and consistent with best practice • A suitable intervention for methamphetamine users • Post treatment follow up (support worker refreshers, Momentum)
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  Clients, EOC andIncidents 2007 to 2016 0 1000 2000 3000 4000 5000 6000 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 YTD 3104 3481 3785 3727 3292 3613 4049 5025 2416 1723 1864 2027 1901 1807 1982 2136 4242 1830 102 85 133 121 105 87 94 105 386% 5% 7% 6% 6% 4% 4% 2% 2% Episodes of Care Clients Incidents Incidents by Clients
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  Questions…. http://www.regen.org.au