Embed Size (px)
Citation preview
www.phrn.nhs.uk
IDTS Leads Perception of Implementing IDTS
The First Stage of the Evaluation of IDTS
Sharon McDonnell
www.phrn.nhs.uk
Research Team
Professor Jenny ShawDr. Jane SeniorDr. Sharon McDonnell
Centre for Suicide PreventionUniversity of Manchester
Funded by the Department of Health, Offender Health
The report will be available on the PHRN website.
www.phrn.nhs.uk
What is IDTS?
IDTS is an acronym for Integrated Drug Treatment System.
A new initiative that aims to radically improve the clinical and psychosocial services offered to substance misusers within prisons.
Particular emphasis on early custody.
www.phrn.nhs.uk
Background
Prison clinical drug services have often been:
under-resourced. unable to provide adequate clinical treatment practices.
Specifically
substitute prescribing incorporating maintenance.
www.phrn.nhs.uk
Background
Many prisons have had poor links between:
Prison clinical services.
CARATS (Counselling, Assessment, Referral Advice and Throughcare).
Substance misuse services within the community.
www.phrn.nhs.uk
Aim of IDTS
To expand the quantity and quality of drug treatment options within prison establishments.
Substitute prescribing.
To provide more effective and needs based treat-ment within prisons.
www.phrn.nhs.uk
Aim of IDTS
Improve the continuity of care for substance misusers
within prison establishments
entering/moving between prisons
and
on release.
Best achieved Integration of prison clinical and CARAT services.
www.phrn.nhs.uk
What is IDTS?
An integrated drug treatment system (IDTS).
Enhanced clinical treatment (Health care)
Psychosocial intervention (CARATS)
Prisoners who arrive at reception who are substance dependent.
www.phrn.nhs.uk
Main Aim: Enhanced Clinical Treatment
Improve clinical management of substance misuse within prisons – resulting in an increase in levels of methadone maintenance prescribing.
A broader range of clinical responses to drug dependence, such as extended opiate detoxification.
www.phrn.nhs.uk
Main Aim: Psychosocial Intervention
28 day structured care package of psychosocial support
Complements enhanced clinical treatment.
Takes into account previous treatment in the community or custody.
and
Provides a platform for longer-term drug treatment in prison and on release.
www.phrn.nhs.uk
First wave of Prisons
46 prisons implementing IDTS.
29 enhanced clinical treatment
17 enhanced clinical treatment and
psychosocial aspect of IDTS.
www.phrn.nhs.uk
Aims of Study
Identify the key steps in the first wave of implementation of IDTS.
Inform the next implementation phase.
Identify the specification for full IDTS research evaluation.
www.phrn.nhs.uk
Aim of the Presentation
Describe the IDTS leads experience of preparing to implement IDTS.
Highlight
The difficulties experienced by prisons preparing to implement IDTS.
The perceived problems once IDTS is implemented.
Suggest how the next wave of prisons could implement IDTS more effectively.
www.phrn.nhs.uk
Methodology
Inclusion criteria
All prisons (n = 46) implementing IDTS enhanced clinical services n=29
clinical and psychosocial services n=17
Sample
n = 38 prisons (83% of first wave prisons) enhanced clinical services n=24
clinical and psychosocial services n=14
www.phrn.nhs.uk
Methodology
IDTS leads from each prison participated in a semi- structured telephone interviews.
Interviews conducted June - Oct 2007 (proposed date they would go live 1st Oct).
To ensure anonymity none of the prisons are identifiable in the study. Mixed methods - Thematic analysis and descriptive statistics.
www.phrn.nhs.uk
Interview Schedule
The leads perception of IDTS.
The perceived level of support/guidance received.
Key obstacles that have delayed implementation and how they have been overcome.
The extent to which IDTS has been/will be implemented.
www.phrn.nhs.uk
Interview Schedule
Their perceived difficulties when IDTS is implemented.
Identify how the second wave of prisons could
implement IDTS more effectively.
www.phrn.nhs.uk
Placing the time frame into context
Interviews were conducted
Transitional process (Prison healthcare services being devolved to PCTs).
The merging of Trusts.
Contractual issues (e.g. ‘Agenda for change’).
www.phrn.nhs.uk
Positive Perception of IDTS
‘It’s brilliant.’ participant 32
www.phrn.nhs.uk
Positive Perception of IDTS
• Missing link in treatment.
• Clinical solution to drug dependency.
• National standardised drug treatment within establishments.
• Enable prisoners to move around the prison estate more successfully.
• Reduce self harm, suicide and drug related fatalities during early release.
• First serious attempt to integrate services – beneficial for prisoners and staff.
www.phrn.nhs.uk
Negative Perception of IDTS
‘They (0ffender Health) fail to realise 80,000 are in custody and the majority are substance misusers.’ participant 29
www.phrn.nhs.uk
Negative Perception of IDTS
Bulldozed into implementing IDTS with little concern for the possible implications.
Specifically
The clinical risk if not implemented correctly.
The unmet need of the current prison population.
The legal implications if these issues are not addressed.
www.phrn.nhs.uk
IDTS Leads
The majority of IDTS leads are enthusiastic and highly motivated individuals.
Various backgrounds and disciplines.
Prison healthcare n = 22 Discipline staff n = 10 External agencies n = 4
PCT IDTS lead n = 2
Knowledge about substance misuse varied dramatically.
www.phrn.nhs.uk
IDTS Lead
Huge variation in protected time to implement IDTS
14 (37%) employed full time IDTS Leads. 24 (63%) had additional responsibilities.
Extreme cases
6 were expected to implement IDTS, in addition to their normal workload.
www.phrn.nhs.uk
IDTS Leads
20 (53%) leads felt they had not been given enough time to implement IDTS.
29 (76%) leads encountered major obstacles.
Many felt that they lacked authority/seniority to deal with some of these problems.
www.phrn.nhs.uk
IDTS leads Specific Tasks
Required to oversee and manage all aspects of implementation
Structural work to implement IDTS.
Implementing a major policy which encroaches on many aspects of a prison regime.
Apply for additional funding.
Managing budgets.
www.phrn.nhs.uk
IDTS leads Specific Tasks
Write protocols.
Communicating/liaising with senior prison staff and outside agencies (e.g. PCTs, steering committees).
Encourage integration between CARATS and healthcare staff.
Recruitment of staff.
www.phrn.nhs.uk
Findings Suggest
IDTS Leads not only need an understanding of substance misuse but also require effective
Management Leadership Problem solving Communication skills
To deal with the multi-faceted problems they might encounter.
www.phrn.nhs.uk
Interviews conducted in the following prisons
• Male
• Female
• Young offenders
• Contracted out
• Public
• Local
• Training
• Open prisons
www.phrn.nhs.uk
Type of Prison
www.phrn.nhs.uk
Local Prisons
Main Concerns
Training prisons will not be ready – creating a bottle neck.
Unable to receive prisoners from court due to this bottleneck.
Overwhelmed by demand.
www.phrn.nhs.uk
Training Prisons
Main Concerns
They might receive unstable prisoners from the local prison.
Safety issues – working with heavy machinery.
An increase in bullying.
Healthcare staff lack of knowledge about substance misuse.
www.phrn.nhs.uk
Contracted out Prisons
Main Concerns
Difficulties acquiring funding from the Home Office.
Risk of overspend as money not released – unable to recruit or send staff on training.
www.phrn.nhs.uk
Young Offenders
Main Concern
Question whether IDTS is suitable for young offenders.
Suggest that focus should be on abstinence not methadone maintenance.
www.phrn.nhs.uk
6 Themes Associated With Implementing IDTS
MAIN THEMES SUB-THEMES
Fundamental Problems • Lack of/or no space. And/or• Buildings not fit for purpose• Lack of funding to provide appropriate facilities. Combined• Difficulties managing the prison population.
Operational Issues • Finances• Estates• Regime
www.phrn.nhs.uk
Themes Associated With Implementing IDTS
MAIN THEMES SUB-THEMES
Communication • Guidance on implementing IDTS• Support• Lack of communication.
Staff-Related Issues • Recruitment• Training• Negative attitudes
www.phrn.nhs.uk
Themes Associated With Implementing IDTS
MAIN THEMES SUB-THEMES
Major Concerns • Protocols• Capping• Legal implications• PCTs• Risk factors
Ethical Issues • Confidentiality• Standard of care
www.phrn.nhs.uk
Theme 1Fundamental Problems
Physical Environment
• Lack of/or no space.
And/or• Buildings not fit for purpose.• Lack of funding to provide appropriate facilities.
Combined• Difficulties managing the prison population.
www.phrn.nhs.uk
Theme 2 Operational Issues
Finances
Inaccurate costing for IDTS.
PCTs/Home Office
Regime
Movement of prisoners
Key performance targets
www.phrn.nhs.uk
Theme 3 Communication
Support
The majority of leads felt inadequately supported.
● Regional steering committee
● Local implementation groups ● PCTs
www.phrn.nhs.uk
Theme 3 Communication
Guidance on implementing IDTS
Felt bombarded with paperwork.
Lack of Communication
Between healthcare and discipline staff.
www.phrn.nhs.uk
Theme 4 Staff-Related Issues
Recruitment
Difficulties accessing IDTS funds (e.g. PCTs). Difficulties recruiting staff.
Training
Unable to train staff if they have not been recruited! Locality of IDTS courses an issue.
www.phrn.nhs.uk
Theme 4: Staff-Related Issues
Negative attitudes towards IDTS
Two leads didn’t agree with IDTS, didn’t want to go on training or implement it.
Some CARAT staff believed that IDTS compromises them professionally.
Two nurses wanted to be conscientious objectors and refused to go on IDTS courses.
www.phrn.nhs.uk
Theme 4Staff-Related Issues
Negative attitudes towards substance misusers
Some healthcare staff disliked caring for substance misusers.
Use negative terminology when referring to them such as ‘dickheads.’
www.phrn.nhs.uk
Theme 5 Major Concerns
76% leads encountered major obstacles.
The following issues created the most anxieties.
● IDTS Protocols ● Transfer of IDTS prisoners ● PCTs ● Capping of IDTS prisoners ● Legal implications
www.phrn.nhs.uk
Theme 5 Major Concerns
IDTS Protocols
‘It’s like keep re-inventing the wheel.’ Participant 5
Wanted standardised protocols whenever possible.
Some had no experience of writing protocols.
Difficult for those who have no knowledge of substance misuse.
Concerned about the legal implications if scrutinised.
Delays (3mths) waiting for outside agencies to sign protocols.
www.phrn.nhs.uk
Theme 5Major Concerns
Capping of IDTS Prisoners
‘We (prison) don’t know what’s coming (demand for IDTS)’. Participant 18
71% (n=27) believe they will be overwhelmed by demand.
The majority leads feel every prison should be capped, especially when they first go live.
Question whether Offender Health’s refusal to cap all prisons is safe practice.
www.phrn.nhs.uk
Theme 5 Major Concerns
Transfer of IDTS Prisoners
‘It’s a joke, we need transfer policies.’ participant 30
Problematic for prisons that cover a large area or feed to, or received prisoners from several other prisons.
Believe Offender Health should pay more attention to transfer issues as it could have serious implications if ignored.
www.phrn.nhs.uk
Theme 5Major Concerns
Leads argued that transfers are necessary
To ensure establishments do not become over- whelmed by demand.
To prevent a bottle neck occurring.
To manage the numbers of IDTS prisoners transferred to establishments that are currently capped.
To ensure safe practice.
www.phrn.nhs.uk
Theme 5Major Concerns
Legal Implications
Possible lack of consistency and continuity of IDTS care across establishments.
Little attention to substance misusers who are already detained.
www.phrn.nhs.uk
Theme 5Major Concerns
Primary Care Trusts (PCTs)
Leads difficulties accessing IDTS funding.
Created delays in recruiting and training staff.
Strained relationship between PCTs and IDTS leads.
Lack of understanding of prison establishments.
www.phrn.nhs.uk
Theme 6Ethical Issues
Confidentiality
The standard of care some substance misusers might receive in some establishments.
Lack of guidance for those already detained.
www.phrn.nhs.uk
Limitations and Strengths of the Study
Limitations
8 (17%) prisons did not participate in the study. Their specific problems and needs might not be identified in study.
Strengths
Provides a unique insight into how many PCTs currently relate with prison establishments whilst preparing to implement a major health policy.
www.phrn.nhs.uk
Recommendations
IDTS leads play a pivotal role in the implement- ation process.
To ensure effective implementation it is necessary to:
● identify,● acknowledge ● address
their specific needs.
www.phrn.nhs.uk
Recommendations
IDTS Leads
Must be receptive to IDTS and its implementation.
They need protected time to implement IDTS.
They need appropriate authority or seniority to deal with senior staff and outside agencies.
They must have effective management, communication and leadership skills.
They should be given a realistic time-frame to implement it.
www.phrn.nhs.uk
Recommendations
Support
Steering committees and local implementation groups should provide the conditions whereby leads feel supported throughout the implementation process.
Communication
Discipline staff should be informed about IDTS in an appropriate manner and at the earliest opportunity.
www.phrn.nhs.uk
Recommendations
Access to IDTS funding
The Home Office and PCTs should ensure that IDTS funding is more accessible to IDTS Leads.
Recruitment and Training of Staff
Should commence at an earlier stage in the next wave of implementation.
www.phrn.nhs.uk
Recommendations
The need for Offender Health
To develop standardised protocols whenever possible.
To reconsider issues surrounding the capping of prisons.
To consider issues surrounding transfer of IDTS prisoners.
www.phrn.nhs.uk
Putting the findings into context
The interviews were conducted prior to IDTS being implemented. Possible
Some of the leads concerns and anxieties might be unfounded.
Emphasises the need to evaluate The specific experiences and needs once IDTS has
been implemented.
www.phrn.nhs.uk
Conclusion
Findings suggest
Prison establishments are embracing IDTS and the vision Offender Health has for the future development of prison healthcare.
www.phrn.nhs.uk
Conclusion
Ensuring that the vision becomes reality requires:
Effective communication between IDTS leads, PCTs and Offender Health.
Critically evaluate all aspects of the implementation process.
The ability to learn from mistakes (i.e. prisons, PCTs Offender Health).
A sense of openness to amendments throughout whole process of implementation.
