HSE Addiction Services HSE Addiction Services Northern Area:Northern Area:
LHO, Dublin Central.LHO, Dublin Central.LHO, Dublin North West,LHO, Dublin North West,LHO, Dublin North EastLHO, Dublin North East
Dr.Siobhan Rooney: Consultant Dr.Siobhan Rooney: Consultant Psychiatrist in AddictionsPsychiatrist in Addictions
Dr.Des Crowley: GP Co-OrdinatorDr.Des Crowley: GP Co-Ordinator
Content.Content.
• IntroductionIntroduction• Historical Development of Addiction Services Historical Development of Addiction Services
and the Numbers attending the Addiction and the Numbers attending the Addiction Services in the Northern Area over the years.Services in the Northern Area over the years.
• Current Services and numbers attending.Current Services and numbers attending.• 4 Tier Service4 Tier Service• Service User’s Pathway and Services availableService User’s Pathway and Services available• Current ChallengesCurrent Challenges
Historical Development of Addiction Historical Development of Addiction Services.Services.
Developed as a harm reduction service in Developed as a harm reduction service in response to HIV epidemic in Dublin in the response to HIV epidemic in Dublin in the late eighties/early ninetieslate eighties/early nineties
Enormous community opposition to the Enormous community opposition to the development of services.development of services.
Services developed in an Ad hoc Services developed in an Ad hoc bases/facilities often no suitable for bases/facilities often no suitable for purpose /purpose /
Numbers registered on the Central Treatment Numbers registered on the Central Treatment List:List:
1994 - 20091994 - 20091994 1995 1996 1997 1998 1999 2000 2001
15291529 22382238 29482948 42154215 54985498 54335433 61456145 71077107
2002 2003 2004 2005 2006 2007 2008 2009
75967596 81558155 83648364 89628962 94289428 97609760 1021310213 1066810668
Numbers registered on the Central Treatment Numbers registered on the Central Treatment List:List:
1994 - 20091994 - 2009Numbers in Treatment: 1994-2009
0
2000
4000
6000
8000
10000
12000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years: 1994-2009
Nu
mb
ers
Current Services and Numbers Current Services and Numbers attendingattending
6 Drug Treatment Centres, 1 Mobile Clinic and a Central Pharmacy6 Drug Treatment Centres, 1 Mobile Clinic and a Central Pharmacy 13 Satellite Clinics. 13 Satellite Clinics. CTL: CTL: August 2010August 2010: : 2040 methadone2040 methadone patients attending with patients attending with 1997 1997
registered at the end of this period. 7 new cases registered.registered at the end of this period. 7 new cases registered. Waiting List: 9Waiting List: 9
LHO AreaLHO Area Dublin North WestDublin North West Dublin North Dublin North CentralCentral
Dublin North EastDublin North East
Attending DTCs, Attending DTCs, satellite clinics etc.satellite clinics etc.
631631 916916 493493
Attending GPs: Attending GPs:
(65 GPs: Level 2: (65 GPs: Level 2: 18, Level 1: 47)18, Level 1: 47)
197197 453453 285285
Total: 935Total: 935
Community Community Pharmacists: 93Pharmacists: 93
591 (29 591 (29 Pharmacies)Pharmacies)
541 (n=25)541 (n=25) 584 (n= 39) 584 (n= 39)
Total: 1716Total: 1716
Graph 1. Illustrates the number of Service Users attending the Graph 1. Illustrates the number of Service Users attending the DTC’s (Drug Treatment Centres) in the different area HSE.DTC’s (Drug Treatment Centres) in the different area HSE.
Number of Service Users attending DTC's
568
654
148
0
100
200
300
400
500
600
700
Dublin NorthWest
Dublin NorthCentral
Dublin North
Dublin North West
Dublin North Central
Dublin North
Total: 1370
Graph 2. Illustrates the number of Service Users Graph 2. Illustrates the number of Service Users attending the Satellite Clinics.attending the Satellite Clinics.
Number of Service Users attending Satelite Clinics
63
261
319
0
50
100
150
200
250
300
350
Dublin NorthWest
Dublin NorthCentral
Dublin North
Dublin North West
Dublin North Central
Dublin North
Total: 643
The Drug Treatment Centre BoardThe Drug Treatment Centre Board
Tertiary Service.Tertiary Service. Patients: Patients:
Dual Diagnosis / Co-morbid Psychological morbidity: Dual Diagnosis / Co-morbid Psychological morbidity: Anxiety and depressive disorders, PTSD, Personality Anxiety and depressive disorders, PTSD, Personality Disorders. Psychotic Disorders, Major Mental IllnessDisorders. Psychotic Disorders, Major Mental Illness
Challenging and aggressive behavioursChallenging and aggressive behaviours HomelessHomeless Service provision for areas not covered in the Service provision for areas not covered in the
community by DTCs / Satellite Clinicscommunity by DTCs / Satellite Clinics Young Person’s ProgrammeYoung Person’s Programme
CCACCA GenderGender During During PeriodPeriod
End of End of periodperiod
NewNew
66 mm 5858 5454 11
LHO Dublin ff 3434 3232 00
North West Total 92 86 1
77 MM 7777 7171 11
LHO Dublin ff 3737 3333 00
Central Total 114 104 1
88 MM 3333 3030 00
LHO Dublin ff 1010 99 00
North East Total 43 39 0
Summary Total
MM 168168 155155 22
FF 8181 7474 00
Total 249 229 2
Numbers attending the DTCB, September 2010
Services:Services: Primary Care Services:Primary Care Services: Level 1 and 2 GPs, Community Pharmacies Level 1 and 2 GPs, Community Pharmacies Specialist Multidisciplinary Teams:Specialist Multidisciplinary Teams:
Drug Treatment Clinics, Satellite clinics, DTCBDrug Treatment Clinics, Satellite clinics, DTCB SASSY TeamSASSY Team Needle ExchangesNeedle Exchanges
Rehabilitation ServicesRehabilitation Services Talbot CentreTalbot Centre Soilse.Soilse.
Inpatient Residential ServicesInpatient Residential Services Inpatient Drug Treatment Units: Cuan Dara / St.Michaels Ward, Inpatient Drug Treatment Units: Cuan Dara / St.Michaels Ward,
Beaumount Hospital.Beaumount Hospital.• Stabilisation ProgrammesStabilisation Programmes• Detoxification ProgrammesDetoxification Programmes
Residential Rehabilitation Unit:Residential Rehabilitation Unit: Keltoi Keltoi
Framework Concepts
• 4 - Tier Model of Interventions
– Service users may receive interventions from 1 of all tiers over the course of their rehabilitation
TIER 1Interventions where
main focus is not drug treatment
TIER 2Drug-relatedInterventions
TIER 3Specialist Drug-related
Interventions
TIER 4Specialist Dedicated
Inpatient or ResidentialUnits or Wards
Family Support Social Care
Pharmacies CommunityBased
Job Prison Community EducationSeeking Setting Setting Services
Skills
Primary Care Outreach
Hospital Setting
Specialist AddictionServices
Vocational Criminal Justice Training & Probation
Services
General Healthcare Setting
Services:Services: PreventionPrevention ++ Treatment Treatment + + RehabilitationRehabilitation Educational Officers:Educational Officers:
Interagency CollaborationInteragency Collaboration Primary Prevention , Harm Reduction, Tertiary Prevention Primary Prevention , Harm Reduction, Tertiary Prevention 4 Health Promoting Settings.4 Health Promoting Settings.
• Schools and YouthSchools and Youth• CommunityCommunity• WorkplaceWorkplace• Addiction Service.Addiction Service.
Client Referral and Pathways: Drug Treatment Client Referral and Pathways: Drug Treatment Clinic in the communityClinic in the community
Service User: Opiate / Cocaine
Initial Assessment: Nurse, Counsellor, GP,
CWO, Urinalysis
Discussion at clinical team meeting:
Referrals to other members of the team and external
referrals
Referral to Other HSE Addiction Rehabilitation Services:Talbot Centre, Soilse.Residential Inpatient + Rehabilitation Services
Referrals: Self, Family +Friends, GPs, Social Services, Statutory, Community Services, Outreach, Prisons, Hospitals, Psychiatric services, Maternity Services
Referral to other services: i.e. SASSY Team, Addiction
Psychiatry
MDT Team: GPs, Nurse, Counsellors, Consultant Psychiatrist, Rehabilitation Integration Service, Outreach, CWO, Hepatitis C Nurse, Liaison Mid-wife,
Sen.GA, Pharmacists
““Menu of Services” Menu of Services” Biological:Biological:
Medications / Substitution Treatments. Maintenance and Medications / Substitution Treatments. Maintenance and detoxification programmesdetoxification programmes
UrinalysisUrinalysis Viral screening and vaccinations,.Viral screening and vaccinations,.
Psychological: Psychological: Comprehensive Psychiatric assessment and Treatment Plan Comprehensive Psychiatric assessment and Treatment Plan Counselling and evidence based counselling interventions.Counselling and evidence based counselling interventions. Psycho-Social and RehabilitationPsycho-Social and Rehabilitation Rehabilitation Integration Services: Comprehensive assessment Rehabilitation Integration Services: Comprehensive assessment
and Care –plan: Focusing on rehabilitation i.e. training schemes, and Care –plan: Focusing on rehabilitation i.e. training schemes, CEE schemes, accommodation issues, support in preparation for CEE schemes, accommodation issues, support in preparation for detoxification and residential treatment and rehabilitation. detoxification and residential treatment and rehabilitation.
CWO: in 1 LHO area: Advising on benefits and advocating for CWO: in 1 LHO area: Advising on benefits and advocating for clients in being able to access benefits.clients in being able to access benefits.
Greater need for family involvementGreater need for family involvement
Client Referral and Pathway:Client Referral and Pathway:Soilse: Soilse: Rehabilitation Day Programme: Rehabilitation Day Programme:
Goals: Stabilisation of Drug Use and Detoxification.Goals: Stabilisation of Drug Use and Detoxification.
Service User
Team + Activities: Keyworker, Educators,
counsellors, Career Guidance, Literacy, Health+Fitness, Art,
Drama, creative pursuits
Comprehensive assessment: Appointed Key worker and development of Care-plan.
Preparation for detoxification, Personal development. 1:1 and
Group work
Interagency Working Rehabilitation Integration Services, residential drug
treatment units and residential rehabilitation Units.
Partnership: Soilse: Rutland
Referral: Self, rehabilitation Integration Services, Treating clinic team, Probation etc as per
treatment clinic.
The Talbot Centre:The Talbot Centre: is a dedicated Prevention service for children, young people is a dedicated Prevention service for children, young people and their families whose lives have been affected by drugs / alcohol in the North Inner and their families whose lives have been affected by drugs / alcohol in the North Inner
City.City.
Client / Service User/ Family
Team: 1 Education Officer, Project Leaders
x 2 (1WTE)3 Project Workers
Comprehensive assessment
Allocated Keyworker and development of
Care-Plan
Collaboration, Interagency Working. Case -managementEducational: PreventionAdvocacy, Counselling, Family Therapy, Outreach
Referrals: Family, community groups, SASSY Team, Social
Workers, Crinian Project, JLOs. Courts, residential Care Centres, Family Support Network, LDTFs
S.A.S.S.Y. (S.A.S.S.Y. (SSubstance ubstance AAbuse buse SService ervice SSpecific to pecific to YYouthouth) Team) Team
1 1 psychiatristpsychiatrist + 0.6 + 0.6 counsellorcounsellorLack of staff severe Lack of staff severe Cover Cover all North Dublinall North Dublin city & city &
countycounty Assess and treat Assess and treat all U-18all U-18 drug drug
and /or alcohol users from and /or alcohol users from catchment area (all drugs)catchment area (all drugs)
Do Do notnot need to be drug free to need to be drug free to attendattend
Assess Assess mental healthmental healthOffer 1:1 Offer 1:1 psychotherapypsychotherapyMedicationMedication if required if requiredAdvise re risky behavioursAdvise re risky behaviours
CBT / MI approachCBT / MI approach Multi-agency liaisonMulti-agency liaison Worked with Worked with 136136 last year last year 1 1 prison clinicprison clinic per week per week 2 sessions at 2 sessions at YPP DTCBYPP DTCB Advice & education role- often Advice & education role- often
country wide via phonecountry wide via phone High risk groupsHigh risk groups in care in care Early interventionEarly intervention for for
tomorrow’s problemstomorrow’s problems
Inpatient Drug Treatment Units: Beaumount Hospital Inpatient Drug Treatment Units: Beaumount Hospital and Cuan Dara, Cherry Orchard Hospitaland Cuan Dara, Cherry Orchard Hospital
Stabilisation Programmes:Stabilisation Programmes: Maintain on methadone maintenanceMaintain on methadone maintenance Detox. from other drug / alcohol useDetox. from other drug / alcohol use
Detoxification ProgrammesDetoxification Programmes:: Detoxification from Methadone 40mg / 50mgDetoxification from Methadone 40mg / 50mg Has attended for counselling and has aftercare planHas attended for counselling and has aftercare plan St.Michael’s Ward: 4 weeksSt.Michael’s Ward: 4 weeks Cuan Dara: 6 weeks: 3 weeks medical detoxification, Cuan Dara: 6 weeks: 3 weeks medical detoxification,
3 weeks Drug Free3 weeks Drug Free 1:1 Counselling, Group Work1:1 Counselling, Group Work
Keltoi: HSE Residential Rehabilitation Unit: Keltoi: HSE Residential Rehabilitation Unit: Drug Free, 8 Week Programme:Drug Free, 8 Week Programme:
Service User
Comprehensive assessment process:
Pre-admission group and urinalysis: Drug Free
Team and Supports: Manager, Keyworkers, residential care workers, counsellors, family
therapy, catering tutor (vacant),CWO, Educational
supports: VEC, Literacy, Fitness, gardening.
Allocated Keyworker and development of
care-plan:Living Skills and capacity building
Referrals: Self, Residential detoxification Units, Rehabilitation Day
Programmes, Rehabilitation Integration Services and
clinical teams, Community GPs
Aftercare: 2 years, 1:1 counselling. Supportive housing / step down facilities, Day Programmes. Ongoing liaison with other services
Keltoi: Residential Drug Free Keltoi: Residential Drug Free Rehabilitation Unit.Rehabilitation Unit.
Feb. 2001 to Dec. 2009. Feb. 2001 to Dec. 2009. Total admissions: Total admissions: 414414, Total completed treatment: , Total completed treatment: 314314 Total No. of assessments:Total No. of assessments: 1278 1278
Since 2007: 90% Completion rateSince 2007: 90% Completion rate
Outcomes at 1-3 years and compared to other research.Outcomes at 1-3 years and compared to other research.
ResearchResearch Smyth et. al. Smyth et. al. (n=113, (n=113, Cuan Dara, inpatient Cuan Dara, inpatient detoxification unit)detoxification unit)
Rosie Study Rosie Study (Residential (Residential rehabilitation rehabilitation nationally: N=81)nationally: N=81)
Keltoi (Residential Keltoi (Residential rehabilitation n=85)rehabilitation n=85)
OutcomesOutcomes 23% free of opiates 23% free of opiates at 2-3 yearsat 2-3 years
41% free of all drugs 41% free of all drugs except alcohol at 1 except alcohol at 1
yearyear
60% free of all drugs 60% free of all drugs except alcohol except alcohol between 1 and 3 between 1 and 3 yearsyears
The Continuum of Care
DetoxificationCuan Dara
LanternSt.Michaels
Education/training Community employmentBridge to the workplace
Harm Reduction /Stabilisation
SoilseC.D.T.sClinics
Residential rehabilitationKeltoi
CoolmineHigh ParkRutland
Day programmesSoilse
CoolmineA.C.R.G
AccommodationGeorges Hill
Peter Mc VerryGranby
Future ChallengesFuture Challenges
Drug Treatment Clinics: Drug Treatment Clinics: Development of a Comprehensive Development of a Comprehensive
assessment assessment Key Worker assigned Key Worker assigned Development of a care plan.Development of a care plan.
Case Manager and case management if Case Manager and case management if required.required.
Greater Interagency Working grounded by Greater Interagency Working grounded by Interagency ProtocolsInteragency Protocols
National Drug Rehabilitation Implementation Committee: Framework DocumentNational Drug Rehabilitation Implementation Committee: Framework Document
Aftercare
Transition Programmes
(e.g. structured
pre-induction)
Budgeting & Money
Management
FamilySupport &Childcare
Justice, Law and Criminal Issues
Support
Education&
Training,Personal
Development
Housing& Tenancy Support &
independent Living
Community Integration,
Social & Recreational
Activities
Employment (including
community employment),
Work Placements
General Health Services,
Health Promotion,
Mental, Physical and Intellectual
Disability etc
Drug SpecificInterventions
Service User
Future ChallengesFuture Challenges
Change of PhilosophyChange of Philosophy Negative Public Image of servicesNegative Public Image of services Changing Needs of Service UsersChanging Needs of Service Users Financial Pressures and pressures of the Financial Pressures and pressures of the
MoratoriumMoratorium Homeless Strategy and impact on servicesHomeless Strategy and impact on services Reconfiguration of ServicesReconfiguration of Services
Aims of ServicesAims of Services
To support Service users in services To support Service users in services based in their locality and at a Tier that based in their locality and at a Tier that meets their needs.meets their needs.
To promote stabilisation and detoxification To promote stabilisation and detoxification and transfer of service users to primary and transfer of service users to primary care services.care services.
Thank YouThank You
QuestionsQuestions