2. FUNDAMENTACIÓN TEÓRICA
4.6. LISTADO DE CONTENIDO Y FLUJO DE LA PROPUESTA
ADS or LCFT CAS staff complete comprehensive assessment and draw up care plan with client
ATR Assessment determines suitability
Treatment provider completes Assessment report based on Tier 3/4 interventions eg
• individual sessions • Community detox • In patient detox
• Residential rehab (Tier 4 and also Clients
Community Order + ATR proposed for 6 months. Supervision Requirement will also be standard
condition. Any additional Requirements will depend on OASys assessment of criminogenic need. NB consider length of Supervision Req’t if
CDVP included. Unsuitable for ATR
To address alcohol issues, PSR writer consider proposing Community or Suspended Sentence Orders with Supervision and ASRO (OGRS 51+) DIDs,
CALM, CDVP OR
If OGRS< 51 Community or Suspended Sentence Orders with Supervision Requirement .
Assessment Report prepared stating reason and email/fax to
OM Score < 20
Yes No
risk of serious harm, purposes of sentencing and likelihood of reoffending.
Aim
To reduce and eliminate alcohol dependency and reduce the likelihood of offending. The Probation Service, in partnership with Addaction will deliver appropriate treatment, supervision and interventions that are intended to meet the needs of punishment and address the critical issues of alcohol dependency and reducing the offender’s likelihood of reoffending and risk of harm to the public.
Suitability
For offenders aged 18 and over who must be assessed as suitable. This includes: offender has committed a violent offence
offence is alcohol related
evidence of entrenched pattern of alcohol dependency evidence that the offender is susceptible to treatment
The offender needs to express a willingness to comply with the requirement.
Outcomes
Offenders who complete the Alcohol Treatment Requirement will have: examined their dependency, behaviour and issues of self-control
acknowledged the harmful impact of their behaviour on victims, community and self learned new skills to help them lead constructive and law-abiding lives
Requirements
The offender will be subject to the following:
Supervision in accordance with Probation Service National Standards
Community based interventions will focus on a range of issues including alcohol use, psychological well-being, offending behaviour and life skills
Required to lead a law-abiding lifestyle.
Attend all appointments as required by the Offender Manager, including appointments with treatment provider and other agencies
being returned to Court promptly for failure to comply
Making the Requirement
Minimum period is 6 months with a maximum of 3 years. Standard ATR length should be 6 months Treatment intervention can include:
Community Care Planned treatment: This can include a range of structured, specialist and evidence based prescribing interventions, psychosocial therapies focussing on alcohol misuse; brief
interventions; health improvement and the amelioration of alcohol related health problems; psychological well-being; offending behaviour; life skills, accommodation issues; and social functioning. If appropriate, it can also include medically assisted alcohol withdrawal in the
community (detoxification) and prescribing interventions to reduce risk of relapse. Treatment and interventions will be delivered and managed through a written individual Care Plan.
Structured Day Programme: a formal care planned programme of day care focusing on issues including offending, relapse prevention, personal development, life skills, problem solving and other practical and emotional support.
Inpatient and Residential Structured Care Planned Treatment: including medicallyassisted alcohol withdrawal, stabilisation, rehabilitationand pharmacotherapy (medication) requiringspecialist residential or inpatient treatment Referrals to ADS.
Additionally, under the ATR, motivational work and solution focused interventions to improve or resolve an offender’s accommodation, attendance at mutual support e.g. Alcoholics Anonymous (AA) (if attendance can be confirmed), education, training or employment can be counted as contact providing it is included in the Sentence Plan and there is a clear audit trail.
All interventions in the ATR will be guided by a formal Care Plan written by the Substance Misuse worker in consultation with the offender.
All aspects of treatment outlined above will be covered by the ATR, which means that there is no need to include a Residence Requirement if an offender is to undertake residential treatment as a component of any care planned intervention(s) detailed in the court report.
OM completes sentence plan within required timescales and provides copy to Substance Misuse Worker within one day
of completion. OMs should provide OASys screening for low and screening and summary for medium and high risk
Substance Misuse Worker confirms attendance, in writing/email, following each appointment. Witness Statements, using agreed pro-forma, will be required
for all FTAs.
If the Substance Misuse Worker rearranges any appointments with the offender, these must be notified to the OM in advance or at
the latest on the day of the original appointment
OM to convene Care/Sentence Plan meeting within 10 working days of sentence. Includes
OM, offender and Substance Misuse Worker. Review meetings should be convened at a minimum of every 14/16
weeks until ATR completion
If the offender is returned to court in breach of their order the Substance
Misuse Worker may be required to attend to give evidence.
evidence of entrenched pattern of alcohol dependency evidence that the offender is susceptible to treatment
The offender needs to express a willingness to comply with the requirement.
Outcomes
Offenders who complete the Alcohol Treatment Requirement will have: examined their dependency, behaviour and issues of self-control
acknowledged the harmful impact of their behaviour on victims, community and self learned new skills to help them lead constructive and law-abiding lives
Requirements
The offender will be subject to the following:
Supervision in accordance with Probation Service National Standards
Community based interventions will focus on a range of issues including alcohol use, psychological well-being, offending behaviour and life skills
Required to lead a law-abiding lifestyle.
Attend all appointments as required by the Offender Manager, including appointments with treatment provider and other agencies
being returned to Court promptly for failure to comply
Making the Requirement
Minimum period is 6 months with a maximum of 3 years. Standard ATR length should be 6 months Treatment intervention can include:
Community Care Planned treatment: This can include a range of structured, specialist and evidence based prescribing interventions, psychosocial therapies focussing on alcohol misuse; brief
interventions; health improvement and the amelioration of alcohol related health problems;
psychological well-being; offending behaviour; life skills, accommodation issues; and social functioning. If appropriate, it can also include medically assisted alcohol withdrawal in the community
(detoxification) and prescribing interventions to reduce risk of relapse. Treatment and interventions will be delivered and managed through a written individual Care Plan.
Structured Day Programme: a formal care planned programme of day care focusing on issues including offending, relapse prevention, personal development, life skills, problem solving and other practical and emotional support.
Inpatient and Residential Structured Care Planned Treatment: including medicallyassisted alcohol withdrawal, stabilisation, rehabilitationand pharmacotherapy (medication) requiringspecialist residential or inpatient treatment Referrals to ADS.
Additionally, under the ATR, motivational work and solution focused interventions to improve or resolve an offender’s accommodation, attendance at mutual support e.g. Alcoholics Anonymous (AA) (if attendance can be confirmed), education, training or employment can be counted as contact providing it is included in the Sentence Plan and there is a clear audit trail.
All interventions in the ATR will be guided by a formal Care Plan written by the Substance Misuse worker in consultation with the offender.
All aspects of treatment outlined above will be covered by the ATR, which means that there is no need to include a Residence Requirement if an offender is to undertake residential treatment as a
NHS Nurses carry out a suitability assessment with the
client
NHS Nurses inform Keyworker. Care plan reviewed and alternative options explored
Key Worker arranges medication with GP. Informs NHS nurse this is available and
continues 1-1 support until detox is available
Detox. is carried out with Nurses attending daily for five days
Key worker sessions recommence and care plan reviewed to explore next steps
Key worker sessions resume care plan reviewed and other
options explored. Not Suitable
Suitable
Completed
Not Completed
The aims of accessing of community based detoxification are:
To reduce health inequalities across Blackpool caused by alcohol misuse
Contribute to reducing the amount of Alcohol related crime, including violent crime. To reduce the number of hospital admissions due to the misuse of Alcohol.
To prevent the death of clients through alcohol withdrawals.
Who is this pathway for?
Clients who are physically dependent on alcohol Clients who fit the criteria for community detoxification
Clients whom the GP is willing to prescribe appropriate medication.
Who is suitable for this pathway?
Clients who wish to become abstinent.
Clients who have adequate support at home to undertake the risk involved of withdrawing with minimal supervision.
Who is not suitable for this pathway?
Anyone who is not physically or psychologically dependent on Alcohol.
Anyone who has health problems which might prevent them withdrawing safely from alcohol with medication.
Detoxification
Client remains in Pre-detox group until bed is ready in detox unit. Enter
unit when appropriate
Return to ADS keyworker and review care plan exploring
alternative options
Return to ADS Key worker. Care Plan reviewed exploring further support needed. Agree next steps Accepted
Completed
Not Completed
The accessing of Inpatient detoxification aims are:
To reduce health inequalities across Blackpool caused by alcohol misuse Contribute to reducing the amount of Alcohol related crime, including violent crime.
To reduce the number of hospital admissions due to the misuse of Alcohol. To prevent the death of clients through alcohol withdrawals.
Who is this pathway for?
Clients who are physically dependent on alcohol
Clients who do not fit the criteria for community detoxification either due to physical health, adverse reaction to withdrawal symptoms or who do not have adequate support at home to safely withdraw whilst on medication
Who is suitable for this pathway?
Clients who wish to become abstinent.
Clients who are not suitable for community based detoxification but who require medication to withdraw safely.
Who is not suitable for this pathway?
Anyone who is not physically dependent on Alcohol.
Anyone who has health problems which might prevent them withdrawing safely from alcohol with medication.
Client responds?
Maintain contact for period of 3 months to motivate client back
into Tier 3 treatment
Client responds and re engagement process begins with AAO project worker
solving problems that have caused dis engagement from Tier 3. 12 week ICP
planned
Re referral to ADS. Support client through information session, assessment and allocation of key worker. AAO project
worker closes case at this point
Client returns to treatment
Close client as a refusal to engage with treatment though will accept as a re referral in the future or as a
treatment naïve client No
Yes
Yes
drinker who is able to cope and remain stable during waiting time
(4 week period).
non engagement with services. AAO workers will support in getting client
into ADS via Outreach
significant difficulties/barriers preventing them from engaging in
Tier 3 alcohol services
Completion of triage and assessment, allocation of keyworker. Access and gateway to Tier 2, 3 and 4
12 week wraparound service, provided outreach support to clients to achieve some stability, in order to (re) introduce to and
Nurse bleeps alcohol liaison service Inpatient or Outpatient Inpatient appointment made
Alcohol Liaison Nurse attends to conduct full assessment, inc Mental
Health screening
Mental Health issues?
Follow Dual Diagnosis Pathway
Full MH assessment and diagnostics reveal level of intervention following Dual
Diagnosis pathway
Detox required?
Detoxification included on and provided as part of
care plan
Detoxification supervised by ALNS over critical period
Brief Intervention Therapy begins
Patient has discharge plan
Patient agrees to outpatient intervention
Referral to outpatient clinic at point of discharge
Patient attends outpatient clinic
3 outpatient appointments
Patient content with outcome
Patient requests further intervention
-
Community Alcohol Services are discussed
Patient agrees
Referral made to CAS
Client attends?
Exit Assertive multi-agency follow up Outpatient Inpatient Yes No Yes No Yes No No Yes No Yes
Appointment made for client with Alcohol Assertive Outreach Team at
Drugline
Contact maintained with client until effectively engaged with alcohol services, including support offered
with Initial attendance
To facilitate onward referral for those requiring more structured alcohol treatment
Criteria
Any Individual with an alcohol issue in custody at Blackpool Police Station
Exclusion criteria would include those whose behaviour in the station presented a risk to arrest referral workers safety e.g violent behaviour and those heavily under the influence of alcohol who were unfit to be seen by a worker.
Client attends suitability assessment @ Open Access: Client and worker discuss expectations
Care plan review takes place Risk assessment updated Conf/Info Sharing updated TOP completed (if appropriate)
Pre-CAF completed / full CAF completed if appropriate Assessor becomes CC for 12 week period, volunteer support offered from point of assessment also for 12 week period.
Contact referring agency case suspended
Client is suitable and drug / alcohol free?
Coast is full?
A space is available client enters COAST
programme
Client relapses?
Client completes coast. Care plan complete / treatment
complete
Referral made to Academy and post-coast
support group
Contact referring tier 3 agency and /or referral to tier 2 treatment services in line with treatment plan.
Referral to other support services e.g. benefits, housing etc. CC to liaise with and update care plan.
COAST is full. Client enters pre-coast group
and 1-2-1 counselling Activate re- engagement policy, inform referring agency Re-referral made to tier 3 treatment service Suspended from programme
Client ends lapse becomes abstinent - return to COAST No No Yes Yes No No Aim
The aim of the pathway is to ensure access to treatment and support for service users who are abstinent from Alcohol and other illicit abd
dependence forming substances.
Who is this pathway for?
Service users who are abstinent / drug free and will benefit having from accessing the COAST community rehabilitation programme.
Who is the pathway not suitable for?
For clients who are alcohol and drug free (abstinent) and are able to attend an intensive (five days a week) community rehabilitation programme lasting between twelve and twenty four weeks .
Glossary of terms used
CC Care co-ordinator
DNA Did not attend
TOP Treatment outcome profile
OA Open Access
Vol Volunteer worker
or
or
or Yes
Client attends triage assessment completed/ updated inc info consent, risk assessment, care plan
developed/ updated, Pre-CAF completed.
Allocation within AAO project. Worker acts as CC
Case work begins, referal to ADS and or other agencies completed.
Handover to Tier 3 service within 12 weeks of assessment. Case closed to
AAO
Client engages with service? > 3 attempts? Exit Yes No Yes No Yes Aim
The aim of the pathway is to ensure access to treatment and support for service users with alcohol misuse problems in Blackpool whoare either treatment naive or eho have droped out of treatment.
Who is this pathway for?
Service users who are having significant problems with their alcohol misuse and are either treatment naive or who have droped out of treatment.
Who is the pathway not suitable for?
Those clients who solely experience problems with drug use or who are under 18 years of age
Glossary of terms used
CC Care co-ordinator DNA Did not attend
TOP Treatment outcome profile
OA Open Access
Vol Volunteer worker
AAO Assertive Alcohol Outreach CAF Common Assessment Framework ADS Addiction dependancy solutions
A Risk Assessment will be carried out at the start of client contact and at the Care Plan Review stage and at any other point of contact with the client when the worker or client considers it appropriate.
If a risk issues arises or a child protection issues arises then a risk management plan / child protection procedures will be followed. A CAF maybe completed with the consent of the parent if the family will benefit from extra support.
Detox Required ?
Application completed for appropriate detox either home or inpatient. Co-ordinating, to
be seamless with when rehab bed is available.
If accepted for Rehab treatment programmes client
makes a choice from those offered,
Detox Completed ?
Client enters Rehabilitation Centre for a period of three to six months. Review at 10
weeks if required.
Completed ?
Key worker sessions recommence and care plan
reviewed to explore next steps and aftercare provision
Accepted ?
Funding Application completed and forwarded
to NHS for approval
Approved ?
Key worker sessions resume care plan reviewed and other
options explored. No Yes Yes Yes Yes No No Yes No No