“Patient Placement Criteria” John Marsden NTA Senior Academic Advisor Reader in Addiction Psychology, Institute of Psychiatry, KCL National Residential Rehab Events - London 29 th March 2011 Effective treatment. Changing lives

Background

 No “one size fits all” recovery pathway  Some people have strong preferences about their care  Wide differences in treatment needs  Evidence for layered or combination interventions • Single prescribing or psychosocial interventions • Combination prescribing and/or psychosocial packages  Evidence from the adaptive continuing care literature  Principle of changing direction if no therapeutic benefit

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PPC expert sub-group

          

David Best

UWS (chair)

Nicola Adamson

Worcestershire Commissioning

Karen Biggs

Phoenix Futures

Jayne Bridge

Mersey Care

Wendy Dawson

Ley Community

Ed Day

Uni of Birmingham

Vivienne Evans

Adfam

Jason Gough

Yorks. & Humber Service User Forum

Kate Hall

GMW

Linda Harris

Wakefield & RCGP

Dave Knight

RCN    

Tom Kirkwood Tim Leighton

TTP Action on Addiction

Peter McDermott NTA project team

The Alliance DH observers: Mark Prunty &  International correspondents:

William White, Alexandre Laudet, Arthur Evans, Mike Dennis, Robert Ali, Steve Shoptaw, Min Zhou Effective treatment. Changing lives

Goal

 Better matching of individuals to treatment packages  Promote clinical expertise and personal preference  Progressive treatment system; recovery-oriented  A wider array of evidence supported interventions

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“PPC” in practice

 Resource for personalising and optimising treatment  Screening for risk, need and preference  Adaptive care criteria (sequencing and layering)  Criteria for judging therapeutic response  Justification for specific intervention or continuing care

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PPC – adaptive care criteria

Screening process 4 individual specifiers: 1. Current recovery/treatment status 2. Substance use 3. Positive intervention preferences 4. Contra-indications

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PPC individual specifiers

Treatment Preferences

☐ Stay in local community ☐ Medication-assisted recovery ☐ Active involvement of social network in recovery plan ☐ Inpatient detoxification ☐ Intensive shorter or longer-term residential treatment in local area (1-12 months) ☐ Intensive shorter-term residential treatment away from locality (1-6 months) ☐ Intensive longer-term residential treatment away from locality (6-12 months) ☐ Preference to continue to work on recovery goals at same or different level of care

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PPC individual specifiers

Contra-indications

☐ Significant risk of domestic violence ☐ Lack of drug-free partner/spouse ☐ Significant cognitive impairment or learning difficulties ☐ Active hepatitis or abnormal liver parameters ☐ Unwilling/able to sustain the regularity of attendance required ☐ Unwilling/able to comply with conditions of residence ☐ Current or previous experience of psychosis ☐ Unlikely to be able to maintain 24 hour abstinence in a day programme setting ☐ In education, training or employment which is best maintained during treatment ☐ Has dependants, no arrangements for care can be made or are inappropriate

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3

domains 1. Severity

(dependence, health, risk, neglect)

2. Complexity

(response, environment)

3. Strengths

(personal, social, economic)

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18 PPC Dimensions

Severity and complexity

☐ Physiological dependence ☐ Psychological dependence ☐ Overdose risk ☐ Relationships and communication ☐ General medical conditions ☐ Psychological disorders ☐ Personality factors ☐ Trauma and stress ☐ Criminal involvement ☐ Risk and neglect ☐ Treatment and recovery history ☐ Recovery environment

Strengths (recovery capital)

☐ Change motivation and therapeutic alliance ☐ Quality of living situation ☐ Supportive social network ☐ Roles and responsibilities ☐ Vocational skills and independence ☐ Coping and outlook

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PPC – taking it forward

 Further development with field  Pilot testing  Monitoring and refinement  Does using produce better outcomes?

 Incorporate outcome risk adjustment  Adjust for push and pull factors

Effective treatment. Changing lives