1. COMMUNITY- BASED- TREATMENT And REHABILITATION
for Drug Users and Recovering Drug Dependents
SONIA H. CARREON, RSW,MPA
HEAD, AFTERCARE AND MSWS

2. Training Contents WHAT IS COMMUNITY-BASED TREATMENT?
II COMMUNITY – BASED TREATMENT APROACH
1 Philosophy of the community-based approach
2 Service Delivery
3 Components and roles of community-based approach
3.1 Community (including outreach)
3.2 Community health centers
3.3 Social support services and NGOs
3.4 Law enforcement
III. INTERVENTIONS
1. Screening and Assessment
Screening questionnaires suitable for use in a community setting (by WHO & UNODC)1. ASSIST
IV. THE OUT PATIENT
THE COMMUNITY-BASED AFTERCARE PROGRAM: A MULTI- SECTORAL APPROACH

3. Training Objectives:
1. Participants would enhance their knowledge and skills on Community-Based Treatment (OPD and the Community- Based Aftercare Program for Recovering Drug Dependents: A Multi- Sectoral Team Approach) 2. Strengthen close coordination among community service providers; 3. Services for Drug Users and Recovering Drug dependents shall be integrated into existing health and Social Service; to be accessible to clients in the community.

4. 4. Strengthen and provide necessary knowledge and skills for the MADAC/ BADAC and line agencies for fast implementation of the Community-Base OPD and Aftercare Treatment.

5. 5. Aimed at helping practitioners in the health, social work and law enforcement sectors implement community-based Treatment.
Encourage the line agencies to promote the comprehensive approach, taking into account different needs(Health, Education, Employment, housing, and other socio-psychosocial, spiritual aspects).

6. Drug use disorders are health conditions that can affect any individual, family and community.
Yet People tend to keep away from the necessary services due to misperceptions, fears of social and legal consequences, and discrimination.

7. On the other hand,
if they get help,
people suffering from drug use disorders can and do manage their condition, recover and lead happy, productive, and full lives.

8. Community-Based Interventions
This program is based on the joint program of the United Nation Organization on Drug and Crime (UNODC) together with WHO that promotes a health-oriented approach to drug dependence.

9. WHAT IS COMMUNITY- BASED- TREATMENT
for Drug Users and Recovering Drug Dependents?

10. LAW ENFORMENT, HEALTH SECTORS SOCIAL SECTORS
It is a multi-sectoral approach involving
LAW ENFORMENT,
HEALTH SECTORS
SOCIAL SECTORS
will produce the most effective response in terms of reducing drug use and providing needed services to persons affected by drug use in the community.
Adopted from the Guidance for Community-Based Treatment and Care Services for People affected by Drug Use and Dependence in Southeast Asia
(United Nations Office on Drugs and Crime (UNODC))

11. to work harmoniously to implement community-based Treatment.
Continuation………………
It aimed to encourage an integrated service delivery from practitioners from
- Health Sectors
- Social Sectors
- Law enforcement Sectors
to work harmoniously to implement community-based Treatment.

12. “Working together can have a positive impact
on the future of youth in your community”
From: Community action on drug abuse prevention

13. How these sectors work harmoniously to implement community-based Treatment.
- Health Sectors
- Social Sectors
- Law enforcement Sectors

14. Problems from getting INTOXICATED - SOCIAL in nature Health problem
Family, friends
Law
Hangover
Feeling sick, vomiting
Stomach pains and problems
Head injuries from falls
Other accidents and injuries
Drowning
Accidental overdose
Arguments
Fighting
Neglecting children
Violence at home
Sexual assault
Child abuse
Being intoxicated
Doing damage to things
Drink driving
Assaulting people
Accidental killing
Drug possession offences

15. Problems from REGULAR or EXESSIVE
Health problem
Family, friends
Law
Brain and nerve damage
Mental health problems
Heart disease, diabetes, cancer
Infectious diseases
Sleep and dental problems
Family problems Marriage problems
Work problems Neglected children No food in the house
Drug possession offences
Drink driving offences
Not paying bills
Sex work
Drug dealing

16. Philosophy of the community-based approach
“To ensure a holistic approach to treatment and care of drug users with the intensity of essential care varied according to the nature and complexity of the problems
experienced by the individual”
The approach is broadly based on the World Health Organization Pyramid of Mental Health Services (See Figure 1).

17. Figure 1. Service organization pyramid for substance use disorder treatment and care

18. Benefits from community-based interventions

19. There is active patient involvement ;
Close linkages and collaboration between service providers in the community;
The process usually starts and is sustained within the community where the drug user and his/her family lives ;
There is active patient involvement ;

20. Increase community support for people with drug problems and promote supportive public opinions and health policy.
Help reduce discrimination and social marginalization; reducing the stigma of drug use ;
It promotes a paradigm change within society to acknowledge drug dependence as a multi-factorial disorder.

21. Enable people with drug-related problems to have improved access to a range of quality services from education, information and drug counselling, to assistance in stopping or reducing drug use and avoiding the harmful health and social consequences of drug use,
Treatment provided in the community is less invasive than other treatments, fostering independence of the client; more accessible and affordable.

22. COMMUNITY-BASED TREATMENT AND CARE SERVICE DELIVERY

24. Community- Based Treatment and Rehabilitation Program
Intake,
Screening and Assessment
ADMISSION?
Yes = TRC
No = for OPD/
community Based AFTERCARE treatment
MADAC/ BADAC
Client/ Drug abuser Surrenders
DOH-TRC or Hospital if client needs detoxification, or other health complications due to drug use
Discharged from In-patient

25. “The journeys of the people who are affected by drug use and dependence through the treatment and rehabilitation system begin and end in the community”

26. SOCIAL WORKERS ARE CASE MANAGERS IN MUNICIPAL SWD TO CONDUCT PSYCHOSOCIAL COUNSELLING, SOCIAL WORK INTERVENTIONS, NETWORKING AND REFERRALS

27. THREE MAJOR COMPONENTS
Community organizations including NGOs
help identify drug users,
conduct basic screening of drug problems and refer to primary health services when required;
focus on preventive education;
health promotion and on the delivery of basic support;
reintegration and rehabilitation services

28. Primary health services
health care services act as an interface between families and community programs on the one hand and hospitals.
Social Welfare Agencies, and NGOs
provide Social Services ,
offer education,
vocational and skills training,
income generation opportunities,
micro-credits, etc.

29. Model of community-based treatment and care for people who are affected by drug use and dependence

30. Components and roles of community-based approach

31. 1. Community (COM. Org.)(including outreach)
Major tasks: Awareness raising’, public education and health promotion, highlighting the complexity of drug use behaviors and consequences.
Role of Community-based workers
Help identify drug users, conduct preliminary screening interviews and basic needs assessment of the user and his/her family and together devise an ‘action plan.’

32. 2. Community health centers
Roles:
They provide basic health care to drug abusers

33. Roles:
The health center offers a good opportunity for brief counselling, which is appropriate for people who do not have severe problems such as clients for OPD.

34. Provide screening for substance use problems and associated health conditions, and provide basic primary health services.
Refer clients with complex problems of psychiatric comorbidity, polydrug use or serious medical problems to hospitals.
Offers basic education and brief counselling on risks of drug-related problems, working in tandem with community organizations, outreach workers and families.

35. Assessment guide for social workers or CO Team

37. Key activities of Health and Social Workers and Other Community Health Team
• Provide advocacies and education to the community;
• Provide sensitivity training on drug use to partner agencies;
• Collaborate with stakeholders in the community (including law enforcement) in conducting preliminary screening
for drug and alcohol use;
• Collaborate with other organizations working with people who are affected by drug use and dependence and HIV,
and providing rehabilitation training;

38. relapse prevention when indicated
Continuation…………
• Provide psychosocial counselling to people affected by drug use and dependence and their families
• Provide rehabilitation services such as life skills and vocational training
• Support mutual-help and support groups for people affected by drug use and dependence
• Provide home visits and home-based care when required and help support non- pharmacological withdrawal and
relapse prevention when indicated

39. Law enforcement
There are fundamental differences between drug dependence treatment and law enforcement procedures.
In the context of law enforcement, illicit
drug use is regarded as criminal behavior.

40. A positive paradigm of community-based care can occur when police recognize the value of a health approach to drug use and dependence.
- Police attitude towards drug dependence treatment will change once drug dependence is recognized as a chronic health disorder having negative health and social impact with many contributing factors, the required response will also be understood as a long term health intervention.

41. Promoting treatment for drug dependence as an alternative to punishment will provide support for an effective approach with a continuum of care.

42. A community-based approach allows for careful screening and assessment of the nature and severity of drug problems and allows the police to use a range of strategies to deal with people affected by drug use and dependence;

43. SUGGESTED THERAPY SERVICES

44. Social Behavior and Network Therapy (SBNT)
The basic principle of the approach is to encourage a change of social network, from one that is supportive of drug use to one that is supportive of abstinence.
Access to welfare supports, together with encouragement from friends, partners, children, parents and other significant individuals is commonly involved in the pathway out of drug use disorders.