1. SOHO RAPID ACCESS CLINIC. AIMS: n To provide a client focussed, low threshold flexible prescribing service. n To offer an easily accessible assessment and treatment service to rough sleepers in Westminster. n To provide information and advice to drug and alcohol users aimed at harm minimisation.

2. BACKGROUND: n Pilot project Oct 99-April 00, partnership between Westminster DAT, BKCW, Westminster Social Services, Hungerford Project and Rivendell Clinic. n Engaging “rough sleeping” drug users in the Soho Area, assessment, prescribing services, access to detox and rehab. n Over 70 assessments carried out in 6month period. n Follow up shows good levels of retention in treatment, but increase in use of Crack. Application for funding to R.S.U, which is successful. n Oct 00 Soho Rapid Access Clinic works from the Hungerford Project, while waiting for premises. Hungerford Project continue to be closely associated with SRAC, which is now funded jointly by BKCW and The Rough Sleepers Unit.

3. BACKGROUND: n SRAC opens at Dean St Hostel Jan 2001, in partnership with Bridge Housing and Arlington Care Association. n SRAC continues to be funded by R.S.U until July 2002, when it is absorbed into CNWL Mental Health Trust, and funded by Westminster Substance Misuse Commissioners. n All referrals to SRAC are made through named referrers, who work for external agencies, there is a close relationship with the local Substance Misuse Units. n SRAC is staffed by a consultant psychiatrist, a team co- ordinator, staff grade Dr, 3 clinical nurse specialists and an administrator.

4. PARTNERSHIP WORK n SRAC currently works with a number of partners. n Equinox, Hungerford, Central CAT team, Westminster CAT team, Passage Centre, Mobile Needle Exchange, Connections at St. Martins, are the current main referrers. n The clinic is based in Dean St Hostel, which is run by Bridge Housing. n All referrals are accompanied by their external worker. n Extensive liaison and support from SRAC staff to referrers and agencies involved with service users.

5. SERVICES OFFERED n Assessment, medical, psychological and social. Access to full psychiatric assessment n Referral for in patient detox n Referral to Care Managers for funding n Methadone titration and on going prescribing n Subutex prescribing n Community alcohol detox n Off site assessment if needed n Treatment for a twelve week period n Assurance of transfer of prescribing n Re titration on release from prison n Extensive harm minimisation information relating to drug using practices

6. PHILOSOPHY & MODEL OF WORK n The assessment workers are trained nurses, who have worked in drug services in both the voluntary and statutory sector, and have experience within the field of homelessness. n Although the assessment tools are cumbersome, the clinic practises flexibility with information gathering, aiming for a sensitive and detailed history to assist with titration. n Medical appointments are flexible, most prescribing appointments offered within two working days, with opportunity for “on the spot titration” if appropriate. n The atmosphere of the clinic is informal, and sensitive to the social exclusion of it’s service users

7. A BRIEF GLIMPSE INTO THE INJECTING PRACTICES AND CONCERNS OF A GROUP OF ROUGHSLEEPERS

8. BACKGROUND n The Soho Rapid Access Clinic noticed increasing reports of “combined” drug injecting, heroin & crack cocaine prepared and injected together. n The client group all have a recent and often protracted history of rough sleeping, little or negative experience of prescribing services. n Traditional treatment services have had difficulty engaging this population in treatment. n Service users were expressing concern about the lack of information available on “snowballing”, experiencing more injecting problems, and having difficulty stopping or controlling their combination use.

9. RESPONSE: n Service user questionnaire completed by 14 service users, seeking their views and experiences. n No previous experience of a programme for crack use. n Interest in additional help with problems they associated with snowballing and crack use. n Triggers for increasing or continuing use were: money, craving, boredom and living in a West End hostel where drug use is pervasive

10. RESPONSE: n Focus group to invite user involvement and consultation. n Feedback from this group has informed, and been part of the development of a series of user informed supportive educational groups. n The group is currently in a period of review, having run at three West End hostels, in the substance misuse units.

11. COMBINATION DRUG USE QUESTIONAIRE n Basic questionnaire completed by 91 service users. This is in addition to service requirements. n All service users asked at initial contact about sharing injecting equipment., approximately 98% confirm sharing, many within the past 24 hrs. n Also high levels of groin injecting, amongst this group, users site ease of access being a primary reason for groin injecting.

22. SUMMARY n What can agencies learn from excluded service users who are homeless? n What prevents services from keeping up with the changing drug use patterns/market ? n How can we respond to drug using practices which challenge traditional treatment provision? n How can we respond to the increase in injecting problems, and service user’s concerns?