1. Care Packages in Substance Misuse Treatment Development of MH Care Clusters: overview  Service users in MH, clinicians found: idiosyncratic referral pathways + conflicting views on priorities + differing views on effective treatment  idiosyncratic packages of care Research  Care Clusters + Clinical Decision Support Tool: Service users with similar needs  same Care Cluster Clustering based on dimensions, including: ■ type & severity of symptoms ■ complexity and chronicity of disorder + knowledge of case history (diagnostic and historical information)  standardised Packages of Care, based on needs

2. MH Care Clusters and Care Packages  Clusters: developed common assessment tool (MH clustering tool)  allocate to appropriate ‘cluster’  begin to identify appropriate package of care  Care packages: –Activities of Intervention  9 major categories, agreed aims of activities –Care Packages combine ‘Core’ & ‘Additional’ elements of care –Service Users with broadly similar needs receive the Core Elements in a Care Package + specific Additional Elements appropriate to their particular needs –Elements are linked to NICE and other best practice guidance

3. Adapting the Care Packages approach to Substance Misuse Same principles as in MH:  Service Users with broadly similar needs receive similar Care Packages  Combinations of evidence-based interventions to achieve intended outcomes How to organise Care Clusters & Care Packages for Substance Misuse?  cluster on two dimensions: –primary substance –complexity (incl. polydrug use, risk, social factors, mental health…)  5 main Care Packages, plus MH interventions in SM treatment: ■ opioid dependence (complex) ■ opioid dependence (non-complex) ■ alcohol dependence (complex) ■ alcohol dependence (non-complex) ■ other substance misuse ■ MH interventions in SM treatment

4. Substance Misuse Care Packages  Some Core and Additional elements (interventions) are common to ALL Care Packages  Other elements only appear in one or two Care Packages  Example Care Package: Complex Alcohol Dependence Core elements specific to this care package: –Alcohol dependence: detoxification prescribing (community) –Alcohol dependence: B vitamin prescribing –Alcohol dependence: relapse prevention prescribing Additional elements for this care package, include: –Opioid dependency - substitute prescribing: detoxification –TIER 4 In-patient treatment –Tier 4 Care co-ordination

5. Competences  Care Packages combine elements delivered by different staff with different competences  Psychosocial and other specialist competences: clarify ‘levels’ for elements of Care Packages  Draws on Routes to Recovery: Psychosocial Interventions for Drug Misuse, all relevant NICE guidance, UK Clinical guidelines  Keywork, keywork plus, specialist competences What are ‘Recovery’ competences..?  Key skills and attributes of practitioners  Service culture  promotes ‘recovery values’ and attitudes in practitioners  structured approach to review and recovery planning