1. EQUS Conference - Brussels, June 16, 2011 Ambros Uchtenhagen, Michael Schaub Minimum Quality Standards in the field of Drug Demand Reduction Parallel Session A: Treatment and Rehabilitation

2. Treatment/rehabilitation standards with high consensus Treatment/rehabilitation standards with moderate consensus for discussion Overview 2

3. TREATMENT / REHABILITATION Standards with high consensus (more than 80% agreement) 3

4. Structural Standards of Services 1. Physical environment: space Evidence: Source: Lit review 19 Expert opinion 32 Expert consensus 39 Research project 6 Practice experience 32 Documents per country: 4

5. (e.g. service has separate rooms for individual counselling) - In my country, this standard is… n = 149 5 Structural Standards of Services 1. Physical environment: space

6. Structural Standards of Services 2. Indication criteria: diagnosis Evidence: Source: Lit review 49 Expert opinion 58 Expert consensus 74 Research project 22 Practice experience 54 Documents per country: 6

7. (treatment indication is always made on the basis of a diagnosis) n = 145 7 Structural Standards of Services 2. Indication criteria: diagnosis - In my country, this standard is…

8. Structural Standards of Services 3. Staff composition: education Evidence: Documents per country:Source: Lit review 44 Expert opinion 62 Expert consensus76 Research project 25 Practice experience 60 8

9. (e.g. at least half of staff has a diploma in medicine, nursing, social work, or psychology) n = 142 9 Structural Standards of Services 3. Staff composition: education - In my country, this standard is…

10. Outcome Standards at the System Level 4. Goal: health stabilisation/improvement Evidence: Source: Lit review 62 Expert opinion 77 Expert consensus 93 Research project 31 Practice experience 58 Documents per country: 10

11. (treatment must be aimed at improvement or stabilisation of health) n = 142 11 Outcome Standards at the System Level 4. Goal: health stabilisation/improvement - In my country, this standard is…

12. Outcome Standards at the System Level 5. Goal: social stabilization/integration Evidence: Source: Lit review 53 Expert opinion 66 Expert consensus 89 Research project 28 Practice experience 53 Documents per country: 12

13. 13 Outcome Standards at the System Level 5. Goal: social stabilization/integration (treatment must be aimed at improvement of social stabilisation or integration) n = 142 - In my country, this standard is…

14. Outcome Standards at the System Level 6. Goal: reduced substance use Evidence: Source: Lit review 62 Expert opinion 78 Expert consensus 93 Research project 37 Practice experience 65 Documents per country: 14

15. 15 Outcome Standards at the System Level 6. Goal: reduced substance use (treatment must be aimed at a reduction of substance use e.g. helping the client/patient to reduce the use or to abstain from psychotropic substances) n = 142 15 - In my country, this standard is…

16. Outcome Standards at the System Level 7. Utilisation monitoring Evidence: Source: Lit review 18 Expert opinion 33 Expert consensus 37 Research project 15 Practice experience 29 Documents per country: 16

17. 17 Outcome Standards at the System Level 7. Utilisation monitoring (services must report periodically the occupancy of treatment slots or beds) n = 142 17 - In my country, this standard is…

18. Outcome Standards at the System Level 8. Internal evaluation Evidence: Source: Lit review 18 Expert opinion 33 Expert consensus 37 Research project 15 Practice experience 29 Documents per country: 18

19. 19 Outcome Standards at the System Level 8. Internal evaluation (services must regularly perform an internal evaluation of their activities and outcomes) n = 142 19 - In my country, this standard is…

20. Process Standards at the Service Level 9. Assessment procedures (1): substance use history etc. Evidence: Source: Lit review 78 Expert opinion 89 Expert consensus 105 Research project 40 Practice experience 78 Documents per country: 20

21. 21 Process Standards at the Service Level 9. Assessment procedures (1) n = 84 21 substance use history, diagnosis and treatment history have to be assessed - In my country, this standard is…

22. Process Standards at the Service Level 10. Assessment procedures (2): somatic status etc. Evidence: Documents per country: 22 Source: Lit review 65 Expert opinion 78 Expert consensus 89 Research project 39 Practice experience 63

23. 23 n= 84 23 somatic status and social status have to be assessed Process Standards at the Service Level 10. Assessment procedures (2) - In my country, this standard is…

24. Process Standards at the Service Level 11. Individualised treatment planning Evidence: Source: Lit review 83 Expert opinion 98 Expert consensus 116 Research project 46 Practice experience 86 Documents per country: 24

25. 25 Process Standards at the Service Level 11. Individualised treatment planning n = 84 25 (treatment plans are tailored individually to the needs of the patient) - In my country, this standard is…

26. Process Standards at the Service Level 12. Informed consent Evidence: Source: Lit review 68 Expert opinion 80 Expert consensus 93 Research project 36 Practice experience 71 Documents per country: 26

27. 27 Process Standards at the Service Level 12. Informed consent n = 84 27 (patients must receive information on available treatment options and agree with a proposed regime or plan before starting treatment) - In my country, this standard is…

28. Process Standards at the Service Level 13. Written client records Evidence: Documents per country: 28 Source: Lit review 65 Expert opinion 75 Expert consensus 92 Research project 32 Practice experience 68

29. 29 Process Standards at the Service Level 13. Written client records n = 84 29 (assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each patient in a patient record) - In my country, this standard is…

30. Process Standards at the Service Level 14. Confidentiality of client data Evidence: Documents per country: 30 Source: Lit review 60 Expert opinion 75 Expert consensus 83 Research project 34 Practice experience 64

31. 31 Process Standards at the Service Level 14. Confidentiality of client data n = 84 31 (patient records are confidential and exclusively accessible to staff involved in a patients treatment or regime) - In my country, this standard is…

32. Process Standards at the Service Level 15. Routine cooperation with other agencies Evidence: Source: Lit review 62 Expert opinion 85 Expert consensus 102 Research project 30 Practice experience 74 Documents per country: 32

33. 33 Process Standards at the Service Level 15. Routine cooperation with other agencies n = 84 33 (whenever a service is not equipped to deal with all needs of a given patient, an appropriate other service is at hand for referral) - In my country, this standard is…

34. Process Standards at the Service Level 16. Continued staff training Evidence: Documents per country: 34 Source: Lit review 55 Expert opinion 74 Expert consensus 86 Research project 31 Practice experience 64

35. 35 Process Standards at the Service Level 16. Continued staff training n = 84 35 (staff is regularly updated on relevant new knowledge in their field of action) - In my country, this standard is…

36. Process Standards of Interventions 17. Assessment procedures (1): substance use history etc. Evidence: Documents per country: 36 Source: Lit review 78 Expert opinion 89 Expert consensus 105 Research project 40 Practice experience 78

37. 37 Process Standards of Interventions 17. Assessment procedures (1) n = 55 37 substance use history, diagnosis and treatment history have to be assessed - In my country, this standard is…

38. Process Standards of Interventions 18. Assessment procedures (2): somatic status etc. Evidence: Source: Lit review 65 Expert opinion 78 Expert consensus 89 Research project 39 Practice experience 63 Documents per country: 38

39. 39 n = 55 39 somatic status and social status have to be assessed Process Standards of Interventions 18. Assessment procedures (2) - In my country, this standard is…

40. Process Standards of Interventions 19. Assessment procedures (3) Evidence: Source: Lit review 63 Expert opinion 74 Expert consensus 85 Research project 36 Practice experience 64 Documents per country: 40

41. 41 Process Standards of Interventions 19. Assessment procedures (3) n = 55 41 psychiatric status has to be assessed - In my country, this standard is…

42. Process Standards of Interventions 20. Individualised treatment planning Evidence: Documents per country: 42 Source: Lit review 83 Expert opinion 98 Expert consensus 116 Research project 46 Practice experience 86

43. 43 Process Standards of Interventions 20. Individualised treatment planning n = 55 43 (treatment plans are tailored individually to the needs of the patient) - In my country, this standard is…

44. Process Standards of Interventions 21. Informed consent Evidence: Documents per country: 44 Source: Lit review 68 Expert opinion 80 Expert consensus 93 Research project 36 Practice experience 71

45. 45 Process Standards of Interventions 21. Informed consent n = 55 45 (patients must receive information on available treatment options and agree with a proposed regime or plan before starting treatment) - In my country, this standard is…

46. Process Standards of Interventions 22. Written client records Evidence: Source: Lit review 65 Expert opinion 75 Expert consensus 92 Research project 32 Practice experience 68 Documents per country: 46

47. 47 Process Standards of Interventions 22. Written client records n = 55 47 (assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each patient in a patient record) - In my country, this standard is…

48. Process Standards of Interventions 23. Confidentiality of client data Evidence: Source: Lit review 60 Expert opinion 75 Expert consensus 83 Research project 34 Practice experience 64 Documents per country: 48

49. 49 Process Standards of Interventions 23. Confidentiality of client data n = 55 49 (patient records are confidential and exclusively accessible to staff involved in a patients treatment or regime) - In my country, this standard is…

50. Process Standards of Interventions 24. Routine cooperation with other agencies Evidence: Documents per country: 50 Source: Lit review 62 Expert opinion 85 Expert consensus 102 Research project 30 Practice experience 74

51. 51 Process Standards of Interventions 24. Routine cooperation with other agencies n = 55 51 (whenever a service is not equipped to deal with all needs of a given patient, an appropriate other service is at hand to referral) - In my country, this standard is…

52. Process Standards of Interventions 25. Continued staff training Evidence: Source: Lit review 55 Expert opinion 74 Expert consensus 86 Research project 31 Practice experience 64 Documents per country: 52

53. 53 Process Standards of Interventions 25. Continued staff training n = 55 53 (staff is regularly updated on relevant new knowledge in their field of action) - In my country, this standard is…

54. TREATMENT / REHABILITATION Standards with moderate consensus (50-80% agreement) 54

55. Evidence: 55 Documents per country: Structural Standards of Services 1. Accessibility: location Source: Lit review 22 Expert opinion 28 Expert consensus 31 Research project 14 Practice experience 26

56. 56 Structural Standards of Services 1. Accessibility: location (service can easily be reached by public transport ) n = 153 56 - In my opinion, this standard should be a minimal standard in my country…

57. 57 Structural Standards of Services 1. Accessibility: location (service can easily be reached by public transport ) n = 153 - In my country, this standard is…

58. 58 Structural Standards of Services 1. Accessibility: location (service can easily be reached by public transport ) n = 25 r = 50 - …feasible, but meets problems – specification

59. 59 Structural Standards of Services 1. Accessibility: location (service can easily be reached by public transport ) No significant differences between investigated regions (Northern Europe, Western & Southern Europe, Central & Eastern Europe) Regional differences:

60. Evidence: 60 Source: Lit review 28 Expert opinion 39 Expert consensus 45 Research project 12 Practice experience 40 Documents per country: Structural Standards of Services 2. Physical environment: safety

61. 61 Structural Standards of Services 2. Physical environment: safety (service is equipped for reanimation and other emergencies like e.g. management of overdose) n = 150 61 - In my opinion, this standard should be a minimal standard in my country…

62. 62 Structural Standards of Services 2. Physical environment: safety (service is equipped for reanimation and other emergencies like e.g. management of overdose) n = 150 62 - In my country, this standard is…

63. 63 Structural Standards of Services 2. Physical environment: safety (service is equipped for reanimation and other emergencies like e.g. management of overdose) 63 n = 17 r = 31 - …feasible, but meets problems – specification

64. 64 Structural Standards of Services 2. Physical environment: safety (service is equipped for reanimation and other emergencies like e.g. management of overdose) 64 Regional differences: No significant differences between investigated regions, but participants from Northern Europe tend to answer more often Yes for GPs office-based services and for non-specialised teams

65. Evidence: 65 Source: Lit review 38 Expert opinion 52 Expert consensus 63 Research project 19 Practice experience 51 Documents per country: Structural Standards of Services 3. Staff composition: transdisciplinarity

66. 66 Structural Standards of Services 3. Staff composition: transdisciplinarity n = 143 (e.g. service employs a multidisciplinary team composed of at least 3 professions) 66 - In my opinion, this standard should be a minimal standard in my country…

67. 67 Structural Standards of Services 3. Staff composition: transdisciplinarity n = 143 (e.g. service employs a multidisciplinary team composed of at least 3 professions) 67 - In my country, this standard is…

68. 68 Structural Standards of Services 3. Staff composition: transdisciplinarity (e.g. service employs a multidisciplinary team composed of at least 3 professions) 68 n = 25 r = 47 - …feasible, but meets problems – specification

69. 69 Structural Standards of Services 3. Staff composition: transdisciplinarity (e.g. service employs a multidisciplinary team composed of at least 3 professions) 69 Non-specialised teams: significantly more often No answer and less Yes-answers from Central & Eastern Europe Significantly less Already implemented-answers from Northern Europe (Only 21 participants from Northern Europe!) Regional differences:

70. Evidence: 70 Source: Lit review 13 Expert opinion 31 Expert consensus 33 Research project 10 Practice experience 26 Documents per country: Outcome Standards at the System Level 4. Discharge monitoring

71. 71 Outcome Standards at the System Level 4. Discharge monitoring (e.g. ratio of regular / irregular discharges, retention rates etc. have to be periodically monitored) n = 142 71 - In my opinion, this standard should be a minimal standard in my country…

72. 72 Outcome Standards at the System Level 4. Discharge monitoring (e.g. ratio of regular / irregular discharges, retention rates etc. have to be periodically monitored) n = 142 72 - In my country, this standard is…

73. 73 Outcome Standards at the System Level 4. Discharge monitoring (e.g. ratio of regular / irregular discharges, retention rates etc. have to be periodically monitored) 73 n = 22 r = 41 - …feasible, but meets problems – specification

74. 74 Outcome Standards at the System Level 4. Discharge monitoring (e.g. ratio of regular / irregular discharges, retention rates etc. have to be periodically monitored) 74 Regional differences: No significant differences between investigated regions GPs office-based services: tendency towards more Yes-answers from Northern Europe

75. Evidence: 75 Source: Lit review 18 Expert opinion 36 Expert consensus 39 Research project 14 Practice experience 32 Documents per country: Outcome Standards at the System Level 5. External evaluation

76. 76 Outcome Standards at the System Level 5. External evaluation (services must regularly allow an evaluation of their activities and outcomes by an independent external evaluator) n = 141 76 - In my opinion, this standard should be a minimal standard in my country…

77. 77 Outcome Standards at the System Level 5. External evaluation (services must regularly allow an evaluation of their activities and outcomes by an independent external evaluator) n = 141 77 - In my country, this standard is…

78. 78 Outcome Standards at the System Level 5. External evaluation (services must regularly allow an evaluation of their activities and outcomes by an independent external evaluator) 78 n = 30 r = 63 - …feasible, but meets problems – specification

79. 79 Outcome Standards at the System Level 5. External evaluation (services must regularly allow an evaluation of their activities and outcomes by an independent external evaluator) 79 Regional differences: GPs office-based services: significantly more Yes-answers from Northern Europe

80. Evidence: 80 Source: Lit review 13 Expert opinion 12 Expert consensus 13 Research project 7 Practice experience 12 Documents per country: Outcome Standards at the System Level 6. Cost-effectiveness ratio

81. 81 Outcome Standards at the System Level 6. Cost-effectiveness ratio (positive outcomes like e.g. number of abstinent patients in relation to treatment costs) n = 140 81 - In my opinion, this standard should be a minimal standard in my country…

82. 82 Outcome Standards at the System Level 6. Cost-effectiveness ratio (positive outcomes like e.g. number of abstinent patients in relation to treatment costs) n = 140 82 - In my country, this standard is…

83. 83 Outcome Standards at the System Level 6. Cost-effectiveness ratio (positive outcomes like e.g. number of abstinent patients in relation to treatment costs) 83 n = 31 r = 69 - …feasible, but meets problems – specification

84. 84 Outcome Standards at the System Level 6. Cost-effectiveness ratio (positive outcomes like e.g. number of abstinent patients in relation to treatment costs) 84 Prison-based services: significantly less Yes- and more No- answers from Western & Southern Europe Regional differences:

85. Evidence: 85 Source: Lit review 2 Expert opinion 2 Expert consensus 2 Research project 2 Practice experience 2 Documents per country: Outcome Standards at the System Level 7. Cost-benefit ratio

86. (tangible benefits like e.g. years of increased life expectancy in relation to treatment costs) n = 139 86 - In my opinion, this standard should be a minimal standard in my country…

87. Outcome Standards at the System Level 7. Cost-benefit ratio (tangible benefits like e.g. years of increased life expectancy in relation to treatment costs) n = 139 87 - In my country, this standard is…

88. Outcome Standards at the System Level 7. Cost-benefit ratio (tangible benefits like e.g. years of increased life expectancy in relation to treatment costs) 88 n = 23 r = 49 - …feasible, but meets problems – specification

89. Outcome Standards at the System Level 7. Cost-benefit ratio (tangible benefits like e.g. years of increased life expectancy in relation to treatment costs) 89 Regional differences: No significant differences between investigated regions

90. Evidence: 90 Source: Lit review 63 Expert opinion 74 Expert consensus 85 Research project 36 Practice experience 64 Documents per country: Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed

91. Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed n = 84 91 - In my opinion, this standard should be a minimal standard in my country…

92. Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed n = 84 92 - In my country, this standard is…

93. Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed 93 n = 27 r = 49 - …feasible, but meets problems – specification

94. Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed 94 Regional differences: GPs office-based services, non-specialised teams: significantly less Yes-answers and more often No answer from Central & Eastern Europe

95. TREATMENT / REHABILITATION Standards with low consensus (less than 50% agreement) 95 NONE