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Effective treatment. Changing lives Patient Placement Criteria John Marsden NTA Senior Academic Advisor Reader in Addiction Psychology, Institute of Psychiatry,

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Presentation on theme: "Effective treatment. Changing lives Patient Placement Criteria John Marsden NTA Senior Academic Advisor Reader in Addiction Psychology, Institute of Psychiatry,"— Presentation transcript:

1 Effective treatment. Changing lives 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

2 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

3 Effective treatment. Changing lives 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 TTP Tim Leighton Action on Addiction Peter McDermott The Alliance DH observers: Mark Prunty & NTA project team International correspondents: William White, Alexandre Laudet, Arthur Evans, Mike Dennis, Robert Ali, Steve Shoptaw, Min Zhou

4 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

5 Effective treatment. Changing lives 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

6 Effective treatment. Changing lives PPC – adaptive care criteria Screening process 4 individual specifiers: 1. Current recovery/treatment status 2. Substance use 3. Positive intervention preferences 4. Contra-indications

7 Effective treatment. Changing lives 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

8 Effective treatment. Changing lives 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 PPC individual specifiers

9 Effective treatment. Changing lives 3 domains 1. Severity (dependence, health, risk, neglect) 2. Complexity (response, environment) 3. Strengths (personal, social, economic)

10 Effective treatment. Changing lives 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 18 PPC Dimensions

11 Effective treatment. Changing lives 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


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