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![Page 1: The Skills Consortium The proposed skills framework West Midlands workforce consultation event 1 st November 2010.](https://reader035.fdocuments.in/reader035/viewer/2022070306/5515e4fe550346d46f8b4eb3/html5/thumbnails/1.jpg)
The Skills Consortium
The proposed ‘skills framework’
West Midlands workforce consultation event
1st November 2010
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Overview
The context of workforce development-established and emerging
The Skills Consortium & the evolution of the skills framework
The framework
Resources & next steps
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Context: Suite of evidence-based clinical guidance 2007
NICE: National Clinical Practice Guideline No. 51. Drug Misuse: Psychosocial Interventions
Orange: NICE and expert consensus
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Contexts: Psychosocial Interventions
“Pharmacological treatments for cannabis and stimulant misuse are not well developed, and therefore psychosocial interventions are the mainstay of effective treatment.” (NICE 2007)
“Treatment for drug misuse should always involve a psychosocial component.” (DoH 2007)
“Psychological treatment has a role as important as substitute prescribing in treating opiate-dependent clients….” (NTA 2005)
“Both pharmacological interventions and psychosocial treatment are more effective when they work together in an integrated and harmonised manner.” (DoH 2006)
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NICE 51 Key priorities for implementation
Brief interventions (structured feedback advice / motivational enhancement)
•Facilitated self-help
•Contingency Management (CM)
- targeting drug use
- targeting physical health compliance
•Behavioural couples therapy
•CBT for common mental illness (anxiety disorders and depression)
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Orange went further- based on expert consensus
Motivational interviewingContingency Management (attendance, behavioural change and BBV)Low intensity interventions for common mental illness:
Computer-based CBTGuided Self-HelpRelaxation techniques
Relapse preventionMapping TechniquesCommunity Reinforcement ApproachBehavioural Couples TherapySocial Behaviour and Network TherapyCBT for depression and anxietyPsychodynamic Therapy
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Does adding psychosocial therapy to OST improve outcomes?
• Ball and Ross’s study of methadone programs (1990)
• McLellan et al (1993) conducted a 24-week clinical trial involving 3 treatment groups:
– methadone with minimal counselling
– methadone plus moderate (i.e. more intensive) counselling
– methadone plus enhanced counselling (including on-site medical/psychiatric, employment, and family therapy)
• NTORS
– patients in MMT who received drug problem counselling sessions had significantly better heroin and cocaine outcomes than those receiving no counselling
+ NICE
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The evidence generally indicates 3 key factors:
• Workers who have clear techniques achieve better outcomes
• Supervision and governance is key
• Outcomes are determined by the quality of the working alliance
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Implementation
Whatever the skills / potential of individual practitioners, the evidence suggests that the
quality of the organisation has a more substantial impact on effective outcomes than
either the intervention chosen or worker involved
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Manualised therapy
STICKING TO THE THERAPY MANUAL:
A HAPPY MEDIUM WORKS BEST
US study on dynamics of cocaine treatment found:
• counsellors who either strictly followed a counselling manual or largely ignored it had the worst outcomes
• departing from the therapeutic script without abandoning the overall structure seems a positive attribute .
Barber J.P. et al., 2006
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For the NTA- the three ‘must do’s’
1. Organisational competence
2. Care coordination / case management competence
3. Deliver evidence based psycho-social interventions
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The Skills Consortium and
the evolution of the skills framework
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A brief history of the consortium
Convened to develop a sector led consensus on good practice and lead workforce development
For the sector, by the sector
Two large sector-wide stakeholder workshops in 2009
These tasked a smaller working group to develop the ideas and the constitution
‘Build it and they will come’
Large stakeholder group endorsed the framework in July
Executive now formed
November website launch
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Recovery orientated systems
‘One of the key principles of a recovery-orientated model is it's integrated. That is, all of the constituent parts, all the various elements of a local system are co-coordinated, speak the same language, communicate with each other and have a congruous set of values and principles that orbit around the affirmative and empowering possibilities of recovery….
Every part of the system is involved in a collaborative effort to increase positive outcomes …….. allow greater flexibility and non-linear movement between system elements.’
NSPs in a recovery-orientated system,
Stephen Bamber
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From this…….to this……..
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HR, MI, ITEP, CM….. recovery communities………
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The roots of the framework
Based on:
Previous guidance (Care Planning Practice Guide in particular)
NICE drug misuse guidance
2007 Clinical Guidelines
Informed by emerging thinking on recovery and personalisation.
It is also informed by ITEP, BTEI and ‘Recovery, Engagement and Life Skills’ model developed by TCU.
As interventions, approaches and technologies emerge it is anticipated that they can be absorbed by the framework.
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Phases of treatment: Care Planning Guide
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Stages of TreatmentStages of Treatment
RetentiRetentionon& &
ChangeChange
Early Early RecoveryRecovery
Changes in Changes in •ThinkingThinking• ActingActing
Early Early RecoveryRecovery
Changes in Changes in •ThinkingThinking• ActingActing
EarlyEarlyEngagementEngagement
• ParticipationParticipation• Therapeutic Therapeutic
Relationship Relationship
EarlyEarlyEngagementEngagement
• ParticipationParticipation• Therapeutic Therapeutic
Relationship Relationship
TreatmentTreatmentReadinessReadiness
::• Needs-Needs-
RisksRisks• SeveritySeverity• MotivatioMotivatio
nn
TreatmentTreatmentReadinessReadiness
::• Needs-Needs-
RisksRisks• SeveritySeverity• MotivatioMotivatio
nn
““TCU Mapping” Interventions for TCU Mapping” Interventions for Adaptive Treatment ProcessAdaptive Treatment Process
OrientationOrientation Re-EntryRe-Entry
MappingMappingJourneyJourney
WorkshopWorkshopfor Menfor Men
TransitionTransitionto Re-entryto Re-entry
Using ClientUsing ClientAssessmentsAssessments
MappingMapping Care PlansCare Plans
DownwardDownwardSpiralSpiral
Mapping Mapping ’’12 Steps12 Steps’’
ParentingParentingSkillsSkills
WorkshopWorkshopfor Womenfor Women
Treatment ATreatment A Treatment BTreatment B
PreparingPreparingfor Changefor Change
GettingGettingMotivatedMotivated
CM/RewardCM/RewardStrategiesStrategies
BuildingBuildingNetworksNetworks
BetterBetterCommComm
HIV RiskHIV RiskReductionReduction
UnlockingUnlockingThinkingThinking
ReducingReducingAngerAnger
© 2009
“TCU Mapping-Enhanced Counseling”
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The Framework
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Engagement Preparation Change Completion Reintegration
DeliveryDeliveryDeliveryDeliveryPreparationPreparationPreparationPreparation ChangeChangeChangeChange Completion Completion Completion Completion EngagementEngagementEngagementEngagement
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Re/
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Comprehensive assessment incChild protectionRisk
Assessment/reassessment of recovery capital
Cataloguing strengths
Recovery/care planningCare coordination (if applicable)Risk managementCrisis managementHealth monitoring
AdvocacyCoachingPro-active engagement/re-engagementBuilding social networksHarm reduction
Multi-agency work, includingChild protectionMental health
Appropriate supported/facilitated referrals to:
Medical monitoring and healthcareMutual aidFinancial and legal adviceHousing, employment, education and training
The care plan should specify the detail of the case management interventions, as agreed with the service user.Case management and key working interventions may utilise mapping techniques and manuals to support their delivery.
Keyw
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RECOVERY
Review
/ Plan
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Review
/ Plan
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timise. (C
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eview, T
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Review
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eview, T
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Review
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/ Op
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Care planned
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Engagement Preparation Change Completion Reintegration
Comprehensive assessment incChild protectionRisk
Assessment/reassessment of recovery capital
Cataloguing strengths
Recovery/care planningCare coordination (if applicable)Risk managementCrisis managementHealth monitoring
AdvocacyPro-active engagement/re-engagementBuilding social networksHarm reduction
Multi-agency work, includingChild protectionMental health
Appropriate supported/facilitated referrals to:
Medical monitoring and healthcareMutual aidFinancial and legal adviceHousing, employment, education and training
The care plan should specify the detail of the case management interventions, as agreed with the service user.Case management and key working interventions may utilise mapping techniques and manuals to support their delivery.
Keyw
orkin
g
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Resources
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Design
Guidance and evidence
Manuals
Competencies
Training
Implementation
Shared Learning
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In the mean time………
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and the Psychosocial Interventions Resource Libraryhttp://www.nta.nhs.uk/PIRL.aspx
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Skills Consortium Work Plan
Three strands:
• Populating the framework/ implementation/ early adopters
• Qualifications
• Evidence and research