The Skills Consortium

The proposed ‘skills framework’

East of England Recovery & Reintegration Conference20th July 2010

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 (the Core Group) to develop the ideas and the constitution

‘Build it and they will come’

Aims of the consortium

To support the drug treatment sector to:

•Identify workforce needs required to promote and sustain beneficial treatment outcomes for service users and their communities

•Review, consolidate and develop existing workforce initiatives with a view to retaining the existing and future workforce

•Support employers and commissioners to equip practitioners and managers with the requisite skills, knowledge and attitudes.

The Core Group’s approach

Core Group: royal colleges; trusts; third sector; users; carers; membership organisations; educators

Develop a constitution and establish a fully constituted consortium in June/July 2010

An elected executive

Criteria for a representative membership (40-60)

All stakeholders can access resources; tools etc.

Launch a skills framework very shortly after the consortium becomes constituted

Framework will be the ‘wire-frame’ of the on-going work of the consortium

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.

The aims of the framework

Aims to be an … integrated (coordinating elements of local systems)

dynamic (responsive to need, moving service users forward)

coherent (focussed on the service user’s journey)

congruent (based on values of recovery and reducing harm)

… modelThe intention is to give all evidence-based interventions and those from the ‘Orange Book’ based on expert consensus a proportionate and integrated position in a conceptual model.

Treatment adaptation/optimisation is key component of the model.

Segmenting delivery:the phases of treatment (columns)

Based on current phases of treatment (CPPG and MoC).

Informed by current thinking on recovery and TCU (ITEP/BTEI/RELS)Engagement: Establishing the process components of key working;

developing the therapeutic relationship; build motivation for change and set initial treatment goals.

Preparation: Refine treatment goals and actively prepare for change. Change: Initiate and maintain changes in substance use, behaviors and

cognitions and build recovery capital. Reintegration: Strengthen community integration, develop recovery capital

and exit formal treatment.

(Reintegration starts at the beginning of treatment and runs throughout. Its focus may shift from safety initially and progress through social, and self-esteem related needs)

Segmenting delivery:the types of intervention (rows)

Keyworking – process/support: elements of keyworking/case management which are offered to all clients and which form the bedrock of treatment

Keyworking – low intensity psychosocial interventions: including psycho-educational interventions, manualised and mapping interventions

“Keyworking+”: interventions requiring additional competencies, training and supervision structures

High intensity or specialist interventions / Specialist/external services

Underpinning values

The core group have explored a range of issue and concepts which have formed the underpinning values of the model. These will be developed as part of the Consortium’s work programme. They include:A supported and facilitated transition from being clinically managed to taking personal responsibility through self-management.The vital role of harm reduction in recovery-orientated treatment.An increased focus on the service user’s strengths, focussing on the development of a positive identity outside of their drug use.An increased use of peer-based recovery mentors and the integration of structured treatment and indigenous recovery support groups.A greater emphasis on the physical, social and cultural environment in which recovery happens, i.e. a shift from clinic-based aftercare to community-based continuing careManners Matter: factors that encourage clients to return and stay the course.

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Interventions focussed on: building the therapeutic relationship; engagement with the care-planning process; building motivation for change and setting initial treatment goals. Session topics could include: personal strengths and resources cost-benefit of drug useambivalencerisk awarenessand may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

Interventions focussed on: refining treatment goals and preparing for change. Session topics could include: commitment to changerecovery goals & change planstriggers for using & management strategiespersonal & community resources and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

Interventions focussed on: initiating and maintaining changes in substance use, behaviour and cognition, and building recovery capital. Session topics could include: cravings relapse prevention and lapse managementleisure/vocational/educational planspersonal and community resourcesskill development (social, personal, vocational) and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

Interventions focussed on: strengthening community integration, developing recovery capital and exiting formal treatment. Session topics could include: future plans and support recovery check listsstructuring timereviewing changes achievedskill development (social, personal, vocational)and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

“Keyw

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g+

” – interven

tion

s requ

iring

add

ition

al co

mp

etencies

Motivational InterviewingFamily supportMotivational enhancement therapyContingency management (attendance)

Low intensity interventions for common mental illness:

Computer-based CBTGuided Self-HelpBehavioural ActivationRelaxation techniques

Contingency management (BBV)Family support

Contingency management (behavioral change)Community Reinforcement ApproachSocial Behaviour and Network TherapyFamily support

Community Reinforcement ApproachSocial Behaviour and Network TherapyFamily support

Hig

h in

tensity o

r specialist in

terventio

ns / S

pecialist/extern

al services

BBV testing and vaccinationCounselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesMedically assisted recovery

Inpatient assessment & stabilisationOral/injectable substitute therapy

Counselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesMedically assisted recovery

Inpatient assessment & stabilisationOral/injectable substitute therapy

CBT for depression and anxiety (IAPT)Behavioural Couples TherapyFamily TherapyPsychodynamic therapyCounselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesResidential and community rehabilitationMedically assisted recovery

Community Detox Inpatient Detox Naltrexone (with CM)

Psychodynamic therapyCounselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesResidential and community rehabilitationMedically assisted recovery

Naltrexone (with CM)

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

orkin

g

Change Change Change Change PreparationPreparationPreparationPreparationEngagementEngagementEngagementEngagement Re/integrationRe/integrationRe/integrationRe/integration

Keyw

orkin

g – p

rocess

Keyw

orkin

g – lo

w in

tensity in

terventio

ns

Interventions focussed on: building the therapeutic relationship; engagement with the care-planning process; building motivation for change and setting initial treatment goals. Session topics could include: personal strengths and resources cost-benefit of drug useambivalencerisk awarenessand may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

Interventions focussed on: refining treatment goals and preparing for change. Session topics could include: commitment to changerecovery goals & change planstriggers for using & management strategiespersonal & community resources and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

Interventions focussed on: initiating and maintaining changes in substance use, behaviour and cognition, and building recovery capital. Session topics could include: cravings relapse prevention and lapse managementleisure/vocational/educational planspersonal and community resourcesskill development (social, personal, vocational) and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

Interventions focussed on: strengthening community integration, developing recovery capital and exiting formal treatment. Session topics could include: future plans and support recovery check listsstructuring timereviewing changes achievedskill development (social, personal, vocational)and may be supported by protocols and mapping tools, and delivered in 1:1 or group settings

“Keyw

orkin

g+

” – interven

tion

s requ

iring

add

ition

al co

mp

etencies

Motivational InterviewingFamily supportMotivational enhancement therapyContingency management (attendance)

Low intensity interventions for common mental illness:

Computer-based CBTGuided Self-HelpBehavioural ActivationRelaxation techniques

Contingency management (BBV)Family support

Contingency management (behavioral change)Community Reinforcement ApproachSocial Behaviour and Network TherapyFamily support

Community Reinforcement ApproachSocial Behaviour and Network TherapyFamily support

Hig

h in

tensity o

r specialist in

terventio

ns / S

pecialist/extern

al services

BBV testing and vaccinationCounselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesMedically assisted recovery

Inpatient assessment & stabilisationOral/injectable substitute therapy

Counselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesMedically assisted recovery

Inpatient assessment & stabilisationOral/injectable substitute therapy

CBT for depression and anxiety (IAPT)Behavioural Couples TherapyFamily TherapyPsychodynamic therapyCounselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesResidential and community rehabilitationMedically assisted recovery

Community Detox Inpatient Detox Naltrexone (with CM)

Psychodynamic therapyCounselling (registered/accredited)Specific health interventions

Mutual aid/recovery communitiesResidential and community rehabilitationMedically assisted recovery

Naltrexone (with CM)

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

orkin

g

Change Change Change Change PreparationPreparationPreparationPreparationEngagementEngagementEngagementEngagement Re/integrationRe/integrationRe/integrationRe/integration

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Limitations and focus of the framework

It focuses on interventions and practice rather than service design or components Change will happen in several areas of someone’s life and at different rates. The service user is located in the phase relating to the key change identified in the recovery planIntegration with mainstream services is key but not directly addressedPre and post treatment interventions/services are not yet included

The model has informed the early development of the NTA’s proposed recovery-orientated service framework. This framework will cover some of the broader issues relating to system & service design and commissioning.

The ambition for the framework

The aim is that the framework becomes the front end or wire frame of an interactive web-based resource hub.

The proposed work programme of the consortium is to populate the framework with:

supporting detail (manuals, guidance, etc)

emerging interventions

shared learning

training networks

relevant occupational standards

And to sponsor early adopters to developinterventions and test implementation.