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Cocaine Services. IN AN IDEAL WORLD – HOW SHOULD THEY WORK?. Presentation Overview. Key Considerations for Service Provision Outline aims of service provision relating to 4 groups of stimulant users as highlighted by SACDM working group Focus mainly on role of dedicated stimulant services - PowerPoint PPT Presentation
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Cocaine Services
IN AN IDEAL WORLD – HOW SHOULD THEY WORK?
Presentation Overview
Key Considerations for Service Provision Outline aims of service provision relating
to 4 groups of stimulant users as highlighted by SACDM working group
Focus mainly on role of dedicated stimulant services
Barriers to service development
Service Design
Every aspect of the service should be measured against its ability to:
Reduce BARRIERS
Increase OPPORTUNITIES
Keep SERVICE USER at the centre
Reducing Barriers Consider Target Group/s
What needs to be done?
Who is best placed to do this?
What training & support do they need?
Ensure that this is available
Early Experimenters
Aim: Ensure that individuals, especially young people, make informed decisions
about drug use & take necessary steps to reduce potential risks
Early Experimenters – cont’d
Target population: General population Individuals and groups known to be
experimenting Services who work with young people Parents High risk occupations / students
Early Experimenters – cont’dInformation - Accessible and Credible
Information about Cocaine should be available through existing contact with young people and included in drugs education.
Targeted information should be a feature to those at high risk eg universities & colleges, high risk occupations.
Training, support and service information must be accessible to teachers, youth workers, parents etc.
Media campaigns etc should target this group
Regular Stimulant Users
Aim: To reduce harm associated with regular
stimulant use To prevent problematic or dependent drug
use To provide access to other specialist
services for those experiencing problems
Regular Stimulant UsersTarget Population: Regular stimulant users Peers Parents Staff at clubs & events i.e. managers,
promoters, security staff, first aid providers Employers Services / professionals who work with
and /or provide education to young people
Regular Stimulant Users
Service Provision Credible and easily accessible harm
reduction information designed by specialist providers
Targeted delivery of interventions where regular users are e.g. clubs, pubs, on the street
Easy access to services for problematic users
Harm reduction information should be targeted and include: Direct harm
associated with drug, methods patterns etc
Risk to self and others e.g. sex work, employment
Prevention of problematic use and progression to opiates to deal with come down
Access to specialist advice or help
Wide range of information sources
Anonymous access such as helpline.
Peer education Specific locations
identified at local level eg A&E, NX, GUM.
Targeted delivery Input by specialist services to planning of
festivals / events involving young people Input to clubs & pubs Presence at events Promotion and provision of Chill Out area –
provision of water, fruit, condoms, staff with specialist knowledge and skills
Partnership working with Events Organisers, pub managers, First Aid providers, Ambulance Service etc
Consider and regularly review where regular users are, and deliver targeted service tailored to group, place and time.
Easy access to services for problematic users (bridge) Easy access to services for problematic
users One specialist service targeting both regular
and problematic use – to avoid barrier of referral, establish trust and credibility
Use opportunity for motivational interventions Reduce period between 1st use and seeking
help (10 years)
Problematic Stimulant Users
Aim:
To reduce harm associated with problematic stimulant use and provide opportunities to
address problems and support positive change
Problematic Stimulant Users
Target Population: Primary stimulant users who are experiencing
problems related to their use Parents / partners of problematic stimulant
users Generic agencies in contact with target group Mental Health services Employers and Trades Unions
Minimise barriers & create opportunities to access specialist service Provide range of referral routes Keep requirement for personal information to a
minimum Access through Telephone Helpline, outreach
venues, referrals from other services Provision of drop-in service including
complementary therapies Flexible opening times Ensure that reception staff are trained and
sensitive to service user needs Specialist services need the ‘right’ image to
attract target group
Minimise barriers & create opportunities to access specialist service
Provide training to generic services to improve response to Cocaine users
Target mental health services, A & E, generic drug services
Ensure that drugs helpline workers have high level of knowledge and understanding of stimulant use and specialist services
Problematic Stimulant Users – Specialist Services Should be holistic and tailored to individual
need – use of assessment as an intervention Emphasis on motivational skills Identification of problems and areas of
desired change Provision of a range of co-ordinated
interventions to provide structured programme
Problematic Stimulant Users Interventions Based on assessment, interventions
should provide a structured programme, tailored to individual need.
Assessment should highlight problems relating to physical health, mental health, relationships, and social circumstances
Problematic Stimulant Users Interventions Core interventions should include:
counselling; skills training (eg problem solving, relaxation); lifestyle change (including diet); cognitive behavioural approaches including relapse prevention and lapse management; complementary therapies; harm reduction
Problematic Stimulant Users InterventionsEasy access to: Mental health assessment and treatment
services as & when required Symptomatic prescribing GP services Psychologist
Specialist Service – essential features Specific project image Track record with user group Credibility with service users Trusted In touch with local trends at street level Flexible and responsive to changing
trends
Specialist Service – essential featuresStaff team (Core) Multi-disciplinary team High level of knowledge & understanding of
stimulant use, user groups and related issues Experienced Must include mental health expertise Commitment to user group Training skills
Specialist Service – essential featuresStaff team (Core/sessional or fast track) Mental health assessment and treatment Symptomatic prescribing Psychologist GP services
Overcoming Barriers - examples
Complementary therapies - especially acupuncture should be available
Use of texting is beneficial for a range of reasons
Opiate / Stimulant co-users
Aim:To adapt services designed for opiate users, so that they more effectively address needs in relation to stimulant use
Opiate / Stimulant co-usersTarget Population: Heroin users who are also using Crack /
Cocaine / Amphetamines Individuals who are prescribed Methadone or
other opiate substitutes and using stimulant drugs (usually Crack)
Prescribing services, needle exchange/harm reduction services, generic drug services
Opiate / Stimulant co-users Assessment of co-users is more complex
than opiate use alone Assessments need to take account of
relationship between patterns and circumstances of drugs used, how one effects the other and the impact of prescribing
Service users need to be encouraged to disclose stimulant use without fear of service being withdrawn
Opiate / Stimulant co-users
Co-users require a flexible service Workers in these services require specific
training and support from specialist services
Opportunistic support can be provided through enhanced needle exchange services, outreach services, projects for sex workers etc
Overcoming Barriers to effective Service Development – priority areas At Strategic level, plans and models of service
delivery must be reviewed to take account of best practice for stimulant users.
Strategy must address all stages Primary stimulant users must be prioritised Service development and design MUST be
informed by individuals / groups who have direct knowledge and experience with the user group
The delay between identifying a need and delivery MUST be reduced
Overcoming Barriers to effective Service Development – priority areas Commissioning arrangements should be outcome
based (realistic), and support responsive and creative services rather than be prescriptive.
Professional and post qualifying training requires specific input
Media portrayal of Crack users / myths needs to be balanced with accurate, factual information
Services / projects need to be adequately resourced and supported
Funding needs to be secure to ensure that learning is not lost, and high quality staff are recruited and retained.
