Challenges, possibilities and opportunities. The practitioner perspective

Challenges, possibilities and opportunities

The practitioner perspective!

Frequent(a*enders(alcohol(project((

1(October(2013((30(September(2015(((Aims:((To(idenAfy(alcohol(dependent(clients,(who(have(frequent(presentaAons/admissions(to(KCH.(((To(oer(asserAve(followMup(and(coordinate(care(with(exisAng(service(providers(in(order(to(avoid(crisis(presentaAons(or(reMadmissions(to(Acute(Care.(

Alcohol&Intensive&Case&Management&Project&(Pilot)&

Project&set8up:&August&2009((

Target&group:(severely(alcoholMdependent(individuals(with(a(history(of(poor(engagement(

(

Model:(asserAve(community(outreach((

Set8up:(case(coordinator,(volunteers,(small(caseload((10M12(clients(at(any(one(Ame)(

Project&Overview&&

Aims&and&ObjecBves&(

To(reduce(the(severity(and(longer(term(consequences(of(severe(alcohol(dependency(to(adults(with(histories(of(treatment(resistant(behavior.(

(

To(reduce(the(level(of(unplanned(uAlizaAon(of(acute(health(care(services(by(treatment(resistant(alcohol(dependants(including(a(reducAon(in(non(planned(admissions.(

(

To(increase(levels(of(engagement(with(both(primary(health(care(and(specialist(alcohol(treatment(services(

Number of clients! March(2015:(((((((((((Referred(45(clients(

((((((((((((((((Working(with(15(clients(

0(

3(

6(

9(

12(

Age(20M30( Age(31M40( Age(41M50( Age(51M60( Age(61M70( Age(71M80( Age(81M90(

Age&range&referred&clients&

Volunteers:(circle(of(support(( 4(volunteers(from(July(2014( Weekly(contact((

Clients(were(accompanied(to:((

Cityroads((Oaklodge((War(museum((Evolve((St.(Thomas(Hospital(Nunhead(Cemetry(((CDAT(M((FoundaAon(66((AAU(M(home(M(Southwark(Art(exhibiAon((SMT((GP(((Marina(House(M(Dragons(cafe(M(hostels(( 2((exM)(clients(became(volunteers(in(2015(

Support(with(technology:(((Enabling(communicaAon:(6(mobile(phones(((SupporAng(access(online(resources:(((5(eMtablets((android)(((Thanks(to(Maudsley(Charity(

Data(collecAon(with(eMtablet(support:(

Warwick((Edinburgh(Mental(WellMbeing(Scale(PHQM9(Depression(GADM7(Anxiety( TOPs(M(quality(of(life(quesAons(

When(indicated:(

Personal(Crisis(Plan((advanced(direcAve)(Drinking(diary(Anxiety(/(depression(selfMhelp(manual( Sleeping(problems(selfMhelp(manual(WRAP((recovery(plan)(

Challenges!

Complex clients - extreme behaviour !

Client&Group&Key&PresenBng&Issues&

Health&

COPD(Diabetes(

Cirrhosis(of(the(liver(

Heart(Failure(

Mental(Health(

Schizophrenia(

Alzheimers(

Korsakos(

DemenAa(

TB(

Housing(

Family(Exclusion(

Homelessness(

Social&

Social(Exclusion(

Unemployment(

Financial(Hardship(

Client&Group&Prole&

!Challenges mentioned by clients: !

!Fragmentation of cure, care, prevention !

!and care-givers!

!Where to find support experience?!

!!!!

Possibilities!

Example(

Mr.(A.(((age(38((acute(physical(health(problems(

(ED((alcohol)(admissions(before(engagement:(

( 10(presentaAons(to(Emergency(Department(at(KCH(between(12/2013(and(04/2014(( 9(admissions(to(hospital((ED(admissions(aher(engaging(with(frequent(a*enders(project:(

( 3(ED(presentaAons(aher(engagement(from(21/03/14( in(collaboraAon(with(other(services(arranged(for(a(deepMclean(of(his(house,((((((alcohol(detox(at(Cityroads(and(ahercare(support((Oak(lodge)(((((Volunteer(involved(since(June(2014((regular((weekly)(contact( AbsAnent(from(alcohol(since(May(2014.( Accepted(to(be(a(SLAM(volunteer(in(February(2015(M(supporAng(others.(

Client&Support&Structure&

Housing&&&Benets&

Medical&

Social&(incl.&living&condiBons&&&&Mobility)&

Mental&Health&

Criminal&JusBce&

Social&Services&

Dietary&

Level of Support

RED AMBER GREEN

Daily Monthly Weekly

Project&Delivery&

Project&Delivery&Delivery&Methodology&

&

Five&key&principles:&&

Principle&1(M(Flexible(engagement(Principle&2(M(MulAple(engagements((Principle&3(M(Facilitated(and(rapid(access(to(services(Principle&4(M(Coordinated(approach(to(care((Principle&5(M(HolisAc(approach(to(meeAng(needs((

!Complex presentations:!

!- I-space: mental health!- It-space: broken neck !

- We-space: isolation!- Its-space: illegality !

! !

Holistic Approach

Integral Recovery !J. Dupuy - 2014!

Opportunities!

Future&Building&on&the&model((Conclusion

The Alcohol Intensive Case Management project has the potential to both reduce the overall utilisation of acute health care and deliver a shift towards more planned care and successful treatment outcomes.

Project&Outcomes&and&Achievements&

Key&Lessons&

CommunicaAon(and(partnership(working( ProacAve(methodology(( CollaboraAon(between(medical(sta(and(project(worker(

Research(( CommunicaAon( Data(

Key(Lessons(M(conAnued:((AsserAve(outreach(model(works((Role(models(needed(M(sAgma((Circle(of(support(M(volunteers((GeneralisAc(approach((incl.(medicaAons)((Complexity(reducAon((ICT)((OpAmal(autonomy((Focus(on(strengths,(happiness,(health((PrioriAse(building(/(maintaining(meaningful(((((relaAonships(between(client(and(careMgivers(

Contact(Details ((

Danny&Heckman&&Deputy(OperaAons(Manager(Turning(Point(&

&&E8mail:&danny.Heckman@turningMpoint.co.uk((Paul&du&Buf&(E8mail:&paul.dubuf@slam.nhs.uk(