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Challenges, possibilities and opportunities
The practitioner perspective!
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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.(
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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)(
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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(
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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&
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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(
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Support(with(technology:(((Enabling(communicaAon:(6(mobile(phones(((SupporAng(access(online(resources:(((5(eMtablets((android)(((Thanks(to(Maudsley(Charity(
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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)(
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Challenges!
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Complex clients - extreme behaviour !
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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(
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Client&Group&Prole&
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!Challenges mentioned by clients: !
!Fragmentation of cure, care, prevention !
!and care-givers!
!Where to find support experience?!
!!!!
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Possibilities!
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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.(
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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&
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Project&Delivery&Delivery&Methodology&
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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((
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!Complex presentations:!
!- I-space: mental health!- It-space: broken neck !
- We-space: isolation!- Its-space: illegality !
! !
Holistic Approach
Integral Recovery !J. Dupuy - 2014!
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Opportunities!
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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.
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Project&Outcomes&and&Achievements&
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Key&Lessons&
CommunicaAon(and(partnership(working( ProacAve(methodology(( CollaboraAon(between(medical(sta(and(project(worker(
Research(( CommunicaAon( Data(
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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(
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Contact(Details ((
Danny&Heckman&&Deputy(OperaAons(Manager(Turning(Point(&
&&E8mail:&[email protected]((Paul&du&Buf&(E8mail:&[email protected](
