Microsoft word - idts needs assessment 2008-09.doc

HMP LEEDS
INTEGRATED DRUG TREATMENT SYSTEM
NEEDS ASSESSMENT OF TREATMENT DEMAND

Author: Lydia Mwanje (Commissioning Support Officer)
Safer Leeds Commissioning Team
Whilst every care has been taken to ensure the accuracy of the data, it is supplied on the condition that employees
of Leeds City Council and Leeds Primary Care Trust cannot be held responsible for any error, omissions or
misrepresentation whether negligent or others.
Contents


1.0 Introduction. .……. 3
1.1 Methodology………………………………………………………………………………. Reception screening process. ………. ………. 4
Total number of new receptions………………………………………………. ………. ………. 4 Number of drug users through reception……………………………………. ………. 5 Number of reception initial substance misuse clinical assessments………. ………. ………. 5 doors…………………………………………………………………………………… 3.0 Detoxification.……….………. 6
3.1
Total number of detoxification programmes……………………………………………. ………. 6 Number issued detox on reception………………………………………………………. ………. 6
4.0 Maintenance…………………………………………………………………………………………
Number of new receptions on maintenance……………………………………………………… 7 Total number on maintenance……………………………………………………………. ………. 7 Type of drug issued…………………………………………………………………………………. 8 Counselling Advice Referral and Throughcare Service…………………………. ………. 9
Number of initial and comprehensive substance misuse assessments completed…………. 9 Short duration drug programme……………………………………………………………………. 9 Number of drug intervention records completed…………………………………………………. 1 Prison release data………………………………………………………………………………… 11
Drug Intervention programme Leeds……………………………………………………………… 12 Throughcare prescribing pathway protocol for HMP Leeds……………………………………. 12 Clinical substance misuse staff calculation…………………………………………………. 13
Projected number of patients………………………………………………………………………. 13 profile……………………………………………………………………………………………
8.0 References………………………………………………………………………………………….
1.0 Introduction

The objective of the Integrated Drug Treatment System (IDTS) is to expand and improve the provision
ƒ Increasing the availability, consistency and quality of service ƒ Diversifying the range of treatment options available to those in prisons ƒ Integrating drug treatment provided by prisons healthcare with those services provided by the Counselling, Assessment, Referral, Advice and Throughcare Services (CARATS) ƒ Strengthening continuity of care for drug users entering, moving between and exiting prison The IDTS needs assessment process is intended to gain or update a picture of the potential demand and capacity issues in relation to the delivery of drug treatment in Leeds Prison. This assessment has been used to inform the IDTS treatment plan in relation to the planning of staff, work areas and throughcare.

1.1 Methodology
In order to build up a picture of the overall size and nature of drug users needs within HMP Leeds a
number of available data sources were used . Core data from the healthcare substance misuse team
and the Counselling, Advice Referral and Throughcare Service (CARATS) was used to identify the number of: ƒ drug users coming through reception
ƒ initial healthcare screens
ƒ clinical substance misuse assessments (triages)
ƒ CARAT assessments, detoxifications and maintenance treatments initiated
The data gathered was used to calculate the number of amended cell doors needed and to populate the clinical substance misuse staff calculator which generated a profile of the clinical staff required to provide IDTS. Reception screening process
Across all prisons that take offenders from court a new healthcare screening process has been introduced. The purpose of the reception screening for substance misuse is: ƒ To enquire about drug and alcohol use and to screen for evidence of dependence in those ƒ To determine immediate healthcare needs, including withdrawal for which there should be access to adequate and effective prescribing by a doctor for management upon reception into local prison custody Wherever possible, location should be in a unit that offers access to unrestricted observation at all times 24 hours a day by healthcare staff trained in substance misuse. This observation is best made through open healthcare hatches (HM Prison Service, 2000). Reception screening has to be brief and in a local prison should be focused to ensure that appropriate prescribed clinical management is undertaken by a doctor upon reception. Total number of new receptions

Between April 2007 and May 2007 there were a total of 5884 new numbers into reception. Figure 1
shows the number of new receptions per month in this time period, there was an average of 420 new
New numbers into reception
458 499 434 425 429 453 452 425 340 411 386 371 396 405 - 5884
Number of drug users through reception

The following data examines the number of drug misusers that were seen through reception each
month from April 2007 - June 2008. A total of 1934 drug users went through reception between these dates (1556 between April 2007-March 2008 and 378 between April and June 2008). Figure 2 shows the total number of new receptions and how many of these were drug users. An average of 33% of new receptions are drug users. Number of receptions and number that are drug users
Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jun Total
Reception 458 499 434 425 429 453 452 425 340 411 386 371 396 405 - 5884
Drug
user 162 147 169 141 149 132 154 150 120 121 111 - 153 115 110 1934
user 35% 29% 39% 33% 35% 29% 34% 35% 35% 29% 29% - 39% 28% - Number of reception initial substance misuse clinical assessments
From the 1934 drug users through reception 1824 (94%) of them had an initial substance misuse clinical assessment. 933 of the completed initial assessments required methadone/Buprenorphine stabilisation and 816 commenced detox.
An initial calculation has been made on the number of amended cell doors that maybe needed for
unrestricted observation by healthcare staff trained in substance misuse, based on the number of drug users coming through reception. ƒ An average of 138 drug users are seen in reception per month ƒ Based on this around 35 drug users are seen on average per week This figure has been rounded up to 50 based on lessons learned from other IDTS prisons, this means that around 50 amended cell doors could possibly be needed at a cost of £1200 each. Total cost would
3.0 Detoxification

3.1
Total number of detoxification programmes

Figure 4 shows the number of detoxification programmes per month between April 2007 and June
2008. A total of 2213 detoxification programmes have been held between these dates (1818 between
April 2007-March 2008 and 395 between April and June 2008).

Figure 3
Number of detoxification programmes
April 2007 - June 2008
Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- 159 164 144 158 145 149 194 166 104 157 130 148 147 123 125 2213
Number issued detox on reception
A total of 885 new receptions commenced detox between April 2007 and May 2008. Figure 5 shows the type of detox commenced. The majority of detox (90%) was for methadone detox. Number of receptions commencing detox
Type of detox

4.0 Maintenance
4.1
Number of new receptions on maintenance

Figure 5 shows the number of new receptions on maintenance. A total of 933 new receptions were on
maintenance treatment between April 2007 and May 2008. It is not recorded whether maintenance treatments were commenced or continuous. Number of re ceptions on ma inte na nce
Type of ma inte na nce
Total number on maintenance

Figure 6 shows the total number of individuals on maintenance per month between April 2007 and June
2008. The number maintained on methadone decreased between April-December 2007 but has been
increasing steadily since January 2008, the most significant increase is seen from March- April 2008.

Figure 6
Number on maintanance
Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- May Jun Jul
Sep Oct Nov Dec Jan Feb Mar
Jun Total
Methadone 250 238 230 221 220 214 232 222 199 238 249 231 285 278 276 3583 Buprenorphine 28 24 28 26 19 14 24 30 31 25 35 22 33 22 13 374 Suboxone 19 18 8 14 19 12 18 17 11 10 17 18 33 22 13 282 Type of drugs issued
Figure 7 shows the type of drugs issued in 2007/08. More methadone was issued over the year than any other drug followed by drugs for alcohol detox. The same trend is seen in the drugs issued in April to June 2008. Type of drugs issued
Type of drug
Counselling Advice Referral Advice and Throughcare Service
Number of initial and comprehensive substance misuse assessments completed

Figure 8 shows the number of initial assessments and comprehensive substance misuses assessments
(CSMA) completed by CARATS between April 2007 and June 2008. Figure 8 Number of initial and comprehensive substance misuse assessments
completed
Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- 128 137 139 154 123 129 125 261 194 180 156 89 150 146 117 35 28 21 39 58 56 41 54 39 63 86 57 95 - - Short Duration Drug Programme (SDDP)

Figure 9 shows the number of starts and completions on the short duration drug programme in
2007/08. It shows that of the 132 starts in the year 86 (65%) completed the programme. Data from
April 2008-June 2008 shows that there has been 36 starts and 21 (58%) have completed. Short Duration Drug Programme - starts and
completions 2007/08
Number of Drug Intervention Records completed
Figure 10 shows the number of Drug Intervention Records (DIRs) completed by CARATS between April 2007-June 2008. A total of 2228 DIR were completed (1815 between April 2007–March 2008 and 413 between April-June 2008).
Figure 10
Number of DIR completed by CARATS
128 137 139 154 123 129 125 261 194 180 156 89 150 146 117 2228

6.0 Prisoner


In 2007/08 a total of 964 drug misusers were released from Leeds prison, 184 of these were non DIP
clients and 780 were DIP clients.
Figure 11 shows which area prisoners released returned to. The majority of DIP and non DIP clients returned to the West area. The west area is made up of Bradford, Leeds, Calderdale, Wakefield, Kirklees and Other areas. Returning to w hich area
Figure 12 shows which DAT in the West areas prisoners returned to. The majority of DIP prisoners returned to Leeds, Bradford or Kirklees, the majority of non DIP clients returned to Leeds, Wakefield and other areas. Returning to the West DAT area
Drug Intervention Programme - Leeds
Data received from the Drug Intervention Programme (DIP) in Leeds shows that during 2007/08 CARATs referred 260 clients to DIP and 240 of these engaged with DIP on release: ƒ 117 of the referrals were for clients that had been on a longer than 12 month sentence or had ƒ 123 of the referrals were for clients that were on short sentences and re-engaged with DIP after ƒ 20 of the referrals did not agree to a care plan and were not taken onto the caseload. Recent data from April 2008 – June 2008 shows that 40 referrals have been made to DIP by CARATs and of these: ƒ 18 were clients that had been on a longer than 12 month sentence or were never known to DIP ƒ 22 were clients who were on a short sentence and re-engaged with DIP after case suspension. Throughcare, Prescribing Pathway Protocol for HMP Leeds

For all releases going from HMP Leeds and returning to DIP a Throughcare prescribing pathway
protocol has been developed which informs pharmacy at HMP Leeds of clinic appointments made for
prisoners being released. A number of risk factors have been identified which need to be considered and include ƒ Clients released from prison without CARATs knowing or the substance misuse team ƒ If client is released after 4pm on the day of his release ƒ If client is released without any prescribing medication. If the above happens all CARAT workers do provide one to one on harm reduction discussing the risks Clinical Substance Misuse Staff Calculator
The staff calculator was used to generate a profile of the clinical staff required to provide IDTS using the available data from the healthcare substance misuse team and CARATS.
7.1
Projected number of patients

Figure 13 shows the numbers used to calculate the staff profile which is based on data from April 2007-
March 2008.
Definition
Number of patients requiring an initial substance misuse clinical assessment Patients requiring assessments by a doctor on the day of reception Clinical assessment by a doctor on the day after reception Patients requiring stabilisation (Methadone or Buprenorphine) Total maintenance treatments either started or continued Number of clients requiring 72 hour monitoring (i.e. testing positive to stimulants on arrival) Involvement in CARAT Comprehensive Substance Misuse Assessments and care planning Full review of maintenance treatment with keyworker and client (at 13 weeks) Number of patients requiring a secondary course of treatment Number of patients requiring Naltrexone prescriptions Number of patients requiring acomprosate prescriptions

7.2 Staff
Figure 14 shows the staff profile that was calculated using the data in figure 13.
N.B. from November 2008 there will be 150 extra bed spaces which needs to be taken into
account.

Figure 14
Staff required – whole time equivalent
Nurses Bands 5/6 and Registered Pharmacy Techs Total estimated staff complement – whole time equivalent
8.0 References
1. Department of Health (2006) Clinical management of drug dependence in the adult prison setting. Including psychosocial treatment as a core part. 2. National Treatment Agency for Substance Misuse (2007) Integrated drug treatment in prisons (IDTS). Needs assessment guidance 2008-09. 3. National Treatment Agency for Substance Misuse (2007) Needs assessment guidance for adult

Source: http://www.childrenleeds.co.uk/assets/0/256/258/266/286/e1b3716f-d593-49cd-99a9-9af456b6ce68.pdf