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North Yorkshire Alcohol Pathway Edition 2 April 2017

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North Yorkshire Alcohol Pathway Edition 2 April 2017 North Yorkshire Alcohol Pathway Edition 2 April 2017 Based on NICE alcohol pathway & associated guidelines – accurate as at 3rd April 2017 Slide 2: Overarching North Yorkshire Alcohol Pathway Reference guides: Slide 3: Reference guide for delivery of alcohol identification and structured brief advice Slide 4: Reference guide detailing North Yorkshire Horizons Service offer Slide 5: Reference guide detailing Compass REACH Service offer Slide 6: Commissioned services that deliver alcohol interventions across North Yorkshire 04/07/2017 Slide 7: References Edition 2 North Yorkshire Alcohol Pathway (2 of 8) 16 years old or older 9 years old and under 10 - 15 years old, or individual has learning disability and is under 25 years old Gain consent and assist client to complete If over 18 years and have safeguarding If over 18 years & require Urgent response required Complete validated alcohol screening questionnaire to concern; report as follows: adult social care referral: call 999 Compass REACH determine drinking risk level, and Urgent response required call 999 T: 01609 780780 (option 1 & Screening Tool appropriate course of action. AUDIT-C is Not urgent but response required: then 3) Refer to the Children and available on the recommended as gold standard. T: 01609 780780 (option 1 then 3) Website Families Service Compass website Website Gain consent from (Safeguarding Advice): T: 0800 008 7452 individual prior to referral T: 01609 780780 (option 1 then 3) Website If time is limited: If time is limited: AUDIT-C Referral form FAST* MSASQ* AUDIT-C score: 5 or more (score 4 or more Urgent response required if individual is 65 years or older) M-SASQ score 2 or more call 999 Score less than 2: Refer FAST score: equal to or greater than 3 Indicates possible & to universal Healthy Indicates possible increasing/ higher risk increasing or higher risk If safeguarding concerns: Child Programme (5-19 drinking drinkers Refer to the Children and service) Families Service Single Point of Contact: T: 01423 557711 Gain consent and assist client (Safeguarding Advice): to complete T: 01609 780780 full AUDIT (option 1 then 3) Score 2 or more: (10 questions) Refer to Compass REACH using the Referral Form AUDIT score 8-19 AUDIT score 20+ available on their AUDIT score 1-7 16-17 year olds (score 7 or more if individual is 65 Possible dependence website (refer to action years or older) T: 0800 008 7452 for score 8-19 if Refer to Compass REACH using Score 8-15 determines hazardous/ DO NOT deliver a brief the Referral Form available on over 65 years and increasing risk drinking status intervention – this is score 7 or more) their website Score 16-19 determines harmful/ not shown to be T: 0800 008 7452 Low risk drinking higher risk drinking status effective status If Compass REACH identifies that an under 18 year old If new referral, aged 18-19 years old (25 if individual Reinforce sensible drinking Over 18’s only: Over 18 years old: requires a pharmacological limits as part of broader Gain consent and refer to North Yorkshire Horizons intervention, discuss with has a learning disability) conversation Deliver structured alcohol brief Specialist Service for comprehensive assessment, and refer to North Yorkshire and North Yorkshire Horizons identifies that Provide alcohol units leaflet intervention(s) and treatment and recovery support Horizons Compass REACH could (Refer to slide 3) Single Point of Contact: better address needs, T: 01723 330730 seek advice from Compass (Refer to slide 3) REACH re transfer of care, Include details of risk assessment on referral if and vice versa Over 18’s only: individual is deemed to pose a risk to staff/ others Contact North Yorkshire Horizons Single Point of Contact for details of local mutual aid/ peer support groups that client may wish to consider attending, and give to client Edition 2 North Yorkshire Alcohol Pathway: Delivery of Alcohol Identification and Structured Brief Advice AUDIT scores: 8-19 (AUDIT score ≥7 if over 65 years old) (3 of 8) 1. Gain consent and assist client to complete AUDIT questionnaire 2 (a) AUDIT score 8 – 19 2 (a) AUDIT score 20+ (AUDIT score ≥7 if individual is 65 years or older) Gain consent from client and Score 8-15 determines hazardous/ increasing risk drinking refer to North Yorkshire Horizons Single Point of Contact status (T: 01723 330730) Score 16-19 determines harmful/ higher risk drinking status Include details of risk assessment on referral if individual is deemed to pose a risk to staff/ others 3. Offer a session of 3. The session should be offered immediately within same interaction as AUDIT 3 & 4a,c. Contact North Yorkshire Horizons structured brief advice on completed, and if not an appointment should be made for as soon as possible after Single Point of Contact (01723 330730) alcohol, completion of AUDIT. for information on local mutual aid groups following completion of and give to the individual/ patient before they NYCC funded Drug Train The session should take between 5 and 15 minutes leave training session The session should be based on evidence-based principles such as FRAMES and should cover: • Potential harm, reasons for changing behaviour, health and wellbeing benefits • Barriers to change • Practical strategies to reduce alcohol consumption • Lead to a set of goals Provide alcohol units leaflet to the individual/ patient before they leave 780780 (option 1 then 3) then 1 (option 780780 Emergency: call call 999 Emergency: : 01609 : 01609 T Safeguarding concerns referred via referred concerns Safeguarding 4 (a) If on going relationship with 4 (b) Offer an extended brief 4 (c) Offer an additional session of client, monitor alcohol consumption intervention if individual does not brief advice if required through on-going conversations respond to brief advice use Making Every Contact Count techniques to assist you in broaching the conversation 4 (b) The session should be based on evidence-based motivational interviewing principles The session should take between 20 and 30 minutes Provide alcohol units leaflet to the individual/ patient before they leave Up to 4 sessions may be beneficial 04/07/2017 Edition 2 If individual cannot be contacted: North Yorkshire North Yorkshire Alcohol Pathway Horizons will contact referrer to confirm accuracy Adults: North Yorkshire Horizons Service Offer (eligibility criteria: AUDIT score ≥20) of contact details and continue to endeavour to (4 of 8) make contact. North Yorkshire Horizons Single Point of Contact completes triage with individual: - telephone, face to face; Meet and Greet (drop in) sessions are cited in - Triage completed as soon as possible following referral, usually immediately if self referral and individual willing; as soon as various community venues across North Yorkshire etc possible if professional referral depending on when service makes contact via referral details provided on a weekly basis, aimed at identifying individuals d (AUDIT repeated) who could benefit from North Yorkshire Horizons Severity of Alcohol Dependence Questionnaire (SADQ) completed Service. North Yorkshire Horizons also has a presence in Given details of local Invited to meet volunteer to support/facilitate AUDIT score: 20 or more AUDIT score: 19 or less Police Custody Suites on an agreed basis mutual aid groups access to mutual aid groups confirmed – possible (over 18’s only) (over 18’s only) dependence confirmed Over 18’s only: Appointment booked (at triage) with the Treatment Service of Appointment booked (at triage) with Health and Wellbeing Given details of local 1, recovery groups, mutual ai mutual groups, recovery 1, st mutual aid groups - North Yorkshire Horizons (referral to 1 appointment offered: Team: health assessment; blood borne virus screening and max. 3 week) vaccinations ‘Next Steps’ (pre-treatment) group offered: jointly facilitated by North Yorkshire Horizons Treatment Service and Recovery and Mentoring Service Signpost to service commissioned to deliver Comprehensive assessment completed by North Yorkshire Horizons Treatment Service structured brief advice (may be completed over more than one appointment): (Refer to Slide 6) • SADQ result reviewed • Based on FRAMES principles • NICE compliant diagnostics undertaken • Drink diary discussed Provide alcohol units • Recovery Plan discussed leaflet • Local mutual aid and recovery groups discussed and information provided See slide 1 for for details slide 1 See Mild dependency identified (SADQ Moderate Severe dependency identified Do not use SSRI’s or GHB Score: 15 or less) dependency identified (SADQ Score: 15 – (SADQ Score: More than 30) in treatment of alcohol 30) misuse. Benzodiazepines should only be used in Alcohol Recovery Pathway: 10-20 week programme based on motivational interviewing and psychological therapy techniques such as short term detoxification Referral to adult social care and/ or safeguarding, if applicable safeguarding, and/ or social care adult to Referral cognitive behavioural therapy. Comprises: 10 weeks psychosocial and relapse prevention interventions and optional 10 week ‘Back to You’ group. Pharmacotherapy interventions facilitated concurrently, where deemed clinically appropriate Nalmefene (RED drug), acamprosate or oral naltrexone and psychosocial programme Community Medically Assisted Detoxification Medically assisted Inpatient Treatment of conditions co-morbid with alcohol misuse: pathway considered. Nalmefene prescribing considered detoxification and residential reviewed throughout 12 week period and Pharmacological agents: diazepam; rehabiliation
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