Methadone & Alcohol Reducti on & Cessati on Project (MARCP)

Gavin McPhail

Occupational Therapist

Addictions Service: North Ayrshire Locality

gavin.mcphail@aapct.scot.nhs.uk

Aims of Presentati on

To discuss the Methadone & Alcohol Reduction & Cessation Project as well as the processes involved in planning, organising and running a ‘recovery orientated’ community signposting activity group within North Ayrshire Addictions Services.

MARCP

Funding Alcohol & Drug Partnership (ADP) Necessary to provide quarterly monitoring reports

AimTo provide recovery orientated additional/intensive support for patients receiving methadone script wishing to either reduce or detoxify from this.

Inclusion Criteria - Phase 3 (stable and positive in attitude to recovery)- < 30mls methadone (this has now increased to anyone wishing to reduce or detox)- No diazepam script- No severe mental health issues

Staff- Charge Nurse (co-ordinator)- Occupational therapist- Project Worker (North Ayrshire Council – Children & Families Social Services)

• Filtering process for project (inclusion criteria met)

• Patient lettered with invitation to appt

• Joint assessment of need completed (C/N & OT)

• COPM & CHRISTO assessment

• ? NAC input (children/activity/social)

• Provide intensive OT input if need identified

• Suitable ? – Moving Forward Group

MARCP - Process

• Similar needs expressed during ax.

• Expressing a desire to move forward in recovery journey

• Save replication of intervention

• Increased care provision

• Foot in the door approach

• Indirect benefits from attending

MARCP - Rati onale

• Meaningful structure introduced to their day

• Access services available to them independently and integrate back into their local community

• Increase motivation to change

• Increase in occupational participation

• Increase in physical activity and personal well-being

• Peer to Peer support (addiction/motivation/social)

• Significant disparity between post COPM/CHRISTO scores

• Patients feel satisfied and supported in their recovery journey

Group Programme - AimsIntroduce local services by facilitating group workshops aimed at increasing patient knowledge of available options through presentations, activity, engagement in bite sized interventions and opportunistic self referral…

Group ProgrammeDate Time Activity Venue Facilitators

10th January13:00 - 16:00

Introductions, Group Rules & Expectations, Ice Breakers Activity: Games, Wii Etc.

Ardeer Centre All

17th January 13:00 - 16:00 Workshop: KA Leisure - GP Referral

Activity: Exercise Class

Ardeer Centre

Gavin (OT)Jillian (SN)Jackie (KA)

24th January 13:00 - 16:00 Workshop: Job Centre - CV Writing & Benefits

Activity: Nordic Walk

ArdeerCentre

Gavin (OT)Claire (Job Centre)

Angela (KA)

31st January 13:00 - 16:00 Workshop: Library Services & Basic Computing Courses

Activity: Computing

ArdeerCentre

Gavin (OT)Jillian (SN)

Lisa (Librarian)

7th February 13:00 - 16:00 Workshop: Look Ahead

Activity: Relaxation

Look Ahead Irvine

Cheryl (OT)Jillian (SN)Trish (LA)

14th February 13:00 - 16:00 Workshop: Fresh Air-Shire

Activity: Exercise Class

ArdeerCentre

Gavin (OT)Jillian (SN)

21st February 13:00 - 16:00 Workshop: Dietitian - Healthy Eating: Cooking on a Budget

Activity: Preparation for Healthy Eating Challenge

ArdeerCentre

Gavin (OT)Jillian (SN)

28th February 13:00 - 16:00 Workshop: Food Shopping

Activity: Cooking Challenge & Buffet

ASDA&

Ardrossan

Gavin (OT)Jillian (SN)

6th March 13:00 - 16:00 Workshop: Wrap Up, Certificates etc.

Activity: Patient Led

ArdeerCentre

Gavin (OT)Jillian (SN)

Participants11 patients (3 male; 8 female)

Staff2 – 3 Staff per group (2 addictions staff + 1 NAC)

LocationVarious

Duration 9Weeks

Budget £200

Group - Open to both OT and/or MARCP patients - Must attend all workshops/activity groups

Transport- Patients to facilitate own transport arrangements- Graded support where appropriate

Group Programme – Informati on

Letter sent to every patient who expressed an interest in attending, with group content and structure enclosed

Map with individually tailored travel instructions / advice provided

Telephone call requesting patients intent to attend

Any special requests etc

All group members provided intent to attend and declined any assistance with travel

MARCP – Pre Group Preparati on

11/11 patients gave intent to attend – no special requests made

WEEK 10/11 patients attended

WEEK 21/11 patients attended

WEEK 30/11 patients attended

WEEK 40/11 - group discontinued

All patients were contacted after each group. All stated their intention to attend the following week’s group and

only 1 requested any support to enable their attendance.

MARCP – The Group

No formal post evaluation was completed; however, each patient was contacted to ascertain their reasons for non-attendance: -

1. Did not feel ready to join a group / anxious2. Did not wish to mix with previous drug users3. Gained employment4. Family crisis5. Could not be bothered6. Town/village rivalry7. Time did not suit

MARCP – Post Group Evaluati on

√ Opportunity to network with other professionals / agencies√ Increased my knowledge re: available services√ Interagency working

Negative’s

X Financial restrictions X Lack of suitable venues

X Keeping everyone happy (time/availability)

X iPatient DNA’s

X Personal experience & knowledge

Evaluati on – Organising Group

Positive’s

√ Multi purpose Hall with excellent facilities √ Positive experience with and interest expressed by external agencies

Negative’sX Attendance X Lack of communication with patients

Evaluati on – Running Group

Positive’s

√ Enabled opportunity to reflect on own practice

√ Existing contacts etc in place to replicate group

Negative’s

X Contacting and obtaining feedback from group members X Discontinued OT involvement

Evaluati on – Evaluati ng Group

Positive’s

Hindsight…

EvaluationTransportation

Pre Group Visit Therapeutic

Relationship

Statistics taken between Nov 2011 & Dec 2012

37 Patients

14 patients either :reduced methadone to zero (10), or completed a Suboxone detox (4)

5 / 37 unsuccessful Failed to attend (2), Started using Heroin again (2), or Decided against continuing (1)

One patient who started using again has since completed a Suboxone detox

18 / 37 patients are continuing to reduce

Total reduction in daily dispensed methadone = 441mls

MARCP – Some Stats

• 81% of discharges were planned

• 100% of patients who completed a pre and post assessment using the COPM improved their overall Performance & Satisfaction scores.

Performance Initial - 3.05; Post - 6.73; Increase of >100%Satisfaction Initial - 2.95; Post - 6.52; Increase of >100%

MARCP – Some Stats

• 82% of patients reduced their alcohol consumption

• 100% of patients either demonstrated an Improvement or Stabilised their functioning when measured through CHRISTO assessment

MARCP – Some more stats

Overall, how would you describe your experience as a user of the service?

• I’ve found it to be a great help it has allowed me to change my life for the better which made my families life better.

• Great, really friendly and helpful.

• Explains things well.

• Treated with respect and care.

• I found the workers very helpful and very friendly, you can talk to them without them judging you.

• Helpful.

• Good service for people wanting off methadone. We are generally ignoredand only seen once a year.

• Everyone was helpful and friendly and went out of there way to help me.

MARCP – Pati ent Sati sfacti on Questi onnaire Results

• Funding extended until September 2013.

• Now incorporate patients who wish to reduce or detoxify from alcohol.

• Anyone can access the programme if they are wishing to reduce their methadone use.

MARCP – What Now???

Thanks for listening!

Any further questi ons?