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(

Age&range&referred&clients&
12(
9(
6(
3(
0(
Age(20M30( Age(31M40( Age(41M50( Age(51M60( Age(61M70( Age(71M80( Age(81M90(

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&
Mental(Health(

Social&
Family(Exclusion(

TB(

DemenAa(

Cirrhosis(of(the(
liver(

Alzheimers(

Heart(
Failure(

COPD(

Homelessness(
Unemployment(

Diabetes(

Korsakos(

Social(Exclusion(

Schizophrenia(

Financial(Hardship(

Housing(

Prole&

Client&Group&

!
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.(

Project&Delivery&

Client&Support&Structure&
Level of Support
Housing&&&Benets&
Medical&
Social&(incl.&living&condiBons&&&&Mobility)&
Mental&Health&
Criminal&JusBce&
Social&Services&
Dietary&

RED

AMBER

GREEN

Daily

Weekly

Monthly

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((

Holistic Approach

!
Complex presentations:!
!
- I-space: mental health!
- It-space: broken neck!
- We-space: isolation!
- Its-space: illegality !
!
!

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(