INTRODUCTION

Service specifications are part of a wider contract or service level agreement that also include the contractual framework, legal conditions and various schedules.

The primary focus of this service specification is adult drug misuse treatment. It is, however, recognised that many services provide both drug and alcohol treatment. It is therefore important for commissioners to recognise the applicability of this service specification to alcohol treatment services.

This sample service specification is intended to provide general guidance on commissioning clinical services for the management of drug dependence in prison, and is not to be used as a fixed and prescriptive template. The sample should be adapted at local level, tailored to the particular type of providers and interventions purchased and should not hamper the development of innovative work.

Annexes A and B suggest templates for more detailed clinical delivery plans in local and trainer prisons that will be useful for commissioners and providers.

It is good practice that commissioners develop specifications in partnership with service providers and in consultation with service users and carers.
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1. DEFINITION OF THE SERVICE
The purpose of the service will be to provide timely and safe assessment and evidencebased clinical management of problematic drug use. The service will be supported by the Prison and the CARAT service to provide an integrated clinical and psychosocial approach to patients with substance misuse problems.
Services and treatments available to patients will evolve as opportunities arise. A phased introduction of the proposed changes will allow new working arrangements and interdepartmental collaboration to develop, while new staff train and work together, towards establishing shared objectives, working practices and a common ethos for the team.
This phased process should be led by the most pressing needs of substance users entering the prison, incorporating current good practice in the management of suicide
1,2 and post-release fatal overdose
3
in addition to recognised physiological and mental health risks associated with substance withdrawal.
A care pathway, described by a series of negotiated and agreed protocols, will necessitate firm integrated working between this new service and existing CARAT service, Mental Health Inreach service and the resettlement team.
To ensure that ongoing treatment provided within the prison is continued on transfer or release, robust continuation of care agreements will be established with key feeder prisons, the prisoner escort service (PECS), Drug Intervention Programme Teams (DIP) and community-based services.
In order to provide adequate prescribing from the outset, it will be necessary to introduce a comprehensive assessment process. This includes contact with any current prescribers and treatment providers, incorporating the assessment procedures of DIPs and validating information from pharmacists.
The clinical substance misuse service will become part of the greater healthcare provision within the prison, linking with, supporting and utilising existent healthcare provision in reception screening, primary care nursing and medical provision, and mental health services. The service will provide the specialist interventions (drug and alcohol assessment, dose induction/stabilisation, observation, detoxification and maintenance, ongoing clinical assessments and reviews, and harm minimisation work).
The service delivery will be in line with clinical criteria described by The Department of
Health
4
, The Prison Service
5,6
the National Treatment Agency
7
, Royal College of
General Practitioners and Royal College of Psychiatrists
8
.
2. AIMS AND OBJECTIVES OF THE SERVICE
2.1. Core aims
The core aims of the service are:
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To develop effective and comprehensive substance misuse services for the population of the prison in partnership with other healthcare, Criminal Justice
Services (CARAT, Drug Intervention Programme and Probation), community drug treatment services, social care providers and the prison service.
To deliver within the overall constraints of the Prison environment and the available budget efficient, equitable and economic services.
To ensure that HMP ****** receives continuous substance misuse clinical care treatment services.
2.2. Key objectives
The Key objectives of the service are:
To implement a clinical care drug treatment service as a fully integrated function of the overall Integrated Drug Treatment System in HMP *****.
Treat a projected total of ****** prisoners per annum. o ***** first reception prisoners treated annually. o ***** prisoners on transfer from other prisons treated annually.
To implement a clinical care drug treatment service in line with the requirements of the Dept of Health Clinical Management of Drug Dependence in the Adult
Prison Setting (November 2006).
To implement a clinical care drug treatment service which meets the organisational standards and needs of the Prison Service.
To measure and secure improvements in health, social functioning and offending status and prevent or decrease morbidity, disability and associated physical and social harms associated with substance misuse.
To develop and maintain a multi-disciplinary approach to the delivery of substance misuse services.
2.3. Outcomes for prisoners
Better drug treatment for prisoners which meets the requirements of the NTA
Models of Care and Treatment Effectiveness strategy.
Prisoners to receive drug treatment in prison which within the constraints of a prison setting is equal to the treatment they would receive in the community.
Improved care coordination of prisoners within the prison by integrating treatment with CARAT, Health Care, and Mental Health Services.
Better targeting of interventions to meet the individual needs of prisoners.
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Ensuring that following a screening/triage and comprehensive assessment a comprehensive range of coordinated and structured treatment services are available for the prisoner.
Provide a seamless journey of care for prisoners from the prison to community services including Primary Care Trusts, Mental Health Trust, Drug Intervention
Programme Teams and Drug Treatment Services.
3. CLIENT GROUP SERVED
All remand and convicted prisoners, including immigration detainees, at HMP ***** who are dependent adult drug users.
4. ELIGIBILITY CRITERIA
Services should cater for dependent opioid users, including those who present with additional polydrug use or the common concurrent use of benzodiazepines, psychostimulants and alcohol at any time of their detention in custody.
Services should also be able to cater for primary users of other drugs including the primary users of crack cocaine.
5. REFERRAL PATHWAYS
5.1. Screening assessment
All prisoners will be health screened on the day of reception into prison. Those identified as having a drug dependence need will be referred to specialist substance misuse staff on same day for triage assessment and immediate prescribed clinical management.
Clear care pathways will need to be established between the clinical substance misuse team and Healthcare. Individuals identified by Healthcare reception staff as requiring triage drug or alcohol assessments will need to be referred promptly and accompanied by the initial screening information. The Substance Misuse assessment staff should be available to receive referrals or discuss potential cases with Healthcare staff whenever this is required. The level of enquiry required at the initial screening will need to be agreed and the most suitable method of carrying out drug testing decided.
5.2. Triage assessment
A triage assessment will then be initiated by the substance misuse clinical staff
(completing the Drug Information Record up to and including the healthcare section).
The aim of the triage assessment is to determine the seriousness and urgency of a client’s problems, the most appropriate type of treatment, and the client’s motivation to engage in treatment.
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5.3. Comprehensive assessment
A comprehensive assessment will be completed if structured clinical treatment is undertaken, whether detoxification or maintenance prescribing is indicated.
Responsibility for clinical decisions rests with the doctor or other authorised healthcare prescriber, but such decisions are not made in isolation but as part of a multi-disciplinary process. The CARATs staff will be responsible for drawing up the comprehensive assessment, but the clinical team will contribute to it.
Comprehensive assessment is a continuing process and continues throughout contact with the se rvice. It seeks to thoroughly assess the exact nature of the client’s substance misuse problems, and coexisting problems in the other domains of health (mental and physical), social functioning and offending. It also contains a full risk assessment of factors that might lead to harm to self or others.
6. DEVELOPMENT OF CARE PLAN
6.1. Initial care plan
An initial care plan will be completed by CARATs staff for all those taken onto the case management caseload after triage assessment. The initial care plan will be undertaken jointly with healthcare staff, and will focus on immediate needs and work needed to motivate the client to engage in further treatment.
6.2. Comprehensive care plan
All those in treatment will have a written and structured care plan resulting from assessment. It will cover the four key domains;
Drug and alcohol use
Physical and mental health
Criminal involvement and offending
Social functioning
All care plans:



 set the goals of treatment and milestones to be achieved set goals in some or all of the four key domains indicate the interventions planned and which agency and professional is responsible for carrying out the interventions make explicit reference to risk management and identify the risk management plan and contingency plans where needed
The care plan is reviewed and evaluated at regular intervals or at the request of a member of the care team or service user. Frequency of reviews is geared to clients' needs.
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Care plan review does not necessarily involve a case conference of all providers involved in the care of the individuals. For example, GPs can undertake the review during an ordinary appointment and decisions are discussed with other professionals and fed into the joint care planning process.
The care plan identifies the review date (the date of the next review meeting is set and recorded at each meeting).
The review process looks at:



 relevance of the care plan the effectiveness of the care plan and outcomes unmet needs client satisfaction with the care
The care plan is tailored to the clients' needs and circumstances and responds flexibly to clients' problems.
The care plan is developed with the active participation of the service user and takes into account the user's wishes and needs.
The service user and key worker/case manager agree and sign the care plan in circumstances where this is agreed. In more unusual circumstances where there are any disagreements about elements of the care plan, this should be recorded.
7. DESCRIPTION OF SERVICES, CARE AND INTERVENTIONS PROVIDED
All treatment services provided will be informed by a full assessment of need, including a risk assessment and all risks identified must be managed in line with the Prison ACCT risk management process.
The provider will be responsible for creating a full clinical delivery plan, such as outlined in Annex A, specifying exactly how the following services will be delivered in the local context. .
7.1 Drug screening for all new prisoners on the first night of reception a) The provider will ensure that all prisoners who have clinical substance misuse needs identified at reception are assessed by a member of the clinical team. b) The provider will ensure that this assessment will include urinalysis to confirm declared recent drug use. c) The provider will ensure that all prisoners screened as having an active substance misuse problem will be referred for treatment to the stabilisation unit. d) The provider will ensure that they have an agreed protocol for managing late receptions which should include the availability of patient group directions for symptomatic relief where the arrival is so late that a response from an out of hours service would not provide more effective care.
7.2 Triage assessment for all prisoners screened as having a substance misuse problem
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a) The provider will be responsible for providing a triage drug and alcohol assessment for all prisoners who have a substance misuse problem identified by the initial health care screening process.
7.3 Prescribed management of withdrawal on the first night of reception a) The provider will ensure that if this clinical assessment indicates the need for first night prescribing, the patient will be seen by a doctor on the stabilisation unit.
7.4 5 day Stabilisation period for a projected ***** prisoners per annum
A 5 day Stabilisation unit for prisoners identified by the clinical drug assessment as requiring a stabilisation period for their opiate, alcohol, stimulant and benzodiazepine dependence will be provided to ensure: a) That all prisoners assessed as requiring treatment for opiate dependence are titrated and stabilised over a 5 day stabilisation period using either Methadone or
Buprenorphine, with clinical observation to include withdrawal and intoxification monitoring at least twice a day. b) That if clinically indicated that a longer period of titration and stabilisation will be available. c) That all alcohol dependent prisoners who are assessed as requiring a medically assisted detoxification will require prompt medical intervention and 24 hour unrestricted observation. d) Those stimulant users who report recent stimulant use and who are screened by a toxicology test have twice daily blood pressure, pulse and pupil light responsiveness testing for the first 72 hours of their custody, or until all observations are within national limits.
7.5 14 / 21 day detoxification programme for a projected ***** prisoners per annum a) A 14 / 21 day detoxification regime will be provided for all prisoners for whom this is an appropriate treatment option in line with Dept of Health Clinical
Management of Drug Dependence in the Adult Prison Setting.
The detoxification regime when undertaken at this speed will be provided on a unit/wing which can provide a safe and secure environment for both the clinical observation of prisoners and the secure dispensing of controlled drugs.
7.6 Maintenance programme (22 days or over) for a projected **** prisoners per annum a) Maintenance programmes for opiate dependent prisoners will be provided for prisoners, in line with Dept of Health Clinical Management of Drug Dependence in the Adult Prison Setting. b) Following stabilisation the maintenance regime will be provided on a wing location that allows for the prisoner to access secure dispensing of controlled drugs.
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7.7 Screening for BBV a) Targets should be in place to increase the numbers of prisoners with an identified substance misuse problem who are screened for exposure to Blood Borne
Viruses (BBV), Hepatitis B + C, and HIV, limited by the necessity of ensuring time for pre and post test counselling.
7.8 Testing and i mmunisation of BBV’s a) Targets should be in place to increase the testing and immunisation of prisoners for BBV’s. This will be the responsibility of the Prison Health Care Provider, the
***** Primary Care Trust.
7.9 Benzodiazepine a) Benzodiazepine reduction will provided to prisoners who are assessed as requiring it in line with Dept of Health Clinical Management of Drug Dependence in the Adult Prison Setting.
7.10 Dual Diagnosis a) Treatment for patients with a serious mental illness and a substance misuse problem will be provided in line with Dept of Health Clinical Management of Drug
Dependence in the Adult Prison Setting, Section 13. b) This recommends an integrated approach to care. The provider will therefore work with both the prison and community mental hea lth services, CARAT’s,
Health Care and the Prison Service to provide a coordinated care and treatment package.
7.11 Health Promotion
The service will complement the prison CARAT team by providing health promotion services which support a whole prison approach and aim to: o Build the physical, mental and social health of prisoners o Help prevent the deterioration of prisoner’s health during or because of custody o Help prisoners adopt healthy life behaviours that can be taken back in to the community upon release a) The service will provide advice on prevention of HIV, hepatitis and other drugrelated problems to prisoners assessed or being treated for their substance misuse problems. b) The service will screen / test prisoners for HIV and hepatitis B and C. c) The service will immunise prisoners requiring a Hepatitis B immunisation. d) The service will provide a basic health assessment including referral to
Prison Health Care services. e) The service will provide psychiatric screening and refer to and work in conjunction with mental health services if indicated by the assessment process.
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7.12 Other Interventions a. The service will provide Leaflets on the risks associated with substance misuse and service available in the prison and community. b. The service will Liaise with and refer to other services both within and external to the prison.
8. RELEASE PLANNING, AFTERCARE AND SUPPORT
Release planning and onward referral should be a planned element of treatment. The clinical substance misuse service will link with the CARAT and resettlement team to optimise support on release.
Co-ordination of drug treatment services will be through the CARAT key worker. The development of the Drug Intervention Programme (DIP) across the country means that
Criminal Justice Interventions Teams (CJITs) will be able to access treatment providers in every area for continuity of treatment after release.
In the event of unplanned releases outside of the hours when the CARAT team may operate, the clinical team will be required to arrange continuation of prescribed care directly with a community treatment provider.
9. SHARED WORKING WITH CARATS
The clinical service on the stabilisation unit will require a daily presence from the CARAT team. Joint group work, shared assessments and treatment plans will all serve to avoid duplication and increase communication. The level and speed of integration will need to be defined and worked towards. From the outset, however, the provider should identify areas of shared work, recording and information that will bring benefits to both staff and clients. The two services should endeavour to combine their respective regular team meetings at the earliest opportunity.
10. WORKFORCE RESPONSIBILITIES a. The provider will ensure that enough doctors, nurses and pharmacists are available to enable controlled drug prescribing and dispensing daily, including weekends, such drugs to be administered by supervised consumption.
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b. The service will be delivered by a multi-disciplinary Substance Misuse Team. To maintain and further develop a multi-disciplinary Prison Mental Health Care Team c. To ensure continuity of staff working in all the services at all times and to notify the prison drug strategy lead of all personnel changes, shift patterns and agency arrangements. d. The Provider shall ensure that its staff are available for professional consultation with staff delivering primary care and mental health services to the prison population e. The provider will ensure that all personnel deployed into the Prison are appropriately qualified and registered f. The provider will ensure that all staff have the required security clearance to work in a prison setting.
g. To provide integrated administrative and management systems to facilitate the execution of substance misuse services h. To attend relevant in-house prison service meetings.
10.1. Medical Lead a) A specialist doctor (Addiction Psychiatrist, substance misuse specialist or GP with
Special Interest), will be required to act as medical lead for the service. They will have clinical respo nsibility for the management of the patient’s drug problem. This will entail accurate diagnosis, provision of pharmacological and brief psychosocial interventions where appropriate and coordinating the clinical management of comorbid physical health problems.
10.2. Clinical Lead a) A specialist nurse with clinical responsibility for the delivery of planned patient care.
10.3. Service Management a) To manage the substance misuse service and to lead, support and implement systems for delivery of the service model.
b) To provide managerial support and clinical expertise to the prison drug strategy lead to ensure effective co-ordination and delivery of substance misuse health care.
c) To provide sufficient management capability and capacity to enable delivery of efficient substance misuse care services and to implement key elements of the IDTS and Prison Key Performance Targets.
10.4. Nurses a) Provision of 7 day a week, 24-hour professional service, centred on the stabilisation unit with an outreach service to other locations for continuing after-care b) Carrying out drug screening of new arrivals and those currently in treatment c) Carrying out full clinical assessments d) Formulating initial individual clinical care plans e) Supporting, advising and monitoring all IDTS patients f) Provide, if suitably qualified, a nurse prescribing service under the direction of the clinical lead, for ongoing provision of treatment following initial assessment by a doctor.
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g) Liaising with CA RAT team, and other outside agencies, current prescriber and GP’s relevant to all new arrivals h) Administering controlled drug medication as prescribed to the prisoner.
i) Refer to Healthcare Dept. patients in need of non-emergency general medical services j) Refer to Health care those requiring HBV screening, testing and vaccination k) To be alert for prisoners at risk of self harm and to open a relevant ACCT document. l) Review, in partnership with members of the clinical substance misuse service and
CARAT key worker, previously initiated treatment plans and amend as required m) Communicating information obtained to colleagues as required n) Monitoring daily progress of those in first week of treatment, and less frequently those no longer deemed in need of frequent individual contact o) Participating in supervised administration to those in receipt of controlled medication or other drugs used in the treatment of substance misuse or with a misuse potential in prison (PSO 3550) p) Attending Team meetings as required q) Providing, in alliance with CARAT team, health promotion and harm minimisation education r) Liaising with other wing and medical staff as required facilitating the transfer of patients from the stabilisation unit and any secondary facility to normal allocation s) Ensure recording of clinical activity using the agreed performance management / data collection tools. t) Refer to CMHT those believed to be suffering a mental illness
10.5. Doctors a. Assess new arrivals referred by Substance Misuse Nurse for urgent drug or alcohol treatment b. Initiate and document all prescribing plans on day/night of arrival in prison in accordance with agreed prescribing protocols c. Offer wider motivational support to encourage patients to engage in treatment d. Refer to CMHT those believed to be suffering a mental illness e. Initiate any urgent medical intervention that may become apparent during a patient’s specialist assessment f. Refer to Healthcare Dept. patients in need of non-emergency general medical services g. To be alert for prisoners at risk of self harm and to open a relevant ACCT document. h. Review, in partnership with members of the clinical substance misuse service and CARAT key worker, previously initiated treatment plans and amend as required i. Refer to relevant Nursing staff those in need of HBV vaccination
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11. SERVICE PRINCIPLES
The following service principles apply :

To provide interventions that will support the welfare of the individual prisoner receiving the service.

To provide a strong user focus which will build a positive therapeutic alliance that will, within the constraints of the Prison environment, encourage and support the prisoners’ involvement in all aspects concerning the management of their care.

To uphold and respect the human rights of clients in a prison setting.

To continually assess and to respond to the changing needs of the client incorporating risk management strategies.
 To take into account the social, cultural and religious context of the client’s circumstances when making decisions concerning him.
 To use the client’s own social and professional network of support as much as possible.

To provide interventions that involves coordinated partnership working.

To take into account the health/disability issues. Social, cultural and religious context of the client’s circumstances when making decisions concerning him/her.
12. QUALITY STANDARDS
All Service Providers or Contractors for service provision and their employees will be expected to maintain high standards of professional behaviour and performance.
All Service Providers will demonstrate the following at all times;
That they understand the nature and purpose of the service in a manner consistent with the Prison Partnership Board, Community Safety
Partnership/Drug Action Team and joint commissioning agents (DAT, PCT,
Prison), Drug Interventions Programme Guidance, Dept of Health, National
Treatment Agency Guidance and in line with the aims of the National Drugs
Strategy.
That the specification contained in the contract will be maintained.
That they are operating working practices which comply with employment legislation, Health and Safety at work legislation and legislation associated with the Community Care Act and Mental Health Act, Children Act 1989
(Amendment 2004), Race Relations Act 1976 and Amendment 2000, Sex
Equality Act 1975, Disability Discrimination Act 1995, Disability Rights
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Common Act 1999, Carers Act 2005 and compliance with any future legislation encapsulated in this area.
That competent staff are employed to carry out the tasks required in the specification and that competence is task-related according to the standards of works.
That a sufficient number of staff is employed to carry out the tasks required in the specification.
That the service provider complies with the local security strategy for the prison.
That the Service Provider has its own Quality Assurance System and a
Quality Control System that monitors performance against the specification.
That the service is measured against QuADS (Quality in Alcohol and Drug
Services) organisational standards and SMAS Commissioning Standards.
That the Service Provider is compliant to DANOS (Drug and Alcohol National
Occupational Standards).
- That the Service Provider complies with the requirements and standards of the Healthcare Commission.
13. POLICIES, PROTOCOLS AND WRITTEN STRATEGIES
All policies should have a named person with responsibility for implementation and monitoring.
Service to have written strategies on the reduction of drug-related death (blood-borne infections and overdose prevention).
Service to have a written Hepatitis B immunisation strategy or have adopted the DAT strategy. This strategy tackles maximising the number of clients immunised and the number of completed courses of immunisation.
Service to have a written plan on how clients who drop out of treatment are encouraged to re-engage.
Service to have written plans on consultation with service users and carers.
Clinical care pathway protocols should be in place.
to enable continuity of treatment between prison and community prescribing, healthcare and pharmacy services pre and post release.
to enable sharing of information between CARATs, healthcare, CJITs, community drug treatment providers and offender managers for comprehensive treatment planning and provision during custody.
to ensure immediate adoption of existing treatment in transfers from local prisons and key trainer prisons.
to ensure the current prescription and complete clinical record accompanies the prisoner on transfer to the receiving prison to enable immediate adoption of existing treatment.
to enable arrangements for the clinical record to accompany prisoners and any medication required to be available during appearances in court.
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14. EQUIPMENT AND RESOURCES
To ensure that all substance misuse care services are resourced with appropriate consumables and equipment to ensure delivery of services.
14.1. Resources to be provided by the Prisons

Escort of patients to medical appointments, and the safety of staff

Provide biometric dispensers when available

Shared office and consultation space

Sufficient furniture for staff: desk and chairs

IT hardware and support

Telephones

Procurement and replenishment of administration and office stock
Consultation and meeting room space

All major capital items will be provided by HMP *****
14.2. Resources to be provided by Prison Health Care
General Medical / Acute and Emergency Health Care Services for all prisoners which will include basic substance misuse screening of prisoners on first night.
Payment for Hep B / C and HIV tests.
Payment for vaccine for Hep B immunizations.
Nicotine replacement therapy.
15. MONITORING AND REVIEW
Since this is a new service development the performance targets may be subject to change and negotiation during contracting and performance reviews. Targets and information requirements may initially be based around the following;
-
No’s of referrals and referral sources
-
No’s screened
No’s Assessments
-
No’s Admissions to 5 day stabilisation
No’s Admissions to 14 day detoxification
-
No’s Admissions to 21 day detoxification or longer
No’s being commenced on methadone maintenance
Numbers accessing CARAT 28 day Psychosocial programme
Numbers waiting for through care treatment and continued prescribing on discharge
No’s accessing and receiving through care and appropriate prescribing on discharge
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16. APPENDICES
1.
2.
3.
4.
5.
Clinical Management of drug dependence in the Prison Setting.
IDTS Workforce Strategy
Prison Health care Standards
28 day Psycho-Social Model
Continuity of care Guidance
17. REFERENCES
1. Shaw J, Appleby L & Baker D (2003), Safer Prisons: A National Study of Prison
Suicides 1999 –2000 by the National Confidential Inquiry into Suicides and Homicides by
People with Mental Illness, Department of Health, London.
2. H M Prison Service (2001), Prevention of suicide and self-harm in the Prison Service, an internal review.
3. Home Office Online Report Series (2003), Singleton N, Pendry E, Taylor C, Farrell M and Marsden J, Findings 187, Drug-related mortality among newly released offenders. www.homeoffice.gov.uk/rds/pdfs2/r187.pdf
4. Dept of Health (2006), Clinical management of drug dependence in the adult prison setting.
5. HM Prison Service (2000), PSO 3550, Standard for the clinical management of substance misuse.
6. Dept of Health (1999), Drug misuse and dependence
– guidelines on clinical management, The Stationery Office.
7. The National Treatment Agency (2005), Models of care for treatment of adult drug misu ser’s.
8. Roles and Responsibilities of Doctors in the Provision of Treatment for Drug and
Alcohol Misusers, Royal College of General Practitioners, Royal College of Psychiatrists
2005.
9. Royal College of Psychiatrists (2002), Co-existing Problems of Mental Disorder and
Substance Misuse (dual diagnosis): An Information Manual, Royal College of Psychiatry
Research Unit.
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ANNEX A - LOCALS
DETAILED LOCAL CLINICAL DELIVERY PLAN TEMPLATE FOR LOCAL PRISONS
REFERRAL AND CARE
PATHWAY PROTOCOLS
NEGOTIATED AND AGREED
WITH:
1. Healthcare
reception screening
primary care nursing
general medical provision
Details of WHAT WILL BE IN PLACE
(if specific protocol document exists, simply reference it: if not, describe the pathway arrangements)
DATE WHEN IN PLACE
2. CARATs
3. Mental Health
(incorporating the Care
Programme Approach)
4. Resettlement Team
5. Offender Supervisors /
Offender Managers
6. CJITs
7. Prison Escort Service
8. Community Health Services
ASSESSMENT SYSTEMS AND (describe local arrangements planned)
PROTOCOLS IN PLACE
Clinical contribution to triage and comprehensive assessment
Contribution to assessment of:
prescribers of any current treatment
Other treatment providers
CJITs
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Follow-up monitoring of individuals with a clinical indication who decline treatment following reception
Details of WHAT WILL BE IN PLACE
FIRST NIGHT CARE
Initial healthcare screening
triage assessment
urinalysis
First night prescribed management of withdrawal
doctor available to prescribe methadone or buprenorphine to all dependent opiate users
dose induction in stabilisation unit
unrestricted 24 hour observation
(describe local arrangements planned)
PRIMARY OPIATE USERS (describe local arrangements planned)
5 day minimum dose induction in stabilisation unit
DATE WHEN IN PLACE
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Followed by
Standard minimum 14 day opiate detoxification (longer if required)
Details of WHAT WILL BE IN PLACE
Or
Opiate substitute maintenance
Clinical assessment of clients representing to services for detoxification or pre-release prescribing
PRIMARY STIMULANT
USERS
72 hour watch over stimulant withdrawal
Longer term mental health watch to monitor depression and mood changes
SECONDARY LOCATION
REQUIREMENTS
Secondary location plans for numbers expected
SECONDARY RECEPTIONS
ON TRANSFER FROM OTHER
PRISONS
Protocols in place for immediate continuity of existing treatment
(describe local arrangements planned)
(describe local arrangements planned)
(describe local arrangements planned)
(describe local arrangements planned) KEY WORKER/CASE
MANAGER & CARE PLAN
Case management of CARAT worker in place
Arrangements for completion of care plan and reviews
DATE WHEN IN PLACE
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ANNEX B - TRAINERS
DETAILED LOCAL CLINICAL DELIVERY PLAN TEMPLATE FOR TRAINER PRISONS
REFERRAL AND CARE
PATHWAY PROTOCOLS
NEGOTIATED AND AGREED
WITH
Details of WHAT WILL BE IN PLACE
(if specific protocol document exists, simply reference it: if not, describe the pathway arrangements)
DATE WHEN IN PLACE
1. Healthcare
reception screening
primary care nursing
general medical provision
2. CARATs
3. Mental Health
(incorporating the Care
Programme Approach)
4. Resettlement Team
5. Offender
Supervisors/Offender Managers
6. CJITs
7. Prison Escort Service
8. Community Health Services
ASSESSMENT SYSTEMS AND
PROTOCOLS IN PLACE
(describe local arrangements planned)
Clinical contribution to comprehensive assessment and review process
PRIMARY OPIATE USERS (describe local arrangements planned)
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Protocols and arrangements in place for continuation of existing prescribed opiate substitute maintenance
Details of WHAT WILL BE IN PLACE
Clinical assessment of clients representing to services for detoxification or pre-release prescribing
Protocols in place for withdrawal management
PRIMARY STIMULANT
USERS
(describe local arrangements planned)
Protocols in place for long term mental health watch to monitor onset of depression and mood changes
LOCATION REQUIREMENTS (describe local arrangements planned)
Location plans for numbers expected
(describe local arrangements planned) KEY WORKER/CASE
MANAGER & CARE PLAN
Case management of CARAT worker in place
Arrangements for completion and review of care plans
DATE WHEN IN PLACE
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