Developing Alcohol Integrated
Care Pathways
Workshop
Sean Meehan, Associate Delivery Manager,
Alcohol Harm Reduction National Support Team,
Department of Health
Alison Wheeler, Regional Alcohol Manager, Drink Wise North West,
Department of Health
Aim and Objectives
• To develop an understanding of alcohol treatment
pathway work as one of the ways to improve the
effectiveness and capacity of local treatment systems
– Understand the national context and guidance
– Understand the value of pathway work
– Understand how to implement a typical pathway
improvement process
– Understand some useful techniques and ‘top tips’
– Gain insight into the learning from a regional approach
High Impact Changes
MoCAM Guidance on Integrated
Care Pathways (DH, 2005)
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Commissioners should ensure that each alcohol treatment
intervention has an Integrated Care Pathway (ICP), which should be
agreed with and between local providers, and built into service
specifications and service level agreements. Integrated care
pathways should contain the following elements:
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A definition of the treatment interventions provided
Aims and objectives of the treatment interventions
A definition of the client group served
Eligibility criteria (including priority groups)
Exclusion criteria or contraindications
A referral pathway
Screening and assessment processes
Development of agreed treatment goals
A description of the treatment process or phases
Co-ordination of care
Departure planning, aftercare and support
Onward referral pathways
The range of services with which the interventions interface
Further guidance expected from DH via Alcohol Learning
Centre website
What can we expect from DH
guidance?
• Guidance on why, who, how and
what
• Useful checklists
• Examples of alcohol treatment
pathways
• Alcohol pathways to consider
Emerging issues from NST visits
• Most areas are wanting support with pathway
development
• Re-designing the treatment system and tendering are
common in many areas
• Some areas have pathways in place but these do not
reflect a whole system approach
• General lack of confidence in how to implement a
pathways project plan
• Commissioners are sometimes not in the driving seat
• Some areas have advanced work programmes
Why Develop Integrated care
Pathways?
Integrated care pathways should provide access to a range of
services and interventions that meet an individual’s needs in a
comprehensive way and should be developed
because:
• Alcohol users can have multiple problems that require
effective co-ordination and treatment
• Several specialist and generic service providers may be
involved in the care of a service user simultaneously or
consecutively
• Continuing and evolving care needs requiring referral to
services at different tier levels
• To provide consistency and parity of approach
• To ensure access to care is not based solely on individual
clinical decisions or historical arrangements
• Common language
What is Process Mapping?
Process Mapping is a method for defining:
• The sequence of steps and activities to be
performed along the Integrated Care Pathway
• Service responsibilities for these steps and
activities
• Areas that lie outside the process but impact
upon it
• The relationship that exists between the
different professionals in the process and the
potential problem areas
• Identifies blocks to access, throughput and
transitional fallouts
Top Tips on Developing Integrated
Care Pathways and Process
Mapping
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Decide on project manager/lead
Decide on milestones
Standardise - decide on format, schematic, narrative, colours, essential
elements
Develop in partnership
Reflect the service user experience
Process is as important as the finished product
Pathway for each intervention
Evidence based
Consultation
Process map – integrate with data and capacity
Develop a common assessment and care planning process with common
documentation to avoid duplication
Re-design
Publish
Example of a Mapping Template
Service Name
Tier of Intervention
(Please Tick)
Intervention
1
2
3
4
Integrated Care
Pathway in place?
Yes / No
Target User Group
(please tick)
Increasing Risk
Higher Risk
Dependant
Partners
Treatment Model Example
LES GP
Audit Score
Assessment
Brief
Advic
e
<16
Back to
Tier 2
>16
GP
Tier 2
Arrest
Referral
Assessment
Detox
Required?
Suitable for
counselling?
Yes
No
Refer to
GI
Consultant
Yes
Self
Tier 3
Provide
Counsellin
g
Hospital
(Wards and A & E)
Assessment
No
No
Liaise with
Case
Manager?
In hospital
detox
Care Plan, Liaise with GP /
Psychiatrist for medically assisted
detox
Discharge
to GP
OR
Successful?
No
Yes
A Typical ATP
Learning from Drink Wise North
West Pathways Event
Outcome from the event to be delivered by sub
regions, supported by DWNW:• Validation of pathways
• Building an effective outcomes framework
Regional development and support:• Homelessness pathways
• Dual Diagnosis pathways
• Building the business case for investment
Discussion
• What action are you taking/plan
to take to develop alcohol
pathways?
• What challenges are you facing?
• Identify how you plan to take this
work forward?