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Home > Rehabilitation: the fifth pillar of the National Drugs Strategy.

Keane, Martin (2007) Rehabilitation: the fifth pillar of the National Drugs Strategy. Drugnet Ireland , Issue 23, Autumn 2007 , pp. 1-2.

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The mid-term review of the National Drugs Strategy (2005)1 recommended that rehabilitation become the fifth pillar of the Strategy and that a working group be established to develop an integrated rehabilitation provision. The Report of the Working Group on Drugs Rehabilitation was launched on 7 June 2007.2 The report makes a number of key recommendations and sets out the structural arrangements required to implement them. The overall goal is to provide an integrated rehabilitation service to current, stabilised and former drug users. This article summarises the main structural arrangements and recommendations in the report. 

Structures for the delivery of rehabilitation services

National Drug Rehabilitation Implementation Committee and national rehabilitation co-ordinators

A key proposal is to add to the existing structures of the drug strategy by establishing a National Drug Rehabilitation Implementation Committee (NDRIC), chaired by a senior rehabilitation co-ordinator (new post). The committee will be made up of representatives of the Health Service Executive (HSE), the National Drugs Strategy Team (NDST), the National Advisory Committee on Drugs (NACD), the community and voluntary sectors, rehabilitation and healthcare professionals, problem drug users and families of problem drug users. In addition, it is proposed that 10 rehabilitation co-ordinators and appropriate numbers of support staff be appointed. These co-ordinators will contribute to the development of local protocols, service-level agreements, quality standards and care plans, and to the overall tracking of client progression. The report recommends that the co-ordinators join the treatment and rehabilitation sub-committees of local drugs task forces and take the lead in overseeing the implementation of the recommendations of the Working Group in their respective geographical areas. 

Recommendations

Protocols, service-level agreements and quality standards

The Working Group recommends that the NDRIC develop broad national protocols to facilitate inter-agency working, which, when approved by the Cabinet Committee on Social Inclusion and the Inter-Departmental Group on Drugs, will form the basis for the development of local protocols (that will require final approval by the NDRIC). The Group envisages that the protocols will cover issues such as confidentiality, common assessment tools, referral procedures and conflict resolution between agencies. It also recommends the development of service-level agreements (SLAs) at national and local level, to give clarity on the roles of each agency. The development of national and local SLAs will follow the same procedures as indicated for the development of inter-agency protocols. A quality standards framework should be developed for service providers, to include enhanced case management procedures. The framework will be set out by the NDRIC and will follow procedures similar to those proposed for the development of the protocols and SLAs. The framework will help to identify the core competencies required by service providers to enable them to deliver rehabilitation programmes. 

Case management, care plans and key workers

The HSE will be responsible for case management, for ensuring that this service is carried out by the responsible agency, and for tracking the progression of service users through the system. Case managers will liaise with key workers who will deal directly with clients receiving specific services. Client-centred care plans based on assessment, with negotiated and agreed goals, will form the basis of case management and progression. Care plans will be holistic and will address a range of personal, educational, housing and employment needs. 

Medical support

The report recommends an expansion in the range of treatment options, an increase in the number of local GPs and pharmacies, and an increase in the number of residential detoxification beds from 23 to 48 (HSE lead), pending the outcome of the report on residential treatment/rehabilitation.3 Building on the work of the Research Outcome Study in Ireland (ROSIE),4 research should be undertaken to examine the outcomes of methadone maintenance programmes. 

Community Employment (CE) (vocational rehabilitation)

The health requirements (HSE lead) and educational requirements (Vocational Education Committee (VEC) lead) of CE participants should be addressed while they are on the scheme, with the help of service-level agreements. The number of drug-specific CE places should be increased from 1,000 to 1,300 to reflect demand and the settling down of the regional drugs task forces (FÁS lead). A pre-stabilisation initiative, focusing on preparation for CE, should be developed (HSE lead).

Employment

Stronger links with employers, employer organisations and trade unions need to be established to facilitate ease of access to the workplace for recovering drug users (Department of Enterprise, Trade and Employment lead), while access to ongoing support for employers of drug users and for recovering drug users in employment is recommended (Case managers and rehabilitation co-ordinators lead). The report recommends that research on progression pathways to employment should be undertaken (NACD lead). 

Access to education

Factors that make it difficult for recovering drug users to access education should be identified and removed where possible and an education fund for drugs rehabilitation should be established (Department of Education and Science lead). An outreach approach should be developed by the Vocational Education Committees to identify and develop responses to the adult educational needs of problem drug users in rehabilitation. 

Housing

Local authorities should liaise with local drugs task forces to facilitate recovering drug users who wish to return to or move into local authority housing in the community. Dedicated supported accommodation, staffed appropriately, should be provided to cater for clients who have difficulties with an independent living environment. The provision of transitional/half way housing for recovering drug users should continue to be expanded. The long-term housing needs of problem drug users who are capable of independent living should be addressed, for example, through the rental accommodation scheme. (Department of Environment, Heritage and Local Government lead). 

Rehabilitation of offenders

Drug treatment and rehabilitation programmes should be made available to all problem drug users in prison in the context of mandatory drug testing and drug-free prisons, and a continuum of care put in place for when they leave prison. A review of the operation of the local prison liaison groups should take place (Irish Prison Service and the Probation and Welfare Service lead). 

Childcare

The HSE, in conjunction with the Office of the Minister for Children should decide on how best to integrate childcare facilities with treatment and rehabilitation services and subsequently progress the matter. Research is recommended to inform this process (HSE lead). Childcare services for children of problem drug users should adopt an approach focused on the development of the children (Office of the Minister for Children lead). 

Role of families in the rehabilitation process

Service providers should actively encourage family reconciliation, where appropriate. Families should be seen as service users and involved in the recovery of drug using family members (Case managers, HSE and service providers lead). A pilot short-stay respite programme for families of drug users should be developed (HSE lead). 

Conclusion

This report sets out a sound structural framework with key relevant recommendations to advance the strategic response to the rehabilitation needs of current, stabilised and former drug users. The report provides a real challenge to Government departments and agencies already involved – and those newly involved – in the delivery of the National Drugs Strategy to combine their expertise and energy towards delivering much needed rehabilitation services. In this regard, the development of inter-agency protocols and service-level agreements are vital to enable these different agencies to develop agreed strategic and operational goals. The development of a quality standards framework identifying the core competencies and associated training needs of service providers will add to the quality of services being provided. 

The recommendations in this report for the delivery of an expanded service, in terms of  treatment options, educational and vocational training options, and employment supports, are a welcome addition to the National Drugs Strategy. These services should build on the achievements of the strategy thus far and contribute to the social reintegration of current, stabilised and former drug users. Finally, the appointment of national co-ordinators and the establishment of the NDRIC will be followed by the development of an agreed action plan, with key performance indicators to assess outputs and measure outcomes. 

1. Steering Group for the mid-term review of the National Drugs Strategy (2005) Mid-term review of the national drugs strategy 2001-2008. Dublin: Department of Community, Rural and Gaeltacht Affairs.

2. Working Group on Drugs Rehabilitation (2007) National drugs strategy 2001–2008: rehabilitation. Report of the working group on drugs rehabilitation, May 2007. Dublin: Department of Community, Rural and Gaeltacht Affairs.

3. This report is being finalised by the HSE Working Group on Residential Treatment & Rehabilitation (Substance Users) and will be published in due course.

4. See article on ROSIE Findings 4 on p. 9 of this issue.

Item Type
Article
Issue Title
Date
July 2007
Page Range
pp. 1-2
Publisher
Health Research Board
Volume
Issue 23, Autumn 2007
EndNote
Accession Number
HRB (Available)

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