System and procedures

SYSTEM AND PROCEDURES
“MANAGING TREATMENT AND REHABILITATION”

Abdullah Baniyameen
baniyameen@aol.com
July 1, 2009

TREATMENT PROTOCOL:

QUALITY IS NEVER AN ACCIDENT. IT IS ALWAYS THE RESULT OF CAREFUL PLANNING, TEAM WORK, AND A COMMITMENT TO EXCELLENCE.

HAPHAZARD AND UNPLANNED GROWTH IN THE FIELD:

• Lack of understanding of the magnitude of the problem.
• Lack of awareness of the need to provide multi disciplinary care.
• Absence of documented literature on the nature of services to be offered.
• Lack of training, hence, no professionalism in the field.

MINIMUM STANDARD OF CARE:

• Continuum of care gets focused which in turn, ensures effective service delivery.
• Ensures optimum utilization of services through networking and convergence.
• Helps in planned growth and provides opportunities for evaluation.
• Availability of documented literature providing guidelines which can be replicated.

ADDICTION MANAGEMENT:

• No single treatment is appropriate for all individuals. There is a need to offer a range of treatment services based on individual needs.
• Treatment needs to be readily available.
• Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
• Treatment does not need to be voluntary to be effective.
• Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.
• Drug abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
• Counseling (individual and/or group/ family) and other behavioral therapies are critical components of effective treatment for addiction.
• An individual’s treatment and service plan must be assessed continually and modified as necessary to ensure that the plan meets the person’s changing needs.
• Possible drug use during treatment must be monitored continuously.
• Treatment programs should include assessment for HIV-AIDS, Hepatitis B and C, Tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk or infection.
• Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.

PRINCIPLE OF EFFECTIVE TREATMENT:

• Comprehensive program by a multi disciplinary team addressing the varied needs of the client.
• Detoxification services to make withdrawal safe and comfortable.
• Repeated assessment and treatment to address the changing needs of the client medical and psychiatric.
• Psycho social treatment for the total recovery of the client through proven methods like counseling, group therapy and re-educative sessions.
• Exposure to self-help groups.
• Exclusive psycho social care to families to improve their quality of lives.
• Availability of culturally relevant vocational training, by utilizing local resources.
• Identification and networking with other existing facilities for reintegration into society.
• A clearly defined long-term after care program focusing on 'whole person recovery' which includes relapse prevention.

TREATMENT PROCESS:

• Identification and early intervention.
• Detoxification and managing co morbid medical and psychiatric problems.
• Psycho social management of dependency.
• Therapy program for families.
• Extended care program/after care program including vocational rehabilitation.

TREATMENT ISSUES:

• Access, availability and admission criteria.
• Assessment.
• Early intervention.
• Treatment content.
• Aftercare and referral.
• Documentation and evaluation.

ACCESS, AVAILABILITY AND ADMISSION CRITERIA:

• Adequate number of service agencies available to cover the affected population.
• Services easily accessible with regard to location and transportation.
• Treatment available without delay since it may lead to worsening of the condition.
• A range of treatment services and options available to address the individual needs of the clients – in – patient, out-patient, day care program.
• Services available irrespective of the kind of drug abused, legal status of the drug involved HIV status of the client or history of prior treatment.
• Services available irrespective of age or gender, religion, caste or political beliefs.
• Services available irrespective of the patient's, socioeconomic or employment status or his ability to pay.
• Services available in custodial settings like prisons and police cells.
• The period of treatment to be adequate (either out-patient or in-patient) in order to make the program effective.

ASSESSMENT:

• Assessment of physical and psychiatric disorders in order to plan intervention.
• Access to laboratory for assessing medical problems and other facilities for identification of drugs through body fluid.
• Assessment of the social circumstances of the clients which includes family, employment, financial and legal position.
• Psychological instruments for assessment of psycho social functioning.
• Maintenance of records from entry of the client into the service till termination.

EARLY INTERVENTION:

• Routine self - assessment questioning to screen for drug dependence available in general health facilities, work places, educational institutions etc.
• Active promotion of early intervention for drug related problems with special emphasis on specific population groups like children of addicts, street children, pregnant women etc.
• Information about assessment procedures and treatment resources made available to individuals who are initial contact points for potential patients - medical practitioners, nurses, social workers etc.
• Staff of health care services, teachers in schools, police, and social workers is trained during their education in the recognition, basic management and referral of individuals with drug related problems.
• Procedures exist for counseling family members, employers, and other service agencies who seek assistance in initiating drug users into treatmen

MEDICAL AND PSYCHIATRIC MANAGEMENT:

• Minimizing withdrawal symptoms.
• Providing essential medicines to deal with withdrawal related emergencies.
• Providing medical and psychiatric help to deal with drug related problems.
• Ensuring availability of essential equipment like ECG, Oxygen cylinder, suction apparatus etc.
• Ensuring ready accessibility to laboratory facilities.
• Availability of links between the treatment program and other services to facilitate intervention for other co-morbid conditions.

PSYCHOSOCIAL MANAGEMENT:

• Availability of services on a continuum of care basis.
• Availability of services to strengthen motivation.
• Adequate provision of individual counseling, group therapy and re-educative sessions.

AFTERCARE AND REFERRALS:

• Criteria for discharge of clients determined by the recovery status.
• Attention paid to further treatment and support which may be required based on the client's condition/problems diagnosed, lack of resources and other requirements.
• Alternative pathways in case of partial or complete failure of treatment.
• Regular links with other agencies for referrals and criteria for admission.
• Aftercare services, in-patient, out-patient and day care to sustain the recovery of clients and families.
• Specific programs to identify and deal with relapses and improve the quality of life.
• Opportunities to get vocational training through networking.
• Services to reach out to unmotivated clients through home visits.

RESIDENTS BILL OF RIGHTS:

• Protecting the human rights of clients.
• Maintaining confidentiality – not divulging any information about the client to individuals or authorities without the client’s consent.
• Informing clients and their family members about the nature and content of the treatment as well as the risks and benefits to be expected.
• Obtaining prior consent from the client regarding the conditions and restrictions of treatment agencies.
• Allowing the client to interact with and visits from family and others.
• Strictly avoiding physical restraint to detain or restrain clients who are legally competent to leave.
• Setting defined criteria for the expulsion of clients due to violation of rules, violence, continued use of drugs etc.
• Ensuring that a documented complaint procedure exists and is made known to clients and their relatives.

TREATMENT SETTING AND INFRASTRUCTURE:

• The physical environment designed to protect the well being of clients ensuring hygiene, safety and protection.
• Availability of privacy for in-patient/ residential clients.
• Availability of privacy for conducting group therapy/individual counseling sessions.
• Access to recreational facilities for in-patient/day care clients.
• Provision to store records of clients to ensure confidentiality and a system of easy retrieval.

DOCUMENTATION:

• A RECORD OF PATIENT MANAGEMENT, PROGRESS AND ONWARD REFERRAL TO BE KEPT AND UPDATED ON A REGULAR BASIS.
  
• MEDICAL CASE SHEET:
  Data to be collected - History of addiction, medical history and associated medical and psychiatric problems and medications prescribed.
  
• CASE HISTORY FORM:
  Data to be collected - Case history of the client – Background information, family history, childhood issues, occupational history, financial history, marital history, etc.
  
• FOLLOW UP CARD:
  Data to be collected - The recovery of the client – abstinence and improvements in every area of life and the efforts taken by him to stay abstinent. The measures taken by the center to provide care to the client and his family members.
  
• MEDICAL MANUAL:
  Covers medical management of addiction, treatment for other co-existing psychiatric problems, dealing with medical emergencies related to addiction.
  
• NURSING MANUAL:
  Has to cover the role of nurses, admission procedure, nursing care to be provided during detoxify, delirium emergencies, methodology of dispensing medicines and records to be maintained.
  
• THERAPY MANUAL:
  Has to cover the role of counselors, different therapy to be used, and basic information regarding addiction and recovery, guidelines for conducting group therapy, issues to be dealt during counseling.
  
• FAMILY MANUAL:
  The need for family program, issues to be dealt during counseling sessions, information to be provided during re-educative sessions and topics for group therapy.
  
• AFTERCARE SERVICES MANUAL:
  The importance of after care services, types of services needed and issues to be dealt during follow-up / after care.
  
• NETWORK DIRECTORY:
  Names, addresses and other vital information about agencies who are working with allied fields like hospitals, HIV treatment agencies, laboratories, job placement agencies, vocational training centers.

PROGRAM EVALUATION:

• Diligent investigation of a programs characteristics and merits, to optimize the outcome, efficiency and quality of service delivery.
• Measuring the effectiveness of components of the program – individual counseling, relapse program and vocational training.

EFFICACY OF TREATMENT:

• Abstinence from alcohol or other drugs.
• Improvements in physical and emotional health, interpersonal relationships and vocational and financial functioning.
• Client’s satisfaction with regard to treatment.
• Feedback from referral.

PROGRAM PROCEDURES' REVIEW:

• Periodic meetings of program administrators and staff to make decisions about continuing or changing certain aspects of services.
• Outside monitors to determine that appropriate services, which meet acceptable standards are being provided.
• Funding sources to ensure that money is being spent appropriately.
  
  

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