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The development of dual diagnosis link workers in a mental health trust: reflections from clinical practice
- Author:
- EDWARDS Richard
- Journal article citation:
- Advances in Dual Diagnosis, 4(2), 2011, pp.75-83.
- Publisher:
- Emerald
Delivering integrated treatment for dually diagnosed clients requires an effective whole team response, supported by good quality partnership working. There are a number of different approaches nationally attempting to find a solution to best support an integrated care pathway. This paper describes one such approach; the development and support of dual diagnosis link workers deployed in teams and wards across Avon and Wiltshire Partnership Mental Health (NHS) Trust. The author describes the role of link workers, provides examples of developmental practice, strategies to support the role, identifies barriers encountered and suggests solutions to address these. He concludes that the link worker model is raising awareness of good practice within teams and promoting improved partnership working. A framework to support implementation of the key principles for working with people with a dual diagnosis is outlined.
Developing welcoming systems for individuals with co-occuring disorders: the role of the comprehensive Continuous Integrated Systems of Care model
- Authors:
- MINKOFF Kenneth, CLINE Christie A.
- Journal article citation:
- Journal of Dual Diagnosis, 1(1), 2004, pp.65-89.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This paper reviews a best practice model for design and implementation of system-wide integrated services for individuals with co-occurring disorders, and illustrates the application of that model to the implementation of the specific clinical attitude and practice of welcoming in a number of ongoing Comprehensive Continuous Integrated System of Care (CCISC) projects. Welcoming, while not formally an “evidence based best practice,” is a clinical service delivery standard that also creates a strategic energy to promote implementation of other best practice interventions. Given that CCISC can be designed within the resource base of any system, and given that initial projects have been able to describe some early success in creating meaningful shifts in clinical practice, the model appears to have some face value in application to complex systems. Clearly, more formal evaluation of system, program, and client outcomes from CCISC projects is needed; the authors are currently in the process of designing such evaluation studies. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Dual diagnosis - developing capable practitioners to improve services
- Authors:
- MANLEY David, GORRY Ann, DODD Tom
- Journal article citation:
- Advances in Dual Diagnosis, 1(1), August 2008, pp.20-26.
- Publisher:
- Emerald
Developing capable practitioners who offer high quality care can bring significant improvement to dual diagnosis services. This paper offers some practical solutions and proposes that the wider dissemination of existing skills and resources could effect substantial change. It explores opportunities for building flexible partnerships with health, social care and higher education institutions to meet the training and support needs of the workforce in delivering care to service users with co-existing mental health and substance misuse problems. The article draws on existing practice.
A service framework to meet the needs of people with a co-occurring substance misuse and mental health problem
- Publisher:
- Wales. Welsh Assembly Government
- Publication year:
- 2007
- Pagination:
- 21p.
- Place of publication:
- Cardiff
The importance of developing seamless services for clients requiring both services cannot be stressed too strongly. Evidence indicates that drug and/or alcohol misuse among people with mental health problems is now commonplace but despite the availability of effective treatments, these services are not as co-ordinated as they might be Joining these services together is important because research shows that treatment for substance misuse problems often reduces psychiatric and mental health problems. Furthermore, substance misuse treatment is associated with decreasing substance use, decreased injecting behaviour and hence a reduction in the risk of HIV and hepatitis transmission, and improvements in other related forensic, psychological and physical problems.
A multi-agency evaluation of the Leeds Dual Diagnosis care co-ordination protocol
- Author:
- BELL Richard
- Journal article citation:
- Advances in Dual Diagnosis, 7(4), 2014, pp.162-184.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to demonstrate the learning from the multi-agency evaluation of the Leeds Dual Diagnosis Care co-ordination protocol undertaken by the Leeds Dual Diagnosis (DD) Project in 2013. The evaluation aimed to identify the prevalence of people with DD accessing network member services, and to identify the standard of care network members provided for people with DD in relation to the Leeds Care Co-ordination Protocol. Design/methodology/approach – The evaluation adopted a service evaluation methodology and included features of real world research. Two standardised self-completion questionnaires were administered using Survey Monkey™ software. Findings: The majority of service could provide prevalence data however the quality of data provided was significantly impacted by the limitations of client management systems. Completion of specific DD training beyond basic awareness was generally low and many participants were confused about the different levels of training available. Standards of care varied, a substantial amount of joint working was taking place via informal pathways which relied on established relationships and trust between practitioners and services. Jointing working was often informal when people were not under the Care Programme Approach. Research limitations/implications: Due of the methodological choices the evaluation cannot be considered impartial. The prevalence data gathered lacks robustness and does not reflect the number of people who meet clinical threshold for DD as valid screening tools were not used by all services. The standards of care identified only reflect practitioner's personal views and do not provide a definitive answer to the standard of care being delivered. The response rate in relation to standards of care was low with large amounts of missing data negatively impacting the external validity of data gathered. Practical implications:– The completion of this evaluation demonstrates that it is extremely challenging to undertake a multi-agency evaluation with limited resources. It has highlighted key challenges and areas for future development locally in relation to DD. The themes explored are likely to be of interest to commissioners, service managers, DD consultant nurses and anyone involved in the strategic development of DD. Originality/value: The evaluation has generated information which is of practical significance to local commissioners and Leeds DD Network Members. The knowledge and learning from this evaluation has subsequently been used by the Leeds DD Strategy Group to inform the new action plan for the DD Project, the re-commissioning of substance misuse services and the new mental health framework being developed for Leeds. (Publisher abstract)
A clear view ahead...
- Author:
- BOWLER Shirley
- Journal article citation:
- Connect, 39, Spring 2010, p.13.
- Publisher:
- Homeless Link
Clear-view is a dual diagnosis supported housing project which provides 24-hour support for 14 men and women who are committed to becoming and staying free of drugs. While there are day centres offering support to people with both a mental illness and a substance misuse problem, Clear-view is the only residential service specifically set-up to support dual diagnosed clients. The project, which began in 2006, is the result of a partnership between ECHG, Hull City Council, Hull Supporting People, Hull City Safe and the Housing Corporation. Residents are referred to Clear-view, and, once accepted on the waiting list, encouraged to attend pre-tenancy support. Residents must provide a commitment to remain drug-free. When residents move in they are provided with fully furnished and equipped apartments, supported to cook healthy meals, encouraged to take regular exercise, and have the opportunity to gain ICT skills to help them prepare for education and employment. Every resident must attend 5 group meetings a week, and peer support and role models are an important element of resident’s recovery.
Dual diagnosis: good practice handbook
- Authors:
- WATSON Stuart, HAWKINGS Caroline
- Publisher:
- Turning Point
- Publication year:
- 2007
- Pagination:
- 60p.
- Place of publication:
- London
This guidance aims to provide a clear framework within which staff can continue developing services in the future, in partnership with people using services and carers. It also reaffirms this area as 'core business' and a priority for mainstream mental health services, also working in collaboration with other agencies, such as substance misuse services and drug action teams. The guidance covers: policy; assessment and treatment procedures; implementation; and includes references.
Mental disorders and drug abuse in persons living with HIV/AIDS
- Authors:
- KLINKENBERG W. D., SACKS S.
- Journal article citation:
- AIDS Care, 16(Supplement 1), January 2004, pp.S22-S42.
- Publisher:
- Taylor and Francis
This article reviews the literature on the prevalence of mental and substance use disorders among persons living with HIV/AIDS. Drug use, both injection and non-injection, substantially increases the risk for HIV infection. While injection drug users have the highest prevalence rates for HIV, substantially elevated rates of HIV infection are also present among crack cocaine users and individuals with substance use disorders generally. Persons with HIV/AIDS and a mental and/or substance use disorder have highly variable patterns of accessing services. Persons with HIV/AIDS who have a serious mental illness are more highly involved with services than other groups. Most individuals with co-occurring disorders report some involvement with outpatient primary medical care, although ancillary services such as mental health and substance abuse treatment, transportation assistance, and case management improve involvement in medical care. Women with HIV/AIDS and co-occurring mental and substance use disorders experience unique vulnerabilities, particularly those related to exposure to traumatic events. Given the complexity of needs with which triply or multiply diagnosed individuals present, effective treatment programmes are likely to be those that provide some degree of integrated care.
Mental health policy implementation guide: dual diagnosis good practice guide
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2002
- Pagination:
- 40p.
- Place of publication:
- London
Supporting someone with a mental health illness and substance misuse problems - alcohol and/or drugs - is one of the biggest challenges facing frontline mental health services. The complexity of issues makes diagnosis, care and treatment more difficult, with service users being at higher risk of relapse, readmission to hospital and suicide. One of the main difficulties is that there are a number of agencies involved in a person's care - mental health services and specialist rehabilitation services, organisations in the statutory and voluntary sector. As a result care can be fragmented and people can fall down the cracks. The guidance provides a framework within which staff can strengthen services so that they have the skills and organisation to tackle this demanding area of work. The authors key message is that substance misuse is already part of mainstream mental health services and this is the right place for skills and services to be. Mental health services must also work closely with specialist substance misuse services to ensure that care is well co-ordinated. The authors have also highlighted some existing examples of excellent services working well now. This guidance and the services mentioned, demonstrate the importance of effective leadership at a local level and rigorous training programmes to help staff maintain high standards of service delivery. Cites numerous references.
The triangular treatment paradigm in dual-diagnosis clients with a mental illness
- Authors:
- SIMS John, IPHOFEN Ron, PAYNE Kevin
- Journal article citation:
- Journal of Substance Use, 8(2), June 2003, pp.112-118.
- Publisher:
- Taylor and Francis
This article looks at the role of the specialist dual diagnosis worker in North Wales and how the appointee to this role had been able to facilitate the seamless transition of these individuals through the 'system' of mental health care. This process has been facilitated by the development of an Integrated Pathway of Care, which has been devised by the authors and called the Triangular Treatment Paradigm.