Continuum of services for hard drug users and related staffing and amenagment

1. Home . net Mobile Clinic SCHDU Center S ERVICES C ONTINUUM FOR H ARD D RUG U SERS Reduction the H.I.V. spread in Ho chi Minh City by direct action on the transmission of the virus by injectable drug users © HOIPHUC 2008

7. Information, self recovery and collaboration website (For the person, the family/relatives and the professional) . net Health and community oriented services (district /communes level, high rish population and out patient program) Mobile Clinic Acute detoxifocation services and out patient programs (for elegible person refered by the MC or evaluated at the center) Detoxification Center Services Structure Proposed services points © HOIPHUC 2008

11. General population Risk population Patient in treatment Peer worker Social worker Reference Process Out Reach Program Self or Professional reference Mobile Clinic (5 zones) Health care and testing,Out Reach and Harm reduction program Out-patient and community program Mass Media Campaign . net Information Self recovery program + Vouchers incitatives Management / anti relapse Online continuous formation Online continuous formation Community zone ( 100,000 inhibitants) Reference zone Services zone Refernce to service and structure functionnement Detoxification Center Acute detoxification Out Patient Program © HOIPHUC 2008

12. quan hệ tình cảm Change Process Relation between change stage and concepts The natural change process Contemplation Maintenance Action Preparation Pre Behavioral Cognitive Skills Training PREPARATION ACTION COGNITION BEHAVIOR Relapse Prevention Community support . net M.C. .D.C. . net M.C. .D.C. M.C. Harm reduction program . net M.C. .D.C. OUT REACH PROGRAM M.C. Self Recovery program . net . net M.C. .D.C. Motivational Interview M.C. .D.C. . net © HOIPHUC 2008

15. Self Recovery Program Caracteristics Main concepts by approach Self Recovery online program explore the causes of problem behaviors and provide training on how to change them. The main section of the program are delivered via the Internet as a series of lectures, personnal evaluation and interactive assignments. By providing online coaching, self recovery program allow direct relation with therapist through electronic communication and can be use in a context of lack of resource or rural area service management Motivation to Abstain - Enhancing and maintaining motivation to abstain from addictive behavior Coping with Urges - Learning how to cope with urges and cravings Problem Solving - Using rational ways to manage thoughts, feelings and behaviors Lifestyle Balance – Balancing short-term and long-term pleasures and satisfactions © HOIPHUC 2008

16. Behavioral Cognitive Skills Training Caracteristics Main concepts by approach Challenging irrational beliefs, Relaxation education and training, Self monitoring, Cognitive rehearsal, Thought stopping, Communication skills training, Assertiveness skills training, Social skills training, Functionnal analysis, Coping with craving, Behavioral Cognitive Skills Training involve the development of cognitive and behavioral skill involved involved in the construction of self-efficiency and coping capacity. Cognitive skills training part are procedures designed to allow exploration of the ambivalence and resolution of problem/conflict whom restrain the patient from action. In relapse therapy program , they provide clients with ways to reframe the habit change process as learning experience with errors and setbacks expected as mastery develops . The behavior skills training part is related to skill related to assertiveness, stress management, and other behavior whom have to be address in way to maintain abtinence.. © HOIPHUC 2008

17. Community Support Program Caracteristics Main concepts by approach Community support programs have for objective to help the person in the priorisation of social sphere problematics who have to be addressed first to achieve a dignified life. Community Support Programs also target autonomy of the person after intervention, being aware of the health situation of the person could interfere whith the capacity to achieve such result. Basic needs - Enhancing and maintaining motivation to abstain from addictive behavior Occupational/employement - Enhancing and maintaining motivation to abstain from addictive behavior Relational sphere - Enhancing and maintaining motivation to abstain from addictive behavior © HOIPHUC 2008

18. Medication Use of medication in conjonction withCognitive Behavioral Skills Training Without medication With Agonist With Antagonist Naltrexone Methadone - Bnorphine Patient who present high self-efficiency and strong motivation in parallel with supportive network. Patient who present strong motivation but miss confidance in his self-efficiency to succeed. Patient who present no motivation to change and have a long chronic history of addiction Action - Maintain Action - Maintain Preparation Psychopharmacology for heroin addiction treatment This point is actually relevant only in the case of heroin addiction where drug mecanism of action are well documented and supportive research have been conducted. With new emerging drug of addiction, like Ecstasy and METHamphetamin, where even if mecanism of action are khow, therapist have to rely on their own habilities and do not have access to anatgonist or agonist medication.. © HOIPHUC 2008

19. Estimation Mobile Clinic and Testing Sex Worker Hard drug User People living with A.I.D.S./Conjoint Person tested (01-2006) Person + (01-2006) Male Female By month No Month Total of patients 4 33 (90%) 37 36 1332 Male Female By month No Month Total of patients 30 3 (10%) 33 36 1188 Male Female By month No Month Total of patients 2 16 (90%) 18 36 648 Hbg Hcg H.I.V. x x x x x x x x x x © HOIPHUC 2008

20. Tx Capacity Detoxifocation center and out patient program Toatl patients in Acute detoxification program (1) Motivational interviewing + Vouchers (2) Motivational interviewing + Substitution medication (3) Cognitive bahavioral therapy + Antagonist medication Community Support Length of stay Capacity No Period No Therapist Total of patients 10 days 16 106 1756 Length of stay Capacity No Period No Therapist Total of patients 120 days 25 9 2 450 Length of stay Capacity No Period No Therapist Total of patients 120 days 25 9 3 675 Length of stay Capacity No Period No Therapist Total of patients 120 days 25 9 3 675 Length of stay Capacity No Period No Social W. Total of patients 180 days 30 6 5 900 © HOIPHUC 2008

23. SCHDU Staff Clinical and administrative staff M.C. D.C. . net CSUDI Coordinator 1 Supervisor 1 Formator 1 Assistant 1 Data entry 1 Psychiatrist .5 .5 Doctor 2 3 Nurse 2 3 Webmaster 1 Therapist 2 2 6 Peer educators 5 Social worker 5 Pharmacist 1 Ground agents 4 © HOIPHUC 2008

24. SCHDU Staff Non Clinical staff M.C. .D.C. . net CSUDI Translator .5 Graphist .5 Driver 2 Cook 1 Assistant Cook 2 Maintenance 3 Outside guard 1 © HOIPHUC 2008

25. Formation needs Formation needs by clinical job 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Brain, Behavior and Drug Risk behaviors and H.I.V Change process Motivational service stting Therapist Capacities / Skills Therapeutic relation Motivation interviews tools Fonctional analysis Behavioral cognitive tools Healthy living program Facing death program Harm reduction programs Community systemic management SYSTx Clinical Tools Formation modules list Formation modules Doctor Nurse Psychiatris Pharmacist Therapist Peers educators Social workers Web site manager Ground agent Administrative assistant Data entry assistant Non clinical staff * X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X © HOIPHUC 2008

26. Evaluation Formation and staff performance evalution Therapist Encounter Report Patient Monthly Evaluation Therapeutic relation quality coefficient Evaluated on: Therapeutic relation Tools use Conceptual coherence Time management Evaluated on: Therapeutic relation Comprehension Objective coherence Satisfaction © HOIPHUC 2008

28. Documentation Documents related to SCHDU Title File Output frame of the SCHDU project Activities calendar Human and Material resources Treatment protocol Planified budget and hypothesis SYSTx database mapping Formation Evaluation and patient management paper tools © HOIPHUC 2008

29. Thank you Presented by: Alain Bergeron, Bps. Jules & Paul Emile Leger Fundation Volunteer advisor, Projet Santé Viêtnam [email_address] Marc Paquette, Dr. Medecins du Monde Canada Project Coordinator [email_address] © HOIPHUC 2008

30. Start a little buziness , (National & International program) Start a little buziness is size for international donator who desire to live a online experience of living in a development contry. By contribuing $US 200, the personis paired with an ex-toxicomane and he have they have to start a little buziness for allow him to live in dignity. Onlive interactive analysis of opportunities (buy-sale, service shop, every ideas have to be discuss. Learning opportunities for both and unique experience. Future SCHDU , Continuous idea © HOIPHUC 2008