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Complex Needs Workers, Northamptonshire Drug and Alcohol Service (NDAS)

DAT(s): Northamptonshire.
Region(s): East Midlands
Last updated: 18 March 2004
Summary: Complex Needs Workers.

The need

There are individuals who experience both problematic substance misuse and at least one other significant issue or problem. Most commonly these clients experience some degree of mental health problems. These individuals have complex needs. Because their drug use and mental health issues run parallel to each other it is difficult to determine whether one has caused the other. Furthermore, with the use of drugs and mental health issues:

• it can be unclear whether one has caused or exacerbated the other; and
• each can exist in the absence of the other.

The complex needs that these individuals face can cause them to be chaotic users. They therefore find it hard to access services that require a regular attendance. Missing out on services can increase the vulnerability of clients with complex needs.

Services too may find it hard to engage with clients with complex needs. For example, mental health services might not feel able to attend to a client’s drug issues, and need to refer them to a drugs service. The result can be that neither mental health nor drug and alcohol teams feel wholly responsible for taking the lead in the care of the client. This can prevent a client receiving appropriate care.

Consequently, clients with complex needs require advocacy, support, and flexibility.

The idea

In Northamptonshire there are two Complex Needs Coordinators and two Complex Needs workers. The complex needs team’s job involves short-term, intensive work with complex needs clients to help them to access and remain in treatment.

Complex Needs Coordinators provide:

• social contact;
• referrals to appropriate agencies;
• support and advocacy in dealing with other services;
• an assessment of clients’ needs;
• a flexible and proactive approach to care.

The team also aim to make services as informed as possible about the needs of users with complex needs to:

• reduce the chance of harm and crises befalling clients;
• reduce the chance of clients inappropriately returning to other services (e.g. A&E);
• help clients access and remain in services;
• reduce the number of inappropriate admissions to Acute Mental Health inpatient areas.

How it works

Two members of the team are responsible for each half of the county (i.e. north and south). The Coordinators take the lead role with assessment and care planning, whilst the Workers take the lead in counselling work with the client. However, the team recognise that they need to be flexible within this structure to ensure that clients’ needs are met.

The team receive referrals from:

• within NDAS;
• community and inpatient Mental health services;
• other agencies.

Self referral is only accepted from clients who have previously been complex needs clients. (Other service users cannot self-refer because they are then wanting to engage and therefore do not meet the complex needs criteria).

Coordinators carry out an initial assessment period with clients to:

• identify their needs;
• develop a plan to serve their needs;
• identify which services are best placed to meet their needs.

The Coordinators use a process of client-centred assessment, using tools such as motivational or solution-focused assessments, evidence-based rating scales, and (with clients’ permission) information from other agencies or carers.

After identifying clients’ needs, Coordinators can:

• assist clients to move between services;
• liaise with services;
• advocate on behalf of clients (e.g. by writing reports for probation, or attending multi-agency review meetings);
• provide practical support when necessary, such as transport to appointments;
• provide therapeutic interventions (e.g. solution-focused therapy, motivational interviewing and relapse prevention);
• train other professionals and agencies;
• provide support and consultation to other services;
• offer a rapid assessment and signposting service to clients in inpatient areas.

The team do not currently have any remit to provide medical detoxification.

The majority of the team’s funding comes from Northamptonshire DAT. They also receive funding from the NHS and Social Care.

Key Benefits

The Coordinators’ role:

• makes services more accessible to vulnerable individuals who would normally ‘fall’ into the gaps between mainstream services or fail to remain in treatment;
• encourages flexibility in services, and aids cooperation between mental health and drug services.

Comments

The position of Complex Needs Coordinator is about 18 months old.

The complex needs team are very busy. If the team was larger, they could provide more comprehensive assistance to a greater number of individuals with complex needs.

The complex needs clients use a wide variety of drugs, and often use more than one drug. Whilst alcohol is commonly used, clients also use opiates and stimulants.

Although the Coordinators’ initial intention is to provide short-term help, clients’ ongoing needs often make longer term help a necessity. The long-term needs of clients is indicated by the fact that assertive outreach in mental health (arguably a comparable client group) can last for over three years.

There are many definitions of complex needs. However clients qualify as having complex needs if they experience two or more of the following:

• Homelessness
• Self harm
• Offending behaviour
• Mental illness or mental health problems
• Physical health problems
• Psychological problems
• Substance misuse
• Social issues.

The Complex Needs service will primarily work with clients who:

• present with problematic substance misuse;
• find at least one of the above factors has a significant impact on them;
• have a history of disengagement with services (characterised by initial contact when in crisis, followed by a short period of chaotic attendance resulting in discharge).

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