Nursing in Contexts of Marginalized Health Conference 11

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Nursing in Contexts of Marginalized Health Conference 11 th Sept 2015 Linda O’Driscoll Drug

Nursing in Contexts of Marginalized Health Conference 11 th Sept 2015 Linda O’Driscoll Drug Treatment Court Liaison Nurse

The Drug Treatment Court(DTC) and my role in it What is the DTC? How

The Drug Treatment Court(DTC) and my role in it What is the DTC? How does the DTC operate? What is my role? What are our challenges? What are our successes? Planning for the future?

The Drug Treatment Court (DTC) l The DTC is a specialised court operating within

The Drug Treatment Court (DTC) l The DTC is a specialised court operating within the legal system, which was set up to treat rather than imprison drug users, who have pleaded guilty or been found guilty of crimes before the District Court. We deal with non- violent offenders over the age of 18, whose offending behaviour is motivated by their addiction, rather than mainly for financial gain.

What is the aim of the programme l The programme aims to provide court

What is the aim of the programme l The programme aims to provide court supervised treatment, including career and education support, for offenders who are involved in drug abuse. The idea behind this is that, by dealing with the fundamental reason for the offending, the addiction, the need to offend is no longer present, and the ethos of the court is to prevent recidivism.

DTC Crime Statistics (Internal Review) looking at recidivism l Total Charges : 606 –

DTC Crime Statistics (Internal Review) looking at recidivism l Total Charges : 606 – Pre- DTC : 518 – During DTC : 88 l P 1 : 87 l P 2 : Nil l P 3 : 1 (Internal Garda figures Mar ’ 05) 78. 2% Reduction in Offending March’ 09 (18 mths)

A Journey through the DTC l l l District Court transfers to DTC Assessment

A Journey through the DTC l l l District Court transfers to DTC Assessment - Garda, Probation and Health Acceptance-Sign Bail Bond/Treatment Plan Education Assessment Move through 3 phases - approx. 18 - 24 mths, max of one year in each phase. Court Sitting : Wednesday 2 pm (open court, participant account for themselves)

Pre - Court Meetings l l l Wednesday 10. 30 am Inclusive of team

Pre - Court Meetings l l l Wednesday 10. 30 am Inclusive of team members and Judge Verbal Reports from all agencies Open Discussion Sanctions and Incentives Final decision lies with the Judge

Personal Progression Plans l l l Meet every 6 -8 weeks with participant Review

Personal Progression Plans l l l Meet every 6 -8 weeks with participant Review – Health / Education / Probation Discuss any issues/concerns/progress or lack thereof Assist participant in setting short/long term goals Review accomplishment of short term goals Review Phase progression

DTC Current Statistics 2001 – July 2015 Total Referrals 770 Unsuitable 397 Discharged 259

DTC Current Statistics 2001 – July 2015 Total Referrals 770 Unsuitable 397 Discharged 259 Graduated (Gold 46, Silver 4) 50 Presently on DTC Assessment 18 – – – P 1 – Bronze Phase 29 P 2 – Silver Phase 7 P 3 – Gold Phase 5

My role l I work as an addiction nurse specialist within the multi-disciplinary DTC

My role l I work as an addiction nurse specialist within the multi-disciplinary DTC team, acting as a source of expertise to the team and Judge regarding all aspects of treatment. I perform assessments, make appropriate referrals, compile treatment plans, liaise with any treatment providers the participants’ attend and ensures all team members are aware of every aspect of the participant’s treatment plan.

I am involved in all aspects of each participants care plan, and feed back

I am involved in all aspects of each participants care plan, and feed back to the team. I help compile statistics and research on the DTC, as well as education of interested parties, students and community groups about the DTC, and I represent the treatment services at conferences nationally (and internationally).

Unique Role l My role is unique as I am the only DTC Liaison

Unique Role l My role is unique as I am the only DTC Liaison Nurse in Ireland. There are some Drug Treatment Courts operating in other European countries like Scotland, Belgium and Norway , and they all have their own ways of operating. I have met some other liaisons but with different roles( dual role of supporting and providing information to team can be challenging)

Research showing isolation and lack of resources for nurses working with marginalized clients? l

Research showing isolation and lack of resources for nurses working with marginalized clients? l l l No specific educational opportunities for my role but I keep my CPD up to date and train with my colleagues No supervision Isolation V autonomy? ? New network of addiction nurses may help? ? Lack of funding for travel to conferences is an issue for a very specific role like mine

Reflections on the DTC Learning Outcomes l l l Less fragmentation for the client,

Reflections on the DTC Learning Outcomes l l l Less fragmentation for the client, due to multidisciplinary team communication Open sharing of information Agreed confidentiality Increased network of professionals Bonus points / awards Immediate, accurate and fair sanctioning is an important aspect of our programme

Challenges l l l Slow process Slow referral rate( improving) Lack of political interest(

Challenges l l l Slow process Slow referral rate( improving) Lack of political interest( talk re community courts now) A challenging client base with multiple issues Pressure for graduate numbers How to prove qualitative successes and positive outcomes ( performance matrix, research, client feedback)

Future Planning l l l l l Agreed Defined Role Clarity Clear structure Training

Future Planning l l l l l Agreed Defined Role Clarity Clear structure Training ( not available here) On going Statistical Research / Evaluation Sourcing / Accessing and sharing recourses Working from the ‘Ground Up’ More emphasis on recovery( as emphasised by our participants in recent survey. Focus on quality and consistency Improve public profile( annual report, launch, outreach)

Activities are an important part of our programme

Activities are an important part of our programme

Participants’ Comments l “You feel you are worth something, someone does care, people care”

Participants’ Comments l “You feel you are worth something, someone does care, people care” l “I notice the change in myself, even the way I talk” l “Its not easy. There is work involved in coming in. You have to participate and do work on yourself”

Independent Evaluation available on : http: //www. courts. ie/Home. nsf/Content/Courts+Opening

Independent Evaluation available on : http: //www. courts. ie/Home. nsf/Content/Courts+Opening