recommendations
This report presented findings of a pilot evaluation of a novel step-up/step-down model of withdrawal care for people dependent on methamphetamine.
While the sample size was small, results from the pilot suggest that step-up/step-down care was associated with potentially better client preparation for residential withdrawal as evidenced by fewer clients using methamphetamine on the day before or the day of
admission. Furthermore, beginning withdrawal (or experiencing a ‘crash’ at home) may have contributed to findings of a shorter duration of stay in residential withdrawal and more rapid resolution of withdrawal symptoms among those in stepped-care when compared to those not in stepped-care. Based on these findings, the new model shows considerable promise in providing the greater flexibility of care for methamphetamine suers that is recommended in the literature and meeting the specific treatment and support needs of people who use methamphetamine.
Major systems barriers for implementing the trial were the significant numbers of clients eligible for the trial, the co-incident state-wide AOD systems reform process, limited staff capacity, and lack of smoother communication flow within and between teams at ReGen that were involved in delivering the more intensive support and care.
Results suggested that greater contact with stepped-care services was helpful to clients but it was not clear what the best ‘dose’ or level of engagement was for positive effect. As staff capacity was an obstacle in delivering more intensive care, future development of the step-up/step-down model may include a range of staff roles, such as assertive outreach and counselling staff with a sound understanding of methamphetamine withdrawal and links to NRW services to facilitate home-based and outpatient withdrawal where required.
The Victorian AOD treatment system is in a period of reform and transition. Future
development of a stepped-care withdrawal model needs to be planned in the context of the significant changes that have occurred since the trial, such as changes to the treatment intake system and the structure of non-residential withdrawal services.
The findings from the trial and evaluation, including the challenges experienced and lessons learnt, can inform future planning and implementation of new models of withdrawal management. To support implementation of further change it is recommended that ReGen:
1. Conduct a detailed review of the international and national literature to identify models of stepped-care that may inform future development of the model.
43 | P a g e 2. Consider undertaking additional consultation with service users concerning their
views of the withdrawal stepped-care model to enhance future development of the model.
3. Develop and clearly describe the chosen model of step-up/step-down care and build in systems for evaluation.
4. Conduct comprehensive training with all staff members to ensure the active participation of all staff in the conduct of the program, its procedures and protocols, and their role in the evaluation.
5. Consider where the new model sits within a wrap-around approach to client care, which could include:
a. the use of web-based self-help materials to support client’s preparation for withdrawal and evaluate its effectiveness
b. developing a targeted and structured after-care program specifically developed for users of methamphetamine to allow seamless transition from residential care, and evaluate its effectiveness
44 | P a g e
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