Research project DR/39 (Research action DR)
1. Introduction
Emergency departments play an important role in offering first aid to persons with substance use disorders. These facilities can also inform patients about and refer them to specialized treatment and they can increase motivation for change and treatment. In Belgium, crisis care can be situated within two projects. First, there is the national pilot project for the crisis and case management of patients for substance use disorders, subsidized by the Federal Public Service Health, Food Chain, and Environment. Since 2002, eight centers all over Belgium offer four crisis beds with a maximum stay of five days. Each centre treats at least 300 patients annually. These 8 agencies are: EPSI (AZ Sint Jan, Bruges), EPSI (AZ Stuivenberg, Antwerp), UPSIE (UZ Ghent), EPSI (UZ Leuven), TEPSI (Ziekenhuis Oost-Limburg, Genk), Centre Hospitalier Régional de la Citadelle (Liège), Centre Hospitalier Régional de Namur and Centre Hospitalier Universitaire Brugmann (Brussels). Secondly, there are the so-called Crisis Intervention Centres, which are subsidized by the National Institute for Health and Invalidity Insurance (RIZIV/INAMI). The main goal of these crisis centres is described as: arranging quick admission and intervening in and resolving the crisis situation on the one hand, and physical detoxification and increasing motivation for continued treatment on the other hand. In the following specialized centres, a crisis intervention centre is available: De Spiegel (Lovenjoel), De Sleutel (Wondelgem), Katarsis (Genk), Antwerps Drugs Interventie Centrum (ADIC) (Antwerp), Kompas (Kortrijk), Clean (Liège), Transition (Gilly) and Centre Médical Enaden (Brussels).
An important supportive strategy that may facilitate crisis management for persons with substance use disorders is case management. Case management seems to be particularly effective for linking drug users to the services they need. Case management has been implemented in Belgian substance abuse treatment since 1999. It has been institutionalized as part of the federal pilot project ‘crisis and case management for persons with substance use disorders’. Relatively little is known about the effectiveness of this intervention, nor is there consistency concerning its application.
2. Objectives and methodology
A. Based on 'an epidemiological mapping', the methods, target population and realisations of the services that are involved in crisis management for persons with substance use disorders in Belgium will be described
In order to do so, we will make use of existing databases (e.g. the registration by the University Hospital Leuven, the database of the Federal Service for Public Health concerning the pilot project ‘crisis and case management’ and the registration by the Flemish crisis intervention centres) We will also organize face-to-face interviews, in order to make an inventory of the treatment offer, exclusion criteria, the definition of crisis, treatment methods and costs. For this purpose, we will use the DATCAP (French et al., 1997) and MAPS (Öberg et al., 1997).
B. Precise description of the concept ‘crisis’
Because of the various and rather vague definitions of ‘crisis’, both qualitative and quantitative methods will be used to further specify this definition. Based on a systematic literature review, both psychological and psychiatric aspects of ‘crisis’ will be investigated. Also, quantitative methods (based on available databases) will be used to identify psychological and psychiatric characteristics and any difficulties related to the concept ‘crisis’. These definitions of ‘crisis’ – based on the literature review and quantitative study - will be discussed during focus groups with health care professionals.
C. Description of the key features of case management (CM)
Based on the existing databases of the Federal Service for Public Health, it is possible to quantify how many patients had a contact with a case manager, the duration and frequency of these contacts, and subsequent referrals. These variables will be linked with sociodemographic characteristics (e.g. age, gender, SES, psychiatric diagnosis) and treatment data (e.g. length of stay). These findings will be complemented with a content analysis of the annual reports of all CM projects for substance abusers about the year 2006. By doing so, we want to characterise the target population, case-load, objectives, methods and goal attainment of CM-projects. Further, we plan structured interviews with all case managers involved in these projects. In order to make up validated ‘function profiles’ of case managers in these crisis units and other projects, we will organise focus groups, in which we will make use of 'concept mapping' technique in order to define the functions of the case manager and the basic program characteristics of case management in crisis units for substance abusers.
D. Health economic analysis of the crisis units for persons with substance use disorders
The measurement of costs will be done, based on the existing registration of patients data within these pilot projects and based on incomes and expenditures of these projects per fiscal year. The measurement contains a calculation of the costs of different treatment trajectories patients can follow from intake to the end of treatment. For the listing of the costs, we will make use of the DATCAP (French, 2003). The Drug Abuse Treatment Cost Analysis Program is a validated instrument for mapping costs of drug treatment services. Based on this instrument, we can calculate the costs for each treatment trajectory. Consequently, an estimation can be made of economic impact of the internal organisation of these services, including strengths and weaknesses. In a later stage, we can use these data and probability calculations to make health economic simulations that will lead to suggestions for improving policymaking in these pilot projects.
E. Formulating recommendations for optimising crisis and case management for substance abusers
First, we will summarize and cluster conclusions based on the results of the previous four goals. Based on a SWOT-analysis, recommendations will be formulated for both crisis and case management, on the level of clinical care, the organisation of the treatment facility, and the overall policy, in order to create a better match between service demand and service provision. Second, the results and recommendations will be linked to the daily practice, based on analyses about the monitoring of different models of case management.
Coordinator: Prof. dr. Koen Demyttenaere (Katholieke Universiteit Leuven)
Promotors: Prof. dr. Ronny Bruffaerts (Katholieke Universiteit Leuven), Prof. dr. Guido Van Hal (Universiteit Antwerpen), Prof. dr. Philippe Beutels (Universiteit Antwerpen), Prof. dr. Erik Broekaert (Universiteit Gent) en Dr. Wouter Vanderplasschen (Universiteit Gent).
Researchers: Sofie Hermans (Katholieke Universiteit Leuven), Jessica Fraeyman (Universiteit Antwerpen) en Bjoke Baudoncq (Universiteit Gent)
Crisisopvang voor middelengebruikers in België: een formele evaluatie en aanbevelingen voor een duurzaam beleid - De Evaluatie van Crisis en Case Management (ECCAM) - studie : rapport final
Brussel : Federaal Wetenschapsbeleid, 2011 (SP2583)
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