A member of Birmingham Changing Futures Together’s No Wrong Door Network, the drug and alcohol service CGL, radically changed its service provision in response to the coronavirus pandemic. Offering much greater flexibility, CGL is now supporting people with multiple and complex needs to detox from alcohol at home. Craig Francis Lead Nurse for Birmingham said: “Before COVID-19 we didn’t think home detoxes were possible for this vulnerable group. We’ve proven they are, and the results are incredible. We’re definitely not going back!”

Birmingham Changing Futures Together’s purpose is to improve the effectiveness of service provision to people with multiple and complex needs to enable them to lead more fulfilled lives. At the heart of the programme is the No Wrong Door Network, comprising service providers collaborating to provide more connected support. When the coronavirus pandemic hit, the Network had to adapt quickly to meet the needs of Birmingham’s most vulnerable citizens. A member of the network, CGL (Change, Grow, Live) works with people experiencing substance misuse. Responding flexibly to the crisis, it introduced home detoxes, something previously believed to be too risky.

Before the COVID-19 lockdown, dependent drinking clients referred to CGL Birmingham first attended a welcome group. They were then medically assessed before being offered the relevant support. People moderately or very dependent on alcohol were supported via a medical detox. For those with multiple and complex needs this is challenging so the majority were admitted to the Park House inpatient treatment service, where they could be medically monitored and supported 24-hours-a-day as they detoxed.

Lock down changed everything

“Overnight, we were in a different world,” explained Craig Francis Lead Nurse for Birmingham. “Park House closed and with it the inpatient treatment service. Not able to meet face-to-face, we also couldn’t do our usual assessments for a medical detox. But clients still needed help, particularly those with multiple and complex needs who were dependent on alcohol. The lockdown removed the means and ability to get the alcohol they needed. Referrals to the service were also on the increase, coming from GPs, the criminal justice system and people engaging directly after finding our website. We had a choice: try to mange the alcohol dependence of people who were at risk until the situation changed, or take a radical new approach to medical detoxes.”

Craig continued: “Using the Alcohol Dependence Questionnaire as part of our nursing assessment, service users were given a score for their alcohol dependency, from dependent and in need of medical assistance to mild dependency requiring only psychosocial support. All those who were moderately or more dependent were assessed by a nurse on the telephone directly after referral – usually within days. We asked about their home environment, physical and mental health issues, and any recent hospital admissions. We needed to know their current level of drinking and the pattern. We asked about their previous experience of withdrawal, and their intake of prescribed and non-prescribed medications. We also asked for a summary of their medical history from their GP or via summary care records so nothing important slipped through the gaps.

“To qualify for a home detox, they needed someone able to stay with them 24-hours-a-day especially for the early days,” continued Craig. “We also had to be comfortable they were not a suicide risk. Initially anyone at risk of a seizure was not accepted for home detox but in recent weeks we have relaxed this criterium. If they have been assessed as a potential seizure risk and they meet all other criteria, after a multi-disciplinary team meeting at which the nurse and medic agree, the option to prescribe a seizure prophylactic medication is available.”

Once approved for a home detox and with a personalised plan in place, the client was contacted and arrangements made to start the detox the following week. The individual providing the support at home was briefed and a contract developed so everyone understood what was involved and required. A nurse or other member of staff then delivered the relevant prescription to a pharmacy local to the service user and provided the client with a blood pressure machine. Equipped with their medication, the individual started the detox the following Monday morning. Each client was contacted at least twice a day by a nurse to establish a combined score for their blood pressure, pulse and withdrawal symptoms including sweating, visual and auditory hallucinations. The amount of contact increased if the score suggested it was is necessary.

Craig continued: “Home detoxing has been fantastic. About 85 people have been supported since the middle of April 2020 with numbers increasing week on week.

“The results have been impressive for almost everyone. We have had some very vulnerable, sick people going through this new process. The safety of their own environment is particularly important for people with multiple and complex needs. In the familiar surroundings of their own home they have proved to be more comfortable and stable, getting a better outcome as a result.

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