2009 DIR Training - Prisons

February - March 2009

Scenarios – working in groups

Scenario 1

A prisoner has arrived at Healthcare from the community and a copy of the DIR has been received from the CJIT, the client agrees to engage with Healthcare and CARATs – this includes first night prescribing from a doctor, undergoing a CSMA with CARATs and starting a 5-day stabilisation

What form/s need to be completed to show that the client has received the treatment above, been CSMA’d and agreed a full care plan with CARATs, and how should this be recorded?

Scenario 2

A prisoner has been received from another prison along with their DIR – they have not had a CSMA yet

The receiving prison has completed a CSMA with the client and agreed a new care plan with them – CARATs completed an Activity Form Section 4 to show this and to record the treatment interventions that have now commenced – the client is now “Active” on the caseload

After some time the client disengages from CARATs, and then later is being transferred to another prison – what should be completed on the form/s?

Scenario 3

A prisoner has arrived at Healthcare from the community and NO copy of the DIR has been received, the client agrees to undergo an SMTA but does not wish to engage with CARATs - How should Healthcare record the client’s refusal of further intervention with CARATs?

CARATs make attempts to engage the client but he / she is not interested. Some time later the client is being released and agrees to engage with CARATs for pre-release planning - What form/s do CARATs need to complete to show they are working with the client pre-release and what should be recorded when they are released?

Scenario 1 - answer

Complete Activity Form Section 1 & 2 and 4 recording:

the code of DAT/CSP they came from (4.1)

substances misused that brought them into treatment (4.2a) and the first night prescribing received (4.2b)

that no current CSMA exists but one is going to be completed (4.3), provide date the CSMA completed (4.4)

the date the care plan was agreed (4.5 = Yes)

tick the date they started the 5-day stabilisation (4.6)

Note: When they finish the 5-day stabilisation fill in a new AF 1, 2 & 3 to record end date and exit status for intervention

Scenario 2 - answer

When the client disengages from CARATs an Activity Form should be completed to suspend the client from the “Active” caseload – complete AF Section 1 & 2 and 5.3 to show the date suspended, tick 5.4 “ Client disengages with CARATs” as the reason for suspension and complete 5.7 to close off any “open” treatment interventions that have ended

When the client has transferred complete a separate Activity Form to close the case - complete AF Section 1 & 2 and 5.5 to show the date closed (transferred), tick 5.6 “client transferred to another prison” and record the code of prison transferred to.

Scenario 3 - answer

Healthcare will need to complete 8.1 and 8.2 of the DIR*, recording that the client needs further intervention (8.1 = Yes) but did not accept this (8.2 = No, tick reason for refusal)

Once the client has decided to engage with CARATs, CARATs should review the DIR completed by Healthcare, complete a CSMA with the client and then “re-engage” the client by completing an Activity Form, Section 1, 2 and 5 – record date re-engaged (5.1) and tick reason (5.2)

When the client is released CARATs complete a separate Activity Form to close the case, Section 1, 2 and 5, recording the date closed (5.5) and tick “Client transferred from prison to CJIT” with the DAT / CSP that the client is being transferred to (5.6)

* because the form does not reach an Exit point before Section 8