SOHO RAPID ACCESS CLINIC'

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SOHO RAPID ACCESSCLINIC.

• AIMS
• To provide a client focussed, low threshold
  flexible prescribing service.
• To offer an easily accessible assessment and
  treatment service to rough sleepers in
  Westminster.
• To provide information and advice to drug and
  alcohol users aimed at harm minimisation.

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BACKGROUND

• Pilot project Oct 99-April 00, partnership
  between Westminster DAT, BKCW, Westminster Social
  Services, Hungerford Project and Rivendell
  Clinic.
• Engaging rough sleeping drug users in the Soho
  Area, assessment, prescribing services, access to
  detox and rehab.
• Over 70 assessments carried out in 6month period.
• Follow up shows good levels of retention in
  treatment, but increase in use of Crack.
  Application for funding to R.S.U, which is
  successful.
• Oct 00 Soho Rapid Access Clinic works from the
  Hungerford Project, while waiting for premises.
  Hungerford Project continue to be closely
  associated with SRAC, which is now funded jointly
  by BKCW and The Rough Sleepers Unit.

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BACKGROUND

• SRAC opens at Dean St Hostel Jan 2001, in
  partnership with Bridge Housing and Arlington
  Care Association.
• SRAC continues to be funded by R.S.U until July
  2002, when it is absorbed into CNWL Mental Health
  Trust, and funded by Westminster Substance Misuse
  Commissioners.
• All referrals to SRAC are made through named
  referrers, who work for external agencies, there
  is a close relationship with the local
  Substance Misuse Units.
• SRAC is staffed by a consultant psychiatrist, a
  team co-ordinator, staff grade Dr, 3 clinical
  nurse specialists and an administrator.

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PARTNERSHIP WORK

• SRAC currently works with a number of partners.
• Equinox, Hungerford, Central CAT team,
  Westminster CAT team, Passage Centre, Mobile
  Needle Exchange, Connections at St. Martins, are
  the current main referrers.
• The clinic is based in Dean St Hostel, which is
  run by Bridge Housing.
• All referrals are accompanied by their external
  worker.
• Extensive liaison and support from SRAC staff to
  referrers and agencies involved with service
  users.

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SERVICES OFFERED

• Assessment, medical, psychological and social.
  Access to full psychiatric assessment
• Referral for in patient detox
• Referral to Care Managers for funding
• Methadone titration and on going prescribing
• Subutex prescribing
• Community alcohol detox
• Off site assessment if needed
• Treatment for a twelve week period
• Assurance of transfer of prescribing
• Re titration on release from prison
• Extensive harm minimisation information relating
  to drug using practices

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PHILOSOPHY MODEL OF WORK

• The assessment workers are trained nurses, who
  have worked in drug services in both the
  voluntary and statutory sector, and have
  experience within the field of homelessness.
• Although the assessment tools are cumbersome, the
  clinic practises flexibility with information
  gathering, aiming for a sensitive and detailed
  history to assist with titration.
• Medical appointments are flexible, most
  prescribing appointments offered within two
  working days, with opportunity for on the spot
  titration if appropriate.
• The atmosphere of the clinic is informal, and
  sensitive to the social exclusion of its service
  users

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A BRIEF GLIMPSE INTO THE INJECTING PRACTICES AND
CONCERNS OF A GROUP OF ROUGHSLEEPERS
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BACKGROUND

• The Soho Rapid Access Clinic noticed increasing
  reports of combined drug injecting, heroin
  crack cocaine prepared and injected together.
• The client group all have a recent and often
  protracted history of rough sleeping, little or
  negative experience of prescribing services.

• Traditional treatment services have had
  difficulty engaging this population in treatment.
• Service users were expressing concern about the
  lack of information available on snowballing,
  experiencing more injecting problems, and having
  difficulty stopping or controlling their
  combination use.

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RESPONSE

• Service user questionnaire completed by 14
  service users, seeking their views and
  experiences.
• No previous experience of a programme for crack
  use.
• Interest in additional help with problems they
  associated with snowballing and crack use.
• Triggers for increasing or continuing use were
  money, craving, boredom and living in a West End
  hostel where drug use is pervasive

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RESPONSE

• Focus group to invite user involvement and
  consultation.
• Feedback from this group has informed, and been
  part of the development of a series of user
  informed supportive educational groups.
• The group is currently in a period of review,
  having run at three West End hostels, in the
  substance misuse units.

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COMBINATION DRUG USE QUESTIONAIRE

• Basic questionnaire completed by 91 service
  users. This is in addition to service
  requirements.
• All service users asked at initial contact about
  sharing injecting equipment., approximately 98
  confirm sharing, many within the past 24 hrs.
• Also high levels of groin injecting, amongst this
  group, users site ease of access being a primary
  reason for groin injecting.

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SUMMARY

• What can agencies learn from excluded service
  users who are homeless?
• What prevents services from keeping up with the
  changing drug use patterns/market ?
• How can we respond to drug using practices which
  challenge traditional treatment provision?
• How can we respond to the increase in injecting
  problems, and service users concerns?