Ost capacity building, monitoring and mentoring

Additional Professor, NDDTC, AIIMS, New Delhi

Member: Strategic Advisory Group, IDU and HIV, United Nations

Member: Technical Resource Group, IDU - HIV, NACO, Govt. of India

Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

What’s so special about OST?0 A Medical intervention 0 Involves providing a medication which

0 Has abuse liability of its own 0 Is controlled under the regulations

0 More technically intensive than other interventions 0 More resource intensive than other interventions

……Adequate capacities of service providers and adequate standards of services are critical


Case study0 NACO OST Programme for IDUs (as HIV prevention)


NACO OST Programme: NGO ‘TI’ model

Govt. HOSPITAL

NGO TIDelivery of various harm reduction services: including NSEP and OST


NACO OST Programme: GO-NGO model

Govt. HOSPITALwith OST

NGO TIDelivery of various harm reduction services: including NSEP


Case study0 NACO OST Programme for IDUs (as HIV prevention)0 Two models

0 NGO TI model 0 GO-NGO collaborative model

0 Human resources: Doctor, Nurse, Counselor, managerial staff

0 Critical requirements: 0 Capacity Building0 Quality Assurance


NACO OST Programme: Mechanisms for building capacities and ensuring quality

1. Training

2. Quality Assurance / Mentoring

3. Accreditation

Capacity Building

Evaluation Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

1. Training


3. Accreditation

Capacity Building

Evaluation



Induction Training on OST0 A five day training programme 0 Conducted soon after recruitment of staff 0 Conducted for a mixed group of staff (nodal officers,

doctors, nurses, counselors, data managers, programme managers and outreach workers)

0 Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component

0 BASED UPON A MANUAL 0 Outcome:

0 Trained staff who begin service delivery after receiving a certificate


Induction Training on OST0 A five day training programme 0 Conducted soon after recruitment of staff 0 Conducted for a mixed group of staff (nodal officers,

doctors, nurses, counselors, data managers, programme managers and outreach workers)

0 Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component

0 BASED UPON A MANUAL 0 Outcome:

0 Trained staff who begin service delivery after receiving a certificate


Organization of the manual

Rajat Ray, Anju Dhawan, Atul Ambekar (2011), Implementing OST : A Training manual for service providers, NACO, Government of India, New Delhi


0Organization of the manual0Content 0Format



Areas covered in the trainingDrugs, Drug Dependence, Harm Reduction, Principles of drug treatment, OST:

• Basic knowledge (and attitude)

Assessment and Diagnosis:

• Clinical skills

OST (induction, maintenance, dispensing):

• Clinical skills

Psycho-social interventions:

• Clinical skills

Exposure to a functioning OST centre

Programme management: Dispensing, record maintenance, stock keeping, reporting, referral and linkage:

• knowledge , attitude and skillsPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

Training sessions Day Sessions

Day 1

Introduction exercise: meeting strangers and building a rapportBasics of Drugs: Overview of drugs and drug use disordersDrug-related problems and harmsLocal drug abuse scenario – GROUP ACTIVITYGeneral principles of drug treatment and harm reduction


Day Sessions

Day 2

Opioid substitution therapy – overview

Assessment and diagnosis

Assessment and diagnosis: ROLE-PLAY AND CASE DEMONSTRATION

Buprenorphine- pharmacology

Training sessions


Day Sessions

Day 3

Implementing OST with buprenorphine: induction, stabilisation, discontinuationSpecial clinical situations – adolescents; women; HIV; other medical conditions, dual diagnosisPsychosocial interventionsROLE-PLAY / DEMONSTRATION OF PSYCHOSOCIAL INTERVENTIONSScheme for implementing OST in Government centres: an overview

Training sessions


Day Sessions

Day 4

Exposure to the OST clinic, including demonstrationDEBRIEFING AND EXPERIENCE SHARING

Programme management–I Procurement and suppliesProgramme management–II Record maintenance and reporting

Training sessions


Day Sessions

Day5

Programme management-III Referral and networking, engaging civil societyProgramme management-IV Minimum standards of care, reportingOpen session

Working together: meeting between stakeholders

Training sessions


Content of each session

0Objectives 0Materials and method0Steps 0Highlights (as box items)0Contents of the presentation


0Organization of the manual0Content0Format



Format

0 The manual has been designed to be available in two versions: 1. Hard copy:

0Description of all the sessions0Handouts of slides along with ‘notes’ for the

facilitator





Format

0 The manual has been designed to be available in two versions: 1. Hard copy:

0Description of all the sessions0Handouts of slides along with ‘notes’ for the

facilitator 2. Digital version: (available as a CD or online)

0The manual proper as a pdf file0Power point presentations as hyper links





Highlights of the manual 0 Developed as a ‘guide’ for facilitators

0 Not a substitute for practice guidelines or operating procedures

0 Flexibility for facilitators for local adaptation 0 Applicable to a variety of OST settings 0 Entire training programme has been designed to be

participatory in nature0 Strives to address all three components – knowledge,

attitudes and skills0 Manual encourages training programmes for mixed group

of participants


Training on OST in India

0 Induction Training: Just after staff is recruited, before beginning the service delivery

0 Refresher training: about six months after beginning of services

0 Conducted by Psychiatrists from academic institutes


A pool of trainers has been created through

Training of Trainers (TOT) programmes


Coming soon…

Online Training programme on OST0 Course content similar to existing training programme 0 Could be received by the registered participant at any

time and any place 0 Being developed by:

NDDTC AIIMS


1. Training


3. Accreditation

Capacity Building

Evaluation



Quality Assurance of OST0 In the form of ‘visits’ by OST experts /

mentors 0 Visits aimed at:

0 Assessment of the quality of services0 Interaction with and guidance to the staff on

ensuring adequate quality 0 Mentors / experts: Psychiatrists; experience /

expertise in OST; trained on QA guide0 Outcome:

0 Staff receives hands-on guidance; 0 Authorities receive a report on performance Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

Quality Assurance of OST0 In the form of ‘visits’ by OST experts /

mentors 0 Visits aimed at:

0 Assessment of the quality of services0 Interaction with and guidance to the staff on

ensuring adequate quality 0 Mentors / experts: Psychiatrists; experience /

expertise in OST; trained on QA guide0 Outcome:

0 Staff receives hands-on guidance; 0 Authorities receive a report on performance Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

Atul Ambekar, Ravindra Rao, Alok Agrawal, Anju Dhawan, Rajat Ray, (2013), Quality Assurance of OST in India: A reference guide for mentors, NDDTC, AIIMS and NACO, Government of India, New Delhi


QA Guide: Contents

0 Introduction / About the Reference Guide 0 Conducting a Quality Assurance Visit0 Preparing a Quality Assurance Visit Report0 Tool for OST Quality Assurance Visit0 OST Quality Assurance Visit Report - Proforma0 Annexures: List of common problems and

their solutions; Steps for Planning and Managing QA Visits,


Conducting a QA visit0 Inform the centre staff and concerned SACS prior to visit 0 During visit

0 Observation of the centre, including functioning of the staff and service delivery processes

0 Review of records0 Interaction with

0 Staff – OST centre0 Staff – linked IDU TI 0 Beneficiaries0 Other stakeholders

0 Use the prescribed format to conduct the visit 0 Use the prescribed format to report the visit


Tool for OST quality assurance visit


Section 1: Background information

Section 2: Details of the OST centre

Section 3: Staff-related Details

Section 4: Implementation Of OST

Section 5: Record Keeping-related Details

Section 6: Feedback from Clients and their Families

Section 7: Stock Maintenance & Programme Management

Section 8: Gaps Identified and Addressed

Section 9: Impression on Quality of OST Centre

Tool for OST quality assurance visit


Impression on Quality of OST centre

0 16 - item scoring scale 0 Each item can be scored 1, 2 or 3 0 Option for giving remarks for each item0 Quality grading depends upon the total %

score obtained


Item 1: OST uptake

Item 2: Recruitment and training of staff

Item 3: Knowledge and confidence of staff on OST issues

Item 4: Role clarity

Item 5:Initial assessment of clients before OST initiation

Item 6: Stabilisation dose of buprenorphine

Item 7:Follow-up of OST clients

Item 8:Changes in dose of buprenorphine



Item 9:Duration of maintenance phase of treatment

Item 10:Follow-up of LFU/irregular clients in the field

Item 11:Dispensing-related protocols

Item 12:Record maintenance

Item 13:Stock management

Item 14:Satisfaction of clients and family members

Item 15:Client retention

Item 16: Treatment adherence and compliance



OST Quality Assurance visit report

0Observations/findings and specific recommendations on specific areas of OST implementation

0Other specific inputs provided0Issues for consideration by the

authorities


Annexures

0List of common problems and possible solutions

0Planning and managing the OST QA visits


1. Training


3. Accreditation

Capacity Building

Evaluation



Accreditation 0 All OST centres expected to undergo Accreditation 0 Conducted by an independent agency: National

Accreditation Board for Hospitals (NABH) 0 Through trained team of two experts

0 Technical expert – a psychiatrist 0 Programme expert – a civil society member

0 Using a especially prepared tool 0 Report provides

0 Scores0 Qualitative / descriptive information


Accreditation 0 All OST centres expected to undergo Accreditation 0 Conducted by an independent agency: National

Accreditation Board for Hospitals (NABH) 0 Through trained team of two experts

0 Technical expert – a psychiatrist 0 Programme expert – a civil society member

0 Using a especially prepared tool 0 Report provides

0 Scores0 Qualitative / descriptive information


The Accreditation Tool0 In the form of an excel sheet 0 Filled by both the experts through observations and

interaction


The Accreditation Tool0 In the form of an excel sheet 0 Filled by both the experts through observations and

interaction0 Sections

0 Infrastructure 0 Staff 0 Service Delivery Process 0 Performance 0 Qualitative information 0 “Essential Items”


Accreditation: Essential items Infrastructure Storage of Medications

Staff DoctorOST Nurse

OST Service Delivery Processes

Regularity of functioningAdherence to DOTSDosage ChangeDispensing RecordsStock records

Mechanisms to check diversion

Programme Performance Service utilization


Resource Materials developed for Capacity Building and Quality Assurance

1. Training Manual

2. SOPs 3. Practice Guidelines

4. QA GuidePresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

Facebook Group: “OST Experts, Service Providers and Advocates“

https://www.facebook.com/groups/OST.experts.India/


https://www.facebook.com/groups/OST.experts.India/

Upcoming resource hub:“http://aiimsost.org/“


Conclusion

0 OST is a specialized psychiatric intervention 0 Psychiatrists are in a unique position as

0 Service Providers 0 Teachers and Trainers 0 Evaluators 0 Prgramme planners 0 Advocates

0 We need to enhance our own capacities to help others enhance their capacities


[email protected] fb.com/atul.ambekarPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

Date post:	15-Aug-2015
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Ost capacity building, monitoring and mentoring

Health & Medicine