The declaration on quality indicators and standards at therapeutic communities is intended to be a joint statement
concerning the basic elements of the operating process of European professional therapeutic communities. Its basic principles,
framework of application and aims are as follows:
1. BASIC PRINCIPLES: These are summed up in the ERIT declaration of principles and aims:
· To defend the ethics of service to persons with drug problems.
· To favor exchanges, co-operation and debate among European professionals
in services for people with drug-related problems.
· To recognize health-care professionals and institutions as co-operators
in the drawing up and application of a European policy for drug-related problems.
· To extend European studies and research into aid and assistance for drug
addicts.
2. FRAMEWORK OF APPLICATION: The European experts in the working group represent professional European therapeutic communities which:
· are managed by professional staff, develop
explicit programs of therapeutic and educational activities with the goal of helping patients to integrate themselves into
society as individuals in their own right.
· affirm the usefulness of professional therapeutic
communities as a further resource in achieving those aims, along with other forms of treatment (pharmaceuticals, individual
therapy, etc.) on an inpatient or outpatient basis.
3. AIMS: In line with these basic principles, the declaration is oriented
towards the following goals:
·
To contribute to exchanges and consensus as regards quality in care for drug addicts in a therapeutic community
context.
· To establish common points as a basis for research into and subsequent development of quality in treatment programs of this type.
· To contribute elements useful for the planning of a European policy on quality in treatment
programs for drug addicts: therapeutic communities and other forms of treatment.
This declaration aims to include essential points concerning the quality of treatment for drug abuse. The items included
represent the modus operandi which professionals from professionally run therapeutic
communities in Europe consider to be essential or desirable (insofar as is possible) for such centers.
The signing of this declaration is intended to establish a consensus which will
favor subsequent development and improvement of quality in these programs through continuous research and development.
The points in the declaration are grouped into areas covering
quality indicators and standards for therapeutic communities selected by the group of experts in the course of this year.
FORMAL ASPECTS
1. Therapeutic communities must have government authorization to operate. This
means that they must know and meet all the requirements of local, regional and national law affecting their programs, as indicated
below.
2. TCs must, insofar as is possible, meet the quality criteria laid down by the
authorities as regards approval or accreditation of quality.
3. TCs must, as far as is in their power,
take on a significant role in local, regional or national planning as regards drug addiction.
PHYSICAL RESOURCES, ENVIRONMENT, HEALTH CONTROL.
1.
The physical resources of TCs and those used externally should be suitable for the goals of the programme and should
permit continuous development without interference. They should also be suited to the physical and emotional state of residents.
2. TCs must have sufficient suitable equipment in terms of hygiene, inhabitability
and safety.
3. TCs must keep their equipment and structures in good working order.
4. TCs must maintain an atmosphere conducive to a good self-image on the part
of patients, and must protect them from any aggression, threat or physical, psychological or sexual exploitation.
5. TCs must guarantee a suitable institutional climate between patients and in
relations between patients and staff so as to favour the relationships and growth of patients in a clear, controlled structure.
6. TCs must teach and encourage high standards of hygiene and personal care among
patients, and the assuming of responsibilities in the operation and maintenance of the program suited to the state of patients
and to their treatment plans.
7. TCs must provide easy access for emergency services in case of danger to public
health or to the life of a patient.
8. TCs must strive to provide, insofar as is possible, material and facilities
for physical, educational and recreational activities suited to the needs of patients and the goals of the program.
9. TCs must operate ongoing programs to prevent, identify and control infections.
ECONOMIC ACTIVITIES & FINANCIAL QUESTIONS.
1. TCs must maintain a standard, accredited accounting system.
2. TCs must develop economic viability studies and plans favorable to the achievement
of their quality goals, maintaining minimum requirements for personnel and sundry expenses.
3. If TCs receive payment in advance for treatment, it must reimburse same if
treatment finishes early, except for a pre-set amount for reservation of a place.
TECHNICAL STAFF: MAKE-UP, TRAINING AND SUPERVISION.
1. TCs must have technical staff organization diagrams which differentiate between
management, therapy and educational activities. Information on each staff member must include personal data, qualifications,
job description and rights and obligations.
2. TCs must guarantee that their technical staffs are professional and multidisciplinary.
They must also ensure training (basic. specialist and experience), consistency of training with jobs and sufficient numbers
for the number of inpatients. Training requirements for ex-addicts should be
the same as for the rest of the staff.
3. TCs must strive to standardize procedures for recruitment of staff, based
on the analysis of tasks and the characteristics of the patients treated.
4. New staff members must be trained according to a procedure based on the task
they are to carry out and suited to the persons treated. This includes training prior to and after joining the staff.
5. TCs must maintain continuous training and re-training programs for technical
staff.
6. TCs must apply standardized programs for communication, co-ordination and
internal cohesion between staff members.
7. TCs must apply programs to encourage the professional development of staff
members, to safeguard the emotional stability of the staff and to prevent “burn out”.
8. TCs must, insofar as is possible, apply a pre-set procedure of external supervision
to maintain quality in patient care.
ADMISSION PROCEDURE
1. TCs must have a description of the conditions and procedures for admission,
including: a) information obtained from each applicant; b) procedure for dealing with applications for admission; c) information
held on each application; d) statistics on applications and admissions; and e) procedure in case of non admission.
2. TCs must maintain a clear definition of criteria for admission, and these
criteria must be known and shared with the health care networks and services which refer patients to TCs.
3. Acceptance of a patient must be based on the suitability of the type of programme
for the needs of that patient (as assessed by clinical staff at the TC): it must be determined that the patient requires the
treatment on offer and that the TC can supply the care needed by the patient.
4. During the admission procedure the TC must ensure that the applicant clearly
understands and accepts: a) the nature and goals of the programme; b) the rules of the TC; c) the cost of treatment; and d)
the rights and obligations of patients.
5. During admission TCs must ensure co-operation with medical & psychological
teams treating the patient before admission to the TC, and must document any breaks or changes in treatments applied previously.
6. During admission TCs must document a) the patient's consent; b) responsibility
for medical care; c) family participation in treatment; d) the system of communications and visits; and e) preparedness for
leaving the TC with or without the consent of staff.
INDIVIDUAL PATIENT RECORDS (IR).
1. TCs must keep written records on each patient, including signed and dated
notes on: a) patient identification data; b) patient admission data, including status; c) services and care given to the patient;
d) progress of the patient during treatment; and e) status of the patient on completion of treatment.
2. Patient IRs must include individualized treatment plans with their application,
reviews and modifications.
3. IRs must include documents on
the protection of patients' rights, including consent for the procedures of admission, assessment, treatment, investigation
and monitoring.
4. TCs must strive to include in IRs information on unusual events, accidents
or damage, complications and difficulties in treatment.
5. TCs must apply a plan for the preparation, storage, use, safety and confidentiality
of IRs
PATIENT DIAGNOSIS AND ASSESSMENT.
1. TCs must strive, insofar as is possible, to apply standard methods for patient
assessment and diagnosis, specifying what instruments are used, what staff is in charge and what assessment intervals are
used according to the needs of each patient.
2. TCs must take responsibility for assessing patients in the following areas:
a) physical/ medical; b) substance use and abuse problem; c) psychology and psychiatry; d) family and social; e) legal; and
f) occupational/ vocational.
3. A full medical assessment should be made by a qualified medical practitioner
before individualized treatment is designed.
4. TCs should, if possible, have psychological and psychiatric assessment available
to detect any complications which might threaten the health and welfare of a patient or affect the results of treatment.
5. All results of assessments, analyses and clinical examinations carried out
on admission and during treatment must be recorded in the clinical file within the IR.
6. TCs must strive to use standardized instruments for patient assessment and
established systems of diagnostic classification (DSM, CIE, etc.), and to develop measuring instruments suited to the program.
7. TCs must use a standard format for reports on the progress of patients during
treatment.
8. TCs must use the information on patient assessments to design, review and
update individualized patient treatment and monitoring plans.
TREATMENT: GENERAL POINTS, ACTIVITIES & EDUCATIONAL PROGRAMS.
1. TCs must maintain a standard description of their therapeutic programs, well
defined and made known to patients, staff and institutions, including: a) planned and reviewed targets; b) methods applied
(techniques, theoretical basis, procedures & application criteria); c) activities carried out; and d) envisaged timing.
2. The program description must clearly express its ideological orientation and
include an express declaration that: a) no absolute guarantee is given that the patient's drug abuse problem will be solved;
b) it is centered on the needs of patients with a view to re-integration into society; c) no religious or ideological principle
is imposed.
3. The program description should include internal regulations and a therapy
contract explaining the rights and duties of patients and staff.
4. TCs must apply individualized treatment plans recorded in writing in the IRs
which a) are based on the needs of patients; b) specify the services they require; c) indicate short and long-term goals and
criteria for the completion of treatment; d) program the individualized application of intervention techniques; and e) are
under the direct responsibility of a member of staff.
5. Individualized treatment plans will be designed with the direct participation
of the patient, reviewed regularly with them and modified when necessary.
6. TCs must, insofar as is possible, apply a program oriented towards the family
problems of patients, or must link with other services for treatment.
7. Therapeutic program methods must be based on scientific research, targets
must be objectively assessable and individualized treatment plans must include methods for measuring progress and the results
of interventions.
8. Treatment at TCs must include a timetable planned and reviewed jointly with
patients as a structured but flexible framework for daily life, with spaces and times in common for therapy, activities, leisure
time and inter-personal relationships.
9. Patients' activities must never be used to bring financial profits to the
program. If benefits arise from those activities, they must be invested in materials or activities to benefit patients.
10. TCs must provide or facilitate access to: a) educational programs; b) vocational
advice; c) recreational activities. These activities, along with occupational therapy, must be adapted to patients and supervised
by staff. The information obtained concerning these activities will be stored and used in the planning of individualized treatment.
11. TCs must apply special procedures for treatment of patients who are HIV+
or have AIDS. These must be developed by specialist staff and have clear criteria concerning referral, including psycho-pathological
and neurological assessment and special health preventive and health control measures.
COMPLETION, REFERRAL & MONITORING.
1. TCs must have clearly defined criteria concerning stay times, specifying the
conditions for the completion of treatment, referral to other services and expulsion.
2. These stay time criteria must be specific to each diagnosis, patient problem,
individualized treatment goal and procedure to be applied.
3. In case of complete or partial failure of treatment, expulsion, abandonment
or refusal by the patient to accept the program, TCs must take steps to reduce damage due to continued exposure to substances,
offer patients an alternative plan at the TC or make it possible for them to be re-admitted.
4. TCs must concern themselves with avoiding patients' becoming dependent on
the center, and their whole intervention must be aimed at the re-integration of patients. Departure must be planned in each
individual case via a framework of outings which is sufficient, orderly, progressive and suited to the diagnosis and circumstances
of each patient.
5. TCs must develop specific reintegration plans or co-operate with other social
services to help patients to reintegrate.
6. TCs must, insofar as is possible, apply monitoring plans drawn up before completion
jointly with patients, family and other significant, and reviewed subsequently. This will help to establish contact, support
and attention on a continuous basis, specifying criteria for re-admission and ending of monitoring.
PATIENTS' RIGHTS
1. TCs must support, protect and guarantee the basic rights of patients as regards
human, civil, constitutional and statutory rights.
2. The TC should have a written declaration listing patients' rights and how
they are protected and applied. Apart from the aforementioned rights, active participation in an individualized treatment
plan should be guaranteed, along with protection of the personal privacy of patients and the confidentiality of all information
on them.
3. All patients must be informed of their rights in easily understandable terms,
and must receive a written description of their rights. These descriptions must be displayed in visible places at TCs.
4. TCs must allow patients to maintain communications and receive visits from
family members and other significant. If restrictions are imposed for clinical reasons this must be recorded on the IR and
the therapeutic efficacy of such restrictions must be assessed regularly.
5. All patients must receive and sign a declaration: a) certifying that admission,
continuation, transfer, interruption, completion of treatment and monitoring are on a voluntary basis; b) authorizing the
use of recording instruments, participation in research projects and use of non habitual techniques of assessment and treatment.
6. All patients at TCs must have the rights to bring complaints and claims concerning
the treatment received, and internal reviews of the treatment plan.
RELATIONS WITH THE COMMUNITY AND WITH OTHER SERVICES.
1. TCs must not be seen as an end in themselves but must be integrated into health care networks, co-coordinating with prevention, treatment, rehabilitation and
re-integration networks and services.
2. TCs must, insofar as is possible, maintain an education service oriented towards
the community in order to inform the community of a) its nature, resources and services; b) the needs of the population as
regards prevention and treatment. The purpose of this is to obtain public and private backing for the development and improvement
of resources.
3. TCs must carry out and co-operate with activities to encourage action in society
in response to drug addiction problems
4. TCs must strive to be recognized as teaching centers, and staff members must
strive to provide training on external programs concerned with drug-addiction related problems.
QUALITY ASSURANCE
1.TCs must systematically develop quality assurance activities: a) assessing
how far the theory of programs is consistent with practice; b) via a documented program of mechanisms and activities; c) integrating
all members of staff and professional disciplines with external control mechanisms independent of TCs themselves.
2. Quality assurance activities must include: a) investigation into and assessment
of programs; b) suitability and professional level of technical staff; c) review of the use of resources in the program; and
d) case studies and patient care audits.
3.TCs must draw up annual reports including a) statistics on patient movements;
b) description of the programs and activities carried out; c) make-up of staff, training received and provided by same; d)
rates of efficiency, efficacy and effectiveness of the TC; e) financial balance sheet; f) research carried out; and g) updating
and changes in nature, resources and activities.
4. TCs must carry out in-house studies to assess their intervention model and
identify factors associated with the results of treatment, and must co-operate as far as possible with institutions performing
scientific and research work.
5. TCs must make regular assessments of their efficacy, efficiency and effectiveness,
including the opinions and degree of satisfaction of patients and other users. The resulting information must be submitted
to the staff, management and institutions supporting the TC, for integration into a logical scheme of progress and improvement
of programs.
6. TCs must strive to show that their material and human resources are suitable
allocated via the application of a program which reviews the use of those resources and corrects and excesses, shortfalls
or unsuitable programming.
7. TCs must prove with documents that the clinical care planned and supplied
to patients is assessed and adapted to their needs, via meetings to study cases and patient care audits. The information stored
in patient IRs will be used in these processes.
8. TCs must strive to detect any deviation from optimum attainable levels in
the services provided to patients. Such variations must be analyzed by quality assessment personnel and corrective measures
must be taken and checked out via follow-up studies.
9. The results of case studies and patient care audits must be integrated into
other quality assurance functions: re-allocation of tasks, control and organization of resources, monitoring, development
and continuous training of personnel and planning of treatment strategies and activities.
10. TCs must document the complete patient
care quality assessment process. The results and the information obtained must be reported to the personnel responsible for
the program.
