The public health approach: Prevention, treatment, risk and harm reduction, recovery, social reintegration and rehabilitation

Chair: Marije Beens. National drug coordinator of Ministry of Health, Welfare and Sport of the Netherland

Franz Tratmann, Trimbos Institute
Evidence based and best practices are the two keys to improve the quality of intervention. Stablishing effectiveness of investments. You have to translate the clinical evidence into best practices, taking into account cultural values, and personal preferences. There are some remarks on evidence based programmes. There are certain forms of intervention that cannot be tested in clinical settings, such us some prevention activities. Recognising effective intervention is key.

Setting and the measures need to be  taken into account.

  • Quality standars: structural aspects, process components, outcome standars
  • Guidelines that refern to content, process and structure and organisation
  • Protocoles or SOPs

We also need research to stablish evidence for effectivenes, monitoring at regular intervals and evaluation for measuring results/impact of policy/practice.

Some of the principles of best practices are:

  • High level of coverage
  • Easy accessibility
  • Low threshold
  • Opening hours have to be adapted to the tardet group
  • User friendly environment
  • Continuity of care
  • Client satisfaction
  • Taking into account regional differences
  • Equivalence principle: prison inmates should have access to the same health provisions as available in the community

If you live in a post-communist country the situation is totally different that in you live in a western country, of course.

Marica Ferri, head of sector EMCDD

What are the best practices for us? We don’t have the same the same level of certainties  We need to identify transparency and why we considere some reseach valid for decision making and not others.
People use something that they think is easy to make their lives better in different cultural setting. We also need auality standars.

Evidence are imporant, but evidence do not take decissions, is the people who take these decisions.

We have created a best practices promotion, that include:

  • Data collection strategies: We collate scientific evicence, european activities and a collection of tools,  in collaboration with partners and agencies, such us WHO.
  • Dissemination strategies: We use website, newsletters and mailing. See the http://www.emcdda.europa.eu/best-practice
  • Monitoring and evaluation strategies: we need to take as baseline regional data.

What woks. The implementation is a multiplier. If your implmentation is zero, the impact of your research is zero.

Our challenges are:

  • Decision making has short times,
  • we have new challengues such us new psycoactive drugs,
  • not all the evience need randomize control trials, there is life beyond them.
  • how to communicate uncertainties
  • matching questions with level of evidence

Current opportunities are:

  • evidence based policies
  • willingness for new decision making proccesses
  • new channels of communication

Questions


Head of the national drug policy body in Germany. 
I think that I am the only person in Germany that has read the Trimbus Institute document and
we have the challenge on how to implement all the good standars recommended by the document and the guidelines recommended by the UNODC, as some of these guidelines are very high level, what makes it difficult to implement them in the field.  Our experience in a project in Central Asia is that the implementation of the guidelines depend on the people that is working on the field how to implement the best practices. We have also experiences in Germany and by medical doctors working on OST that are using these guidelines.

Franz Tratmann, Trimbos Institute
Even if you train your services, you need to repeat the training after two months. It is good to have feedback on the supervised intervision, but due to the financial restrictions, this is becoming harder.

Comment around the therminology: Pacients, clients, users…

Franz Tratmann, Trimbos Institute
When we implement programmes in a country, we need to work from inside and make the theory match with the culture.

WHO
Concerning the level of resouces in the country. Governmental financing going into the programmes that have good quality standars interventions is needed.  We have talked a lot around evaluation of interventions, the most urgent evaluation and monitoring at the moment are the evaluations around population impact, and we only have this kind of assessments at national level. There is not systematic approach on the impact at population level. This is a big issue, that implies methodolody, capacity and this needs to be given more attention.

Franz Tratmann, Trimbos Institute
A lot of changes in the population are interfeering in the way we can evaluate the impact of policy measures,  it is very difficult to evaluate, so we are open to suggestions.
 
Thailand
There is a big problem in the country around metamfetamine. for the treatment we try to classify the patients into groups according the severity of their dependence, we also are implementing microempresarial initiatives. For harm reduction, is the ultimate goal for harm reduction is to make the patients  “dependent”  forever?

Franz Tratmann, Trimbos Institute
When we intervene in drug attention, we want people to stop using drugs, but many people don’t do, so it is not only a moral but also a cost-effective obligation to implement alternative that aim to protect harm. There are people that we will use methadone until the end of their days, but other people not.

Public: Today we heard WHO asking from global health coverage, and also HRI calling in the 10 by 20 campaign to redirect budget to harm reduction.

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