Quality statement 4: Trained and competent specialist staff
People accessing specialist alcohol services receive assessments and interventions delivered by appropriately trained and competent specialist staff.
a) Evidence of local implementation of current guidance from the Royal College of Psychiatrists and Royal College of General Practitioners on training and competence for doctors working in substance misuse.
b) Evidence of local arrangements to ensure that all staff carrying out initial assessments in specialist alcohol services are trained in the key elements of motivational interviewing.
c) Evidence of local arrangements to ensure that care coordination with other agencies (for example, housing, employment and social care) is delivered by appropriately trained and competent staff working in specialist alcohol services.
d) Evidence of local arrangements to ensure the use of competence frameworks developed from relevant treatment manuals that guide the structure and duration of psychological interventions for people who misuse alcohol.
e) Evidence of local arrangements to ensure that staff responsible for assessing and managing assisted alcohol withdrawal are trained and competent in the diagnosis and assessment of alcohol dependence and withdrawal symptoms, and the use of drug regimens appropriate to the setting in which the withdrawal is managed.
f) Evidence of local arrangements to ensure that staff working in specialist alcohol services receive appropriate monitoring and supervision.
Process: Proportion of staff carrying out assessments or delivering interventions in specialist alcohol services who are Drugs and Alcohol National Occupational Standards (DANOS) compliant.
Numerator – the number of people in the denominator who are DANOS compliant.
Denominator – the number of staff carrying out assessments or delivering interventions in specialist alcohol services.
Outcome: Decrease in the quantity and frequency of alcohol consumption in people who misuse alcohol.
Service providers ensure that specialist staff carrying out assessments or delivering interventions for alcohol misuse are appropriately trained and competent in accordance with current national guidance.
Health and social care professionals carrying out assessments or delivering interventions for alcohol misuse as part of specialist alcohol treatment ensure they are aware of current national guidance, participate in appropriate training, and engage in evaluation and supervision of their practice.
Commissioners ensure they commission specialist alcohol services with an adequate specialist workforce in accordance with current national guidance and where staff training and competence are monitored and maintained.
People accessing specialist alcohol services are assessed by and receive treatment from appropriately trained and competent specialist staff.
NICE clinical guideline 115 recommendations 188.8.131.52, 184.108.40.206, 220.127.116.11 (key priority for implementation) and 18.104.22.168.
Structure: a) to f) Local data collection.
Process: Local data collection.
Outcome: Local data collection. Data on the prevalence of alcohol misuse in adults is available by region from the NHS Adult Psychiatric Morbidity Survey in England.
At the time of publication (June 2011), current national guidance on a specialist workforce includes:
Drug and Alcohol National Occupational Standards (DANOS).
DANOS should be considered a minimum requirement for practitioners in specialist alcohol services. In addition, relevant specialists will be required for some assessments and interventions, such as mental health assessments and delivery of cognitive behavioural therapy.
The level and type of training or specialism required will vary across different stages of the treatment system. Exact workforce composition and planning should be determined locally in accordance with local need. Provision for ongoing monitoring and evaluation of practice competence, for example, by using video and audio tapes and external audit and scrutiny, should be assured.