COMMUNITY-BASED TREATMENT

Based on Guidance for Community-Based Treatment & Care Services for People Affected by Drug Use & Dependence in the Philippines, UNODC
Learning Objectives:

At the end of the session, the participants will be able to:

1. learn about the Community-Based Treatment (CBTx) as

treatment model, appreciate its effectiveness, and,
identify its distinct features.
2. identify the Key Principles of CBTx.
3. identify the benefits of CBTx & its 3 major components.
4. appreciate the roles & responsibilities of key actors.
5. identify CBTx interventions guidelines.
Community-Based Treatment
• Specific integrated model of
treatment for people affected by
drug use and dependence in the
community which provides a
continuum of care from outreach
and low threshold services,
through detoxification and
stabilization to aftercare and
integration, including maintenance
pharmacotherapy.
• Located in the community
• Community empowerment:
Mobilization of community
resources & participation
• Bio-psycho-social approach
• Primarily outpatient setting
• Continuum of care
• Integrated in community health &
social services
Key Principles of Community-Based Treatment
• Continuum of care from outreach, basic support & reducing the
harm from drug use to social reintegration, no “wrong door” entry
• Delivery of services in the community
• Minimal disruption of social links & employment
• Integrated into existing health & social services
• Involve & build on community resources, including families
• Participation of people who are affected by drug use &
dependence, families & the wider community in service planning
& delivery
• Comprehensive approach, taking into account different needs
(health, family, education, employment & housing)
• Close collaboration between civil society, law enforcement, &
the health sector
• Provision of evidence-based intervention
• Informed & voluntary participation in treatment
• Respect for human rights & dignity, including confidentiality
• Acceptance that relapse is part of the tx process & will not stop
an individual from re-accessing tx services.
Benefits of Community-Based Treatment
• Promote ownership & responsibility
• Community & service users help shape an approach that ensures
appropriate accountability & responsibilities of all those involved in
the delivery services
• Increase community support and promote supportive public
opinions & health policy
• Enables treatment of larger number of patients & promote
paradigm change within society to acknowledge drug dependence
as a multi-factorial disorder
• Treatment is less invasive; less disruptive to family, work & social
life, thereby fostering independence.
• Tx begin & end in the community
• No “best” way of entering
• Drug users are identified in the
community by various stakeholders
• Family, NGO, law enforcement,
etc.
• Preliminary screening
• Basis for close collaboration bet.
NGOs, health & social support
services
3 Major Components of CBTx
• Community Organizations
• help identify drug users
• conduct basic screenings of drug problems
• Refer to primary health services when required
• Focus on preventive education, health promotion & the delivery
of basic support, reintegration & rehabilitation services
• Primary health services are provided in health centers
• Social welfare agencies & NGOs offer education, vocational &
skills training, income generation opportunities, micro-credits, etc.
Roles & Responsibilities of Key Actors
Community Health Centers
• The closest public health facility to the population
• Provide basic health care
• Provide screening for those with substance use problems &
associated health conditions
• Offer basic health education & brief counselling (non-severe)
• Proximity of treatment
• Refers cases with complex problems of psychiatric comorbidity
or serious medical condition to hospitals or specialized clinics
INTERVENTION GUIDELINES
• Screening
• ASSIST, DAST-10, CAGE, AUDIT/DUDIT, etc.
• Assessment & Treatment Planning
• History taking
• Physical examination & investigations
• Treatment options
• Case management
• Treatment planning
• Reviewing treatment progress
• Counseling
• Responding to Stages of Change
• Medical & pharmacotherapy
• Sustained Recovery Management
Sustained Recovery Management
• Domain 1: Physical & Mental Health Support
• Domain 2: Family, social supports, and leisure activities
• Domain 3: Safe housing & environment conducive to health & recovery
• Domain 4: Peer-based support
• Domain 5: (self-) employment & resolution of legal issues
• Domain 6: Vocational skills & educational development
• Domain 7: Community integration & cultural renewal
• Domain 8: Meaning & Purpose in Life
Learning Objectives:

At the end of the session, the participants will be able to:

1. learn about the Community-Based Treatment (CBTx) as

treatment model, appreciate its effectiveness, and,
identify its distinct features.
2. identify the Key Principles of CBTx.
3. identify the benefits of CBTx & its 3 major components.
4. appreciate the roles & responsibilities of key actors.
5. identify CBTx interventions guidelines.