National program “Scoring Results” produced new evidence based interventions, protocols and guidelines on treatment and prevention.
The Netherlands has an extensive and differentiated network of medical, psychosocial and care services for people with substance use or gambling problems. Residential treatment is provided by 18 inpatient clinics (seven of which are specialized wards of psychiatric hospitals) and the other part of the regional substance abuse treatment services. Outpatient treatment services are provided by about 110 agencies, spread over the country. Size of the staff (physicians, psychologists, specialised nurses and social workers) of the treatment services is nationwide about 4000 full time equivalents. In 2007 (inpatient or outpatient) treatment was provided to around 71000 patients, which 47% had the first diagnosis of alcohol dependency and 35% had a primary diagnosis of (hard) drug dependency. Approximately 80% of the nation’s (32.000) chronic hard drug users is in contact with any kind of treatment services, mainly substitution treatment, methadone maintenance. Treatment modalities cover a broad spectrum and vary from crisis intervention, substitution treatment, social and behavioural skill training, social assistance to psychotherapy and pharmacotherapy. In the last decade the substance abuse treatment system has undergone a major reorganization. A large series of scattered organizations, with a variety of aims and target populations, was merged regionally. Funding of the alcohol and drug treatment services is public, from different sources such as public health assurance, municipalities, ministries etc. The cost for addiction care in 2003 to around 140 million euros amounted, about 51% of which was spent on outpatient services and 49% on inpatient treatment.
Renewal program Scoring Results
Renewal program Scoring Results In 1998, on the basis of much criticisms on the quality, efficiency and effectiveness of addiction treatment, a group of directors in substance abuse treatment centres launched an initiative through the National Branch Organization for
Mental Health Care and Addiction Services (GGZ Nederland) for a 5 –year nationwide quality enhancing reform operation for their services, called “Scoring Results”. This initiative was supported by all the state-funded substance abuse treatment services and by the Dutch Ministry of Health which provided the funds for the execution of the program. The main goal of this major reorganisation of the treatment system was to improve treatment outcomes by redesigning all major primary treatment processes. The treatment redesign program “Scoring Results” started effectively in 1999 and will continue through 2007. The major issues of the program were assigned to so called research & development centres (in which regional research institutes cooperate with a number of regional treatment centres), that addressed four clusters of interrelated themes: intake & assessment, abstinence oriented treatment, social addiction care and prevention. The national steering committee “Scoring Results” designed a standard (intervention) protocol for all R&D centres, that consists of 6 main phases: reviewing existing knowledge in search for evidence and best practices drawing up a new service protocol evaluation of the draft protocol piloting and adapting the protocol in one centre piloting and implementing in a number of treatment centres dissemination of the final protocol or intervention At present more then 50 products (protocols, guidelines, handbooks) have been developed, tested and disseminated nationwide in the field of substance abuse treatment as a result of this renewal program “Scoring Results”. Moreover, in 2003 and 2004 two studies were executed to evaluate the degree of implementation and dissemination of (23) newly developed protocols in about 90% of the treatment services. The outcomes of both studies are very encouraging and an excellent example of how research, knowledge development and implementation can be applied in fields of care and treatment.
National Council for Competence Building in Addiction (NCCBA)
In order to improve and strengthen high quality competence building and education on substance use management (e.g. by disseminating new protocols and guidelines produced by Scoring Results), early 2005 a National Council for Competence Building in Addiction (NCCBA) was set up. In this Council of 14 members, representatives of the 5 main professional associations working in the field of addiction and mental health, experts of vocational, academic, educational institutes and treatment services, ministries and research field are meeting 6 times a year to develop strategies and actions on “evidence based competence building” in (under)graduate and continuous education. The Council is actively stimulating the awareness and dissemination of new evidence based knowledge and practice
to providers of training and education and the implementation of new, interactive modules on substance use management in medical schools, faculty of psychology, social work, nursing and occupational therapy. The Council is also involved in setting up a 1-year specialisation in
addiction management for universities for applied science and in creating a masters in addiction for physicians and psychologists. Recently the Council has published a scientific
reference guide „What every professional should know about substance abuse“. In the near future the Council will provide for qualification and accreditation to educational institutions for the domain of substance use management. Package of (15) summarized protocols and guidelines.
Package of summarized protocol and guidelines
As a kind of informational service for foreign colleagues, a package of 15 of the most successful protocols and guidelines of the program “Scoring Results” (following the main phases of treatment and rehabilitation), are summarized in fact-sheets. Moreover, the last fact-sheet provides for a summary of the main outcomes of the implementation studies executed in 2003 and 2004.