I am a Drug Worker in the North West, we as a service continuasly come across clients who DNA appt's, miss pick ups and genrally do not comply with there specific treatment contract. As health proffesionals in this field this is a frustrating problem as we know were commited to guidelines (orange book) and P&P'S.However it begs the question what are we supposed to do to solve this on-going problem. We have all battered our heads with a solution, but to no avail.......So has anyone out ther solved this or come up with a plan to keep clients engaged and prescribed or is it a problem that will never go away !!!!!!!

Hi John, Have a look at this from the NTA - i think it gives some very good and safe suggestions for addressing these sorts of problem

towards successful treatment completion Susi

Hi john,
sorry I had not seen your post earlier.. it must have got mixed up with the bonfire night rockets and sparklers.

i have just skimmed thorugh john Dunn's NTA paper linked by Susi again, and it is brilliant isn't it? I must get hold of a paper version, or at least print a copy, and spread it widely around locally.

there are some extraordinary bits of information in it. How can some services have "withdrawel of treatment" as the end point for 30% of patients? The paper explains in evidence based detail why this must be dangerous, unacceptable and almost always avoidable. I hope the relevant services will find copies of the paper in all their pigeon holes.

there is an interesting mention of contingency management: Quote: ""Contingency management (CM), using treatment incentives to reward positive behaviour change,
has also been found to improve attendance and engagement with treatment. NICE has recently
recommended its implementation in drug treatment services. The NTA has recently supported a
series of CM demonstration projects across England, which are now complete. Advice on the
implementation of CM will be issued by the NTA in 2009. ""

Has anyone seen this advice yet? we had discussions on CM on this site, when the NICE guidelines came out, and some feel it is "blackmail" and not ethical, but I have always found carrots of all kinds have more effect than sticks at producing behaviour change.