Ost capacity building, monitoring and mentoring

1. Additional Professor, NDDTC, AIIMS, New Delhi
Member: Strategic Advisory Group, IDU and HIV, United Nations
Member: Technical Resource Group, IDU - HIV, NACO, Govt. of India
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

2. What’s so special about OST?
0 A Medical intervention
0 Involves providing a medication which
0 Has abuse liability of its own
0 Is controlled under the regulations
0 More technically intensive than other interventions
0 More resource intensive than other interventions
……Adequate capacities of service providers and
adequate standards of services are critical
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

3. Case study
0 NACO OST Programme for IDUs (as HIV prevention)
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

4. NACO OST Programme: NGO ‘TI’ model

Govt. HOSPITAL
NGO TI
Delivery of various harm reduction
services: including NSEP and OST
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

5. NACO OST Programme: GO-NGO model

Govt. HOSPITAL
with OST
NGO TI
Delivery of various harm reduction
services: including NSEP
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

6. Case study
0 NACO OST Programme for IDUs (as HIV prevention)
0 Two models
0 NGO TI model
0 GO-NGO collaborative model
0 Human resources: Doctor, Nurse, Counselor,
managerial staff
0 Critical requirements:
0 Capacity Building
0 Quality Assurance
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

7. NACO OST Programme: Mechanisms for
building capacities and ensuring quality
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
EvaluationPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

8. 1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for
building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

9. Induction Training on OST
0 A five day training programme
0 Conducted soon after recruitment of staff
0 Conducted for a mixed group of staff (nodal officers,
doctors, nurses, counselors, data managers,
programme managers and outreach workers)
0 Class-room type training
0 Highly interactive and participatory
0 Exposure visit – an essential component
0 BASED UPON A MANUAL
0 Outcome:
0 Trained staff who begin service delivery after receiving a
certificate
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

10. Induction Training on OST
0 A five day training programme
0 Conducted soon after recruitment of staff
0 Conducted for a mixed group of staff (nodal officers,
doctors, nurses, counselors, data managers,
programme managers and outreach workers)
0 Class-room type training
0 Highly interactive and participatory
0 Exposure visit – an essential component
0 BASED UPON A MANUAL
0 Outcome:
0 Trained staff who begin service delivery after receiving a
certificate
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

11. Organization of the manual
Rajat Ray, Anju
Dhawan, Atul
Ambekar (2011),
Implementing OST :
A Training manual
for service
providers, NACO,
Government of
India, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

12. 0Organization of the manual
0Content 
0Format
Organization of the manual
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

13. Areas covered in the training
Drugs, Drug Dependence, Harm Reduction, Principles of drug treatment, OST:
• Basic knowledge (and attitude)
Assessment and Diagnosis:
• Clinical skills
OST (induction, maintenance, dispensing):
• Clinical skills
Psycho-social interventions:
• Clinical skills
Exposure to a functioning OST centre
Programme management: Dispensing, record maintenance, stock keeping,
reporting, referral and linkage:
• knowledge , attitude and skills
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

14. Training sessions
Day Sessions
Day 1
Introduction exercise: meeting strangers and
building a rapport
Basics of Drugs: Overview of drugs and drug use
disorders
Drug-related problems and harms
Local drug abuse scenario – GROUP ACTIVITY
General principles of drug treatment and harm
reduction
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

15. Day Sessions
Day 2
Opioid substitution therapy – overview
Assessment and diagnosis
Assessment and diagnosis: ROLE-PLAY AND
CASE DEMONSTRATION
Buprenorphine- pharmacology
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

16. Day Sessions
Day 3
Implementing OST with buprenorphine:
induction, stabilisation, discontinuation
Special clinical situations – adolescents; women;
HIV; other medical conditions, dual diagnosis
Psychosocial interventions
ROLE-PLAY / DEMONSTRATION OF
PSYCHOSOCIAL INTERVENTIONS
Scheme for implementing OST in Government
centres: an overview
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

17. Day Sessions
Day 4
Exposure to the OST clinic, including
demonstration
DEBRIEFING AND EXPERIENCE SHARING
Programme management–I
Procurement and supplies
Programme management–II
Record maintenance and reporting
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

18. Day Sessions
Day5
Programme management-III
Referral and networking, engaging civil society
Programme management-IV
Minimum standards of care, reporting
Open session
Working together: meeting between
stakeholders
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

19. Content of each session
0Objectives
0Materials and method
0Steps
0Highlights (as box items)
0Contents of the presentation
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

20. 0Organization of the manual
0Content
0Format 
Organization of the manual
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

21. Format
0 The manual has been designed to be available
in two versions:
1. Hard copy:
0Description of all the sessions
0Handouts of slides along with ‘notes’ for the
facilitator
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

22. Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

23. Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

24. Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

25. Format
0 The manual has been designed to be available
in two versions:
1. Hard copy:
0Description of all the sessions
0Handouts of slides along with ‘notes’ for the
facilitator
2. Digital version: (available as a CD or online)
0The manual proper as a pdf file
0Power point presentations as hyper links
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

26. Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

27. Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

28. Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

29. Highlights of the manual
0 Developed as a ‘guide’ for facilitators
0 Not a substitute for practice guidelines or operating
procedures
0 Flexibility for facilitators for local adaptation
0 Applicable to a variety of OST settings
0 Entire training programme has been designed to be
participatory in nature
0 Strives to address all three components – knowledge,
attitudes and skills
0 Manual encourages training programmes for mixed group
of participants
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

30. Training on OST in India
0 Induction Training: Just after staff is recruited,
before beginning the service delivery
0 Refresher training: about six months after
beginning of services
0 Conducted by Psychiatrists from academic
institutes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

31. A pool of trainers has
been created through
Training of Trainers (TOT)
programmes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

32. Coming soon…
Online Training programme on OST
0 Course content similar to existing training programme
0 Could be received by the registered participant at any
time and any place
0 Being developed by:
NDDTC
AIIMS
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

33. 1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for
building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

34. Quality Assurance of OST
0 In the form of ‘visits’ by OST experts /
mentors
0 Visits aimed at:
0 Assessment of the quality of services
0 Interaction with and guidance to the staff on
ensuring adequate quality
0 Mentors / experts: Psychiatrists; experience /
expertise in OST; trained on QA guide
0 Outcome:
0 Staff receives hands-on guidance;
0 Authorities receive a report on performancePresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

35. Quality Assurance of OST
0 In the form of ‘visits’ by OST experts /
mentors
0 Visits aimed at:
0 Assessment of the quality of services
0 Interaction with and guidance to the staff on
ensuring adequate quality
0 Mentors / experts: Psychiatrists; experience /
expertise in OST; trained on QA guide
0 Outcome:
0 Staff receives hands-on guidance;
0 Authorities receive a report on performancePresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

36. Atul Ambekar,
Ravindra Rao, Alok
Agrawal, Anju
Dhawan, Rajat Ray,
(2013), Quality
Assurance of OST in
India: A reference
guide for mentors,
NDDTC, AIIMS and
NACO, Government
of India, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

37. QA Guide: Contents
0 Introduction / About the Reference Guide
0 Conducting a Quality Assurance Visit
0 Preparing a Quality Assurance Visit Report
0 Tool for OST Quality Assurance Visit
0 OST Quality Assurance Visit Report - Proforma
0 Annexures: List of common problems and
their solutions; Steps for Planning and
Managing QA Visits,
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

38. Conducting a QA visit
0 Inform the centre staff and concerned SACS prior to visit
0 During visit
0 Observation of the centre, including functioning of the staff and
service delivery processes
0 Review of records
0 Interaction with
0 Staff – OST centre
0 Staff – linked IDU TI
0 Beneficiaries
0 Other stakeholders
0 Use the prescribed format to conduct the visit
0 Use the prescribed format to report the visitPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

39. Tool for OST quality assurance visit
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

40. Section 1: Background information
Section 2: Details of the OST centre
Section 3: Staff-related Details
Section 4: Implementation Of OST
Section 5: Record Keeping-related Details
Section 6: Feedback from Clients and their Families
Section 7: Stock Maintenance & Programme Management
Section 8: Gaps Identified and Addressed
Section 9: Impression on Quality of OST Centre 
Tool for OST quality assurance visit
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

41. Impression on Quality of OST centre
0 16 - item scoring scale
0 Each item can be scored 1, 2 or 3
0 Option for giving remarks for each item
0 Quality grading depends upon the total %
score obtained
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

42. Item 1: OST uptake
Item 2: Recruitment and training of staff
Item 3: Knowledge and confidence of staff on OST issues
Item 4: Role clarity
Item 5:Initial assessment of clients before OST initiation
Item 6: Stabilisation dose of buprenorphine
Item 7:Follow-up of OST clients
Item 8:Changes in dose of buprenorphine
Impression on Quality of OST centre
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

43. Item 9:Duration of maintenance phase of treatment
Item 10:Follow-up of LFU/irregular clients in the field
Item 11:Dispensing-related protocols
Item 12:Record maintenance
Item 13:Stock management
Item 14:Satisfaction of clients and family members
Item 15:Client retention
Item 16: Treatment adherence and compliance
Impression on Quality of OST centre
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

44. OST Quality Assurance visit report
0Observations/findings and specific
recommendations on specific areas of
OST implementation
0Other specific inputs provided
0Issues for consideration by the
authorities
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

45. Annexures
0List of common problems and
possible solutions
0Planning and managing the OST QA
visits
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

46. 1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for
building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

47. Accreditation
0 All OST centres expected to undergo Accreditation
0 Conducted by an independent agency: National
Accreditation Board for Hospitals (NABH)
0 Through trained team of two experts
0 Technical expert – a psychiatrist
0 Programme expert – a civil society member
0 Using a especially prepared tool
0 Report provides
0 Scores
0 Qualitative / descriptive information
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

48. Accreditation
0 All OST centres expected to undergo Accreditation
0 Conducted by an independent agency: National
Accreditation Board for Hospitals (NABH)
0 Through trained team of two experts
0 Technical expert – a psychiatrist
0 Programme expert – a civil society member
0 Using a especially prepared tool 
0 Report provides
0 Scores
0 Qualitative / descriptive information
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

49. The Accreditation Tool
0 In the form of an excel sheet
0 Filled by both the experts through observations and
interaction
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

50. The Accreditation Tool
0 In the form of an excel sheet
0 Filled by both the experts through observations and
interaction
0 Sections
0 Infrastructure
0 Staff
0 Service Delivery Process
0 Performance
0 Qualitative information
0 “Essential Items” 
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

51. Accreditation: Essential items
Infrastructure Storage of Medications
Staff
Doctor
OST Nurse
OST Service
Delivery Processes
Regularity of functioning
Adherence to DOTS
Dosage Change
Dispensing Records
Stock records
Mechanisms to check diversion
Programme
Performance
Service utilization
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

52. Resource Materials developed for
Capacity Building and Quality Assurance
1. Training
Manual
2. SOPs 3. Practice
Guidelines
4. QA Guide
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

53. Facebook Group:
“OST Experts, Service Providers and Advocates“
https://www.facebook.com/groups/OST.experts.India/
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

54. Upcoming resource hub:
“http://aiimsost.org/“
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

55. Conclusion
0 OST is a specialized psychiatric intervention
0 Psychiatrists are in a unique position as
0 Service Providers
0 Teachers and Trainers
0 Evaluators
0 Prgramme planners
0 Advocates
0 We need to enhance our own capacities to
help others enhance their capacities
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

56. atul.ambekar@gmail.com
fb.com/atul.ambekarPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi