1. PRES.ENCARNACAO.ENG

Integration of Drug Intervention
Strategies at the City Level – The Case
of Coimbra
Carlos Encarnação
Mayor of Coimbra
Götenborg – May 27-29, 2009
Portuguese Framework
Main Players
Supply Side / S. Reduction
Demand Side / D. Reduction
Police Departments
Dissuasion Commissions
Health Services
• PSP
• GNR
• PJ
Judicial System
• Investigation Magistr.
• Courts of Law
• NHS
• IDT, IP
Social Network
• Cities Council’s for
Social Intervention
• NGO’s
Other National Gov. Depts
IDT, IP
Institute for Drugs and Drug Addiction
IDT – Institute for Drugs & Drug Addiction
• Mission
• Illicit Drugs & Alcohol
• Areas of intervention / responsibility
• Treatment
• Prevention
• Risk and Harm Reduction
• Rehabilitation
• Demand reduction (dissuasion)
• Investigation & Epidemiological surveillance
• Training
• International representation
IDT – Institute for Drugs & Drug Addiction
Main IDT national community intervention programs
PIF – Focus Intervention Programs (c. 20 projects funded by IDT – 2 years)
• Intervention in leisure spaces / youth music festivals …
• Dysfunctional families
• Young people with risk behaviors
PORI – Operational Program for Integrated Responses
• IDT funded programs developed for detected priority territories (92)
• RAR methodology (more properly RARE…)
• Integrated responses
• both at technical and institutional levels
• fully evaluated at all levels of implementation
IDT – Institute for Drugs & Drug Addiction
General Strategic Principles
• Interventions centered on the citizen
• Territory driven & designed programs
• Integration of institutional efforts
• Integrality & continuity of responses
Drug Intervention Network in Portugal
IDT
• Treatment consultation teams all over the country
• Teams & mediators for community intervention in
• Prevention; harm reduction, rehabilitation…
• National intervention programs (financed whenever necessary)
• Specialized treatment units - alcohol (3), detox. Units (5), therapeutic
communities (3 units + 1200 conventioned beds)
• National network for demand reduction / dissuasion
(18 teams / portuguese law enforcement)
Other National Health Service (NHS) facilities
The City of Coimbra
Coimbra
• More than 1.000 years old
• Roman city of Aeminium
• One of the world’s oldest universities (700 y. +)
• 165.000 to 185.000 inhabitants
• 35.000 university students; 10% from 40 countries
• Activity mainly connected with services,
teaching & health care
• Cluster in biotech, pharma. & software industries
Coimbra : International City Partnerships – Twin Cities
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Santa Clara da Califórnia
Halle
Poitiers
Salamanca
Santos
Aix-En-Provence
Cambridge
Yaroslavl
Fès
Santiago de Compostela
Mindelo
Curitiba
S. Paulo
Beira
Taipa
Pádua
Díli
Damão
Esch-sur-Alzette
Saragoça
EUA
Alemanha
França
Espanha
Brasil
França
EUA
Rússia
Marrocos
Espanha
Cabo Verde
Brasil
Brasil
Moçambique
China (Macau)
Itália
Timor Leste
India
Luxemburgo
Espanha
Coimbra : City Programs
• Urban Rehabilitation Projects - old quarters & city social housing developments
• “Nomads Park” - gypsies temporary housing facilities
• Project “Planalto Seguro” - urban rehabilitation, security & citizenship promotion
• CLAS - Coimbra’s Council of Social Partners (122 State Deps & NGOs)
• Strong civil society …
• RIAC – Coimbra’s Network for Addictions (leader : IDT; c. 20 partners)
•…
CLAS – “City Council for Social Action”
Na organ that directly depends of the Mayor
City of Coimbra : Partners in the Social Council (122+ State Orgs & NGOs)
ACAPO - Ass. de Cegos e Amblíopes de Portugal
ACIC
ACM - Ass. Cristã da Mocidade
ADAV - Ass. de Defesa e Apoio da Vida
ADFP - Fórum Ocupacional
ADIS
Administração Regional de Saúde do Centro
Amigos do Cidadão Doente
ANAI
APELO - Apoio à Pessoa em Luto
APELO - Ass. de Apoio à Pessoa em Luto
APPACDM
APPDA - Coimbra
Ass. Cultural e Recreativa de Casal S. João
Ass. das Cozinhas Económicas Rainha Santa Isabel
Ass. de Moradores do bairro da Rosa
Ass. de pais e Encarreg. de Educação da EB1 de Pereiros
Ass. dos Diabéticos da Zona Centro
Ass. Integrar
Ass. para o Planeamento da Família
Ass. Port. de Estudos e Intervenção em Psicologia Positiva
Ass. Port. de Familiares Amigos e Pessoas com Epilepsia
Ass. Portuguesa de Solidariedade e Desenvolvimento
Ass. Reage
Ass. Social recreativa Cultural Cigana de Coimbra
Ass. Social, Cultural e Recreativa de S. Paulo de Frades
Ass. Sócio Cultural de Recreio e Desportiva dos Pereiros
ATENEU de Coimbra
Banco Alimentar Contra a Fome
Câmara Municipal de Coimbra
Cáritas Diocesana de Coimbra
Casa da Infância Dr. Elysio de Moura
Casa de Repouso de Coimbra
Casa do Pai - Centro de Apoio Social
CEARTE
CEIFAC - Centro Integrado de Apoio Familiar de Coimbra
CELIUM - IPSS
Centro Comunitário de Desenvolvimento e Solidar. Social
Centro de Apoio Social de Souselas
Centro de Apoio Social Pais e Amigos da Escola EB 10
Centro de Assistência Paroq. Santa Cruz
Centro de Bem Estar Social de Brasfemes
Centro de Bem Estar Social Sagrada Família
Centro de Solidariedade Social "O Pátio"
Centro de Solidariedade Social de Adémia
Centro Distrital de Segurança Social de Coimbra
Centro Operário Católico da Conchada
Centro Paroq. de Bem Estar de Almalaguês
Centro Paroq. de Solid. Social da Freg. de Ribeira de Frades
Centro Paroq. de Solidariedade Social de S. Martinho do Bispo
Centro Social da Marmeleira
Centro Social e Recreativo da Cidreira
Centro Social Nossa Senhora da Conceição
Centro Social Nossa SenhoraD’Alegria
Centro Social Paroq. de S. João do Campo
Centro Social S. João
Centro Social Torres do Mondego
Centro Social, Cultural e Recreativo de Quimbres
Centro Social, Cultural e Recreativo do Botão
Centro Sócio-Cultural Nossa Senhora de Lurdes
Centro sócio-Cultural Polivalente de S. Martinho
Comissão de Protecção de Crianças e Jovens de Coimbra
Comunidade Juvenil S. Francisco de Assis
Conferência de S. Paulo
CONSENSUS
Direcção Regional de Educação do Centro
Fábrica da Igreja Paroq. de S. João do Campo
Federação Regional das Associações de Pais do Centro
Fundação AMI - Porta Amiga de Coimbra
Fundação Beatriz Santos
Fundação Bissaya Barreto
Fundação Portug. "A Comunidade Contra a Sida"
G.N.R.
Ginásio Clube de Antuzede
Grupo Sócio Cultural e Desportivo de S. Martinho de Árvore
Hospital Sobral Cid
Humana Global – Ass. for Prom of H Rights, Culture and Develop
I.D.T., I.P. – CRI de Coimbra
IAC - Instituto de Apoio à Criança
INATEL
Instituto de Reinserção Social - Direcção Regional do Centro
IEFP - Delegação Regional do Centro
Junta d Freg. de Almedina
Junta de Freg. de Almalaguês
Junta de Freg. de Antuzede
Junta de Freg. de Assafarge
Junta de Freg. de Brasfemes
Junta de Freg. de Castelo Viegas
Junta de Freg. de Ceira
Junta de Freg. de Cernache
Junta de Freg. de Eiras
Junta de Freg. de Lamarosa
Junta de Freg. de Ribeira de Frades
Junta de Freg. de S. Bartolomeu
Junta de Freg. de S. João do Campo
Junta de Freg de S. Martinho de Árvore
Junta de Freg de S. Martinho do Bispo
Junta de Freg. de S. Paulo de Frades
Junta de Freg. de S. Silvestre
Junta de Freg. de Santa Clara
Junta de Freg. de Sé Nova
Junta de Freg. de Souselas
Junta de Freg. de Sta. Cruz
Junta de Freg. de Sto. António dos Olivais
Junta de Freg. de Torre de Vilela
Junta de Freg. de Torres do Mondego
Junta de Freg. de Trouxemil
Junta de Freg. de Vil de Matos
LAHUC - Liga dos Amigos dos HUC
Liga dos Amigos do C Saúde N de Matos
Liga Portuguesa Contra a Epilepsia
NRCentro - APPC
Obra de Promoção Social do Distrito de C
Obra Social de Torre de Vilela
Policia de Segurança Pública
Rede Europeia Anti-Pobreza / Portugal
Santa Casa da Misericórdia de Botão
Santa Casa da Misericórdia de Coimbra
Saúde em Português
SOL - Eiras
Sub Região de Saúde de Coimbra
Ven Ordem 3ª - Casa Abrigo Pe Américo
Drug Intervention & Other Health Facilities (1)
• IDT, IP (NHS authonomous administration)
• CRI – District of Coimbra Center for Integrated Responses on drugs
• 1 Treatment Team (20 technicians – Psych., Psycol, S. Serv. Techn….)
• 1 Community programs intervention team (6 technicians)
• 4 IDT Specialized Units
• 1 Therapeutic Community (5 techn.; 12 beds – long term treatment)
• 1 Illicit drugs detoxication unit (12 beds)
• 1 Alcohol Unit – Consult., infirmary, day care, etc. – 40 techn., 30 beds)
• 1 Demand Reduction Team (CDT – 3 techn. +)
• IDT Regional Administration Services
• Other IDT financed responses
30.000 consultations / year
• 1 Harm Reduction Team + 1 Shelter Center (15 beds) + 1 HR Cabinet
Drug Intervention & Other Health Facilities (2)
• NHS – National Health Service
• 2 Central General Hospitals (beds: University Hosp. - 1.300 + CHC - 600)
(1 Psychiatry & Mental Health Service with 40 psychiatrists)
• 6 Primary health care Health Centers
• 1 Psychiatric Hospital (60 Psychiatrists, c. 400 beds)
• 1 Paediatric Hospital (c. 200 beds)
• 1 Oncology specialized hospital (c. 300 beds)
• Private Practicioners & Clinics (22/1.000 medical doctors)
• 1 NGO administered protected rehintegration appartment
• 1 NGO administered socio-occupational forum
• 1 NGO administered therapeutic community (IDT funded beds)
• ...
Let’s go for a (virtual) tour…
Coimbra : Diagnosed Priority Territories
Within the scope of the IDT’s PORI Program
Territory 1 – Coimbra Downtown Area
• Heroin traffic & consumption + Buprenorphine Traffic
• Petty crimes (pick pocketing, small thefts), damage to urban structures
Territory 2 – Suburban Barrios of Rosa & Ingote
• Traffic + Consumption (mainly heroin & THC)
• Occasional violent incidents, destruction of urban property
Territory 3 – University Campuses & Beyond
• Alcohol consumption, “Club Drugs”
• Student Festivities, Recreational Areas, Music Festivals
Coimbra : Diagnosed Priority Territories
Territory 1 – Coimbra Downtown Area
PORI
Territory 1
Coimbra : Diagnosed Priority Territories
Territory 2 – Suburban Barrios of Rosa & Ingote
PORI
Territory 2
T2
Coimbra : Diagnosed Priority Territories
Territory 3 – University Campuses & beyond
= … all of the city …
“Queima das Fitas” graduation feast
One hundred years ago ?
And nowadays…
Night Serenade – Fado Songs
Parents & Population from all over the country also participate…
Graduated students parade…
Green - Agronomy
Paradise at the reach of everybody…
Orange - Psychology
Safe Sex ?…
Medical care – I.V. BEER
Girls do it to !...
Discoverers of (Latin)America ?...
Music festivals ... a week long… always drinking
Yellow : Medicine
A “Wine Barrel Tomography” …
Red : Law School…
Conclusion - Strategic Challenges
1.
New treatment protocols
• Multiple drugs, alcohol & drug(s)
• Comorbid mental health problems
• Ultra Rapid Detox Protocols
2.
Better integration of services & of programs with partners (PORI + …)
• Harm reduction - … - Classical “indoor” treatment
• After care services, follow-up protocols, treatment continuity
3.
Evolution from RAR to RARE - Evaluation at all levels
• Cost-efficacy / Efficiency / Health gains
4.
Formal Accreditation of Treatment Facilities, Processes & Protocols
Hundreds of thousands of people in the city…
Bottles all over the place…
Every year the city Mayor has several huge headackes…
Coimbra (Foto) Tour
Thank You
You are all invited to the
Coimbra meeting!
See you next December!
[email protected]