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Alcohol problems support and treatment services framework
Alcohol problems support and treatment services framework
Who the framework is for
1. This document and the attached framework are primarily for those involved in planning, commissioning and managing support and treatment services for people with alcohol problems.
Background
2. The Executive's Plan for Action on alcohol problems (January 2002) sets out the aim for provision of support and treatment services:
3. The Plan includes action for the Executive to:
4. The Plan defines "alcohol problems" as the whole spectrum of harm (actual or potential) to work, relationships, social position, physical or mental health. The amounts of alcohol involved and patterns of drinking will vary from individual to individual and over time. The Plan emphasises that prevention is important and that alcohol problems should be identified as early as possible, so that effective help can be offered.
Improving services
5. The Plan acknowledges that there are gaps in current services and disparities in support and treatment available across Scotland. The policy in the Plan is, over time, and as resources allow, to:
redesign and improve services to respond flexibly to the whole range of alcohol problems;
improve the geographical coverage of services;
provide specialist services for some specific groups, or ensure that mainstream services are more sensitive to their needs; and
ensure that alcohol problems are addressed in an integrated way, alongside other health and social problems, where necessary.
Services as part of local strategies
6. The Plan for Action on alcohol problems requires that:
7. AAT plans need to address prevention, education and communications as well as the provision of support and treatment services for people with alcohol problems and others affected by such problems. Local plans should join up prevention and treatment appropriately. The Plan also requires Alcohol and Drug Action Teams to work together to meet the prevention, education and treatment needs of children and young people in their area.
8. There should be community involvement, including service users and young people in the planning and design of services.
Framework
9.
The framework focuses on the support and treatment elements of local AAT action plans. Its main purpose is to assist those (primarily in AATs, NHS Boards and local authority departments including social work, housing and community services) who plan and commission relevant services to:
assess local needs;
identify service gaps and any unnecessary duplication;
take account of groups who may have difficulties accessing mainstream services;
clarify eligibility criteria and referral processes; and
develop plans for accessible and integrated services accordingly.
10. The framework adopts the following four-tier structure. It is similar, but not identical, to the four-tier model of services in the Health Advisory Service report: Children and Young People, Substance Misuse Services - The Substance of Young Needs (1996).
Arrows denote that:
people may move between tiers as their needs are assessed or change over time
people need not move sequentially between tiers
people may access services at tiers 1 or 2 directly.
11.
The framework is not intended to be prescriptive nor to set out minimum service levels or standards. The approach that is taken in each local area will depend on local needs, circumstances and the resources available. The Plan for Action has, however, identified service elements of proven effectiveness, that should form the basis of services (see section on Effectiveness below). The tiered structure is for ease of use. There are links between the tiers, and some agencies may provide services in more than one tier.
The framework nevertheless:
provides a template for local commissioners and providers of services to agree priorities for development and assess progress; and
will help the Executive to assess the services aspects of local strategies and monitor progress.
Core principles
12. The Plan for Action sets out at paras 5.8 and 5.9 a number of core principles for services:
confidentiality;
accessibility;
ongoing, rather than time limited;
holistic - encompassing the context and causes of alcohol problems;
understanding and supportive, with a non-judgemental attitude;
taking a positive approach;
tailored to the needs of the individual;
joined-up across agencies and other services:
designed with input from service users, carers and communities; and
addressing the needs of other family members.
Providing integrated services
13. Local Alcohol Action Teams (AATs) co-ordinate the provision of support and treatment services provided by: NHS Boards, Primary Care Trusts and LHCCs; social work services (children and families, community care, criminal justice), education, housing and other local authority services; voluntary and independent sector organisations.
These services should provide an integrated spectrum of care for individuals with alcohol problems, their carers and families.
14. Following the core principles, the framework:
describes services that are person-centred, with clear eligibility and access criteria;
promotes clear routes for people to move and be referred between services at different tiers; and
describes services that are provided by the agency best able to do so. The provider will not necessarily be in the statutory sector in every case.
Joint working by and within Alcohol Action Teams
15. The Plan for Action will be delivered locally by AATs and their constituent agencies. AATs need to work with bodies which co-ordinate other local strategies under the broad community planning umbrella. These include:
Drug Action Teams (DATs), in many areas combined with AATs;
those responsible for local health plans, joint health improvement plans and mental health, community care, children's services, criminal justice, community safety and homelessness strategies;
Social Inclusion Partnerships; and
statutory and voluntary equality bodies and service providers.
16.
The effective planning and commissioning of services should be guided by local needs assessment which will inform the configuration and capacity of services required. This requires good information and ISD, on behalf of the Executive is providing a National Alcohol Information Resource (NAIR) to assist this process.
17.
Within the AAT, joint planning and commissioning of services is required. Guidance was provided for DATs on joint commissioning, including carrying out local needs assessments in February 2001 and this applies equally to AATs. The inventory of services carried out in co-operation with the AAT (formerly AMCC) Association in late 2000 gives some indication of current service provision in each area. Further details are available to AATs on request from NAIR.
18. The recommendations of the Joint Future Group on joint resourcing and joint management of community care services and single shared assessment, though starting with older people, apply equally to alcohol problems support and treatment services. In the course of 2002-03 the Executive expects local authorities and NHS Boards to identify when they will extend joint resourcing and joint management to these services, and to extend single-shared assessment to the whole of community care by April 2003. The framework might identify services that could fall under new joint management arrangements. Provisions in the Community Care and Health (Scotland) Act 2002 enable partners locally to delegate functions and to pool resources, which increases substantially flexibility in the way resources are used.
19. The Supporting People initiative for the provision of housing support services which comes into operation in April 2003, will help those with alcohol and drug problems to remain in their own homes in the community.
Accountability
20. The Executive and Alcohol Action Teams are developing a new process for AATs to be held accountable for delivering local alcohol problems action plans. This includes setting out what should be included in these local plans. The principles on which the accountability process will be based are:
it will focus on outcomes, rather than processes and organisational aspects;
a minimum amount of information will be required to allow progress to be assessed;
the process will dovetail with other planning and accountability mechanisms, e.g. the Performance Assessment Framework for NHS Boards, community care plans; and
it will be refined and improved in the light of experience.
21. The tiered structure of the framework will be reflected in the services section of the outline for local action plans.
Effectiveness
22. The Plan for Action states that:
23.
AATs and their constituent agencies should incorporate what is known about effective services in their planning and commissioning. The Health Economics Research Unit report
Cost Effective Measures to Reduce Alcohol Misuse in Scotland, published alongside the Plan, identifies effective practice in:
screening and detection of alcohol problems;
brief interventions by GPs and other health care professionals;
detoxification; and
relapse prevention techniques.
The forthcoming SNAP report on liaison psychology and psychiatry services will cover effectiveness of these services in relation to people with drug and alcohol problems.
24. Three current exercises will improve knowledge of effectiveness:
The Health Technology Board for Scotland's Assessment on relapse prevention (due later in 2002).
The Scottish Intercollegiate Guidelines Network work on management of alcohol problems by primary care professionals (due early 2003).
The Expert Group on needs of people with alcohol-related brain damage, being co-ordinated by the Dementia Services Development Centre at the University of Stirling, on behalf of the Executive (report due for consultation, Easter 2003).
25. CSBS will be considering in due course whether to produce an NHS Standard for alcohol problems services.
Evaluation
26. Better evaluation of services of all types is required. A review led by the Public Health Institute for Scotland, on behalf of the Executive, will make recommendations to improve local evaluation practice, following work starting in June 2002.
Quality standards
27. Services should be delivered to standards which:
focus on improving the outcomes of support and treatment;
cover the most important features of services affecting quality;
are clear and measurable;
are evidence-based;
are published and widely available;
are written in simple language, accessible to service users; and
are regularly evaluated and revised.
28. The Executive has published National Care Standards for residential care of people with drug and alcohol misuse problems. These standards cover residential services including:
29. There are other sets of published quality standards that set out key characteristics of effective services such as Quality in Alcohol and Drug Services (QUADS).
Training and staff support
30. The Plan for Action highlights the role of Scottish Training on Drugs and Alcohol (STRADA) in providing training for staff in both specialist alcohol and generic services. STRADA will develop its training to respond to local training needs identified through the framework and expressed in local strategies.
31. Healthwork UK, on behalf of all the UK Health Departments, is developing a set of competencies for staff working in alcohol and drugs services. These are due later in 2002.
32. The Executive is discussing medical education on addressing alcohol problems, which is required at both undergraduate and postgraduate level, with the relevant Scottish professional bodies.
33. The need to address changes to nurse education in alcohol problems as an early priority will be put to the Nursing and Midwifery Council (which now has responsibility for the pre registration education of nurses) and to NHS Education for Scotland, for post registration education of nurses in Scotland.
Associated documents
34. These include:
Health Department Letter on the role of Alcohol Action Teams (HDL (2002) 17 dated 20 March 2002);
Health Department Letter on the framework for alcohol problems 3 year local action plans (HDL (2002) 60 dated July 2002);
Plan for Action on alcohol misuse - Summary of Evidence, January 2002;
Attitudes Towards Alcohol: Views of the General Public, Problem Drinkers, Alcohol Service Users and their Families, NFO System 3 Social Research, January 2002;
Effective and Cost-Effective Measures to Reduce Alcohol Misuse in Scotland, Health Economics Research Unit, January 2002;
Alcohol - can the NHS afford it? (Recommendations for a coherent alcohol strategy for hospitals - a report of a Working Party of the Royal College of Physicians) 2001, Royal College of Physicians, London;
Assessment and Brief Interventions in Alcohol Misuse, Royal College of General Practitioners (UK)
Joint Future Group implementation documents;
Partnership working and joint commissioning. Guidance for Drug Action Teams, February 2001;
Framework for mental health services in Scotland, September 1997;
SNAP report on liaison psychology and psychiatry services, due spring 2002;
Supporting People: a New Policy and Funding Framework for Support Services (DSS1998);
Homelessness Task Force Report, February 2002; and
Scottish Executive's Equality Strategy, November 2000.
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