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Integrated Care for drug users: Principles and practice
ANNEX 3B
NEEDS ASSESSMENT, SERVICE PLANNING AND REVIEW
Needs assessment, service planning, service review and evaluation are key tasks in designing and delivering an integrated care approach. This is a particularly complex set of tasks in the drugs field because of the often wide ranging needs of individual users and the wide range of agencies and service providers that can respond to these needs effectively. We have set out below a four stage process: needs assessment, reviewing existing services, establishing whether services meet existing need and ensuring service provision is adequate. These are not one off exercises, but are part of a
cyclical process of service review.
1. Needs Assessment
Needs assessment is a critical first step to better understanding the treatment, care and support needs of a population. Conducting a local needs assessment will help to establish the
extent and nature of the drug problem in the area, to describe the socio-demographic profile of users and to examine the common routes through which clients are referred. This will help build a picture of area population need.
A single 'all purpose' approach to needs assessment simply does not exist. The approach to an assessment exercise will depend upon the characteristics of the area and the data available. Official data sources, prevalence studies, action plans, integrated care plans and the views and experiences of drug users, their families and the wider community can all provide potentially useful information for such an exercise.
In the first instance, DATs and partner agencies need to ascertain:
What data are available locally to inform a needs assessment. These can include: prevalence data, information on attendance and attendees at services, waiting times for services, information on socio-demographic characteristics and identified needs on action plans among others.
What additional data are needed to inform the needs assessment process (e.g. eliciting users' views and experiences, and those of their families).
Whether this can be conducted by the DAT, or whether this needs to be commissioned externally.
A guide on how to conduct needs assessment (specific to the Scottish context) will be produced by the EIU early in 2003. In the meantime, a guide to conducting needs assessment in the substance use field has been prepared by the World Health Organisation (WHO). It is available at:
http://www.who.int/substance-abuse/PDFfiles/needsassessment.pdf
2. Reviewing existing services
In conjunction with the needs assessment it will be important to have current information about the appropriateness, accessibility and capacity of existing services. DATs should:
Map out which agencies and service providers are currently involved in developing and delivering services for drug users, including (among others) the number of general and specialist health care professionals, pharmacists, social workers, criminal justice social workers, debt counsellors, housing, employment and training professionals engaged in care.
Identify the relative roles of these agencies and service providers in caring for drug users; identify where partnership working between agencies exists (and where it does not); and ascertain whether there are referral procedures and joint working arrangements in place.
Map out the capacity and characteristics of these services (e.g. opening times, location, waiting times, assessment processes, target client groups, maximum case load and interventions delivered) to help assess how accessible and appropriate these services are to the population of drug users identified in the needs assessment exercise.
3. Establish whether the existing services meet existing need
The next stage will be to examine whether the capacity of both specialist and generic service provision is sufficient. Further, it will be important to assess whether the interventions delivered by these service providers do indeed meet the needs of the local drug using population, and that they are accessible. For example, if there are a substantial number (or a growing number) of stimulant users in your area, you need to establish whether services are attractive to these individuals and whether services are equipped to deal with problems they may present with. This type of exercise is sometimes called a 'gap' analysis. It involves:
Systematic comparison of the needs identified in the assessment exercise with the current level, nature and capacity of service provision in the area.
Identifying where gaps in provision exist, or indeed where services are under-utilised by the drug using population.
4. Ensure service provision is adequate.
If gaps in service provision are highlighted, DATs need to consider how these gaps can best be addressed. For example, if a DAT has identified a growing problem with stimulant use, how is this best managed? Filling gaps in service provision may be achieved by:
developing more effective multi-agency working to ensure a seamless service, ensure that individuals can be moved onto more appropriate services.
adjusting service characteristics: for example, by changing opening times, modes of working and location.
developing new approaches to meet the needs of the local drug using population: for example, by including more psychosocial approaches in treatment programmes.
developing new approaches specifically to target the harder to reach groups: for example, by providing outreach clinics in rural areas, or for women at home with children.
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