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Integrated Care for drug users: Principles and practice

KEY PRINCIPLES AND ELEMENTS OF EFFECTIVE PRACTICE: ASSESSMENT

From our review of the research literature and the evidence that we have gathered through consultation, focus groups and the EIU Working Group, we have identified the following key principles and elements of effective practice:

1. Working with the Individual

An effective assessment process focuses on the individual. It should be:

• needs-led, not service-led, resource-led or unnecessarily time-consuming

• ongoing, not a one-off event

• part of the overall care process

An effective assessment process should encompass:

• the gathering of information about the type and level of needs, attributes and aspirations of the individual

• the development of a profile of the individual

• communication of the assessment outcome to appropriate providers

• an action plan, agreed with the individual and other agencies as necessary that identifies appropriate goals and the services likely to meet the assessed needs

• regular review and monitoring with reassessment at agreed intervals

Annex 4A sets out an outline framework for an assessment process for drug users.

The assessment process should cover the current position and changes in an individual's circumstances and needs. This commonly includes collecting information on personal, family and social circumstances, physical and psychological health, injecting-related risk behaviour and offending behaviour. It should also cover:

• clients' goals

• clients' expectations

• strengths

• support

• boundaries

The process should have a clear time frame. The service user needs to be aware of the proposed length of time involved to complete the assessment process as this appears to have an impact on level of motivation and retention in treatment.

Effective assessment requires the full involvement and participation of the individual at every stage, as far as possible, through:

• The development of a two-way dialogue to ensure that the individual understands the purpose of the assessment and that the assessor has fully understood the information offered by the individual. From the staff's perspective, it is crucial that they are satisfied that they understand the service user's own perceptions about their needs and problems.

• Encouraging ownership by the individual: for example, by the use of tools that support self-assessment, such as the Rickter Scale. The individual should have at least an equal share in the process and the outcome. There should also be an opportunity to record disagreement and agreements.

• Openness to ensure that the individual knows:
  who is involved in the assessment
  what issues are being discussed and by whom
  what judgement is being made about the type and level of their needs

Service users should be able to participate at every stage if they wish. One suggestion is that clients should be offered copies of their assessment summary and/or care plan.

Staff should be trained in the agreed skills and competencies to enable them to build a trusting relationship with the individual and carry out assessment effectively. As far as possible training should be multi agency.

2. Assessment practice and procedures

Drug users come into contact with a wide range of services at different stages of their treatment, care and support. It may be pragmatic and practical to have different levels of assessment to meet the presenting needs of the client; to reduce the risk of over long initial assessments; and to make the most effective use of time and resources. Three levels of assessment are set out in Annex 4A.

Assessment tools can help to guide and structure discussion between staff and individuals. Such tools commonly collect information on the individual's drug use, risk behaviour and health, social and economic circumstances. There is a need for tools that are tried and tested and fit for purpose. Careful consideration should be given to deciding whether an appropriate tool does not already exist and could be used with no or minor modification for the task in hand. A Guide to selecting assessment tools is at Annex 4C.

Self-reporting and collateral reporting are important and vital sources of information in assessing the impact of substance misuse on an individual.

3. Working with other agencies

Agencies should agree the core information (see Annex 4E for draft core data sets) that they are willing to transfer to ensure a smooth transition for the drug user and reduce duplication. Guidance on informed client consent will need to be observed. There would also have to be agreement about the sharing of more detailed information from a third-level or service specific assessment. There may be particular concerns about sharing of information in rural areas where communities are smaller and closer.

The DAT, working with agencies, should draw up clear, strict protocols to support sharing of information between agencies, as well as guidance on information sharing for clients ( see Chapter 6 on Information Sharing).

4. From Assessment to Planning and Delivery of Care

From the assessment there should be an Action Plan for the individual. This Action Plan should be produced after discussion and agreement between the individual and staff who have worked with him/her. Where possible, it could include service providers who could provide the appropriate treatment, care and support. It should draw on the outcome of assessment tool(s), self-assessment by the individual, and the judgement of staff.

The Action Plan should recognise the needs, attributes and aspirations of the individual. It should offer a systematic way to support the individual to make progress towards agreed goals at a pace suitable for him/her; and to enable provider(s) to design and deliver the appropriate treatment, care and support "package". An example of what an Action Plan might contain is at Annex 4A.

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