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Integrated Care for drug users: Principles and practice
Appendix 2 Scottish Drugs Forum -service users' views on assessment - Summary
Introduction
The Scottish Drugs Forum (SDF) and its two ancillary service users' groups, Glasgow Street Intervention Group (GSIG) and Tayside Street Intervention Group (TSIG) were commissioned by the Effective Interventions Unit (EIU) to undertake a short project on the assessment process. The results of this project form part of the evidence base on assessment presented in the assessment chapter of this report.
Aim
The aim of the project was to elicit the views and experiences of current and former drug users of the assessment process.
Methods
Five focus groups comprising current and former service users were conducted in five localities: Aberdeen, Dumfries and Galloway, Glasgow, Perth and Kinross and West Lothian. This ensured representation from urban, semi-rural and rural areas of Scotland. A total of 49 respondents participated. Of these, two-thirds were male and the age range was 24-31 years (average age 28 years). The groups' discussions focused on six key themes:
General views and experiences of the assessment process
The length of the process
The number of workers seen by the user during the assessment process
The influence users had in reaching decisions about their treatment and care
Whether subsequent treatment and care met the expectations raised at assessment
Improvements that could be made to the assessment process
Key Results
There were no unconditional, positive responses about the assessment process. It was unanimously regarded as an alien, external procedure that 'happened' to participants in order to obtain a service.
About half the participants were too chaotic to know or remember what was going on, particularly at initial assessment.
For those who were more stable and were cognisant of the process, assessment was either an uncomfortable procedure to get to where they wanted to go to in the first place or something that had to be put up with to get a desired service.
Service users felt that they were not valued, included or listened to during the assessment process (irrespective of whether they get the services they want).
Service users (at least at their initial assessment) are largely unaware of what the process entails, who will be involved and what the outcomes will be.
With one exception, all participants indicated that the assessment process was too lengthy.
The present position of numerous assessments and reassessments by different agencies is unacceptable to service users. In particular, the need to provide the same information repeatedly was frustrating for users.
Overall clients did not perceive the assessment process to be intrusive. This may reflect an (almost fatalistic) expectation that the process will be intrusive in nature. However, respondents were often unclear why questions on offending were included in assessments.
With one exception, all participants said they had little or no involvement in the decisions reached about their treatment and care.
The assessment process can raise client's expectations about service delivery and possible outcomes to an unrealistic level as these expectations cannot be met locally.
The main suggestions for improving the assessment process were: dispelling the 'them' and 'us' syndrome, having one assessor to complete the whole process, to improve communication between agencies and to share information among agencies to avoid repetition.
Key Conclusions
Overall, users felt that:
Service providers should clearly set out at the start of the process what the assessment entails.
Where possible, assessment should not be undertaken when service users are in an unstable or chaotic condition.
Every effort should be made to speed up the assessment process.
Service providers should raise awareness of local services by providing a 'map' of locally available treatment and care services for service users.
Assessment should be tied into what is available locally. An assessment that is not tied in to service availability will be an abstract affair that will inevitably lead to raised expectations and disappointment.
There should be just one assessor who would provide a gateway to other services. The assessment details, with the client's permission, should be held in one file and provided to other services as and when needed.
Service providers should consider how best to involve service users in the assessment process without raising unrealistic expectations.
Acknowledgement
SDF and EIU would like to thank all service users and recruitment sources for their assistance and help. SDF would particularly like to thank all those who participated in the focus groups
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