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Annex 2 - Guidance

Frequently Asked Questions About The Standards

This paper gives guidance on particular questions raised in the consultation about the National Quality Standards. Where appropriate, information on where additional guidance can be found is given.

What services do the standards relate to?

The standards apply to all services used by people with substance misuse problems. Such services are diverse, ranging from those with minimal contact to those high intensity interventions and include all statutory, independent and voluntary services.

How can all these services meet all of the standards?

All services should meet all the standards relevant to their normal business activities. They should be able to show why they do not have a need to meet particular standards or underpinning statements. For example, personal plans would not be appropriate for services like Alcoholics Anonymous because participants need to be confident that their anonymity is paramount although they could state that the 12-step programme they use would be their equivalent of a personal plan.

What service users are the standards aimed at?

Any person of any age, gender, race, religion who needs a service for a substance misuse problem.

Does this include services for young people?

Yes.

What about those who are on court orders?

The standards apply to services for those on court orders, and the legal implications of their situation need to be made explicit to the service users. This will include information on what will happen if they do not comply with the order.

Is it necessary to supply information on all services within the area? How can services do this?

Making available information on all local services allows individuals to decide which are best for them. This could range from a list of names and addresses of services in the area to a more comprehensive approach which would give greater details about what the other services provide.

To facilitate this process all services should distribute their own information to all other services.

How can someone be acting on behalf of service users?

The standards recognise that there are people who may not be able to seek assistance on their own behalf or are on legally imposed orders. In this case it is even more important that the person seeking a service for them is able to make an informed choice and has access to information on service availability.

Why should information be provided to service users?

A key intention of the National Quality Standards is to promote improvements in the relationship between services and service users. It is therefore essential that service users know what is expected of them by the service, and the consequences of their actions. Equally all staff need to be aware of the service rules to ensure consistency and fairness in delivery.

How can I provide service users with information about the rules of the service? What should this include?

This can be done in a number of ways and will depend on what type of service is being provided. Examples are:

• staff talking to the service users about the rules;
• a contract between the service and service users which details the rules; and
• audio tapes or DVDs.

How you choose to do this will be relevant to the type of support provided and the individual(s) you are working with. It is important that all the rules of the service are covered along with what happens if these are not adhered to. This information should be presented to the individual in a way they can understand.

It is good practice to record that this has been done and the person giving the information and the service user should both sign and date this record.

Although this list is not comprehensive, some of the issues here are:

• Legal responsibilities of the service - including obligations towards children, reporting of criminal offences.

• Confidentiality and sharing information -

• This would include the confidentiality policy of the service, when information given to staff would not be considered confidential, who the service is obliged to share information with, why this is necessary, what information will be shared, how it will be done (electronic, mail, telephone, meetings) and when it will be done (every month, at end of service).

• The service users should be informed about who the service recommends that information be shared with and why. If service users identify someone who they wish to be kept informed of their progress they should be given information on how this will be done.

• The service users' written consent should be sought before any information is shared, unless there is a legal obligation to do so, for example for child protection purposes.

• It is also important that service users fully understand any implications that may arise from not giving permission to pass on information. For example, this could result in repeating details for assessment.

• Integrated Care for Drug Users and Good Practice Guidance for Working with Children and Families Affected by Substance Misuse⁹ both have useful sections on confidentiality and information sharing.

• Making a complaint - The procedure for service users to make a complaint should include how this should be done, for example in writing or orally, who it should be directed to, how the complaint will be dealt with, timescales, and how to appeal against any decision.

• Use of drugs and alcohol - The policy on drug and alcohol use when using the service should be explained and what actions will be taken if the rules are broken or suspected to be broken, including any testing procedures that may be undertaken. It is important to highlight any legal action that may follow.

• Conduct - The policies and expectations of the service should be available to all potential service users. The requirements of the service with regard to time-keeping, keeping appointments, behaviour and participation in treatment should be explained to all service users. It would be good practice to document that this has been done. It is also important that services explain what happens when such requirements are not met. This process may need to be repeated at regular intervals during involvement with a service.

• Engaging with a service - Service users should be informed that a care plan involves conduct compatible with the expectations of a service as well as participation in treatment.

Can a service discharge people with children?

There may be occasions when it is necessary to ask service users to leave the service if they have children. What is important however, is that the needs of the service user's children have been properly considered and appropriate agencies have been informed of this decision and support established. All steps to end the support should be clearly recorded.

Which agencies will have to be informed if someone leaves a service?

This will vary depending on the type of service and the individual case, for example the agency providing funding for the person to attend may need to be contacted. This will almost certainly be the case if the individual is on a legally imposed condition to attend the service.

If a person has dependent children, immediate consideration should be given to whether the social work department will need to be contacted.

How will services provide information on getting further help?

Information could be provided verbally as a person leaves or as part of a leaving pack detailing other services in the area. The pack could include assistance with drug or alcohol issues and how to be re-referred to the service they are leaving. It could also include more general services - libraries, housing services, education establishments.

Why should services ask the views of service users?

Service users' views can identify good practice, problematic areas of service delivery and can assist services to develop and improve.

Why will services send out progress reports and why should service users be given a copy?

A report detailing the work that the service has carried out and any progress made should be provided to any person overseeing the individual's care. The individual should also be provided with a copy of the reports for their own record.

What if the individual can't read?

Even if the individual can't read the report will still serve as a permanent record of the assistance they have received. They will then have the choice to ask for assistance in its interpretation or be able to pass it to another service.

Why would the service want to keep in touch with service users after they leave?

Where people have made progress their experience can serve as a good outcome indicator and may be used to attract or justify funding. Where people have not done as well, their feedback can be used to improve the service.

What do some of the terms mean and how can services ensure that these are met?

• Safe - The standards use "safe" to mean free from danger or the risk of harm. The service should operate from locations which are not hazardous and where service users will be free from attack or persecution and will feel able to discuss sensitive personal issues. Safe provision should be extended to all users of a service, their children, their families if they have contact with the service, the staff of the service and all others who may have direct contact.

• Quality surroundings - This describes the fitness for purpose of the location of the service and the ability to satisfy the stated or implied needs of what the service wishes to achieve. These should be easily accessed, comfortable, well maintained and safe.

• Good standard - The service provides support which has desirable or positive qualities, especially suitable to assist clients make progress in overcoming their dependency and/or any other related needs and operates, in all cases, according to the principles of good practice.

• Appropriate - The standards use appropriate in a number of ways, the definition of these are:

• Regarding service provision - Services supplied will address specific needs identified in service users' care plans.

• Regarding facilities - The location, premises used and any materials and equipment will be suitable to the provision of the service offered.

• Regarding professional help - Help from those holding professional qualifications directly related to the assistance required.

• Regarding other agencies - Agencies who can assist the individual address the needs identified in their care plan, which service users have given permission for the service to contact, and those that the service is obligated to report to.

• Regarding training - All workers will be trained to a level that enables them to effectively carry out all the duties that are required of the position that they hold. Depending on the exact position, minimum qualifications may be legally required.

• When seeking support - To assist the individual locate support if they desire assistance or if there is a legal obligation to do so.

How these are ensured will vary depending on the service provision but they aspire to be the best that each service can provide. In order to measure themselves, services should examine other similar services and it may be useful to compare the processes used in substance misuse services with those in other fields.

How can services make sure people are not bullied, harassed or discriminated against?

It is necessary to provide clear rules, policies and procedures to everyone who is involved with the service. Clear indications of what will happen if these rules are broken should be made available, to show that the service will challenge inappropriate behaviour and take relevant action.

In the event of bullying or harassment, records should be kept about what happened clearly outlining what action was taken. Keeping a diary of events is a good way of ensuring that such records are kept. The records should be reviewed and used to identify any gaps in the policies and procedures and improvements made.

What is an assessment?

The purpose of assessment is to identify the needs and aspirations of the individual to inform decisions about treatment, care and support on an ongoing basis. Assessment should not be confined to examining the wellbeing of the individual but, in the case of the person being a parent, having responsibility for, or living with children, the needs of each of these children should also be assessed on an individual basis and the ability of the individual to provide effective parenting should be evaluated.

It is necessary to recognise that the safety of any children involved is of prime importance and that there should be no delay to taking appropriate action to ensure this.

In 2002, the EIU identified the need for 3 different levels of assessment. They also said that agencies should carry out the type of assessment that is most suitable for the service they are providing. In order to minimise repetition all the levels of assessment should combine to form a full or complete assessment of need.

The EIU define these levels as:

First level or screening

This will be made on first contact with a person to ensure appropriate referral. The information collected at this stage will be fairly basic with only cursory information about their substance use. Questions about the individual's family and household circumstances which will include their children should be asked at this point.

Second level assessment

May be used in health or social work settings when the individual has made a direct approach or has been referred by another agency. This assessment should cover more detailed information on substance use and other factors such as housing, employment, health, and benefits. This assessment should allow some decisions about treatment and care to be made, or whether it is appropriate to refer an individual elsewhere.

If children are involved the partnership approach which underpins the standards is even more relevant. If the initial assessment suggests that the parent's substance misuse is impairing, or likely to impair, a child's health or development, or that the child is suffering, or may suffer, significant harm, the agency should arrange for appropriate people to undertake a detailed assessment of the needs of the children.

Third level or specialist in-depth assessment

May be appropriate when a client has been referred to a specialist agency, or has moved on from entry-level assessment. This assessment would cover in detail the nature and extent of substance use, physical and psychological health, personal and social skills, social and economic circumstances, previous treatment episodes, and assets and attributes of the individual.

A complete assessment of the needs of children would form part of this level of assessment and would be undertaken in partnership with the children, those working with them and those who care for them. This assessment would form the basis for an action plan formulated to address the needs of the children and agreed by all those involved. There should also be evidence of engagement with the children and their views should be recorded. It should also be noted that in relation to children, the intention is a move from referring onto other services to one where the lead professional brings in specialists as required, either to assess or to provide a specified action.

The following documents from the EIU provide additional guidance on assessment:

Evaluation Guide 7 - Using assessment data for evaluation¹⁰

Integrated Care for Drug Users Assessment: Digest of Tools Used in the Assessment Process and Core Data Sets¹¹

More details on addressing the needs of children can be found in the following Scottish Executive Publications:

Getting our Priorities Right - Good Practice Guidance for Working with Children and Families Affected by Substance Misuse¹²

Getting it Right for Every Child: Proposals for Action¹³

Hidden Harm - Next Steps: Supporting Children - Working with Parents

How do services get appropriate professional help for service users whose needs they cannot meet?

It is not uncommon for service users to have multiple issues that they need to address and a single service is unlikely to be able to provide support for all of these. These needs should be identified in the assessment process and actions to assist the individual to address them agreed and recorded in the personal plan. In such cases where it is agreed that it would be beneficial that relevant services or specialists be involved, their assistance should be sought.

It is important to record any attempt made to identify and refer to another service, along with the outcome from that attempt, in the individual's personal plan. It is especially important to do so if no local service can be found to meet the identified needs, as this indicates a gap in the provision of services. Commissioners of local services can use this information in planning ongoing service developments in the area.

What does relevant legal requirements mean?

All services have to meet any legal requirements in regard to their service. This would include along with others legislation, such as:

• Health and Safety
• Employment
• Drugs and Alcohol
• Record keeping and Data Protection
• Property
• Human rights

What is meant by "how the local community are involved will be clearly laid out"?

It is important that service users know how the local community may be involved as it may affect their decision to maintain contact. Some examples of involvement include:

• Local volunteers or befrienders working in the service.
• Local religious groups holding meetings or coming into the service.
• Police involvement.
• Teachers running sessions.
• Other service users' families visiting them at the service.
• Local people on the steering group/management committee.

Information should be given about how service users can maintain their anonymity whilst accessing the service.

The service users should be informed of any expectations that the local community may have of them.

How can the service seek support for individuals' families and those they live with?

If the individual lives with or has responsibility for children, then the guidance given under the section on assessment should be followed.

In the case of other family members they could be given a list of service providers or family support groups in the area, or an appropriate referral could be made with their permission.

How can services get the views of service users or other local organisations and what use will this be?

Various methods could be employed. Some suggestions may be:

• Holding focus groups.
• Assisting peer reviews.
• Collecting feedback through anonymous suggestion/comments boxes.
• Using questionnaire forms or letters with return stamped addressed envelopes included.
• Using electronic forms.
• Providing a website with a service users' forum.

Viewpoints are useful to improve service and enable development of provision.

How can services help individuals to join service users' groups and what training will they need to provide?

The local ADAT should be able to give details of service user groups in the area and where they are held. Alcohol Focus Scotland and the SDF can provide information on how to establish a service users' group.

How can services ensure all staff are appropriately trained?

Services should check with the relevant professional bodies regarding any legal minimum qualification requirements for all posts available and then employ people with these qualifications.

Services should ensure that all staff have access to training that is relevant and appropriate to their position and encourage them to continually update and extend their knowledge and skills.

Frequently Asked Questions About Using the Standards

How can services measure themselves against the Standards?

A good place to start would be to design a new tool or modify one you currently use to aid you with this evaluation. This tool should look at each of the standards and underpinning statements and ask questions about how the service is currently meeting them, to what level it does so, and should list what evidence has been used to determine this.

Ideally the tool should also list any suggestions on how to improve in each area, even in cases where the standards are already shown to be being met to a high level. It would list the actions for improvement which have been identified, who is responsible for implementing them, and the timescales for completion.

Collecting of evidence to record in the tool could be done using a variety of methods, and the greater amount of methods used the more valuable the information collected will be. Although this list is not definitive, these could include examining documents, resources and facilities, interviewing staff, service users and their families, issuing anonymous feedback forms and inviting other agencies to give comments.

Different methods and tools were used to evaluate services in three pilot projects run as part of the consultation on the National Quality Standards. A report on these projects, which cover the type of evidence that could be made available to demonstrate compliance, methods for involving service users and a sample evaluation tool, is available on the Scottish Executive website at http://www.scotland.gov.uk/Publications/2006/pilotreport

What evidence would I use?

Although not exhaustive, a good example of some of the types of evidence that could be provided is contained in the check list used in the pilot project run by Forth Valley Substance Action Team. This check list is contained in the report on the pilot projects mentioned earlier.

How can I involve service users in evaluation?

A range of methods can be used. Some suggestions are an anonymous suggestion box placed in your service, questionnaires sent to service users and ex-service users and their families with prepaid reply envelopes, individual interviews and focus groups. The approach used in the pilot run by Glasgow Involvement Group supported by the SDF, was to interview present users of services about the service they were involved with. Details including the questionnaire they used are contained in the report on the pilot projects.

How can this help services to improve?

On a service delivery level, you should take the information about how you meet each of the standards, and ask how this can be improved. This should generate various suggestions and you should decide on which of these you wish to use. Develop an action plan around how these will be implemented and allocate the resources needed to do this. The plan should identify the person responsible for overseeing each action and list the major milestones to the goal being achieved. This action plan should be reviewed at regular intervals and priority given to the areas where the service is farthest away from meeting the standards.

On a local level, services should send the information from their own monitoring to the local commissioners of services, highlighting any areas that they have had problems in meeting, for example accessing appropriate professional help because no local service exists. This information can then be taken into account when planning further services in the area. It is also important that services report on any areas where they have had successful outcomes as commissioners can disseminate this "good practice" to enable other services to improve.

On a national level, the information about what gaps there are in services and what works well can be used to develop policy and inform funding decisions.

When will my service be monitored?

The standards should be monitored using service providers' and commissioners' existing structures although some modification may be necessary to take the standards into account.

The longer term aim is for the standards to underpin all service planning, commissioning and management activities. A monitoring framework, to support implementation and continuous local self evaluation, will be developed over the next year.

In addition, we would anticipate local commissioners supporting this work as part of a move towards greater accountability and service evaluation.

Will this mean another inspection?

No. Existing inspection frameworks should take into account these quality standards and no additional inspections should be necessary.

What about the extra cost of monitoring the standards?

The standards should not be viewed as additional requirements, but as generic statements which underpin good service delivery, which we, our delivery partners and service users would expect services to be delivering already. We know that these standards are already being demonstrated across service providers. What is now necessary is to ensure consistency across the board. The development of a supporting framework over the next year will consider the key issues such as training and data collection.

What is going to happen next with developing the standards?

Work on the development of a National Quality Standards evaluation framework has already begun and your input into this process will be sought. Particularly of interest will be the methods and tools you have developed to measure your service against the standards and any problems you have encountered in their use.

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