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Chapter Four Service Profile, Processes & Case Studies
4.1 This chapter covers the Incite service, user profiles and processes and gives a brief summary of 6 case studies. It supplements the process evaluation in Chapter 3 which was based on interviews with staff, service providers and service users and it also supports the outcome evaluation in Chapter 5.
4.2 The information is drawn from a number of sources, including the Drugs Action database, a series of pro-formas collected from Incite staff from January to May, full versions of the case studies and an interim version of the Orion database.
4.3 The small number of Incite clients and the absence of other comparable research evidence means that these findings should be reviewed with caution.
Service Profile summary
Referrals
4.4 By May 2005, Incite had received 102 referrals. Of these, 57 had become active clients and 20 remained in contact with the service.
4.5 Active clients spent on average 6 months with the service.
4.6 The majority of service users had had no previous contact with services.
4.7 Self-referrals made up the majority of referrals into Incite (75%).
4.8 More than half of these referrals (58%) found out about Incite through Drugs Action.
Service user profiles
4.9 The mean age of all referrals to the service was 28.5 years.
4.10 Where reported, referrals classed themselves as 'white' (56.6%).
4.11 Over three quarters of all referrals had an Aberdeen City postcode.
4.12 98% of active clients reported first using drugs at 19 years or under, with 48% reporting their drug use as becoming a problem in this age bracket. A further 38% reported problem use before age 30.
4.13 65% of active clients did not report any involvement with criminal justice at time of referral.
4.14 The most frequently reported drugs in order of frequency were crack cocaine, amphetamines, cocaine and ecstasy.
4.15 An examination of the prescribed drugs reported by some active clients indicated some mental health problems.
4.16 Most active clients (77%) were reported as living with friends or family or in supported/rehabilitation units on referral. Some 23% reported living alone or in a hostel.
4.17 Over two thirds (68%) of those becoming active clients were unemployed on referral, with most of these (69%) having been unemployed for more than a year.
Service Processes summary
Appointments
4.18 Approximately 20 appointments were made each week during most of the project's life (June 2003-May 2005).
Outreach/training (February - May 2005)
4.19 Staff spent 4 sessions providing Incite service information and general information and advice on the use of psychostimulants to sex industry workers (11 hours).
4.20 Training was given to 5 other services on 5 occasions during this period.
Interventions and final outcomes
4.21 Of the 57 referrals, 5 clients were classified as having no further requirement for a service, having achieved their goals. A further 28 clients had their cases closed through defaulting on appointments and the remaining 24 were current active clients with no final outcome.
4.22 A group of 11 clients with a 'positive' outcome, or who were currently active, emerged with a pattern of similar interventions received. These included interventions for physical and mental health, social skills and relationships, rather than financial or accommodation help. Relaxation techniques and auricular acupuncture were also received by this group.
Case Studies summary
4.23 Six short case studies were compiled for 6 service users who consented to Time 1 and Time 2 interviews. These were typically based on case files which contained a Drugs Action Referral sheet, an SMR 24 form, an Interventions and Monitoring form, and an Identification of Problems sheet. Two out of the 6 case studies had completed the ASI-S (formal Assessment tool).
4.24 Information was not systematically recorded or standardised between workers. Monitoring of individuals and outcomes appeared anecdotal, and depended on worker opinion rather than systematic recording and evidencing. Measurable outcomes for service users were more to do with physical health, mental health and social relationships than change in drug use. For example, 'agreed actions' only recorded actions such as making follow-up appointments. The data did not measure progress or support the use of specific interventions.
4.25 Relapse prevention interventions were frequently delivered in one-to-one sessions, along with interventions addressing mental health issues. Non-acute physical health issues were also frequent themes running through the case files - for example, staff frequently worked with service users on regulating their sleeping patterns or diet.
4.26 Improvements to 'perceived' problems were sometimes attributed to specific help and support from staff. At other times, they were felt to be something which clients had worked on themselves.
4.27 Service users at times refrained from contacting the service, by breaking their appointments and not responding to contacts from staff. Staff put in a great deal of effort contacting service users who had defaulted on appointments (by text message), but there seemed to be no pattern to determine when clients would choose to re-establish contact.
4.28 Some case files showed that staff communicated formally with other professionals on a case-by-case basis where appropriate. Although service providers did not report regular contact between themselves and Incite staff, the case files provide evidence that Incite did liaise with other agencies when required.
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