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5 Characteristics of Service User Involvement
The successful implementation of the National Quality Standards recognises that effective and efficient substance misuse services requires the active participation of service users in the design, planning, delivery and evaluation of services.
Compliance with the National Quality Standards requires that user involvement be evidenced to different extents, at different levels and through employing a combination of methods. Furthermore, service providers, ADAT's and national bodies will need to evidence through their activity a commitment to continuous improvement in overall service planning, design, delivery and outcomes.
The characteristics of service user involvement can be categorised into broad areas, descriptions of each are provided.
Extent of Involvement
Each method used will, depending on how it is implemented, be more or less effective in enabling the service to be responsive to and reflective of the needs of both current and potential service users.
Before choosing to adopt or revise the use of any particular method consideration needs to be given to the characteristics of the service/region that will affect effective implementation.
Such characteristics will include, but not be limited to, number of services in the area, the integration of services within an area, the size of the service, its location, the frequency and average length of attendance by service users and the average age of service users.
Service providers, commissioners and those at a national level must ensure that the methods tried and used are appropriate. Each method must assist service users to have a voice and influence and inform service delivery in a positive way.
Where people are involved
Local/Service Provider Level
This refers to the responsibility and actions of the specific service. Whilst staff within the individual service will have the greatest opportunity for direct contact with their current service users, they are not necessarily best placed to involve other service users in the area. In addition, while the balance of their activity needs to be weighted to the delivery of the service some flexibility from commissioners/ external scrutiny bodies will be needed in order that the service can grow and adapt to meet both current and future needs. A number of the Quality Standards refer explicitly to the relationship between an individual service user and an individual service; however others refer to how the service works with other services, family members and the local community.
Regional Level
There are 22 Alcohol and Drug Action Teams ( ADATs) in Scotland. Some have boundaries coterminous with local authorities whilst others are based on NHS Board boundaries. However, all currently have the responsibility to ensure national strategies are implemented in accordance with local need. This means there is an expectation of awareness of need at this level and that services are provided to meet this need. The Quality Standards explicitly state the need for integration of services and the need for service development and delivery. This is most appropriately facilitated at a regional level either by the ADAT or delegated to one of its partners. The function and accountability framework of ADAT's was recently reviewed as part of the Stock Take Report. Any changes to ADAT's resulting from this may have an effect on the responsibilities and functions at the regional level and on effective service user involvement.
National Level
Responsibilities at a National Level include ensuring that there is service user involvement in the development of policy. A recent example of this has been the establishment of a National Service Users Group attached to the Drugs Related Deaths Working Group. National bodies are in a unique position to obtain and reflect the views of service users. The current work being undertaken to develop future direction and content of the national drug and alcohol strategies will include a greater emphasis on the involvement of service users, families and communities.
Methods of involving people
There is no absolute blue print for involving service users and the precise methods used will depend on the type of service and the needs of the service users. Equally, none of these methods are mutually exclusive and more than one could be used effectively at any one time.
Clearly the effectiveness of service user involvement is not simply about choosing appropriate methods. A critical element is about HOW they are implemented. Consideration should always be given to any proposed method's relevance, usefulness and potential for providing a satisfactory outcome.
For each method defined below the following assumptions are being made. Each of these steps will be vital for effective implementation of any chosen method.
1. From the outset, written or verbal information should be developed with the involvement of service users
2. Any written documents and verbal instructions should be piloted with a representative group of those individuals being asked to participate to ensure understanding, ease of use and appropriateness.
3. Sensitivity regarding the timing of methods should be a consideration. For example, asking services users to complete surveys immediately after they have been asked to leave a service may affect results.
4. Communication with those involved and those affected should be maintained on an ongoing basis, even if the message is that the survey/newsletter is still to be developed. This information should be displayed in a prominent place to ensure that service users are aware of what is going on.
5. Results, from the method used; need to be communicated in a readily understood and clear manner. If any changes to the service are proposed, it should be made clear that this is as a result of "service user involvement" and not attributed to other reasons.
Given that the definition of Service User, as agreed by the group, extends to all those affected by substance misuse, consideration should be given by all service providers as to how they wish to involve family members, carers and friends. Many service providers adopt the practice of asking all clients during the initial assessment process who they want to be involved and whether any information should be shared with family members/carers/friends. This decision is recorded and updated during the time the client remains with the service. As is explained below different methods will suit different groups of service users depending of the service they access, their level of engagement and many other factors.
Suggestion boxes
These are perhaps the most basic level of user involvement, but can be very effective if users have confidence that their views will be listened to and that they will receive feedback on the suggestions/comments made.
Suggestion boxes should be prominently displayed with details of how frequently the suggestions are collected and how quickly the service will provide feedback on suggestions made. A notice board should be provided next to the suggestion box which highlights suggestions made and responses from the organisation. Service providers must ensure that they acknowledge all suggestions even if it is not possible to implement them at that particular time.
Service user surveys using a written questionnaire
Surveys can be used for a variety of purposes and take a number of different forms. Four options are included here. Each option has it merits and the decision as to which option is chosen should be based on the objective of the survey and the characteristics of the service.
1. Anonymous self completion questionnaires
2. One-to-one between staff and service users
3. One-to-one between service users and an external party
4. One - to -one between service users and a trained current/ex service user.
Focus groups of service users
These can provide a greater degree of interaction with service users than one-to-one interviews, and can be facilitated in different ways.
For example, by ex-service users, by current staff members, by external agency or by staff from another service.
Consultation
Consulting with service users for any operational matter is crucial. Service users are often best equipped to inform the change, especially when this relates to the programme, range of interventions available or particular aspect of the operational delivery and practice. However, service users views could also be encouraged to influence overall organisational policy, staffing arrangements and overall direction of the service.
Contribution to Action Team Plans
Currently the primary means of collated and reporting on annual activity to the Scottish Executive is through the Corporate Action Plan. However local Alcohol and Drug Action Teams also develop and contribute to a range of other local Plans. Service user involvement in both defining the required actions and in defining and describing progress has the potential to ensure that such activity is not only meaningful but is accurately explained. It also enables Service Users to be actively involved in the development and on-going monitoring of local strategies and to assist in informing national strategy. Contribution can be sought either informally through specific questions ask in reception areas, through more formal consultation events or by direct discussion with service user organisations.
Membership of Committees/Boards
Many organisations have come to recognise the value of having service users as members of their Management Committees or Boards. There is a clear need for service users (whether current or former) to be able to access the same level of support and training afforded to other Management or Board members.
Peer Mentoring
Developing a mentoring system can be very effective for the on-going development of services. Some people respond better to information from someone who has lived the experience and has first hand knowledge of the issues that they are facing. However, it is important that Mentoring is part of a coherent strategy that has preparatory and follow up work built in.
Training
This is to be understood as where the training is devised and delivered by service users or where service users are involved in the facilitation of the event. Services must ensure that there is adequate support for service users who take part in training both before and after the sessions. This support would be important to work through any issues that the training may raise for individuals.
Recruitment
Involvement at any stage of the recruitment process of service staff, from commenting on the job description to the person specification, to short listing, and being on the interview panel.
Role Profiles and Appraisal for Staff
Role profiles and appraisal tools and systems for staff are becoming increasingly common in the health and social care fields. The implementation of these systems often requires each staff member to provide evidence that demonstrates competence against stated elements. Involvement of current and former services users in developing such evidence in a structured objective manner could be a welcome addition to this process.
Newsletters
Document designed and written by Service Users, the audience may be both service users and staff.
Marketing and Publicity of the Service
From devising service leaflets and documents to attendance at open days and speaking to referring service providers.
Tender Process
Service users can be involved in developing the information that is sent by the organisation as part of their tender submission. This can include evidence of the organisations service user involvement mechanisms and responses from service users on what they think of the service. Where required service users can also play a valuable contribution to the formal tender presentation event.
Facilitation
Service users who have benefited from the necessary prior training and support can also be used to facilitate focus groups of other service users, groups at training events, and groups during external and internal consultation events. The need to provide on-going access to training and support should not be overlooked. Facilitation skills can become rusty if not used and in-service training can help prevent this happening.
Inspection and Audit
The use of inspection and audit processes within the substance misuse field has increased in recent years. Services are increasingly required to demonstrate to external organisations the contribution they make and the outcomes they achieve. In the vast majority of inspection and audit systems the voice of the service user must be heard and evidence of service user involvement demonstrated. For residential services operating within a "therapeutic community setting" service users are involved as active members of the Team that reviews the service as part of a "peer review system" with other similar services. For more information about this please go to - www.rcpsych.ac.uk/pdf/Service%20Standards%20for%20Addictions%201st%20edition%202006.pdf
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