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3. Maximising Recovery
This section contains the Government's response to recommendations designed to improve the individual care which people need to receive to maximise recovery.
Recommendation 4 - assessment of need
All service users have the right to a comprehensive assessment of need which will lead to an inclusive recovery plan that is measurable, achievable, realistic and timeous ( SMART) in design. The plan will place the service user - the owner of the plan - at its centre; be agreed and signed by both the assessor and service user; and include a timetable for ongoing formal review of changing needs. The plan will be coordinated by a named professional who will be responsible for assisting the person to achieve their goals; arranging, facilitating and recording reviews and updating the plan; and advocating for the service user when required to ensure that their needs are met.
Government response
A comprehensive care plan, regularly reviewed, is a core part of the National Quality Standards for Substance Misuse Services, published by government in 2006. We expect compliance with the National Quality Standards to be part of the new accountability framework being looked at by the SACDM/ SMACAP delivery reform group.
Recommendation 5 - Meeting needs
Local strategic planning partnerships should regularly undertake a comprehensive needs assessment including service user views and a review of:
- their current care, treatment and rehabilitation provision; and
- available funding and current spending - with a view to informing the future configuration of services.
This must address ring-fenced substance use funding, other ring-fenced resources of special relevance to substance use and 'generic' funding. Any resulting reconfiguration should integrate specialist care and treatment services and the range of essential interventions described in this report. This will require a plan to address workforce development. Best value principles should apply.
Government response
A key aim of the delivery reform group is to develop and propose arrangements for delivery which, as far as possible, ensure that resources are used efficiently and effectively and that local partners can demonstrate to Government that this is the case.
Audit Scotland is conducting a comprehensive study of the scale and effectiveness of spending on tackling drugs, and will report no later than spring 2009. We will consider any recommendations for improvement arising from the Audit Scotland report.
Recommendation 9 - Psychological health
In all areas, comprehensive packages of care - including a range of recognised psychological treatments - should be available locally. Psychological approaches to address the commonly occurring issues of trauma, abuse, sleep disorders, anxiety, depression and anger in the promotion of recovery are seen as a minimum requirement in all areas.
Government response
A comprehensive care plan, regularly reviewed, is a core part of the National Quality Standards for Substance Misuse Services (5), published by government in 2006.
In December 2007, the Scottish Government published guidance on the care and support for people with co-occurring substance misuse and mental health problems, with six practical recommendations focussing on delivering change and improvement for individuals, their carers and their families in prevention, care and recovery services (6). Progress will be monitored through the Mental Health Implementation Review process from 2008.
Recommendation 10 - Fertility planning
It must be recognised that medical and social interventions may increase fertility. All women attending services must receive care to help them protect and control their fertility to ensure optimal timing of pregnancies.
Government response
A comprehensive care plan, regularly reviewed, is a core part of the National Quality Standards for Substance Misuse Services, published by government in 2006.
Respect and Responsibility, Scotland's national sexual health strategy, covers the sexual health needs of everyone living in Scotland. The strategy states that the full range of contraceptive methods should be available to all patients, who will be supported to make an informed choice.
More specifically, each year we request and receive an update from NHS Boards on the services they provide for drug users.
Recommendation 12 - representation
National and local accountability arrangements should require ADATs to describe the mechanisms in place to ensure access to free independent specialist legal advice and representation which has expertise around the specific issues presented by those with substance use problems.
Government response
Proposals for activity related to a problem drug use recovery network will include consideration of how to achieve a shared understanding of how to build the capacity of advocacy services.
Recommendation 13 - Education, training and employment
In its strategic approach to address problem substance use the Scottish Government should prioritise the development of a robust strategy to improve prospects for employment or meaningful activity. Employability/meaningful activity issues must be part of assessment. Agreeing and setting a national employability referral target with consideration given to incrementally increasing this target to reflect the developing understanding of client aspirations should be a priority. To increase the employment rate of people with problem substance use, all local areas should agree employability performance measures and outcomes, including:
- percentage of service users asked about employment, training, education or volunteering during assessment;
- number of clients referred to employability services; and
- measures of 'distance travelled'. Exploration of the potential for improving employment opportunities within public bodies should be considered.
Government response
The Road to Recovery recommends that specific attention should be paid to Scotland's Employability Framework 'Workforce Plus' (8).
The Scottish Government considers transition to employment or training to be an integral part of the care planning process. The indicators described here should be part of both the needs assessment carried out locally and local monitoring arrangements under the accountability framework.
Recommendation 15 - Children and families
The role and approach of all services in relation to children of substance misusing parents needs to be explicitly stated to ensure consistency of approach and support across Scotland. Each area will agree and publish the support it offers substance-using parents. This statement will be designed to ensure consistency of approach within the locality and ensure support is available at the earliest opportunity - even before pregnancy; services must publish their confidentiality policy and informed consent process. Information-sharing between professionals should be in line with good practice (as articulated in GIRFEC). There must be a recognition that the needs of children at risk are paramount.
Government response
The Road to Recovery outlines a raft of actions in place, or planned, to implement the Government's agenda on Children Affected by Parental Substance Misuse ( CAPSM). The Scottish Government believes that addressing the needs of children in substance misusing families should be incorporated into part of wider work on Getting it right for every child (9), and that in order to deliver the support, care and protection children affected by parental substance misuse need to share in the same aspirations and outcomes we want for all of Scotland's children, it is essential to build on this child-centred approach. In particular we will work to build the capacity and quality of local services and strengthen the role of both universal and specialist practitioners, as well as the management of risk.
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