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SECTION 2 - ADPs: LINKING OUTCOMES
Linking National Outcomes to Service Delivery Outcomes
24. As discussed, the key aims of this document are to assist you in improving outcomes-focused working in services and in explaining the importance of drugs and alcohol services through the contribution they will make to achieving both national outcomes and priority outcomes for your local area. This is true for outcomes both directly and indirectly related to drugs and alcohol.
25. A brief description of the different "levels" of outcomes used in this document (national outcomes, high-level outcomes, intermediate outcomes and service delivery outcomes) has been provided below; this is followed by a worked example explaining how the outcomes should link together.
26. Some outcomes might be relevant to include at more than one level. For example, reduced consumption of alcohol by people in contact with alcohol misuse services is an important service delivery outcome, but it is also a desired intermediate outcome for the local population. Reduced consumption by service users may help to reduce local population consumption but it will not necessarily be achieved if alcohol consumption is increasing in the non-service user population and/or if services have inadequate reach. Service delivery outcomes will only affect intermediate outcomes if enough of those people who could benefit from a service are reached.
27. It is also important to consider the timescales over which outcomes might be achieved. Many outcomes in SOAs will be long-term aspirations such as lower rates of alcohol-related hospital admissions or improved life expectancy. To monitor progress towards these, outcomes need to be defined at the service delivery level, such as reduced alcohol consumption amongst people attending alcohol misuse services, and intermediate level such as reduced alcohol consumption in the local population. It is recognised that achievement of lower level outcomes can also take some time and changes are not likely to be immediate. The length of time over which outcomes at each level might be achieved will depend on the outcomes concerned but it is important to think about the time sequence and the timescale for achieving them. Service commissioners and services will wish to develop mechanisms for measuring progress towards achieving outcomes as a means for both reporting on activity and for developing a better understanding of how long it can take to achieve positive change.
National Outcomes
28. National Outcomes are the 15 priority outcomes which the Government aims to achieve in the next ten years. Improvements in drugs and alcohol problems will help to contribute to a number of these outcomes, in particular those listed below. A full description of these outcomes can be found in Annex B.
National Outcomes most relevant to drugs and alcohol
National Outcomes |
2 | 4 | 5 | 6 | 7 | 8 | 9 | 11 |
Economic potential | Young people successful learners | Children get the best start in life | Longer, healthier lives | Tackled inequalities | Improved life chances of those at risk | Lives safe from crime, danger & disorder | Strong, resilient communities |
29. The Scottish Government has also developed a set of 45 National Indicators to track progress towards these outcomes. Many of the National Indicators are potentially relevant to local government and can be used as indicators to inform local outcomes within SOAs.
30. The National Indicators most relevant to alcohol and drugs are:
Indicator 18: reduce alcohol related hospital admissions by 2011
Indicator 29: decrease the estimated number of problem drug users in Scotland by 2011
High-level outcomes
31. Sitting under these national outcomes are a number of drugs and alcohol related high-level outcomes. High-level outcomes are likely to be community or population-level (perhaps equivalent to the "Local Outcomes" in SOAs) and are reliant on the achievement of a number of intermediate outcomes (see below). Achievement of high-level outcomes will not solely be due to the activity of alcohol and drugs partnerships; other partnerships and agencies will have a key role.
32. The high-level outcomes listed in the box below are not exhaustive and are provided as examples of outcomes that local areas may wish to have as priorities. The list is meant as a tool to assist you in thinking about outcomes that would be relevant to your local area while ensuring there is a clear link with and contribution to the National Outcomes. You have a key role in achieving the high-level outcomes that specifically relate to drugs and alcohol. You should also contribute to achieving other high-level outcomes where alcohol and drugs issues are a factor.
33. Success in achieving a large number of high-level outcomes from across the country will contribute to the achievement of National Outcomes.
High level outcomes relevant to drugs and alcohol Drugs-specific - Reduction in drug related morbidity, mortality and deaths.
- Less drug-related crime:
- Acquisitive
- Violent
- Organised
Alcohol-specific - Reduced alcohol related injuries, physical and psychological morbidity and mortality
- Less alcohol related violence/abuse/offences and anti-social behaviour
Relevant to both drugs and alcohol - Less absenteeism/presenteeism caused by drug use/alcohol consumption in the workplace and educational establishments
- Increased employability of Scottish workforce
- Increased productivity in the workplace.
- Increase in young people (and adults) completing school, college or training
- Increased educational attainment
- Reduction in adults on benefit due to drug/alcohol related incapacity
- Reduction in children's exposure to substance misuse
- Reduced number of children looked after and accommodated/separated from parents
- Safer and happier families and communities
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Intermediate Outcomes
34. Intermediate outcomes are those outcomes that contribute to the achievement of high-level outcomes. They show the link between achieving service delivery outcomes specific to drugs and alcohol and high-level outcomes which may be a priority within that specific community or area. They can be used to show the importance of supporting drug and alcohol work in achieving the wider community's priority outcomes. At a population level, intermediate outcomes are unlikely to be achievable by a single organisation or intervention.
35. It is likely that a number of intermediate outcomes will contribute to the achievement of high-level outcomes.
36. In Section 3, we have provided examples of intermediate outcomes related to drugs and alcohol together with indicators and measures which may be useful in demonstrating the achievement of these outcomes. These have been split into the following priority themes :
- Recovery - specialist and generic services
- Children Affected by Parental Substance Misuse ( CAPSM)
- Enforcement and Availability; and
- Prevention - changing attitudes, environment and culture
37. These themes were chosen as they are the key strands of activity on alcohol and drugs and are reflected in the Government's strategies.
38. Full lists of all the outcomes relevant to each key theme can be found in Annex C.
Service Delivery Outcomes
39. Service delivery outcomes are the short-term outcomes directly attributable to a service and they should feed into the achievement of intermediate outcomes. It is likely that a number of service delivery outcomes will contribute to the achievement of intermediate outcomes. Each service, or groups of services, in your area should have their own service delivery outcomes relevant to what they are expected to achieve with their service users.
40. The service delivery outcomes will probably relate directly to specific outcomes agreed with each of their service users. Services should work with each of their service users to develop an individual care plan, specifically designed to meet that individual's needs. The achievement of service user's outcomes should be monitored, allowing the service to evaluate how well it is doing and to identify what works well and what can be improved.
41. For public health services, the service delivery outcomes will depend on the intervention.
42. What is important for all service delivery outcomes is that it is reasonable to expect the service to achieve these outcomes with their users or participants, regardless of the contribution of other services.
43. At a population level, the reach of services becomes important. Service delivery outcomes will only affect intermediate outcomes if enough of those people who could benefit from a service are reached and participate with the service.
44. As with the intermediate outcomes, in Section 4 we have provided examples of service delivery outcomes related to drugs and alcohol together with indicators which may be useful in measuring the success of these outcomes. These have been split into the same priority themes as the intermediate outcomes:
- Recovery;
- Children Affected by Parental Substance Misuse ( CAPSM);
- Enforcement and Availability; and
- Prevention.
45. Before moving on to these lists of intermediate and service delivery outcomes, it may be useful to look at the worked example below, which has been provided to illustrate how service delivery, intermediate and high level outcomes could link through to the achievement of national outcomes.
A worked example
46. The diagram below (Figure 1) shows the different "levels" of outcomes. The national outcomes sit at the top of the triangle, as everything should feed into one or more of these national-level outcomes. As discussed, many of the 15 national outcomes are relevant to drugs and alcohol.
Figure 1: An example of how a service delivery outcome may link into higher-level outcomes and ultimately influence the achievement of National Outcomes.
47. As depicted in the example, a priority outcome for a service may be that their service users reduce their drug use. It is the role of the service to help each individual attending their service to achieve this outcome.
48. By accessing the service, individuals should receive the support they need. It is the responsibility of the local partners (local authority, NHS and voluntary sector in partnership through the ADP) to ensure that individuals are able to access a range of services as and when they need them. Services must be commissioned on the basis of a needs assessment. If the service is successful in achieving this service delivery outcome it should reduce the drug use in the local area, assuming the reach of the service is sufficient.
49. In turn, if services support enough people in the local area to reduce problem drug use, then, over time, the level of drug-related morbidity and deaths in that area should reduce. The concept of reach is important in translating individual service delivery and intermediate outcomes to high-level and national outcomes. These higher level outcomes will only be achieved if a big enough proportion of individuals change their behaviour. Ultimately the achievement of the high level outcome in the example will influence the achievement of the National Outcome: "We live longer, healthier lives".
50. This example is simplified and is provided purely to show the link between the different levels of outcomes.
51. To help guide you through this document, you will notice a small triangle in the top right corner of each page - in Section 3 the intermediate, high-level and National Outcomes are highlighted showing that these are the focus of this section; in Section 4 the same triangle is shown but the service delivery outcome has been highlighted, as this is the focus of this section. At the start of each section, we have repeated the diagram above, again highlighting the parts relevant to that section.
52. Another way of visualising the links between the levels of outcomes has been shown in Figure 2, which depicts the fact that a number of outcomes may influence the achievement of one or more higher level outcomes. There are inevitably links both ways, e.g. the service delivery outcomes may also be influenced by the success of one or more intermediate outcome. Three examples have been provided to help you to understand the links.
Figure 2: Diagrams showing that various outcomes may feed into one or more higher-level outcome, together with examples to illustrate these links.
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