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SECTION 4 - ADPs: INFLUENCING SERVICE DELIVERY
73. This section focuses on your role in working with services and/or service commissioners to identify service delivery outcomes, which demonstrate the benefits of service activity and which can assist in the performance management of services. The achievement of service delivery outcomes should feed into the achievement of intermediate outcomes, high-level and ultimately the national outcomes. This section focuses on the bottom layer of the triangle below - service delivery outcomes, see Figure 4.
74. You will have a role in influencing service delivery. You may also be a service commissioner or this responsibility may be devolved to another partnership. In any case, you can play a role in influencing the identification of priority service delivery outcomes. If you are commissioning services you may have an additional role of working directly with services to ensure they monitor and evaluate how well their service users are achieving outcomes. Whatever your role, it is vital that service delivery outcomes are person centred through meeting each individual's specific needs and helping them achieve their personal goals. Service delivery outcomes can relate to programmes of activity and other interventions as well as the process of treatment and care.
Figure 4: The link between the different levels of outcomes - those important when working with services are highlighted in yellow.
75. Activity which delivers the service delivery outcomes should help your local area to achieve the intermediate outcomes described in Section 3. The list of service delivery outcomes suggested here is by no means exhaustive and has been provided to give you some example outcomes and potential indicators which may be relevant to your local area. The suggested indicators may be applicable to the achievement of one or more outcome. These indicators are not compulsory and services may wish to review the information they already collect and consider whether this would indicate the achievement of their selected outcomes.
Recovery - Specialist and generic services (treatment & harm minimisation and health, social care, housing etc)
76. As recovery will mean different things at different times to each individual, a range of appropriate services, both specialist drugs and alcohol services and generic services (for example housing, mental health, finance etc) should be available at a local level. We recommend that partnerships should regularly be in contact with services to gauge trends in need; ensure provision of local service information and feed back to services on regional barriers to access.
77. As well as providing an assessment of service users' needs and providing a range of responses to meet these needs, services should, as far as possible, focus on service users' strengths, promote recovery and integrate their aspirations into the service users' own plans for the future. Services should focus on service users' choice, even where they are subject to "coercive" treatment (e.g. Drugs Treatment and Testing Orders). For specialist services, a key issue will be to bring about behaviour change rather than simply treating symptoms or problems.
78. Services should promote techniques for self-management, encourage the development of meaningful relationships and participation in positive activities and, where possible, provide assistance with employment and development of parenting skills etc.
79. Service users should be encouraged to feed back on the service they receive at all stages of their recovery and their views should be incorporated into service developments or improvements as much as possible.
80. The following list of service delivery outcomes should help your local area to achieve the intermediate outcomes described in Section 3. In some cases there will be a range of services that will need to work together to achieve the outcome.
Specialist:
Service delivery outcomes | Measures/Indicators |
|---|
Service users are fully involved and participate in planning for their own sustainable recovery (i.e. a person centred approach is used) | - Service user satisfaction - Service users fully engaged in own care plan - Service users with individual focused care plan - % of planned discharges |
Services make appropriate referrals to other support or treatment services when required and as appropriate | - Information about all services is readily available - Number of referrals to other agencies - % assessed as in need of services after 12 months % of service users moved on to other services - % of service users who return within 3/6/etc months - % of service users who are happy to move on from service/planned discharges |
Service users reduce chaotic or risky behaviour | - % of those referred that have stopped substance use - % of those referred that have reduced substance use - Proportion of intravenous drugs users reporting sharing needles - Proportion of intravenous drugs users routinely using needle exchange services |
Increased knowledge of consequences and risks of alcohol consumption and drugs use in participants of education programmes | - Number of alcohol brief interventions delivered in area - Number of substance misuse education events delivered - Level of underage drinking ( SALSUS) - Number of people reporting using illicit drugs (Scottish Health Survey ( SHeS)) - Number of people drinking within recommended limits ( SHeS) - Number of people who are aware of Government advice on having alcohol-free days each week |
Drugs - Service users stop drug misuse - Service users reduce drug use - Service users reduce drug related harm | - % of those referred that have stopped substance use - % of those referred that have reduced substance use - % of service users that protect themselves from Blood Borne Viruses ( BBV) - % of Service users with BBV that participate in appropriate treatment - Proportion of intravenous drugs users reporting sharing needles - Number of drug related deaths and/or drug related overdoses |
Alcohol - Service users stop drinking alcohol - Service users reduce amount of alcohol drunk - Service users reduce alcohol related harm | - % of those referred that have reduced substance use - % of those referred that have stopped substance use |
Generic:
Service delivery outcomes | Measures/Indicators |
|---|
Health Service users have improved/no deterioration in health | Health - % that have improved nutrition/healthy weight - % that have improved dental health - % registered with GP/dentist - Hospital discharges |
Mental health - Service users have improved/no deterioration in mental health - Service users have increased self-awareness - Service users have increased confidence/self esteem | Mental health - % receiving mental health treatment - % with improved mental health % increased self-confidence/self esteem - Number of suicides and self harm Hospital discharges |
Social - Service users have improved/no deterioration in social functioning/personal relationships - Service users are more involved/included in their community | Social - % with improved relationships with partner/family/friends - % who have contact at least once a week with people who do not live with them ( SHeS) - % of service users undertaking voluntary work in the community - % of adults who feel involved in their local community |
Finance and employment - Service users have improved financial status and stability - Service users have improved participation in meaningful activity - Service users have improved employability status (e.g. moved into employment / voluntary work) - Service users have an increased awareness of work/training opportunities open to them - Service users have improved engagement with education and training - Service users have improved career aspirations - Service users have an improved understanding of their rights and responsibilities | Finance and employment - % engaged in meaningful activity (volunteering, training, education, employment etc) - % that manage money effectively % of services user into paid employment - Number of workplaces that provide employment/training for former and recovering substance misusers - Number of service users with literacy and numeracy difficulties % of service users referred to moving on/employment support/education services |
Accommodation - Higher proportion of service users are living in safe, settled and appropriate (supported and non-supported) accommodation | Accommodation - % of service users in settled housing - % that have a formal occupancy agreement and understand their and their landlords rights and responsibilities - % that live in accommodation that meets minimum habitation standards (i.e. not damp, not overcrowded, good repair) - % of service users that are confident that they won't become homeless again - % of service users homeless - % of service users sleeping rough - Homelessness assistance statistics ( HL1 - questions 16b 2 and 20b 3) |
Children Affected by Parental Substance Misuse ( CAPSM)
81. Local drug and alcohol services are critical in helping to protect children affected by parental substance misuse. Identifying families where children are at serious risk, providing help, and, where necessary, co-ordinating further action aimed at alleviating harm, is a role in which drug and alcohol services need to demonstrate confidence.
82. Care is needed when monitoring the achievement of certain outcomes. For example, in certain circumstances an increase in the number of children referred to services may be needed in the short / medium term in order to tackle problems. This should not be seen as a negative if it is linked to improving the safety and meeting the needs of those children.
83. The following list of service delivery outcomes should help your local area to achieve some or all of the intermediate outcomes described in Section 3. The list is by no means exhaustive and has been provided to give you some example outcomes and potential indicators which may be relevant to your local area. The indicators may indicate the achievement of one or more outcome.
Service delivery outcomes | Measures/Indicators |
|---|
Improved parenting skills of service users | - Increased attendance at services such as dentists by children affected by parental substance misuse - Level of nursery/school attendance - Children's attainment - Increased number of children having positive relationship with parents - Increased number of parents who recognise the impact of their substance misuse on their children - Number participating in family activities |
Increased identification and assessment of children affected by parental substance misuse | - Number of appropriate referrals to social work/family support workers - Number of appropriate referrals to children's reporter - Number of children who have clear contingency plans in the event of an emergency |
Increased number of children in touch with services living in supportive and stable households/safe environments | - Number of children appropriately separated from parents as a result of the parents' substance misusing behaviour - Number of appropriate referrals to social work - Number of appropriate referrals to children's reporter - Improved school attendance and achievement |
Increased number of children in touch with services having positive relationships with their substance misusing parents | - Number of children and their parents in an agreed programme of intervention |
Increased participation in community activities for children affected by parental substance misuse | - Number of children participating in community based activities - Number of referrals or self-referrals to other agencies, groups and activities |
Increase in children using services' self confidence, allowing them to be more resilient in their situation | - Number of children able to express their feelings - Number of children who know who to ask for support or advice - Number of children empowered to ask for support and advice - Attendance rates of children affected by parental substance misuse |
Increased recognition by parents in touch with services of the impact of their substance use on their children | - Number of parents aware of impact of substance use - Reduction in numbers of children whose lives are disrupted by parental substance misuse |
Improved school attendance and attainment in children affected by parental substance misuse and in touch with services | - Attendance rates of children affected by parental substance misuse - Attainment information for children affected by parental substance misuse |
Enforcement and Availability
84. Activity around the enforcement and availability of alcohol and drugs will vary considerably. This is primarily due to the difference in the "legality" of use - it is legal to consume alcohol, but not to use drugs. For alcohol, activity may relate to reducing access through controlling availability and the provision of safer drinking and wider environments. For drugs, enforcement is more about reducing and disrupting supply. Much of this activity will be done at partnership level, within national guidance or requirements, although services may have a role in implementing this policy
85. The following list of service delivery outcomes should help your local area to achieve the intermediate outcomes described in Section 3. The list is by no means exhaustive and has been provided to give you some example outcomes and potential indicators which may be relevant to your local area. The indicators may indicate the achievement of one or more outcome.
Service delivery outcomes | Measures/Indicators |
|---|
Increase in the enforcement of current legislation | - Prosecution rates - Number of recorded crimes and offences - drugs |
Managers and staff have increased knowledge of their legal obligations | - Participation in Licensing training - Participation in eg Best Bar None schemes |
Supply chain of drugs in local area disrupted | - Overall reconviction rate for drug offences - Improved detection |
Increase in confiscation (seizure) of drugs and assets | - Amount/weight of drugs and assets confiscated from drug dealers |
Prevention: changing attitudes, environment and culture
86. Local services and partners play a key role in providing prevention and education programmes, diversionary activities and bringing about culture change. In developing appropriate service delivery outcomes it is important to remember that these should be outcomes than can immediately and directly be attributable to a programme. For example, not using drugs or misusing alcohol is not an appropriate service delivery outcome because it is not just education that will influence whether or not an individual starts or stops using drugs or misusing alcohol. Service delivery outcomes should concentrate on those outcomes that services can realistically influence in those using the service and which plausibly contribute to intermediate outcomes like change in behaviour.
Service delivery outcomes | Measures/Indicators |
|---|
Increased knowledge of consequences and risks of alcohol consumption and drugs use in participants of education programmes | - Number of primary school children attending Choices for Life - Participation in substance awareness events (including number of children, young people, parents and carers attending events) - Alcohol brief interventions delivered in area - Number and type of substance education events delivered across all sections of the community - Level of underage drinking ( SALSUS) - Number of people reporting using illicit drugs - Numbers of people drinking within recommended limits - Number of people aware of sensible drinking guidelines - Number of people aware of the unit content of different alcohol drinks - Evidence of dissemination of range of information |
Improved and increased engagement of participants with age appropriate social activity, positive lifestyle, community activities | - Numbers/proportion of young people/adults regularly participating in positive activities |
Fewer service users drink above recommended daily and weekly guidelines | - Number of adults drinking within recommended limits - Level of underage drinking |
- Service users stop drug misuse - Service users reduce drug use - Service users reduce drug related harm | - % of those referred that have stopped substance use - % of those referred that have reduced substance use - % of service users that protect themselves from Blood Borne Viruses ( BBV) - % of Service users with BBV that participate in appropriate treatment - Proportion of intravenous drugs users reporting sharing needles - Number of drug related deaths and/or drug related overdoses |
Improved engagement of participants with learning | - School/college/training attendance - Qualifications achieved |
Improved parental and community engagement by service users | - % of adults who feel involved in their local community great deal or a fair amount ( SHeS) |
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