ADP VALIDATED SELFEVALUATION OF THE QUALITY
PRINCIPLES: POSITION
STATEMENT
Introduction
The Care Inspectorate on behalf of the Scottish Government are carrying out a programme of work to support the validation of Alcohol and
Drug Partnerships and services’ self-assessment of performance and progress in implementing and embedding the Quality Principles. The
programme will provide an evidence-informed assessment of local implementation, measurement and quality assurance of Alcohol and Drug
Partnerships and services adherence to the Quality Principles at a strategic and service level to support and drive a culture of self-evaluation.
This Position Statement has been designed around the Guide to evaluating drug and alcohol services using quality indicators for
use by Alcohol and Drug Partnerships. It provides a structure within which we can ensure a consistent and professional approach to
evidencing implementation of the Quality Principles whilst providing a framework of quality indicators to support self-evaluation which leads to
improvement across drug and alcohol services.
The purpose of this ADP Position Statement is aimed at encouraging Drug and Alcohol Partnerships and services to provide a considered view
of performance against each of the Quality Principles using the quality indicator framework, highlighting good practice and areas that would
benefit from improvement. All questions should be read individually and answered using this template. Once the Position Statement is
completed the information submitted will be considered by the review team.
An evaluative statement around your level of success should be entered in each of the ‘Position Statement’ boxes; Demonstrate how you
know. This is a free text area. In considering this question, services should be gathering evidence and developing auditing processes which
illustrate how well the lives of individuals are improving. The Quality Principles: Standard Expectations of care and Support in Drug &
Alcohol Services, August 2014 identify a number of sources of evidence services and Alcohol and Drug Partnerships can use to demonstrate
the quality of service provision and adherence to the Quality Principles.
If you have identified areas of good practice enter this in the ‘Good practice’ box.
If you have identified an area for improvement or have a suggestion for an improvement, enter this in the ‘Actions required to improve aspects
of practice/performance’ box.
It is important to record the evidence that supports each statement in each of the text boxes. This maybe by bullet point and may include a
reference to policies, standard operating practices, management information or other sources of evidence not suggested. Provided the
evidence source is recorded there is no need to produce the actual evidence at this stage of the process.
Please complete the Position Statement and return to Amy Goldie at amy.goldie@careinspectorate.com. by Friday 19 February 2016.
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What Key Outcomes Have We Achieved?
At a high level, Aberdeenshire has achieved the following key outcomes, as demonstrated by the related indicators
documented in our delivery plan:
Prevalence
• Self reported use of alcohol and drugs by 13 and 15 year olds has been reducing over the past decade.
• The estimated prevalence of problem drug use has not increased and may have declined, although the change in
rate is not statistically significant (2013 0.67%; 2000 0.8%)
Health
• Alcohol related hospital stays continue to decline with current rates the lowest in 18 years.
• Drug related hospital stays continue to decline with current rates the lowest in 12 years.
• Stable drug related death rate, in the face of a national increase.
Families
• Reduced rate of parental alcohol related case conferences since 2012.
Environment
• % of 15 year olds ever offered drugs has reduced since 2006 to 29%.
Services
• Waiting times have improved from Aberdeenshire being one of the worst in Scotland to having consistently met the
3-week target since March 2015.
Community Engagement
• We have grown the number of community led support groups in Aberdeenshire including 4 family support groups
and 13 Peers support groups
• We have evidence that our community is more empathetic and supportive of recovery.
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1. Key Performance Outcomes
QI 1.1 Improvements in the quality of service provision
QI 1.2 Adherence to the Quality principles
QI 1.3 Improvements in outcomes for individuals, carers and families
Principle 1. You should be able to quickly access the right kind of drug and alcohol service that keeps you safe and supports you throughout
your recovery.
Principle
1.1 How do you demonstrate that the majority of
individuals wait no longer than three weeks
from referral received to appropriate drug or
alcohol treatment that supports recovery?
Demonstrate how you know
Waiting times are reviewed on a monthly basis by the ADP Support Team. All services are supplied
with information on waits and are asked for an explanation if there appears to be a problem.
Measures have been put in place to avoid people in certain geographical areas having to wait longer
that other areas and services have now split teams into these areas to help address this. We have
also established Single Points of Access SPOA across Aberdeenshire and, in particularly North
Aberdeenshire, these are ensuring that people are assessed and seen by the most appropriate
service quickly. Drop in services are available associated with SPOA in the towns in North
Aberdeenshire and plans are in place to establish these in South Aberdeenshire. CAIR Scotland also
provide some drop in capacity across Aberdeenshire.
In addition to direct service delivery, Drugs Action has developed ‘advice now’ on their website and
is creating a library of short films to ensure people can get access to advice 24/7. Drugs Action also
operates 7 days a week provision in Aberdeen city which includes telephone helpline, daily duty
drop-ins and needle exchange which is also used by people from Aberdeenshire.
We have improved our waiting times dramatically in the last year. This continues to be monitored
closely and potential issues are addressed through closer partnership working e.g. staff shortages,
maternity, sickness or change to service delivery geography have been resolved through identifying
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other capacity and training other services to support.
1.2 How do you demonstrate that individuals do
not wait longer than six weeks to receive
appropriate treatment and support?
See above. Single points of access have ensured that agencies are not spending time assessing
clients that should have been referred to other organisations. This has freed practitioners to focus
on relevant work. The ADP Support Team monitors waiting time data on a monthly basis and
facilitates a discussion with services about any cases approaching the 6-week deadline. In most
cases, these are data entry anomalies but occasionally, the circumstances of the case can be highly
complex resulting in undue delay.
1.3 How do you demonstrate improved outcomes
for individuals and their families as a result of
them accessing and receiving treatment and
support services?
Aberdeenshire was one of the areas involved in the pilot for the Recovery Outcome Web (ROW).
Some of our agencies have continued to use the ROW regularly. Others have agreed to start or
resume use of the tool once they have completed the training offered by SDF in Aberdeenshire in
early March 2016. Once the national DAISy MIS system is operational, we will be able to assess the
extent of improved outcomes across all of Aberdeenshire and benchmark our progress against other
areas of Scotland. At the moment, we are not able to do this.
Services are asked to complete a quarterly monitoring form and submit to the ADP Support Team.
The review form asks for good practices as well as good news stories and this has provided a variety
of excellent examples of people achieving real outcomes as a result of support provided by our
services.
Our Service User Involvement Coordinators have conducted two questionnaires based on the Quality
Principles, one with Service Users and one with support staff. These have provided independent
evidence on how well the quality principles have been implemented. (Aberdeenshire A.D.P. Report
on Service User Questionnaire, 2015 Appendix 1).
89.8% of respondents felt that the service they were using was available to them when they most
needed it. Whilst the result of these surveys was relatively reassuring, it has identified areas
requiring some focussed attention to ensure we can improve further.
We have 4 family support groups in Aberdeenshire as well as three active community fora who also
contribute to improved outcomes. The fora seek feedback from the projects they support, such as
family support groups, about the outcomes achieved. A good example of this is the recent South
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Forum Annual Report.
All our services undergo monitoring reviews which incorporates questions around what they are
doing to ensure improved outcomes. We also have close links with Scottish Families Affected by
Alcohol and Drugs (SFAAD) and have a part time SFAAD worker in Aberdeenshire.
All our services undergo monitoring reviews which incorporates questions around what they are
doing to ensure improved outcomes. We also have close links with Scottish Families Affected by
Alcohol and Drugs (SFAAD) and have a part time SFAAD worker in Aberdeenshire.
We have recently started a pilot assertive outreach project in North Aberdeenshire. A worker will
make contact with any individual that had missed appointments, to support their engagement with
treatment. The intention is that assertive outreach will be a core function of our Single Point of Entry
Services and that this will extend to including individuals unknown to services identified through the
national SPARRA database.
Identified Good Practice
North is the area of Aberdeenshire that has seen the greatest problems with access to alcohol and drug services. Most of the innovation in the shire has
been initiated in the North and learning has been taken when appropriate to improve services in the Central and Southern areas.
Single Point of Access offers prompt, appropriate access to Alcohol and Drug Services through professional or self referral. This service is open to people
that are experiencing problems with their own alcohol or/and drug use or that of others. People experiencing these problems are able to have an
appointment with an alcohol or drugs worker very quickly so they can be supported to engage with the most appropriate agency for them. This
intervention has ensured that professionals predominantly work with clients at the top of their licence. This has released some capacity as agencies work
only with the clients they are best placed to serve and others are sign posted to more appropriate interventions. These clinics are especially strong and
established in North Aberdeenshire and they are involved in preventative and harm reduction work as well as treatment.
Moving on services that provides support for continuation of recovery and re-establishment of lifestyle infrastructure have been established. This has also
meant that specialist services can disengage earlier, increasing their capacity.
Shared Care in North Aberdeenshire operates between Clinical Substance Misuse Services, Turning Point Scotland (TPS) and CAIR Scotland, third sector drug
treatment organisations. One appointment is delivered by the clinical service the next by with TPS. This allows the clinical service to provide care for more
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clients and the client to be offered a broader service. This has led to increased capacity, much closer working between the organisations, and a smoother
transition from the clinical stage of treatment.
Turning Point Scotland (TPS) and the NHS Kessock Substance Misuse Clinic have initiated a project to reduce unplanned discharges in North Aberdeenshire.
In Kessock, when a client drops out of treatment, (i.e. did not attend appointments) the CPN had to make a decision to discharge that person. If this
happened, this was recorded as an unplanned discharge. TPS now follows up any individual that has dropped out of treatment and support them to
maintain contact with the service and keep appointments.
Training for all staff involved in input of Waiting Times data has been delivered. This included a wider group of staff and agenda, so that everybody
understands the importance of people receiving quick access to services.
Late night clinics are offered for those that are working or cannot attend during the day.
Please summarise any actions required to improve aspects of practice/performance
Single point of Access to be fully introduced in South and Central Aberdeenshire to ensure “Drop in” capacity is available in all of the larger towns in
Aberdeenshire.
The assertive outreach pilot will be rolled out across Aberdeenshire.
Outreach will be extended to other groups that don’t routinely engage with treatment services, such as those identified through SPARRA and homeless
people.
Single point of access staff will routinely ask about the needs of family during the initial assessment.
Needs of family and significant others will be included in the single shared assessment.
Web based assistance for people in crisis will be further developed (DA has submitted an application to SG test of change fund to explore seeking feedback
via a web based platform.)
Recovery Outcome Web will be used to measure outcomes across all services in line with introduction of DAISy following training in early March.
We will increase the availability of clinic time as required e.g. late night clinic times.
Please indicate on the scale below the level of service performance
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
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How well do we meet the needs of our stakeholders through person centred approaches?
2. Getting help at the right time
QI 2.1. Experience of individuals of improved health, wellbeing, care and support
QI 2.2 Prevention, early identification and intervention at the right time
QI 2.3 Access to information about support and treatment options
Quality Principle 2. You should be offered high quality, evidence-informed treatment, care and support interventions which keep you safe
and empower you in your recovery.
Principle
2.1 How do you demonstrate that all individuals
are treated fairly and equally, with respect and
dignity, as a person able to make their own
choices?
Demonstrate how you know
In Aberdeenshire alcohol and drug services are delivered by a range of organizations that operate
across recognized pathways to recovery. These include Aberdeenshire Council, Community
Substance Misuse Service (CSMS), NHS Clinical Services, Third Sector Alcohol and Drug Services
(Turning Point Scotland (TPS) & Drugs Action (DA)), Private residential facility (Alexander Clinic) and
Third Sector Moving on Services (CAIR Scotland and Aberdeen Foyer). All of these organizations
have presented; a variety of ways that they demonstrate how they know they are meeting the
quality principles and good practice examples. These have been entered here against the relevant
principles below. Where no particular organization is named this would be seen as the general case
in Aberdeenshire ADP. In some cases organizations have presented; different ways that they know
that they are meeting the principles or examples of good practice this has been attributed to the
organization.
Aberdeenshire has a range of motivated committed teams that care about the quality of services
that are delivered to their clients. They are aware of the stigma that clients can suffer from and
work to build self esteem through respect and regard. This is an important aspect of registration
requirements SSSC and NMC. The National Quality Standards have been used to reinforce respect.
Service users are made aware of the Council’s ‘Have Your Say ‘(formal compliment, comment or
complaint) procedure which is supported by a Values in Social Care leaflet.
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2.2 How do you demonstrate individuals are able
to access safe, secure and comfortable
surroundings when engaging with services?
2.3 How do you demonstrate that the choice of
interventions is based on the best available
evidence and agreed guidance?
A key component of Aberdeenshire ADP’s ethos is the notion of a ‘parity of esteem’ for all partners.
Citizen activists are seen as just important a partner as anyone else. So for example, The Forums
now have a Chair, Joint-Chair and three Vice-chairs who have a citizen activist, lived experience
background. They have equal standing as members of the full ADP committee. Forums have
complete self-determination free from interference from other interests.
The Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1) Identified that
89.8% of those asked said they felt comfortable with the people supporting them. Feedback
processes in the various services include this aspect of care and issues are addressed as they arise.
The ADP do not collect results of this feedback.
All premises have been inspected to ensure safety, accessibility and comfort. These all reached a
good standard. Many agencies conduct home visits and arrange other venues for meetings that are
mutually acceptable.
The lease on the Kessock Clinic in Fraserburgh is soon to come to an end and new premises are being
sought. Many agencies conduct home visits and arrange other venues for meetings that are mutually
acceptable
Due to our geographical challenges, the ADP philosophy is increasingly to move away from a limited
range of centralised services to instead improve access by having a greater presence in a range of
smaller communities. This does mean that services have to be creative in finding and accessing
venues as it is seldom possible to offer dedicated custom made venues.
In Aberdeenshire the full range of ‘Heat 11 treatment types’ are available. These are delivered by a
range of agencies i.e. NHSG, Aberdeenshire Council, Drugs Action, CAIR Scotland, Aberdeen Foyer
and Alexander Clinic. Each service has staff trained in delivering a range of evidence based
interventions e.g. Cognitive Behavioural Therapy, Motivational Interviewing etc. These are
supported by HR processes such as learning and development, supervision, performance
management etc.
Services are supported in Grampian through an ADP funded intervention called CERGA (Current
Evidence, Reference and Guidance in Addictions). This is a group of addictions professionals
supported by University of Aberdeen academics working to support the use of evidence in practice.
This group the use published and unpublished literature to support policy and decision making. They
provide a regular “what's new” literature update and will respond to research questions submitted
by any member of the addictions workforce. They are also able to give a local point of view to any
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findings they achieve. The outcomes of their work include systematic literature reviews providing
evidence-based practice recommendations. Examples of their work can be found on the HiNET
website. link Interventions shown not to be evidence based (E.G. Neuro Electric Therapy) will not be
supported by the ADP even if there are local requests to do so.
Evidence from Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1) shows
that most (92%)of the people surveyed said that they were given information and support to make
the choices for their care
2.4 How are individuals provided with information
on the range of recovery models and therapies
which supports their different areas of their life
and enables them to move forward at their own
pace?
Our single point of access explores the options for clients at a primary interview. Clients are able to
choose from a range of treatment modalities so they can embark on the path best suited to their
needs.
As clients progress with their care and treatment they are offered further options that reflect their
changing requirements. This is further developed in North Aberdeenshire but in South and Central
also will operate as a comprehensive community resource.
The ADP maintains a comprehensive up-to-date directory of specialist and generic services. This is
available to all staff and clients and enables informed discussion about the treatment and service
choices available. http://www.hi-netgrampian.org/wp-content/uploads/2015/11/Alcohol-and-DrugServices-in-Aberdeenshire-Aug-2015.pdf
Clients can be offered a residential option and although the Alexander Clinic provides a local
residential detox and rehabilitation services, other residential rehabilitation facilities across the
country are used depending on the client’s needs and preferences.
The options available to clients will be developed further through the use of Self Directed Support
(SDS).
Aberdeenshire is currently a quarter of the way through a collaboration with IRISS to figure out how
best substance misuse clients and services can use SDS provision to their advantage. TPS are about
to recruit 2 peer workers to support this project. Further details are available at
http://pilotlight.iriss.org.uk/content/sds-substance-misuse-recovery.
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2.5 How are individuals provided with appropriate
harm reduction advice which might include safer
use, managed use and abstinence?
The goals of the client are facilitated whether these are harm reduction, managed use or abstinence.
This is the case for all substances whether they be legal e.g. alcohol or illegal. Residential
detoxification and rehabilitation for alcohol or drugs can be secured through application to the local
authority and NHS if required. Community detoxification is managed by the NHS and is available in
North Aberdeenshire and roll-out of this new offering is planned for South and Central
Aberdeenshire.
Information leaflets are used to reinforce messages and are available in different languages.
Language line translation services are also used by all services to ensure those without English as a
first language can understand the advice.
Needle exchanges are available in single points of access services, treatment agencies and
pharmacies in all the sizable towns across Aberdeenshire. Details are available from the ADP service
Directory: http://aberdeenshireadp.org.uk/wp-content/uploads/2015/08/ADP-Service-DirectoryMay-2015.pdf
Naloxone training and supply is available at SPOA and from drug treatment agencies. The
availability of Dry Blood Spot Testing and treatments for blood borne viruses is available alongside
treatment for drug problems.
Referral or advice for other health issues are supported e.g. dentist.
A consultant psychiatrist oversees the care of clients in need of clinical treatment this operates in
line with the Orange Guidelines.
ORANGE BOOK
clinical_guidelines_2007.pdf
2.6 How is agreement with individuals obtained on
how information may be shared with other services
including ensuring they understand when this may
be done without an individual’s agreement?
The following is discussed with all service users:
“In order for a good service to be provided, sometimes information needs to be shared with other
agencies and individuals that are involved in support and treatment. The information will only be
shared on a “need to know” basis and consent is required to do this.”
If they are willing to give their consent, a consent to share information form is completed. There is
an option on the form for them to state any agencies or individuals that they do not consent for
their information to be shared with.
Clients are informed that confidential information must be disclosed to a third party irrespective of
their consent in the following circumstances:
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•
•
•
•
•
•
Where there is a serious risk to a child or young person
Where there is a serious risk of self-harm or harm to others
Where there is an obligation to report a crime
Where disclosure is legally required (i.e. by statute or a court)
Where urgent medical attention is required
Where public interest considerations outweigh other considerations
The overwhelming majority of clients that took part in the Aberdeenshire A.D.P. Service User
Questionnaire, 2015 (Report at Appendix 1) said that confidentiality was discussed (87.3%).
A decrease has been seen in anonymous reporting within our services on DAWT and SDMD this was
associated with initiating discussions about ensuring consent to share information.
Identified Good Practice
North is the area of Aberdeenshire that has seen the greatest problems with access to alcohol and drug services. Most of the innovation in the shire has
been initiated in the North and learning has been taken when appropriate to improve services in the Central and Southern areas.
Single Point of Access offers prompt, appropriate access to Alcohol and Drug Services through professional or self referral. This service is open to people
that are experiencing problems with their own alcohol or/and drug use or that of others. People experiencing these problems are able to have an
appointment with an alcohol or drugs worker very quickly so they can be supported to engage with the most appropriate agency for them. This
intervention has ensured that professionals predominantly work with clients at the top of their licence. This has released some capacity as agencies work
only with the clients they are best placed to serve and others are sign posted to more appropriate interventions. These clinics are especially strong and
established in North Aberdeenshire and they are involved in preventative and harm reduction work as well as treatment.
Moving on services that provides support for continuation of recovery and re-establishment of lifestyle infrastructure have been established. This has also
meant that specialist services can disengage earlier, increasing their capacity.
Shared Care in North Aberdeenshire operates between Clinical Substance Misuse Services, Turning Point Scotland (TPS) and CAIR Scotland (third sector drug
treatment organisations). One appointment is delivered by the clinical service the next by with TPS or CAIR. This allows the clinical service to provide care
for more clients and the client to be offered a broader service. This has led to increased capacity, much closer working between the organisations, and a
smoother transition from the clinical stage of treatment.
Clients have a choice in what agency they work with to help them in their recovery, including statutory or third sector. They also have choices of
treatments/supports offered and venues to be seen. All clients seen within 21 days of referral.
Members of the public can drop in anytime, when services are open for advice and information.
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Monthly harm reduction messages are circulated to refresh risk conversations and communicate new concepts.
In Grampian there is a group of professionals that have an interest in Substance Misuse that come together with the University of Aberdeen to support the
use of evidence in practice. This group, Current Evidence, Reference and Guidance in Addictions (CERGA) can support the use of published and unpublished
literature to support policy and decision making. They provide a regular “what's new” literature update and will respond to research questions submitted
by any member of the addictions workforce. They are also able to give a local point of view to any findings they uncover.
Please summarise any actions required to improve aspects of practice/performance
Information about Data protection/sharing information leaflets will be made available to all clients.
More premises will be staffed in such a way, as to have one member of staff available to deal with unplanned drop ins.
Advertising/marketing of services available will be improved and the ADP website will be remodelled to be a more effective communication platform.
Monthly harm reductions messages will be circulated more widely, including via Twitter.
Regular development days will be offered to staff and these will cover Harm reduction.
Training needs analyses will be conducted and a learning and development plan developed.
Facilities in South and Central will be reviewed to ensure they meet need.
Single shared assessment will be further developed to support a robust assessment process and facilitate sharing of information.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
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3. Impact on staff
QI 3.1 Staff motivation, development and support
Quality Principle 3. You should be supported by workers that have the right attitudes, values training and supervision throughout your
recovery journey.
Principles
Demonstrate how you know
In Aberdeenshire alcohol and drug services are delivered by a range of organizations that operate
across recognized pathways to recovery. These include Aberdeenshire Council, Community
Substance Misuse Service, NHS Clinical Services, Third Sector Alcohol and Drug Services (Turning
Point Scotland & Drugs Action), Private residential facility (Alexander Clinic) and Third Sector Moving
on Services (CAIR Scotland, Council Employability service and Aberdeen Foyer). All of these
organizations have presented; a variety of ways that they demonstrate how they know they are
meeting the quality principles and good practice examples. These have been entered here against
the relevant principles below. Where no particular organization is named this would be seen as the
general case in Aberdeenshire ADP. In some cases organizations have presented; different ways that
they know that they are meeting the principles or examples of good practice this has been attributed
to the organization.
Staff in Aberdeenshire are involved in service development at all levels. The Service delivery group
manages development processes across the organisations and parity of esteem is the ethos that
underpins this. Relationships between staff across the various organisations are positive and
productive. This is especially evident in the North of Aberdeenshire and is developing well in the
South and Central.
3.1 How do you make individuals feel welcome,
work in a person centred way and believe that all
Training for staff supports them to be non judgemental in dealing with service users. Privacy is
respected. The recovery journey is a concept that has gained traction over the years and services
are better at recognising the importance of communicating the possibilities of recovery.
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individuals have the ability to change and recover?
3.2 How do you provide timely evidence informed
treatment and support that meets an individual’s
needs?
3.3 How do you demonstrate that services provide
trauma informed support and recognise any
current or previous trauma the individuals are
dealing with?
Motivational interviewing is part of most consultations and supervised practise is used to continually
improve skilled interaction.
Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1) suggests that the
majority of the service users that took part found services supportive of their choices.
All people that are in need of help because of alcohol and/or drug use and approach services in
Aberdeenshire take part in an assessment. A recovery plan is agreed, developed and implemented informed by the needs identified. See 2.3
Heat targets are met in Aberdeenshire for access to drug and alcohol services.
The Implementation of the recovery outcome monitoring tool (ROW ) across Aberdeenshire will
provide an assessment of how well our services enable recovery progression.
The assessment process aims to pick up any past or current trauma and this is recorded in the Single
Shared Assessment (SSA). Staff have been trained to recognise symptoms of trauma and are trained
to encourage and deal with disclosure. E learning “Introduction to trauma is available to staff on line.
http://nhs.learnprouk.com/lms/user_level/NavigatorHome.aspx The care plan will recognise the
path for recovery and recovery pathways are fully integrated into treatment pathways, policies,
procedures and working practice. Referrals are made to other agencies e.g. domestic abuse services,
rape and abuse counsellors. Referrals to psychiatry or psychology are also available.
Drugs Action have lead workers with expertise in domestic violence, sexual trauma and prostitution.
These lead workers ensure all staff are trained and updated on good practice in this area.
Current work is being undertaken re commissioning to enable trauma informed services to be
purchased by Aberdeenshire Council.
Joint work is being undertaken with CJSW, building on the implementation of the Commission on
Women Offenders, e.g. Open Secret now provide a service within HMP Grampian
3.4 How are individuals provided with harm
reduction advice which may include safer use,
managed use and abstinence?
See 2.5. Also, all workers are trained to offer harm reduction advice. Risks are identified as part of
all assessment and how safety can be increased is discussed and recorded in care plans. This could
be provided by one to one discussion with an experienced member of staff or via telephone. A
monthly harm reduction message is communicated to refresh consistent messages and the
knowledge. This is used in Needle Exchanges and could be extended to include all workers.
3.5 How do you support individuals to set their own
recovery goals and manage their own care and
support?
Client centred recovery plans are based on the clients’ views and aspirations. Multi-agency meetings
can mobilise a variety of expertise to offer support to meeting recovery goals. Regular one-to-one
reviews with clients gives opportunity to review goals and progress and allow practitioners to help
clients to manage their recovery. Referrals to other agencies can be made when other help is
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identified as advantageous.
The Community SMS assessment process is explained on the Aberdeenshire website. The Self
Directed Support (SDS) model is used.
Aberdeenshire services are working with IRISS in a co-production project to figure out how best we
service and clients can take advantage of SDS provision in a substance misuse context.
3.6 How do you talk to individuals about their plans Single point of access are including conversations about endings as well as journeys. This is aimed at
and the arrangements for moving through the
establishing early the expectation of progression and recovery. Agencies often use the same
service and/or reducing, ending their contact with
buildings and so care can be handed over to other agencies when clients indicate their readiness.
Joint meetings with service users are had to facilitate this. Due to complex, long term problems,
services?
some people may need to be in service for many years to keep them safe. In addition, complex
issues such as dual diagnosis/relapses occurring means that goals/timescales can change depending
on individual circumstances and in fact recovery is not a linear process but a long term journey
where people can require support for many years.
For planned exits from service, service users are reviewed and given the opportunity to discuss their
experiences of engaging with services. Clients comment that they have been able to move on
positively and did not realise the level of support that they would receive. Unfortunately there are
unplanned exits from service when clients are imprisoned, leave the area, relapse, etc. and are not
able to be reviewed at the time they exit. Should there be any negative reasons that are
highlighted to us for service users leaving the support of our service we would look at this and make
any necessary changes. Assertive outreach could aim to draw people back into services to resume
their recovery.
3.7 How are individuals encouraged to connect
with the recovery community and mutual aid
groups?
Single Point of Access workers will discuss and explain the groups that are available. Services
encourage individuals to attend groups especially in a transition period and when they are thinking
about of moving on in a planned way.
Through Aberdeen Foyer, strong links are made with North East Scotland College and individuals
moving on from our service are given opportunities to access other services and social activities
before leaving clinical services. Moving on workers will accompany people to groups if they want
this to give them the confidence to join.
Participation in Alcoholics Anonymous and Narcotics Anonymous is part of attendance at the
Alexander clinic. Further engagement with community groups are encouraged from secondary care
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where greater autonomy is present.
It was a recommendation of the Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015
(Appendix 1) that the promotion of the recovery community and mutual aid groups should be
stronger. The ADP have recognised that this is an area of weakness and have taken steps to change
this.
Identified Good Practice
Client led assessment, which is flexible with an ongoing focus on keeping people safe as well as supporting recovery.
Co location gives staff the opportunity to work closely together and get to know each other.
Drugs Action have lead workers with expertise in domestic violence, sexual trauma and prostitution. These lead workers ensure all staff are trained and
updated on good practice in this area.
Please summarise any actions required to improve aspects of practice/performance
Further work on the customer pathway to build confidence and smooth journeys will be carried out to ensure that service work in a more collaborative
basis ensuring all staff operate at the top of their license.
A recovery pack will be developed that includes information about; recovery, its possibilities, how the different services can enable goals to be met and all
the local services including self help meeting schedules. The client’s recovery plan will be included in the pack when it is completed and the client will be
encouraged to keep the pack.
Staff will encourage and support clients to connect with a recovery community or mutual aid groups.
All staff from all agencies will be encouraged to interact with each other on a face to face level for the good of the service users.
Assertive outreach will engage with people that leave services in an unplanned way.
A strategy for trauma informed services will be developed.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
16
4. Impact on the community
QI 4.1 Impact on communities
Quality Principle 3 - that is anyone who has a role in improving outcomes for individuals, families and communities affected by problematic
drug and alcohol use.
Principles
Demonstrate how you know
4.1 How well are you building and promoting
positive community capacity and engagement to
reduce overall alcohol consumption and drug use in
your local communities?
Aberdeenshire has three Community Forums, each supported by a part-time Community
Engagement Officer and a participatory budgeting fund of £20k per annum. On allocating Forum
funds, they apply a strict criteria asking applicants to show what they will achieve, stressing the need
to report back on the activities which are also shared with the wider community.
South_Forum_Fundin
g_2015.docx
Community Forums have a dedicated section in the Aberdeenshire ADP delivery plan with actions
specifically aimed at community capacity and a budget to be allocated according to local priorities.
Through the community forums and the ADP work with local people to identify community needs
around alcohol and drugs. The community is engaged at all stages of our work in planning,
evaluating and identifying key areas of work. Community members take an active role in our
community forums and working groups as office bearers and committee members. All community
forums have promoted their work and that of the wider partnership at community events across
Aberdeenshire and through planned engagements.
Through the community forums the Aberdeenshire ADP ensures localised decision making and has
supported many successful community led projects (examples are support of local peer led support
groups and increase of recovery cafes, supported community focussed events such as the Blethers
and the Family Recovery Event).
Community Forums also help to create wider community networks, involving a wider range of
community partners. They link in with community planning and education and prevention networks
and can influence these. Community forums are also instrumental in organising training and learning
workshops to help build community capacity (recovery café training, NPS training etc.).
17
Capacity building also takes place through regular consultation (conversation cafes, surveys) of
people with lived experience as part of the work of the SUIOs.
4.2 How do you demonstrate improved outcomes
for communities as a result of implementing whole
population approaches?
4.3 How do you demonstrate improved outcomes
for communities as a result of focused preventative
Drugs Action has piloted use of Facebook and an online self-audit tool to engage with the whole
population in the North East, resulting in 3000 completed online quizzes in the past 12 months.
Training and awareness raising sessions to professionals and community groups of interest are held
across Aberdeenshire regarding NPS through DA’s Incite service.
Drugs Action has created an educational NPS film which is now on YouTube with over 1300 views in
the last 3 months.
CSMS have participated with police in Operation Hotspur and Festive Initiative. Awareness raising
sessions with other local authority teams and groups in the community were provided e.g.
community education and education. Also CSMS participated in local events including e.g. Turriff
Show and Careers Fairs.
The ADP has built an extensive website and has a growing Twitter following, having gained 450
followers in 18 months.
This is done by measuring effect where the number of variables is so vast is difficult however in
Aberdeenshire we have seen reduced prevalence of problem drug use, reduced DRD rate, reduced
alcohol deaths, reduced alcohol hospital admissions, reduced youngsters using, increased
community engagement, reduced stigma and increased community empathy for recovery and
reduced waiting times. Whereas in Scotland as a whole, increasing DRDs and increased drug
prevalence is evident.
Participatory budgeting within the forums has allowed us to measure specific activities within
community and allowed a targeted approach on specific issues to be investigated; an example of this
is the forum commissioning a consultancy on young people across Aberdeenshire.
Our most objective method of measuring intangible outcomes is through the use of the CPP Citizen
Panel Surveys. The panel comprises about 1200 citizens demographically balanced across the 6
administrative areas of Aberdeenshire for age, gender and location. Questions about people’s views
and experience of alcohol and drug community problems; attitudes towards recovery; attitudes
towards alcohol availability and knowledge of how to engage have been asked and have provided us
with reassurance that we are making good progress as well as identifying opportunities for
improvement.
We have had a range of preventative engagement and training projects and events in relation to
NPS. While it would be difficult to measure a direct relation of those to long term improved health
18
activities to raise awareness of new psychoactive
substances?
outcomes for communities, each of these will have to be evaluated as to relevance for participants
and learning outcomes and evidence of more information and better knowledge (also about services
and support). These are valuable community outcomes that will impact positively on the wider
health outcomes.
A qualitative traffic light ‘red, amber, green’ monitoring tool has been used to gauge the professional
and wider community’s level of concern about NPS over the past 3 years, led by the ADP’s NPS
Group. This has demonstrated that the initial widespread generic concern (red) has reduced and has
been replaces with more specific concerns around looked after children. Training and development
sessions have focused in on these communities.
Feedback from the Incite training sessions is received and is on the whole very positive with people
commonly reporting feeling more informed and confident in dealing with NPS in their workplace or
community. However, it is difficult to demonstrate improved outcomes as a result of preventative
activities in the short term because factors such as price, availability of NPS are significant
influencing factors relating to NPS.
Communities are being encouraged to collect and hand in NPS wrappers and pass them to a central
point which will aid our analysis of NPS trends etc. Agreement from cleansing in the LA to do the
same.
We generally have low drug related deaths in Aberdeenshire. Much of the change from year to year
is probably due to chance. It is therefore difficult to detect any fluctuations in DRD rate due to
changes in community NPS attitudes. We have not recorded any DRD as an exclusive result of NPS.
Identified Good Practice
Training and awareness raising sessions were held across Aberdeenshire regarding NPS delivered by Drugs Action’s Incite service. This included a full day in
Fraserburgh academy delivering sessions by year to the whole school, followed by a parents’ workshop in the evening.
Training and awareness raising sessions to professionals and community groups of interest are held across Aberdeenshire regarding NPS through DA’s Incite
service, this training has been delivered to 1088 people, (April to Dec 15) with attendees coming from a diverse range of the population
An educational NPS film which is now on YouTube with over 1300 views in the last 3 months was created.
TPS staff rota is structured in such a way that a member of staff is always available to speak to a member of the public or service user if they drop in.
Drugs Action has piloted use of Facebook and an online self-audit tool to engage with the whole population in the North East, resulting in 3000 completed
online quizzes in the past 12 months.
A training calendar for NPS has been developed and these events will continue to take place over the next two reporting periods at various locations across
Aberdeenshire. These will also be advertised on our website as well as via Aberdeenshire ADP to help increase the reach.
19
Incite continues to be part of any newly established NPS reference group in partnership with Aberdeenshire ADP and other interested parties.
Relationships in recovery communities are building and gaining momentum.
Please summarise any actions required to improve aspects of practice/performance
We will investigate the use new technologies to reach more people and influence alcohol and drug use. This is a particular priority given the rural nature of
Aberdeenshire.
Application to SG test of change fund to pilot use of social media to advertise the new open access services has been submitted.
The service user involvement coordination team will include life experience data in their planned study which will focus on those involved in peer and
mutual aid. This data will include offending, GP and hospital attendance, employment, education and community engagement.
Peer researchers will be trained to improve the evidence base for Alcohol and Drug Services and interventions.
The relationship between mental health and NPS/stimulant use remains a significant challenge with growing anecdotal evidence to suggest that use of
these drugs can exacerbate pre-existing mental health problems and can also cause mental health problems. The importance of training to mental health
service staff and also the need for accurate advice and information regarding mental health and use of NPS and stimulants is therefore essential. We
therefore plan to offer ongoing refresher training to this group and build on the excellent joint working experiences (particularly in relation to the work at
RCH).
Addiction worker training program will be offered to people in long term recovery in Aberdeenshire
We will continue to support the development of stronger recovery communities throughout Aberdeenshire
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
20
How good is our delivery of services?
5. Delivery of key processes
QI 5.1. Assessing and responding to need to reduce harm
Quality Principle 4. You should be involved in a strength based assessment that demonstrates the choice of recovery model and therapy is
based on your needs and aspirations.
Principles
5.1.1 How do you demonstrate that assessments
are based on an individual’s strengths and assets?
Demonstrate how you know
In Aberdeenshire alcohol and drug services are delivered by a range of organizations that operate
across recognized pathways to recovery. These include Aberdeenshire Council, Community
Substance Misuse Service (CSMS), NHS Clinical Services, Third Sector Alcohol and Drug Services
(Turning Point Scotland (TPS) & Drugs Action (DA)), Private residential facility (Alexander Clinic) and
Third Sector Moving on Services (CAIR Scotland, Council Employability Service and Aberdeen Foyer).
All of these organizations have presented; a variety of ways that they demonstrate how they know
they are meeting the quality principles and good practice examples. These have been entered here
against the relevant principles below. Where no particular organization is named this would be seen
as the general case in Aberdeenshire ADP. In some cases organizations have presented; different
ways that they know that they are meeting the principles or examples of good practice this has been
attributed to the organization.
Holistic assessment is carried out which includes exploring a client’s assets. This is done at clients
pace (over more than 1 session) A new Single Shared Assessment (SSA) is currently being developed
which is much more strengths based.
Regular case file audit and supervision is carried out by Team Managers.
Regular supervision of workers by Team Managers.
Alexander clinic use a detailed and documented bio-psycho-social assessment.
In Aberdeenshire council the assessment is based on a Self Directed Support approach, considering
individual strengths.
The Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1) identified that
the majority of respondents (79.7%) thought that their strengths and assets were identified and
considered when planning care.
21
5.1.2 How do you demonstrate that assessments
are carried out in a sensitive and supportive way?
5.1.3 How do you demonstrate that assessments
identify and record any traumatic events in an
individual’s life which may affect them?
All assessments are done on a one to one basis in a private consulting room unless the client would
like another person present. Staff are trained to ask questions and give the service users time and
support to answer as best as possible. A system of supervised practice and case file audit evaluates
how sensitive and supportive practitioners are and provides feedback to develop practice. A choice
of venues and times are available.
The Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1) identified that
82.2% of those that responded had received an assessment. 88.65% said they were able to express
their views
Assessments are holistic and include exploring any underlying issues which may be the root cause of
the problem with alcohol or drugs. Assessment documents include life story sections that can record
any traumatic events in an individual’s life which may affect them. Domestic abuse/personal safety is
also included in this section.
84.8% of respondents in The Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015
(Appendix 1) were supported with current or past trauma.
5.1.4 How do you explain the range of treatment
options available to individuals?
Information is provided to service users on other services available in face to face or telephone
interactions. This is backed up by a range of literature and web based information.
http://aberdeenshireadp.org.uk/ These conversations are had at various points throughout a
person’s recovery journey.
The Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1) showed that the
majority 92.4% of those responding said that they felt they had been given all information required
to make an informed choice on service and treatments.
5.1.5 How do you demonstrate that the views of
individuals are listened to, noted and used to
develop their personal recovery plan?
Staff are trained to carefully listen to clients’ views and use them to develop a personal recovery
plan. In most agencies service user reads and signs this only if they are happy with the plan once
complete.
Various service user feedback has reflected this including Aberdeenshire A.D.P. Report on Service
User Questionnaire, 2015 (Appendix 1) which shows that most, 92.4% participants felt they were
listened to and supported in their choice of treatment
22
5.1.6 How do services demonstrate that
assessments which require more than one session
do not prevent individuals accessing services
quickly?
A crisis plan is undertaken as a priority and essential interventions are initiated. An initial brief
assessment is carried out in the first appointment to ensure the person is accessing the appropriate
service. Thereafter, a more in-depth assessment is carried out when appropriate. A Single Shared
Assessment is normally done over two appointments; these are either a week or two weeks apart.
These are recorded in the service user’s notes.
5.1.7 How do you demonstrate that individuals are
clear of the reasons and benefits of recording
information about their recovery journey on local
and national data systems?
Documentation includes an area where the service user should sign that they give the consent to
share information if they do not object to their information being shared amongst various bodies in
connection with their support needs and care. The reasons and benefits of recording this
information are verbally explained to the service users before they sign.
See 2.6 and 2.8.
5.1.8 How are individuals made aware that with
their consent, information may be shared with
other services including when this may be done
without their permission?
See 2.6
The following is discussed with each service user:
“In order to provide a safe and effective service it is often necessary to share information with other
agencies and individuals that are involved with treatment and support and also receive information
from them. Information will only be shared on a “need to know” basis and consent is required to do
this.”
If clients are willing to give their consent, they complete a consent to share information form. There
is an option on the form for them to state any agencies or individuals that they do not consent for
their information to be shared with. They are informed that confidential information must be
disclosed to a third party irrespective of their consent in the following circumstances:
• Where there is a serious risk to a child or young person
• Where there is a serious risk too of harm of self or others
• Where there is an obligation to report a crime
• Where disclosure is legally required (statute or court)
• Where urgent medical attention is required
• Where consideration to public interest outweigh other considerations
This is normally signed on their first assessment appointment.
A Leaflet from ISD circulated to all services explains the data sharing implications of DAWT/SDMD
and Daisy
23
Identified Good Practice
North is the area of Aberdeenshire that has seen the greatest problems with access to alcohol and drug services. Most of the innovation in the shire has
been initiated in the North and learning has been taken when appropriate to improve services in the Central and Southern areas.
Single Point of Access offers prompt, appropriate access to Alcohol and Drug Services through professional or self referral. This service is open to people
that are experiencing problems with their own alcohol or/and drug use or that of others. People experiencing these problems are able to have an
appointment with an alcohol or drugs worker very quickly so they can be supported to engage with the most appropriate agency for them. This
intervention has ensured that professionals predominantly work with clients at the top of their licence. This has released some capacity as agencies work
only with the clients they are best placed to serve and others are sign posted to more appropriate interventions. These clinics are especially strong and
established in North Aberdeenshire and they are involved in preventative and harm reduction work as well as treatment.
Moving on services that provides support for continuation of recovery and re-establishment of lifestyle infrastructure have been established. This has also
meant that specialist services can disengage earlier, increasing their capacity.
Shared Care in North Aberdeenshire operates between Clinical Substance Misuse Services, Turning Point Scotland (TPS) and CAIR Scotland, third sector drug
treatment organisations. One appointment is delivered by the clinical service the next by with TPS. This allows the clinical service to provide care for more
clients and the client to be offered a broader service. This has led to increased capacity, much closer working between the organisations, and a smoother
transition from the clinical stage of treatment.
Consent forms are signed by clients agreeing to share information. Staff take the time to discuss issues of Information sharing so that service users fully
understand the issues. Developmental work to ensure the consistent use of chronologies is currently ongoing within Aberdeenshire Council Substance
Misuse Team.
CAIR Scotland give all clients a copy of their Recovery Outcome Web results and their Recovery Action Plan
Please summarise any actions required to improve aspects of practice/performance
Drugs Action and CAIR Scotland are implementing a new case management system during 2016 which will make it easier for workers to see when
reviews/user feedback is required to be done and to highlight particular risk issues for each client. This is a cloud based system which will be accessible in
rural locations.
Universal use of the Recovery Outcome Web monitoring tool will be rolled out this year to enable clients to visually appreciate the progress they have
made, enable workers to focus on areas of slow progress and enable the ADP to have a collective appreciation of progress benchmarked against other areas
of Scotland.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Good
Very Good
Excellent
24
QI 5.2. Planning for individuals and delivering care and support
Quality Principle 5. You should have a recovery plan that is person centred and addresses your broader health, care and social needs, and
maintains a focus on safety throughout your recovery journey.
Principle
5.2.1 How are individual’s made aware that their
Recovery Plan belongs to them and its agreed
actions are to be achieved in partnership?
5.2.2 What are the arrangements to demonstrate
that Recovery Plans are reviewed on a regular
basis at a time agreed between staff and
individuals?
5.2.3 Do Recovery Plans include information on
reducing harm?
Demonstrate how you know
In Aberdeenshire alcohol and drug services are delivered by a range of organizations that operate
across recognized pathways to recovery. These include Aberdeenshire Council, Community
Substance Misuse Service (CSMS), NHS Clinical Services, Third Sector Alcohol and Drug Services
(Turning Point Scotland(TPS) & Drugs Action (DA)), Private residential facility (Alexander Clinic) and
Third Sector Moving on Services (CAIR Scotland, Council Employability Servicve and Aberdeen Foyer).
All of these organizations have presented; a variety of ways that they demonstrate how they know
they are meeting the quality principles and good practice examples. These have been entered here
against the relevant principles below. Where no particular organization is named this would be seen
as the general case in Aberdeenshire ADP. In some cases organizations have presented; different
ways that they know that they are meeting the principles or examples of good practice this has been
attributed to the organization.
During assessment the recovery plan is discussed with the service user. Once they are happy with it,
they are asked to sign it along with their key worker that they are happy to proceed with it. A copy of
the care plan is offered to each client.
Interventions may be required in terms of Children and Families and CJSW contact though service
users has to give consent.
Recovery plans are reviewed every 12-24 weeks as routine, but if there is a need, this can be done
more frequently. This is documented, dated and signed. This is overseen in supervision and can be
seen in files. The Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1)
showed that the majority of service users 69.6% that took part in the survey had their recovery plans
reviewed regularly. This number could be improved. It is possibly a perception problem e.g. Do
workers tell their clients that the conversation they are having is a review of their care plan.
The recovery plan takes into account risk assessments that are made throughout the assessment
process. This assessment includes information on reducing harm.
See 2.5 and 3.4
25
5.2.4 Do Recovery Plans aim to achieve stable
recovery beyond treatment into aftercare?
5.2.5 Do Recovery Plans detail further services that
individuals may need to access as part of their
progression through treatment and care back to
the wider community?
5.2.6 Do Recovery Plans look towards an
individual’s moving on from a service, in line with
their aspirations, and agreed timescales?
5.2.7 Before moving on how do you provide relapse
prevention advice and assertive engagement with
local mutual aid groups and/or the recovery
community?
5.2.8 If an individual relapses how you do
demonstrate that when they re-engage with
services they are treated with dignity and respect
that welcomes their continued efforts to achieve
Aberdeenshire services operate on the basis that sustained recovery is a realistic goal for most
people. Where appropriate, recovery plans aim to capture the goal of stable recovery beyond
treatment and aftercare.
This is demonstrated by the provision and referral to moving on services and the widespread growth
of peer led peer support groups.
Recovery plans include information on other services that are accessed in progression through
treatment and care. e.g. Employability Service.
A range of services are involved in reviews along with the service user and this is recorded in review
notes.
Individuals’ moving on goals are recorded in recovery plans.
At a strategic level, the ADP has progressively been increasing investment in ‘moving on’ services.
Regrettably, we are not yet able to demonstrate this progression systematically and look to the
DAISy MIS system to help us to do this when it is introduced.
Relapse prevention is discussed at closure. All clients are advised and encouraged to use open access
back into service should they want to get some immediate advice/want to re-engage with ongoing
support. Relapse prevention advice and assertive engagement with local mutual aid groups and/or
the recovery community is highlighted and discussed in the service user’s recovery plan.
Participation in Alcoholics Anonymous and Narcotics Anonymous is part of attendance at Alexander
clinic. Further engagement with community groups is encouraged from secondary care where
greater autonomy is present.
Special attention is paid to enthusiastic service users increasingly contributing to recovery groups,
taking a lead in Forums and becoming local recovery ‘icons’ about the risks of relapse. Should such
individuals relapse, they have further to fall and may be embarrassed to re-engage with local
supports.
The Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1) recommends
that awareness and engagement with mutual aid groups and the recovery community is reinforced.
Staff are trained to realize that addiction is a relapsing condition and that all services users have the
strength, motivation and will to eventually recover from their addiction. Relapses are not seen as
failure but as yet another learning opportunity. Therefore, when a service user re-engages with our
services they are treated with dignity and respect that welcomes their continued efforts to achieve
26
the recovery goals in their Recovery Plan?
the recovery goals in their Recovery Plan.
5.2.9 Are individual’s provided with a copy of their
recovery plan?
All individuals are offered a copy of their recovery plan. Many refuse to take a copy however.
Identified Good Practice
North is the area of Aberdeenshire that has seen the greatest problems with access to alcohol and drug services. Most of the innovation in the shire has
been initiated in the North and learning has been taken when appropriate to improve services in the Central and Southern areas.
Single Point of Access offers prompt, appropriate access to Alcohol and Drug Services through professional or self referral. This service is open to people
that are experiencing problems with their own alcohol or/and drug use or that of others and is very easily accessed or re accessed. There are no criteria or
referral necessary. . Recovery is discussed from the first interview. The SPOA has been set up to ask consent to make contact periodically jut to see how
things are going and check that no further help is needed. These clinics are especially strong and established in North Aberdeenshire and they are involved
in preventative and harm reduction work as well as treatment.
Moving on services that provides support for continuation of recovery and re-establishment of lifestyle infrastructure have been established. This has also
meant that specialist services can disengage earlier, increasing their capacity.
Shared Care in North Aberdeenshire operates between Clinical Substance Misuse Services, Turning Point Scotland (TPS) and CAIR Scotland, third sector drug
treatment organisations. One appointment is delivered by the clinical service the next by with TPS. This allows the clinical service to provide care for more
clients and the client to be offered a broader service. This has led to increased capacity, much closer working between the organisations, and a smoother
transition from the clinical stage of treatment. People experiencing these problems are able to have an appointment with an alcohol or drugs worker very
quickly so they can be supported to engage with the most appropriate agency for them. Recovery Plans are developed together and responsibility is
shared.
Every client has a recovery plan. Fixed caseload amounts that are manageable are encouraged, so that time is available to see services users and manage
all paperwork involved in case management.
Please summarise any actions required to improve aspects of practice/performance
More clients will be actively encouraged to take a copy and ownership of their recovery plan.
All clients will have a recovery pack that will include the plan. This will be kept until the client is ready to take responsibility for it.
Progress through to moving on services will be discussed at single point of access. A Recovery coach will more often meet with each client and their drugs
worker to establish early what goals are identified for moving on. Recovery coaches will more often work alongside drugs workers before the end of
27
treatment to facilitate a warm hand over.
Single point of access staff will arrange to contact service users periodically to check that recovery continues to progress. This will continue (with consent)
once the person is no longer in contact with services.
Recovery Outcome Web tool will be implemented consistently across all services, providing reassurance to the ADP that all clients have a recovery plan that
is regularly reviewed and that recovery outcomes are being achieved.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
28
QI 5.3. Reviewing progress, joint planning and decision making
Quality Principle 6. You should be involved in regular reviews of your recovery plan to demonstrate it continues to meet your needs and
aspirations.
Principles
5.3.1 Do individual’s reviews include an assessment
of their strengths and recovery capital?
5.3.2 Do individual’s reviews include an assessment
of the effectiveness of their treatment?
Demonstrate how you know
In Aberdeenshire alcohol and drug services are delivered by a range of organizations that operate
across recognized pathways to recovery. These include Aberdeenshire Council, Community
Substance Misuse Service, NHS Clinical Services (CSMS), Third Sector Alcohol and Drug Services
(Turning Point Scotland (TPS)& Drugs Action(DA)), Private residential facility (Alexander Clinic) and
Third Sector Moving on Services (CAIR Scotland Council employability service and Aberdeen Foyer).
All of these organizations have presented; a variety of ways that they demonstrate how they know
they are meeting the quality principles and good practice examples. These have been entered here
against the relevant principles below. Where no particular organization is named this would be seen
as the general case in Aberdeenshire ADP. In some cases organizations have presented; different
ways that they know that they are meeting the principles or examples of good practice this has been
attributed to the organization.
The review documentation contains two sections, one that asks the service user what their major
strengths and supports are for recovery. Also what are their barriers for their recovery. This is
discussed with the service user when their goals for their treatment are worked out.
The local Authority Self Directed Support assessment is asset based.
Service user reviews include an assessment of the effectiveness of their treatment. Case notes. GP
letters. Test results. Reports and the community Substance Misuse Team Outcomes Survey all
demonstrate this information.
5.3.3 How are individuals’ plans reviewed as they
progress on their recovery journey to demonstrate
it reflects the changes in their situation?
Service user plans are reviewed regularly as they progress on their recovery journey to reflect the
changes in their situation this is demonstrated in client records. Frequency of review depends on
the individual but is at least every 12 weeks.
5.3.4 How are matters such as future aspirations,
wider health needs, family, children, finances,
education, employment and housing discussed
Matters such as future aspirations, wider health needs, family, children, finances, education,
employment and housing are discussed in detail with service users at their reviews and weekly or
fortnightly appointments. As work is on a person centered level an individual’s needs vary over time
29
including information about services which help
you achieve these?
and issues that arise will be dealt with accordingly.
5.3.5 How do you support individuals to access
wrap around services such as housing, volunteering
and employment?
Access wrap around services such as housing, volunteering and employment is supported by helping
contact to be made, providing information and if required, accompanying people to the other
services.
The ADP have agreed additional resources to provide new services to support people to access this.
We also have secured money from DWP in 15/16 to support this agenda.
CSMS is part of Aberdeenshire Council. There are direct links to the Housing Service and the
Employability Service.
•
•
•
•
There are volunteering opportunities for those who have positively moved on.
Group work is provided on both a rolling programme and a self-contained basis.
Use is made of 3rd Sector resources-CAIR and Foyer for group work where appropriate
The Prince’s Trust for moving to mainstream service provision.
There is also joint working with Aberdeen and Fraserburgh colleges.
5.3.6 How do you demonstrate individuals are
treated with dignity and in a non-discriminatory
way?
On initial contact the service user is ask how they would like to be addressed, they are spoken to in
private, well furnished and heated rooms to make them feel at ease. They are treated with dignity.
Everyone is treated the same and services do not discriminate.
This can be seen in
• Letters of thanks/support. Supervised practice. File records.
• Regular supervision by Team Managers.
• All Aberdeenshire Council and NHS staff must undertake mandatory Equalities and Respecting
Diversity training.
• Staff will also have registration requirements ( see 2.1)
• Aberdeenshire A.D.P. Report on Service User Questionnaire, 2015 (Appendix 1)
30
Identified Good Practice
Turning Point Scotland has outreach teams in Banff, and Peterhead that see service users in the community.
They also have offices in Banff and Peterhead that are designed to give service users a safe, purpose designed venues to see staff.
They also have drop in facilities in Fraserburgh’s, ‘Here for you Centre’ to see service users and members of the public.
All staff have regular supervision.
Aberdeenshire Council has 2-part time Homelessness Workers whose remit includes working with people in contact with CSMS.
Service users can receive a service through the Employability Team.
Please summarise any actions required to improve aspects of practice/performance
More, earlier direct links with the moving on services and reviews will be made.
Outreach services are new in Peterhead. These will be developed across the rest of Aberdeenshire.
Roll out of the ROW tool and analysis through the DAISy system.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
31
QI 5.4. Involving individuals in the delivery of services
Quality Principle 7. You should have the opportunity to be involved in an on-going review of how services are delivered throughout your
recovery.
Principle
5.4.1 How do you enable individuals to have their
say in how services are delivered?
Demonstrate how you know
In Aberdeenshire alcohol and drug services are delivered by a range of organizations that operate
across recognized pathways to recovery. These include Aberdeenshire Council, Community
Substance Misuse Service (CSMS), NHS Clinical Services, Third Sector Alcohol and Drug Services
(Turning Point Scotland (TPS) & Drugs Action (DA)), Private residential facility (Alexander Clinic) and
Third Sector Moving on Services (CAIR Scotland, council employability Services and Aberdeen Foyer).
All of these organizations have presented; a variety of ways that they demonstrate how they know
they are meeting the quality principles and good practice examples. These have been entered here
against the relevant principles below. Where no particular organization is named this would be seen
as the general case in Aberdeenshire ADP. In some cases organizations have presented; different
ways that they know that they are meeting the principles or examples of good practice this has been
attributed to the organization.
In all of our services clients have the opportunity to guide how the service is delivered to them. This
is done through assessment and planning processes.
Where appropriate clients are asked to design program content e.g. moving on interventions.
Service User Involvement Coordinators have a lead role in ensuring service users across
Aberdeenshire have the opportunity to feedback their views and experiences. A recent client and
staff survey (Appendix1) has been completed and findings from these are feeding into ADP action
plans
All services use feedback processes and client fora to capture views to influence the development of
services.
To influence the wider service provision, service users are encouraged to attend their local forums,
conversation café’s and big blethers.
Service users have also been supported to attend local conferences and training events. Aberdeen in
Recovery, Fraserburgh in Recovery, NHS Conference, Pilotlight.
Four very good examples of individuals influencing how services are delivered include:
• The ADP transport pilot being conducted as a result of transport problems being highlighted
in conversation cafes.
32
•
•
•
5.4.2 How do you make clear to individuals their
responsibilities and what they can expect from
your service (supported by the Recovery
Philosophy)?
5.4.3 How are individuals informed of your
complaints procedures and how they can make a
complaint if they are unhappy with the service they
have received?
5.4.4 How are individuals informed about
independent advocacy services that can help them
be heard?
Citizens being able to design and commission local services via their local Forum.
The ADP’s deliver plan being strongly influenced by the voice of clients and citizens.
The Pilotlight SDS co-production project being commissioned to include citizens in figuring
out how best to utilized SDS provisions.
All Aberdeenshire services regularly discuss the responsibilities of all parties. Services emphasize
coproduction through discussion and often contract type documents. These processes give
information and make clear what is expected from both the individual and the service. Service
users are encouraged to take ownership of their own recovery and work with agencies to achieve
this. These points are made clearer when the recovery care plan is signed.
In Aberdeenshire services individuals are informed of complaints procedure at first encounter either
in welcome packs, being given copies and through displays on posters in waiting areas. These are
explained and discussed. This is again reiterated if a client is unhappy with the service they have
received.
Aberdeenshire A.D.P Report on Service User Questionnaire, 2015 (Appendix 1) shows that the
majority, 69.6% of those surveyed were aware of what to do if they had a complaint/
All agencies display leaflets and posters advertising Advocacy North East (Aberdeenshire). The
services are discussed especially if a need presents.
Identified Good Practice
There is a wide range of methods for seeking feedback including the work of Aberdeenshire ADP Service User Involvement team.
We try and create a working environment that the service users feel relaxed coming to and they feel that we are trying to do our best to help them with
their recovery journey.
Volunteers from previous programs support participants to voice their opinions and suggestions.
Please summarise any actions required to improve aspects of practice/performance
We will seek feedback from people not engaged or post engagement rather than people in services because we speculate just speaking with the latter may
give us skewed results.
We will engage with and promote other services that can help service users improve their lives and recovery pathway e.g. wider community groups
For sessional programs Co-production session will be included at the end help design the next program.
We will roll-out the ‘Patient/Client Opinion’ methodology.
We will monitor SDS and analysis to allow a clearer understanding particularly of those not accessed as eligible for support, to see what ADP funding will
need to pick up if anything.
33
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
QI 5.5. Involving family and carers in the lives of the individuals accessing services
Quality Indicator 8. Services should be family inclusive as part of their practice
Principles
5.5.1 How do you demonstrate individuals
understand that ‘family’ can mean those people who
plays a significant role in their lives?
Demonstrate how you know
In Aberdeenshire alcohol and drug services are delivered by a range of organizations that operate
across recognized pathways to recovery. These include Aberdeenshire Council, Community
Substance Misuse Service, NHS Clinical Services, Third Sector Alcohol and Drug Services (Turning
Point Scotland & Drugs Action), Private residential facility (Alexander Clinic) and Third Sector
Moving on Services (CAIR Scotland and Aberdeen Foyer). All of these organizations have
presented; a variety of ways that they demonstrate how they know they are meeting the quality
principles and good practice examples. These have been entered here against the relevant
principles below. Where no particular organization is named this would be seen as the general
case in Aberdeenshire ADP. In some cases organizations have presented; different ways that they
know that they are meeting the principles or examples of good practice this has been attributed to
the organization. Aberdeenshire ADP. They therefore will not necessarily pertain to all activity in
Aberdeenshire ADP.
At assessment, routine appointments and reviews, links with friends and family are encouraged as
well as attempts to mend any broken bridges so this can be use as additional support to give
strength to maintain the recovery journey. Referrals to family support services, significant other
supports are made via Care Managers. Family members can attend reviews if client agreeable.
Prescriptions collected by family members. Care plans reflect supports available.
CSMS uses the term Significant Others to reflect this and significant others can be referred for a
Carer’s Assessment.
34
Work is undertaken with significant others in their own right and with family members at
appropriate times.
The ADP has delivered a significant workforce development series of workshops in conjunction
with Scottish Families Affected by Alcohol and Drugs on ‘family inclusive practice’ to most staff.
The Aberdeenshire A.D.P Report on Service User Questionnaire, 2015 (Appendix 1) revealed that
60.7% of those that answered said that they had been given the option of a significant other’s
involvement.
5.5.2 Do individuals understand that family members
can only be involved in their recovery journey if they
want them to be?
Service users are informed that it is not compulsory to maintain family supports. In some services
a mandate is signed by a client before any family member can be involved in their journey. Aberdeenshire council CSMS service work with family members in their own right either through
1:1 or group work.
5.5.3 How do services help and encourage
individuals to involve others who can support their
recovery?
Staff are all trained on family inclusive practice this would include trying to identify any positive
outside influences that service users might have and encouraging them to utilise this to improve
their recovery capital.
The Aberdeenshire A.D.P Report on Service User Questionnaire, 2015 (Appendix 1) identified that
68.3% of respondents said that the service supported them to improve their relationships ,
5.5.4 How do you help individuals minimise the risk
that their drug or alcohol use may have on those
around them?
Through assessment, risks that the service user may present to those around them are identified.
Services users are given advice and are asked to acknowledge those risks that they pose and take
steps to minimise those risks. Examples are by offering treatment, support, naloxone training, Dry
Blood Spot Testing, psychiatric reviews, access to a medical officer and leaflets on safe storage of
methadone.
Roizen’s 4 Ls model is used in Community SMS (CSMS).
•
CSMS staff fulfil the role of Council Officers with regards to Adults in need of Support and
Protection procedures.
35
•
•
Police concern reports are received and there are also links with the Adults in Need of
Support and Protection Team.
Joint work with Police Scotland for Operation Hotspur and Operation Sandside in Dec 2015.
ABO21-CAT2-Operat
ion-Hotspur-finalv2.doc
•
Use of the Child’s Journey template for reporting on Children and Families.
Drugs Action deliver Compass which provides 1-1 support to children/young people who are
affected by parental substance use issues. The focus of this service is to address any risk issues,
identify and develop supportive factors for the child/young person and help them develop
resilience so there life chances are not adversely affected as a result of the parental substance use
issues. 5.5.5 How do you demonstrate that individuals know
that if they have children their needs and well-being
will be a primary concern?
5.5.6 How do services demonstrate that the needs of
members of an individual’s family, and those
individual’s lives with, are considered including
seeking support for them?
It is always made clear that children are put first. All children that come into contact with service
users are recorded in their notes. Advice is given on how to keep children safe. For example safe
storage of medicine leaflet given to every client. Child protection reports have section for client’s
views.
In collaboration with the Child and Family Protection Partnership, the ADP has delivered a series of
workforce development workshops on Child protection and GIRFEC in addiction servicers as well as
jointly developed guidance.
All staff have to keep up to date with Child protection Training as this is a part of their registration
requirements in both social work and nursing.
Limits of confidentiality as cited at 5.1.8
The needs of members of an individual’s family, and those individual lives with, are considered by
the services through the following:
A significant Other service is provided by the local authority this includes.
• Work with families as part of the recovery plan.
• Input in Children and Families Services as required- see 5.5.4.
• Referral on for Carer’s assessment where appropriate particularly where dual diagnosis
identified and additional support is required. Currently Aberdeenshire council CSMS are
36
involved in the consultation process around changes for Carer’s which will be implemented
with the change in legislation in 2017 which will introduce new duties for the Local
Authority.
Drugs Action operates a family support group for loved ones to attend. Family members can also
access 1-1 support in their own right.
The ADP supports four Family Support Groups in Aberdeenshire.
The ADP has lobbied Scottish Government to include service delivery for significant others within
the HEAT waiting times regimen so that family members have the same priority as other service
users. Sadly, this has been to no avail.
Identified Good Practice
Family inclusive practice is part of the core competency framework at Drugs Action. Family members have access to 1-1 and group support. Children
affected can be supported via the Compass service (although this has limited capacity).
The Kessock Clinic and Turning Point Scotland works in partnership with Social work, Turning Point, CAIR Scotland and other 3rd sector organisations to
create a good working environment for service users to visit. Together they reduce any unnecessary barriers to treatment.
Provision of Family Inclusive Practice Workshops in 2015.
Current developmental work re numbers of Significant Others acting as unpaid carers and the length of time required for an assessment of their needs to
be undertaken.
The 2015 ‘It’s a family affair’ Community Workshop in Inverurie attracting 160 people.
Aberdeen foyer’s work is underpinned by recognition that Recovery is a family affair and encourages and include family members where necessary.
Up until recently Aberdeenshire had the support of an SFAD Family Support Worker.
Please summarise any actions required to improve aspects of practice/performance
We will increase partnership working with services supporting families/significant others.
Family inclusive practice will be addressed at planned development days.
We will continue to lobby to include significant others in the waiting times regime and ROW outcome monitoring/ DAISy infrastructure.
We will recruit a replacement for the SFAD Family Support Worker.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Very Good
37
How good is our management?
6. Policy, service development and planning
QI 6.1 Planning and improving services
Principle 5. You should have a recovery plan that is person-centred and addresses your broader health, care and social needs, and maintains
a focus on your safety throughout your recovery journey.
Principle
Demonstrate how you know
6.1.1 Is your
Delivery Plan
aligned with
the SOA and
joint
operational
plans? How is
this done in
practice, and
how is
progress
monitored
and
managed?
Our delivery plan was developed on a bottom up and top-down basis with the goal of achieving balance between following and leading
service operational plans. The delivery plan is aligned with the SOA/LOIP and CLD Partnership Plan and increasingly CSP priorities. This was
achieved by working in partnership with partners through regular dialogue and the sharing of evidence. In practice, the CPP delegates
responsibility to the ADP and has adopted the ADPs high level outcomes within the SOA/LOIP. The ADP Lead Officer contributes to the
development of the CPP’s joint thematic operational plans which sit below the LOIP/ SOA. Progress is managed through each strategic
action being led by a designated partner and monitored by a designated ADP committee. Each committee reports progress to the full ADP
quarterly and the ADP reports to the CPP on an annual basis. We are called to account to the Community Planning Partnership Board
annually at a face to face meeting where we receive feedback and are able to answer any questions. A subset of indicators from our
Delivery Plan is incorporated into the SOA and this is monitored on an exception basis at every CPP executive team meeting once every 2/3
months.
Additionally on an ad hoc basis we are invited to provide an update to the 6 area committees in Aberdeenshire. The Aberdeenshire ADP
Chair has a seat on the CPP Board and the Lead Officer has an active role on the CPP Executive Team.
We submit all strategies and plans to the CPP for comment and agreement.
This is the feedback we received from our last presentation at the CPP Board “11. SOA FOCUS: ALCOHOL AND DRUGS
There had been circulated a joint report dated 19 May 2015, by the Alcohol and Drugs Partnership Commissioning and Performance
Manager and the Strategic Development Officer (Community Planning), which provided the Board with an update on progress made by the
Alcohol and Drugs Partnership in delivering the outcomes set out in the Single Outcome Agreement. During discussion, members asked
38
questions about other organisations that could help to support the delivery outcomes; the variation of Alcohol Brief Intervention delivery
across Aberdeenshire; the role of the recovery community in prevention; and the impact of the cessation of the bus pass project. After due
consideration, the Board agreed:(1) to acknowledge the progress made by the Aberdeenshire Alcohol and Drugs Partnership in delivering the outcomes set out in the Single
Outcome Agreement;
(2) to acknowledge the comments made by partners demonstrating how they were contributing to the alcohol and drugs priority;
(3) to acknowledge the information provided on the Partnership’s performance to improve outcomes, plan preventatively and join up
resources; and
(4) to instruct officers to provide further information on the impact of the cessation of the bus pass pilot project.”
Aberdeenshire ADP are also very active on a number of CPP sub groups which has also allowed us to determine areas of joint work and
shared outcomes as well as avoiding duplication of funding and activities.
6.1.2 Is your
drug and
alcohol
strategy
based on a
comprehensi
ve, dynamic
assessment
of current
and future
needs?
Rather than develop a new strategy, our current strategy is reflected in our delivery plan. The delivery plan is based on an assessment of
the current situation both from the perspective of our understanding of local need and national expectations. We mapped, consolidated
and reduced the national expectations to a manageable number. We developed understanding of local need through a) reviewing our
performance indicator data; b) commissioning Health and Service Needs assessments; c) Quantifying current and anticipated demands on
services; d) Conducting numerous conversation cafe dialogues with the community; e) Listening to the views of our Community Forums.
This is a dynamic process insofar as delegated ADP sub-committees are at liberty to refine their operational action plans based on the ADP
delivery plan.
There is a huge uncertainty about future trends and other determinants such as the law and budgets but nevertheless, the delivery plan
looks to the future by setting targets and anticipating the increasingly important role of community inclusion and involvement.
39
6.1.3 Does
your Delivery
Plan take full
account of
the Quality
Principles
and how are
you
identifying
the specific
steps you
need to take
to
demonstrate
these are
being
implemented
and
embedded in
practice?
Yes – we have specific actions within the delivery plan (SG shared this as a good example to other ADPs) that will be our measure for
ensuring the quality principles are fully and effectively implemented and embedded in the daily work of all our services. Each of the
actions have been assigned to an ADP partnership group and also have an ADP Support Team member allocated to ensure updates and
progress being made. This ensures that these actions are being taken forward by the relevant ADP group and receive the required support
to ensure all actions are being progressed on an ongoing basis.
Our Service User coordinators have completed a SU survey in regards to the Quality principles and findings are being presented in March
with recommendations to be taken forward by services. This is being followed up by a survey for support staff in all services and will follow
the same process.
The following are some examples of Delivery Plan actions that support the Quality Principles
4. We will increase the co-production of community recovery activities by growing the range of mutual aid groups and recovery focussed
initiatives across Aberdeenshire, identifying and addressing areas with lack of provision, aiming for at least one in each of the 15 major
towns.
6. We will develop a ‘Service User Reference Group’ where those with lived experience of dependency/addiction and recovery can voice
their views, thoughts and aspirations.
2. Service users and family members will be invited to participate in the evaluation, design, commissioning, and performance review of
services.
3. There will be at least 4 events planned each year in collaboration with those with lived experience of drug/alcohol dependency to
ensure that recovery and issues associated with recovery promoted as positive, possible and happening in communities within
Aberdeenshire.
2. We will ensure that all alcohol and drug services can demonstrate the effectiveness of their interventions on their clients’ collective recovery
outcomes by working to the client’s personalised recovery plan and monitoring progress against the national recovery outcome indicators.
40
3. We will ensure that all alcohol and drug services, including Community Pharmacy, can demonstrate their adherence to the Quality Principles and
service user involvement through a self-assessment validated by independent audit via SDF or peer researchers in anticipation of a validation
inspection by the Care Inspectorate starting Autumn 2015 over 18 months.
1. We will work with all partners to implement one of the pillars of public service reform to locally integrate services and develop local area ‘Recovery
Oriented Systems of Care’ as detailed in Appendix A where roles, responsibilities and processes are clearly defined and understood.
2. We will ensure that all treatment and support services have explicit referral criterion and understand their expected contribution within the
Aberdeenshire ‘Recovery Oriented System of Care’ as detailed in Appendix A, on which ADP funded services will focus their efforts to ensure value for
money from ADP investment.
6.1.4 Do you
have
Recovery
Orientated
Systems of
Care (ROSC)
in place and
are these
fully
implemented
?
We have a ROSC in place but continue to develop this as we continuously review our practice and identify areas requiring further work.
We have developed a customer Journey (See 11) which has helped services look at recovery from a person centred perspective.
We have made progress against some of the Distinguishing features of a ROSC including:
•
Being person-centred – We have reviewed service processes and identified the need to make it easier to access services and as a
result we have provided funding for Single Points of Access across Aberdeenshire. These will provide advice and assessment before
referring people onto the most appropriate service where required. In some cases we are able to undertake urine testing etc
which enables people to access treatment much quicker. We have seen a reduction in our waiting times and service users are
getting seen at the most appropriate place at the most appropriate time. During the review it was also identified the capacity of
moving on services was insufficient. We have directed additional resources in this area with match funding received from DWP to
support more people to move on in their recovery journey. During 15/16 we will review the impact of the Single Points of Access
and the expanded moving on service.
•
Being inclusive of family and significant others – we have embedded within our assessment the need to encourage links and
interventions to include this group. We arranged for Family Inclusive Practice workshops to be delivered last year and continue in
15/16. We have 4 family support groups and continue to develop these in 15/16. Our Service User Involvement Co-ordinators also
promote family inclusive practice. Our Children Families and Young People Group have undertaken a lot of work on this and
ensure that support is given where families would benefit. An example is the work with a residential provider who enables children
to accompany their mother in a residential recovery setting. The CFYP group have worked with this service to develop a post that
41
will focus on the child and direct activities in line with GIRFEC and SHINARRI. This will start in 15/16 and will be reviewed by the
CFYP in a year’s time. The Community Forums also paid for an event in January “Recovery – A family affair” which was extremely
well attended by over 160 people.
•
The provision of individualised and comprehensive services - such as housing, employability and education – through our wider
partnership we are working with a range of services including DWP and Housing. We have incorporated employability as part of
our recovery offer and plan to look at potential housing related projects in 15/16. Our work in this area recently attracted the
attention of other areas resulting in our Lead Officer delivering a presentation on ‘An ADPs perspective on Homelessness’ at a
recent housing conference in Inverness.
•
Services that are connected to the community – we have 3 Community Forums which have a wide membership and our services
link very closely into these, in particular our third sector services. Finance is available to these groups to fund local community
programmes, which support our outcomes, as they see fit. Our single points of access will be delivered in a variety of locations
within communities including pharmacies, community halls, etc.
The diagram below was agreed as our Recovery and Treatment ROSC and was developed by services with ADP support staff after
piloting a redesign.
42
Single point of Access
Assessment/Risk/ Recovery
outcomes begin.
Community Recovery.
Tier 2 &1 services
Education. Brief Intervention.
Harm Reduction
Mutual Aid, 3rd Sector. Commissioned Services
CSMS
Link in Community Mental health,
learning Disabilities,
Adult services when appropriate.
Tier 3 Treatment/ Stabilisation
NHS TEAM.
Stepped Recovery Clinics.
CPNs.
Complex co morbid, chaotic.
Clients for stabilisation.
Addiction Worker.
Ongoing recovery and
stabilisation
ROSC/ Community Rehab
Ongoing review & monitoring.
ROSC/ Community Rehab
Ongoing review & monitoring
ORT Shared
Care Clinics
will have 3
steps of
Recovery
within them.
CPN,
Addiction
Worker& GP.
3 Monthly Review
to meet
prescribing
guidelines and
review of ROSC
plan. Recorded
goal setting and
review being
person centred.
Addiction worker pre
and post Alcohol
Detox. Harm
reduction,
motivational
enhancement.
CBT. Family support.
Mental Health Assessment.
Physical Health, BBV, Twinrix
GP at Shared Care.
3 monthly review with allocated
workers & client.
Review of ROSC & ORT.
Interventions given.
Referred on when appropriate.
Joint worked with D.A., or CSMS.
Counselling/ Motivation, relapse prev.
Referred to CPNs for
Screening of suitability
for Community Detox.
Risk Assessment and
home environment
assessment
completed.
43
These clinics
can transfer
within each
other as to
client’s stage
of recovery.
Within this model
there is evidence
of supervision
and recording will
be included.
Reducing size
of caseloads
& improving
psycho social
interventions.
(Heat Target)
Transfer of skills
within multi
agency approach
to improve choice
and opportunities
for recovery.
Workers identify
suitability for detox
and refer to CPN.
Preparatory
counselling for detox.
Recovery goals and
relapse prevention
work.
Addiction workers
support client’s
family/carer with
joint working with
CPN during detox
and continues
recovery and relapse
prevention on its
completion.
Request from
registered GP for
Supervised Home
Detox as per protocol.
Specialist CPN input
and support to
Community Hospitals
with Alcohol Detox.
And linking back into
community supports
on discharge.
Every service user has a recovery plan with regular reviews and a sample of these will be reviewed as part of the monitoring process.
We were part of the pilot to review the Scottish Government Recovery Outcome Tool and plan to continue to use this.
Aberdeenshire ADP is extremely proactive in involving community and mutual aid groups. Our Service User Involvement Coordinators
have been employed to ensure genuine service user involvement, which drives our ROSC and redesign of services.
Identified Good Practice
There is a joined up approach and culture of respect across the third sector partnership.
We work with all our stakeholders to maximise all our funding and resources. We work closely and jointly with a broad range of partners to improve
services to our service users.
We are fortunate to enjoy good partner and community relationships. This has enabled a high standard of partnership working leading to a plan fully owned
by partners and the community. These relationships have been strengthened through an ADP Partnership Agreement founded on the basis of a ‘parity of
esteem’ across partners and the community. As a result, small partners and community members feel they have influence and voice.
Taking into account ADP National Outcomes, expected ADP contributions to other partner outcomes (E.g. H&SCP & CLD), Ministerial expectations and the
like generates a ‘priority’ list in excess of 120 items. We took poetic license to consolidate and refine this list into a more manageable set of external
44
expectations prioritised against local need. This has reduced the risk of the ADP and partners feeling overwhelmed and therefore more willing to engage in
our delivery plan. Our Delivery Plan was cited by Scottish Government as an example of good practice to other ADPs.
Our ROSC is being used as the basis for updating collection of residential rehabilitation outcomes.
Please summarise any actions required to improve aspects of practice/performance
All staff who are working in our service and who we work with will increase their knowledge of ROSC and the Quality Principle and put theory into practice.
Our delivery plan is still significant with 112 distinct strategic actions across the four domains of prevention, protection, recovery and inclusion. Maintaining
progress across such a large range of actions will be challenging, not least if the resources available to do this diminish or government introduce even more
expectations.
A key improvement that will enable improved decision making will be our universal use of the Recovery Outcomes Monitoring Tool and DAISy information
system. Support from Scottish Government to enable the development of a DAISy compatible case management system would be a bonus.
Given that we have a range of different services working in collaboration across Aberdeenshire, we still need to maintain a focus on good partnership
working to enable people to move effectively out of services. If current progress on drawing services to work evermore closely within the agreed ROSC
doesn’t continue, the ADP has indicated its intention to consolidate further in the future through contractual means.
Monitor the new SDS way of working, including capacity, processes etc.and review new spend as a result of this.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
45
QI 6.2 Performance management and quality assurance
Principle 2. You should be offered high quality, evidence informed treatment, care and support interventions which keep you safe and
empower you in your recovery.
Principle
6.2.1 What systems do you have in place for service
monitoring and review and reporting on
performance within your Delivery Plan?
Demonstrate how you know
We have a Commissioning Performance and Finance sub group of the ADP who receive regular
monitoring and performance reports often on specific areas for improvement e.g. waiting times.
Services are required to complete quarterly monitoring reports and have 6 monthly monitoring
visits. This information is used to support the CPF to make effective financial decisions in regards to
value for money and effective and suitability of service against our current needs.
Each item in the delivery plan has a corresponding lead overseeing ADP sub-committee and
designated lead partner. Each sub-committee reports progress at the full ADP committee.
A mid year review is conducted and presented to the CPF group to help determine appropriate
spend on services, value for money of issues that may need to be addressed. The report also asks
for good news stories/ good practices. Different areas of performance are reported back through the
CPF.
6.2.2 Do you have agreed standards across all your
services which quality assure that your services are
being delivered effectively and efficiently that fully
reflect the Quality Principles?
This is an area we have recognised as requiring improvement. Services are working much closer
together and with a very similar approach and utilise case conferencing regularly to ensure
consistency of standards. We have only the quality principles set as a measure for all services but at
reviews each organisation are asked about the standards and each have a way of monitoring their
services through self evaluation, although some recognise they could improve this. Work through
the workforce agenda is taking this forward for the service delivery group who will then agree to
common standards.
6.2.3 Do you gather information and seek the views All partners have quality assurance processes that include these elements.
from staff, individuals, carers and families, as an
The ADP has undertaken two surveys within the past 4 months which were based on the quality
integral part of quality assurance?
principles, one for Service Users and one for service delivery staff. The findings are influencing
46
behaviour and service improvements in areas highlighted within the final report from the surveys. By
and large, the results provide considerable reason to be pleased and reflect very well on the efforts
of services.
We have 4 family support groups where we also receive valuable information and as a result of
these we held a family event with about 160 attendees. We have also ran family inclusive training
events. Each of the services complete a customer survey/service satisfaction questionnaire.
6.2.4 Are staff clear what is expected of them in
order to deliver high quality services?
All services have performance management processes which includes these elements. Work is being
undertaken to produce a Workforce Development Plan for Aberdeenshire ADP.
As our ROSC matures, we are managing to obtain agreement from services what they will and should
not contribute to the ROSC. We encourage staff to operate at the top of their license and as a result,
withdraw from activities that other services might be better suited to deliver. Given the style of
approach of our ADP, this is an iterative process based on the idea of consent rather than
compulsion when services feel ripe for change.
6.2.5 Is performance reported clearly and
accurately to all stakeholders including the public?
The performance review process includes clear feedback to workers and services. The
Aberdeenshire A.D.P Report on Service User Questionnaire, 2015 (Appendix 1) has been made
available on the ADP website and the results of the staff questionnaire is awaited.
We are also currently looking at our website to update to meet the needs of all potential visitors to
the site where we will have national and local performance displayed. Performance is reported
regularly to stakeholders and is areas requiring improvement.
We hope that the implementation of the ROW tool will make much more transparent what ‘good
performance’ constitutes and how we attribute good client outcomes to a particular service or
intervention.
Identified Good Practice
Clear attribution for responsibility of delivery of each item within the ADP Delivery plan.
Good partnership relationships with partners that enable the evolution of solutions based on mutual regard rather than command and control.
47
Monthly PLT (private learning time) is used to look at quality of the service we provide and make improvements.
Turning Point Scotland has entered into an advertising agreement with Funding Solutions for Education. They are producing a three-page folder alongside
Peterhead Academy Senior Students to promote and advertise services in North Aberdeenshire. They are also using this folder to promote school activities.
This will be read mainly by parents of all school children in North Aberdeenshire.
The Foyer report on the positive destinations people achieve which in turn promotes recovery and provides local role models
Sharing of good news stories and practices
Please summarise any actions required to improve aspects of practice/performance
We will develop systems to allow us to better report meaningful performance data to the Public.
We will engage with and provide more training opportunities for staff seeking to work in partnership with other organisations to promote better
partnership working relationships.
We will review how we improve quality assurance measures.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Adequate
48
QI 6.3 Securing improvement through self-evaluation
Principle 7. You should have the opportunity to be involved in an on-going evaluation of the delivery of services at each stage of your
recovery.
Principle 8. Services should be family inclusive as part of their practice.
Principle
Demonstrate how you know
6.3.1 Do you have a common and robust approach
to self-assessment and improvement? Is this
approach guided by the Quality Improvement
Framework and Quality Principles?
All services have their own method of self-evaluation. The current self-evaluation process, managed
by the Care Inspectorate, has revealed some appetite to develop a common approach guided by the
quality principles.
6.3.2 What progress are you making in achieving
demonstrable improvements in the quality and
delivery of service improvement and performance
through purposeful self-evaluation?
We can see improvements through monitoring ISD data on waiting times. We have only just started
a new review process and we will look to review and evaluate this at the end of this operational
year. This will be done in conjunction with all groups which form the ADP.
We also now have base line information gathered through the Aberdeenshire Service User and staff
Questionnaires (2015). This will be reapplied regularly to help measure improvement in quality
6.3.3 How do you routinely gather the views about
the experiences of individuals and their families in
evaluating the impact and supporting
improvement of your services?
Each service collects views about the experiences of individuals and families. We have also
conducted various Conversation Café events on specific topics e.g. homelessness and within the
Grampian SMS conference.
Each service conduct their own evaluation questionnaire but this could be improved and at the
recent reviews it was identified that family members were often missing from this process. However
we do have close links with SFAD to aid this and a number of family inclusive training events have
taken place to aid the ability to do this.
There are 2 SUI coordinators who run a number of SU events which provides valuable feedback
49
6.3.4 How do you encourage, support and train
staff to carry out evaluation on the quality of
services they deliver as an integral part of their
work using the Quality Principles?
All services have their own process for evaluating the quality of their services these include
Protected Learning Time, supervision, clinical service and team meetings Outcome measurement
self-reflective practice, Registration PRTL requirements and surveys. The ADP could be more active
in coordinating this process.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
50
QI 6.4 Involving individuals who use services, carers and other stakeholders in service planning
Principle 7. You should have the opportunity to be involved in an on-going evaluation of the delivery of services at each stage of your
recovery.
Principle 8. Services should be family inclusive as part of their practice.
Principle
Demonstrate how you know
6.4.1 Do you have an agreed strategy and clear
framework in place to demonstrate systematic
engagement and meaningful involvement of
individuals who use services, carers and other
relevant stakeholders?
6.4.2 How do you demonstrate that engagement
with individuals, carers and other stakeholders is
used positively to shape and influence policies and
inform service planning and development?
Services have various strategies for engagement.
The ADP as a whole has committed to inclusion and community engagement as one of four themes
within its delivery plan. This includes:
- The key role of the ADP Forums
- Encouragement of community members to take active leadership roles within the Forums
- A Commitment to facilitation of community engagement through investing in 3 x 0.5 wte
Community Engagement Officers to support the Forums
- A Commitment to facilitation of community engagement through investing in 2 x 0.6 wte
Service User Involvement Coordinators
- Presence of a 0.5 wte SFAAD Family Support Development Officer
see 6.2.5
Following feedback from numerous sources, through services, cafe conversations surveys, big
blethers conferences etc we have increased our involvement with JCP and established a process to
try and address issues of sanctions as soon as possible, have supported more family and community
groups and this has led to development of single points of access as well as new resources for
moving on services.
The delivery Plan was pulled together as a true partnership and shared widely with local community
groups as well as strategic groups, many of whom commented and resulted in amendments before
the plan was finalised
6.4.3 How do you demonstrate that the views of
individuals, carers and other stakeholders influence
Each conversation café results in a report containing various recommendations. These
recommendations are incorporated into the delivery plan directly or incorporated into the agenda of
51
the improvements you make?
the ADP through direct feedback from Community Forums.
The work and spend of Community Forums is exclusively dictated by the views of their membership.
Identified Good Practice
Variety of methods deployed for user feedback
Aberdeenshire A.D.P Service User and staff Questionnaire (2015)
Service user feedback is overseen by the board of Directors at Drugs Action and service users attend DA’s annual planning day comprising of staff, board
members and service users. This is used to inform a range of actions which can include amending opening times, staff training, developing new services
and this year has resulted in the development of a service user forum
Again we ask service users their views and feed back all the time on how we can improve the service we run. Some service users were involved in painting
and decorating the two offices that we have in Banff and Peterhead.
ADP Delivery Plan
Please summarise any actions required to improve aspects of practice/performance
We will routinely feedback to service users what we have done in response to their feedback.
We will develop a communication / engagement strategy
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Good
52
QI 6.5 Commissioning arrangements
Principle 2. You should be offered high quality, evidence- informed treatment, care and support interventions which keep you safe and
empower you in your recovery.
Principle
Demonstrate how you know
6.5.1 Does
your ADP
have a
commissionin
g plan in
place?
Aberdeenshire have developed a commissioning and Performance strategy this year. We were hoping to implement this fully in 16/17 but
due to the uncertainty of the funding allocation for next year and the decision of Aberdeenshire Council to implement Self Directed
Support to Alcohol and Drugs funding, we are slightly behind with our anticipated schedule. However we are fully committed to ensuring
that we have a full review of all services, the value of these and to eradicate unnecessary duplication.
6.5.2 Are your
commissionin
g strategies
coherent with
your vision
and the
priorities set
out in your
Delivery Plan?
Yes, the commissioning and Performance strategy was created with delivery plan and other changes in mind.
6.5.3 How do
you monitor
and evaluate
how well the
We ask services to complete quarterly reports and visit for a full monitoring review every 6 months. In addition to this we have completed
work on waiting times and on accuracy and completeness of input to SDMD with this work ongoing in preparation for transfer to DAISY.
We have undertaken quite a bit of analysis on discharge and as a result are piloting assertive outreach for people who are proving hard to
engage with as well as those who fail to attend appointments and those who just stop attending. We are currently reviewing all services53
There are clear actions in our delivery plan here are some examples:6. By April 2017, the ADP will only fund services based on evidenced models of care specified as required within the ROSC and able to
demonstrate significant improvements in aggregate service user outcomes.
7. The ADP will conduct a competitive tendering process for all ADP funded services, to maximise value for money and facilitate consolidation
and integration where this has not yet occurred.
8. The ADP will map out the total resource utilised in Aberdeenshire in preventing, treating or dealing with the consequences of problem
alcohol and drug use to inform ongoing planning, service redesign and the use of earmarked ADP funds.
services you
commission
are delivering
positive
outcomes for
individuals
and their
families?
which will look at a broad range of performance factors for each service including volumes, discharges and cost to name a few. There are
also some recommendations from these findings and from conducting the reviews that will be put to the CPF for agreement.
.
Identified Good Practice
Development of a commissioning and Performance Strategy.
Identified other match funding resources and common areas of work with partners to save resource and reduce duplication
Please summarise any actions required to improve aspects of practice/performance
All services that come under the ADP umbrella will do more joint working to maximise use of current resources. This is more important now due to funding
cuts.
We will monitor impact of Self Directed Support which has been implemented in Aberdeenshire to include Drug and Alcohol Services
We will ensure Value for money, reduce duplication and ensure Specialist services doing just that
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Adequate
54
55
7. Management and support of staff
QI 7.1 Training, development and support
Principle 3. You should be supported by workers who have the right attitudes, values, training and supervision throughout your recovery journey.
Principle
7.1.1 Do you have a workforce development
strategy in place which includes a comprehensive
training and development programme in line with
Recovery Orientated Systems of Care (ROSC)?
7.1.2 How do you demonstrate staff are involved in
the strategic planning of training and
development?
7.1.3 How do you demonstrate that staff across
services demonstrate a sound knowledge and
understanding of the Quality Principles and are
confident and competent in applying these in
Demonstrate how you know
The ADP are developing a Workforce Development Plan. Work so far has included:
• Identification of some of the main drivers for workforce development for Aberdeenshire
ADP
• Identification of who can be considered Aberdeenshire’s alcohol and drug workforce
• An identification what an alcohol and drug workforce should deliver in Aberdeenshire
• A self assessment and gap analysis of what the alcohol and drug workforce is (and could be)
delivering
• An examination of some of the L&D activity that is available
• Investigation of how electronic Learning and Development (L&D) platforms used within
Aberdeenshire Local Authority and NHS Grampian can incorporate an Aberdeenshire ADP
L&D activities (eg e learning) and Directory
• Learning needs analysis questionnaire has been drawn up but is on hold.
Development days have been planned to address current learning and development issues in
advance of a learning needs analysis.
We have had two workshops to start to identify the goals for Workforce development. A learning
needs analysis has been prepared but has not been issued because of the risk that the recent
questionnaires that staff have been asked to complete would reduce the response rate.
Development days have been planned that will identify training needs relating to specific
developments.
Various performance management processes have started to incorporate the quality principles. Staff
participated in a survey in 2015 which was based on the quality principles. This work is about to
report.
56
practice?
7.1.4 What employee development and supervision
systems are in place to develop the skills and
competence of your workforce?
All services work to a framework of practice development and supervision systems. These are
monitored through service review.
Identified Good Practice
Drugs Actions own QA framework
We always try and take advantage of available training that will improve our working practice.
Please summarise any actions required to improve aspects of practice/performance
Aberdeenshire Workforce Development Plan will include: Stakeholder consultation plan, Service User Involvement framework, Learning and Development
Plan, Performance management framework. This will be underpinned by the Quality Principles.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Very Good
Excellent
Adequate
57
8. Partnership working and resources
58
QI 8.1 Partnership working
Principle 2. You should be offered high-quality, evidence informed treatment, care and support interventions which keep you safe and
empower you in your recovery.
Principle 6. You should be involved in regular reviews of your recovery plan to demonstrate it continues to meet your needs and aspirations.
Principle 7. You should have the opportunity to be involved in an on-going evaluation of the delivery of services at each stage of your
recovery.
Principle
Demonstrate how you know
8.1.1 How do you demonstrate effective
partnership working towards implementing and
embedding the Quality Principles in service
planning, design and delivery to improve the
quality of your services?
Aberdeenshire ADP have an infrastructure of groups that facilitate consultation on and
implementation of strategy e.g. Service Delivery Group, Partnership meetings, Multi-agency clinical
meetings, community forums, these include all partners.
8.1.2 What formal arrangements are in place
between your ADP, Child Protection and Adult
Protection Committees?
Aberdeenshire Child & Family Protection Committee
The ADP has a close operational and strategic relationship with the Child & Family Protection
Committee. The Chair of the ADPs Children, Families and Young People Sub-Committee has a seat on
the Child & Family Protection Committee and GIRFEC Management Group.
Management information is shared to identify emerging trends and increasingly each committee
seeks to provide challenge for the other. For example, an ADP update is regularly provided and
recently, the Child & Family Protection Committee was invited to ask one of the licensing solicitors
to lead a discussion around the Licensing (Scotland) Act 2005. This was to with particular reference
to the statutory licensing objective ‘protecting children from harm’ to see whether the committee
considered the current licensing arrangements to protect children to be adequate.
The Children, Families and Young People chair and ADP & CFP lead officers monitor the agenda and
outcomes of the National Alcohol and Drugs Partnership and Child Protection Committee to inform
our local agendas.
Operationally, the committees have collaborated closely in the design and delivery of GIRFEC
training and workshops for addictions staff as well as the production of local written guidance for
practitioners: http://www.girfec-aberdeenshire.org/guidance/parental-problematic-alcohol-anddrug-abuse/
Aberdeenshire Adult Protection Committee
59
8.1.3 What progress have you made towards
implementing a whole population approach at a
local level to reduce overall alcohol consumption in
the population?
Strategic arrangements between the Adult Protection Committee and ADP are less well developed
because the local view is that there isn’t a direct relationship between addictions and ASP. When
the ADP Partnership was developed, it was accepted that there was no need for formal ADP
representation from the ADP on the APC – the existing working arrangements (i.e. police and LA
being on the APC and the ADP) would suffice.
Operationally, it is Aberdeenshire’s policy that people suffering from an addiction would not
necessarily meet the Adult Protection ‘three point test’ criteria unless there was some other dualdiagnosis although each case would be individually assessed. Self-harm with capacity or temporary
vulnerability doesn’t fit well within the scope of the Adult Protection legislation. Any such referrals
would instead be passed to the Community Substance Misuse Service (CSMS) for assessment. Within
the Aberdeenshire ROSC, CSMS is considered the lead agency for adult support and protection or
incapacity/ cognitive impairment cases.
According to the ADP Partnership Agreement, responsibility for maintaining a link between the ADP
and ASP Committees sits with the Local Authority and Police. Following adoption of Aberdeenshire’s
ASP/ addictions policy and an independent review of public protection arrangements in
Aberdeenshire in 2012, we concluded that the current arrangements were adequate.
There are good operational relationships between ADP and ASP colleagues. For example, recently
the ADP Lead Officer and ASP Team Manager met to debate whether someone suffering multiple
admissions to hospital due to their drinking or drug taking and at risk of dying would be deemed
“unable to protect themselves from serious harm” and considered an adult at risk. The ASP Team
Leader thought not but agreed to take this question to her national group.
Aberdeenshire has a very clear ‘whole population approach’ to alcohol comprising the following
elements:
A planned programme of public health campaigns. The next to be implemented is a booklet on
“alcohol and older people” highlighting the potential for hazardous interactions between alcohol
and medicines commonly prescribed for older people. This will be distributed to older people
collecting their prescriptions.
Provision of universal education for p1-s2 children on alcohol and other drugs via the ALEC service.
Maintenance of open access tier two alcohol advisory services as part of our network of single points
of entry to services.
We’ve broadened delivery of ABI across a range of non-clinical services as a means of overcoming
some of the difficulties we’ve encountered in achieving our ABI targets within priority clinical
settings.
All 3 Alcohol Licensing Fora in Aberdeenshire are bought in to the need to improve controls on the
60
availability of off-sales in Aberdeenshire. Unfortunately, so far, we have been unable to persuade
the Licensing Boards. We continue to provide objective data to inform their decisions and seek to
mobilise community views to provide further influence
Identified Good Practice
The ethos of Aberdeenshire’s ADP is one of parity of esteem. This is managed through consultation and agreement. There are times that this is challenging
however it is integral to partnership working.
The close relationship between the ADP and Child Protection Committee. For example, drawing in the additional views of the Child and Family Protection
Committee from a whole population perspective to influence the Licensing Boards. CSMS attendance at the Homelessness Strategic Outcome Group.
CSMS are on a rota to offer some additional support to housing resource. The aim is to enable people to retain tenancies better, by dealing with debts,
benefits, managing a home, improving health etc.
CSMS and CJSW developing the King Street Resource Centre and offering interview space to Health colleagues
Please summarise any actions required to improve aspects of practice/performance
We will all improve joint working across all the services
ADP and ASP committees will review current arrangements to assess their adequacy in light of the Quality Principles guidance.
We will review and revise arrangements to secure high levels of ABI activity in General Practice, A&E and Antenatal.
Review the ADPs partnership agreement.
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Good
Very Good
Excellent
61
8.2 Management of resources
Principle 1. You should be able to quickly access the right drug or alcohol service that keeps you safe and supports you throughout your
recovery.
Principle
Demonstrate how you know
8.2.1 Do you have a rigorous and collaborative
approach to financial planning and management of
ADP resources to achieve improved outcomes for
people in recovery?
8.2.2 How are you collectively tackling inequalities
and reducing demand for specialist services?
We have a detailed plan within our delivery plan on how we would like to use resources. Some
uncertainty around next year’s funding and what impact Health and Social Care Partnerships will
have is a concern at the moment. Services are being assessed on activities and trends over last 5
years as well as value for money. We have resources available for community Forum and the
governance and monitoring of this has been reviewed this year. We are proactive in securing some
match funding which has allowed us to invest more in moving on services and we currently have
applications in for match funding for an AWTP and assertive outreach
We have increased spend and activities on prevention which includes engaging with wider partners
to highlight this agenda. We have established single points of access across Aberdeenshire to assess
all potential SUs and ensure that they are referred to the correct provider. We have supported the
third sector to develop this and to support specialist services so they are only doing the specialist
role, whilst the third sector organisation support with wider recovery issues and provide a moving on
service. We are also very active on the local tackling Poverty and inequalities group. and are looking
at the potential to ensure wider services are equipped to deal with our customer group.
Specific outreach services have been developed to engage with women involved in sexual
exploitation, LGBT communities and young people at risk of developing problems
Training is delivered to professionals to build capacity to respond and address early signs of
NPS/other substance use across Aberdeenshire
Aberdeenshire ADP has been working hard to encourage all three ADP and NHS Grampian to adopt
the same funding allocation formula as Scottish Government use to allocate ADP funds across
Grampian, rather than rely on an outdated historical allocation. We have yet to secure such an
agreement.
62
Identified Good Practice
To reduce referrer uncertainty and to ensure specialist services work at the top of their license, we have introduced Single Points of Entry Services.
Drugs Action has attracted funding from the Robertson Trust to develop preventative approaches in relation to reducing whole population drinking using
young people as ‘Culture Changers’
Drugs Action is developing accessible outreach services in community locations across the South and Central Aberdeenshire to help engagement at an early
stage.
Specific outreach services have been developed to engage with women involved in sexual exploitation, LGBT communities and young people at risk of
developing problems
Training is delivered to professionals to build capacity to respond and address early signs of NPS/other substance use across Aberdeenshire
Drugs Action has also engaged with the Business Community via having a presence and raising awareness at health fayres and providing training within the
oil and gas sector. This has resulted in Drugs Action receiving the Award for Outstanding Contribution to Society from the Grampian Chamber of Commerce
in 2015.
TPS are developing a multi skilled generic drug and alcohol workforce.
Please summarise any actions required to improve aspects of practice/performance
We will pool funding and joined up commissioning between the ADP and individual partners.
We will negotiate hard to ensure that Aberdeenshire ADP is able to secure an objectively fair share of ADP resources in Grampian.
SMS/CJSW seeking funding to enable an Occupational Therapy resource to be accessed by service users.
We will strengthen wider partnership working at an operational level covering the vast geography of Aberdeenshire.
We will identify further opportunities to influence changes to health inequalities
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Adequate
Very Good
Excellent
63
How good is our leadership?
9. Leadership and direction
9.1 Vision, values and culture across the partnership
9.2 Leadership of strategy and direction
9.3 Leadership of people
9.4 Leadership of change and improvement
Principle 1. You should be able to quickly access the right kind of drug and alcohol service that keeps you safe and supports you throughout
your recovery.
Principle 2. You should be offered high-quality; evidence-informed treatment, care and support interventions which reduce harm and
empower you in your recovery.
Principle 3. You should be supported by workers who have the right attitudes, values, training and supervision throughout your recovery
journey.
Principle 7. You should have the opportunity to be involved in an on-going evaluation of the delivery of services at each stage of your
recovery.
Principle
Demonstrate how you know
9.1. Does your ADP have a clear strategic direction,
agreed by all partners that connects your vision,
values and aims with your single outcome
agreement, Delivery Plan and recovery outcomes?
The ADP has a Three Year Service Delivery Plan that was developed in consultation with all partners.
Lines of responsibility have been agreed and progress is monitored closely within a framework of
ADP subgroups.
See 6.1.2
64
9.2 Does your Delivery Plan include details of how
decisions are made on investment of the available
financial resources utilised in prevention,
treatment and recovery?
The ADP Partnership Agreement describes the role of the Commissioning, Performance and Finance
sub-committee in managing decisions on investment and financial control on behalf of the ADP.
The delivery plan illustrates the financial changes required to ensure finances match the priorities
identified.
9.3 How do you foster a culture of collaborative
working and promote effective working
relationships to achieve high levels of performance
and professional standards?
Aberdeenshire ADP Chair holds a three year term. This responsibility is rotated around partners and
at present lies with NHS Grampian. A range of groups take responsibility for aspects of the work of
the ADP and report into the main ADP committee. The partnership agreement lays out how
partners within the ADP work together to achieve high levels of achievement. This agreement is due
for review and will be updated following transition to the next ADP chair.
At a philosophical level, the ADP seeks to work on a collective distributed leadership basis through
consent rather than command and control. This is illustrated by the diversity of partners leading
different parts of the ADP agenda.
The ADP use a range of means to assess need and collectively agree the direction for the
partnership. Evaluative processes identify progress and action plans are monitored for achievement.
Continuous improvement methodologies are used to think, plan, do, study and act so that goals are
met.
9.4 As leaders, how do you secure capacity for
improvement and strive for excellence in the
quality of care, treatment and recovery services for
individuals, their families and other stakeholders?
Identified Good Practice
Relationships within the Aberdeenshire Alcohol and Drug Partnership are cooperative and fruitful. Opportunities are taken to work jointly with others to
make the better use of resources.
A Partnership Agreement that captures the ethos of the ADP founded on ‘parity of esteem’ and influence and persuasion rather than command and control.
Please summarise any actions required to improve aspects of practice/performance
Joint working will continue and develop between all statutory and 3rd sector services.
The Partnership Agreement will be refreshed
Please indicate on the scale below the level of service performance for this Quality Principle.
Unsatisfactory
Weak
Adequate
Good
Good
Very Good
Excellent
65
Summary of identified action to improve aspects of practice/performance in relation to the Quality Principles
Quality Principle
1.You should be able to quickly access the appropriate service
that supports your recovery
Immediate Action
Required
Some Action Required
No Action Required
Timescale
The Single Point of
Access and assertive
outreach will be made
available across
Aberdeenshire.
A communications /
engagement strategy
will be developed that
will include publicity
and website
development.
2. You should be offered high quality, evidence based
treatment, care and support interventions which empower you
in your recovery
Regular development
days will be delivered
to facilitate joint
learning and address
operational issues.
3. You should be supported by workers who have the right
attitudes, values, training and supervision to assist your
recovery
Work to further imbed
processes that will
facilitate movement
through the recovery
journey will be carried
out so that clients are
supported to meet
66
their recovery goals
and connect with the
communities that are
helpful to them.
4. You should be involved in a full, strength-based assessment
that demonstrates choice of recovery model and therapy based
on your needs and aspirations
Training for asset based
and coproduction
approaches will be
delivered. Recovery
coaches will be
involved in the journey
of clients earlier in the
treatment phase. They
will ensure that
recovery goals are
established early and
will be able to pick this
up when the client is
ready.
5. You should have a recovery plan that is person centred and
addresses your holistic health, care and social needs
A recovery pack will be
developed that will
reflect the possibilities
of recovery. Clients will
be encouraged to see
the pack as belonging
to them as a symbol of
their ownership of their
recovery. They may
need to keep the pack
67
at the treatment centre
until they are able to
6. You should be involved in regular reviews of your recovery
plan to demonstrate it continues to meet your needs
All relevant agencies
will be included in
review processes.
7. You should have the opportunity to be involved in an
ongoing evaluation of the delivery of services, at each stage of
recovery
More service user’s
forums will be
developed, so that
more service users are
involved in service
development.
The service user
involvement
questionnaire will be
administered annually.
8.Services should be family inclusive as part of their practice
The services are built
around the service
users individual
recovery needs. We will
do more to involve
families, with the
service user’s
permission. Service
Users will be asked
frequently if they think
that their significant
others have unmet
68
needs that could be
supported. These needs
will be met through
engagement with
appropriate services.
Appendix 1
5h-ADP-Report-on-S
ervice-Users-Questionnaire-Results-2015.pdf
69