“The Road to Recovery
in Forth Valley
1
Contents
1.
Foreword from the SAT Chair.................................................................................................................................................... 3
2.
Executive Summary ................................................................................................................................................................... 5 - 6
3.
Introduction ........................................................................................................................................................................................... 7
4.
The Forth Valley Substance Action Team and Strategic Partnerships............................................ 9 - 10
5.
Our Challenge .......................................................................................................................................................................... 11 - 15
5.1 Tobacco ............................................................................................................................................................................... 11 - 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
The Forth Valley Substance Use Strategy 2009 - 2011
5.2 Alcohol ................................................................................................................................................................................. 12 - 14
5.3 Illegal Substances .......................................................................................................................................................... 14 - 15
6.
Progress to date ..................................................................................................................................................................... 17 - 22
6.1 Culture Change and Communities – pillar 1 .......................................................................................................... 18
6.2 Prevention, Education and Young People – pillar 2 ................................................................................. 18 - 20
6.3 Provision of Support and Treatment Services –pillar 3 .......................................................................... 20 - 21
6.4 Protection, Controls and Availability – pillar 4 ............................................................................................. 21 - 22
7.
What More Needs to Be Done ..................................................................................................................................... 23 - 38
7.1 Preventing Substance Use ....................................................................................................................................... 23 - 26
7.2 Promoting Recovery (through reformed delivery of services) .......................................................... 26 - 33
7.3 Law Enforcement and Criminal Justice............................................................................................................ 34 - 35
7.4 Getting it Right for Children in Substance Misusing Families ............................................................ 36 - 38
8.
Workforce Planning, Facilities Planning and Information-based Approaches .................... 39 - 40
9.
Assuring Delivery, Quality and Fairness ............................................................................................................. 41 - 44
10. Paying for the Strategy ............................................................................................................................................................... 45
11. References................................................................................................................................................................................... 47 - 50
12. Appendices ................................................................................................................................................................................ 51 - 94
1
“The Road to Recovery in Forth Valley” | Contents
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
2
“The Road to Recovery in Forth Valley” | Contents
1. Foreword
1|1
George Eliot
The health and wellbeing of the population of Forth Valley residents is critical to improving the life
circumstances and life expectancy of those who live within our boundaries. Reducing the harm caused
by problematic substance misuse is vital if we are going to make Forth Valley a better and safer place to
live, work and visit.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
“It is never too late to become what you might have been”
One of the major challenges we face in Scotland today is to reduce alcohol related harm. The Forth Valley
area is no different in that respect to any other area. This issue will remain a challenge to all within the
partnership of FVSAT for many years to come.
Tackling drug, alcohol and tobacco problems requires planning at all levels, international, national,
regional and local. Through the development of our strategy ‘The Road to Recovery in Forth Valley’, we
attempt to ‘forward plan’ in line with the current evidence, to ensure
we are providing all that is required to promote recovery within our
treatment system. We are confident that we can tackle these issues
in partnership, reducing over time the damage to communities and
families from the misuse of alcohol and drugs.
We will attempt to invest our resources where the problems are most
visible and disruptive, particularly where it may impact negatively on
the lives of children affected by parental substance misuse. We will
involve the communities themselves, as they need to be engaged and
consulted about the responses the services are providing.
Fiona Mackenzie
Chair of the Forth Valley Substance Action Team
3
Section 1 | Foreword
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
4
Section 1 | Foreword
2. Executive Summary
1|2
One success in particular was the establishment of the Forth Valley Substance Action Team (SAT) – a
unique strategic partnership which considers all substances, tobacco, alcohol and illegal drugs, within
its remit. The SAT has created a structure based on need, encompassing local forums for each council
area, substance-specific groups, such as the Tobacco Action Group, and groups with specific remits,
such as the Critical Incidents Group. In line with recent national guidance from the Scottish Government
local Alcohol and Drug Partnerships will be developed. The previous work undertaken by Forth Valley
Substance Action Team, together with this strategy, provides a sound basis to fulfil the following remits
described by the national framework:
•
provide a clear assessment of local needs and
circumstances, including both met and unmet
needs
•
identify key outcomes relating to drugs and
alcohol misuse, their place within the wider
framework of priority outcomes contained
within Single Outcome Agreements, and how
their achievement will be measured
•
set out clearly and openly the total resource
that each partner is directing to the pursuit of
alcohol and drugs outcomes
•
set out an outline of the services to be
provided and/or commissioned reflecting
the local assessment of need, including
developing a service map which identifies all
services available locally
•
consider issues such as workforce
development and ensure that the workforce is
equipped with the skills to deliver
•
set out an approach for the commissioning
and delivery of services, including preventive
interventions, in pursuit of the outcomes
identified.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
The aims of the Forth Valley Substance Use Strategy are:- to describe the continuing challenge of
substance use in Forth Valley, to celebrate achievements over the past five years, and to set out in broad
terms the direction for the future.
Our Challenge
Substance use is a feature of human existence – a
global phenomenon spanning cultures and all of
history. In Forth Valley, as in the whole of Scotland,
the nature of substance use is changing. Although
tobacco use has declined, an estimated 56,000
people still smoke within Forth Valley. Helping more
smokers to quit and providing an environment in
which people are encouraged not to start would
help reduce this number. However the trend in
alcohol use is upwards. It is estimated that at least
50,000 people in Forth Valley are dependent on
alcohol or drinking at harmful or hazardous levels.
The number of people using illegal drugs is lower,
at an estimated 8,500, but the potential associated
harm is high, especially for around 2,000 problem
drug (mainly heroin) users. A change has been seen
in the types of drugs being used, with increased
cocaine use for example, and a greater tendency
for individuals to use more than one substance.
The range in type of substance used, nature of
the effects, and associated disease burden is large,
leading to many people in Forth Valley being
affected by substance use in some way.
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Section 2 | Executive Summary
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Progress to Date
The Substance Action Team has channelled its
resources into health gain, for those affected by
substance use, through a framework based on
the previous national policy. The partnership has
facilitated major developments in service provision
across both generalist and specialist approaches.
In the support of voluntary organisations such
as Signpost (now Signpost Recovery), the SAT
has facilitated a more comprehensive range of
provision. Steps have also been taken to quantify
the numbers of children in Forth Valley whose
names are on the Child Protection Register and
who are affected by a parent or carer’s substance
misuse.
What More Needs to be Done?
This strategy is based on the four themes outlined
in ‘Road to Recovery – the National Drug Strategy’,
namely prevention, recovery, Criminal Justice and
children and families.
In terms of prevention, efforts will build on existing
good work with children and young people in
schools and develop education of the population.
A better understanding is required of the
underlying factors which lead to substance use,
and how these should be addressed. Working
closely with community planning partners in
targeted areas such as regeneration, and the
inequalities agenda in general, will help in this.
6
Section 2 | Executive Summary
For recovery, treatment services will continue to
be reviewed and developed. Operational
partnerships between services will be
strengthened, including ensuring that everyone is
working to a recovery ethos and person-centred
care. The Treatment strategy involves a major
redesign of substance use services with the aim
of providing more support at the point of need.
Alcohol brief interventions are being emphasised
across a number of settings. Smoking cessation
services will be reviewed, with an aim to increase
uptake of the service whilst maintaining a high
quit rate.
Within the criminal justice section the enforcement
of laws aimed at restricted access and supply will
help. For both alcohol and tobacco there have
been developments in national policy which
require local support and enforcement when
made law. Greater input for all substances for those
in contact with any part of the criminal justice
system is envisaged. There is scope to work even
more closely with community safety partnerships.
For children and young people living in substance
misusing families, the focus will be to build on
existing work to address prevention and early
detection, and to identify and manage risk.
3. Introduction
1|3
The Forth Valley
Substance Action
Team and Strategic
Partnerships
•
A vision statement/ mission statement for Forth Valley agreed by the SAT
•
An overview of the SAT, its remit and structure, and how it functions.
•
Summary of links to other strategic partnerships
Our Challenge:
•
An overview of the issue of substance use in Forth Valley and the burden
to the population.
Progress to date
•
A summary of the achievements of the SAT over the last decade, in terms
of involvement of stakeholders, service development and outcomes for
clients. (Section 6 and Appendix 4)
What more needs to
be done?
•
A summary of the outcomes visioning work and current development
plans/ strategies within SAT. (Section 7 and Appendices 5 and 8)
Workforce Planning,
Facilities Planning and
Information-based
approaches
•
A review of all contributors to the substance use agenda that could be
described as providers,
•
A summary of current staff and their attributes,
•
A review of likely needs in relation to workforce development and a plan
for this development.
Assuring Delivery,
Quality and Fairness
•
An overview of performance management arrangements, monitoring
and evaluation
Paying for the
Strategy:
•
An overview of mechanisms for agreement of development plans,
including funding and implementation.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
This paper gives a summary of the Forth Valley Substance Use Strategy 2009-2011. It consists of the
following:
At various points in the paper it is necessary to separate out work, based on the type of substance in
question - illegal substances, alcohol and tobacco.
7
Section 3 | Introduction
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
8
Section 3 | Introduction
4. The Forth Valley Substance Action
Team and Strategic Partnerships
The Substance Action Team1 is a multi-agency partnership, reporting directly to the Scottish Government2,
established to implement and respond to national strategy on drugs, alcohol and tobacco and volatile
substances.
The following is the mission statement of Forth Valley Substance Action Team:
“We will strive towards a future for the population of Forth Valley where people have a sense of wellbeing
and purpose without the use of harmful substances.”
This translates to a set of principles, which the SAT
works to, as follows:
•
We work to an ethos of prevention and
education, and minimising harm relating to
substance misuse
•
Child protection is of paramount importance
•
We aim to work in a flexible and pro-active
way
•
Our approach is based on partnership working
•
We aim to be client-centred, meeting
individual needs in a non-judgemental way
•
We endorse and adopt the recovery principle
•
Employability subgroup
•
Prescribing and Treatment Sub-group
•
Young Person’s sub-group
•
Family Support Network and Communities
Sub-group
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Forth Valley Substance Action Team
1|4
A diagram showing the organisational structure
of the SAT (August 2009) and subgroups can be
found in Appendix 1.
The SAT also has a planning role, and forms the
main governance system by which this strategy
will be implemented, linking in to the governance
arrangements for individual agencies and
organisations.
The work of the SAT takes place within the
following forums and sub-groups:
•
Substance Misuse Forums for
Clackmannanshire, Falkirk and Stirling
Strategic Partnerships
Beyond SAT
•
Finance subgroup
Scottish Government
•
Health Reference Group
•
Critical Incident Group
•
Education and Prevention Group
•
Process of Care Group
•
Data Sharing Group
With the recent change in Scottish Government
has come an emphasis on the economy, to the
extent that most of the stated ‘purpose targets’3
are related to growth and participation in
employment and income. There is a close
relationship between substance use, health
and economic aspects such as employability,
•
Tobacco Action Group
9
Section 4 | The Forth Substance Action Team and Strategic Partnerships
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Alcohol & Drug Partnership
Strategy Documents
income and productivity. In general, deprivation
predisposes to substance use, and conversely
substance use tends to reduce an individual’s
capability in terms of employment and income.
In addition the Scottish Government has five
strategic objectives4. These are to make Scotland
‘safer and stronger’, ‘greener’, ‘healthier’, ‘wealthier
and fairer’, and ‘smarter’.
Substance use is an issue across all of these
objectives, but in particular is related to health,
community safety (‘safer and stronger’), and
employability (‘wealthier and fairer’).
The Scottish Government Health Department has
introduced and modified a system of indicators
for the functioning of NHS Board areas. (The HEAT
indicators5 cover Health Improvement, Efficiency,
Access, and Treatment). The HEAT indicators
relevant to substance use relate to reducing
smoking and alcohol consumption. In addition
there is now a target on access to treatment
services.
Appendix 2 summarises the key outcome
indicators relevant to substance use that FVSAT
are working to.
The Scottish Government has produced a number
of strategies relating to substance use and these
are listed in Appendix 3.
Local Authority and Community
Planning Partnerships
Each local authority has a responsibility to develop
a Single Outcome Agreement (SOA)6 initially, with
responsibility transferring to Community Planning
Partnerships over time. SOAs will vary between
Local Authority areas, but all will include objectives
relevant to substance use.
10
Section 4 | The Forth Substance Action Team and Strategic Partnerships
Local NHS planning
NHS Forth Valley produces a Local Development
Plan and a Local Health Plan each year, incorporated
within a Corporate Plan7. This describes how
the HEAT targets are to be met, and includes
the identification of and delivery against local
priorities. In addition there is monitoring of activity
and planning within and between Community
Health Partnerships (CHPs) and the acute sector.
Local partnership approaches
Each local authority may produce a Joint Health
Improvement Plan (JHIP)8,9,10 often in relation to
community planning. JHIPs will often prioritise
substance use issues. The Substance Misuse
Forums are integral to developing plans to address
substance use issues in each local authority / CHP
/ CPP area and under new national guidance will
become Alcohol and Drug Partnerships.
Other strategic partnerships of relevance locally
include:
•
Forth Valley Health and Homelessness
Steering Group
•
Forth Valley Mental Health Delivery Group
•
Forth Valley Child Protection Action Group
•
Forth Valley Blood Borne Virus Strategy Group
•
Forth Valley Oral Health Strategy Group
•
Licensing Boards and Substance Misuse
Forums of Local Authorities
•
Youth Partnerships Forums
•
Forth Valley Sexual Health Steering Group and
local council implementation groups
•
Local Domestic Abuse Forums
5. Our Challenge
1|5
We must rely on the WHO (World Health Organisation) Burden of Disease Programme of 200011 to provide
an estimate of burden to the population of Disease (in the absence of a Burden of Disease and Risk Factor
Study for Scotland). The WHO programme estimates that for Western European populations, tobacco
use accounts for about 24% of the burden of all risk factors, alcohol 13% and illicit substances 4%. All
substance use is therefore associated with a significant burden to the population. Illegal drug use causes
significant devastation to individuals and families. By this measure the impact of legal substance use is
even greater.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Substance use and related disease in Forth Valley impact on the population in terms of mortality and
morbidity, and have effects which are physical, psychological and social.
The following paragraphs give an overview of the burden to the Forth Valley population relating to
substance use.
5.1 Tobacco
Tobacco use in those aged 16 years and over in
Forth Valley can be summarised using data from
the Scottish Health Survey, 200312:
•
Never smoked cigarettes at all ..........................49%
•
Used to smoke cigarettes occasionally ...........5%
•
Used to smoke cigarettes regularly ................21%
•
Current cigarette smoker ......................................24%
Using these percentages there are approximately
56,000 current adult smokers in Forth Valley.
The Tobacco Atlas13, based on 2001 census and
2003/04 Scottish Household Survey gives an
estimate which is slightly higher at 60,000.
Smoking prevalence in Forth Valley is highest in
the 25–34 age group and drops progressively in
older age groups.
The impact of smoking tobacco is huge. It is
associated with a range of diseases, the level of
increased risk varying depending on the disease.
Most cases of lung cancer are likely to have been
caused by smoking for example. In addition,
smoking is associated with the development of
cancers of the mouth and throat, stomach, bowel
and bladder.
New cases per year 15
Lung cancer
240
Colorectal cancer
170
Cancer of the head and neck
55
Stomach cancer
57
Cancer of the oesophagus
38
Young People
Using alcohol and tobacco together also greatly
increases the risk of developing oral cancer.
The Scottish Schools Adolescent Lifestyle and
Substance Use Survey (SALSUS)14 report, 2006
estimates that in Forth Valley, 5% of 13 year olds
are regular smokers increasing to 15% at the age
of 15 years.
Smoking also causes chronic obstructive
pulmonary disease (COPD). Evidence from primary
care disease registers16 suggests a prevalence of
about 5,000 people in Forth Valley with a diagnosis
of COPD.
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Section 5 | Our Challenge
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Smoking significantly increases the risk of heart disease, and there are about 15,000 Forth Valley residents
on a coronary heart disease (CHD) register16.
The Scottish Smoking Ready-Reckoner17 estimated that in any single year there are 591 deaths in Forth
Valley that can be attributed to smoking; 2,900 admissions to hospital and an overall cost to the NHS of
£8M.
In addition tobacco use, especially in young people, predisposes to the use of other substances especially
cannabis. Tobacco use in young people is the best predictor of illegal drug misuse in later life, due to the
frequency in which cannabis is used with tobacco.
Inequalities in tobacco use
The tobacco atlas13 illustrates variation in smoking prevalence between areas within the three CHPs,
relating to deprivation:
Area with highest prevalence
%
Area with lowest prevalence
%
Clackmannanshire Alloa South and East
36.6%
Dollar and Muckhart
14.4%
Falkirk
Bowhouse
39.9%
Bantaskin
16.8%
Stirling
Raploch
32.6%
Blane Valley
13.0%
5.2 Alcohol
Estimates of weekly alcohol use in Forth Valley
from the Scottish Health Survey 200312 are:
•
29% of men consume 8 or more units on the
heaviest drinking day
•
•
28% of women consumed 3 or more units on
the heaviest drinking day
•
12% of women consumed 6 or more units on
the heaviest drinking day
Consuming over 14/21 units
(recommended limit) ..............................................17%
•
Consuming over 35/50 units .................................5%
In terms of units consumed on the heaviest
drinking day, the Scottish Health Survey gives the
following estimates:
•
49% of men consume 4 or more units on the
heaviest drinking day
12
Section 5 | Our Challenge
These are likely to be under-estimates as true
alcohol consumption can be of the order of 50%
higher than the self-reported figure.
1|5
Males
Females
All
Dependent
5,400
1,900
7,300
Hazardous or
harmful
29,000
14,400
43,400
Low risk drinker/
Non-drinker
56,200
79,500
135,700
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Estimates of the prevalence of type of drinking behaviour18 give the following for the number of Forth
Valley residents aged 16-64 years in each category:
This can be illustrated using a pyramid:
Alcohol drinking behaviour categories: estimated number in Forth Valley residents aged 16-64
13
Section 5 | Our Challenge
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Service Access Data
5.3 Illegal Substances
In 2004/05 of the 1,485 alcohol related discharges
of residents (all ages) in Forth Valley19:
The study “Estimating the National and Local
Prevalence of Problem Drug Misuse in Scotland”20,
referring to the year 2003, indicates that there
are likely to be 1,866 problem drug users in Forth
Valley at any one time. Data from Forth Valley
services suggest that at any one time about 700
individuals are current clients.
•
23% (340 discharges) were for acute
intoxication
•
22% (320 discharges) were for harmful use
•
16% (235 discharges) were for alcoholic liver
disease
In 2004 there were 72 deaths registered in Forth
Valley19 in which alcohol was a known underlying
or contributing cause of death, accounting for
2.4% of all deaths.
Data from the Forth Valley Adult Health and
Lifestyle Survey 200421 provides some estimate of
the (self-reported) use of illicit substances in those
aged 16-74 years in Forth Valley, as follows:
•
About 8,500 Forth Valley residents have used
some form of illegal substance recently
•
The SALSUS survey 200614 estimates that in Forth
Valley 16% of 13 year olds, and 34% of 15 year
olds reported consuming alcohol in the previous
week.
There are about 7,200 cannabis users, 2,200
ecstasy users, 1,900 cocaine users, 1,600
amphetamine users in Forth Valley.
•
At any one time approximately 800 people
use hallucinogens, 700 use benzodiazepines,
300 use cocaine, and 300 use solvents
Inequalities in alcohol use
Where information is available on Forth Valley
residents attending substance use services22,
it shows that about half have physical health
problems, and half mental health problems.
Young People
Data on health inequalities in terms of
consumption are not available. However,
admissions data19 show a large gradient with
deprivation. In 2004 in Forth Valley there
were 22 alcohol related discharges per 10,000 in
the first quintile of deprivation and 106 per 10,000
in the fifth quintile.
14
Section 5 | Our Challenge
Hepatitis C is predominantly contracted through
the practice of sharing injecting equipment , and
in Forth Valley there are about 80 new cases per
year23.
Drug Related Deaths
The SALSUS14 survey 2006 estimates that In Forth
Valley, 5% of 13 year olds have used drugs in the
last month compared with 15% of 15 year olds.
Additional information shows that 13% of 13 and
15 year olds in Forth Valley had used cannabis in
the last year; 7% had used stimulants in the last
year, 2% had used psychedelics and 1% had used
opiates (heroin, methadone).
General Register Office for Scotland (GROS)
reports that in 2007 there were 26 drug related
deaths in Forth Valley24. As the numbers in Forth
Valley are relatively small it is difficult to draw
definite conclusions, but, in common with the rest
of Scotland, there seems to be an increasing year
on year trend. The main cause of death tends to be
heroin overdose and deaths tend to be in males
aged 25 to 34 (with a trend to the average age of
death increasing). There is growing concern due
to the number of deaths where alcohol has been
consumed.
Criminal Justice
In 2006 the legal situation for new clients was such
that 36% were at liberty pre adjudication, and 9%
at liberty post conviction. In addition 45% reported
that they had previously been in prison22.
The use of illicit substances often leads to crime of
property. It is thought that most crimes of property
are substance related. In terms of crime related
directly to illicit substances, there are about 600
offences of possession with intent to supply, and a
further 1,400 offences of possession in Forth Valley
each year22.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Young People
Inequalities in illegal
substance use
The Forth Valley Adult Health and Lifestyle survey
for 200421 showed that there were inequalities
in illegal drug use, but the gap seemed to be
narrowing with 4.9% of respondents in areas of
high deprivation reporting having used illegal
drugs, compared with 3.7% in the least deprived
areas. There is little doubt however that problem
use of illegal substances is associated with poorer
economic circumstances. Substance use is also
an issue of inequality. Addressing substance use
helps to address inequalities, and likewise, tackling
deprivation is likely to impact on substance use.
15
Section 5 | Our Challenge
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Alcohol & Drug Partnership
Strategy Documents
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Section 5 | Our Challenge
6. Progress to Date
1|6
•
An approach based on the four pillars:
1. Culture Change and Communities,
2. Prevention, Education and Young People,
3. Provision of Support and Treatment Services
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Progress on substance use issues in Forth Valley over the last decade can be summarised as follows:
4. Protection, Controls and Availability25
•
Continued development of the SAT partnership and delivery structures
•
A commitment to consider the relationship between all substances, including illegal drugs, alcohol
and tobacco, and the impact on risky behaviours.
•
Development and implementation of an Annual Corporate Action Plan as required by the previous
Government.
•
Specific redesign and major development of local drug services, especially in the voluntary sector,
e.g. Signpost Recovery.
•
Organisation of services through a tiered model - where higher tiers tend to be more specialised
Although we are moving towards the four themes described in the new drugs strategy26, it is appropriate
to review the work done thus far under the 4 pillars as this is what we have been working to. The following
sections describe in more detail the progress to date under the four pillars.
17
Section 6 | Progress to Date
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
6.1 Culture Change and
Communities – Pillar 1
6.2 Prevention, Education
and Young People – Pillar 2
Progress on culture change and communities has
been made through the three local substance
forums, established in 2001. Within the Corporate
Action Plan27 (CAP) - the main emphasis previously
has been on reducing harmful and hazardous
alcohol consumption, and reducing alcohol and
drug related crime, by providing information
and publicity about the risk of harm relating to
substance use.
Progress to date in relation to prevention is
indicated by the following:
In terms of changing attitudes towards the use
of alcohol and illegal drugs, as implied by current
prevalence of substance use and trends, success
has been limited. However for tobacco use there
have been two major successes:
•
•
•
Increased awareness of, and commitment
to, prevention and education with regard to
tobacco, alcohol and illicit drugs, amongst all
service providers
•
A greater emphasis on child protection
•
The setting up of a prevention and education
subgroup
The following paragraphs provide more detail on
progress to date in relation to:
•
General prevention and education work
National legislation28 and local enforcement in
relation to smoking in enclosed public places,
such that this is now not only illegal but also
socially unacceptable
•
Child Protection
•
Young People’s service
National No Smoking Day29 – an annual event
which has built year on year to a major event
raising awareness
Schools
Changing culture is difficult. As an objective in itself
it is not particularly SMART30 (specific, measurable,
attainable, realistic and timely). Culture means
different things to different people so it is not
specific, it is difficult, if not impossible, to measure,
and changes through the sorts of inputs that are
feasible, are unlikely to be attainable or realistic.
In terms of future work culture change will come
under a broader preventative approach.
18
Section 6 | Progress to Date
Much progress has been made in developing
work on prevention and education in schools.
For the first time Curriculum For Excellence
offers an opportunity within the school/nursery
community to share the responsibility for health
and wellbeing. Schools and nurseries make a
significant contribution to prevention through
specific learning programmes and also through
opportunities for wider learning, developing
qualities of resilience and adaptability, and good
spiritual health. Children and young people need
to receive credible, accurate information in order
to make informed choices. This work has been
taken forward largely through the development
of Health Promoting Schools31. In particular Smoke
Busters raised the profile of tobacco use as a health
issue in schools.
1|6
Raising awareness of, and addressing issues
relating to, substance misuse will also be a priority
for many workplaces throughout Forth Valley.
Through ongoing development of the Healthy
Working Lives32 programme, workplaces will
be supported to develop supportive substance
policies and to implement activities that promote
a reduction in alcohol and drug consumption in
the workplace and support onward referral.
Community
One of the partnership’s priorities in an attempt to
reduce drug related death will be to continue to
facilitate the Drugs and Alcohol First Aid Initiative
(DAFAI). Community involvement is of paramount
importance here,
Providing training to individuals from a wide range
of settings can promote a greater understanding
of how to prevent death from drug and alcohol
overdose. This training offers advice on what action
can be taken by individuals to assess and reduce
risk, and promote life support skills to service users,
carers and their families.
In summary there is a range of excellent work
across Forth Valley. This needs to be mainstreamed
more to achieve greater equity across the settings
of schools, communities and workplaces.
The Child Protection agenda is supported by SAT
across both operational and strategic forums with
joint policies and protocols being developed across
Critical Partnerships to improve the efficiency
and consistency of information sharing. Child
Protection training is mandatory for all substance
misuse services affiliated to, and commissioned
by, the SAT and robust child protection policies
are a requirement of compliance with the National
Quality Standards for Substance Misuse Services.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Workplace
The number of children on Child Protection
Registers in the three local authority areas who
are affected by a parent or carer’s substance
misuse will vary from month to month. Children
appear on, or are removed from, the register as
their circumstances change and all three local
authorities’ registers will change regularly as a
result. However, the table below shows a ‘snap
shot’ as of August 2009. Child protection workers
have indicated that while the numbers will
fluctuate, the overall proportion of children on
the register who are affected by substance misuse
remains relatively constant. It should be noted that
there is a higher proportion of children affected
in Clackmannanshire. This is partly due to a slight
variation in recording, but is mainly attributable to
the higher rates of substance misuse in the area
when compared to Stirling and Falkirk.
Clackmannanshire Falkirk
Stirling
52
86
41
Child Protection
Number of children
on the Child
Protection Register
Over the last few years there has been an
increased awareness of parental substance misuse
issues in relation to the impact on children. The
child protection agenda has been particularly
emphasised and prioritised.
Number who are
registered primarily
due to parental /
carer substance
misuse
42
29
13
19
Section 6 | Progress to Date
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Young People’s Services
Illegal drugs
Services for children and young people have been
developed, including the following:
We have set up or made improvements in the
following services:
•
Connect Services for Young People
•
Psychology service
•
Barnardos Axis Service Falkirk
•
Moodjuice – addiction website34
•
Clackmannanshire Young Persons Nurse
•
Community Pharmacy Service
•
Freagarrach Stirling Alcohol and Drug Service
•
Grangemouth Family Substance
Abuse Support;
•
Locals Against Drug Abuse (LADA)
•
Stirling Family Support Service
•
Signpost Recovery
•
General Practitioner Prescribing Service (GPPS)
•
Community Alcohol and Drug Service (CADS)
•
Forth Valley Criminal Justice Drug Treatment
Service
•
Addictions Support and Counselling (ASC)
•
Progress 2 Work
•
Community Rehabilitation. – Go Forth
•
Inpatient Detoxification
•
Connect Services
•
Freagarroch – Falkirk, Stirling
•
Young Person’s Nurse – Clackmannanshire
•
Harm Reduction Service
•
Hepatitis C Treatment Service
6.3 Provision of Support
and Treatment Services
– Pillar 3
One of the main areas of focus of the Substance
Action Team has been service provision. There have
been many developments and re-design projects,
across partner organisations and sectors, in the
past 10 years. In particular the role of Signpost
Recovery33 has developed significantly. Other
recent developments include the development of
an agreed treatment strategy promoting a range
of prescribing options.
More detail on progress to date is presented in
appendix 4. The following paragraphs list the
major areas of development in relation to illegal
drugs, alcohol and tobacco. Many services address
problems relating to both alcohol and illegal
drugs. Between them these services combine
a range of interventions including replacement
prescribing, medication to reduce the symptoms
of dependence, psychological approaches aimed
at changing behaviour, social and other means
of support and help with skills development and
improving employability.
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Section 6 | Progress to Date
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Tobacco
We have set up or made improvements in the
following services:
The main progress made has been in establishing
and developing smoking cessation services across
Forth Valley. These include:
•
Community Pharmacy Service
•
Grangemouth Family Substance Abuse
Support
•
Locals Against Drug Abuse (LADA)
•
Alcohol Link
•
Stirling Family Support Service
•
Brief Intervention
•
Addiction Support and Counselling (ASC)
•
Community Alcohol and Drug Service (CADS)
•
Alcohol Liaison Service
•
Forth Valley Criminal Justice Drug Treatment
Service
•
ASC Go Forth
•
Employment Connections
•
Progress 2 Work
•
In-patient Detoxification
•
Connect Services
•
Young People Nurse –Clackmannanshire
•
Freagarrach – Stirling, Clackmannanshire
•
Locality clinics
•
Drop-in sessions
•
A smoking cessation service for the acute
setting
•
Smoking cessation work through general
practices
•
Smoking cessation work through pharmacies
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Alcohol
In addition many of the services listed under
alcohol and illegal drugs provide smoking
cessation advice.
6.4 Protection, Control
and Availability
Within Forth Valley good progress has been made
on limiting access to substances and upholding
the law.
Illegal drugs
Central Scotland Police (CSP) have used tactics
such as Operation Overlord to address substance
use and drug dealing at all levels. Members of the
CSP Drugs Unit work closely with other agencies
in an effort to ensure that the activity of drugs
dealers operating in the CSP area is disrupted as
much as possible.
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Section 6 | Progress to Date
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Responding to intelligence, Drugs Unit Officers
operate with their colleagues in the Tactical Crime
and Drugs Unit and at local police stations to
tackle drug suppliers.
The public are protected from the risks associated
with needle and drug paraphernalia discardation,
by setting up a data collection system, and feeding
in to the FV Blood Borne Virus Strategy Group
and individual Community Safety Partnerships to
inform local action.
Alcohol
A test purchasing scheme for alcohol is one means
by which Central Scotland Police can ensure the
law on alcohol sales is enforced.
A number of test purchase initiatives have taken
place throughout Central Scotland and where
premises have been found to have sold alcohol
the relevant report to the Procurator Fiscal will be
made.
Central Scotland Police developed an Alcohol
Fuelled Disorder Strategy in December 2007 to
tackle public space and night-time economy
disorder. Included is a victim centred approach and
the need to provide reassurance to communities.
Community Safety Partnerships within Forth
Valley have in some areas developed problem
solving partnerships aimed at reducing anti-social
behaviour related to alcohol consumption.
22
Section 6 | Progress to Date
The establishment of new Licensing Boards and
forums35, with a recognised objective for Public
Health has helped in ensuring that freedom of
access to alcohol is appropriate. These now balance
the needs of the population for entertainment
and an opportunity for socialising, and the needs
of providers to have successful businesses, against
the health risks of alcohol consumption to the
population. The establishment of a court based
arrest referral scheme has seen many people move
into treatment and support services.
Tobacco
In terms of legislation the major success of
recent years has been the introduction of a ban
on smoking in public places28. Compliance has
been good, but monitoring and enforcement is
required. The full impact of this change has yet
to be quantified, but smoking cessation services
noticed an increase in activity in the immediate
aftermath of the ban.
In addition Trading Standards departments have
put in place test purchasing schemes in Forth
Valley. Retailers who sell cigarettes to the young
volunteers will be sent a warning letter or be
reported to the Procurator Fiscal depending
on the circumstances. Those retailers who do
not sell to the young people are sent a letter of
congratulations by Trading Standards but are also
warned that they may be the subject of further
test purchases.
7. What More Needs to be Done?
‘The Road to Recovery’ National
Drug Strategy26 - Four Themes
7.1 Preventing
Substance Use
The recently published national drugs strategy,
the Road to Recovery, very much emphasises
prevention and recovery – and focuses on four
key themes (rather than the four pillars previously
used).
Prevention is a key part of the Scottish Government’s
approach to substance use and an established
principle of SAT.
The recently established
prevention and education sub-group will
have an over-arching role in developing
this work further in Forth Valley. The key
themes from the national policies seem to
be 26 36 37:
1. Preventing Substance Use
2. Promoting Recovery (through reformed
delivery of services)
3. Law Enforcement and Criminal Justice
4. Getting it Right for Children in Substance
Misusing Families
This section describes what more needs to be
done in Forth Valley, and is organised around
these four themes. The sub-headings within
each theme are based on an interpretation of
the Road to Recovery, and recent national policy
documents on alcohol and tobacco where
relevant.
•
Understanding the natural history of
substance use
•
Provision of information and education
•
Moving towards changing beliefs and values,
behaviour and culture
•
Settings approach: Home, community,
schools, workplace, care settings
•
Addressing wider determinants/ issues
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Over the last year or so there has been much preparatory work considering where we are with substance
use and services, and considering where we want to be. A ‘visioning paper’ has been produced for the
SAT. This was based on a brief stakeholder analysis and compared where we are with best practice and
evidence in relation to illicit substances, tobacco and alcohol. (See appendix 5 for a summary of gaps
identified in the visioning work). The visioning work identified that there was a need to undertake a more
formal assessment of need, which will commence soon.
1|7
(Appendix 6 outlines a brief description of each
theme. Appendix 7 is a table which applies the
themes from the Road to Recovery to each
substance type of interest, incorporates themes
from Scotland’s Relationship with Alcohol36, and
Scotland’s Future is Smoke-Free37, and considers
whether there is sufficient commonality for all
substances to be considered together under each
theme)
23
Section 7 | What More Needs to be Done?
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Understanding the natural
history of substance use
Within Forth Valley we need to keep up to date with
research on the natural history of substance use,
and implications for prevention. Experimentation
with the use of alcohol and illegal substances
(including volatile substances) carries risk of harm
or death in itself; and for all substances (especially
tobacco) experimentation can lead to regular
use. Ultimately we need to ensure that those
choosing to use substances are fully informed of
the risks of immediate and longer term harm and
of progression to dependence and its associated
problems.
Provision of information and
education
The provision of information forms a key part of any
preventative approach. Education means going
beyond simply providing information, but also
making sure it is retained and understood (in the
hope that this knowledge influences behaviour).
The school is probably the most important setting
in regard to education, and the recent national
Health Promoting Schools31 drive has moved
health higher up on schools agendas and further
developments on this front continue. The Schools
(Health Promotion and Nutrition) (Scotland) Act
200738 and the introduction of Curriculum for
Excellence39 now ensure that health and wellbeing
is an integral part of the school improvement
and quality assurance processes. These national
developments encourage schools to develop a
holistic approach to promoting and protecting the
physical, social, emotional and mental wellbeing
of pupils, staff and the school community.
24
Section 7 | What More Needs to be Done?
Substance education curriculum
includes learning experiences
which:
•
develop knowledge, skills and understanding
in relation to substance use and misuse
•
explore and debate values, attitudes and
behaviours
•
understand the impact of risk taking
behaviour on life choices
•
help make informed personal choices which
will keep children/ young people safe and
healthy
Substance use education is therefore an essential
element of this holistic approach to health.
Our schools will be supported to deliver high
quality, developmental learning opportunities
and experiences on substance use that respond
to the needs and priorities. Staff will be offered
a programme of continuous and flexible staff
development, which builds on current research
and addresses local needs.
Examples of work to be developed include
•
Review of the health education framework for
Clackmannanshire educational establishments
•
A research project on Social Norms and
alcohol consumption with young people
•
The development of an interactive approach
to tobacco and alcohol use in Stirling’s
McLaren Cluster as part of the primary/
secondary transition process.
1|7
Moving towards changing
beliefs and values, behaviour
and culture
Providing information may improve knowledge,
but does not necessarily alter beliefs and values
and thereby behaviour. Linking to the mental
wellbeing agenda there is still potential to take a
more holistic approach aimed at improving things
like self-confidence, resilience and inter-personal
relationships. This applies across all age groups,
but for children fits in with the curriculum for
excellence39 within schools.
However, awareness-raising campaigns remain a
large part of national policy on changing attitudes
and thereby behaviour. We need to continue to
work on awareness-raising across all substances,
in particular through the following:
•
Illegal drugs – Know the Score Campaign
•
Alcohol – National Alcohol Awareness Week
•
Tobacco – National No-Smoking Day/ Week29
•
Mental Health Awareness Week
•
Choices for Life
Relevant and up-to-date resources and materials
will be readily accessible through our Health
Information and Resources Service42 to a wide
range of practitioners to facilitate ongoing delivery
of substance use education and prevention.
Settings approach: Home,
community, workplace, care
settings, schools and other
education settings
A focus for us over the next five years will be to
work in partnership with workplaces and
community groups to provide information
and raise awareness but also undertake brief
intervention with heavy non-dependent drinkers
with a view to supporting behavioural change.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Education is not limited to children and schools
however. The visioning work identified peer
education as a gap, (applying across all settings,
and relating to all substances) which needs to be
explored. In addition targeting information needs
at users of substance use services and their carers
is also important.
The Healthy Working Lives32 programme supports
workplaces to consider alcohol issues and policies.
A further partnership priority is to deliver our Drugs
Awareness First Aid Initiative (DAFAI) throughout
the community. This training is offered across a
wide range of agencies and settings to develop a
greater understanding of drug related overdose
and to promote life support skills.
Promoting positive mental health and wellbeing
is central to the prevention of substance misuse.
There is commitment to increasing the number of
trainers equipped to deliver the Scottish Mental
Health First Aid Programme43. This will enable key
stakeholders to access this nationally accredited
training which aims to reduce suicide and selfharm and to promote positive mental health.
Working with voluntary organisations across Forth
Valley to raise awareness of alcohol and substance
issues was identified as a gap in the visioning
exercise, and will be addressed.
In terms of tobacco we aim to develop a smokefree homes programme. Again this requires a
partnership approach, working across disciplines,
and perhaps a greater diversity of methods than
we have used previously.
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Section 7 | What More Needs to be Done?
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Addressing wider determinants/
issues
The wider determinants in substance use
include deprivation (including homelessness),
employment and again the mental wellbeing
agenda. We will work with Local Authorities44,45,46
and Community Planning Partnerships47,48, 49
to develop and implement Single Outcome
Agreements 6 which will address these wider
determinants of substance use.
In particular, we will continue to support Street
Sport and WISH to engage people across the
Forth Valley area in programmes and activities to
offer alternatives to exclusion, substance use and
crime. The Street Sense programme will continue
to be rolled out, engaging former users as peer
educators working with young people in a variety
of settings.
These are good examples of programmes which
provide diversionary activities, and there is perhaps
more that we can do in this area.
7.2 Promoting Recovery
(Through Reformed
Delivery of Services)
This section considers what more should be done
in Forth Valley to identify and meet the needs of
people with problems relating to substance use,
through the provision of services, and via other
contributors. Following the ‘Road to Recovery’26, it
consists of
•
a review of the recovery ethos and person
centred care
•
a summary of plans for developing treatment
and rehabilitation services for each of illegal
drugs, alcohol and tobacco
•
considering how to strengthen the
connections with other services (including
generic services) and relevant stakeholders
•
blood borne viruses, and
•
drug related deaths
The recovery ethos –
an explicit principle
An ethos of recovery is stated explicitly within
the principles of the Substance Action Team.
Contributing services may need to revisit this
ethos, and consider what it means in action. It is
most relevant to opiate addiction, and also applies
to severe problem alcohol use, but is less relevant
in smoking cessation. This was emphasised in
the visioning work which identified a need for a
more holistic, needs-led, flexible approach. This is
compatible with the new national strategy.
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Section 7 | What More Needs to be Done?
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Individual care plans are appropriate for alcohol
and illegal drugs, especially where needs are likely
to be long-term and complex; and tobacco to a
lesser extent.
Care plans should include the following.
•
holistic assessment of their needs
•
agreed outcomes (goals)
•
regular review
A review of care planning will be delivered through
the developing treatment strategy and embedded
in the work plan of the process of care group.
Range of Treatment and
Rehabilitation Services
We will continue to develop the range of treatment
and rehabilitation services as follows:
•
Illegal substances – through the Treatment
Strategy and development plans for each of
the services.
Assessment
It is important to remember that provision of help
depends on identification of a problem or need –
through some form of assessment. All contributing
stakeholders have a role in assessment, which
may be quite opportunistic. For example NHS
service staff when in contact with patients should
consider substance use – smoking, alcohol use,
or the use of illegal substances – as a potential
issue. The development of a Health Promoting
Health Service is key to this approach, which
supports early intervention and the identification
of problems.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Person-Centred Care and the
Individual care plan
The national strategy describes the range of
treatment services as:
•
Community Rehabilitation,
•
Prescribing substitute drugs,
•
Detoxification and relapse prevention
programmes,
•
Residential rehabilitation,
•
Harm reduction services
•
Crisis services.
•
Alcohol services – through the development
of an alcohol strategy, encompassing the
elements described below.
The following paragraphs describe what more
could be done in Forth Valley on each of these
where appropriate, for each of illegal drugs, alcohol
and tobacco:
•
Tobacco – through the development and
integration of smoking cessation services, and
allocation of smoking cessation monies.
Illegal Drugs
The further development of the range and
provision of treatment and rehabilitation will be
taken forward through the SAT action plan, the
treatment strategy and development plans for
each service. The following paragraphs aim to give
a direction of travel based on the visioning work
and national policy.
27
Section 7 | What More Needs to be Done?
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Type of Substance – illegal substances
There is a need to consider substances other than
opiates and benzodiazepines, such as:
•
Cocaine
•
Amphetamine
•
Crystal methamphetamine
•
Hallucinogens
•
Crack cocaine
•
Cannabis
•
Volatile substances
Each can be associated with problem use
which may range from risk of death from acute
intoxication, to longer-term problems with or
without dependence. For services which aim
to provide input relating to all substances there
needs to be a systematic review of what is actually
available, and how this compares to best practice.
Specific client groups – illegal substances
The visioning work and comparison against
standards, showed that there is a need to
continue development in working with specific
client groups such as drug using pregnant women,
drug users with severe enduring mental illness.
Community Rehabilitation – illegal
substances
This will be addressed though developments
(including co-ordination, key working, outreach
services and psychosocial interventions) in specific
services like CADS, Signpost Recovery and ASC.
This also links to the need to effectively integrate
with other services relating to employability.
Befriending / advocacy services, structured
counselling (internet counselling) and family
support were identified as areas for development
which could be incorporated into community
rehabilitation. Also the visioning work suggested
looking at Substance Misuse Nursing in the
three Local Authority areas. Equity of access and
expansion of psychology services are also required
to be reviewed.
Prescribing substitute medicines – illegal
substances
Developments in substitute opiate prescribing will
be taken forward through the new Forth Valley
treatment strategy, and include development
in pharmacy provision, data recording, and GP
prescribing, described below:
Pharmacies form a crucial part of the prescribing
based management of problem use of illegal
substances. There is a need to ensure the
availability of private areas in all pharmacies for
supervised consumption of medicines. Patient
education, communication and support for
pharmacy services is critical to an integrated care
model.
SMR (Scottish Morbidity Records) 25 forms are
completed for episodes of treatment before being
submitted electronically by the services to ISD.
The data informs ISD’s national data base which
28
Section 7 | What More Needs to be Done?
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In terms of the GP prescribing service the vision for
the future consists of the following:
•
To increase the number of participating
GPs, to ensure equity across Forth Valley
by developing the model of community
prescribing (ref )
•
Commissioning of Local Enhanced Services
with GPs and/or other providers should
ensure there is an appropriate level of service
capacity given local needs to provide coordinated and holistic care.
•
To develop GP Prescribing Service (GPPS) to
incorporate non medical prescribing
•
To maintain effective referrals pathways to and
from all substance related services in Forth
Valley
•
To maintain quality and effectiveness of
service in line with National Quality Standards
•
To develop and implement appropriate
training for GPs, health centre staff,
Community Pharmacists and keyworkers
•
To develop the service to offer buprenorphine
as options for treatment for opiate users
Detoxification and relapse prevention
programmes – illegal substances
Detoxification and relapse prevention already
form a key part of the treatment and support. The
development of the Forth Valley Tox programme
was innovative due to the fact that the hosting
service was in the voluntary sector. This service
is undergoing evaluation and it is clear, from
early reports, that where it is situated has had a
positive impact on the client. This, alongside the
intensive support package offered, has seen some
success. In-patient beds for drug stabilisation and
group work in relapse prevention were ideas to be
explored for the future, based on visioning work.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
indicates prevalence and harm. Forth Valley will
be one of the first ADAT areas to implement the
new data base, in partnership with ISD. This new
database will improve the ability to track the client
journey which is critical in preventing anyone
falling through the net and will help to provide
valuable outcome information.
The visioning exercise identified cognitive
behavioural
therapy
(CBT),
motivational
interviewing and solution focussed approaches
as important areas to develop further. This would
be mainly through workforce development. It also
identified a relapse prevention group as an option
for development.
Residential rehabilitation – illegal substances
Residential rehabilitation is provided out of area, in
some situations for severe and complex problems
relating to alcohol and drug use, only if assessment
indicates.
(For general practices not involved in GPPS, there
still needs to be a basic awareness of the issues
associated with illegal drug use, the services
available and how to access them together with
promoting inclusion and reducing stigma.)
29
Section 7 | What More Needs to be Done?
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Harm reduction services – illegal substances
Harm Reduction is a public health approach that
aims to reduce drug related harm experienced
by individuals and communities and should be
integral to all services working within the substance
misuse field. Services focussing specifically on
needle exchange, injecting behaviours and blood
borne virus prevention are provided by Signpost
Recovery Harm Reduction Service and Community
Pharmacy needle exchange. The blood borne virus
strategy will address the need for a collaborative
co-ordinated approach to harm reduction service
provision.
Crisis services – illegal substances
As part of an individual care plan, it is worthwhile
to include some form of contingency plan for a
situation where a crisis arises. The client can be
guided toward contacting the other crisis help
services that are available out of hours. Signpost
Recovery offers an on-call telephone support at
weekends.
Alcohol
Development of services for treatment and
rehabilitation will be taken forward through a new
alcohol strategy for Forth Valley. The following are
the main themes from the visioning work and
national policy;
to recognise the need for, and then to deliver,
brief intervention while ensuring that there are
clear pathways established for those requiring
referral on for more intense support to address
their alcohol use. Brief intervention can be carried
out within the local authorities within housing /
homeless settings, social work. There is also a need
to engage the police in this work.
We will develop brief intervention in other NHS
settings: A&E, in-patient and out-patient settings
within the NHS, Maternity and through dental
practices. This extends to non-NHS settings social
work; police (custody cells), education, and
homelessness services. In addition the expertise
of the community pharmacist is being explored to
tackle alcohol screening and brief intervention as
an innovative approach, within a pilot project.
Community Rehabilitation - alcohol
Most treatment for alcohol dependence is
community based. Improvement in this area will
be addressed though developments in specific
services like CADS, Signpost Recovery and ASC.
This includes
•
care planning and review
•
regular key-working sessions
•
structured day programmes,
•
care planned day care with interventions
targeting specific groups
•
community care assessment and case
management of alcohol misusers
•
a range of evidence based prescribing
interventions, and
•
community based alcohol detoxification
Brief Intervention - alcohol
We must have a clear view of what has to be done
within the NHS local system linking to HEAT, the
overall aim is to make sure that we have enough
healthcare professionals and partners equipped
30
Section 7 | What More Needs to be Done?
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Detoxification and relapse prevention
programmes - alcohol
Detoxification and relapse prevention already form
a key part of the treatment and support provided.
The visioning work suggests the need to extend
in-patient beds for alcohol detoxification, in
line with prevalence and need. Group work
in relapse prevention was also identified as an
area for development in the visioning work.
Where appropriate this would be based on an
aim for abstinence. Guidance on in-patient and
community detoxification is being developed.
In relation to this the visioning work suggested
a need for more alcohol liaison nurses to cover
evenings and weekends at A&E, as there is a
risk due of patients being discharged and self
discharging before they can be seen. The plan
would be to implement an out –patient focus and
recall the patients to be seen by the Liaison nurse.
Tobacco
Development of smoking cessation services will be
taken forward through the Tobacco Action Group.
Latest data on smoking cessation suggest that
the quality of the service is good in that the quit
rate for those accessing the service and setting a
quit date is high. In order to meet HEAT targets,
however, the number of people going through the
service needs to be increased (doubled), without
any compromise in service quality.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
There are also links to the need to effectively
integrate with other services relating to
employability to promote and encourage the
progression of clients to employment, through
projects such as Go Forth and APEX.
Prescribing substitute drugs - tobacco
NRT availability and prescription will be taken
forward through the Tobacco Action group
“Detoxification” and “relapse prevention”
programmes - tobacco
In tobacco use, bupropion and varenicline could
be considered interventions for detoxification.
Self-help-groups aid in relapse prevention, but
capacity could usefully be increased.
General Medical Services - tobacco
Residential rehabilitation - alcohol
Residential rehabilitation is provided out of area, in
some situations, for severe and complex problems
relating to alcohol and drug use.
Crisis services - alcohol
The development of places of safety in relation to
alcohol could be seen as crisis services. There is
currently a proposal for a pilot project in the City
of Stirling over the festive period.
Most general practices do provide some form
of smoking cessation input. This may be advice,
one-to-one work, or group work and may include
prescription of NRT etc. Information on this work
needs to be captured. There is scope to build on
the work being carried out and the enthusiasm
of staff, through further staff training, improved
delivery of an appropriate range of interventions
(brief intervention, motivational interviewing and
prescription).
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Section 7 | What More Needs to be Done?
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Overall the main approach to developing smoking
cessation services will be to build on what
already exists. In particular there are a number of
approaches that are likely to be useful:
Substance use is an issue for everyone and all
services in Forth Valley. The services that are
relevant (identified in national policy or local
visioning work) are:
•
Mapping out current and future potential
processes and pathways
•
General Medical Services
•
•
Having a clearly defined service specification
Acute services including maternity and
gastroenterology
•
Reviewing management and financial
arrangements
•
Mental health services
•
Pharmacy Services
•
Psychological services
•
Dietary (Dietetic) advice
•
Dental services
•
Sexual health services (inc. family planning)
•
Employability Services
•
Services for social support – including social
care services, child care, housing
•
Children’s services
•
Advocacy support
•
Carers and Families and related services
including family support
•
Podiatry
•
Older people’s services
•
Blood-borne virus services
•
Out of Hours services
•
•
•
Development of a branding and marketing
plan for smoking cessation services – to
improve awareness of what exists across all
partner organisations to smokers in Forth
Valley
Further developing of links with Healthier
Working Lives and other health improvement
initiatives.
Further integrating practice within substance
use services.
Making the connections
with all relevant services and
stakeholders
Problem substance use is associated with a
wide range of health and social issues, either
in terms of predisposing factors, or in terms of
the consequences of substance use. For these
associated issues there are a range of services which
aim to make some impact. Making connections
with other generic and specialist services was
a theme within the visioning work and also the
national drug strategy.
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Section 7 | What More Needs to be Done?
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•
Current provision through these services
relevant to substance use for each of tobacco,
alcohol and illegal drugs
•
How this compares to national guidance and
policy
•
What may be required to improve each
service’s input to the issue of substance use.
The visioning work identified potential posts or
roles that could help to ensure links between
services. Potential areas for the training and
development of existing staff were explored and
suggestions made for improving integration. The
various sub-groups of the SAT will consider these
potential options and agree a way forward.
Blood-borne viruses
Illegal substance use may be through the use of
intravenous administration. Much of the work
of the Substance Action Team has an impact on
the risk of transmission of blood borne viruses.
Forth Valley has a Blood-Borne Virus strategy
group, which has good representation from those
involved in substance use. Work in this area will be
taken forward by this group, but needs to link in
with the SAT.
Drug-related deaths
The Critical Incident Group is tasked with
reviewing any drug deaths that occur within Forth
Valley. The group is made up of key partners, such
as Central Scotland Police, Scottish Prison Service,
SAT, Treatment Services (Addiction Consultant
–Chair), Scottish Ambulance Service, FV NHS,
Procurator Fiscal Service and Local Authorities.
The group currently meets quarterly, but following
a death, a ‘core group’ meets monthly to discuss
the cases in depth.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
A systematic approach would be to consider the
following for each of the above:
The aim of the group is primarily two-fold. Firstly
to learn lessons from any drug deaths that have
occurred in the Forth Valley area, and secondly,
to develop preventative measures in order to
reduce the risks of any future drug deaths through
information shared regarding non fatal overdose
cases. This group will continue to lead work in this
area, linking back to the wider SAT. A good example
of the work is a project between the Substance
Action Team and the Scottish Ambulance Service
to facilitate referrals to Drug Services for those
who experience overdose and seek support from
the ambulance service. This incident will trigger a
referral to a drug support service.
The group has recently re-defined its remit, agreed
clear tasks, and is developing a clear process for
learning from drug-related deaths. Through the
development of a workplan.
Treatments for BBVs were identified as an issue
in the visioning work, but are being addressed
through means other than this strategy.
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Section 7 | What More Needs to be Done?
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
7.3 Law Enforcement and
Criminal Justice
The strategy is very much aimed at three key
issues.
•
SUPPLY – By means of enforcement,
disruption and diversion, reduce the
availability of drugs in the community and
arrest those involved in their supply and
trafficking.
•
DEMAND – By supporting police activities
such as drug education and diversion to
interventions, aimed at reducing drug
demand and dependency, through
partnership working.
•
HARM – By supporting police and partner
activities aimed at reducing drug related harm
This section covers:
•
Enforcement of laws relating to illegal drugs,
alcohol and tobacco;
•
Substance use in those who are in contact
with the criminal justice system
•
Community safety and problem solving work
Enforcement relating to
substance use laws
Illegal Drugs
The Central Scotland Police Force Drugs
Strategy provides a comprehensive and directed
approach to disrupting drugs supply and use
throughout Forth valley. It aims to build on current
interventions such as the Arrest Referral Scheme,
while harnessing resources to enforce relevant
legislation such as the Proceeds of Crime Act, 2002
and the Misuse of Drugs Act 1971.
The Association of Chief Police Officers (Scotland)
(ACPOS) published its revised Drug Strategy in
200750, building on the work developed from the
inaugural ACPOS Drug Strategy in 2003.
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Section 7 | What More Needs to be Done?
Central Scotland Police are committed to
addressing the main aims and objectives identified
through the ACPOS Drug Strategy; however, the
Central Scotland Police Drugs Strategy is aimed at
local solutions to local problems while addressing
drugs on a Scottish and UK perspective.
Alcohol
The main approach will be to continue the work
already in place relating to enforcement, including
test purchasing and the work of the licensing boards
and forums. One example of a forthcoming project
is the over 21’s policy in Clackmannanshire. Area
Command in conjunction with Clackmannanshire
Council are due to commence an over 21’s policy
for the purchase of alcohol from off-sales premises
in February. Licensees who suspect a customer
to be under the age of 21 can ask customers for
identification. There is widespread support for the
scheme from licensees. This local authority-wide
over 21s policy will be a first for Scotland.
1|7
In addition to continuing the work described
under progress to date, we need to be prepared
for possible changes in legislation, as outlined in
recent national consultation on:
•
Reducing the attractiveness of tobacco
products
•
Reducing the availability of tobacco products
•
Reducing the affordability of tobacco
products
The Tobacco Action Group will consider the local
implications for these potential changes.
Substance use in those who
are in contact with the criminal
justice system
The visioning work identified certain client groups
related to crime and criminal justice, where there
was potential to develop further input:
•
Criminal justice system – people arrested
•
Prisoners – (esp. those being released)
•
People involved in prostitution
In addition to building on what exists, such as the
Criminal Justice Drug Treatment Service, there is
a need to ensure that there is joined up working
with wider strategic developments in relation
to those in contact, or likely to be in contact,
with the criminal justice system. Relevant recent
developments are:
•
Ministerial agreement in principle that the
NHS take over prison healthcare (although this
will require legislation change)
•
The recently established Community Justice
Authority is setting up a Health Forum
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Tobacco
Community Safety and
problem solving
There will be continued development of the links
with community safety partnerships, and further
problem-solving partnerships, to explore and
intervene in the links between substance use and
anti-social behaviour.
A systematic approach would consider substance
related issues (mainly illegal drugs and alcohol)
across a spectrum, from people involved in
any form of criminal behaviour, to those being
investigated by the police, i.e. arrested, trial,
conviction, custodial sentence, release – etc.
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Section 7 | What More Needs to be Done?
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
7.4 Getting It Right For
Children In Substance
Misusing Families
Current best estimates indicate that 40-60,000
children in Scotland may be affected by parental
drug misuse.51 The immediate effects of this
can include children being at risk not only from
neglect, but also from emotional and physical
abuse. Long-term risks can also include poor
physical and mental health.
Getting It Right For Every Child is the Government’s
policy for addressing the needs of all children
– it provides the framework within which public
agencies can work better together with a focus on
improving outcomes for children.52 It is important
that the needs of children, affected by parental
substance misuse, are recognised and addressed,
whether the substance is drugs, alcohol or both;
or indeed anything else that puts children at risk.
Ongoing work should
•
build the capacity of universal and targeted
services to improve the identification process,
Growing up in a household where parents are
using drugs and alcohol can affect the life chances
of the child for the worse and exacerbate health
inequalities. The children who live with parents
who have drug and alcohol problems are among
the most vulnerable in our society today, more
needs to be done at a local level to minimise
harm. In general this refers to illegal substances
and alcohol, although children whose parents or
carers smoke are also at risk. Implementation of
the Scottish Government Early Years Strategy will
contribute to this area of work.
•
improve the assessment, recording and
planning for children at risk;
•
maximise the skills of the workforce within
universal services to identify and address their
concerns about children at an early stage and,
where necessary, bring other expertise on
board;
•
maintain consistent high standards of cooperation, joint working and communication,
across Forth Valley, where more than one
agency needs to be involved;
Children and young people in this situation require
particular support and care to ensure that they
share in the same high aspirations and outcomes
as all of Scotland’s children.
•
promote and maintain a confident and
competent workforce in the statutory
universal and targeted services as well as the
independent sector
•
must improve access to prescribing regimes
for those parents with substance problems
Addressing the needs of children in substance
misusing families was identified as an area
for development within the visioning work.
Recognising the role of the young carer is vital;
the young person needs to be identified early and
offered some form of respite which is available
and funded locally; the role of partner services to
recover the whole family is vital.
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Section 7 | What More Needs to be Done?
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The ongoing challenge is that some of the harm
caused by substance misuse will still be very much
‘hidden’ for some children. A climate should be
created within the Forth Valley treatment system
that focuses on recovery, thus reducing the
negative impact of substance misuse on the lives
of children in Forth Valley.
One of the first significant attempts to understand
and tackle the problems of children and young
people affected by parental abuse – the Hidden
Harm report – was published in 2003 by the UK
Government’s Advisory Council on the Misuse of
Drugs. This report significantly raised the profile
of the issue and highlighted the challenges for
public agencies to work together more effectively
to address it.
Since then, the Government, local authorities
and other partners have done considerable work
in Scotland to turn policy recommendations
into improvements on the ground. The previous
administration’s report, Hidden Harm – Next
Steps (2006), set out a wide-ranging plan of
action across numerous sectors (from social care,
maternity services, early years and schools to
drug and alcohol services and child protection) to
make significant improvements to ways in which
vulnerable children are identified and protected.1
Prior to this, Getting Our Priorities Right provided a
useful framework for Child Protection Committees
and SAT to take forward action into their own areas
in the form of local protocols to help identify and
protect children.
Prevention and early
intervention
development of prevention and education
initiatives will have an impact on parental
substance use. Appropriate awareness of child
protection issues, in relation to substance use
across all agencies, will be increased through
child protection planning and children’s services
planning in partnership with the SAT. This will
ensure that appropriate child protection systems
are in place and used.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Hidden Harm
Identification and management
of risk
All services are acutely aware of the need to
asses the risks posed to the children of substance
misusing adults (including those children who do
not live with the adult but who have significant
contact).
Forth Valley drug and alcohol services play an
active part in case conference meetings discussing
the welfare of vulnerable children in substance
misusing families, and can offer both written and
verbal assessments of the impact of substance
misuse on an individual’s parenting capacity.
The Forth Valley Service Response Group will
continue to address operational issues in relation
to the identification of vulnerable children and
young people and how services can ensure
that these children are identified at the earliest
opportunity. In addition, training for staff in
the assessment of risk is noted in the Road to
Recovery26 and must be implemented across Forth
Valley, firstly in Clackmannanshire.
Stronger links have also been made with local
maternity services in order to improve the
identification of risk to the unborn child and/or
partners.
The further development of services along the
lines of a recovery based model, and further
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Section 7 | What More Needs to be Done?
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Alcohol & Drug Partnership
Strategy Documents
Support
Co-ordination
Links have been made with local Young Carer’s
projects and this must be enhanced in the coming
months, to ensure that any child or young person
who is caring for someone with a substance misuse
issue, receives appropriate and timely support.
Overall Co-ordination in relation to child
protection, is channelled through the Forth Valley
Service Response Group which reports to the G5
Reporting Group. In terms of children, other local
strategic partnership groups exist which need to
be aware of substance use issues. The group will
continue to consider how information sharing and
joint assessment can be developed further.
Family Support Services are established in each
of the 3 Local Authority areas. In addition to
providing one to one support and/or groupwork,
these services are skilled in delivering “Parent to
Parent” and “What About Me Training?” to parents
and carers. These programmes will be used to
educate parents/carers about how to talk to their
children about substance misuse and can help
foster positive family dynamics.
Other initiatives undertaken to provide support to
vulnerable children and young people have been:
•
Best Practice booklet for practitioners.
•
Information leaflet regarding addiction and
pregnancy.
•
Information leaflet about the safe storage of
methadone.
•
Interagency Information Sharing Protocol
In addition, safer storage stickers will be produced
for bottles and other medicinal packages, to
prompt parents to store safely in the home, further
reducing the risk of ingestion by those whom they
are not prescribed for.
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Section 7 | What More Needs to be Done?
The home setting
The home environment is an important aspect of
the lives of children, and the use of substances by
parents or carers forms part of this. In the case of
tobacco there is risk associated with environmental
exposure to tobacco smoke. In the cases of illegal
substances and alcohol use there is not only the
risk of carers being incapable of looking after
children, but a ‘social exposure,’ in the sense that
children may grow up believing substance use
to be the norm. The need for Smoke Free Homes
initiatives has been stated elsewhere, but it may
be worth considering the potential for Alcohol
Free Homes and Drug Free Homes initiatives.
The stakeholder analysis work asked about gaps in organisation. This can be considered in 3 main
domains – human resources, facilities/ equipment/ material, and intangibles (information, processes,
guidelines etc.).
Workforce Planning
Staff Well-being
A consideration of human resources is key. This
includes, but is not limited to, those stakeholders
who are also providers of services. Current and
future human resources need to be considered
in terms of number and type (e.g. of staff ), their
knowledge, skills, attitudes and behaviour.
Working closely with individuals who have
complex needs can be stressful. The harrowing
nature of addiction when at its most chaotic,
and the Child Protection responsibilities that staff
have to undertake, should not go unrecognised.
Programmes should be put in place to alleviate
workplace stress and promote alternative
therapies not only to clients but also to staff.
Nationally, NHS Health Scotland and NHS
Education Scotland have developed a drug and
alcohol workforce strategy. Forth Valley Substance
Action Team recognises the need to ensure
that the workforce delivering services are well
trained, motivated and flexible to changing need.
This is particularly necessary if staff are to be as
supportive as they can be in the recovery process.
The diverse range of staff working with clients with
substance related problems within our workforce
within social care, voluntary sector, housing and
health, are all governed by different regulatory
bodies, qualifications and standards. However,
consistency and competence at the point of
delivery is key, and must prevail to affect the level
of change envisioned in the strategy.
Development of the substance use NHS workforce,
is part of the ongoing workforce planning process
within NHS Forth Valley this needs to build on
further to benefit from the successes of joint
training.
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
8. Workforce Planning, Facilities
Planning, and Information-based
Approaches
Staff retention can be an issue, frequent changes
in staff can have a negative impact on client
relations and relationships. The considerable time
and investment in staff training and development
is lost if there is frequent turn over within staff
groups.
Training needs assessment
A skill audit for addiction staff in Forth Valley will
be carried out by the Consultant Psychologist
for the East Coast of Scotland Addiction Services
Managed Clinical Network. This will identify the
skill levels and optimise their use within the Forth
Valley treatment services. These skills will be used
to help facilitate and promote the recovery of
clients.
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Section 8 | Workforce Planning, Facilities and Information-based Approaches
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Facilities Planning
For the NHS Forth Valley there is a major revision
of facilities, through the integrated healthcare
strategy, which includes the building of a new
acute hospital, a restructuring of community
hospitals and a Community Service and Primary
Care Development Plan. Many of these changes will
impact positively on services relating to substance
use. Facilities planning for such services, needs to
be through this mechanism.
Information-Based Approaches
Part of the visioning exercise consisted of collecting
existing guidelines on best practice etc. There is
scope to develop local integrated, multi-agency
guidelines, protocols and pathways. Local systems
need to be structured appropriately to aid timely
revision of these guidelines.
Overall these approaches need to be considered
with the SAT and sub-groups – whilst recognising
the need to link to the structures for organisational
development within each partner agency.
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Section 8 | Workforce Planning, Facilities and Information-based Approaches
9. Assuring Delivery, Quality
and Fairness
Governance and Performance Management
The Substance Action Team forms a structure for governance in relation to assuring delivery of this
strategy. The Forth Valley SAT action plan therefore forms the main means for implementing this strategy,
and needs to be revised to follow its structure. Responsibility for planning and delivery in relation to this
strategy, lies with the relevant SAT sub-groups, and Local Authority Substance Misuse Forums. Governance
arrangements within individual organisations are relevant also.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
This section is about ensuring that the strategic framework, development plans, and the actions and
tasks within this, help us achieve our vision.
1|9
Appendix 8 consists of a table allocating responsibility for taking forward the areas identified in section 7
to the relevant groups, organisations and agencies – with the support of the SAT.
The SAT support team will support the work of
the groups described above, through a planning
process including such methods as:
•
Needs assessment
•
Impact assessment
•
Redesign
•
Guideline development and audit
•
Evaluation
•
Project management
•
Stakeholder involvement
•
Equality and diversity impact assessment
(EQIA)
Where necessary additional expertise can be
brought in. For example within NHS Forth Valley,
this could include input from, the redesign
programme, the clinical effectiveness department
and the equality and diversity project manager.
Performance management on substance use
should mainly fit in with general performance
management arrangements (within the NHS and
Local Authorities, via HEAT and SOA for example).
Currently services are monitored nationally both
through the SMR 25 submissions to the Substance
Misuse Data Base, which holds the national
prevalence data for Drug Treatment, and also
through the National Waiting Times data base,
which charts the length of wait across Scotland
for different treatment modalities. Locally services
comply by submitting service activity and
outcome reports to the Substance Action Team.
A target has been set by the Scottish Government
to deliver Alcohol Screening and Brief Intervention
within Primary Care, in line with Sign 74 guidelines.
This target will be monitored and measured
by the Scottish Government through the NHS
performance management process HEAT (Health,
Efficiency, Access and Treatment) H4.
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Section 9 | Assuring Delivery, Quality and Fairness
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
National Quality Standards for
Substance Misuse Services
Background:
The Scottish Government introduced National
Quality Standards (NQS) in 200753 (See Appendix
9). The key reasons for the introduction of NQS
were;
•
Every substance misuse service needs to be
client focused
•
Every substance use service must provide
acceptable levels of service delivery
•
Every service should be striving to achieve
continuous improvement
•
The Scottish Government requires greater
scrutiny of service provision and service
delivery. NQS will feature in this process.
Quality Standards were created to move the focus
of service provision onto engaging more closely
with service users in the planning and delivery of
services.
Implementation
Services in Forth Valley demonstrated a high level
of compliance with the standards via the many
very good procedures, protocols and recording
methods in use. Overall services were very
positive about NQS and could see the value of
implementing them.
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Section 9 | Assuring Delivery, Quality and Fairness
Progress to date
Forth Valley is well prepared and has started
the process of self evaluation using the piloted
checklist. NQS must continue to feature in the
daily approach to monitoring and evaluation and
can be used to complement the introduction of a
monitoring system based on outcomes.
What Next:
The provision of support for service providers is
key to the successful introduction and application
of Quality Standards and the establishment of a
culture of continuous improvement.
Service User Involvement
In 2006, FV SAT conducted a study in relation to
Service User Involvement within local drug and
alcohol services. The purpose of the report was to
obtain a baseline measure of levels of service user
involvement at that time. From the information
gathered, it became clear that both service
providers and service users considered service
user involvement essential and valuable. There
was a degree of service user involvement evident
but, there was strong agreement that this could
be improved and carried out on a more consistent
basis across Forth Valley.
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Research
There have been several pieces of research work
in Forth Valley. Larger research programmes
tend to take place nationally. Research arose as
an issue within the stakeholder analysis. It was
suggested that there would be a benefit from
the development of a research strategy and the
employment of a research officer. This would
also lead to a systematic means of monitoring
and evaluating all services in Forth Valley. This is
an area that may be worth exploring. A research
project on social norms and alcohol consumption
with young people is currently underway in Forth
Valley. If approved the Forth Valley Substance
Action Team will lead the way in effective and wellresearched prevention and early intervention work
that will inform practice nationally. This academic
and practice based research will be disseminated
through peer reviewed journals.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Since this time however, there have been
significant barriers to improving service user
involvement. A small number of services provided
dedicated and enthusiastic support to establishing
service user involvement across Forth Valley. There
was some success with this but it quickly became
clear that a greater investment of time and resources
would be required to significantly improve the
current situation. At present, this protection of
staff time is not possible and individual services are
being encouraged to develop internal processes
for service user involvement. The challenge will be
to build on this and establish a robust, effective and
consistent approach to service user involvement
across Forth Valley as per the vision gap analysis.
There is potential to enlist the support of the PPFI
volunteers who work within the NHS, in CHPs and
the acute setting.
Equality Impact Assessment
Equality and Diversity Impact Assessment (EQIA),
is a means of assessing current and future
services and functions against legal policy and
moral requirements, for provision which is fair
and equitable. For the NHS and partners, there
is a legal requirement to consider the potential
impact on groups and individuals on the basis
of race, gender and disability. It is best practice
however that all strands of equality are addressed
– or equality mandates and assess impacts for
age, religion or belief and sexual orientation are
in place. In addition the visioning work suggested
a review of the equity of service provision – i.e.
based on geography. The further development
and implementation of this strategy and related
plans etc. within it will be subject to EQIA.
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Section 9 | Assuring Delivery, Quality and Fairness
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Alcohol & Drug Partnership
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44
Section 9 | Assuring Delivery, Quality and Fairness
10. Paying for the Strategy
1 | 10
Plans which require additional funds will need to follow a process such as that below. Where NHS funding
is sought, this needs to be approved by the Health Strategic Planning Group. In the diagram, ‘other’
represents the equivalent process for partner organisations.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Financial governance arrangements for work in relation to substance use are key. In general the main
structure for financial governance is through the SAT. The finance sub-group has a key role. As much of
the work in relation to substance use is developed in partnership, the funding often requires a partnership
approach too. The SAT has developed expertise in what may be termed joint commissioning.
Health Strategic
Planning Group
Service Design Board
Ratified service design
proposal
Ratified business case for
service development
Other
Substance
Action Team
Ratification
Planning Group
Service redesign / Business
case development
Sub-groups
The process for financial decision-making varies between local authorities:
•
Clackmannanshire - through the budget monitoring group
•
Falkirk - through the corporate management team, policy and resource committee
•
Stirling - ‘Stirling Council’ make overall budget decisions, with specific budgets devolved to each
Director to make decisions in line with overall budget policy
45
Section 10 | Paying for the Strategy
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46
Section 10 | Paying for the Strategy
11. References
1 | 11
Forth Valley Substance Action Team
http://forthvalleySAT.co.uk/v2/
2.
Scottish Government
http://www.scotland.gov.uk/Home
3.
Scottish Government Purpose Targets
http://www.scotland.gov.uk/About/scotPerforms/purposes
4.
Scottish Government Strategic Objectives
http://www.scotland.gov.uk/About/scotPerforms/objectives
5.
HEAT indicators
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/17273/targets
6.
Single Outcome Agreements
http://www.improvementservice.org.uk/component/option,com_docman/Itemid,43/task,cat_
view/gid,561/
7.
NHS Forth Valley Corporate Plan
http://www.nhsforthvalley.com/web/files/BoardMeetingMarch08/Item4_4_corporatePlanDraft_
5_190308_JF.pdf
8.
Clackmannanshire Joint Health Improvement Plan
http://www.clacksweb.org.uk/document/1228.pdf
9.
Falkirk Joint Health Improvement Plan
http://www.falkirk.gov.uk/coins/ViewSelectedDocument.asp?DocumentID=1967
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
1.
10. Reference to Stirling Joint Health Improvement Plan
http://minutes.stirling.gov.uk/pdfs/scouncil/Reports/SC20041216JointHealthImpPlan.pdf
11. WHO Burden of Disease Programme
http://www.who.int/healthinfo/bodproject/en/index.html
12. Scottish Health Survey 2003
http://www.scotland.gov.uk/Publications/2005/11/25145024/50251
13. Tobacco Atlas Scotland
http://www.scotpho.org.uk/home/Publications/scotphoreports/pub_tobaccoatlas.asp
14. SALSUS 2006
http://www.drugmisuse.isdscotland.org/publications/local/SALSUS_2006.pdf
47
Section 11 | References
1 | 11
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Alcohol & Drug Partnership
Strategy Documents
15. ISD Cancer Information Programme
http://www.isdscotland.org/isd/338.html
16. ISD Prevalence data in the QOF
http://www.isdscotland.org/isd/3367.html
17. ISD Smoking Ready Reckoner – personal communication
18. The English National Treatment Agency (2005) consultation document on a
‘typology of drinkers’:
19. ISD Forth Valley Alcohol Profile
http://www.alcoholinformation.isdscotland.org/alcohol_misuse/files/ForthValley_Profile2006.pdf
20. Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland
Executive Report November 2004 Hay G, Gannon M, McKeganey N, Hutchinson S, Goldberg D
http://www.drugmisuse.isdscotland.org/publications/local/prevreport2004.pdf
21. Forth Valley Adult Health and Lifestyle Survey 2004
http://www.nhsforthvalley.com/web/files/Public_Health_files/Adult_Health_and_Lifestyle_
Survey_05.pdf
22. ISD Drug Misuse in Scotland Statistics 2007
http://www.drugmisuse.isdscotland.org/publications/07dmss/07dmss.pdf
23. Annual Report of the Director of Public Health, Forth Valley 2006
http://www.nhsforthvalley.com/web/files/Public_Health_files/AnnualReport06.pdf
24. GROS Drug Related Deaths
http://www.gro-scotland.gov.uk/statistics/publications-and-data/drug-related-deaths/drugrelated-deaths-in-scotland-2007/index.html
25. Protecting Our Future: Scottish Executive’s Drug Action Plan
http://www.scotland.gov.uk/Resource/Doc/158170/0042803.pdf
26. The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem
http://www.scotland.gov.uk/Resource/Doc/224480/0060586.pdf
27. Forth Valley SAT Action Plan 2008-09
http://forthvalleySAT.co.uk/v2/index.php?option=com_docman&task=doc_download&gid=486&Itemi
d=63
48
Section 11 | References
1 | 11
29. National No Smoking Day
http://www.nosmokingday.org.uk/smokers/index.htm
30. George T. Doran. There’s a S.M.A.R.T. way to write management’s goals and objectives.
Management Review (AMA Forum), pages 35–36, November 1981.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
28. Clearing the Air
http://www.clearingtheairscotland.com/
31. Health Promoting Schools
http://www.ltscotland.org.uk/healthpromotingschools/
32. Healthy Working Lives
http://www.healthyworkinglives.com/
33. Signpost Recovery
http://www.signpostrecovery.org.uk/support/index.php
34. Moodjuice Forth Valley
http://www.moodjuice.scot.nhs.uk/
35. Licensing (Scotland) Act 2005 - Section 142: Guidance for Licensing Boards
and Local Authorities
http://www.scotland.gov.uk/Resource/Doc/175487/0049459.pdf
36. Changing Scotland’s relationship with alcohol: a discussion paper on our strategic approach
http://www.scotland.gov.uk/Resource/Doc/227785/0061677.pdf
37. Scotland’s Future is Smoke Free: A Smoking Prevention Action Plan
http://www.scotland.gov.uk/Resource/Doc/223415/0060163.pdf
38. Schools (Health Promotion and Nutrition) Scotland Act: Health promotion guidance
for local authorities and schools
http://www.scotland.gov.uk/Resource/Doc/222395/0059811.pdf
39. Curriculum for Excellence
http://www.ltscotland.org.uk/curriculumforexcellence/
40. Know the Score
http://www.knowthescore.info/kts/CCC_FirstPage.jsp
41. Alcohol Awareness Week
http://www.alcoholawarenessweek.com/
49
Section 11 | References
1 | 11
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
42. Health Information and Resources Service (HIRS) – NHS Forth Valley
http://www.nhsforthvalley.com/home/Services/healthpromotion/hirs/hirs_intro.html
43. Scotland’s Mental Health First Aid
http://www.healthscotland.org.uk/smhfa/
44. Clackmannanshire Council Online
http://www.clacksweb.org.uk/
45. Falkirk Council
http://www.falkirk.gov.uk/home.aspx
46. Stirling Council
http://www.stirling.gov.uk/
47. The Clackmannanshire Alliance
http://www.clacksweb.org.uk/community/planning/
48. Falkirk Community Planning Partnership
http://www.falkirkonline.net/Community%20Planning/Community%20Planning%20Partnership.aspx
49. Stirling Community Planning Partnership
http://www.stirling.gov.uk/index/community/communitypartnership/partnership.htm
50. Association of Chief Police Officers in Scotland (ACPOS) - Drug Strategy Revised 2007
http://www.acpos.police.uk/Documents/Policies/CRIME%20%20-%20ACPOS%20Drug%20Strategy
%202007.pdf
51. Hidden Harm: responding to the needs of children of drug users
(Advisory Council on Drugs Misuse) 2003:
http://www.scotland.gov.uk/Publications/2006/05/05144237/0
52. Getting it right for every child in kinship and foster care:
http://www.scotland.gov.uk/Publications/2008/05/22161610/0
53. National Quality Standards for Substance Misuse Services
http://www.scotland.gov.uk/Resource/Doc/149486/0039796.pdf
50
Section 11 | References
12. Appendices
1 | 12
Forth Valley SAT Organisational Structure August 2009
Appendix 2
Outcome Indicators
Appendix 3
Scottish Government recent strategies relating to substance use
Appendix 4
Progress To Date – Detail
Appendix 5
Summary Of Gaps – tiered model best practice
Appendix 6
The 4 Themes - taken from the National Drug Strategy ‘The Road to Recovery’
Appendix 7
Applying National Strategy to Main Substance Types
Appendix 8
Allocation of Responsibility to areas within Section 7
Appendix 9
National Quality Standards
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 1
51
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 1 - Forth Valley SAT Organisational Structure August 2009
Links are made through
shared membership, agenda
items and work plan actions
Forth Valley Substance Action
Team
Chair: Fiona Mackenzie CEO
NHS FV
Finance
Sub-group
Chair:
Elaine Lawlor
SAT Coordinator
Clackmannanshire Substance
Misuse Forum
Chair: Ian Shovlin
Falkirk Substance
Misuse Forum
Chair: Margaret Anderson
Stirling Substance
Misuse Forum
Chair: Leo McGrath
Criminal Justice Social Work
Acting Director of Social Work
Manager Childrens Services
Health
Reference Group
Chair:
Kathy O’Neill
Critical
Incident Group
Chair: Dr.
Claire McIntosh
General Manager
Clacks CHP
NHS Alcohol &
Drug Service
Prescribing &
Treatment
Sub Group
Process of
Care Group
Chair:
TBC
Young Person’s
Sub-group
Education &
Prevention Group
Chair:
Hazel Meechan
Tobacco
Action Group
Chair:
Oliver Harding
Health Promotion
Manager
Consultant in Public
Health Medicine
Family Support
Network &
Community
Sub-group
There are occasional short-life working groups
52
Section 12 | Appendices
Employability
Sub-group
1 | 12
HEAT indicators relevant to substance use:
•
•
H4. Achieve agreed number of screenings
using the setting-appropriate screening tool
and appropriate alcohol brief intervention, in
line with SIGN 74 guidelines by 2010/11.
H6. Through smoking cessation services,
support 8% of your Board’s smoking
population in successfully quitting (at one
month post quit) over the period 2008/9
– 2010/11.
The Scottish Government with COSLA has
produced a number of outcome indicators, on the
basis of which local authorities/ CPPs are required
to produce Single Outcome Agreements SOAs.
Those relevant to substance use are:
•
•
Indicator 10: Decrease the proportion of
individuals living in poverty
Indicator 15: Increase the average score of
adults on the Warwick-Edinburgh Mental Wellbeing Scale by 2011
•
Indicator 16: Increase healthy life expectancy
at birth in the most deprived areas
•
Indicator 17: Reduce the percentage of the
adult population who smoke to 22% by 2010
•
Indicator 18: Reduce alcohol related hospital
admissions by 2011
•
Indicator 22: All unintentionally homeless
households will be entitled to settled
accommodation by 2012
•
Indicator 23: Reduce overall reconviction rates
by 2 percentage points by 2011
•
Indicator 24: Reduce overall crime
victimisation rates by 2 percentage points by
2011
•
Indicator 28: Increase the percentage of adults
who rate their neighbourhood as a good
place to live
•
Indicator 29: Decrease the estimated number
of problem drug users in Scotland by 2011
•
Indicator 31: Increase positive public
perception of the general crime rate in local
area
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 2 - Outcome
Indicators
Indicator 44: Improve the quality of healthcare
experience.
53
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 3 - Scottish Government recent strategies relating to
substance use:
Brief Description
National Strategy – the Road to Recovery
Gives strategic direction for drug services in
Scotland.
Focuses on illegal drugs, and mentions alcohol at
times
(forms the basis for section 7 of this strategy
document)
Scotland’s relationship with alcohol
A consultation document on proposals for
changes in national policy and legislation with the
aim of reducing harmful and hazardous drinking.
Scotland’s Future is Smoke Free
Sets a direction for action on prevention and
education in relation to tobacco in Scotland
Ministerial Task Force on Inequalities
Makes recommendations for the Scottish
Government on issues key to addressing
inequalities, including substance use.
Previous strategies relating to substance use include:
ADAT Review
Reviews the structure and functioning of Alcohol
and Drug Action Teams.
(most cover alcohol and illegal drugs only)
Tackling Drugs in Scotland: Action in Partnership
Set the direction nationally for work on drugs
and introduced the 4 pillars: young people,
communities, treatment and availability. (These
developed over time and are used as the basis for
section 6 of this strategy document.)
Essential Care: A Report on the Approach
Required to Maximise Opportunity for Recovery
from Problem Substance Use in Scotland
Commissioned by the Scottish Advisory
Committee on Drug Misuse, it focussed on the
support that is needed to address problems in
areas of service users’ lives other than addiction,
such as general health, mental health, social
skills and relationships. It led to the current focus
on recovery.
54
Section 12 | Appendices
1 | 12
A Breath of Fresh Air for Scotland - Improving
Scotland’s Health: The Challenge. Tobacco
Control Action Plan (2004)
Reviewed national tobacco control policy and set
out a plan for action
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Plan for Action on Alcohol Problems: Update (2007) Provides an update on the previous action on
alcohol problems document.
Other strategies and guidance
In addition to the above there are many national strategies, relevant to substance use, which require to
be implemented locally. These include:
Acute Services
•
Health Promoting Health Service: Action In Acute Care Settings (CEL 14
(2008) 20 March 2008)
Blood Borne Viruses
•
Hepatitis C Action Plan for Scotland - Phase I: September 2006 - August
2008
•
Hepatitis C Action Plan for Scotland Phase II: May 2008 – March 2011
•
Hidden harm – Next Steps
•
“It’s everyone’s job to make sure I’m alright” Report of the Child Protection
Audit and Review
•
Aberlour: “Have We Got Our Priorities Right?”
•
Aberlour: “A Matter of Substance”.
Children and young
people
•
Getting it Right for Every Child
•
A Curriculum for Excellence - The Curriculum Review Group
Housing and
Homelessness
•
Housing Scotland Act 2001
•
Helping Homeless People - Delivering The Action Plan For Prevention
And Effective Response - January 2004
Mental Health
•
Mental Health Delivery Plan
Mental well-being
•
Towards a Mentally Flourishing Scotland: Discussion Paper on mental
health improvement 2008-2011
Oral Health
•
Oral Health Strategy for Scotland (2000)
Sexual Health
•
Respect and Responsibility: Strategy and Action Plan for Improving
Sexual Health
Child Protection
55
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 4 - Progress to Date
- Detail
Progress
General Prevention and
Education Work
•
The revision of a curricular framework
to be implemented within educational
establishments
in
Clackmannanshire.
Undertaken by Create Consultancy, this project
draws on the strengths of what is already being
delivered and sets out a new framework which
integrates three curricular priorities for children
and young people; substance education,
sexual health and relationship education and
emotional and mental wellbeing.
•
Facilitation of a pilot project looking at
the impact of social norms and alcohol
consumption on young people. This two year
project, developed in partnership with the
Scottish Association of Alcohol and Drug
Action Teams (SAADAT), will explore and
challenge perceptions of alcohol use amongst
young people within two secondary schools
in Falkirk. The experience and learning from
this pilot will influence future development of
social marketing.
•
In one area of Forth Valley an innovative
approach to reducing tobacco and alcohol
use has been developed, through the use of
interactive teaching methodologies, children
were supported to enhance their understanding
of tobacco and alcohol. Members of staff
were trained to deliver substance education
using co-operative learning techniques, the
programme culminated in a conference where
young people shared their learning.
The
project increased understanding of substances,
enhanced young peoples’ confidence and
supported the primary/secondary transition
process
•
The development of interactive methodologies
to support Personal and Social Education
programme in primary and secondary schools.
Examples of this work include:
Vision
Schools continue to play an important role in
improving health and wellbeing of children
and young people. Working in partnership with
families and a wide range of agencies, they provide
universal support to all children and offer more
intensive support at times of need.
With the introduction of Curriculum for Excellence
and the Schools (Health Promotion and Nutrition)
(Scotland) Act 2007, health and wellbeing is now
an integral part of school improvement and quality
assurance processes. These national developments
support schools to develop a holistic approach and
to take steps to promote and protect the physical,
social, emotional and mental wellbeing of pupils,
staff and the school community.
Education on, and prevention of, substance misuse
are essential elements of this holistic approach and
schools will be supported to deliver high quality
learning opportunities and experiences that are
developmental and best respond to children,
young people and community needs and priorities.
Investment will be made to enhance the capacity
of those who work in schools, to raise awareness
of, and prevent substance misuse. School staff
will be offered a programme of continuous staff
development which builds on current research and
responds to emerging issues as they implement
new approaches. A particular challenge for us
will be to integrate substance misuse education
and prevention across the curriculum, moving it
from being the focus of a few staff to becoming
the responsibility of all.
56
Section 12 | Appendices
1 | 12
The recent establishment of a prevention and
education sub-group of the SAT provides a
forum for planning across all substances.
Workplace
Raising awareness of, and addressing issues relating
to, substance misuse will also be a priority for many
workplaces throughout Forth Valley. Through
ongoing development of the Healthy Working
Lives programme, workplaces will be supported
to develop supportive substance policies and
implement activities that promote a reduction in
alcohol consumption in the workplace.
Community
One of the partnerships priorities will be to
continue to facilitate the Drugs and Alcohol First
Aid Initiative (DAFAI), and supporting multi-agency
links and community involvement by providing
training to individuals from a wide range of settings
to; support a greater understanding of drug and
alcohol overdose; offer advice on what can be
done to assess and reduce risk; and promote life
support skills.
In summary there is a range of excellent work
across Forth Valley. This needs to be mainstreamed
more to cover all schools.
Child Protection
Over the last few years there has been an
increased awareness of parental substance misuse
issues in relation to the impact on children. The
child protection agenda has been particularly
emphasised and prioritised.
Research and Policy drives over recent years reflect
the significant increase in the numbers of children
living in families where parent(s) misuse drugs
and/or alcohol across Scotland. The national
estimates are that 60,000 children in Scotland are
affected by parental drug misuse and 100,000 by
parental alcohol misuse. In addition, young people
themselves are known to be consuming alcohol
and/or drugs at a younger age and, in some cases,
on a more frequent basis (SALSUS 2006). This too
must be considered as a child protection issue.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
•
Forth Valley SAT recognises the importance its
services have in protecting children and young
people affected by parental substance misuse.
Forth Valley Substance Misuse Services are
uniquely placed to collaborate, co-operate, share
information early and share their expertise. The
Child Protection agenda is supported by SAT across
both operational and strategic forums, with joint
policies and protocols being developed across
Critical Partnerships, to improve the efficiency
and consistency of information sharing. Child
Protection training is mandatory for all substance
misuse services affiliated to and commisioned
by the SAT. Robust child protection policies are
a requirement of compliance with the National
Quality Standards for Substance Misuse Services.
Young People’s Services
Services for children and young people have been
developed, consisting of the following:
Connect Services for Young People
Offers a service to young people aged 12-18
years within the Falkirk Council area who are
experiencing difficulties relating to substance
misuse and/or offending behaviour.
57
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Barnardos Axis Service Falkirk
Provides substance screening, comprehensive
assessments, care planning, group-work, individual
sessions, intensive intervention, and family
support to young people aged 12-18 years in the
Falkirk area.
Clackmannanshire Young Persons’ Nurse
The Young Persons’ service is provided through
Children and Families Social Work and provides
specialist assessment and follow up care, treatment
and rehabilitation for young people between the
ages of 12 – 18 years who are exposed to high
risk substance use and/or vulnerable to mental ill
health.
Freagarrach Stirling Alcohol and Drug Service
Provides support to young people in the Stirling
area with their substance misuse issues, to help
minimise risks and maximise opportunities for
well-being, education and/or employment and
social inclusion.
Provision of Support and
Treatment Services – Pillar 3
General
One of the main areas of focus of the Substance
Action Team has been service provision. There have
been many developments and re-design projects,
across partner organisations and sectors. The role
of Signpost Recovery in particular, has developed
significantly. Other recent developments include
the development of an agreed prescribing strategy
promoting a range of prescribing options.
More detail on progress to date is presented below,
58
Section 12 | Appendices
based on the substance of interest and the tiered
model covering general services, illegal drugs,
alcohol and tobacco:
Psychology Service
The psychology service has grown steadily since its
inception in July 2007, funded by FVSAT. Available
sessions have been communicated to all services
working within the FVSAT treatment system.
There are discussions in progress to facilitate
the implementation of consultation with these
services. Currently one to one sessions focused on
case discussion/supervision comprise the majority
of consultation activity. The future development
of the service includes the creation of regular
facilitated peer/group supervision and reflective
practice groups. Consultation is provided on a
team basis for some services. The psychology
function is part of the managed clinical network
covering a number of board areas.
Moodjuice
The addiction element of the Moodjuice web
site is a welcome addition to our resource library.
The original web site was developed to support
mild to moderate mental health problems. This
innovative approach to service delivery will both
increase access to psychological interventions
and help build the skill and capacity to deliver
within the staff group. There is an opportunity
for email access to a discussion forum where a
psychologist can offer support to key workers,
learning portfolios can be developed by staff and
there are an abundance of resources relating to
addiction stored on the site.
1 | 12
TIER 1
Community Pharmacy Service
Moodjuice
A community pharmacy service has been
developed through more focussed training and
communication providing:
An addiction element of the Moodjuice web site
has been developed to provide direct access
to psychological interventions for patients. This
innovative approach will help build the skill and
capacity of staff via email access to a discussion
forum. Learning portfolios can be developed
by staff and there is an abundance of addiction
resources and information.
•
Dispensing and Supervision of Substitute
Opiates – Methadone and Buprenorphine
•
Pharmacy Needle Exchange
•
Minor ailment service
Grangemouth Family Substance Abuse
Support; Locals Against Drug Abuse (LADA);
Stirling Family Support Service
These services address the needs of family
members in relation to substance misuse and
offer:
•
Family support group sessions
•
One to one support/Home visits
•
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
Signpost Recovery
Signpost has operated as a tier one direct access
service to provide advice and information
relating to problematic substance misuse to
individuals, families and the wider community.
A comprehensive assessment is provided within
four working days of referral. The service offers:
•
Time limited support (group work, problem
solving)
Support to kinship carers
•
Support for self detoxification
•
Good parenting support
•
Access to housing and welfare advice
•
Involvement of families and carers in the
planning and delivery of treatment.
•
Advice and support to access primary
healthcare
•
24 hour telephone support service
•
Sexual health advice
•
Referrals to other agencies
•
Harm Reduction Service - needle exchange
•
Information to local community, groups &
individuals
•
Forth Valley Tox – a detoxification service
•
Arrest referral service
•
Use of alternative therapies on the appropriate
users i.e. Auricular Detox , Chi Gong and neuro
electric therapy
59
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
TIER 1 (continued)
Stirling Family Support Service
Stirling Family Support has developed a network
of families affected by substance use issues who
provide support to each other. It has driven forward
good practice for working with family members,
including the publishing of clear guidelines on
how to include families in treatment services.
Other work includes:
•
Establishing or expanding support to kinship
carers.
•
Good parenting support
•
Involvement of families and carers in the
planning and delivery of treatment.
•
Use of alternative therapies on the appropriate
users i.e. Aricular Detox, Qi Gong and neuro
electric therapy.
TIER 2
General Practitioner Prescribing Service (GPPS)
GPPS promotes and encourages GPs in the support
and treatment of opioid users in Primary Care.
Provides support and training to GPs, Community
Pharmacists and keyworkers. This service has
successfully increased capacity for treatment
locally, with a capacity for 96 patients.
TIER 3
Community Alcohol and Drug Service (CADS)
CADS is the specialist substitute prescribing service
and manages the needs of patients with complex
care issues including mental health and pregnancy.
The service provides a methadone maintenance
programme for patients. Buprenorphine has
recently been introduced as a treatment option.
Psychology Service
The Psychology Service has been operational
since July 2007 and provides 1-1 sessions focused
on case discussion/supervision. Consultation is
provided on a team basis. The Psychology Service
supports the development of competencies
60
Section 12 | Appendices
within the staff group to support the delivery of
pyschological therapies to clients within their
care.
Forth Valley Criminal Justice Drug Treatment
Service
This is a partnership between Forth Valley NHS
and the Criminal Justice Social Work Service in
each council area. This service provides both the
Fast Track and Drug Treatment and Testing Order
(DTTO) Programmes.
The multi-disciplinary team manages the care and
treatment of 80 Fast Track places and 30 DTTO
places.
1 | 12
ASC Go Forth
In-patient Rehab
Go Forth Community Rehabilitation Programme is
managed through Alcohol Support & Counselling
Service (ASC). It aims to assist people in recovery
from substance dependency, to gain personal/
professional skills and support them in moving
towards education, training, volunteering and/or
employment. The aim is to bridge the gap between
substance treatment services and employment
services.
Residential rehabilitation is appropriate and
effective for some people with substance misuse
problems. These numbers are small and in Forth
Valley as there is an emphasis on treating people in
their local community. However when community
interventions are proving ineffective, in some
cases it is considered whether, in the longer term,
a period of rehabilitation would prove useful. There
is a local joint policy between health and the 3
local authorities which governs the assessment,
placement and resourcing of placements. Funding
of placements is shared equally between health
and the local authority in which the client resides.
On average around six people per year are placed
in residential rehabilitation facilities outwith Forth
Valley. The most frequently used is Ronachan
House in Argyllshire. In recent months, there has
been an increase in the number of clients who,
due to their presentation would benefit from
residential rehabilitation, this treatment option is
currently under review.
Progress 2 Work
Progress 2 Work is a local programme assisting
people with drug misuse issues back into training
or employment, through help with CV writing,
mock interviews and funding to undertake the
disclosure process.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
TIER 4
61
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Alcohol
TIER 1
Community Pharmacy Service
Stirling Family Support Service
There are plans currently underway to develop
a pilot programme for a Community Pharmacy
in Clackmannanshire to deliver Alcohol Brief
Interventions to their clientele, supported by the
enhanced service budget allocation. This work is
in line with the bigger strategic plan to shift the
balance of care in health, in partnership with
Community Pharmacy services.
Family Support services offer support across all
substances in Forth Valley, recognising that no
matter the substance, families will be impacted
upon when use becomes more problematic.
Grangemouth Family Substance Abuse
Support
Family Support services offer support across all
substances in Forth Valley, recognising that no
matter the substance, families will be impacted
upon when use becomes more problematic
Locals Against Drug Abuse (LADA)
Family Support services offer support across all
substances in Forth Valley, recognising that no
matter the substance the families will be impacted
upon when use becomes more problematic.
Signpost Recovery
Signpost Recovery provides a direct access
Alcohol Service – Alcohol Link, which provides
practical support to anyone in Forth Valley wishing
to address problematic alcohol consumption.
This includes one to one, group work, CBT and
motivational work, debt, housing difficulties and
also offer benefit advice. The service has promoted
and developed good links with Al–Anon, which
is critical to providing intensive support and to
the maintenance of recovery.
62
Section 12 | Appendices
Brief Intervention
Brief Intervention is a short evidence-based,
structured conversation about a health issue, with
a client/patient, that seeks in a non confrontational
way, to motivate and support behaviour change
in an individual. It is appropriate for any individual
who is regularly exceeding the daily benchmarks
of 2-3 for females 3-4 for males, with the lower
limits recommended
H4 : The, Health Improvement, Efficiency and
Governance, Access and Treatment target for
Alcohol is set to promote the use of the setting
appropriate screening tool as recommended in
the SIGN 74 guidelines Management of Harmful
Drinking in Primary Care. There are local trajectories
to be achieved by NHSFV, overall the Scottish
target is 149,449 by 2010/11.
The SESP (Scottish Enhanced Service Programme)
has been developed to engage general
practitioners, creating a focus on screening. We
have a very large number of practices who are
actively involved in this work to date 51 out of our
56 primary care practices are actively screening.
There are plans to pilot the work in Community
Pharmacy settings, thus promoting their huge
capacity for promoting health in the community.
1 | 12
To support this work there had to be some
format for data collation/reporting, an IT package
has been introduced to monitor the enhanced
services overall, ESCro is the software package, this
will enable us to keep a watchful eye on the goal.
A resource support pack was developed which
provided all of the most appropriate leaflets,
guidelines and support services information.
There will be a training resource which will form
part of the Moodjuice website, this will be entitled
‘Moodjuice Addiction’.
General Practitioners
Midwives
Alcohol Liaison Nurse (Acute)
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
TIER 1 (continued)
TIER 2
Addiction Support and Counselling (ASC)
•
advice and information
ASC provides a range of services, relevant to all
substances, but mainly focussing on alcohol:
•
therapeutic group work
•
service user groups
•
advocacy, employment referrals
•
training and community rehabilitation/
employability.
•
structured counselling with qualified
counsellors
•
prevention and education programmes
•
progress to higher education
TIER 3
Community Alcohol and Drug Service (CADS)
The Alcohol Service receives 1000 referrals per year
primarily from general practitioners, adult mental
health services, ASC, Alcohol Link and the Alcohol
Liaison Service. Those referred are assessed and
taken into treatment within 2 weeks.
The Alcohol Liaison Service commenced in
June 2006 based within the CADS building at
Bannockburn Hospital. This has led to progress in
developing a consistent approach to, and delivery
of, alcohol interventions in secondary care.
In November 2006 the service acquired two
dedicated alcohol detoxification beds in Ward 1
FDRI. The beds operate at 100% occupancy and
there is currently a 6 week wait to access one.
The Alcohol Service is currently providing training
to the general practices who are participating
in the SESP relating to Screening and Brief
Interventions for Hazardous and Harmful Drinking
within primary care.
Forth Valley Criminal Justice Drug Treatment
Service
FVCJDTS supports people with poly drug use
(those who use more than one substance) which
therefore includes alcohol.
63
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
TIER 4
ASC Go Forth
Progress 2 Work
Go Forth Community Rehabilitation Programme
aims to assist people in recovery from alcohol
dependency, to gain personal/ professional skills
and support them in moving towards education,
training, volunteering and/or employment.
The aim is to bridge the gap between alcohol
treatment services and employment services.
Progress 2 Work assists people with alcohol misuse
issues, back into training or employment, through
help with CV writing, mock interviews and funding
to undertake the disclosure process.
Careers Scotland
This service aims to provide careers information,
advice, support and career planning for clients of all
ages. Key workers provide holistic support to assist
young people to enter and sustain employment,
training or Further Education.
Employment Connections
This services aims to provide support and
guidance to people in Stirling who wish to access
information, training and employment. Employers
or businesses can access business funding
advice/support, information, a comprehensive
recruitment service and bespoke training for
newly created vacancies.
64
Section 12 | Appendices
In-patient Rehab
Residential rehabilitation is appropriate and
effective for some people with substance misuse
problems. These numbers are small and in Forth
Valley as there is an emphasis on treating people in
their local community. However when community
interventions are proving ineffective, in some
cases it is considered whether, in the longer term,
a period of rehabilitation would prove useful. There
is a local joint policy between health and the 3
local authorities which governs the assessment,
placement and resourcing of placements. Funding
of placements is shared equally between health
and the local authority in which the client resides.
On average around six people per year are placed
in residential rehabilitation facilities outwith Forth
Valley. The most frequently used is Ronachan
House in Argyllshire. In recent months, there has
been an increase in the number of clients who,
due to their presentation would benefit from
residential rehabilitation, this treatment option is
currently under review.
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Tobacco
Within the tiered model, all smoking cessation is effectively Tier 1.
Community Pharmacy Service
Stirling Family Support Service
A pharmacy smoking cessation project has been
funded through smoking cessation monies.
anything specific on tobacco
Stop Smoking Services (SSS)
Grangemouth Family Substance Abuse
Support
Provides information and advice on reducing
harmful smoking practices i.e. smoking in front
of children, leaflets on pregnancy & smoking
etc. referral-on to local cessation clinics where
appropriate.
A smoking cessation service is co-ordinated
through the Health Promotion Department,
and provides locality clinics and drop-in clinics
across Forth Valley. In addition there is a smoking
cessation service provided within the acute sector.
Primary care teams may also provide smoking
cessation.
Signpost Recovery
Smoking cessation work is provided as part of
the harm reduction services within Signpost core
service.
65
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 5 - Summary of Gaps - tiered model best practice
Alcohol
66
Section 12 | Appendices
Drugs
Tobacco
1 | 12
• Comprehensive substance misuse
assessment, including complex cases when
appropriate
• Care planning and review for all in-patient
and residential structured treatment
COLOUR CODE:
Black: currently provided
Grey: under development
Red: To do
• Care planning and review, regular keyworking sessions as standard practice
• Structured day programmes, care planned
day care with interventions targeting specific
• A range of structured, evidence based,
psychosocial therapies and support to
address alcohol misuse
• Groups
• Community care assessment and case
management of alcohol misusers
• A range of evidence based prescribing
interventions, including medically assisted
detox in the context of a package of care, inpatient or residential care appropriate to the
size of population
• Provision of information, advice and training
and “shared care” to others delivering Tier 1
and 2 and support for Tier 3 services
• Comprehensive substance misuse assessment
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Alcohol Tiered Model
• Range of evidence based prescribing
interventions, community based alcohol
detoxification
Tier 4
Tier 3
• Liaison services ,e.g.
- acute medical
- psychiatric services
- maternity
- mental health
- hep c services
- older peoples services
- social care services (child care) housing
Tier 2
Tier 1
• Alcohol advice and information
• Targeted screening and assessment for those
exceeding DH guidance
• Referral of those requiring more than simple brief
interventions for specialised alcohol treatment
• Partnership or “shared care “ in a range of settingswhere the main focus is not treatment, all partners
• Alcohol specific counselling, advice and
support
• Extended brief intervention to reduce
alcohol -related harm
• Mutual aid groups e.g. Alcoholics
• anonymous
• Overarching strategy, incorporating education and
prevention work and training
• Alcohol specific assessment and referral of
those requiring more structured alcohol
treatment
• Provision of simple brief interventions for hazardous/
harmful drinkers in
• Triage assessment which may be part of
locally agreed arrangements
- primary care settings,
- acute hospitals,
- social work,
- police (custody cells),
- education,
- homelessness services
• Partnership or “shared care” with staff
from tier 3 and 4 provision, or joint care of
individuals
• Family support accessible and equitable access to all
family members affected by substance misuse
67
Section 12 | Appendices
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Drug Tiered Model
• Provision of special groups for which need is
identified e.g. drug using pregnant women,
drug users with severe enduring mental
illness
COLOUR CODE:
Black: currently provided
Grey: under development
Red: To do
• A range of these services for drug using
offenders
• Comprehensive drug misuse assessment
• Care planning co-ordination and review for
all in structured treatment, often with regular
key-working sessions as standard practice
• Community care assessment and case
management for drug misusers
• Inpatient specialist drug and alcohol
assessment, stabilisation, and detoxification
• Range of prescribing interventions
• Range of structured evidence based
psychosocial interventions to assist
individuals to make changes in drug and
alcohol using behaviour
• A range of drug and alcohol residential
rehabilitation service options
• A range of supportive accommodation for
drug misusers
• A range of the above interventions for
substance using offenders
Tier 4
Tier 3
Tier 2
• Harm reduction activities as integral to care
planned treatment
• Structured day programmes and care
planned day care e.g. interventions targeting
specific groups
• Liaison services for acute medical, psychiatric
services , pregnancy, mental health and
hepatitis services
• Liaison services for social care services, child
protection and community care teams, housing,
homelessness
Tier 1
• Triage assessment and referral for structured drug treatment
• Drug interventions which attract and motivate drug misusers into
treatment systems, engagement with priority groups- pregnant women,
offenders and stimulant users
• Drug related support for clients seeking abstinence
• Drug related aftercare support for those who have left care planned
structured treatment
• Interventions to reduce risk of overdose and diversion of prescribed drugs
• Partnership or “shared care” working
with specialised drug treatment services,
to provide specific drug treatment
interventions for drug misusers within the
context of their generic service i.e.
- housing ,
- social care,
- general healthcare,
- prison,
- FVCJTS
• Brief psychosocial interventions for drug and alcohol misuse
• Drug treatment screening and assessment
• Liaison and support for generic Tier 1 service providers
• Referral to specialised drug treatment
• Outreach services to engage clients into treatment and to reengage
people who have dropped out of treatment
• Drug advice and information
• A range of the above interventions for drug misusing offenders
• Overarching Strategy incorporating education
and prevention work and training
• Brief interventions for specific target groups including high risk and other
priority groups
• Family support accessible to all family
members affected by substance misuse
• Interventions to reduce harm and risk due to BBVs and other infections
including needle exchanges and the support of co-ordinated pharmacy
based needle exchanges
68
Section 12 | Appendices
1 | 12
• Smoking Cessation, highly intensive and
complex
• Developing Stop Smoking Services and
strengthening local action on tobacco
COLOUR CODE:
Black: currently provided
Grey: under development
• Smoking CesSATion, low intensity and
simple
Red: To do
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Tobacco Best Practice Model
Tier 4
Tier 3
Tier 2
Tier 1
• Tobacco control policies
• Prevention and Education
• Reducing tobacco promotion, ensuring
compliance with existing legislation and
tackling loopholes in the law.
• Supporting national education and media
campaigns on tobacco and developing local
campaigns
• Reducing exposure of non-smokers across
the area to second hand smoke
• Reducing the availability and supply of
tobacco products - legitimate, smuggled
and counterfeit, and addressing the supply
to young people
• Establish well funded, comprehensive
tobacco control programmes that de
normalise tobacco use (making nonsmoking the norm)
69
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 5 (cont.) - Gaps
identified in the visioning work
The following are areas identified as gaps by
stakeholders through the visioning exercise. They
are all-inclusive and have not been prioritised:
Client Groups - Gaps
•
People who are admitted to acute/emergency
services
•
Inpatients (misusing substances on the wards)
•
Hepatitis A
•
Hepatitis B
•
Hepatitis C
•
Severe and enduring mental illnesses
‘Life circumstances’
•
Criminal justice system – people arrested
Substances used (Extent – volume, frequency)
•
Prisoners – (esp. those being released)
•
Alcohol
•
People involved in prostitution
•
Tobacco
•
Opioids
‘Age/ social status’
•
Cocaine
•
Young people (esp. those using substances)
•
Other stimulants
•
Young women
•
People attending University, further education
colleges, workplace training schemes,
•
Children of drug using parents
•
Young carers
•
Parents
•
Older people (re. alcohol)
‘Disease/ health problem/ health status’
Assessment and
Intervention - Gaps
Principles
•
‘Holistic approach’ - access to all relevant
information, including social work, health,
police, as well as other services such as
housing, etc.
•
Flexibility
•
Needs led approach
•
In partnership with the client (esp. young
people), family and other agencies involved
•
Dual diagnosis
•
Alcohol related brain injury, Korsakoffs
•
Pregnant women
•
Good quality treatment
•
Stable drug users
•
•
Drug users who are committed to change.
•
People who have suffered from some trauma
in the past,
Evidence-based interventions, which take into
account the social, physical and emotional
wellbeing of the client.
70
Section 12 | Appendices
1 | 12
•
Cognitive Behavioural Therapy (CBT)
•
•
Motivational, solution focused,
•
Subutex,
Interventions
•
Methadone,
Enablements
•
Buprenorohine,
•
Suitable housing
•
Suboxone,
•
Welfare rights information
•
Any other new drugs
•
General advocacy support
•
•
Specific social support service for clients
Local Residential Rehabilitation facilities with
appropriate accommodation for parents and
children.
•
Advocacy support
•
•
‘Real access’ to employment opportunities, or
training etc.
A Problem Solving Partnership in
Clackmannanshire similar to the one in
Stirling.
•
Dietary (Dietetic) advice
•
•
Peer education projects and utilising the skills
of the voluntary sector
Psychiatric care of patients undergoing
interferon treatment
•
Health Information Resource Service (HIRS)
Service Types
•
Befriending/ advocacy services
•
More ‘Tier 4’ services
•
Structured counselling
•
Throughcare and aftercare.
•
Internet counselling.
•
Family support
•
Family support
•
‘Social firms’
Organisation - Gaps
•
A relapse prevention group
Principles
•
Abstinence based peer support groups
•
•
Maternity liaison
Organisations need to think in terms of both
internal and external co-ordination
•
External co-ordination is one aspect of
partnership working
•
Partnership working encompasses strategic
partnership and operational teamwork
•
Economies of scale may exist where one part
of the service could support others
Testing for hepatitis
Treatment
•
Treatments for BBVs,
•
Dental services
•
Contraception (inc. contraceptive implants for
all female drug users)
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Assessment
71
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Strategic Partnership
Human Resources
•
Joined up approach in terms of policies
Staff:
•
Acknowledge and develop links to CHPs and
community planning partnerships
•
More detached youth workers (outreach)
•
Alcohol Liaison nurses to cover evenings and
weekends at A&E.
•
Substance Misuse Nurse in each of the 3 Local
Authority areas
•
Another development officer for
Clackmannanshire.
•
Research officer
•
Prescribing strategy, ensure direction for all
agencies
Specialist link post, who could go and work
with the community mental health teams
•
Whole review of all services, with
recommendations and changes.
Specialist pharmacist to the drug services in
Forth Valley
•
Occupational therapist based within CADS
Service Level Agreements with all services.
•
Link with lead for maternity services
•
Research nurse based in CADS
•
Specialist post in maternity liaison, (could
be one or two sessions a week by one of the
CADS charge nurses)
•
Substance misuse link nurse based in liaison
psychiatry
•
A dedicated alcohol consultant post, or
increase to the time currently available
•
Links with Consultant Psychiatrist for Older
People. (re. alcohol)
•
A link nurse to work in CADS and Old Age
Psychiatry. (re. alcohol)
•
Link worker with the community mental
health teams (re. alcohol)
•
•
•
•
•
•
Engage and build relationships with
departments such as housing.
Organisational focus on partnership working
to avoid duplication of services and to ensure
that clients receive the most effective service.
There needs to be openness regarding the
bigger agenda of the NHS and their plans,
budgets, etc
Communication
•
Need to improve understanding of each
other’s roles and responsibilities,
•
Create awareness of the impact of policy
decisions on, and for, each other’s services.
•
Services need to develop better information
sharing systems with one another, outlining
exactly what they do and who they do it with,
and probably more importantly, what they
don’t do and who they don’t work with.
•
Need clear and open communication
•
Need to have a way of ensuring that all
services know about what changes are taking
place as well as any developments.
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Section 12 | Appendices
1 | 12
Information-based approaches
•
Psychiatry and physical medicine skills of the
statutory services re. stimulants
•
Each service should develop and introduce
good practice guidelines for all staff.
•
Structured counselling skills of ASC
•
•
Highly trained individuals – child protection
Need a common system for referral, to
and from services, that is formalised and
acceptable to all.
•
Training on substance use for midwifes
•
•
Training of two nurses to provide
contraceptive training
Where a referral from one service to another
is planned, the reason for the referral and
the expectation of both the referring agency
and the receiving agency should be resolved
before the referral takes place.
•
Better links/clearer processes with each other
•
Better links between e.g. maternity services
and all substance services, use CADS as
example.
•
Measurable outcome data
•
Quarterly review sheets
Facilities
•
Private areas in all pharmacies for supervised
methadone consumption.
•
Places for assessment of individuals with
substance misuse issues and mental health
problems.
•
In-patient beds for drug stabilisation and
perhaps detoxification
•
Pharmacy Sunday opening
Financial aspects
•
Review equity of services
•
•
In-patient beds for alcohol detoxification (and
other associated resources, e.g. staff )
Funding process requires to be investigated to
ensure open and honest communication.
•
Sharing of best practices and promote
continuity of care.
•
Access external funding through partnership
to reduce competition.
Structural Approaches
•
Integrated Addiction teams similar to those
in Glasgow with professionals from multidisciplines under one roof.
•
CPA meetings and liaison with community
mental health teams
•
Specialist child protection team
•
A multi-agency “one stop shop” for people
experiencing difficulties with alcohol
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Skills:
SAT Groups
•
Process of care Group could be more creative
and proactive in terms of strategic thinking,
with strong leadership and improved agenda.
•
Consider a FVSAT prevention and education
sub-group with responsibility for progressing
that section of the CAP and ensuring evidence
is disseminated and translated into practice.
73
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Care - 2006
Evidence – to underpin what we
are and should be doing
•
•
•
UK & Scottish Drug Policy from the late 1990s
- treatment services for offenders
NTORS (National Treatment Outcome
Research Study)
National Quality Standards for Substance Use
Services
•
Forth Valley Health and Homelessness
Strategy
•
Smoking Kills 1998
•
Breath of Fresh Air, A Plan for Action a Plan for
Health 2004
•
A & E stats regarding alcohol
•
DRD research and stats
•
Deaths/Heart Disease etc linked to Smoking
•
NICE guidance on buprenorphine
•
SIGN Guidelines
•
SIGN 74
•
Scottish Executive Hep C Action Plan
•
Sexual Health Strategy
•
Local statistics
•
Evidence from the richness and diversity in the
range of services available in Forth Valley
•
2003 HTBS document ‘Prevention of Relapse in
Alcohol Dependence’
•
Suboxone, waiting on pilot being completed
in Glasgow.
•
National Treatment Agency guidance
•
Smoking Kills 1998
•
Breath of Fresh Air, A Plan for Action a Plan for
Health 2004
•
Drugs – facing facts. The report of the RSA
Commission on illegal drugs, communities
and public policy. 2007
•
Plan for Action on Alcohol Problems: update
2007
•
Evaluation of effectiveness of Drug Education
in Scottish Schools Feb 2007
•
Pathways to Problems report Nov 2006
•
Towards a Future without Tobacco – 2006
•
Forth Valley Sexual Health Strategy - 2006
•
The Mental Health of Young People – a
Framework for promotion, prevention and
74
Section 12 | Appendices
Overlap – between services
provided by agencies
Principles
•
Overlap is not necessarily a bad thing. It can
be an aid to change from one treatment
regime to another.
•
Overlap could be a means of developing
more interesting and attractive (to the client)
services
•
Overlap may lead to replication which may
not be useful.
•
We need to know what each service is doing,
and capacity
•
Joint working and joint funding are key
•
The Process of Care Group has a key role
•
Overlap may exist as a result of offering choice
1 | 12
Organisation
•
•
Stop short term funding of projects
•
Stop the creation of competition between
services
•
Stop excessive meetings and make them
more outcome focussed.
•
Review all the strategic meetings across Forth
Valley and rationalise this.
•
Review the function and role of FVSAT and
look to devolve some of the power to local
forums.
•
Enhance communication between FVSAT and
the Forums.
•
Obtain Support from FVSAT on funding issues,
especially to voluntary organisation whose
time is spent chasing funding instead of
managing a service.
•
Referral on to other service which provide
similar interventions
Councils appointing private firm to cover
smoking cessation as has happened in Clacks.
Progress and suggestions
•
•
The Tier structure and more structured
recording systems seems to have solved the
former issues regarding this.
Review of what alcohol support services are
available to ensure there is no duplication.
Things We Should Stop Doing
– that add little/ no value
Client/ involvement
•
Stop ignoring the clients – ask them to assist
us in reviewing what we deliver, and how we
deliver it
•
Ensure there is feedback from the client group
(client quality)
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Sources of overlap
The following is a review of services based on the
tiered model approach, showing areas of best
practice that we think need further development:
Treatment
•
Stop methadone prescribing (‘cure’ or
maintenance)
•
Stop providing treatment if the treatment plan
has no objective or is not meeting the desired
objective
75
Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 6 - The 4 Themes
3. Law Enforcement and Criminal Justice
1. Preventing Drug Use
•
An approach consisting of interventions
upholding the law on substances.
•
Includes (prevention), detection and
prosecution in relation to offences relating to
the supply, possession and use of substances.
•
Aims to reduce not only supply but also
demand and harm.
•
Covers all substances - illicit substances,
alcohol and tobacco
•
Should also include a consideration of policy
development (e.g. in tobacco and alcohol)
which leads to new legislation and how this
can be enforced
•
•
•
An approach consisting of a range of
interventions aimed at reducing the likelihood
of individuals smoking, consuming alcohol
at hazardous or harmful levels, or problem
substance use.
Often, but not exclusively aimed at children
and young people.
Classifies those using substances as
‘experimenters’, ‘regular users’ and ‘problem
users’.
2. Promoting Recovery (through reformed
delivery of services)
Where recovery means “a process through
which an individual is enabled to move on
from their problem drug use, towards a drugfree life as an active and contributing member
of society”.
4. Getting it Right for Children in Substance
Misusing Families
•
Focuses on the effects of substance use in
others (mainly parents) on children and young
people.
•
Service users’ needs and aspirations are placed
at the centre of their care and treatment.
•
•
an aspirational, person-centred process. An
ethos of continuous improvement of services
Aims to improve the identification and
management of related risk, and support to
minimise risk and actual harm
•
Links strongly with broader work on child
protection and family health.
•
•
Aims mainly at treatment services (rather than
prevention)
•
Includes assessment of and interventions
aimed at problem/ hazardous/ harmful
substance use, including dependence and
substance related harm.
•
excludes assessment and treatment of
substance related disease.
•
Is likely to involve processes such as needs
assessment, redesign and the development of
service delivery plans.
76
Section 12 | Appendices
1 | 12
The following diagram illustrates how the themes relate to substance use and related problems,
with children and young people being a cross-cutting theme and strongly linked to education and
prevention:
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 6 (i)
Prevention and Education,
and Enforcement
Never used
Tried
Irregular use
Substancerelated
disease
Regular use
Experimentation
Abstinence
Reduced,
safer
controlled
use
Problem use:
(hazardous
and/or harmful
with/without
dependence with/
without
co-morbidity)
Assessment, management,
intervention, including
harm reduction
Reform
Delivery
Recovery
77
Section 12 | Appendices
78
Section 12 | Appendices
The progression
from abstinence to
experimentation, to
regular use and then
problem use, applies to
most illegal drugs.
Information and
education on the
range of illegal drugs
may reduce the risk of
problem use.
Changing beliefs and
values may reduce the
likelihood of problem
illegal substance use.
Understanding the
natural history of
substance use
Provision of information
and education
Moving towards
changing beliefs and
values, and behaviour
1. Preventing Drug Use
¸- information and
education on all
substances should
usefully be provided
together.
Information and
education on tobacco
may reduce the risk of
use.
Changing beliefs and
values may reduce the
likelihood of smoking.
Information and
education on alcohol
may reduce the
risk of problem use.
Awareness raising
campaigns are
emphasised in national
policy.
Changing beliefs and
values may reduce the
likelihood of problem
alcohol use.
¸- working on positive
beliefs and values,
self-confidence and
resilience spans all
substance use.
Looking at the ‘natural
history’ of substance
use and delivering
interventions at key
points is appropriate
across all substances.
Common approach to
all substances?
The progression
described does not
apply so well to
tobacco. Regular use is
also problem use.
Tobacco
The progression
from abstinence to
experimentation
(infrequent use),
to regular use and
then problem use
can be applied to
alcohol. Problem use
encompasses harmful
and hazardous use.
Alcohol
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
Appendix 7 – Applying National Strategy to Main Substance Types
Settings approach is
appropriate – homes,
communities and
schools are most
relevant.
The physical and social/
cultural environment
is important in illegal
substance use. Tackling
deprivation should
impact on problem
substance use. Certain
substances can relate
to culture and sociogeographic factors, e.g.
volatile substances,
cocaine.
Settings approach:
Home, community,
schools, workplace, care
settings.
Addressing wider
determinants/ issues.
1. Preventing Drug Use (cont.)
Settings approach is
appropriate – homes
(esp. Smoke Free
Homes initiatives),
communities and
schools are most
relevant.
The physical and social/
cultural environment
is important in
tobacco use. Tackling
deprivation should
impact on tobacco use.
The physical and social/
cultural environment
is important in
alcohol use. Tackling
deprivation should
impact on problem
alcohol use.
Tobacco
Settings approach is
appropriate - National
policy emphasises
the workplace. Within
the setting of licensed
premises, promoting
choice on measures
is emphasised in
national policy.
Homes, communities
and schools are also
particularly relevant.
Alcohol
¸ - addressing wider
cultural, social and
economic factors
will impact on all
substances, making
the connections
with beliefs, values,
self-confidence and
resilience.
¸ - prevention work
across settings can be
generic – spanning all
substances.
Common approach to
all substances?
Appendix 7 (cont.)
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
79
Section 12 | Appendices
Tobacco
80
Section 12 | Appendices
¸ - key to the approach
to addressing harmful
and hazardous use
¸
N/A
¸
¸
¸ (depends on
substance)
¸
• community
rehabilitation
• prescribing substitute
drugs
• detoxification and
relapse prevention
programmes
The recovery ethos
applies well to alcohol
use.
Not really considered
The recovery ethos
applies to most illicit
substances, but is
particularly relevant to
heroin. It may not apply
so well to the use of
volatile substances, for
example.
• screening and brief
intervention
Range of treatment and
rehabilitation services:
The recovery ethos – an
explicit aim.
Common approach to
all substances?
¸ - although little
emphasis on longer
term relapse prevention
to date.
¸- NRT
N/A as such
¸- still huge potential
for opportunistic
approaches
The range varies with
the substance.
The recovery ethos does ¸
not apply to tobacco
use – which may not
impact significantly
on social functioning.
The target for tobacco
use should usually be
abstinence. (i.e. more
than for alcohol or
illegal substances).
2. Promoting Recovery (through reformed delivery of services)
Alcohol
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
Appendix 7 (cont.)
Tobacco
¸
¸
¸- especially
designated places of
safety
¸- requires integration
with mental health
services, housing,
employability
– and primary medical
services
¸
¸
¸
¸- requires integration
with mental health
services, housing,
employability
• residential
rehabilitation
• harm reduction
services
• crisis services
Effective integration
with generic services
Range of treatment and
rehabilitation services
(cont.)
¸- requires integration
with primary medical
service
N/A
N/A
N/A
2. Promoting Recovery (through reformed delivery of services) (cont.)
Alcohol
¸- but services to be
integrated with varies.
Under SOA etc. all
services need to take
some responsibility for
addressing substance
use issues and
problems.
¸ - prevention work
across settings can be
Common approach to
all substances?
Appendix 7 (cont.)
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
81
Section 12 | Appendices
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Section 12 | Appendices
Supply
Enforcement of laws
relating to the supply
and possession of illegal
substances.
• Social Responsibility
Fee
• Measures to Control
The Availability Of
Alcohol
• Raising Minimum
Purchase Age
• Minimum Retail
Pricing
• Promotions and Loss
Leading
Enforcement of
licensing laws on
the supply and
consumption of alcohol,
especially to underage
drinkers. (Also links to
licensing boards)
Scotland’s relationship
with alcohol, includes
suggestions for changes
in legislation and policy
which would require to
be enforced:
3. Law Enforcement and Criminal Justice
Alcohol
• Reducing the
affordability of tobacco
products.
• Reducing the
availability of tobacco
products
• Reducing the
attractiveness of
tobacco products
Enforcement of laws
on the advertising, sale
and procurement of
tobacco – especially
related to age, and
including supply from
overseas. Enforcement
of laws on smoking in
public places.
National policy includes:
Tobacco
Although enforcement
is relevant to all
substances, and mainly
an issue for police
services, the laws
and situations vary
considerably between
substances.
Common approach to
all substances?
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
Appendix 7 (cont.)
Relationship to nonsubstance-related
crime – crimes of
property, crimes against
the person, anti-social
behaviour.
Supply
Problem substance use
is a factor influencing
crimes of property.
Entry to the criminal
justice system provides
an opportunity for
addressing problem
substance use.
Problem alcohol use,
especially short term
intoxication is often
a factor in crimes
against the person and
anti-social behaviour.
Entry to the criminal
justice system provides
an opportunity for
addressing problem
alcohol use (which is
possibly under-utilised
at present).
• Separate Alcohol
Checkouts
• Further Restricting
Promotional Material
in Licensed Premises
• Restrictions On
Alcohol Advertising
• Alcohol Product
Labelling
Enforcement of (cont.):
• Drink Driving
3. Law Enforcement and Criminal Justice (cont.)
Alcohol
The relationship
between tobacco use
and crime is not strong.
Tobacco
The relationship
between crime and
substance use varies a
lot depending on the
substance.
Common approach to
all substances?
Appendix 7 (cont.)
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
83
Section 12 | Appendices
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Section 12 | Appendices
Problem substance
use is a particular issue
for those detained in
prison.
Problem alcohol use
is a particular issue
for those detained in
prison.
Identification and
management of the risk
to children of parental
problem alcohol use is
important.
Identification and
management of the risk
to children of parental
problem substance use
is important.
Direct support to
families in relation
to illegal drug use is
important.
Identification and
management of risk
Support
Direct support to
families in relation
to alcohol use is
important.
Prevention and early
detection in parental
problem alcohol use is
an important factor.
Prevention and early
detection in parental
problem substance use
is an important factor.
Prevention and early
intervention
Common approach to
all substances?
Direct support to
families in relation
to tobacco use is
important.
The identification and
management of the risk
to children of parental
smoking is more
problematic.
Prevention and early
detection in parental
smoking is less
important.
¸ - a common
approach is likely to be
worthwhile.
¸- to some extent a
common approach is
likely to be worthwhile.
¸ - to some extent a
common approach is
likely to be worthwhile.
Tobacco use is a
¸ - substance use work
particular issue for those in prisons spans all
detained in prison.
substances.
Tobacco
4. Getting it right for Children in Substance Misusing Families
Settings approach
– prison
3. Law Enforcement and Criminal Justice (cont.)
Alcohol
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
Appendix 7 (cont.)
Tobacco
Co-ordination of
services and input in
relation to tobacco may
be less important than
other substances.
Tobacco is unique in
terms of the significant
risk associated with
passive exposure to
environmental tobacco
smoke. Smoke Free
Homes initiatives can
have positive outcomes
for the whole family.
Co-ordination of
services and input in
relation to alcohol use
is crucial.
Although
environmental
exposure may be much
less direct compared to
smoking, Alcohol Free
Homes initiatives may
be worth considering.
Co-ordination of
services and input in
relation to illegal drug
use is crucial.
Depending on the
drug, environmental
exposure may be much
less direct compared
to tobacco smoking,
however Drug Free
Homes initiatives may
be worth considering.
Co-ordination
Settings approach
- home
4. Getting it right for Children in Substance Misusing Families (cont.)
Alcohol
¸ - to some extent a
common approach is
likely to be worthwhile.
¸- to some extent a
common approach is
likely to be worthwhile.
Common approach to
all substances?
Appendix 7 (cont.)
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Illegal Drugs
1 | 12
85
Section 12 | Appendices
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 8 – Allocation of Responsibility to areas within Section 7
Groups and Agencies
Processes and Plans
7.1 Preventing Drug Use
7.1.a Understanding the natural
history of substance use
Link in to national work
Alcohol & Drug Partnerships
(ADPs)
7.1.b Provision of information
and education
Alcohol & Drug Partnerships
Curriculum for excellence and
health promoting schools
Schools and Educational
establishments
Curriculum for Excellence
implementation plans
Accreditation schemes for
health promoting schools
7.1.c Moving towards changing
beliefs and values, and
behaviour
whole system approach
Knowledge and Skills
Framework (KSF)
7.1 d Settings approach: Home,
community, schools,
workplace, care settings
Community Development work Gold, silver and bronze awards
Healthy Working Lives (NHS)
7.1 e Addressing wider
determinants/ issues
Alcohol & Drug Partnerships
(ADPs)
Community Planning
Partnerships (CPPs)
Community Health
Partnerships (CHPs)
SOAs (G9)
Fairer Scotland Fund
7.2 Promoting Recovery (through reformed delivery of services)
7.2.a The recovery ethos – an
explicit aim
other key strategies
Forth Valley ADP
Local ADPs
Workforce development and
Person-Centred Care and the
Individual care plan
Health Reference Group (HRG)
Project Redesign Board
Tobacco Action Group
Alcohol Strategy Group
Treatment strategy
Alcohol Plan
Tobacco Plan
Other workplans for groups and
services
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Groups and Agencies
Processes and Plans
7.2 (cont.)
7.2.b Range of treatment and
rehabilitation services:
Health Reference Group
Project Redesign Board
Tobacco Action Group
Alcohol Strategy Group
Treatment strategy
Alcohol Plan
Tobacco Plan
Other workplans for groups
and services
Assessment
Health Reference Group
Project Redesign Board
Tobacco Action Group
Alcohol Strategy Group
Treatment strategy
Alcohol Plan
Tobacco Plan
Other workplans for groups
and services
7.2.b.i Illegal Drugs
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
Type of Substance
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
Community Rehabilitation
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
Prescribing substitute drugs
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
Detoxification and relapse
prevention programmes
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
Residential rehabilitation
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
Harm reduction services
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 8 (cont.)
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Section 12 | Appendices
1 | 12
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 8 (cont.)
Groups and Agencies
Processes and Plans
7.2 (cont.)
Crisis services
Health Reference Group
Project Redesign Board
Treatment strategy
Other workplans for groups
and services
7.2.b.ii Alcohol
Alcohol Strategy Group
Alcohol Plan
Brief Intervention
Alcohol Strategy Group
Alcohol Plan
Community Health Partnerships Enhanced services
implementation plan
Community Rehabilitation
Alcohol Strategy Group
Alcohol Plan
Detoxification and relapse
prevention programmes
Alcohol Strategy Group
Alcohol Plan
Residential rehabilitation
Alcohol Strategy Group
Alcohol Plan
Harm reduction services
Alcohol Strategy Group
Alcohol Plan
Crisis services
Alcohol Strategy Group
Alcohol Plan
7.2.b.iii Tobacco
Tobacco Action Group
Tobacco Plan
Prescribing substitute drugs
Tobacco Action Group
Smoking Cessation Services
Tobacco Plan
Detoxification and relapse
prevention programmes
Tobacco Action Group
Smoking Cessation Services
Tobacco Plan
7.2.c.i General Medical Services
Health Reference Group
HRG workplan
Illegal Drugs
Health Reference Group
Community Health Partnerships
General Practitioner Prescribing
Service
GPPS Steering Group
7.2.c Effective integration with
other services and contributors
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Section 12 | Appendices
1 | 12
Groups and Agencies
Processes and Plans
7.2 (cont.)
Alcohol
Alcohol Strategy Group
Community Health Partnerships
Health Reference Group
ABI Co-ordinator
Tobacco
Tobacco Action Group
Community Health Partnerships
Health Reference Group
7.2.c.ii Acute services including
maternity
Health Reference Group
Acute services
ABI Steering Group
Implementation of CEL 4 2008
on HPHS
Mental health services
Health Reference Group
MH Delivery Plan Group
MH services
MHDP
(HEAT)
7.2.c.iii Pharmacy Services
Health Reference Group
Pharmacy services - Contracts
Pharmacy Strategy
7.2.c.iv Psychological services
Health Reference Group
MH Delivery Plan Group
Psychological services
Community Alcohol and
Drug Service(CADS)
Psychological Services Strategy
7.2.c.v Dietary (Dietetic) advice
Health Reference Group
Nutrition and Dietetics Dept.
Dietetics and nutrition redesign
7.2.c.vi Dental services
Health Reference Group
Dental Services
Oral Health Strategy
7.2.c.vii Sexual health services
(inc. family planning)
Health Reference Group
Sexual health services
Sexual Health Strategy Group
Curriculum
Sexual Health Strategy
7.2.c.viii Employability Services
ADP Employability Group &
Health Group Employability
services
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 8 (cont.)
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Section 12 | Appendices
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 8 (cont.)
Groups and Agencies
Processes and Plans
7.2 (cont.)
7.2.c.ix Services for social
support
Local authorities social services
(Young Carers, Open Secret,
Women and Domestic Violence)
7.2.c.x Advocacy support
Advocacy Service
7.2.c.xi Carers and Families and
related services
Alcohol& Drug Partnerships
Family Support Network and
Communities Sub-group
7.2.d Action to tackle
blood-borne viruses
Health Reference Group
BBV strategy group
7.2.e Action to prevent
drug-related deaths
Critical Incident sub-group
7.3 Law Enforcement and Criminal Justice
Forth Valley ADP
Alcohol & Drug Partnerships
Central Scotland Police
Community Justice Authority
Local authority trading standards
7.3.a Enforcement relating to
substance use laws
Central Scotland Police
Community Justice Authority
Local authority trading standards
7.3.a.i Illegal Drugs
Central Scotland Police
Community Justice Authority
Local authority trading standards
7.3.a.ii Alcohol
Central Scotland Police
Local authority trading standards
7.3.a.iii Tobacco
Central Scotland Police
Local authority trading standards
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Section 12 | Appendices
Advocacy Strategy
1 | 12
Groups and Agencies
Processes and Plans
7.3 (cont.)
7.3.b Substance use in those
who are in contact with the
criminal justice system
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 8 (cont.)
Forth Valley ADP
Central Scotland Police
Community Justice Authority
Arrest Referral Service
7.4 Getting it Right for Children in Substance Misusing Families
Forth Valley ADP
G5 Reporting Group
Alcohol & Drug Partnerships
Forth Valley Service Response
Group
Young Person’s sub-group
Child Protection Groups
Integrated Strategic Planning
Group for Child Health
Child Health Forum
7.4.a Prevention and early
intervention
Forth Valley ADP
G5 Reporting Group
Alcohol & Drug Partnerships
Forth Valley Service Response
Group
Young Person’s sub-group
Child Protection Groups
Integrated Strategic Planning
Group for Child Health
Child Health Forum
7.4.b Identification and
management of risk
Forth Valley ADP
G5 Reporting Group
Alcohol & Drug Partnerships
Forth Valley Service Response
Group
Young Person’s sub-group
Child Protection Groups
Integrated Strategic Planning
Group for Child Health
Child Health Forum
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 8 (cont.)
Groups and Agencies
7.4. (cont.)
7.4.c Support
Forth Valley ADP
G5 Reporting Group
Alcohol & Drug Partnerships
Forth Valley Service Response
Group
Young Person’s sub-group
Child Protection Groups
Integrated Strategic Planning
Group for Child Health
Child Health Forum
7.4.d Co-ordination
7
Forth Valley ADP
G5 Reporting Group
Alcohol & Drug Partnerships
Forth Valley Service Response
Group
Young Person’s sub-group
Child Protection Groups
Integrated Strategic Planning
Group for Child Health
Child Health Forum
7.4.e Settings approach - home
Forth Valley ADP
G5 Reporting Group
Alcohol & Drug Partnerships
Forth Valley Service Response
Group
Young Person’s sub-group
Child Protection Groups
Integrated Strategic Planning
Group for Child Health
Child Health Forum
92
Section 12 | Appendices
Processes and Plans
1 | 12
A further performance management system involves monitoring against the national quality standards.
Implementing these standards will also assist services to attain continuous improvement. These standards
are very much client focussed, and are presented below:
1. You will be provided with all the information
you need to help you decide about using the
service
2. You will have al the information you need
about arrangements for ending your contact
with the service
3. You will be able to access safe, quality
surroundings when engaging with the service
4. You will be involved in a full assessment which
makes sure that decisions about your care and
support are based on your needs
5. You will receive a written personal plan that
clearly sets out what the service will provide to
meet your needs.
6. The service will work with you to achieve the
jointly agreed actions in your personal plan
7. You will be able to discuss and plan your
long-term support with service staff, involving
your family, other organisations, services or
representatives as appropriate
8. You will receive quality support and care
9. The service will work with a wide range of
partners, including other services, so that your
needs are met.
There can be no doubt that NQS will play a part
in the way that the Scottish Government propose
to monitor and evaluate how well services are
equipped to meeting the needs of service users.
The introduction of quality standards will have
a dual function. In addition to being a way of
providing a national perspective of how relevant
our services are in addressing clients’ needs, it
has the additional role of helping services to
demonstrate to funders and service commissioners,
how it’s procedures and policies are focussed on
the needs and aspirations of clients.
Forth Valley
Alcohol & Drug Partnership
Strategy Documents
Appendix 9 – National Quality Standards
Evidence
As earlier stated, effective and robust evidence
that we are meeting Quality Standards offers a way
of measuring how well our services are meeting
the needs and aspirations of clients and will make
a major impact in the achievement of continuous
improvement. The key to making sure that Quality
Standards become an integral part of our approach
to all levels of interventions is to ensure that the
evidence for meeting each standard is robust,
understood by all members of staff and is pivotal
to all that we do.
10. The service you receive has been designed
with you, your family, and their needs of the
local community in mind.
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Forth Valley
Alcohol & Drug Partnership
Strategy Documents
94
Section 12 | Appendices