Aberdeenshire Alcohol and Drug Partnership, Care Inspectorate Validated Self Assessment Report Over 2016 the Care Inspectorate conducted various activities to support a validated self assessment of Alcohol and drug Partnerships. A self assessment position statement was submitted, service users and staff questionnaires were completed online and in hard copy, case file reading was conducted and an onsite visit was held. In September feedback from the activities was received. Below the comments from the Care Inspectorate feedback have been aligned to actions in the delivery plan as well as other pieces of feedback gathered in various arenas recently. These additional pieces of feedback were Staff and Service User Questionnaires collected by the Service User Involvement Co-ordinators, Last Years and development Days. Also described are some actions that have already been taken and some s that will be necessary to start to act on the Care Inspectorate feedback. The ADP are asked to contribute actions to respond to the feedback and agree the s below. 1. Key Performance Indicators - Quality 3.1.2 We will ensure that all alcohol and drug services can demonstrate the effectiveness of their interventions on their clients collective recovery outcomes by working to the client s personalised recovery plan and monitoring progress against the national recovery outcome indicators. Team) By April 2016 Principle 1 Several outcome tools were used across services to measure and record improvements in individual s wellbeing i.e. Outcomes Star and Recovery Outcome Web (ROW). Whilst some progress had been made towards standardising measuring outcomes through embedding the use of the ROW tool in some services, the ADP recognised that there would be benefit in having the ability to consolidate reporting once ROW was universally embedded across all services and DAISy was operational. Although the ROW was being piloted, feedback from staff using this was less than positive. Whilst multi-agency training had been delivered to prepare staff in using the ROW tool, this did not appear to be the choice of tool staff wanted to use. There would be benefit from obtaining staffs and service users experience of this tool in order to resolve any implementation issues. S&SUQ Services to ensure that Recovery Plans are developed for each client and that each individual has an opportunity to contribute to their own plan thus encouraging personal responsibility for their own recovery Done ROW training was provided on the 1 st November by the Scottish Government. Resulting from staff feedback, an exercise, mapping the dimensions of the Recovery Outcome Star to the Recovery Outcome Web, has helped the transition to the Web for some people. The mapping document can be used as a reference which gives more detail for practitioners to work with. All services have agreed that they will move to the web however there are IT issues that are holding back this transition in CSMS. Planned Action -The ADP will request data against the Recovery Outcome Web Dimensions along with quarterly reports,
2. Getting Help at the Right Time - Quality 3.2.1 We will work with all partners to implement one of the pillars of public service reform to locally integrate services and develop local area Recovery Oriented Systems of Care as detailed in Appendix A where roles, responsibilities and processes are clearly defined and understood. Team) By Sept 2015 Principle 2 Whilst third sector staff were highly positive that the SPOA approach was providing prompt and effective pathways into services, staff working in statutory services, i.e. CSMS, felt there had been little consultation or involvement with them in the implementation and roll out of SPOA across Aberdeenshire. Some staff felt excluded from the process and not well integrated within SPOA pathways. The ADP were aware that some staff had found the change process to be quite contentious and that they needed to be clearer in their communication to ensure all staff were well informed and understood their role within the Recovery and Treatment ROSC to work effectively together to meet individual s needs. S&SUQ Closer working practices between all partnership agencies, which might include multi agency conferences, consultations and development days. Where proven successful, practices can be discussed/shared. Shared single assessments to be developed and will follow client from agency to agency. S&SUQ Regular feedback from experienced frontline staff about their working experiences to be used to inform specific service needs throughout Aberdeenshire DD Discharge from service may not be discharge from the ROSC. SPOA can channel people to their next service. DD Confusion over referrals and SPOA We need Share information on who stays in SPOA and for what and what criteria is used to move on to individual services (care pathways) DD Staff were unsure if needs Done - Discussion about the SPOA was facilitated at the development days in September. A high number of operational staff from all treatment and support agencies attended and engaged very well. Development Days will be repeated at the request of staff. In Process - Assertive outreach and Single Point of access will be in place to help people that need the alcohol and drug services to stay engaged, move to services that are more reflective of their needs (e.g. moving on services) or to embark on a planned discharge. Planned Action - We will explore ways to support people that have needs that could be met by alcohol or drug services to engage with services. Planned Action - A clear set of criteria for each service will be developed for the Commissioning and Performance Group. Planned Action - The North Partnership Group will work with the local general health care services to raise awareness of alcohol and elderly people.
around Mental Ill Health, Co morbidity, Older Drug or Alcohol Users, Transport and People whose addictions lead to chaotic lifestyles were met as well as they could be. There is higher prevalence of problematic alcohol use than would be reflected in the numbers of alcohol referrals to services Work to keep chaotic clients in service, making access to services easier and publicising services has meant that the Case Loads of Practitioners are soaring. CCC One stop shop 4.4.6 We will develop the ADPs website, Forum Facebook pages and Twitter feed and improve marketing and awareness of services so that citizens know how and where to access help and support. Community Forums (ADP Support Team) Posters were being distributed which showed the recovery and treatment pathways and they were to review their means of communication including social media, website and community forums to keep staff informed and fully involved with ROSC development and implementation. S&SUQ Development of comprehensive marketing plan to show communities that there is help available, recovery does happen and to help break down stigma. CCC Message out about Naloxone, Better advertising, use of social media, better information from treatment centres into community, marketing services and treatment Questionnaires SBAR (S&SUQ) 2.3.9 We will review the Drugs GP Enhanced Contract and agree expectations of shared care. 3. Impact on Staff Quality Principle 3 Some staff we spoke to felt some GPs had stigmatising attitudes towards individuals with drug problems and did not prescribe ORT. For CCC Breaking Stigma, Planned Action - A refreshed ADP website which will be in place by March 2017 will mark the launch of a new communications plan that will include the use of social media. Planned Action - The Local Enhanced Service for drugs is being reviewed.
CPF Group (Public Health) By April 2016 2.1.6 We will review and revise our arrangements for Opiate Replacement Therapy in line with the ORT report recommendations Service Delivery Group (ORT Accountable Officer) By April 2016 3.4.1 We will develop an integrated alcohol and drug workforce development plan for Aberdeenshire for paid and unpaid colleagues based on an initial training needs analysis and informed by the SG Quality Principles. This will include NPS awareness, workforces understanding of whole population approach to alcohol, relapse prevention, suicide prevention, fire risk assessment for vulnerable people, smoking cessation and the roll-out of NEPTUNE guidance for care and treatment of NPS and updated Orange Book guidelines for treatment of addictions within Emergency Departments, General Practice, Sexual Health and Substance Misuse Services. Team) By Dec 2016 a few individuals this was an additional barrier to engagement and gaining access to Tier 3 treatment services. This suggests that further work is needed to develop ROSC locally. Whilst most staff were positive about their line management support, file reading analysis highlighted little or no evidence of line manager oversight in case file records to demonstrate that effective supervision and monitoring was taking place. Reviewing approaches to recording staff supervision and manager oversight in individual cases would provide clearer evidence of staff support and quality assurance activity. DD Would motivational hooks be used in work with people? Would learning styles be explored when considering how to approach relapse prevention? Planned Action - Supervision will be included in a Workforce Development Framework it will be stipulated that Supervision records will link to client records. Planned Action - Leaning and Development plans will include motivational hooks and learning styles 3.1.3 We will ensure that all alcohol and drug services, including Community Pharmacy, can demonstrate their adherence to the Quality Principles and service user involvement through a selfassessment validated by independent audit via SDF or peer researchers in anticipation of a validation inspection by Whilst most staff we spoke to and those who responded to the staff survey were familiar with the Quality Principles, service users we spoke to were not familiar with the Quality Principles and had not received any information about these from services. Planned Action - Quality Principles leaflets will be included in the Welcome packs that are being developed by CAIR Service Managers will be asked to ensure that all clients are offered a copy of these principles.
the Care Inspectorate starting Autumn 2015 over 18 months. Team) By Dec 2015 4. Impact on the Community Quality 1.3.4 We will ensure that generic and specialist workers can access ABI training and ongoing updating on whole population approaches and alcohol s harm to others. CPF Group (ADP Support Team) By April 2016 Principle 3 The ADP recognised that demonstrating impact and improved outcomes for communities could be strengthened through systematic evaluation of initiatives that were aimed at reducing alcohol consumption and drug use in local communities, including implementation of whole population approaches. 5. Delivery of Key Processes - Quality 3.1.2 We will ensure that all alcohol and drug services can demonstrate the effectiveness of their interventions on their clients collective recovery outcomes by working to the client s personalised recovery plan and monitoring progress against the national recovery outcome Principles 4,5,6,7,8. The quality of risk assessments could be further developed by greater detail and thorough analysis of identified risks. Staff acknowledged that sharing of assessment information between services could be strengthened, for example, CSMS did not DD No Simple way of sharing information between services Highlighting how things are recorded / how often DD Assessments and what information is shared. Case Planned Action Influenced by the Early Intervention and Prevention group the Integrated Joint Board will focus on the proportion of people in Aberdeenshire drinking above sensible limits and identified as dependent drinkers, school age children that have had a proper alcoholic drink, levels of supermarket offsales, alcohol related deaths and alcohol related hospital admissions. d Planned Action - North Aberdeenshire have started to look at single shared assessment documentation. This will aim to create a useful set of information that will travel with the client. The basis of this work has been the Recovery Outcome Web
indicators. Team) By April 2016 3.3.4 We will contractually require ADP funded services to a) ensure every client has a person-centred recovery plan; b) contribute to recovery planning in partnership with the local single point of access service where relevant; c) Review progress with the client at 3,6 and 12 months using the Recovery Outcome Indicators; d) inform quality improvement via direct service user feedback; e) Publish performance against agreed service outcomes; and f) participate in an ISP to support DAISy. CPF Group (ADP Support Team) From Dec 2015 3.2.1 We will work with all partners to implement one of the pillars of public service reform to locally integrate services and develop local area Recovery Oriented Systems of Care as detailed in Appendix A where roles, responsibilities and processes are clearly defined and understood. Team) 2.3.1 In collaboration with relevant partners we will improve the identification of children vulnerable due to parental substance use. CF&YP Group (CSSW) By April 2017 receive assessments from other services involved with the individual, NHS assessments done in the community were not shared with HMP NHS staff. Commissioned and statutory services could be encouraged to share assessments and recovery plans when referring to other services to reduce duplication of effort and evidence progress made. Although our case file analysis found that the majority of recovery plans identified agreed outcomes, half were not SMART. The quality of plans could be strengthened by containing measurable, realistic and achievable actions with clearer timescales and milestones. Some individuals in the focus group were unaware of the advocacy service. In all the files we read there was no evidence to demonstrate that individuals had been told about independent advocacy services. Whilst there were positive examples from individuals and staff of family inclusive practice in individuals treatment/recovery, this was less evident in file reading analysis where there were dependent children. In four out of six cases there was a lack of evidence that the individual has been told that the needs and wellbeing of their children were a primary concern. Three out of the five applicable cases Conferencing should happen on an area basis. Can we all use and share information DD How much confidence do we have around GIRFEC Increasing awareness of all agencies about child protection/safety Does it become a fundamental part of the service DD Potential loss of statutory child protection cases Planned Action - South and central Aberdeenshire are working to find a way of pulling services together around localities one of the aims of this is improving communication around people that they jointly work with. Planned Action - Service managers will be asked to ensure that their staff agree SMART outcomes within recovery plans. A plan for case file reading will be included in future self evaluation. Planned Action - The Aberdeenshire advocacy service has been invited to speak at the Service Delivery Group to discuss how they can promote their service throughout the ROSC Done - The ADP CF&YP group have approached the GIRFEC group to establish how the ADP should work with the GIRFEC network.
were rated weak or unsatisfactory to being alert to and responding to the needs and wellbeing of dependent children. Whilst staff felt there were robust processes to identify and assess dependent children some staff still experienced occasions where they were not always made aware. The Named Person is not identified in the SSA but asked for in the SDA assessment. S&SUQ Increased family involvement (where appropriate) in the assessment/treatment plan development stages Development Days (DD), & 3.3.1 We will work towards collective and transparent funding and commissioning of alcohol and drug services within the emergent wider health and social care partnership processes. CPF Group (ADP Support Team) From Dec 2015 3.1.3 We will ensure that all alcohol and drug services, including Community Pharmacy, can demonstrate their adherence to the Quality Principles and service user involvement through a selfassessment validated by independent audit via SDF or peer researchers in anticipation of a validation inspection by the Care Inspectorate starting Autumn 2015 over 18 months. Team) By Dec 2015 6. Policy Service Development and Planning Whilst the ADP had developed a commissioning and performance strategy for monitoring commissioned and statutory services, its implementation had been delayed due to uncertainty of funding allocation decisions, including self-directed support implementation. The ADP recognised they needed to develop their approach to gathering and recording how effectively the Quality Principles were being implemented and embedded in practice across services to ensure consistency of standards. Planned Action - Family involvement will be recorded in the Single Shared Assessment Planned Action - Service managers will be asked to ensure that the named person for an individual s children is recorded in the case file. A plan for case file reading will be included in future self evaluation. In Process - The Aberdeenshire ADP Commissioning and Performance Strategy work is underway. Planned Action - A self evaluation system will be designed to collect evidence of how the Quality Principles are being implemented and case file reading will be included.
4.1.1 We will encourage all ages of community members to participate in ADP Community Forum meetings or activities, overcome barriers to their participation and support them to come up with ideas and plan, develop, fund, implement and evaluate their projects. Community Forums (ADP Support Team) Ongoing Some service users stated they were not aware of the community forums and felt more online awareness/social media to seek their views could be utilised. DD Strengthen ways to involve communities in support for people and for support to happen in communities. CCC Message out about Naloxone, Better advertising, use of social media, better information from treatment centres into community, marketing services and treatment 3.4.1 We will develop an integrated alcohol and drug workforce development plan for Aberdeenshire for paid and unpaid colleagues based on an initial training needs analysis and informed by the SG Quality Principles. This will include NPS awareness, workforces understanding of whole population approach to alcohol, relapse prevention, suicide prevention, fire risk assessment for vulnerable people, smoking cessation and the roll-out of NEPTUNE guidance for care and treatment of NPS and updated Orange Book guidelines for treatment of addictions within Emergency Departments, General Practice, Sexual Health and Substance Misuse Services. Team) By Dec 2016 3.1.3 We will ensure that all alcohol and drug services, including Community 7. Management and Support of Staff Quality Principle 3 The ADP acknowledged that whilst work was in progress to developing a workforce strategy this was not yet implemented. Training and education had been delivered to the majority of commissioned services on raising awareness regarding the Quality Principles and embedding these in practice. This should also be undertaken with staff within statutory services including Social Work, NHS and GPs. Some staff and service users were not aware or acquainted with the Quality Principles. The S&SUQ Training courses for all staff in partnership agencies, developed through input from those with lived experience of addiction and recovery and from experienced staff. S&SUQ Development/Involvement of more specialised services to work with experienced staff involved, e.g. individual support (specialist counselling/referrals) should be available to clients who have suffered trauma and require additional support to work through this. Planned Action - A refreshed ADP website which will be in place by March 2017 will mark the launch of a new communications plan that will include the use of social media. Planned Action - The Workforce Development Plan will be ready for consultation in December. Ongoing - The Quality Principles have been included in all interventions with staff. Ongoing - The Quality Principles have been included in all interventions with
Pharmacy, can demonstrate their adherence to the Quality Principles and service user involvement through a selfassessment validated by independent audit via SDF or peer researchers in anticipation of a validation inspection by the Care Inspectorate starting Autumn 2015 over 18 months. Team) By Dec 2015 ADP needs to consider how it heightens knowledge and understanding of the Quality Principles to ensure service user involvement is maximised. 3.2.1 We will work with all partners to implement one of the pillars of public service reform to locally integrate services and develop local area Recovery Oriented Systems of Care as detailed in Appendix A where roles, responsibilities and processes are clearly defined and understood. Team) By Sept 2015 8 Partnership working and resources. Some staff within statutory services felt that there was a lack of understanding of each other s role and remit. Further work could be undertaken to improve multi-agency working and clarify customer pathways within ROSC. S&SUQ Develop closer working links between CSMS, Mental Health Services, Voluntary Services etc. making for a more rounded service experience and greater menu of options. DD We need more information about who does what to avoid duplication Clear information on all services re Type of client suitable/eligible Services on offer Information to offer service users/good news stories staff. Planned Action - The quality Principles will be included in the Welcome packs being developed by CAIR Done - Development days and joint learning opportunities have been run and have been well attended by all agencies Planned Action - Criteria for services will be developed for the Commissioning and Performance Group 3.3.1 We will work towards collective and transparent funding and commissioning of alcohol and drug services within the emergent wider health and social care partnership processes. CPF Group (ADP Support Team) There was a perception from some staff of an uneven distribution of resources between third and statutory sector services which was affecting partnership working. The ADP needs to look at how they can reduce this feeling of disharmony across services. S&SUQ Recruitment of more staff on the ground Planned Action - Communication about the commissioning process will be available to all staff Done - Development days, Locality meetings and shared learning will aim
2.2.3 We will encourage effective collaboration between substance misuse services and children s services to improve the coordination of alcohol and other drug interventions for looked after children and those excluded or at risk of exclusion to build resilience and secure the best outcomes. CF&YP Group (Education and Children s Services) From April 2016 Joint working between drug and alcohol services and children s services could be improved by strengthening GIRFEC processes and improved sharing of information including parent and child s assessment and recovery plan. DD How much confidence do we have around GIRFEC Increasing awareness of all agencies about child protection/safety Does it become a fundamental part of the service DD Potential loss of statutory child protection cases 3.2.1 We will work with all partners to implement one of the pillars of public service reform to locally integrate services and develop local area Recovery Oriented Systems of Care as detailed in Appendix A where roles, responsibilities and processes are clearly defined and understood. Team) By Sept 2015 3.4.1 We will develop an integrated alcohol and drug workforce development plan for Aberdeenshire for paid and unpaid colleagues based on an initial training needs analysis and informed by the SG Quality Principles. This will include 9. Leadership and direction Some staff felt threatened by the service redesign and roll out of key initiatives. A route for collating staff views and representing these strategically would better support collaborative working between statutory and third sector partners and identify areas that require further support or training. There could be benefit from identifying further opportunities to support staff across services to come together to foster a culture of collaborative working, share learning and innovative practice across Aberdeenshire. Increased multi-agency training to embed the Quality Principles in practice, ROW and single point of access approach could further enhance multi-agency working. DD More information should be cascaded to operational staff on new developments etc (ask staff). Briefings (brief) for operational staff. We would like operational staff involved in groups/meetings re developments Gatekeeper re emails to avoid receiving several times DD Is Terminology used across sectors a barrier to communication? to facilitate partnership working. Done -The ADP CF&YP group have approached the GIRFEC group to establish how the ADP should work with the GIRFEC network. Ongoing - Development days, Locality meetings and shared learning will aim to facilitate partnership working. Ongoing - A news Letter has begun to keep operational Staff appraised of service developments across the Aberdeenshire ADP Planned Action A self evaluation system will be designed to collect evidence of how the Quality Principles are being implemented and case file reading, staff opinion and service user opinion will be included. Ongoing - Development days, Locality meetings and shared learning will aim to facilitate partnership working.
NPS awareness, workforces understanding of whole population approach to alcohol, relapse prevention, suicide prevention, fire risk assessment for vulnerable people, smoking cessation and the roll-out of NEPTUNE guidance for care and treatment of NPS and updated Orange Book guidelines for treatment of addictions within Emergency Departments, General Practice, Sexual Health and Substance Misuse Services. 3.3.4 We will contractually require ADP funded services to a) ensure every client has a person-centred recovery plan; b) contribute to recovery planning in partnership with the local single point of access service where relevant; c) Review progress with the client at 3,6 and 12 months using the Recovery Outcome Indicators; d) inform quality improvement via direct service user feedback; e) Publish performance against agreed service outcomes; and f) participate in an ISP to support DAISy. CPF Group (ADP Support Team) From Dec 2015 3.2.1 We will work with all partners to implement one of the pillars of public service reform to locally integrate services and develop local area Recovery Oriented Systems of Care as detailed in Appendix A where roles, responsibilities and processes are clearly defined and understood. S&SUQ Improving methods of accessing service user opinion/views on service provision. S&SUQ Adopt a means of working which allows for more practical engagement with clients S&SUQ Further support and encouragement from Service staff to attend peer support/mutual aid groups (Mutual Aid/Peer Support questionnaire currently ongoing to assess impact of such groups on an individual s recovery). Planned Action - Service user opinion will continue to be used to gain feedback. Ongoing - A mutual Aid and Peer Support Group Programme will be kept on the Aberdeenshire ADP Website and will be kept up to date. This information will be given to all new service users.
Team) By Sept 2015 Examples of Good Practice Identified by the Care Inspectorate Turning Point Scotland Service Development Moving On and Engagement S&SUQ More information/links with moving on services S&SUQ Less clinical and more social interventions DD Gaps Identified Support for people that are chaotic and in recovery process Support for people in long term methadone programs Planned Action - A leaflet will be available to give an overview of Alcohol and Drug Services in Aberdeenshire Planned Action - All services will be promoted through a refreshed Aberdeenshire ADP website.