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What methods did EIU use?
We undertook a number of exercises to draw together this work on integrated care:
A Reference Group was established to draw on expertise from health, social care and the voluntary sector to support the EIU in the development of the integrated care work. This group met on six occasions during the course of the work. Membership of the Reference Group is set out in Appendix 1. The EIU is very grateful for their support and contributions.
Review of the research literature
EIU conducted a review of the relevant research and policy literature on integrated care systems, accessibility of drug services, assessment tools in the drugs field, the effectiveness of drug services and interventions and good practice in monitoring and evaluation. Some of this review work was conducted by members of the EIU Working Groups (see below). Key sources of health and social care research were searched including Medline, EMBase, PsychInfo, ASSIA, CINAHL, Social Sciences Information Gateway, Cochrane Library, Campbell Collaboration, Evidence Base 2000 and the NHS e-library.
Primary research studies
The EIU commissioned and conducted a number of research projects as part of the integrated care work. The Scottish Drugs Forum (SDF) were commissioned by EIU to conduct a series of focus groups with service users on both assessment and planning and delivery of care. Further SDF focus groups commissioned by the Scottish Executive with stimulant users provide information for the accessibility section. Andy Rome from the EIU conducted a study of the use of assessment tools in Scotland. Finally, studies commissioned as part of the Scottish Executive Drug Misuse Research Programme have also informed this work, including a systematic review of the international literature on the effectiveness of treatment.
EIU Working Groups
Through the Reference Group, three Working Groups were established by EIU to look at three components of the integrated care approach: accessibility of services, assessment practice and the planning and delivery of care. The membership of these groups is set out in Appendix 1. These groups met on at least three occasions and provided a wealth of practical experience and expert knowledge in each area. The EIU is grateful to participants for their support and contributions.
EIU Consultation Workshops
Five consultation workshops were organised across Scotland in March/April 2001. The views and experiences of practitioners, service providers and commissioners elicited at these seminars are presented throughout this document. In June 2002, a further 2 workshops were held with service providers to discuss the preliminary findings of specific elements of integrated care and identify further examples of innovative practice.
How is the evidence presented?
We have divided the evidence collected into five main 'types' and (where applicable) used these types throughout the document. Please note that there are some instances where sources, principally policy documents, are difficult to categorise. In these cases references alone have been provided. The types are as follows:
Type 1 Systematic reviews
Type 2 Narrative Reviews
Type 3 Primary research studies
Type 4 User consultations
Type 5 EIU Working Groups / Consultation Workshops
Use of terms
We have tried to be consistent in the use of terms. In some of the research studies and other policy documents that we have reviewed terms are used interchangeably. For example, the terms 'agencies', 'organisations' and 'services'. Throughout the document, we have used:
the term 'service provider' to describe any agency or organisation involved in directly providing treatment, care or support to service users.
the term 'agency' to describe any organisation involved in the planning and commissioning of services for drug users.
the term 'service user' to describe any individual who has (in the past) or currently uses a health or social care service.
n.b. in some, limited, instances and depending on the context, the term 'agency' also refers to a provider role
There is some variation in the terms used to describe individuals who may benefit from an integrated care approach. In some cases, this reflects the terminology used in the research literature and policy documents. This document is primarily concerned with those individuals who need services because their use of drugs is causing significant levels of harm to themselves, their families or their communities.
What is in this document?
Chapter 2 examines and discusses the definitions and concepts of integrated care for drug misusers. It also sets out the key principles that underpin an integrated care approach and the key elements of the integrated care process. This chapter also introduces Harry - the case study that runs throughout the document.
Chapter 3 discusses the importance of accessibility of drug services. The key service and individual service user characteristics that determine accessibility are presented. These are followed by key principles and elements of practice. An Annex which specifically examines the issue of waiting times for drug services is attached to the Chapter.
Chapter 4 examines and discusses the process of assessment and describes the key principles of evidence-based, effective assessment placing the service user at the centre of the process. It also describes the different levels of assessment, discusses self-reporting and sets out further information on assessment tools. The key results of a Scottish survey of assessment practice and a core assessment data set are provided in Annexes.
Chapter 5 examines the process of planning and delivery of care for the individual drug user and discusses care co-ordination. It also highlights issues to be addressed in the planning, design and delivery of services at a local level. It introduces the concept of an integrated care plan and offers an example in an associated Annex.
Chapter 6 examines the process of information sharing. It offers practical guidance to DATs and service providers on the exchange of personal client information across treatment, care and support services drawing on examples from health and social care. Key principles of information sharing are also set out.
Chapter 7 discusses monitoring and evaluation within the context of integrated care. It examines the type of monitoring and evaluation that could be conducted at strategic level and service level. This chapter also discusses the importance of building an evaluation culture within and across services.
Appendices at the end of the document provide additional supporting information. These include: research summaries, summaries of the findings from service users' focus groups, an outline of the training offered by Scottish Training on Drugs and Alcohol (STRADA) and an outline of the current criminal justice initiatives that apply to drug users.
How do I use this document?
This document is designed as a 'bench document'. By this we mean you should be able to pick up and use each chapter as a standalone section, and pull out relevant sections to use or copy. We have tried to keep duplication to a minimum but, if the chapters are to be read in isolation, a certain amount of repetition is essential.
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