Background and history
Services for dealing with substance users in Forth Valley were previously delivered in a relatively unco-ordinated fashion. The SAT was attended by numerous representatives from each commissioning authority. The group reflected the state of planning and inter-agency relationships at the time. The size and scope of its remit made effective action difficult. Like most such groups its membership was not consistent and the development of trust and an ability to work effectively together was slow. Despite these restrictions the SAT did successfully bid to the Scottish Executive for funds to support a pilot project of an alternative to custody scheme. A Forth Valley SAT Strategy was also produced & published before reorganisation of the SAT was undertaken, with a view to increasing its effectiveness & local impact, in 1999.
Service delivery
Strategy - SAT
Strategic change
It was recognised that the SAT needed to improve its effectiveness and local accountability. In 1999 the SAT partners embarked on a process of re-organisation. Each partner agreed to have one senior SAT representative. The SAT also recruited a local community representative for the first time. A process of team-building involving "away days" facilitated by consultants experienced in public sector organisational development and community engagement was undertaken. Subsequently a restatement of the Forum structure was made with the forum becoming the recognised route for dialogue between the communities and the SAT. The aim was to develop an effective "bottom-up" approach to planning and service delivery.
The Tiered Approach - Development of an Integrated System of Service Delivery
In 2000, Forth Valley SAT set up a multi-disciplinary group to consider the need for a new street-level treatment service. This group delivered an options paper which was consulted on widely through the SAT forums and at a multi-agency away day involving all local partners. This process identified the need to consider a way of organising services which would deliver a range of treatment options to drug users when they needed them, with minimal waiting times and improved accessibility. Services would be placed within a continuum of "Tiers" (Diagram 1). Tier 1 would be the direct access (street) level at which basic assessment would be undertaken. The person could then be managed within Tier 1 if their needs could be met there or would be referred on (using agreed criteria) to the most appropriate service for their needs.
Each Tier would deliver specific interventions which would imply the training & skill requirements of staff. Protocols using agreed criteria would facilitate the rapid movement of individuals through the system. 4 Tiers were agreed:
Tier 1 - direct access including self-referral; assessment using
common shared assessment tool; access to harm reduction services; general counselling
& support
Tier 2 - referral only; specialised assessment; specialised counselling
interventions
Tier 3 - referral only; specialised medical interventions
Tier 4 - referral only; rehabilitation (community & residential);
shared care
Delivery - New Services
The SAT partners used the Tiered system to inform their subsequent commissioning of new services. All new funds are agreed by SAT. Services commissioned have included:
Signpost Forth Valley
The first element of the Tiered approach was the delivery of a Tier 1 Service. Funding was through new local authority "Rehabilitation" funds which were pooled and administered through the Health Board.
Forth Dimension & 4D Structured Day Programme
A process of development involving New Futures funding and local partners led to the funding of a new model of community rehabilitation. New SAT funds for "Rehabilitation" were successfully bid for allowing the development of an attached structured day programme.
CADS Shared Care Service
New SAT "Treatment" funds were used to enhance the existing Shared Care model in Forth Valley.
CSCA becomes CSSAD
The Central Scotland Council on Alcohol altered its constitution to become the Counselling & Support Service for Alcohol & Drugs. This better reflects activity and places CSSAD in the Tiered system.
Delivery - Processes of Care & New Systems
Service providers have used the structure underpinning the tiered approach to examine the key elements required for effective service delivery and develop processes of care to deliver improved outcomes for drug users. This process has included:
Service providers group: All service providers (including generic providers) meet regularly to discuss issues of integration, problems around inter-agency interfaces etc.
Process of care group: All specialist providers are involved in the development of clear & agreed pathways of care which will support the development of protocols and agreements ensuring patients are being managed in the most appropriate service for their needs.
Shared common assessment tool & Service Directory: The SAT Co-ordinator led a multi-agency group (including GPs) which developed & agreed a new assessment tool and information pack containing up to date information on Forth Valley Services.
Information-sharing policy: A multi-agency group developed a Forth Valley information-Sharing Policy which has been examined & accepted by the local Caldicott Committee & other responsible parties in all partner agencies.
Positive influences
A number of important elements have facilitated the progress in Forth Valley:
Difficulties encountered
Despite the considerable progress there have been areas of difficulty, some of which are still being negotiated:
Conclusions
In recent years the Forth Valley SAT has endeavoured to improve interagency working and planning to better engage their community and deliver services which are more likely to meet the needs of drug users.
The Tiered Approach