Addiction, Health, Behaviour Change | CGL

Improving entry into services

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Improving entry into services

28 March 2018

Assessment is the key opportunity to engage individuals into treatment and is it is essential that the assessment experience is beneficial for the service users whilst also enabling an accurate assessment of risk and need.

Learning from service user feedback, complaints, incidents, death investigations and root cause analysis of serious incidents within CGL, we identified the following themes:

  • More focus was given to the paperwork and processes than the person
  • Service users often found the initial assessment overwhelming
  • Over assessment resulted in service users not accessing the right pathways and disengaging after assessment
  • Inconsistent identification and a lack of clear pathways prevented rapid access
  • Local/regional variances in assessment tools and processes increased data collection requirements, diluted the ability to analyse the data and impacted negatively on the service user experience.

Aims and objectives

Our overarching objective was for CGL to provide the right services, to the right person, at the right time, in the right way.

To achieve this we put together a plan to review and improve the organisational approach to assessment and planning in line with CGL values and evidence based practice. Our aims were to

  • Improve the service user experience and outcomes
  • Better support practitioners in identifying and responding to service user risks and needs
  • Enable early identification and management of service user risks
  • Reduce disengagement, deaths and avoidable harm
  • Reinforce assessment as an intervention itself
  • Streamline the assessment process through creating efficiencies including paperless/paper light approaches
  • Ensure a minimum organisational standard of care during assessment and planning.

of service users in Birmingham expressed that they found their assessment with CGL to be a positive experience

Our approach

We utilised the CGL quality improvement cycle to carry out our review.

The key steps were:

  1. Collation of data – quantitative and qualitative.
  2. Identification of what is/isn’t working.
  3. Consultation with staff and service users.
  4. Review of evidence base and national guidance (CQC, PHE, NICE).
  5. Development of new assessment tools.
  6. Pilot of new assessment tools.
  7. Evaluation of pilot and further development of tools in response to learning and feedback.
  8. National implementation of standardised assessment tools with ongoing monitoring of impact.

As a result CGL has developed both a new approach to assessment and planning along with new assessment tools and processes. A staged approach has been taken to support with identification of appropriate onward pathways and phasing and layering of interventions (in line with the updated clinical guidelines on drug misuse and dependence).

Actions resulting from the review

Our review resulted in the development of the following assessment tools:

  • Triage: a brief assessment to identify the individual needs of the service user and the appropriate onward pathway
  • AUDIT-C: A screening tool to assess alcohol consumption, drinking behaviors, and alcohol-related problems. A score of 16 or more will trigger completion of the SADQ
  • SADQ: A 20-item questionnaire to measure severity of dependence on alcohol
  • Personalised Assessment: a comprehensive assessment of risk and need divided into a number of sections; one section being the medical assessment. Any risks and actions identified are automatically populated onto the Service User Plan.

This formed a framework for three key pathways:

  1. Brief intervention:  If the Triage (incorporating the alcohol AUDIT) identifies that a brief intervention will meet the service user’s needs, then no further assessment is required.
  2. Extended brief intervention: If the Triage indicates that extended brief interventions is the appropriate pathway, the Consent and Confidentiality Form needs to be completed along with the NDTMS section of the Personalised Assessment. Additional sections of the Personalised Assessment can be completed if required and appropriate.
  3. Structured Treatment: If the Triage indicates that the service user requires structured treatment, be that clinical, psychosocial or both, then the Consent and Confidentiality Form and all sections of the Personalised Assessment should be completed. For those requiring opioid substitution treatment, the medical assessment section should also be completed by a medic.
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Big data ensures the organisation is continually responding to service user needs and staff development

Impact to date

  • From April 2016 until January 2017 99% of service users in Birmingham expressed that they found their assessment with CGL to be a positive experience
  • During the first month of implementing the new tools, CGL’s Northamptonshire Service has reported a 12% increase in retention from point of referral
  • The ability to directly input assessments onto the internal case management system prevents duplication and has improved data quality saving on average, 25 minutes per worker, per assessment
  • The use of the new Service User Plan module, (a new function of the internal case management system), has led to more meaningful interactions about the service user perception of risk and how to reduce risky behaviours
  • This module also enables quick access to dynamic risk information
  • Local data enables staff and managers to understand themes of service user behaviour, to consider patterns in risk increase or decrease, enabling identification of any skill gaps for staff
  • Big data ensures the organisation is continually responding to service user needs and staff development.

Next steps

We will:

  • Iteratively evaluate impact and respond to learning and feedback
  • Review assessment tools/process for specialist services such as criminal justice and young people
  • Consider how new digital interventions can further enhance assessment experience and outcomes for service users e.g. online self-screening and referral
  • Work with commissioners to evidence what we’ve learnt from this piece of work so that this learning can be embedded consistently in all of our services.