Monitoring of interventions for people with substance abuse and addiction problems - how do we know what

Why monitor outcomes from interventions? Several reasons from different perspectives: legislation and regulations from the Swedish board of health and welfare ”open comparisons” and national inspection show that there are problems with client participation and the monitoring of interventions. better care for people who have dependency problems

”…the overall purpose with social work is to maintain a good or improve an inadequate quality of life for those people we are trying to help…” Source: Blom, B & Morén, S (2011) Utvärdering i socialt arbete – Utgångspunkter, modeller och användning “…clients’ subjective experiences of welfare and wellbeing are a central source of knowledge for those who deliver and manage social work…”

“Local monitoring is a necessary part of an evidence-based programme but also for social workers wanting to work rationally and goal- focused way without calling their work evidence-based” Source: Bergmark, A, Bergmark, Å, & Lindström, A (2011) Evidensbaserat socialt arbete, Teori, kritik, praktik

Mandate from the city council: Good quality evaluation and forward planning should involve those people who use the city’s services, in order to increase service-user influence and contribute to an improved quality of service It is very important that we all continue to improve analyses and monitoring within our respective organisations

Care and treatment of adults = 160 million Swedish kronor (ca 17.7 million EUR) Costs for the city of Gothenburg Benefits for the clients? What are the outcomes? Net Costs 2012

Is a department effective if it: follows the rule of law is accessible treats clients in a polite and respectful way has low/high costs per user has procedures for dealing with complaints is based on respect for people’s integrity and their right to make their own decisions has a high proportions of outpatient care has well-trained staff has agreements with other organisations Quality (indicators) in social services

Performance Structural Process Outcomes from the client’s perspective Activities in the organisation Predetermined structural conditions The aim is that ”open comparisons” will focus much more on performance indicators

Reversed perspective based on outcomes Performance Structural Process To measure results from the user’s perspective To measure processes and conditions (activities) To measure predetermined structures (funding, staff etc.)

Uppföljning av Insatser för Vuxna med missbruks eller beroende- problematik. Monitoring of Interventions for Adults with abuse or dependency related problems UIV

To increase client involvement and to give the social worker a structure for the interview at the end of the intervention To increase knowledge about the effects of interventions Feedback to policy makers on the effectiveness of the organisation Compare outcomes with other municipalities To show which healthcare providers have positively rated results for a particular type of intervention To allow setting up of goals that are related to benefit to the user Contribute to increased quality and the better utilisation of economic resources The aim of UIV

How we do this in practice All social workers/social welfare officers interview their clients at the end of the intervention Questions are based on a structured method with all clients being asked the same questions Questions: Background information (age, sex, care provider etc.) Which intervention the client received The client’s evaluation of the intervention The social worker’s evaluation of the intervention

Inpatient care and treatment Outpatient care Foster care for adults Type of interventions

National Development Council to ensure development and long-term maintenance of the model representatives from regional Research and Development units, universities and social workers/managers for more information see:

Monitoring outcomes should guide our actions rather than plans that have no connection with benefit to the client Monitoring provide a basis for dialogue – dialogue creates possibilities for development