Monitoring of interventions for people with substanceabuse and addiction problems- how do we know what works?

marco.fredin@grkom.se0046 761-30 77 65

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: www.nuso.se

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