It can take a lot of courage to come into one of our services for help. For some people it will be the first time they have ever contacted a drug and alcohol service. Others have previously had help with us and are coming back and may be dealing with difficult feelings around coming back into treatment.
To support people in this moment, we need to make sure people have the best possible start to their treatment with us.
However, our data shows that the first four weeks after accessing help is when people are most likely to drop out of services. This means they are leaving us before they are better. Our research discovery project explored the reasons behind this and helped us to understand what could keep people motivated and engaged and what could stop them from coming back.
Getting support starts with an assessment
Anyone who comes to us for help has to have an assessment. This helps us get to know a client and to understand what they need help with. It also helps us to identify any risks so we can work with them and others to keep them safe.
During an assessment, we have to collect a lot of information and ask a lot of questions. Some of the questions we ask are sensitive such as asking about children, any sexual health concerns and whether there’s any history of self-harm or domestic violence. Most of us would struggle to discuss such personal topics with a total stranger.
At the same time, there are strict requirements around the data we need to collect for our commissioners including Public Health England and Public Health Scotland. This requires us to ask lots of additional questions when we first meet clients.
Our staff work really hard to make the assessment feel more like a conversation. However, our case management systems aren’t set up for this and while they are good at collecting and reporting on data, they don’t support workers in having a free-flowing conversation and to start building a rapport with clients.
How could we collect all the information our commissioners need and, at the same time, create a positive experience for our clients?
Designing a tool to facilitate conversations
We decided to develop a tool which would allow the conversation to flow and allow clients to talk about what was important to them, in the order which mattered to them.
Our current case management systems require information to be entered in a certain order.
If a worker wants to move onto a different section of the assessment, they still have to answer all the questions in the previous section before they can move on to the next. This makes it difficult to have a free-flowing conversation and record information at the same time.
We started with some paper designs of a concept which supported a client-led conversation and tested this with frontline workers. Once we had their feedback and knew this was something which would work, we started designing the tool for real. We gave it the name “The Conversation Tool”.
In order to design a tool to support assessments, we needed a clear understanding of all the questions we needed to ask and, importantly, an understanding of why we were asking those questions.
We held workshops with people from across the organisation and mapped out what we need to know and when. There were lots of discussions about this. Some questions aren’t needed for mandatory reporting reasons and might seem intrusive. But not asking them could mean we don’t have a full understanding of risks or understand other organisations who might be working with the client. This would make it harder for us to keep people safe and develop a care plan.
We also needed to consider how we collected the information. Did we need the information to be structured data so we could report it to our commissioners, or could we ask for the information in a less structured way and ask more open questions? We added as many open questions and freetext boxes to the Conversation Tool as we could while still collecting the structured data that we need. We included prompts so that it’s clear to staff, especially those newer to completing assessments, what they should be asking clients.
Read the full blog post here.
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