Medication Assisted Treatment (MAT) standards: access, choice, support

Appendix 1 Qualitative Measures of Implementation

Purpose

The qualitative measures are designed to explore the experiences of:

a) people currently using services and the wider group of people who may need services;

b) family members or nominated person(s);

c) people who provide services;

The aim is to measure how well the standards are being met on the ground, and whether the process and structures put in place are translated into an experience that:

a) treats people with dignity and respect;

b) demonstrates that services strive to promote access to treatment and support;

c) promotes choice and offers people support to make an informed choice;

d) is person-centred, trauma-informed and family member or nominated person(s) inclusive (where the person wishes this);

e) provides appropriate options for whatever problem substance use the person is seeking help for;

f) facilitates a range of harm reduction approaches;

g) helps people plan for the end of treatment.

Meeting the standards depends on a cultural of improvement and raising expectations, as much as establishing the right procedures and protocols. The intention is to use the experiential information gathered to promote continuous quality improvement and support the implementation of the standards.

Approach

The questions are inevitably slightly different for each group whose views are being sought, but are designed to mirror and explore the same themes. [sample questions to be piloted will be available as part of the suite of resources]

People who use services or are potentially in need of services

The questions are framed in such a way as to make sense for people who have very different experiences of services, from very recent to longer term, and whose problems relate to different substances. The aim is to capture the range of experiences that people have in terms of how services have - or have not – succeeded in giving them the care and support they needed, in a timely fashion.

It is anticipated that peoples' experience will change as the MAT standards are rolled out, and that the ongoing exercise of seeking their views will in itself contribute to change, in shaping peoples' understanding and expectations of what options are available to them.

People who provide services

The implementation of the MAT standards is a process and clearly some services will be able to make faster progress than others, according to factors such as location, available resources, numbers of staff, and their levels of skills and confidence.

The aim is to elicit information in a way that acknowledges these issues, so that services are helped to identify gaps and areas where support may be needed to make further progress, at the same time as highlighting examples of best practice that can be shared.

Family or nominated person(s)

All people accessing services should be asked if and who they would like to nominate to be alongside them (with 'family' defined in the broadest sense).

Questions are designed to explore how well family inclusive practice is integrated, and to what extent families are facilitated and supported to accompany, support and be involved with peoples care and treatment.

What will be measured

The questions do not rigidly follow the order of the MAT standards but aim to capture the key questions of choice, access and respect for the person as principles for implementation. They are designed to find out whether:

• people understand they can have access to treatment on the day of presentation and receive a prescription or appropriate support on the day of their first visit;
• people are able to access care and support whatever substances they are using or is problematic for them;
• people feel they are supported and are given enough information to make the right choice for them, are satisfied with their decision and feel able to ask for a review of their choice;
• people feel comfortable to ask for the information and support they need to keep safe and well and have access to the full range of harm reduction approaches;
• people feel confident that their information will be shared between services to help them in a crisis and feel confident their family member or nominated person(s) will be contacted in a crisis;
• people are confident they will be supported to re-engage with services if they have dropped out;
• people feel the service is responsive to their needs and have a sense of progress;
• people feel they are treated fairly, and with compassion;
• family members or nominated person(s) feel they are included in discussions about peoples care and treatment;
• family members or nominated person(s) feel they are listened to and taken seriously if they contact a service with concerns, including about immediate risk of harm;
• service providers know about and understand the purpose of the MAT standards;
• service providers are able to offer care and treatment at first appointment, including prescription for opioid users and appropriate support for people with other types of problem substance use;
• service providers are – and feel - supported to gain the knowledge skills and confidence to implement the standards;
• service providers are able to offer the full range of harm reduction interventions (Wound care, BBV Testing/Vaccination/Treatment, Safer Injecting advice, IEP, Naloxone).

Delivery

The qualitative evaluation will be carried out in local ADP areas in partnership with local teams.

It is intended to pilot the measures over a 3-6 month period to test the approach and delivery method.

This is important in order to explore some key questions for the future implementation of the evaluation programme, for example:

• what capacity already exists in local areas to do this work?
• what extra support is required to build capacity and resource?
• how will this be developed into a sustainable and consistent model?
• is the current design effective in gathering the required information?

The answers to these questions will ensure that method and design are refined and adapted if necessary and will inform the development of a framework for analysis.