Residential Rehabilitation Working Group: drug and alcohol residential treatment services - recommendations

Annex A

Recommendations

1. Access: Principle - There should be access to residential treatment on an equitable basis across Scotland.

a. The Scottish Government should continue to address equality of access and discrepancies of provision in local areas to create an even and equitable playing field.

b. ADPs should ensure residential treatment is available as an option for people who require this intervention in their local area and monitor demand and access. 

c. The Scottish Government should ensure that an up-to-date definitive list of treatment providers should be developed and made available to local areas. 

d. The Scottish Government should ensure that DAISy captures and reports key data on all residential treatment episodes. 

e. Barriers to accessing residential treatment should be better understood through stakeholder consultation.

2. Capacity Planning: Principle - There is a clear understanding of need, demand and capacity.

a. Consideration should be given by the Scottish Government to undertaking a needs assessment with regard to residential treatment.  It is recommended that people with lived experience, families and practitioners are involved this work. 

b. Further work should be developed by the Scottish Government to measure current capacity accurately, understand and monitor waiting times, anticipate demand and monitor bed usage to maximise efficiency. 

3. Best value: Principle - Funding models for residential treatment need to ensure value for money

a. Funding models should be comprehensively mapped by the Scottish Government and the relative advantages and disadvantages understood. 

b. The of the cost of treatment and its relationship to provider treatment models and corresponding value for money should be further explored with the aid of health economists. 

4. Standardisation: Principle - A standardised approach to support good practice should be developed. 

a. The Scottish Government should consider the establishment of specific standards to support the commissioning of residential placements.  This should include, but not be limited to; minimum time in treatment, mental health support including for complex trauma, relationship with communities of recovery, embedded harm reduction principles, housing, education and employability, outcome monitoring, aftercare etc. 

5. Pathways: Principle - Referral pathways should be clear, consistent and easy to navigate

a. The Scottish Government and Alcohol and Drug Partnerships should work together to scope and compare current referral pathways including referral criteria and inclusions/exclusions.  There should be a focus on vulnerable groups and those with the greatest need.  Best practice should be developed on pathways into and from residential treatment.  Shared learning and examples of good practice should be used to improve these. 

b. Work should be developed which explores diversion from the criminal justice system or in acute healthcare settings directly to residential rehabilitation.  This could be done through tests of change, pilots or specific research. 

6. Research: Principle – The approach to providing residential treatment should be underpinned by the evidence 

a. The Scottish Government should facilitate research into residential treatment pathways, models, outcomes, value for money and service user experience to understand who will benefit most from it. 

b. Researchers should map local community-based resources such as mutual aid and other recovery initiatives by ADP with a view to researching their relationship to residential rehabilitation services. 

c. A dialogue should be opened on these subjects with the Drugs Research Network Scotland and Scottish Alcohol Research Network with a view to sharing knowledge and to develop research projects.

7. Models of delivery: Principle - The diversity of residential treatment interventions across Scotland needs to be understood

a. Further scoping work should be commissioned by the Scottish Government on the detail of the variety of treatment models available and on their components (medical, psychological and social approaches) and of the evidence base underpinning these.  

8. Support to the Drugs Deaths Task Force: Principle - The work to improve access to residential treatment should support the work of the Drug Deaths Task Force. 

a. It is recommended that the Scottish Government facilitate the development of a relationship between the work to improve access to residential treatment and the Drugs Death Task Force Multiple Needs Subgroup to explore the place of residential treatment and in reducing drug (and alcohol) deaths. 

b. The work to improve access to residential treatment should continue to support tests of change to improve access to residential rehabilitation for at-risk groups and learning from these should be disseminated.

9. Explore the potential for a national approach to measuring the success of residential rehabilitation services: Principle – Outcomes should be measured, published and monitored.

a. It is recommended that the Scottish Government explores a national approach to establishing and agreeing commonly agreed outcome measurements.

b. The measurement of these outcomes should be recorded within the DAISy database to support local service planning.