Service Evaluation of Scotland's Take-Home Naloxone Programme
An independent service evaluation of the implementation of Scotland’s National ‘Take Home’ Naloxone programme which has been rolled out in Scotland since November 2010. The report presents findings on the programme's processes and structures, the effectiveness of these, an early indication of impact, lessons learned and policy implications.
Appendix 5: Online survey of service providers
Sample
1. We received 186 responses to our survey of service providers involved in the THN programme. A few key points about the respondents are below:
- We received responses from all territorial Health Board areas. Most (25%) came from the Greater Glasgow & Clyde area.
- Most respondents were based in community settings (87%) but 13% were based in prison.
- 40% were involved in naloxone training and supply; 31% were involved in training only; 9% in supply only; and 8% identified themselves as the local naloxone lead.
- Respondents represented a range of professional groups including nurses, CPNs or addictions nurses (38%) and voluntary sector workers (18%).
- Most were employed by the NHS (61%) or voluntary sector agencies (26%).
Train the trainer (TTT) training
2. Most respondents (71%) have taken part in a TTT course.
3. Nearly all (96%) of those who had taken part in TTT training described it as highly or fairly effective in equipping them to provide naloxone training and nearly three quarters (70%) felt it was either fairly or highly effective in equipping them to supply naloxone. Comments from participants included:
"It helps you to understand how it works. It gives you the confidence to talk about it and helps you explain it to others."
"This was a well prepared and well delivered course with good course material. It did exactly what it said on the tin."
Service users
Recruitment
4. Most service providers (71%) felt that the THN programme is successful in engaging those most vulnerable to problem drug use.
5. Service providers reported that word of mouth from peers, direct targeting by professionals and word of mouth from professionals are the most effective means of recruiting service users to the THN programme. 87%, 87% and 86% of service providers described each of these methods respectively as fairly or highly effective. Social media (which was described by 23% as fairly or highly effective) and websites (28%) were seen as the least effective methods of recruitment.
Training
6. Over two-thirds (69%) of respondents said they had trained service users in naloxone.
7. Staff who have trained service users have not necessarily taken part in a TTT course. 13% of those who reported training service users have not taken part in a TTT course.
8. Of those respondents who have completed a TTT course, 81% have gone on to train service users.
9. A quarter (26%) of all those who have delivered training to service users have trained between one and ten service users, but 16% have trained between 51 and 100 service users and 12% have trained more than 100.
10. The most common venues for delivering training to service users are NHS clinics (50% of respondents identified this) and voluntary sector agencies (40%).
11. Training is delivered using a mixture of 1:1 and group approaches. 58% said they have delivered training using both 1:1 and group approaches, 31% said they have delivered training mainly on a 1:1 basis, and 10% mainly on a group basis.
12. Service providers view 1:1 training as more effective for service users than group training. 68% described 1:1 training as highly effective, compared with 49% for group training. Respondents explained that 1:1 training means that 'the client is able to ask questions they might not have asked in front of others' and 'it is ideal for delivery within the clinic setting during an appointment.'
13. However, Table 1 shows that prison workers have a slight preference for group training: 56% of these staff described group training as highly effective, compared with 50% for 1:1 training.
Table 1: Perceptions of 1:1 and group training for service users
| Total (n=115) | Community (n=99) | Prison (n=16) | |
|---|---|---|---|
| % of service providers who described 1:1 training as highly effective | 68% | 71% | 50% |
| % of service providers who described group training as highly effective | 49% | 47% | 56% |
Supply
Table 2: Training and supply of service users
| Total | Community | Prison | |
|---|---|---|---|
| % of service providers who have trained service users | 69% (n=167) | 69% (n=144) | 70% (n=23) |
| % of service providers who have supplied service users | 49% (n=162) | 50% (n=139) | 43% (n=23) |
14. Nearly half (49%) reported supplying naloxone to service users.
15. There is a discrepancy between the proportion of service providers who have trained service users in naloxone (69%) and those who have supplied naloxone to service users (49%), as illustrated in Table 2.
16. Service providers in every Health Board area reported supplying naloxone to service users. 82% of respondents in Lanarkshire said they had supplied naloxone, 81% in Lothian and 63% in Greater Glasgow & Clyde[48].
17. Nearly half (45%) of those respondents who had supplied naloxone to service users reported supplying naloxone to between one and 15 service users. 13% said they supplied between 51 and 100 and 16% said they had supplied more than 100 service users.
18. NHS clinics are the main setting where naloxone is supplied to service users. 65% of those who supplied naloxone said they used this setting. 23% said they supplied at voluntary sector agencies, 20% at community centres/facilities, 15% at pharmacies, 15% at service users' homes, 11% in prison and 10% at another outreach location.
Impact/attitudes
19. Service providers felt that the THN programme has had a positive impact on service users, as displayed in Table 3. Most notably, 92% of service providers agreed or strongly agreed that the programme has made service users more aware of life saving techniques such as resuscitation, 90% agreed or strongly agreed that it increased service users' awareness of the causes of drug overdose, 86% agreed or strongly agreed that it has saved lives, and 73% agreed or strongly agreed that it has empowered service users to take greater control of their health.
Table 3: Impact on service users
| Strongly agree | Agree | Disagree | Strongly disagree | Don't know | |
|---|---|---|---|---|---|
| The THN programme has not reduced the number of drug-related deaths (n=169) | 4% | 15% | 40% | 19% | 22% |
| The THN programme has deterred people who use drugs from using other harm reduction measures (n=169) | 1% | 10% | 44% | 25% | 21% |
| People who use drugs are reluctant to get involved with the THN programme (n=169) | 6% | 20% | 49% | 15% | 10% |
| There is potential for greater involvement of people who use drugs in the THN programme (n=169) | 31% | 57% | 4% | 2% | 6% |
| The THN programme has empowered people who use drugs to take greater control of their health (n=169) | 17% | 56% | 8% | 2% | 17% |
| The THN programme has made people who use drugs more aware of the causes of drug overdose (n=169) | 37% | 53% | 3% | 2% | 5% |
| The THN programme has made people who use drugs more aware of life saving techniques such as resuscitation (n=169) | 42% | 50% | 2% | 1% | 5% |
| The THN programme has saved lives (n=169) | 48% | 38% | 1% | 1% | 12% |
20. Comments from respondents include:
"People will be more aware of the signs of overdose, they will have learned about dispelling the myths, they will feel confident about the intervention and feel more in control to do something to help."
"Gives drug users a greater understanding of the high risk times of overdose. Encouraged drug users to seek medical help when someone overdoses."
"They [service users] leave the training session more empowered and more confident of their ability to save a life."
21. Most service providers 88% felt there is potential for greater involvement of service users in the THN programme.
Families/carers
Training
22. Nearly a third (29%) of service providers have trained family members/carers in naloxone.
23. 56% of those who have trained families and carers said they have trained between one and five family members/carers.
24. Service providers reported that training of families and carers most commonly takes place in NHS clinics (46%), voluntary sector agencies (38%) and in families' homes (27%).
25. There appears to be a slight preference for 1:1 training: 65% of those who had delivered training to families and carers said that a 1:1 approach was highly effective, compared with 48% for group training.
Materials
26. Service providers were uncertain about the effectiveness of the 2013 naloxone materials for families and carers. 50% described these materials as fairly or highly effective but 39% did not have an opinion.
Supply
Table 4: Training and supply of families and carers
| Total (n=161) | Community (n=138) | Prison (n=23) | |
|---|---|---|---|
| % of service providers who have trained families and carers | 29% (n=164) | 31% (n=141) | 17% (n=23) |
| % of service providers who have supplied families and carers | 17% (n=161) | 17% (n=138) | 13% (n=23) |
27. Table 4 shows that there is a discrepancy between the proportion of service providers who have trained families/carers (29%) and those who have supplied families/carers (17%).
28. 56% of those who have supplied families and carers have supplied between one and five families/carers.
29. Two-thirds (67%) of those who have supplied families/carers have supplied them at an NHS clinic, 22% at voluntary sector agencies and 22% at families/carers' homes.
Impact/attitudes
30. Table 5 shows that service providers reported that the THN programme has had a positive impact on families and carers. For example, 68% feel that families and carers feel reassured knowing that they could help to prevent overdose. As a respondent commented, 'the families are sometimes the ones faced with an overdose situation and can feel totally helpless, the training can give them some confidence in dealing with the situation.'
Table 5: Impact on families and carers
| Strongly agree | Agree | Disagree | Strongly disagree | Don't know | |
|---|---|---|---|---|---|
| Families and carers are reluctant to get involved with the THN programme (n=169) | 3% | 12% | 38% | 14% | 32% |
| There is potential for greater involvement of families and carers in the THN programme (n=169) | 36% | 47% | 1% | 1% | 17% |
| Families and carers feel reassured knowing they could help prevent overdose (n=169) | 21% | 47% | 2% | 3% | 27% |
| Families and carers feel more confident in using life saving techniques (n=169) | 20% | 43% | 1% | 2% | 36% |
| The THN programme has placed a significant burden on families and carers (n=169) | 1% | 4% | 37% | 23% | 36% |
31. Over four-fifths (83%) of service providers felt that there is potential for greater involvement of families and carers in the THN programme.
Staff
Training
32. 28% of service providers have trained staff in naloxone. Most (56%) of those who have trained staff have trained between one and 15 members of staff.
33.Staff training tends to take place in NHS clinics (49%), voluntary sector agencies (33%) and community centres/facilities (27%).
34. Training for staff appears to be delivered mainly in groups - 61% of service providers said they deliver training to staff in this way.
35. Group training is seen as more effective for staff: 96% who have delivered training to staff said that group training was fairly or highly effective, compared with 67% for 1:1 sessions. A respondent commented that group training 'allows for discussion and sharing of experiences.'
Materials
36. 72% of all respondents said that the 2013 naloxone materials for use by professionals are either fairly or highly effective.
Supply
Table 6: Training and supply of staff
| Total | Community | |
|---|---|---|
| % of service providers who have trained staff | 28% (n=163) | 30% (n=140) |
| % of service providers who have supplied staff | 16% (n=161) | 17% (n=138) |
37. Table 6 shows that 16% of service providers said they had supplied naloxone to staff. This is lower than the percentage (28%) who said they had trained staff in naloxone.
38. Most (68%) of those who have supplied staff reported supplying between one and 15 staff members.
39. Supply tends to take place in voluntary sector agencies (56% of those who had supplied staff said they had supplied at this setting) or NHS clinics (40%).
Friends/peers
Materials
40. Nearly half (48%) of service providers reported that the 2013 naloxone materials for friends and peers are fairly or highly effective. However, 43% felt unable to give an opinion about these materials.
Impact/attitudes
41. Table 7 shows that service providers felt that the THN programme has had a positive impact on friends and peers of service users. 68% agreed or strongly agreed that friends and peers feel more reassured knowing that they could help to prevent an overdose. A respondent remarked that naloxone gives 'comfort and hope to families and friends of people who use drugs.'
Table 7: Impact on friends and peers
| Strongly agree | Agree | Disagree | Strongly disagree | Don't know | |
|---|---|---|---|---|---|
| Friends and peers are reluctant to get involved with the THN programme (n=169) | 4% | 12% | 44% | 10% | 29% |
| There is potential for greater involvement of friends and peers in the THN programme (n=169) | 28% | 51% | 1% | 1% | 20% |
| Friends and peers feel more reassured knowing they could help prevent an opiate overdose (n=169) | 19% | 49% | 3% | 1% | 28% |
| Friends and peers feel more confident in using life saving techniques (n=169) | 17% | 49% | 1% | 1% | 33% |
| The THN programme has placed a significant burden on friends and peers (n=169) | 1% | 7% | 34% | 21% | 37% |
42. Nearly eight in ten service providers (79%) felt that there is potential for greater involvement of friends and peers in the THN programme.
Partnership working
43. Table 8 shows that service providers were, in general, positive about partnership working in their area. 79% felt that partnership working in their Health Board area is fairly or highly effective.
Table 8: Perceptions of partnership working in Health Board areas
| Not at all effective | Slightly effective | Fairly effective | Highly effective | Don't know | |
|---|---|---|---|---|---|
| Total (n=169) | 1% | 11% | 41% | 38% | 9% |
| Ayrshire & Arran (n=8) | - | - | 38% | 25% | 38% |
| Borders (n=6) | - | - | 50% | 33% | 17% |
| Dumfries & Galloway (n=6) | - | 17% | 33% | 50% | - |
| Fife (n=10) | - | 20% | 40% | 40% | - |
| Forth Valley (n=27) | 4% | 7% | 52% | 37% | - |
| Grampian (n=21) | 5% | 10% | 33% | 38% | 14% |
| Greater Glasgow & Clyde (n=39) | - | 13% | 31% | 46% | 10% |
| Highland (n=7) | - | 14% | 43% | 14% | 29% |
| Lanarkshire (n=11) | - | - | 27% | 64% | 9% |
| Lothian (n=24) | - | 13% | 58% | 29% | - |
| Orkney (n=1) | - | - | 100% | - | - |
| Shetland (n=3) | - | 33% | 33% | 33% | - |
| Tayside (n=6) | - | 17% | 50% | 17% | 17% |
44. A lesser proportion, 50%, felt that partnership working at the national level is fairly or highly effective, but most of the remainder (44%) felt unable to comment on this.
Potential lives saved
45. 86% agreed or strongly agreed that the THN programme has potentially saved lives and 70% said they were personally aware of lives having potentially been saved as a result of naloxone administration. Comments from respondents include:
"Two patients in the same week [potentially] saved the life of a user."
"People are alive [as a result of naloxone] who would otherwise be dead."
"We have several examples of people who have survived due to quick administration of naloxone."
46. Prison-based staff were more likely (79%) to be aware of lives having been saved than community staff (69%), as shown in Table 9.
Table 9: Awareness of potential lives saved by naloxone administration
| Total (n=169) | Community (n=145) | Prison (n=24) | ||
|---|---|---|---|---|
| Are you personally aware of lives having been saved as a result of naloxone administration? | Yes | 70% | 69% | 79% |
| No | 30% | 31% | 21% | |
47. Respondents reported being aware of at least 500 potential lives being saved as a result of naloxone administration (it is "potential" as not all overdoses would necessarily result in death and it is not possible to quantify therefore how many lives have been saved)[49].
48. Table 10 shows that respondents in each Health Board area were aware of potential lives having been saved, with the exception of Orkney, where there was only one respondent. Service providers in Greater Glasgow & Clyde reported being aware of 114 lives saved, 113 in Forth Valley, 73 in Lothian, 41 in Grampian and 40 in Lanarkshire.
Table 10: Estimated Potential lives saved by Health Board area
| Area | Estimated number of lives saved |
|---|---|
| Greater Glasgow & Clyde | 114 |
| Forth Valley | 113 |
| Lothian | 73 |
| Grampian | 41 |
| Lanarkshire | 40 |
| Fife | 30 |
| Borders | 22 |
| Tayside | 20 |
| Ayrshire & Arran | 18 |
| Dumfries & Galloway | 12 |
| Highland | 12 |
| Shetland | 5 |
Strategy and policy support
49. Service providers' views of strategy and policy support for the THN programme were quite mixed but a significant proportion of respondents felt unable to comment, as shown in Table 11.
Table 11: Perceptions of strategic and policy support
| Highly or fairly effective | Don't know | |
|---|---|---|
| Strategic and policy support within the Scottish Government (n=169) | 54% | 39% |
| Strategic and policy support within your NHS Health Board (n=168) | 69% | 24% |
| Strategic and policy support within your ADP (n=168) | 71% | 19% |
| Strategic and policy support within Scottish Prisons (n=168) | 36% | 58% |
| Strategic and policy support within SDF (n=168) | 57% | 39% |
50. We should note that, although 36% of all respondents felt that support within Scottish Prisons is highly or fairly effective, this figure increases to 79% among prison-based respondents.
Support materials
51. Service providers had mixed views about the effectiveness of naloxone support materials. Table 12 shows that service providers were, in general, positive about the support materials produced for use by professionals. 72% described these as fairly or highly effective. 61% described the national naloxone website as fairly or highly effective and the figures for materials produced for families and carers (50%) and peers and friends (48%) were lower. However, it is important to note that significant proportions of respondents felt unable to comment on these materials.
Table 12: Perceptions of support materials
| Highly or fairly effective | Don't know | |
|---|---|---|
| Materials for use by professionals (n=168) | 72% | 17% |
| Materials for families and carers (n=168) | 50% | 39% |
| Materials for peers and friends (n=168) | 48% | 43% |
| The national naloxone website (n=145) | 61% | 28% |
Contact
Email: Fran Warren
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