Brief Insight 10: NHS Highland: Caithness Drug & Alcohol Recovery Service (CDARS): Assertive outreach project

Background

The Drug and Alcohol Recovery Service for Caithness and Sutherland (CDARS) consists of a small team based in a rural setting. CDARS was already delivering MAT and harm reduction support through drop-in and open referral clinics before this project, with one nurse prescriber at either end of the county. After reviewing local and national service data, the team decided to run an assertive outreach test of change in Caithness to add to their existing service offerings. Their test of change began in January 2023 after successfully recruiting additional support workers. The team engaged with their board’s Caldicott Guardian to secure guidance and permissions for the project. They then developed a checklist designed to support their partners to identify and trigger an outreach from their service.

Impact

The local police service now include the checklist as part of their information recording system. The information collected is added to their Vulnerable Persons Database supporting quicker information sharing to the CDARS team. Since January 2023, the service has recorded their number of weekly trigger referrals. They are applying quality improvement methodology to analyse these figures to determine whether people have previously accessed their service, are currently open to them, or, are not yet known. They then focus on the outcomes of those contacts to inform their approach. Feedback from the people receiving outreach has been positive with thanks expressed to the team for their consistent and proactive care.

Learning

The main challenge identified by the service is confidentiality. The Caldicott Principles set out guidelines to protect people and their confidential information. CDARS received approval to conduct assertive outreach to those considered high risk.

The team’s method of evaluating staff experience has been particularly successful. Based in two separate offices, they use electronic record keeping to capture what is impacting staff. Each day staff members choose from five scored emoji which tracks their ongoing experience.

Top Tips

• Build relationships and contacts – partnership working can be a strength of rural communities.
• Consistency in outreach and team members helps build trust with people.
• Start small and grow your project from there – quality improvement tools can help with this.
• Communication helps reduce stigma and improve people’s understanding of available options.

Next Steps

CDARS will continue measuring the impact of this project’s work in Caithness with a view to expanding into other areas including inpatient and primary care.