Supporting people accessing drug and alcohol treatment for the first time
It takes a lot of courage to ask for help. We designed our new Conversation Tool to make that first conversation as easy as possible.
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 4 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.
Throughout the design and development of the new tool, we involved people from across the organisation. We tested each iteration of the tool with our frontline staff and made changes based on their feedback. We held workshops and design crits where we’d show parts of the tool and get feedback from experts. We also piloted the Conversation Tool in three services so we could test how it worked when being used to carry out assessments.
One of our principles when designing the tool was that it could support a more collaborative conversation between staff and their client. To do this, we made sure all the questions were written in plain English and written as if they were asking the client directly, rather than writing about them. Additionally, we only show questions which are relevant to the client. For example, if someone needs support with their drinking and has never taken any drugs, they will only get asked about alcohol. While this makes it easier for workers and better for clients, there was a great deal of complex mapping and data wrangling behind the scenes.
Rolling it out in our services
A few months ago, we started to roll out the Conversation Tool and some of our services are now using it to do assessments. We’ll continue this process over the coming month. Although the tool was designed with the people who use it, and it is easy to use, we recognise that any change can be difficult and people will have questions and feedback. We met with service managers, team leaders and frontline staff to demo the tool and talk through how it could be adopted in their service. We also set up communication channels so we can continue to answer staff’s questions post launch.
We’ve started to gather some feedback and learnings from our early adopters. Staff have told us that the Conversation Tool is easy to use, saves time and helps them have a more free-flowing conversation. The word “friendly” is often used by staff to describe the tool. Staff have also fed back that some of the questions — such as asking people to rate their mental health on a scale of 1–10, have helped them with getting clients to open up more.
We’ve also had some feedback about how we can improve the tool so we’ll be making some changes over the next few weeks. We’ve learnt a lot about rolling out new products and how we can support services in adopting new tools. The Conversation Tool was designed with the people who use it as part of their day job and this has been a huge factor in its success.
However, we’ve also been reminded that change is hard — even positive change — so you have to prepare for and expect challenges. Moving from collecting data in a highly structured format to collecting client information in a more flexible way is a big shift for some of our frontline workers.
Our own staff described the ideal assessment as being a conversation between them and a client but reporting requirements and case management systems haven’t always supported this. The Conversation Tool allows us to re-define what a good assessment looks like. It means meeting all our reporting requirements but, at the same time, providing the best possible welcome for a new client.
Next steps
We’ll be rolling out to our remaining English services using Nebula in the next few weeks before we start to roll out in our Scottish services. As more services start to use the Conversation Tool for assessments, we’ll gather more feedback so we can understand the impact we’ve had.
Our success measures were improving client experience, improving worker satisfaction and reducing the amount of admin time related to assessments. We also want to improve data quality so we’ll be assessing the quality of the information we’ve collected to see whether we know more about our clients through doing assessments this way.
Staff using the Conversation Tool still have to use Nebula for everything other than the initial assessment, including risk assessment and care planning. Working between two systems can be difficult and so in future we’d like to develop further modules of the Conversation Tool. Ultimately, we want to make it as easy as possible for our staff to give people the best possible support so that they have the best chance of getting better.
We’ll share more feedback as we learn more. We’d also love to hear from anyone who has designed and developed tools to support frontline staff in this way.
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