advocacyAdvocacy for Drug Users

Effective Interventions Unit

A Guide

Tackling Drugsin Scotland

Act

ion

inPartnership

SCOTTISH EXECUTIVE

Remit

The Unit was set up in June 2000 to:

• Identify what is effective – and cost effective – practice in prevention, treatment, rehabilitationand availability and in addressing the needs of both the individual and the community.

• Disseminate effective practice based on sound evidence and evaluation to policy makers, DATsand practitioners.

• Support DATs and agencies to deliver effective practice by developing good practice guidelines,evaluation tools, criteria for funding, models of service; and by contributing to the implementation of effective practice through the DAT corporate planning cycle.

Effective Interventions UnitSubstance Misuse DivisionScottish ExecutiveSt Andrew’s HouseEdinburgh EH1 3DGTel: 0131 244 5117 Fax: 0131 244 3311

EIU@scotland.gsi.gov.ukhttp://www.drugmisuse.isdscotland.org/eiu/eiu.htm

Scottish ExecutiveEffective Interventions Unit

Effective Interventions Unit

Advocacy for Drug Users: A Guide

What is in this guide?

Definitions of advocacy and a brief outline of the different types The role of advocacy in ensuring accessibility and best outcomes for drug users and their families Information on who currently provides advocacy Who is best placed to deliver advocacy Types of advocacy that are most appropriate to this client group

What is the aim?

To help DAATs and local partners consider whether, and how, advocacy could be incorporated into the development of Integrated Care.

Who wrote this guide?

Vered Hopkins, Emma Harvey and Karin O’Brien of the Effective Interventions Unit.

Who should read it?

This guide is aimed at DAATs, local partners and service providers.

© Crown copyright 2004

ISBN 0-7559-3768-3

Further copies are available from:Effective Interventions UnitSubstance Misuse DivisionScottish ExecutiveSt. Andrews HouseEdinburgh EH1 3DGTel: 0131 244 5082 Fax: 0131 244 3311

EIU@scotland.gsi.gov.ukhttp://www.isdscotland.org/goodpractice/effectiveunit.htm

The text pages of this document are produced from 100% elemental chlorine-free,environmentally-preferred material and are 100% recyclable.

Astron B36458 06-04

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Contents

Introduction 5

Chapter 1: What is advocacy 7

Chapter 2: Could advocacy be useful for drug users? 13

Chapter 3: Provision of advocacy services to drug users 19

Chapter 4: Advocacy services for young people 23

Chapter 5: Advocacy services in rural and remote areas 27

Chapter 6: Planning and delivering advocacy services 29

Appendix 1: Participants at the consultation seminar 35

Appendix 2: Results of questionnaire to service providers 37

Appendix 3: Useful information sources 41

References 43

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5

Introduction

‘Integrated Care for Drug Users: Principles and Practice’ (EIU 2002) identified the potential importance of advocacy as part of the overall process of treatment, care and support for drug users. More recently, the ‘Mind the Gaps’ report (SACDM, SACAM 2003) identified advocacy as one of the key features of service provision for people with co-occurring substance misuse and mental health problems.

The purpose of this EIU guide is to help DAATs and local partners to consider whether, and how, advocacy could be incorporated into the development of Integrated Care. However, there is currently only limited advocacy provision targeted specifically at drug users and little evaluation or research evidence. It is important, therefore, that we emphasise that this guide aims to offer a first step towards the development of advocacy services for drug users.

Advocacy is widely recognised as an important way of enabling and empowering people to make informed choices and to gain, and remain, in control of their own lives. It helps people to have access to the information they need, become aware of the options open to them and make their views and wishes known. Advocacy safeguards people through encouraging good practice and preventing neglect or abuse. It can help to prevent crisis, support people during crisis and ensure service users and their families achieve the best outcomes from the range of services they use.

This document aims:

to consider what advocacy is and to outline the different types of advocacy

to set out the role of advocacy in ensuring accessibility and best outcomes for drug users and their families

to present information on who currently provides advocacy to drug users

to look at who is best placed to deliver advocacy

to consider the types of advocacy that are most appropriate for this client group.

This document also sets out some of the issues and questions that DAATs and their partners may need to think about when setting up or extending advocacy services. It goes on to consider briefly the specific issues involved in setting up advocacy provision for young people and for service users in rural areas.

Research and Consultation

The process of gathering evidence to inform this document confirmed that only a limited amount of evidence and information is currently available on advocacy for drug users. To help us extend the evidence base for this guide we have conducted:

a review of available literature

a survey of a selection of treatment and care service providers (see appendix 2)

a one-day consultation event with a range of key individuals from advocacy and treatment and care service providers (see appendix 1)

four focus groups with service users in four different areas throughout Scotland designed and led by the Scottish Drugs Forum (for a copy of the full report contact EIU).

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THANK YOU

The EIU wishes to thank all those who have participated in the survey and the consultation event, and all those who helped by contributing examples, information and views. In particular we would like to thank the service users who participated in the focus groups and provided us with valuable information and SDF for organising and running the focus groups.

We would also like to thank the Advocacy Safeguards Agency and The Scottish Independent Advocacy Alliance for their detailed advice and information on independent advocacy.

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Chapter 1: What is advocacy?

Advocacy is recognised as playing an important part in helping marginalised groups become more socially included. There are different types and different forms of advocacy. It can take the form of an ordinary activity, part of every day life, that is provided and received by most people at some point in their lives. For example, many of us may ask a family member or a friend to accompany us to a formal appointment to help us either by speaking on our behalf or by helping us to express our views. Advocacy can also be a formal organised activity for people who are vulnerable and excluded, treated badly because of prejudice, have no family or friends to support them or whose family and friends are part of the problem.

The aims of advocacy

A Independent Advocacy A Guide for Commissioners: Supplement’ (Scottish Executive 2001) suggests that advocacy has two main themes:

Safeguarding individuals who are in situations where they are vulnerable.

Speaking up for, and with, people who are not being heard, helping them to express their views and make their own decisions and contributions.

Advocacy is about promoting people’s rights and helping them maintain control over their own lives. Advocacy can promote social inclusion and raises awareness of the obstacles faced by excluded and isolated individuals. Advocacy involves supporting and empowering people to speak for themselves, speaking on behalf of people who are unable to speak for themselves, helping people to explore the range of options open to them and clarifying a particular course of action. It can enable people who are marginalized, such as drug users, to express their views, to be heard and to have a say in crucial decisions that affect their lives.

From the evidence that we have gathered, we have identified a number of values and beliefs that underpin the provision of advocacy services. These include:

all service users have the right to be heard and for their views to be respected

with the right help, everyone can learn to communicate more effectively and gain more control over their own lives

everyone has the capacity to contribute and people need help to overcome issues that prevent them from contributing

the social and economic exclusion of some people in society who are seen as ‘less important’ is always a risk

there is a need for partnership work between those who plan and provide services and those who use services

some clients feel let down by services. Service providers are not always aware of these situations.

Information

“Advocacy is not new. Peopledo it every day for theirchildren, for their elderly ordisabled relatives, and fortheir friends. Concernedindividuals or groups do it forpeople who are particularlyvulnerable or undervalued”.(Advocacy: A Guide to GoodPractice, 1997).

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“The dilemma for theadvocate is how to giveinformation, not advice,and how to represent theclient without takingcontrol on the decisionsmade” (EIU consultationevent, 2003).

What is advocacy a response to?

‘Key Ideas on Independent Advocacy’ (Advocacy 2000) suggests that advocacy is a response to four general problems:

Lack of community contact with services and the social isolation and exclusion of some people

The disempowering effects of some services and a lack of independent support for some individuals

People lacking in confidence, experience, or skills to stand up for themselves

General public prejudice or ignorance about certain people

Who can advocate?

Anyone can act as an advocate as long as an individual has asked them and they are willing to become involved in that way. An advocate can speak on behalf of a wide range of people to help ensure they receive what they are entitled to. Very often people choose a relative, a friend or a carer to advocate on their behalf. Some people, provided there is no conflict of interest, choose another service provider to advocate on their behalf. Others choose either a trained volunteer advocate or a professional advocate working through an independent advocacy agency. Yet others ask the help of self-help groups or voluntary organisations.

Our review of the evidence and the responses from our consultation suggests that an advocate is someone with competent listening, negotiating and communicating skills; that an advocate needs to earn the trust of the person they are advocating for; and that an advocate should have good understanding of the person’s situation and a working knowledge of available services.

The role of the advocate

The primary role of the advocate is to be on the side of the person they are supporting and ensure that his/her opinions and wishes are being listened to. The advocate should follow the agenda of that person and work in a way that is directed by that person’s ideas, hopes, wishes and ambitions. It is important to act in a non-judgemental way and, as far as possible, avoid actions that might compromise neutrality and loyalty to the supported person.

Our research and consultation suggest a number of key factors that seem to influence the effectiveness of an advocate. These are set out in the following table:

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An advocate should An advocate should not

be articulate and precise in expressing the views of their client

whenever possible support the client to speak for themselves rather than act for or represent them

know how to professionally use their position to make the client’s views and wishes heard

make sure the client knows their rights

ensure the client knows what is happening and is kept informed at every stage

be knowledgeable about the correct procedures to follow (when raising issues with professionals e.g. in health or social work)

ensure that they are putting across what the client wants, rather than what they think is best for the client

build up trust between themselves and the client and treat the client with respect

create a good working relationship with other professionals so that they do not feel threatened by the presence of an advocate

be available (where possible) when the client needs them

X feel defensive, protective or sympathetic towards the client

X be judgemental or critical

X take over client’s lives

X encourage clients to think that they are likely to get everything they want

X be swayed by their own opinions or views

X be pushy or intimidating towards the client or other professionals

X befriend the client or become embroiled in situations outside their remit/capacity

Note: This table has been created by EIU from the analysis of our findings.

Types of advocacy

There are different types of advocacy. The Scottish Executive, through the Advocacy Safeguards Agency is promoting the development of Independent Advocacy. This means that advocacy projects/services, and their advocates, operate independently of other service providers. This removes any conflict of interest and enables an independent focus on the individual. The aim of independent advocacy is to ensure that advocacy is completely on the side of the person.

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There are 3 main models of independent advocacy:

Individual professional advocacy

This is carried out by professional, trained, paid or unpaid individuals who are independent of any service provider or agency. The primary loyalty and accountability of independent advocates is to the people who need advocacy rather than to the agencies providing health and social services.

Individual professional advocacy services often provide support to a range of individuals or groups for short or long periods of time, depending on what support is required. These services are set up to ensure that they are as free as possible from interests that conflict with those of the people they support. Independent advocacy should be available to anyone. However, it can be especially helpful for people who do not have a family member or a friend to help them, and do not want to rely on providers of other services for support. It is also useful when support is needed from somebody neutral,who does not need to be concerned about conflicting interests with their own employer or colleagues. Individual professional advocacy is a useful way to support people to develop their confidence and aspirations, and ensure they receive the services to which they are entitled.

Citizen advocacy

The objective of citizen advocacy is to encourage ordinary people to become more involved with the welfare of those who might need support in their communities. Citizen advocacy projects usually involve unpaid ordinary members of the community speaking on behalf of another person to protect their interests. This is usually done on a one-to-one basis and involves providing general long-term support to an individual by helping them to develop a trusting relationship with a member of the community and regaining their place within the community. Citizen advocacy projects also aim to have a lastingimpact on the community, not just on the individual they support.

By using citizens to bring about greater social inclusion, such projects aim to support local communities to be more inclusive, raise awareness of local services and improve the quality of services. A citizen advocate would usually:

work with only one person at a time work voluntarily and not be motivated by personal gainencourage the person they are supporting to present their own interests have a personal commitment to support the individual they are working with.

Collective advocacy

Collective advocacy, or group advocacy, as it is sometimes called, is when a group of people with common views on a particular subject or similar experiences join together to make their voices heard. The idea behind collective advocacy is that people possess more power, have more sway and are better at supporting one another when they come together and organise as a group. Collective advocacy often takes place when people have become so dissatisfied with something that they feel they have to complain collectively to be heard.

Information

The Advocacy Safeguard Agencyhas published a mapping report:‘A Map of Independent AdvocacyAcross Scotland’ (2003-4). Thereport provides a comprehensivemapping of services and includesa description of individualprojects, sources of funding andinformation on developmentplans.

For a copy go to: www.advocacysafeguards.org

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“Family and friends willbe there long after theservices pull out” (EIUquestionnaire, 2003).

“I use my worker [asan advocate] because Itrust her and I don’thave much contact withmy family” (ServiceUser, EIU focus groups2004).

Collective advocacy entails forming a group to meet and discuss possible courses of action, delegating duties to group members and, in some cases, electing a chair or a spokesperson. It is an effective form of advocacy to deal with issues that affect a whole group of people and provides a mechanism for a group to support individuals.

Collective advocacy is not addressed in this guide. For more information on this type of advocacy see ‘Principles and standards in Independent Advocacy’, Part B, Advocacy 2000, January 2002.

The 2 other types of advocacy most commonly mentioned in our survey and consultations were:

Advocacy provided by other (non-advocacy) services

Many people who are already engaged with servicesreceive advocacy from those services or from other (non-advocacy) service providers. Although the staff carrying out this kind of advocacy are often not formally trained advocates, they may have substantial knowledge and experience of the needs and aspirations of a specific client group and the nature of their condition. However, their effectiveness as advocates may be compromised if the interests of the service they work for conflicts with that of the client.

Advocacy provided by family and friends

The most common form of advocacy is that provided by family and friends. Often people provide this kind of support to their relatives and friends without realising they are acting as advocates. This form of advocacy could be as simple as a friend or family member accompanying someone to a doctor’s

appointment or going along to the job centre to help fill out forms and ask for advice. For many people, family and friends are the only constant support they have throughout a difficult period.

SUMMARY

Advocacy is about protecting and empowering people and not about taking over their lives.

Advocacy can be an ordinary activity provided and received by many people and part of every day life.

Anyone can be an advocate but advocates should ensure that they act only on the side of the person receiving support. This is the aim of independent advocacy.

There are different types of advocacy including independent advocacy and more informal advocacy by providers, family or friends.

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“The request for advocacyservices from both drug andalcohol users has risensharply”.

“Advocacy can help restorefaith amongst clients that theirneeds are being addressed in amore holistic fashion”. (EIU Questionnaire 2003).

“I had to go up to the appealfor the social. I went upmyself and just got more orless kicked out the door. ThenI took someone else with meand it got sorted. That’s ‘cos Ihad somebody up with meand they spoke for me”.(Service User, EIU focusgroups 2004).

Chapter 2: Could advocacy be useful for drug users?

There is a growing recognition of the benefits of advocacy to marginalized groups, including drug users (see ‘Mind the Gaps’ SACDM,SACAM 2003). Drug users often experience a range of problems and need to deal with a range of agencies. At different stages of their recovery process, individuals may benefit from different types of advocacy. For example, a drug user who is not in touch with services may rely on family and friends for advocacy. Once they have begun receiving treatment, clients may rely on staff from the treatment and care services to advocate on their behalf. When they are ready to move on, recovering drug users could benefit from the help of an independent advocacy agency.

What are the problems drug users face?

Evidence shows that people who have drug misuse problems will, in many cases, have a range of other difficulties in their lives. These difficulties include problems with housing, family relationships, employment, offending behaviour and debt. This means that a wide range of interventions and support will need to be deployed to address those problems (Integrated Care for Drug Users EIU 2002).

Service users commonly feel that support is offered to them at the beginning of the recovery process and that, very often, when they are ready to move on to services such as employability or housing, support is no longer there. Consequently, service users are often

unaware of the options open to them, the specific services they can access and how to go about accessing these services. In addition, drug users often suffer from a wide range of barriers and low self-esteem. They find it difficult to express their views and are often not skilled at getting people to listen to them.

Advocacy and drug users

The evidence from the EIU advocacy survey, consultation seminar and focus groups suggest that service users and providers consider advocacy to be an important component of effective treatment and care provision.

Reasons given by service users and providers for the usefulness of advocacy included:

Drug users often need to use a widerange of specialist and generic services. Advocacy can help them find out what services are available and how to access them.

By being knowledgeable about specific subjects, an advocate can add weight and credibility to a client’s case.

Advocacy can help people understandtheir rights and the range of choices they have.

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“Advocacy is not just aboutcomplaints. There are occasionswhen clients who have becomevery close to service providerswant also to talk to anindependent person who is notdirectly involved with theprovision of that service. Thiscan be a sign that the clientwants to move on”. (EIUConsultation Seminar 2003).

In addition, service users and providers identified a number of activities that they associated with advocacy but which would not fall within the remit of an independent advocate. These activities might include a range of support, such as

helping clients to sort out and understand the large amounts of information they receive which can be confusing.

helping service users who find reading and writing difficult to complete forms and read a range of information sources.

helping clients who may not represent themselves very effectively to make themselves heard by telling them what to expect from a meeting, and how to conduct themselves when speaking to other people.

helping clients to be realistic about what to expect from services and what is expected from them when they use services.

helping service users to deal with the negative attitudes towards them from a range of professionals.

When planning advocacy service for drug users, it will be important to define the scope of advocacy and to make the core remit of the provider(s) explicit. It will also be crucial for the advocates to know where clients can get the other support that they might need.

A recent mapping exercise of independent advocacy agencies in Scotland (ASA 2004) identifies substance misusers and other marginalized groups, including the homeless and people leaving prisons, as “hidden” groups for whom there is the largest gap in independent advocacy provision. The ‘Mind the Gaps’ report (SACDM, SACAM 2003) identifies advocacy, alongside early intervention, broadly based intervention and person-centred intervention, as a key feature of service provision for people with co-occurring substance misuse and mental health problems. The report recommends that advocacy services should become integral to the care plans for this client group.

Where and when is advocacy most needed?

The majority of the service users who participated in our focus groups had personal experience of having someone speaking on their behalf or representing them. ‘Personal treatment’ was identified as the area where most participants needed advocacy. This included accessing GP services and negotiating changes in treatment interventions. Some felt that without somebody advocating on their behalf, their chances of registering with a GP or receiving access to a range of treatment and care services would have been reduced. Other service users received advocacy which included support with benefit appeals, court attendances and housing.

The majority of the service providers who responded to the EIU survey reported that many of their clients needed advocacy support when dealingwith agencies including housing, social work, training & employment, children and family teams, GPs and the police. More specifically, the issues with which clients needed advocacy included benefit, finance and debt, physical and mental health, training and employability, substitute prescribing, and childcare.

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The limits of advocacy

It is important to recognise the limits of advocacy and be clear about what it cannotachieve. The purpose of advocacy is not:

to create a substitute for making services more accessible or to bypass user involvement in the planning and delivery of services

to avoid the need to provide person-centred services

about making complaints (although advocacy may involve supporting people who want to make a complaint and helping them to do so effectively).

Advocacy is often provided to those most in need of safeguarding, who are often least likely to have their needs and rights recognised, but who are also least likely to provide specific instructions or have specific ideas about what they want or need. Consequently there is always the danger of the advocate taking over the process rather than empowering the client to deal with issues themselves. Therefore standards must be in place to ensure that best practice is carried out. For information about standards see Principles and standards in Independent Advocacy organisations and groups (Advocacy 2000, January 2002).

Advocacy and befriending services

It is important to stress that advocacy is not the same as providing befriending services. The Befriending Network Scotland says the role of a befriender is primarily about social contact and about forming a reliable, trusting relationship, and therefore not about doing practical jobs like driving, shopping or DIY. Befriending offers supportive reliable relationships through volunteer befrienders to people who would otherwise be socially isolated. For more information see www.befriending.co.uk

Information

Relatives and carers of substance misusers can also benefit from advocacy services. EIU’s review: Supporting Families and Carers of Drug Users (published November 2002) describes how those taking on carer roles can often experience difficulties in dealing with agencies such as NHS, Jobcentre Plus and Education services. These experiences, along with the self-blame and guilt that families can feel, can result in them having little energy or confidence in challenging decisions or systems.

Many family support groups throughout Scotland offer forms of advocacy to relatives and carers of substance users. For more information contact Davy Macdonald, National Community Engagement Officer, Scottish Drugs Forum, Tel: 0141 221 1175, E-mail: davy@sdf.org.uk

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SUMMARY

At different stages of the recovery process, an individual drug user may benefit from different types of advocacy.

Advocacy is seen as most beneficial when service users are trying to get access to treatment and care options.

Relatives and carers of drug users may also benefit from advocacy.

It is important to be aware of the limits of advocacy and be clear about what it can and cannot deliver.

THINK ABOUTTHINK ABOUTTHINK ABOUT

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What Service User Focus Group participants said about advocacy:

About an advocate: “theyhave to be a good listenerwho will empower the personto speak, giving them theright advice and supportingthem through the process.Taking them to their meetingand offering support whereneeded and if the person getsstuck or flustered then speakfor them”.

An advocate needs to be:“someone who canempower you, telling youhow to put it over andwhat to say and beingthere to support you andwork things out if they gowrong”.

“I’ve had a support worker give me ahand to do an appeal against theDSS and without her help I wouldprobably have lost the case. Shehad the right ideas about how toapproach it and everything. Shewisnae over experienced but she’ddone enough work or research onhow it worked to get a successfuloutcome. Some of them go to greatlengths to help you and actuallyknow what they’re doing”.

“It was useful for me because Ineeded stuff sorted with thehousing and I saw my workerdealing with it, it was reallyhelpful to see how they wentabout it, seeing what they saidand how they said it, this reallygave me a lot of confidence todo it myself, learned a lot fromhim”.

“I have had my Mum andmy worker speaking forme and both have beenthe same. I have got whatI wanted, it just dependson who you think can helpyou best”.

“As my friend knew what I was goingthrough and knew the doctor heoffered to come with me and speakto him. He put it over in a betterway from me because he wasn’tangry or annoyed with the doctor.The good thing from this was that heunderstood what I was going throughbecause he had been through it, andI felt that he listened and understoodmy situation. It was good because Igot back on my prescription and I amnow doing well”.

An advocate needs:“general people skillsbecause you can have allthis experience but, see, ifyou are a bad person, see,if you have a stinkingattitude, you are hopeless,people aren’t going torelate to you”.

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“I was a bit f…d up right,and wasn’t in touch withagencies, then my masort of became…she tookthe role of speaking onmy behalf”. (ServiceUser, EIU focus groups2004).

“I would go to someonewho knew about what Iwanted. If that was afriend that I know couldhelp then that is who Iwould go to”. (ServiceUsers, EIU focus groups2004).

Chapter 3: Provision of advocacy services to drug users

Many drug users receive advocacy without being aware that this is the term for the service they are receiving. Drug users receive advocacy from a range of sources and consider knowledge of the subject and good people skills to be key qualities of an effective advocate.

Who provides advocacy to drug users?

Our evidence suggests that the majority of drug users receive advocacy from service providers with whom they are in contact, e.g. staff within treatment and care services, not from specialist advocacy services. Many drug users (especially those who are not in touch with services) receive advocacy from familymembers and friends. However, some reported not to have a lot of contact with their families. Some reported that when they make contact with services, staff within these services tend to replace family and friends in providing advocacy. According to our evidence, only a minority of service users currently receive advocacy from independent advocacy agencies.

Both service users and providers felt that, in the case of drug users, staff from treatment and care services were well placed to provide advocacy. Reasons given included:

advocacy provided by a drugs worker would maximise a client’s potential of ‘staying clean’

staff within treatment and care services have the best knowledge of drug users

service users are often not in a position, and may be reluctant, to approach another service. Getting to know and learning to trust new staff can be a real challenge.

Who should provide advocacy to drug users?

The majority of service providers (EIU Advocacy Survey 2003) believed independentadvocacy to be the most appropriate source of advocacy. However, when asked to comment further, many highlighted a range of potential difficulties with relying on independent agencies to provide advocacy for their clients. They felt that independent advocacy services are often not very well informed about drug misuse issues. They also had concerns that separate independent advocacy services designed specifically for drug users may have a stigma attached to them. There was also a view that, despite the value of independent advocacy services, drug users often feel unable to access them.

Some respondents thought advocacy should be a specialist role carried out by formally trained individuals working within treatment and care agencies. Some felt it was not always appropriate for family and friends to provide advocacy because often they were too involved, they may be part of the problem or may promote their own agenda rather than that of their drug-using relative.

When considering the most appropriate providers of advocacy to drug users in their local area, DAATs and their partners may wish to consider the strengths and weaknesses of different types of advocacy. From the research and consultation evidence we have put together the following table:

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STRENGTHS WEAKNESSES

Independent Advocates

✓ Independent advocates do not need to consider any agenda other than the client’s

✓ Independent advocates can offer a sense of general perspective to clients and help with every aspect of their lives (including those not directly linked to their drug use)

✓ They can stay with a client throughout the recovery process and provide an element of stability

✓ They can also be available if the client loses contact with a specific drug service

✓ They will not be seen as aligned to any specific service or agenda

Independent Advocates

X Many clients will be in contact with a number of services and may be reluctant to tell their story to yet another person

X Clients may not want to go through the process of getting to know and learning to trust another professional

X Independent advocates may not have an in-depth knowledge of drug-specific issues or understand the recovery process

X Independent advocates who are not used to working with this client group may find building up trusting relationships challenging

Treatment and care service providers

✓ There will already be a trusting working relationship between staff and clients

✓ Treatment and care service providers have a good knowledge of the issues faced by this client group and will have experience of dealing with them

✓ Staff working in the drug misuse field will have good understanding of the range of services clients need to access and a knowledge of what is available

Treatment and care service providers

X Clients may need advocacy with issues that are outside the remit of the service

X There may be conflict of interests, for example, if a client requests help with complaining about the service

X Accessing advocacy within a treatment service may increase clients’ stigma, especially when dealing with services where their drug use is not known

X Could add to clients’ dependency on staff and deter them from ‘moving on’ to other services

X When leaving the treatment and care service, clients may also find they lose the support of an advocate

Family and Friends

✓ Often family and friends provide the only constant support that is available to clients and continue with their support beyond the involvement of services

✓ They already know a lot about the condition of clients and have an understanding of their needs

✓ Clients trust their family and friends

Family and Friends

X Family members and friends may not be neutral and may be guided by their own agenda rather than that of the client

X Family and friends can be too involved in clients’ lives and not be able to appreciate the general picture

X In some occasions, family and friends may be part of the problem and / or may themselves need help and support

Note: EIU has produced this table from the research and consultation evidence.

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“I was going through a DLAappeal. So, I went and gotmyself a worker, an advocate tospeak up for me. But I got thisworker and I just didn’t feelconfident with her. She justdidn’t have a clue what she wasdoing and she wasn’t getting allthe information that she needed… and I went up and I lost it”.(service user EIU focus groups2004).

The impact of advocacy

Service users felt that the key quality of an advocate is their knowledge about the subject on which they were advocating. Whether the advocate was independent or a member of their family did not seem to matter to them (EIU focus groups 2004).

Impact on service users

The majority of service users felt that the advocacy they received had a positive impact on their lives. The key factor they highlighted in determining the success of advocacy was the level of competence and knowledge of the person advocating for them. Service users also felt that good advocacy services depended on advocates having ‘good people skills’. These include someone who is:

Trustworthy – “someone you can trust and isn’t going to tell people”

Non judgemental – “someone that wouldn’t judge you”

Good listener – “good at listening and

putting it back a better way”

Honest – “they have to be honest and open with you, giving you good advice telling you when you won’t get something so as not to build up your hopes”

Focus group participants also thought that, providing they have the above qualities, ex-service users could have a role in providing advocacy.

Confusion over the term ‘advocacy’

Service users who participated in the EIU focus groups found the term advocacy confusing.Some participants did not understand the term at all and others had a vague idea of what the term meant. Yet others were confused because they connected the term advocacy with the legal system and the position of an advocate. All participants felt that the confusion over the term advocacy means that drug users would be unlikely to approach services that are advertised as ‘advocacy services’. Participants felt that drug users will not know what type of interventions such services provide.

Anticipating this confusion, Principles and standards in Independent Advocacy (Advocacy 2000, January 2002) suggests that, when explaining the concept of advocacy to people who might use it, it is important to:

not use jargon.

use a range of communication techniques (i.e. don’t just rely on leaflets).

instead of using the word advocacy, say it is about help to talk to people about health issues, money, housing etc. and that it is about having someone on your side.

explain the difference between an advocate and other service providers (e.g. drug worker, nurse, GP).

explain what advocacy cannot do or cannot help with.

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use examples that clearly demonstrate how advocacy helped individuals in similar situations.

Impact on professionals and service providers

Health and social care professionals and service providers may have some concerns about the role of the advocate in relation to their own role. It may be helpful for DAATs/local partners to consider how to realise awareness of the benefits of advocacy both for the individual and the care provider.

Effective advocacy can assist with the identification of the individual’s needs and inform the care planning process.

SUMMARY

Evidence suggests that drug users are currently more likely to receive advocacy from treatment and care service providers or family and friends rather than from independent advocates.

There are different strengths and weaknesses associated with different providers of advocacy for drug users.

Service users felt that, to be effective, advocacy services depend on the advocate having a level of knowledge about the subject and good people skills.

The term advocacy can be confusing for service users and many are not sure what it means or the kind of service it refers to.

23

“Advocacy is not agood word. It’s tooposh. It should becalled ‘putting yourvoice forward”.(ASA 2003).

“Most of my life ithas felt like no onewas listening tome”. (Youngperson, ASA 2003).

Chapter 4: Advocacy services for young people

The Guide to ‘Services for Young People with problematic drug misuse’ (EIU 2003) identifies the role of DAATs in working to ensure that services uphold children’s rights. Advocacy can help uphold the rights of children and young people experiencing problems due to their own substance misuse by supporting them to say what they think and how they feel, encouraging them to be involved in decisions about their lives and by helping them to be heard. Advocacy can also help ensure young people receive the services they need and are entitled to.

How advocacy can help young people

Young people who are misusing drugs may also experience a number of other problems, including: disrupted education, behavioural disorders, criminal behaviour, family breakdown or dispute, and physical and psychological harm. Often, for these young people, substance misuse is only one of a number of risk-taking behaviours they are engaged in. Young people may need to access a wide range of specialist and generic services. Advocacy can help to ensure that young people are able to access the services they need.

A research project aiming to inform the development of independent advocacy for children and young people in Glasgow (Advocacy Project: Children should be seen and HEARD! Marjorie Gillies, August 2002) found that: children and young people may not recognise that they need the support of an advocate. Nevertheless, those who participated in the research cited instances when an advocate might have empowered them to say what they wanted or to understand information they were given. For more information and a copy of the report contact Marjorie Gillies, 0141 201 9354 or Marjorie.gillies@yorkhill.scot.nhs.uk.

The Advocacy Safeguards Agency also conducted a national research study during the summer of 2003 looking at advocacy for children and young people in Scotland. Key findings from the research suggest that young people need advocacy in situations where they feel particularly vulnerable. These situations include: school exclusions; bullying; contact with the police, social workers and the Children’s Hearing system; homelessness; using hospital services; for some within their local communities and during transition to college or workplace. For a copy of the report contact David Cameron on 0131 524 9380 or go to www.advocacysafeguards.org.

In addition, the young people who participated in the research highlighted the following points as key aspects of advocacy services:

Young people found the word advocacy ‘off putting’ and preferred terms like ‘sticking up for you’ and ‘someone who’s on your side’.

It was more important to young people that an advocate is a good listener, patient, trustworthy and loyal, than whether or not they were independent.

Evidence / Information

Children’s rights are about: “Being treated as an individual in [their] own right. To have their opinions heard and respected regardless of age. To be kept informed about all decisions relating to them within their capacity of understanding. To have an advocate act for them” (Service Provider, Yorkhill Advocacy Research Project, August 2002).

24

Many of the young people thought they would be able to relate better to a younger advocate – especially someone who has been through similar experiences.However, some felt an older person may be more confident and assertive.

Young people wanted an advocate who is ‘clued up’ and who ‘knows their way round the system’. They also wanted an advocate who is open-minded.

Young people wanted to be reassured that what they discuss with the advocate would remain confidential, although most said they would not mind their parents knowing they are seeing an advocate.

Information / Example

Fife’s Children’s Rights Service is in the process of developing a Children’s Rights Strategy. The strategy will comprise four key elements, including:

Children’s rights advice, information and associated support (including training andawareness raising strategies) Children’s participation AdvocacyRepresentation and assistance (including legal and non-legal forms), monitoring andproofing activity.

In order to ensure the needs for advocacy of vulnerable children and young people are met Fife’s Advocacy Strategy Group (jointly co-ordinated by NHS Fife, Social Work and Barnardo’s)are funding an Advocacy Development Worker that will be based within Fife’s Children’s Rightsservice.

For more information contact Peter Nield, Fife’s Children’s Rights Co-ordinator, 01592 265294

Children’s Rights Officer

Aberdeenshire Council has a Children’s Rights Officer that works jointly with Social Work and Education services. The role of the Children’s Rights Officer is to make sure children and young people know about their rights, and are listened to and treated fairly. The officer ensures that young people placed away from home have access to an independent person as part of an overall strategy to ensure their safety and access to appropriate services. The Children’s Rights Officer provides young people with information and advice about their rights;helps young people to represent their views at meetings; listens to and takes seriously what young people say; and helps young people put forward their views about services. The serviceis aimed at children and young people who have been placed away from home by Social Work or Education services, and young people who have moved on from care, including those with special needs.

For more information go to: www.aberdeenshire.gov.uk/web/children.nsf/html

25

“Adults think we mighthave an option, but just,it’s their option or whatthey think – it’s obviouslybeen a while since they’dbeen young”. (14 yearsold, August 2002).

Advocacy services for children and young people in Scotland

The mapping of advocacy services in Scotland conducted by the Advocacy Safeguard Agency in 2003/4 revealed the following services for children and young people:

Who Cares? Scotland provides advocacy for children and young people in care in all but three local authorities throughout Scotland

North Ayr and Drumchapel in Glasgow have developed generic children’s advocacy and rights projects funded through Social Inclusion Partnerships

There is one independent anti-bullying advocacy project for children and their parents

Many voluntary sector children’s services provide advocacy on an ad hoc basis to their clients

There is only one independent advocacy organisation for children and young people in Scotland

SUMMARY

Advocacy can help uphold the rights of children and young people experiencing problems due to their own drug misuse.

Young people need advocacy in situations where they feel particularlyvulnerable, e.g. school exclusion, contact with the police and social work, bullying.

Young people find the term advocacy ‘off putting’.

Young people want their advocate to be ‘clued up’.

26

27

Chapter 5: Advocacy services in rural and remote areas

Developing and accessing advocacy services in rural areas can be difficult. The location of services can be a major barrier. Expensive and limited public transport can make it very difficult for individuals to access services. Lack of childcare provision and limited opening times may also contribute to the difficulties in attending services. In addition, rural areas often have a limited range of specialist treatment and care services. This means that there are fewer treatment and care staff to provide advocacy to substance users and that clients may need to make more use of generic advocacy services.

At the same time, problems maintaining anonymity in rural areas may mean substance users would prefer to use generic advocacy services that do not label them. Difficulties in maintaining acceptable levels of confidentiality and possible high levels of stigma can pose a real challenge to service provision. For example, insmall communities where everyone knows everyone else, matching clients to advocates can become a complex procedure. This problem is made more difficult by the fact that often advocacy services in rural areas attract only a small number of volunteer advocates leaving service providers with a restricted choice when matching advocates to clients.

Rural advocacy services

Rural advocacy services tend:

not to specialise in one particular client group but deal with a range of clients and issues

to have to be very flexible in meeting the needs of individual clients (e.g. outreach services for clients with no transport)

to be relatively small with one or two paid workers and some volunteers.

Anecdotal evidence suggests that individuals living within small and close-knit communities may be cautious about using advocacy services. This is largely because of a reluctance to ‘rock the boat’ in case they are perceived as ‘trouble makers’. Advocacy services may be seen as encouraging clients to complain about other services and generally promote a culture of discontentment with services or the way they are provided.

Information

It is often assumed thatpeople living in rural areaswould travel to nearby townsto access services. There issome evidence to suggest thatthis is more likely to happen in‘dormitory’ areas, and that alarge number of people areless likely to travel to accessservices.

Integrated Care for DrugUsers (EIU August 2002).

Example

A client living in a rural area needed an independent advocate who could deal with the local Health Board, the local school and the local Social Work Department. Attempting to match this client with one of the four volunteer advocates from the local advocacy service became very difficult because: one volunteer was a member of the local Health Council, the other was an employee of the Health Board, another was a parent whose own child was in the same class as the client’s child and one volunteer was on holiday.

28

SUMMARY

Location and timing of advocacy services is a particular difficulty in rural and remote areas where accessibility is often a problem. There may be a greater role for generic advocacy services.

Anonymity and confidentiality are important for clients.

29

Chapter 6: Planning and delivering advocacy services

As outlined in previous chapters, our evidence suggests that different service users, in different geographical locations, may need different types of advocacy services. In addition, at different stages of the treatment and care programme people will need to use advocacy services for different reasons. This is a key issue to address whencommissioning and planning.

DAATs who are planning to develop an advocacy service for drug users in their area may wish to consider ways to ensure clients have access to an independent advocacy service. Plans to develop an advocacy service could benefit from linking in to other local plans and initiatives.

A recent, important development has been the creation of the Advocacy Safeguards Agency, funded by the Scottish Executive, which supports and promotes the establishment of Advocacy Planning and Implementation Teams in each local authority and health board area in Scotland. The role of these teams is to identify local gaps in provision and plan the development of services. Each team produces a three year plan. Developing advocacy services for drug users should fit in within these local plans. Forinformation on your local team contact David Cameron at ASA on 0131 524 9380.

Information

The Advocacy Safeguard Agency (ASA) is funded by the Scottish Executive Health Department infurtherance of the Executive’s commitment to strengthening independent advocacy. ASA’s purposeis to make sure that good quality independent advocacy is available to anyone in Scotland whoneeds it.

ASA’s main functions

1. Development To assist health and local authority commissioners to develop independent advocacy acrossScotland and across all health and social care groups. This includes identifying and addressinggaps in independent advocacy provision, informing commissioners of developments in nationalpolicy, legislation and best practice and producing guidance to assist the independent advocacyplanning and implementation process. The development workers are able to provide a mediationrole, between commissioners and the services they fund.

2. Evaluation To ensure that the principles, practice and outcomes of the work done by advocacy organisationsare meeting the needs of the people who use them. This will be done by carrying out evaluationsof advocacy organisations, identifying issues, and suggesting solutions to any difficulties that maybe affecting their work. Valuation is also about acknowledging the good work of an organisationand about sharing and developing good practice.

3. Policy Development To develop policy and good practice in relation to independent advocacy across Scotland, and toinform relevant government policy and legislation.

4. Research To research matters relating to independent advocacy and in particular the effect of independentadvocacy on the lives of the people of Scotland.

For more information contact: David Cameron, Tel: 0131 5249380, Email:ASAinfo@advocacysafeguards.org

30

Specialist or generic services

Our findings (EIU Advocacy Survey 2003 and Focus Groups 2004) suggest that at different times drug users may need or want to use different types of advocacy services. DAATs and partner agencies may, therefore, want to ensure that a range of services is available for them to choose from. It is, therefore, important to ensure that drug users have access to both specialist and generic advocacy services.

Specialist advocacy services focus on the particular needs of drug users and their families. They are often attached to treatment and care services. On the one hand, clients may find it easier to identify with specialist services and often such services will have built up good networks and are well-informed about the general situation of treatment and care services. On the other hand, some clients reach a stage where they no longer want to be identified as ‘drug users’ and prefer to access services that are also used by other client groups.

Generic advocacy services in principle are open to the wider population for any advocacy issue (in practice most schemes have some criteria for access) and are usually independent. These services are often accessible, inclusive and make efficient use of resources, especially in rural areas. Some generic projects will have a person who specialises in providing advocacy to a specific group such as drug users. For some recovering drug users, accessing generic advocacy services may symbolise moving on from specialist services.

Assessing the need for advocacy

Before embarking on the expansion of existing advocacy services or the development of new services it is important to systematically measure the extent and nature of the need for such services amongst drug users. This process will help to ensure that new or expanded services are designed to meet the specific needs for advocacy amongst drug users, that such services are accessible and well-integrated with other treatment care and support services. For more information see ‘Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users’ , EIU 2004.

When the information is available from the needs assessment, one of the key decisions is whether there should be an independent advocacy service that is separate from other treatment and care services, or an expansion of advocacy services already offered by treatment and care services (if there are any). It may be that a “mixed economy” is preferred solution given the different types of needs among drug users.

Examples of specialist services

AIMS (Advocacy) provides advocacy services to people who misuse or have misused drugs. Morespecifically, the service focuses on people experiencing difficulties engaging with existing services.Through a combination of group and individual advocacy, the service encourages clients to developtheir own self-advocacy skills. For information contact: AIMS (Advocacy) 31 Hamilton Street,Saltcoats, Ayrshire, KA21 5DT. Tel 01294 608664 email aims.advoc@ukonline.co.uk

Advocacy North East employs a specialist advocacy worker to assist drug misusers acrossAberdeenshire. The advocacy worker aims to help clients take control of their own lives and engagewith agencies and communities to regain a contributory role in society. For information contact:Advocacy North East Tel 01467 622674 email, advocacyne@btconnect.com. New address from1 November 2004: Unit 2, South Road, Insch, AB52 6XF

31

Key Questions to ask when planning advocacy services

General

Is there a need for advocacy for drug users in your area? Have you consulted with potential service users, their carers and local communities about the type and nature of advocacy the need and who they see as best placed to deliver?

Have you clearly defined the scope of the service? Have you considered the strengths and weaknesses of different types of advocacy?

Who will form the client base of the service? Would it focus on specific groups,e.g. people with co-occurring drug misuse and mental health problems, youngdrug users, women drug users? Or will it be open to all? Are there any groupsof clients the service may not appeal to?

Will the service provide advocacy to families and carers? How would it deal with a situation where the needs of the family member differ from those of the drug user?

Have you considered how to safeguard confidentiality, particularly in a rural or remote area?

Independent Advocacy Service

Is there already an Independent Advocacy Service in your area (find out fromASA or SIAA)?

If so, can the existing service be made more accessible and effective for drug users? Will advocates need training and support to increase their knowledge andawareness about the problems of drug users? Advocates will also need to know where drug users can get the other kinds of support they might need.

If not, who can deliver the new service? Would it be delivered by paid advocates, volunteers?

Where should it be based ? What geographical area will it cover?

What links or contacts should the service have with treatment and care services?

Expansion of existing advocacy provision

How would the advocacy role be independent of the other aspects of a treatmentand care service? How would potential conflicts of interest or staff loyalty be handled?

How would staff involved in advocacy receive training for their advocacy role?

What are the implications if a client requires advocacy with another service provider whose role may conflict with the main provider for that client?

How will you maintain the distinction between advocacy and support work?

32

Training needs

The process of developing advocacy services should also establish what the training needs are of those advocating on behalf of drug users. For a comprehensive list of what advocates need to know and suggestions on ways of training people to be advocates see Advocacy 2000 ‘Key Ideas on Independent Advocacy’ section 5, August 2000.

According to the previous distinctions there will be two different categories of training needs.

The first category is of independent advocates who may be advocating on behalf of a range of service users, including drug users. These service providers will need training around issues related to this specific client group including:

the process of treatment and care for drug users

the role of the relevant professionals and agencies

the range of services drug users need to access

awareness raising about the possibility and nature of relapse

Example

Borders Independent AdvocacyService do not find it helpful toprovide intensive training to theirvolunteers out of context. Volunteersreceive an initial induction coursefollowed-up with on-going relevanttraining and support while they areworking with their first client.

For information contact Joan Lawson, Tel: 01573 225777

Information

The Scottish Independent Advocacy Alliance (SIAA) is a registered charity funded by the Scottish Executive Health Department.The SIAA is a membership organisation for advocacy groups and other organisations with a commitment to independent advocacy.The SIAA supports the advocacy movement by promoting the importance of diversity and high quality advocacy alongside strong principles and standards across Scotland.

1. Providing a strong national voice for independent advocacy organisations

2. Supporting the growth of existing independent advocacy organisations

3. Promoting the development of new independent organisations

4. Awareness raising and training.

The SIAA provide training around the role of an advocate, the impact/value of advocacy and the appropriate expectations of an advocate to commissioners, service providers, users, carers and other professionals who come into contact with advocates. They also provide capacity building training for advocates.

For more information contact Sheben Begum on 0131 455 8183 or e-mail enquiry@siaa.org.uk

33

The second category is an advocate in an established (non-advocacy) service. These service providers will need training around advocacy issues, including:

the aim of advocating on behalf of clients

specific issues around advocacy (e.g. the relationship between their views and the views of those they support)

the benefits, boundaries, risks and limits of advocacy

the role of the advocate.

Monitoring and evaluation of advocacy services

The aims of providing advocacy services to drug users are:

to promote their interest and help them make decisions regarding their own lives

to empower them to access the services they need, and make their voice heard and views known.

It is important to assess on a systematic basis, through regular monitoring and evaluation, whether these aims are being met. Outcome measures include:

Accessibility: are advocacy services provided at the time and place that best suit service users?

Empowerment: do service users feel empowered to represent themselves and to speak for themselves as a result of advocacy intervention?

Accessing services: do service users feel more knowledgeable about the options that are open them and how to access the range of available services?

For advice and information on planning, conducting and reporting an evaluation see EIU Evaluation Guides on www.drugmisuse.isdscotland.org/eiu/eiu.htm

SUMMARY

It is important for service commissioners and planners to recognise the diverseneeds for advocacy services amongst drug users.

The extent and nature of the need for advocacy services should be measured before extending or developing new services.

There may be a need to ensure that both specialist and generic advocacy services are available.

There is a need to think about and plan for training and support for staff and volunteer advocates.

Advocacy services should be monitored and evaluated to ensure they deliver the service they were set up to provide.

34

Ind

ep

en

den

t A

dvo

cacy

Conta

ctA

SA

, S

IAA

. I

s th

ere

Indep

enden

t ad

voca

cy

pro

visi

on in y

our

area

?

Does

this

pro

visi

on

exte

nd t

o d

rug

use

rs?

From

your

need

s ass

ess

men

t did

yo

u iden

tify

a n

eed f

or

indep

enden

t or

oth

er f

orm

s of

advo

cacy

?

Oth

er

form

s o

f ad

vo

cacy

No

Yes

Conta

ct y

our

loca

lad

vo

cacy

pla

nn

ing

&

Imp

lem

en

tati

on

team

thro

ugh y

our

loca

l hea

lth

boar

dfo

rad

vice

Could

you h

elp

with

train

ing

on d

rug iss

ues

?

Yes

Fro

m a

tre

atm

en

t p

rovid

er

or

oth

er

serv

ice

By F

am

ily a

nd

frie

nd

sC

oll

ect

ive /

Gro

up

/ C

itiz

en

ad

vo

cacy

See

‘Advo

cacy

a g

uid

e fo

rco

mm

issi

oner

s’ f

or

more

in

form

atio

n.

Can

/ s

hould

you

pro

vid

e s

up

po

rt t

o

fam

ily o

r fr

iends?

How

will

you

rais

e a

ware

ness

of

the

ben

efits

of

advo

cacy

am

ong p

rofe

ssio

nal

s an

d p

rovi

der

s?

How

will

you ‘se

ll’ t

he

con

cep

t o

f ad

vo

cacy

to s

ervi

ce u

sers

?

Th

ink A

bo

ut

Wh

ere

will

the

serv

ice

be

bas

ed?

Wh

o w

ill a

ct a

s ad

voca

tes?

Volu

nte

ers,

pai

d a

dvo

cate

s,

curr

ent

staf

f?

Ho

w w

ill y

ou t

rain

and

support

sta

ff?

(conta

ct

SIA

A f

or

advi

ce)

Wh

at

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ou n

eed t

o d

o t

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mai

nta

inco

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tyan

d i

mp

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ty?

How

will

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eal w

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poss

ible

con

flic

ts o

f in

tere

st?

No

Develo

pin

g a

dvo

cacy

serv

ices

35

Appendix 1: Participants at the consultation seminar 9/12/03

Keith Anderson Scottish Prison Service

Caroline Blair Glasgow City Council

Patricia Bowerbank APEX Scotland

David Cameron Advocacy Safeguards Agency

Angela Cameron Women in Work

Colin Campbell Lothian and Borders Police

Ben Cargill Scottish Drugs Forum

Pat Greenhough Scottish Drugs Forum

Marie Hayes NHS Lanarkshire

Les Johnston Grampian Police

David Kerr North Ayrshire Advocacy Service

John Lang West Fife Community Drugs Team

Simone Ledraw Scottish Drugs Forum

Stevie Lydon Argyll and Clyde ADAT

Senga MacDonald Drugs Action

Catherine Maidment Dundee Independent Advocacy Support

Audrey McGhee NHS Forth Valley

Mandy McNeil-Burt Advocacy North East Ltd.

Allison Murray Glasgow City Council Social Work

Joe Nowosielski Zone, Training for New Futures

Ruth Owen Forth Valley Advocacy

Polly Patrick Advocacy North East Ltd.

Jackie Pearson North Ayrshire Council

Janine Rennie Counselling and Support Service for Alcohol and Drugs

Marion Robertson Scottish Prison Service

Hazel Robertson Dundee City Council (representing ADSW)

Ken Scott Forth Dimension

Gill Scott Substance Misuse Division, Scottish Executive

Angela Swift Fife NHS Addiction Service

Rosina Weightman Primary Care Facilitation Team

George Wilson Cranstoun Drug Services (Scotland)

36

37

Appendix 2: Results of questionnaire to service providers

This questionnaire was conducted in order to inform the guide to advocacy for drug users about the views and experiences of service providers. The aim of the questionnaire was to find out the views of service provider about:

the context and issues in relation to which drug users need advocacy who is most likely to provide advocacy to drug users at present who is best placed to provide advocacy services to drug users.

Method

The questionnaire included 4 key questions and answers to the questions were on a scale (either 5 or 6-point scale). Respondents also had the opportunity for open-ended comments at the end of each question and at the very end of the questionnaire.

226 questionnaires were sent to a range of service providers, including specialist treatment and care service providers and generic service providers (including housing, training, employment and childcare).

Who responded to the questionnaire?

88 questionnaires were returned. Just over half were completed by service managers, chairs or co-ordinators; the rest were completed by project workers, group members / volunteers, social workers, community engagement officers, nurses, counsellors or administrators.

What services do they work for or represent?

The biggest single group of respondents worked for treatment and rehabilitation services. The second largest group of respondents worked for services for young people. Other respondents worked for training agencies, employment agencies (including Jobcentre Plus), family support groups or self help groups.

The target group of clients respondents work with:

The biggest single target group was drug and alcohol users. Other target groups included families / carers; young people; and bereavement groups.

Summary of results

Substance misusing clients were perceived by the majority of respondents to need advocacy most of all when dealing with housing, social work and training and employment agencies. However, a smaller majority also believed their clients need advocacy help when dealing with Children & Family teams, GPs, Police, Jobcentre Plus and FE colleges.

It was perceived that clients need advocacy most of all in relation to benefit, finance and debt issues. Interestingly, substitute prescribing was seen as the issue clients least need advocacy with.

Most clients have received advocacy from staff within treatment and care agencies. Very few clients receive advocacy from staff within treatment and care agencies who are formally trained advocates.

Service users were more likely to receive advocacy from family and friends than from independent advocacy agencies.

38

Independent advocacy agencies were considered to be the most appropriate agencies to provide advocacy help to substance users. However, when asked to comment, many respondents highlighted a range of potential difficulties with relying on independent agencies to provide advocacy for their clients.

About 1/3 of respondents thought it was not appropriate for staff who were not formally trained advocates to provide advocacy support. Just over 40% thought it was not appropriate for family and friends to provide advocacy support, but just over half thought it was appropriate.

Question A: When dealing with which agencies do clients need advocacy support?

'I believe many of my clients need advocacy support in dealing with this agency'

05

1015202530354045

Soci

al w

ork

Hou

sing

Chi

ld &

Fam

ilyTe

ams

GPs

Oth

er h

ealth

Polic

e

Trea

tmen

t &re

habi

litatio

nag

enci

es

Trai

ning

&em

ploy

men

tag

enci

es

Jobc

entre

Plus

FE C

olle

ges

No.

of r

espo

dees 1 Strongly

Agree2

3

4

5

6 StronglyDisagree

Question B: In relation to which issues do clients need advocacy?

What proportion of your clients need advocacy help in relation to these issues?

05

10152025303540

Substi

tute Pres

cribin

g

Physic

al hea

lth

Mental

Health

Housin

g

Childc

are

Training

/ Emplo

ymen

t

Benefi

ts,fin

ance

&Deb

t

Crimina

l Jus

tice

Dealin

g withne

ighbo

urs

No. o

f res

pond

ees

NoneLess than halfHalfMore than halfAllDon't know

Question C: Who provides advocacy?

Advocacy work can be split to two main components. The one component is helpingclients express their own views and the other helping clients make decisions

39

regarding their own lives. For that reason question C has been divided to 2 parts, each aiming to find out who provides advocacy support to clients.

Question C1: Where do clients receive help with expressing their own views?

Where do your clients recieve help with expressing their own views?

05

101520253035404550

Staff w ithin service-not trainedadvocates

Staff w ithin service- trained advocates

Staff from anotherservice

IndependentAdvocacy agency

Family / Friends

No.

of r

espo

ndee

s

None

Less than half

Half

More than half

All

Don't know

Question C2: Where do clients receive help to make decisions about their own lives?

Who helps your clients make decisions regarding their own lives?

05

101520253035404550

Staff w ithin service-not trainedadvocates

Staff w ithin service- trained advocates

Staff from anotherservice

IndependentAdvocacy agency

Family / Friends

No.

of r

espo

ndee

s

NoneLess than halfHalf

More than halfAllDon't know

40

Question D: Who should provide advocacy services to substance users?

0

5

10

15

20

25

30

35

40

45

Staff w ithin service-not trainedadvocates

Staff w ithin service- trained advocates

Staff from anotherservice

IndependentAdvocacy agency

Family / Friends

No.

of r

espo

ndee

s

1 NotAppropriate2

3

4

5

6 VeryAppropriate

For further details on the questionnaire and for a full report on the questionnaire results contact EIU, Tel: 01312445117 or E-mail: EIU@scotland.gsi.gov.uk

41

Appendix 3: Useful information sources

There are a number of useful websites and publications, some of which appear elsewhere in the text of this report, that provide further information about advocacy.

Advocacy Safeguards Agency

The Advocacy Safeguards Agency is funded by the Scottish Executive Health Department in furtherance of the Executive’s commitment to strengthening independent advocacy. ASA has four key functions:

To support commissioners of services to develop independent advocacy. To evaluate existing independent advocacy organisations. To ensure independent advocacy is part of national policy developments. To research the impact of independent advocacy.

Telephone: 0131 524 9380

Web: www.advocacysafeguards.org

Scottish Drugs Forum

The Scottish Drugs Forum is the national non-government drugs policy and information agency working in partnership with others to co-ordinate effective responses to drug use in Scotland. It is the umbrella agency for all those concerned with tackling drug use in Scotland. SDF aims to support and represent at both local and national levels a wide range of interests, promoting collaborative, evidence-based responses to drug use.

Telephone: 0141 221 1175

Web: www.sdf.org.uk

Scottish Independent Advocacy Alliance

The Scottish Independent Advocacy Alliance (SIAA) was set up as a result of the work undertaken by SIAA's predecessor, Advocacy 2000(http://website.lineone.net/~advocacy2000/) (a 3-year project set up to look at the Advocacy Movement's needs and how these could be supported in the future). It was believed that a National Advocacy organisation was required which would be solely devoted to support, promote, and defend Advocacy. The SIAA aims to:

provide information, advice and support to local Advocacy organisations undertake training on advocacy and related issues for agencies in the statutory and voluntary sectors and ensure the 'voice' of the Advocacy Movement is heard at a National Level to influence current and future Practice and Policy.

Telephone: 0131 455 8183

Web: www.siaa.org.uk

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National Disability Authority

The National Disability Authority is an independent statutory agency established under the aegis of the Department of Justice, Equality and Law Reform by the National Disability Authority Act 1999. NDA strives to ensure that the rights and entitlements of people with disabilities are protected.

Tel: (01) 6080400

www.nda.ie

National Youth Advocacy Service (NYAS)

The NYAS is a children’s charity which offers socio-legal advocacy services to children, young people, parents, carers and professionals. They provide independent representation and advice, ensuring that the voice of children and young people can be heard in all matters affecting them.

Tel: 0151 649 8700

www.nyas.net

Other useful websites

Citizens Advice Bureaux (CAB)

CAB are probably the best known of the advice organisations in Scotland and help people deal with over 400,000 problems a year.

Whilst not an Advocacy service their online advice and guide service can give basic advice and information on a wide range of matters, including debt, benefits, housing, legal matters, employment, immigration and consumer issues. Local offices also offer advice and help with filling in forms and can be found through the CAB website or local telephone directories.

Web: www.adviceguide.org.uk

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References

Advocacy 2000 (January 2002): Principles and Standards in Independent Advocacy organisations and groups

Advocacy 2000 (August 2000): Key ideas on independent advocacy

Advocacy Safeguards Agency (January 2004): A map of independent advocacy across Scotland edition 2003-2004

Advocacy Safeguards Agency (September 2003): Advocacy for children and young people in Scotland

Quinn A. et al (June 2003): Older people’s perspectives: Devising information, advice and advocacy services. Joseph Rowntree Foundation

Scottish Advisory Committee on Drug Misuse SACDAM and Scottish Advisory Committee on Alcohol Misuse (SACAM) (2003): Mind the Gaps: Meeting the needs of people with co-occurring substance misuse and mental health problems. Report of the joint working group

Scottish Executive (January 2000): Independent Advocacy - A Guide for Commissioners

Scottish Executive (January 2001): Independent Advocacy - A Guide for Commissioners: Supplement

Scottish Health Advisory Service (Scottish Office 1997): Advocacy: A Guide to Good Practice. The Scottish Office

SHA Trust (January 2002): Independent advocacy in Scotland: From patchwork to blanket

SHS Trust (April 2002): A map of independent advocacy across Scotland

The Scottish Office: Advocacy, a guide to good practice

Yorkhill Advocacy Research Project (August 2002): Children should be seen and HEARD! Independent advocacy for children and young people. Yorkhill NHS Trust, NHS Greater Glasgow

Scottish ExecutiveEffective Interventions Unit

Dissemination Policy1. We will aim to disseminate the right material, to the right audience, in the right format, at theright time.

2. The unit will have an active dissemination style. It will be outward looking and interactive.Documents published or sent out by the unit will be easily accessible and written in plain language.

3. All materials produced by the unit will be free of charge.

4. Material to be disseminated includes:

• Research and its findings• Reports• Project descriptions and evaluations• Models of services• Evaluation tools and frameworks for practitioners, managers and commissioners.

5. Dissemination methods will be varied, and will be selected to reflect the required message,and the needs of the target audience.

These methods are:

• Web-based – using the ISD website ‘Drug misuse in Scotland’ which can be found at:http://www.drugmisuse.isdscotland.org/eiu/eiu.htm

• Published documents – which will be written in plain language, and designed to turn policy intopractice.

• Drug Action Team channels – recognising the central role of Drug Action Teams in developingeffective practice.

• Events – recognising that face-to-face communication can help develop effective practice.

• Indirect dissemination – recognising that the Unit may not always be best placed to communicate directly with some sections of its audience.

6. This initial policy statement will be evaluated at six-monthly intervals to ensure that the Unitis reaching its key audiences and that its output continues to be relevant and to add value to thework of those in the field.

w w w . s c o t l a n d . g o v . u k

9 780755 937646

ISBN 0-7559-3764-3© Crown copyright 2004

Astron B36458 06-04