Highland Alcohol & Drugs Partnership (HADP) in our value statement give a clear commitment to applying an evidence-informed approach in preventing and reducing drug and alcohol related harm. For HADP, our values and principles provide the foundations for partnership working and they describe the beliefs, ideals and priorities that all partners are committed, and signed up to, to guide all partnership activity.
Despite the priority accorded to evidence-informed approaches, we have had limited opportunity to discuss or debate what this actually means in practice. In 2017, the focus of our annual stakeholder conference was evidence-informed practice, and it was interesting to discover how varied partners interpretations were. Ultimately, conference attendees agreed on a position similar to what is set out in Rights, Respect and Recovery (2018) which acknowledges that delivery of national and local strategy requires;
“an evidence informed approach, which appropriately involves academic evidence, the voice of lived and living experience, family members, those with professional experience and other intelligence on alcohol and drug related harm and recovery”Scottish Government. (2018). Rights, Respect and Recovery, p.4
So, as an Alcohol & Drug Partnership (ADP), what activity have we undertaken to put an evidence-informed approaches into practice across a broad spectrum that ranges from prevention and population approaches, through to treatment and support for recovery?
HADP have been proactive in promoting “‘What Works’ in Drug Education and Prevention”. At times this has involved difficult discussions where evidence has been queried, usually because it does not reflect what is considered common sense. The finding that popular and well intentioned approaches, such as inputs by the Police and testimonials from people with lived experience, are associated with no, or negative, preventative outcomes has been challenging for some partners. It is not to say that these approaches are not useful in other settings, but they should not be used in drug education and prevention because they do not provide young people with the tools they need to make healthy choices about substances. Instead, HADP has focused on prevention models delivered in supportive environments, which use non fear arousal techniques, and which provide the freedom to learn about drug use within a broader conversation about choice and risk, rather than standalone inputs.
To adhere to an evidence-informed approach, we have developed a Substance Awareness and Prevention Education Framework which links to the Curriculum for Excellence and relevant health and wellbeing outcomes. The framework is supported by the Highland Substance Awareness Toolkit an online library providing information and a range of evidence-informed learning resources, including lesson plans on alcohol and drugs. HADP has also invested in peer education models and social influence approaches so that the tone of substance use education is more neutral, based on evidence, and involves young people in the design, development, and delivery. As the evidence on delivering brief interventions to young people has evolved, we have utilised research findings to develop training for teachers and youth workers that is effective in enhancing skills and confidence for discussing drugs and alcohol with young people.
To strengthen our evidence-informed approach to prevention programmes, HADP has recently entered into a partnership with Winning Scotland and several other ADP areas to participate in a national pilot of the Planet Youth model. The model originated in Iceland, where it has contributed to significant reductions in young people’s substance use. Over the past 10 years, more than 100 peer reviewed articles have been published on its effectiveness in relation to prevention and public health. The Planet Youth pilot will involve relevant stakeholders (schools, communities, partner agencies, leisure providers, parents and young people) collaborating on proactive strategies to reduce risk and increase protective factors in key spheres of a young person’s life. The findings from a recent study conducted by the University of Stirling gathering stakeholders views on Bringing the Icelandic Model to Scotland has been vital in informing how we take forward implementation of the model.
At the other end of the spectrum, in order to support people who are homeless with substance use problems and complex needs, HADP has invested in a Housing First pilot project being delivered in collaboration with Highland Council, NHS and The Salvation Army. An excellent series of seminars organised by Scottish Universities Insight Initiative on “Homelessness, health and harm reduction” highlighted overwhelming evidence, much of which is considered ‘gold standard’, which indicates that Housing First works and is cost effective. Fidelity to the model has been essential and thus far, local data indicates improvements in health and wellbeing for people receiving support. HADP has stipulated that people at higher risk of non-fatal overdose and drug-related death are prioritised for Housing First, and we are collecting data in this area with the aim of adding to the evidence-base. HADP recognises that as well as having a responsibility to utilise evidence, we also have a responsibility to contribute and help grow the evidence-base.
One a more personal level, I have a somewhat ambivalent relationship to ‘evidence’. On one hand it is essential to my role and is crucial in guiding how best to prevent and reduce drug and alcohol related harm. Whilst on the other hand, I appreciate the challenges in navigating through quantitative evidence, in particular. I have experience of many encounters in communities, where I have presented data on drug use issues that have been strongly contested because it does not reflect the experience of local people. Consequently, I have determined that qualitative evidence is just as vital and should be accorded equal status in the hierarchy of evidence. In practice, I have found that a combination of both, or mixed method studies, can be very useful for gaining insight into drug related issues. Given the challenges being faced across Scotland in relation to reducing drug deaths, it would be beneficial to expand action research approaches, where partnerships between people and families with lived and living experience, academics, policymakers and practitioners;
“tackle real-world problems in participatory, collaborative, and cyclical ways in order to produce both knowledge and action“.O’Leary, Z. (2017). Action Research. In: O’Leary, Z. ed. The essential guide to doing your research project. [Online]. London: SAGE, pp. 350-359.
Through participation in the Drugs Research Network Scotland, HADP members have gained increased access to high quality evidence to inform our local policy and practice. We also have opportunities to grow the evidence-base and strengthen our knowledge and skills to tackle real world problems through collaboration and action.
About the Author
Debbie has been Coordinator for Highland Alcohol and Drugs Partnership for almost 10 years providing support for a range of different organisations and services. Prior to this role, Debbie was Coordinator for Alcohol Brief Interventions and also worked as a Training Officer for Scottish Training on Alcohol and Drugs (STRADA).