Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users
Chapter 11: Needs Assessment for Rural Populations
It is a particular challenge to find out about the needs of people in rural areas, and to design appropriate services to meet those needs. This is especially true for drug users. In some parts of rural Scotland, high levels of alcohol consumption, particularly among men, is seen as culturally acceptable. This may result in problem alcohol use going undetected and untreated for many years. On the other hand, rural communities often know who the drug users are, and these individuals may be viewed with considerable hostility. Drug users and their families need to be able to access services anonymously, but it is difficult for them to do so without travelling great distances to the nearest city (and this may be made impossible by inadequate or unaffordable public transportation). In some cases, individuals may feel that their only alternative is to move away from the area altogether.
Methods for finding out about the needs of rural populations
The use of anonymous household surveys or questionnaires may be successful in rural areas, but care must be taken to avoid over-surveying. Helplines are often another useful source of information, but there is anecdotal evidence to suggest that individuals in one region may phone the drug or alcohol helplines in the cities of neighbouring regions in an effort to remain anonymous. The use of outreach services and / or snowballing may be another useful method of finding out about needs in rural areas.
Evidence Evidence suggests that families and neighbours in rural areas are more likely to support someone with alcohol dependency and will refuse professional help to avoid the stigma attached to alcohol misuse . . . .
[On the other hand,] drug misusers often find it difficult to access treatment . . . . Funding levels were mentioned as a crucial issue. It was felt that failure to attract sufficient funding could be partly attributed to hostility within the community towards drug misusers and, conversely, to a denial that a drugs problem could exist in a rural area.
(Source: Rural Poverty and Inclusion Working Group, 2001) |
Primary care teams - including GPs, practice nurses, midwives and health visitors - have a vital role to play in assessing the needs of drug users and their families in rural areas, as the local GP surgery may be the first port of call for many individuals. However, staff may need training to recognise the drug-related needs of this population, and to know how to respond to them helpfully. In addition, it is crucial that there are good joint working arrangements and agreed information-sharing protocols in place between primary care staff, the local social work department, the police, fire and ambulance services, and the voluntary sector. Needs assessment in rural areas should be a multi-agency effort. Co-operation between all the relevant partner agencies will be necessary.
Options for addressing the needs of rural populations
In many rural areas, accessibility problems mean that expertise in the area of drug misuse is often incorporated into "generic" services, such as GP surgeries, or local community hospitals. However, it is important that professionals are adequately trained and supported to provide this specialist service. Problems of staff attitudes in "generic" services can be a barrier to drug users seeking and receiving help. In many areas, individuals may have to travel some distance to find a practitioner willing to prescribe methadone. In some areas, specialist outreach services may be a better option for meeting the needs of rural drug users. For example, a number of DAATs in Scotland are exploring the provision of mobile needle exchange facilities.
Example: The A73 Project: Meeting the needs of drug users in rural Clydesdale Following a spate of drug-related deaths in the Lanark area, several public meetings were held where members of the public called for an increase of services on the ground. The A73 project was set up in response to this demand. The aims of the project are to: develop a comprehensive outreach service, which incorporates needs assessment, in the rural areas of Clydesdale; and reduce drug-related harm, and encourage drug users to make contact with services.
The project targets drug users (experimental, recreational and injecting drug users) who are hard-to-reach, or out-of-reach of existing services in Clydesdale, to identify gaps in service delivery and find out why some clients don't use treatment services. Questionnaires or semi-structured interviews are used to get the views of the target population. Meeting clients in their own territory is essential, and A73 tries to be resourceful and creative in their approach - for example, through arranging to meet clients in their own homes, or linking into other services that clients are involved with, and using snowballing to find out about clients who are not involved in services. This requires networking among practitioners, and a collaborative multi-agency approach. The project is already responding to needs that have been identified through their interviews and questionnaire responses. A73 currently provides out-of-hours support, and plans to officially open one or two evenings per week as a result of client demand. The project is based in office accommodation, rather than directly linked to a clinical service provider, and service users have indicated that they prefer this arrangement. Next year, the project will set up programmes to deliver training on specific requested topics, such as overdose prevention and management, first aid, and safer injecting techniques. They are developing a peer education programme, and plan to deliver training and confidence building programmes to peer educators as a first step. Finally, the project is looking into the possibility of setting up a user forum / focus group as part of the needs assessment process. For further information on the A73 Project, contact Maureen Woods, Maureen.Woods@lanpct.scot.nhs.uk. |