1. Outcome Evaluation on routine data (Italy) by Mila Ferri - Emilia-Romagna Region Manager Alessio Saponaro - Emilia-Romagna Region executive Piero Selle - Drug addiction Department Manager at emme&erre, Padova Slide1emme&erre - Padua

2. Context Promoter: Regional Department for Drug Addiction Participants: Outpatients services for drug addictions Slide2emme&erre - Padua consultancy firm: emme&erre to build and implement a regional information system regarding the outcomes of cases undertaken by the outpatients services, in order to support regional planning and service management Model aim Target: service clients, and not the individual case. Model users/beneficiaries: regional department managers and service managers. Not the service clinicians Emilia-Romagna Region

3. Outcome definition Level 1: overcoming or improving drug and/or psychotropic drug use/abuse - reduction of drug consumption - leaving drug dependence culture - awareness and management of relapse risk outcome Level 2: improving quality of life- maintenance and improvement of physical condition - risk recognition and management - ability to manage relationship with the social services - taking care of body - psychopathological compensation - psychological balance - emotion management - individual autonomy - social integration Slide6emme&erre - Padua Managerial levelClinical level

4. Level 1: overcoming or improving drug and/or psychotropic drug use/abuse Tool built by emme&erre and verified with outpatients services Substances under investigation Tool verified at national level Warning : this tool cannot be used during residential treatments Slide8emme&erre - Padua - heroin - cocaine - hashish - marijuana - psychopharmaca drugs (not prescribed) - ecstasy (MDMA) - amphetamines

5. 1) Have you used hashish or marijuana over the past six months? YESNO 2) Have you used hashish or marijuana over the past month? YESNO 3) Have you used hashish or marijuana over the past week? YESNO 4) How frequently have you used hashish or marijuana over the past week? 1Several times a day 2Once a day 3Almost everyday 4A couple of times a week 5Once a week 6Haven’t used it 5) Over the past month, have you spoken to anybody who has used drugs such as hashish or marijuana at least once? YESNO 6) Over the past month, have you seen drugs such as hashish or marijuana? YESNO 7) Over the past month, have you touched (held in your hand) drugs such as hashish or marijuana? YESNO 8) Over the past month, has someone offered you drugs such as hashish or marijuana? YESNO Example: hashish and marijuana Slide 9emme&erre - Padua

6. 1) Abstinent for six months without any contact with the drug scene 2) Abstinent for six months with some contacts with the drug scene 3) Abstinent for one month without any contact with the drug scene 4) Abstinent for one month with some contacts with the drug scene 5) Abstinent over the past week 6) Has used once over the past week 7) Has used a couple of times over the past week 8) Has used once a day over the past week 9) Has used several times a day over the past week Individual substance indicator Slide10emme&erre - Padua

7. Index of concordance (367 cases) Drugs Hashish Ecstasy Amphetamines Cocaine Heroin Psychpharmaca drugs Self-report vs. urine test 0.870.820.980.920.880.77 Self-report vs. therapy sheet 0.830.950.980.950.880.82 Therapy sheet vs. urine test 0.840.790.990.910.850.78 Slide12emme&erre - Padua

8. Level 2: improvement in quality of life There is no specific quality of life test for drug addicts; The N.H.P. measures distress, and hence is useful for assessing a group whose state of health is normally compromised; It is user-friendly and encompasses only 38 items; Its dimensions (energy, pain, physical mobility, emotional reaction, sleep, social isolation) are correlated with the effects of drugs, particularly in heroin addicts, who account for over 80% of cases; It is correlated with tests that investigate quality of life levels; There are information analysis standards; Verified at European level; It is not protected by copyright Slide13emme&erre - Padua Reasons for choosing the Nottingham Health Profile (N.H.P.):

9. Questionnaire administered: at intake (between the second and third interview); at six-monthly intervals from intake (+ or - 15 days); on being sent into residential or semi-residential care; on leaving residential or semi-residential care; on being discharged from an outpatients service. Slide14emme&erre - Padua

10. Distance from drug-use to intake heroincocainepsychopharmaca drugs hashishecstasyamphetamines 1) Abstinent for six months without any contact with the drug scene 31.5%48.9%83.0%42.6%78.7%93.6% 2) Abstinent for six months with some contacts with the drug scene 0.0%2.1%4.3%8.5%4.3%2.1% 3) Abstinent for one month without any contact with the drug scene 6.4%19.1%2.1%6.4%10.6%4.3% 4) Abstinent for one month with some contacts with the drug scene 3.1%4.3%2.1%0.0%2.1%0.0% 5) Abstinent over the past week12.8% 0.0%6.4%4.3%0.0% 6) Has used once over the past week 2.1%4.3%2.1%8.5%0.0% 7) Has used a couple of times over the past week 10.6%8.5%6.4%19.1%0.0% 8) Has used once a day over the past week 19.1%0.0% 4.3%0.0% 9) Has used several times a day over the past week 14.9%0.0% 4.3%0.0% Total100.0% Slide15emme&erre - Padua

11. Change distribution HeroinCocaineHashish worse than at intake23.4%25.5%21.3% same as at intake44.7%53.2%51.1% better than at intake31.9%21.3%27.7% total100.0% Slide16emme&erre - Padua

12. Quality of life N.H.P. - Average values Slide17emme&erre - Padua at intakeAt six months First threshold (situation at risk) Second threshold (compromised situation) Energy39.529.614.640.8 Social isolation24.4 7.125.6 Emotional reactions 29.229.815.535.0 Physical Mobility 12.89.34.714.8 Sleep27.022.85.919.8 Pain8.69.32.914.4 (0= no distress – 100= maximum distress)

13. change in heroin use and quality of life Average values Slide18emme&erre - Padua Energy Social isolation Emotional reactions Physical Mobility Sleep Pain worse than at intake 34.914.826.76.621.42.7 same as at intake 38.227.829.311.222.76.7 better than at intake 44.826.731.019.737.215.7 (0= no distress – 100= maximum distress)

14. Strengths 1.Transparent assessment model regulations. 2.Strict method and valid tools. 3.Region and service managers involved in planning. 4.Tools that do not use professional language (medical, psychological, social services) but attempt an holistic view of the person (quality of life). 5.Success when the service manager undertook a managerial position, leaving behind the clinician’s role. Slide20emme&erre - Padua

15. Weaknesses 1.Changes in regional management: loss of project creator. This slowed the process. 2.Lack of support and supervision during the experimental phase regarding both feedback and organisational development: led to the fact that the more resistant services broke away. 3.Difficulties when the service manager percieved to see him/herself more as a clinician than a manager. 4.Resistance (ideological) from the staff who concentrated on their relationship with the user, rather than the outcome. 5.Poor culture of data in services. Slide21emme&erre - Padua

16. Model development Improve layout tools. Include some questions about lifestyle: e.g. employment status, housing status, state of health (any pathologies), legal situation, which go alongside the subjective assessment of quality of life. Include the assessment model within the conditions that enable access to public funds in order to strengthen its use. Slide22emme&erre - Padua