Introduction
This project was jointly commissioned by the Scottish Government, the Association of Directors of Social Work ( ADSW) and the Institute for Research and Innovation in Social Services ( IRISS). Its purpose was to review the evidence base to determine the contribution made by social work and social care to supporting people with alcohol and/or other drug problems. The findings were to be set within the context of the recovery based approach to working with substance use 1 that is at the core of Scotland's national drugs strategy.
Aims and methodology
The review involved three separate searches:
1. Evidence of the effectiveness of social work/social care interventions with people with alcohol or drug problems
2. Information about social services' workforce development in the area of substance use
3. Evidence of specific social work roles and functions with people who have alcohol or drug problems.
To do this a combination of Rapid Evidence Assessment (search 1) and Rapid Evidence Mapping (searches 2 and 3) were undertaken.
Findings
Interventions
A total of 57 relevant studies were included in the final review. The majority of studies related to forms of 'case management'. Case management is a term covering a wide-ranging set of approaches to providing and coordinating appropriate service provision. In Scotland and the UK one form of case management is better known as care management. Key features of effective case management approaches identified in the search included:
- The form of case management offered needs to match the needs of the service users being worked with: the more complex the needs of the service user group, the more intensive and long-term the form of case management will need to be.
- The more serious the problems of service users, the more likely that case management will be beneficial.
- Approaches that focussed on developing and sustaining a relationship appeared more likely to be linked to positive outcomes than forms of case management which focussed on effective service coordination.
- Other common features of successful case management approaches included:
- A tendency to have a limited number of service users per worker
- An emphasis on creatively engaging individuals, for instance through out-of-hours work and interventions based in service users' homes or other places that they might attend
- Access to additional services rather than simply coordinating existing services
- Availability when needed, for instance through 24-hour on call services or long-term consistent availability
- All emphasised skilful communication and engagement, and a large number based this on motivational interviewing or variations thereof.
In addition, there were some promising social work interventions not based on case management, particularly in relation to families where parental substance use problems were raising serious concerns about whether children could remain at home. They may be worth considering in a Scottish context. However such interventions will require rigorous evaluation to begin to address the concerning lack of studies relating to interventions with children affected by parental problem drug and/or alcohol use.
