Staff & Recruitment

The workbook will be owned by yourself and we would hope it will assist you with reflective conversations with your practice Assessor/ supervisor. We hope that you will gain practical experiences of the scenarios we have provided and the Student workbook will give you additional direction of what to consider when supporting a patient in the community .

They will also highlight that it will be through discussion between the practice supervisor / assessor and the student that will identify if part or all of the document is to be completed. 

The document will be your (students) property, it is not required as part of your university work but will inform your practice supervisor / practice assessor of your progress in placement and the evidence from this will inform interim and final assessment.

Take a few minutes to read through the following scenarios and think about what you would do as the newly qualified Staff Nurse in each scenario.  Think about how you would act at the time, what actions you would likely take, what you would do with the patient, who you would inform, and if you would follow this up with another visit/referral to specialists etc.

Discuss your answers with your Practice Supervisor or Practice Assessor. These are designed to give you scenarios to discuss are part of a reflective discussion.

Question 1

You are asked to visit a gentleman who has a sore bottom and it turns out he has a pressure ulcer on his right buttock. How would you assess this and what would your care plan consist of? What else would you do?

Assessment – Have you considered…

• What grade of pressure ulcer this is?  Pressure Ulcer Grading Chart
• Have you measured the wound?
• Have you considered the reason for the patient developing this pressure ulcer and looked at ways in which to minimise further damage?  (Think SSKINS)
• Have you informed the caseload holder?

Planning Care

• Think about dressings – what would you likely want to use for the different grades?
• Consider how much exudate (fluid) is coming from the wound
• Consider how often to visit and change dressing
• Consider what you want dressing to achieve (absorb, reduce bacterial load, protect, progress to healing etc)
• How often would you measure the wound?
• How often would you change / update the care plan?

Question 2

You go to visit a lady who has type one diabetes who requires the nurses to administer her insulin. What are the steps you would take prior to administering her insulin?

Have you considered…

• Have you checked her Nursing notes to ensure no-one else has visited this patient prior to your arrival?
• Have you checked her Direction to Administer?
• Once you have checked the patients Blood Glucose level, have a think about what the ‘normal range’ would be for this patient – discuss with your mentor.
• What steps would you take if the patient is hypoglycaemic / hyperglycaemic?
• If safe to do so, are you familiar with the device used for administering insulin?
• Is your device in line with the safer sharps policy?
• Have you disposed of the sharps appropriately?

Question 3

One of your patients who has a wound on their leg has phoned to say his wound is very painful and his dressing has fallen off. When you saw him yesterday there was minimal pain at dressing change however you did think it was exuding more fluid than before. What things would you consider when you go to visit this man? What would your assessment include?

Have you considered…

• Is the current dressing appropriate for the increased exudate levels
• Frequency of visits (may need increased)
• Are you expecting the wound to increase in pain?
• Consider wound infection – if likely, what steps might you take?  (Remember, is it localised or systemic?)
• Does this gentleman need referral to Vascular / TVN?
• Would you change his care plan, nursing assessment, waterlow?

Question 4

A patient phones to advise that their catheter bag has been empty all morning and their stomach is becoming painful. What would you do? Is there any advice you can give over the phone initially?

Have you considered…

• Asking them to change position to allow gravity to assist
• Asking the patient about their bowels (are they regular / constipated)
• Ask about fluid intake over past 24 hours
• Provide reassurance
• If requiring a visit – what would you be looking for?
• What would indicate a change of catheter is required
• Are there any signs of CAUTI
• How would you record your visit?  (Think about Catheter Assessment Procedure)

Question 5

The carer of a palliative patient calls to say that their loved one has become very distressed and is trying to get out of bed. They had been administered 2mgs midazolam only an hour before hand and are on a syringe driver with diamorphine for their pain. How would you assess this situation? Is there anything else that could be causing this agitation?

Have you considered…

• Patients’ position in bed / chair
• Bladder
• Bowels
• How many breakthrough doses over past 24 hours
• Is the breakthrough dose sufficient
• Should we consider adding Midazolam to the Syringe Driver?
• Medication review from GP / Independent Nurse Prescriber
• Support for family
• Home Care / Marie Curie

• NMC student standards
• PEF portal
• Diabetes UK – Resources for Professionals and Patients
• NMC – The Code
• Gibb Reflection cycle toolkit Edinburgh University
• NMC – Reflective accounts Revalidation

Topic: Alcohol.

Description: Alcohol focused activity for use in Social Studies. Young people will begin to understand how alcohol misuse can have a negative effect on the local community.

Type: Lesson plan.

Target group: Third; Fourth.

IT/practical requirements: Access to IT desirable for additional research by young people but not essential. Flipchart paper and pens required. 

Implications for staff: None.

Cost attached: No.

Resource link: Alcohol and the community (pdf)

QA Tool: Alcohol and the Community

Topic: Alcohol; Drugs.

Description: The AS IT IS DVD is a resource that tackles the issues of gang fighting, territorialism, offending behaviour and substance misuse. The DVD was produced by a partnership of statutory and voluntary agencies based in Glasgow. Accompanying pack was developed by Glasgow Council on Alcohol.  DVD includes interviews with real people and graphic imagery which some people may find disturbing. The resource challenges entrenched thinking by showing how choices made by gang members have impacted in their own and other people’s lives.  Police Scotland advise that the resource is an early intervention toolkit and can be used with P7, S1 & S2 pupils.  This resource will generate discussion and provoke different thinking with all age groups.  It is recommended that parental consent should be obtained if this resource is to be used with persons under the age of 16. It is strongly recommended that staff view the films and teaching aids prior to use.  If additional hard copies are required please contact Inspector Stevie Kinvig, Police Scotland.

Type: Pack.

Target group: Second; Third; Fourth.

IT/practical requirements: Access to DVD Player/PC & Projector to allow DVD to be played.

Implications for staff: The nature of this resource means that staff should review prior to use, young people may have experienced gang fighting & consequences & as a result may require support during and after use of the resource. DVD contains graphic scenes of violence.

Cost attached: No.

Resource link:   

QA Tool:

Topic: Alcohol.

Description: Alcohol based activity focussing on the impact of advertising for use in Social Studies. Can be used as a standalone lesson or to complement Take a Drink Drama performance. Explores the extent to which young people’s choices and decisions around alcohol consumption can be influenced by advertising.

Type: Lesson plan.

Target group: Third; Fourth.

IT/practical requirements: Access to IT would be useful for further research by young people but not essential. Selection of magazines and newspapers would be useful.

Implications for staff: None.

Cost attached: No.

Resource link: Assessing the impact of advertising (pdf)

QA Tool:

More information coming soon…

Topic: Alcohol; Drugs.

Description: Alcohol/Drug based activity for use in Mathematics. Can be used as a stand alone lesson or to complement Take a Drink Drama performance. Explores the effects of alcohol/drugs on society by analysing relevant data.

Type: Lesson plan.

Target group: Third; Fourth.

IT/practical requirements: Access to computers required for pupils to research topic and present findings.

Implications for staff: None.

Cost attached: No.

Resource link: Analysis of alcohol facts and figures (pdf)

QA Tool:

Topic: Alcohol.

Description: A four week peer education programme for use with S1 and S2 pupils developed by senior pupils in St Roch’s High School in Glasgow.  The course focuses on alcohol and has three themes: safety, health and dignity.  The course comprises a series of interactive workshops to help young people make positive choices about alcohol.  The pack can be used by staff to deliver alcohol education to young people or by senior students wishing to gain experience of peer education delivery. Positive choices about alcohol.

Type: Pack.

Target group: Second; Third; Fourth; Senior phase.

IT/practical requirements: Access to smartboard required for session 3 –WEBSITE REFERRED TO NO LONGER AVAILABLE, please use http://choicesforlifeonline.org/cards/alcohol-the-effects-on-your-body.aspx

Implications for staff: Support for delivery of this resource is provided by Glasgow Council on Alcohol.

Cost attached: No.

Resource link: Health, Safety and Dignity

QA Tool:

Topic: Alcohol.

Description: Resource pack which includes bottles and units activity, alcohol quiz and discussion around safety tips and advice. Explore common myths and misconceptions around alcohol and alcohol use.

Type: Pack.

Target group: Third.

IT/practical requirements: For best results the session should be delivered along with a collection of bottles, jar of pickled liver and beer goggles.  Please contact your local GCA office or Health Improvement Team to borrow resources.

Implications for staff: None.

Cost attached: No.

Resource link: Myths and Facts (zip)

QA Tool:

Organisation

Alcohol Focus Scotland

Course Name

Rory – using the Rory resource in Schools

Aim of the course

Aim 

• Learners will enhance their awareness and understanding of the problems caused by alcohol in Scotland;
• have a greater awareness of the impact of harmful parental drinking on children and families;
• more confidence to respond to children who are or may be affected by parental drinking.

Description of Training course

The training explores the Rory storybook and resource pack, which aims to build resilience and protective factors in children.  The pack comes with a range of age appropriate lesson plans and activities which focus on exploring relationships, development of problem solving and communication skills. 

Dates of training (Day, date, year)

Throughout year, available from training@alcohol-focus-scotland.org.uk 

Participants (who should apply? Criteria?)

Primary school staff (P1-7) who would like to learn more about Rory and how it can be used with children aged five to eleven years, building resilience and increasing social & emotional wellbeing.  

Trainers / organisation

Alcohol Focus Scotland is the national charity working to prevent and reduce alcohol-related harm.

We want to reduce the impact of alcohol on individuals, families, communities and Scotland as a whole.

We want to see fewer people have their health damaged or lives cut short due to alcohol, fewer children and families suffering as a result of other people’s drinking, and communities free from alcohol-related crime and violence. 

Closing date to apply to attend (for example – 2 weeks before the course start date)

Until course is full 

Time

This is a 4hr course delivered over 2 x 2hr sessions, usually 4pm-6pm.

Contacts / booking details / website etc.https://www.alcohol-focus-scotland.org.uk

training@alcohol-focus-scotland.org.uk 

Call: 0141 572 6700

Venue

Varies, contact provider training@alcohol-focus-scotland.org.uk

Topic: Alcohol

Description:   Together with PACE Theatre, Choices for Life have produced a series of dramas “Someday” which are all interlinked. They tell the story of Liam, Sophie and Scott as they experience peer pressure, smoking, drugs and alcohol for the first time and must face the consequences that lead from it. 

Sophie’s story is about a group of school girls who have been invited to a house party and offered alcohol.  It focuses on Sophie, who gets really drunk and the consequences that follow.  

The film lasts approximately 15 minutes and can either be watched on its own or as part of the someday series covering other substance misuse topics.  You can also see what happened to Sophie after the party by watching the follow on film “Facing the consequences” – a documentary style drama exploring long and short term consequences.

Type: Online resource, Film

Target group: Third Level

IT/practical requirements: Access to the internet required 

Implications for staff: No additional training required

Cost attached: No

Resource link: 

• Film – Sophie’s Story
• Follow up Film – Facing the consequences

QA Tool: Sophie’s Story QA Tool

Topic: Alcohol; Drugs.

Description: Drama performed by PACE Theatre Company highlighting the dangers of risk taking behaviour to young people, for example, the consequences/situations facing young people under the influence of alcohol and or drugs. The drama follows three characters who attend a party and all have very different experiences due to their excessive alcohol consumption. Follow up workshops are delivered by Glasgow Council on Alcohol to allow discussion about issues raised in the play.  This play is commissioned by NHS GG&C for all Glasgow Secondary Schools at present.  If you are interested in running a similiar project outwith the Glasgow area please contact PACE Theatre Company directly.  Take A Drink 2012 Evaluation Report available on request.

Type: Performance/Drama.

Target group: Third; Fourth; Senior phase.

IT/practical requirements: Stage area required or large hall depending on audience size. Drama company provide all required equipment including sound equipment.

Implications for staff: None.

Cost attached: No.

Resource link: http://www.pacetheatre.com

QA Tool:

Topic: Alcohol; Drugs; Tobacco.

Description: Interactive, incentive based information on alcohol, tobacco and other drugs.  This online resource contains information for young people and parents/carers as well as video clips, games, competitions and a link to Becky Booze Buster. Provides information on alcohol.  Additonal information on drugs and tobacco has recently been added.

Type: Online interactive resource.

Target group: Third; Fourth.

IT/practical requirements: Computer with internet access.  You Tube access required to watch videos.  Link to Becky Booze Busters is via Facebook or email.

Implications for staff: None.

Cost attached: No.

Resource link: Young Booze Busters

QA Tool:

Organisation

Alcohol Focus Scotland

Course Name

Oh Lila – a learning resource for pre – school aged children

Aim of the course

The course explores the key themes of the Oh Lila resource and how it relates to building resilience in children. Oh Lila is linked to the curriculum for excellence with a particular focus on Health & Wellbeing.

On completing training learners will:

• Have enhanced awareness and understanding of the problems caused by alcohol in Scotland
• Be more aware of early years policies and strategies
• Be able to identify ways to confidently use Oh Lila
• Be more confident in managing disclosures

Description of Training course

Oh Lila is a flexible resource which aims to build resilience and protective factors in young children, helping them to explore their emotions, develop social skills and identify trusted adults. The 4 hr workshop provides learners with an interactive and engaging experience.

Dates of training (Day, date, year)

Throughout year, available from training@alcohol-focus-scotland.org.uk

Participants (who should apply? Criteria?)

Target group – Nursery workers and practitioners working with children of pre-school age (3-5yrs) to help them to identify trusted adults and understand that asking for help is a positive behaviour.  

Min/max participants – Min 6 and max of 18

Trainers / organisation

Alcohol Focus Scotland is the national charity working to prevent and reduce alcohol-related harm.

We want to reduce the impact of alcohol on individuals, families, communities and Scotland as a whole.

We want to see fewer people have their health damaged or lives cut short due to alcohol, fewer children and families suffering as a result of other people’s drinking, and communities free from alcohol-related crime and violence.

Closing date to apply to attend (for example – 2 weeks before the course start date)

Until course is full

Time

Training is delivered over 4 hours – usually 9am-1pm or 1pm-5pm.

Contacts / booking details / website etc.https://www.alcohol-focus-scotland.org.uk

training@alcohol-focus-scotland.org.uk

Call: 0141 572 6700

Venue

Varies, contact provider training@alcohol-focus-scotland.org.uk

The New NHSGGC Alcohol and Drug Prevention Framework

Following a rapid review of the alcohol and drug prevention International evidence base between 2012 and 2018, an updated version of the NHS Greater Glasgow and Clyde Prevention and Education Model which will now be known as the NHS Greater Glasgow and Clyde (NHSGGC) Alcohol and Drug Prevention Framework has been developed.

The new NHSGGC Alcohol and Drug Prevention Framework has 3 main components :

1. Context

The new NHSGGC Alcohol and Drug Evidence Briefings, Implementation Plan and Monitoring Tool take a whole population focus with a life-course perspective being integral to the work. They encourage innovative partnership working and encompass the most recent changes to alcohol, drugs and related topic policy and evidence based practice and changes to the landscape since 2012. A key focus of the Prevention Framework is on the promotion of equalities whilst addressing health inequalities and the impact of life stages, deprivation and vulnerability in the most at risk groups such as vulnerable young people, looked after children, older people and the homeless population.

The definition for prevention in the Prevention Framework is as follows :

Prevention is defined as encouraging and developing ways to support and empower individuals, families and communities in gaining knowledge, attitudes and skills in which to avoid or reduce alcohol and drug issues and alcohol and drug related harm.

2. The ten key themes that underpin implementation of alcohol and drug prevention initiatives / services

• Reducing Stigma
• Asset-based and person-led approaches
• Workforce development
• Harm Reduction
• Whole-systems approach and person-centred
• Multiple risks and how they interact
• Trauma-informed practice
• Health Inequalities and deprivation
• Community empowerment
• Evidence informed

3. The NHSGGC Alcohol and Drug Prevention Evidence Briefings

• Pre-birth, Infancy and Early years
• Children and Young People
• Adults
• Older People
• At-Risk Groups and Vulnerabilities
• Society-wide Approaches

The original NHSGGC Alcohol and Drug Prevention and Education Model (2008), collated Prevention and Education evidence base (2012) and new NHSGGC Alcohol and Drug Prevention Framework (2019) can be viewed at the NHSGGC Health Improvement Alcohol and Drug Team website.

For further details on the NHSGGC Prevention Framework please email Trevor Lakey, Health Improvement Lead (Alcohol and Drugs) for NHSGGC via ggc.mhead@ggc.scot.nhs.uk*.

*Please note that this is a generic admin inbox and not monitored immediately. If you, or someone you know are in distress and need an immediate response call the emergency services on 999 or NHS24 on 111.

What is alcohol and drug prevention?

There are various definitions of prevention that typically include some or all of the following elements:

• Discouraging any use of alcohol and drugs
• Delaying the use of alcohol and drugs
• Avoiding the development of harmful alcohol or drug use or dependence amongst those who are using substances  
• Preventing individuals from additional alcohol or drug use
• Reducing the harm associated with alcohol or drug use
• Tackling risk factors and increasing individuals’ resilience to prevent problem alcohol or drug use

In the NHS Greater Glasgow and Clyde Alcohol and Drug Prevention Framework, the definition for prevention is as follows:

Prevention is defined as encouraging and developing ways to support and empower individuals, families and communities in gaining knowledge, attitudes and skills in which to avoid or reduce alcohol and drug issues and alcohol and drug related harm.

• Environmental prevention addresses reducing the availability and accessibility of alcohol and drugs in the community.

Effective prevention and education in NHS Greater Glasgow & Clyde involves a wide range of stakeholders including (but not limited to) those working in:

• Alcohol and drug recovery services
• Recovery communities
• Community and voluntary organisations
• Homelessness and housing services
• Community Safety
• Government departments and Local Authorities 
• Primary care
• Mental health services
• NHS Scotland
• Employers
• Fire and Rescue Services
• Licensing Boards 
• Police Scotland
• Scottish Prisons Services
• Youth groups
• Education Services
• Health and Social Care Partnerships (HSCPs)
• Licence owners

This briefing provides detail on the ten key themes which underpin the successful delivery of alcohol and drug preventative approaches outlined in subsequent evidence briefings in the NHSGGC Alcohol and Drug Prevention Framework. These themes can be considered when developing, implementing and monitoring all alcohol and drug prevention initiatives and services.

• Reducing Stigma
• Asset-based and person-led approaches
• Workforce development
• Harm Reduction
• Whole-systems approach and person-centred
• Multiple risks and how they interact
• Trauma-informed practice
• Health Inequalities and deprivation
• Community empowerment
• Evidence informed

Need to know

• Parental alcohol and drug use can have a negative effect on children. If this is the case, it is considered to be an Adverse Childhood Experience (ACE) alongside other harmful experiences such as physical abuse, emotional abuse and neglect. An accumulation of ACEs can increase the risk of a child being affected by problem alcohol and drug use in later life
• Children who grow up in homes with problem alcohol or drug use are more likely to develop alcohol and drug issues themselves and face significantly higher risks of medical, psychosocial and behavioural issues
• Children who are exposed to alcohol prenatally can have specific and lifelong neurodevelopmental  problems collectively referred to as Fetal Alcohol Spectrum Disorder (FASD)

Key Findings

• Improving parenting skills and bonding between children and their parents is an effective preventative approach
• A focus on developing protective skills, values and attitudes in early years education is effective 
• For children whose mother has issues with alcohol or drug use, effective prevention begins before the child is born to lower their risk of problem alcohol or drug use later in life and positively influence their development
• The individuals delivering an approach – teachers, psychologists, mentors, peers – need on-going, high quality training and support. This includes training to ensure their practice is trauma-informed
• One approach might not fit all. The age, developmental stage, circumstances and needs of each child and family within a targeted group need to be considered when designing and delivering a prevention programme

Good Practice

• Strengthening Families parenting programme
• Children Harmed by Alcohol Toolkit C.H.A.T.
• Oh Lila resource pack for pre-school 

Potential Stakeholders

• Early years education (including childcare services)
• Prenatal and postnatal care (including health visitors)
• Families and children 
• Third sector
• Police Scotland
• Social workers

Need to know

• Adolescence represents a period of vulnerability to alcohol and drug use issues and related harm
• The earlier a young person begins alcohol or drug use, the more likely they are to develop alcohol and drug issues later in life
• Those with greater exposure to Adverse Childhood Experiences (ACEs) may have a higher risk of developing certain problems later in life including issues around alcohol or drug use
• Care-experienced children and children whose parents have issues with alcohol and drug use are particularly vulnerable groups

Key Findings

• Successful preventative interventions engage children and young people in their design and development Sessions for children and young people need to be interactive. Lectures that primarily provide information are ineffective 
• A focus on developing protective skills, values and attitudes is effective 
  Fear arousal does not prevent alcohol and drug use in children and young people 
• The individuals delivering an approach – teachers, psychologists, mentors, peers – need on-going, high quality training and support and where possible have clear alcohol and drug policies in place to deal with any alcohol and drug incidents
• One intervention approach might not fit all. The age, developmental stage, circumstances and needs of each child or young person within a targeted group need to be considered when designing and delivering a prevention programme

Good Practice

• Strengthening Families programme 
• Children Harmed by Alcohol Toolkit (C.H.A.T.)
• Rory resource pack 
• LifeSkills programme  

Potential Stakeholders

• Families and children
• Education services 
• Colleges and universities
• Social workers, youth workers
• Police Scotland
• Young people 
• Employers
• Allied health professionals
• Primary care, acute care and youth health services
• Housing services
• Third sector services

Need to know

• For the purposes of this briefing, adults have been defined as anyone aged 25-50 years old
• 24% of adults in Scotland exceeded the low-risk weekly drinking guidelines in 2017 
• In 2014/15, 6% of people in Scotland had used one or more illicit drugs in the last year 
• Problem alcohol and drug use amongst adults are more prevalent in Greater Glasgow and Clyde than on average for Scotland 
• The rate of problem drug use amongst adults was highest in the 25 to 34 years age group in Scotland 
• On average, men consume alcohol on more days of the week than women in Scotland, and consume more units of alcohol

Key Findings

• There is strong evidence for the effectiveness of Alcohol Brief Interventions (ABIs) in primary care settings in reducing the weekly consumption of alcohol in adults 
• There is strong evidence for the effectiveness of well-planned psychosocial and developmental prevention interventions involving multiple services in reducing alcohol and drug related harms
• There is some evidence for the effectiveness of cognitive behavioural therapy, behavioural couples’ therapy and pharmacotherapy in reducing alcohol and drug related harms, as well as clear alcohol and drug policies in the workplace
• There is an evidence gap relating to whether diversionary activities can be effective in preventing alcohol and drug use in adults

Good Practice

• NHS Health Scotland resources on delivery of ABIs
• Oldham Borough Council pilots
• Brighton and Hove City Council ‘named workers’ 
• Newcastle City Council roll-out of Naloxone
• Barnsley Metropolitan Borough Council Naloxone pilot
• The SOLVE training package  

Potential Stakeholders

• Adult alcohol and drug services
• Allied health professionals
• Employers
• Scottish Prisons Service
• Recovery groups 
• Local authority staff
• Social care staff
• Mental health professionals
• Community learning and development staff
• Police Scotland

Need to know

• In this evidence briefing, older adults have been defined as anyone aged 50 and over. At present, the proportion of older people with substance misuse continues to rise more rapidly than can be explained by the rise in the proportion of older people in the UK. 
• While overall alcohol and drug consumption is falling, in older generations there is evidence that it is increasing, yet there is currently no alcohol strategy in Scotland that specifically considers the needs of older adults
• Older adults with problem alcohol use are the least likely to receive treatment, but the most likely to have positive outcomes
• Isolation and loneliness are more prevalent amongst older adults. The evidence supports “a strong social role” for drinking alcohol in older adults, thus interventions need to avoid “paradoxical harm”
• Age-related factors increase the risk of problem alcohol and drug use, including retirement, bereavement, dementia and chronic ill-health.

Key Findings

• Older adults should be included as a distinct group within alcohol strategies, and their lived experience should be used to help design effective services
• Older adults’ alcohol and drug use is commonly misdiagnosed or missed entirely. Training primary care staff to spot problem alcohol and drug use, specifically in over 50s, will improve access to treatment, particularly when an older age identification test and cognitive impairment test are used
• Venue choice is critical to making services accessible and acceptable for older adults, with a focus on access for those with limited mobility
• Intervention involving employers is important in being able to manage the transition to retirement 
• Age-related alcohol guidelines need to be developed to combat a very low level of awareness of what these are amongst older adults
• Reduced hepatic function and the issue of poly pharmacy in older adults mean that pharmacological interventions may be less appropriate for this group

Good Practice

• Mast-G and MoCA assessment tests 
• Older adults’ Cognitive Behavioural Theory manual (SAMHSA)
• Healthy working lives initiative 

Potential Stakeholders

• Alcohol and drug services
• Geriatric services
• Community services 
• Allied health professionals
• Employers
• Pain management services
• Policy teams

Need to know

• Socioeconomically deprived groups often report lower levels of average alcohol use but experience greater or similar levels of alcohol-related harm. 
• Alcohol and drug-related deaths are much higher in the most deprived areas, compared to the least 
• Alcohol and drug use issues are more common amongst homeless people than the general population
• All LGBT+ populations experience some form of health inequality, including an increased risk of alcohol and drug use issues
• Alcohol and drug use issues are more common for those with pre-existing mental health issues or behavioural disorders, but equally alcohol and drug use can increase the risk of developing certain mental health issues
• The prevalence of alcohol and drug use issues is much greater in the prison population than in the general population
• At-risk groups are not mutually exclusive, and often an individual will face multiple risks, and thus multiple barriers to services

Key Findings

• Integrated services and care pathways are important for all at-risk groups to tackle multiple and complex needs effectively. This includes multi-agency working, continuity of care and considerable wraparound support eg housing, finance and employment services
• At-risk groups face barriers to accessing services. For LGBT+ groups, health staff training and awareness can be effective in mitigating this, as well as capturing data on sexual orientation and gender identity to inform service design and delivery
• Specific services, workers and spaces can be effective for supporting protected characteristic groups. 
• Those with coexisting mental health and alcohol or drug use issues (dual diagnosis) can benefit from tailored interventions which are non-confrontational, simultaneously address mental health and alcohol or drug use, and are delivered by trained staff
• For homeless populations, assertive, long-term outreach services and Housing First approaches have demonstrated effectiveness in increasing engagement and reducing alcohol and drug related harms
• Rapid, easy and timely access to services is particularly important for homeless populations, and those involved with Criminal Justice services

Good Practice

• Pride in Practice
• Leeds Dual Diagnosis Project
• Housing First Glasgow 
• Turning Point Scotland218 Centre
• The High Impact and Complex Drinkers project
• Tomorrow’s Women  

Potential Stakeholders

• Homelessness services and housing providers
• LGBT+ services
• All health professionals
• Scottish Prison Service
• Third sector 
• Alcohol and drug services
• Mental health services
• Police Scotland
• Service users/peer involvement
• Social work

Need to know

• The availability, affordability and acceptability of alcohol are the primary drivers of consumption and harm
• Advertising is heavily invested in by the alcohol industry and exposure to advertising increases alcohol related harm
• Over the last 30 years, alcohol in the UK has become more affordable. Greater affordability in the off-trade has led to different patterns in alcohol consumption, with more people drinking at home, as opposed to in pubs and other leisure settings
• Opioids have been implicated or potentially contributed to 86% of drug related deaths in Scotland 

Key Findings

• Reducing alcohol availability through reduced hours/days of sale and clear licensing practices has been shown to be effective in minimising alcohol related harms. Low drink-driving limits and appropriate minimum age levels are also effective, in combination with strict enforcement
• There is evidence that reducing affordability through a combination of minimum unit pricing and taxation is effective in minimising alcohol related harms
• As exposure to alcohol advertising has been linked to greater alcohol related harms, regulation is needed to minimise this
• Supervised drug consumption facilities can reach marginalised groups, facilitate safer drug use and enable access to health and social services
• Drug checking at events/festivals and safer use social media campaigns can help minimise harms associated with use of drugs such as ecstasy and MDMA
• Access to Naloxone can help to prevent opioid related deaths, particularly for those released from prison

Good Practice

• Scotland’s National Naloxone programme
• RSPH labelling examples
• What’s in the pill? campaign 
• Minimum Unit Pricing in Canada 
• Consumption rooms in Denmark 

Potential Stakeholders

Alcohol and drug services

Police Scotland

Scottish Prison Service

Education Services  

Licence holders 

Advertising regulators

Licensing Boards 

Allied health professionals

Social Work

• NHS GGC Prevention Framework – Bibliography
• Annex 2 GGC Alcohol and Drug Prevention Framework Contributors and Methodology
• Annex 3 Acts, Initiatives, Strategies, Reports
• A and D Framework Elements – Summary Table