Suchergebnisse

The paper outlines the nature and extent of illegal drug use in Scotland. The paper provides a detailed discussion of the impact of HIV among injecting drug users in Scotland. It is shown that although HIV remains a major public health concern within parts of Scotland, most notably in Edinburgh and Dundee, HIV infection remains low elsewhere within Scotland. Although concern in relation to HIV has receded in light of the continuing low prevalence, there has been growing concern over the marked increase in drug-related deaths among drug users within parts of Scotland. Within the policy sphere greater attention is now being given to topic of drug prevention and the impact of drug use on community well being.

AbstractIn this paper we report upon the development and operation of a "street‐level" response to the problems of interprofessional joint working in providing appropriate care for elderly people living in one Scottish city. The "exchange system", as it was known in the locale, was a mechanism for co‐ordinating the movement of elderly people between the geriatric, psychiatric, and residential services within the city in response to changes in the needs of the individual elderly person, and the needs of service providers. The importance of the scheme stemmed from the fact that it was not imposed on professionals' work, but rather that it developed out of that work.By focusing on the operation of interprofessional joint working at the street level we draw attention to those complexities involved in such work which are often overlooked in the broad policy statements on joint working which have emerged from government departments, and health and social services agencies. Policy makers and analysts alike have largely ignored the meaning and consequences of joint working at the level of professionals' actual work, and it is this lacuna in the literature that the paper seeks to address. The paper concludes with an appeal to researchers and practitioners to describe any such schemes of whatever nature operating in their own locales. In so doing a corpus of knowledge looking critically at the experience of interservice and interprofessional collaboration at the street level may emerge which would inform broad policy statements.

Repeated calls for improved joint working between agencies and professionals providing social care have had limited success. Following a brief review of possible reasons for this, it is argued that joint working cannot truly succeed unless it does so at street level at the professional/user interface. Yet this level has received little attention. Taking the example of a mechanism created to ease communications and negotiate transitions between a range of services for the elderly, the paper demonstrates that there exists an important but neglected role for brokers or mediators (so-called 'reticulists') who display an awareness of the political realities and power dimension of organisational life and who operate on the margins and in the interstices of services. Of the lessons to be learned from this initiative in joint working the most important is that a direct transplant is likely to suffer rejection. The mechanism reported on is a product of its environment—a 'bottom-up' response to a perceived problem—and tailored accordingly.

Due to high relapse rates after leaving treatment, drug users are often recommended to participate in some form of lower intensity continuing care. The importance of aftercare is widely accepted, but little empirical data are available about the effectiveness of continuing services over longer periods of time and following various treatment modalities. In this study, we assessed the influence of various forms of aftercare on treatment outcomes and service utilization over a 33-month period among a naturalistic cohort of 653 drug users treated in prison or community settings, as part of the Drug Outcome Research in Scotland (DORIS study). Although participation in aftercare after initial treatment is rather unusual, the odds of having experienced a drug-free period (after 8 months) (OR = 1.91, 95% CI 1.10–3.33) and of being abstinent from heroin (after 33 months) (OR= 0.56, 95% CI 0.34–0.94) almost doubled. Program aftercare was of little additional value after intensive residential treatment, but particularly important after prison-based and community treatment and if combined with self-help participation. Consequently, attractive and fitted aftercare services should be offered as an integrated part of various treatment modalities.