March 2006
P-PG/Epid (2006) E
FINAL REPORT
of the
PROJECT “LOCAL MONITORING OF DRUG PROBLEMS”
Appendix 2
Rapid Situation Assessment
FINAL VERSION
Acknowledgements
The concept of the module Rapid Situation Assessment of the Pompidou Group project on Local Monitoring of Drug Problems is derived from a corresponding approach introduced by the World Health Organisation for the assessment of the HIV/AIDS epidemic and the United Nations Office for Drugs and Crime (UNODC) for its Global Assessment Programme (GAP) as an alternative method of information when gathering administrative statistics are lacking and surveys with representative sampling are not feasible. In the Local Monitoring project of the Pompidou Group the RSA covers a wider range of aspects of the local drug situation and puts more emphasis on the systematic collection of informed expert opinions than the original GAP method, but when applicable the module follows the guidelines published by UNODC[1].
Contents
Multi-city Annual Reports Questionnaire (MARQ)
Responses to the local drug situation
The objective of the Rapid Situation Assessment (RSA) is to provide an overview of the local drug use patterns and trends and the local interventions to the extent that can be rapidly assessed on the basis of existing data, papers, reports, expert opinions and key informants. The RSA is one of the preparatory steps in establishing a local drugs monitor. It follows the Information, Needs and Resources Assessment (INRA), but you can implement the RSA simultaneously with the INRA. Although the RSA is not designed to deliver an evidence-base for policy or practice, in many cases it can and will support local policy and practice by revealing problem areas that call for action. This additional benefit however is not addressed and elaborated in this paper.
The decision to monitor the local drugs situation can originate from a general drive for evidence-based policy and practice, independent of the actual situation at the time, but more often such decision will be based on an awareness of existing problems or emerging trends. If there are no problems or if drug use is not yet an issue on the local policy agenda it will be difficult to allocate resources for the development of a drugs monitor. The RSA will provide arguments on WHY to monitor specific aspects of the local drugs situation and it can shape the perception of local policy and practice about the type of information they need to do their jobs.
Monitoring of complex objects, like drug use patterns and drug interventions, implies the selection of a limited number of elements that can be considered as being “indicative” for the condition of the object under surveillance. Such elements are called “indicators” and drugs monitoring then becomes monitoring of selected indicators about the drugs situation.
There is a global consensus about which indicators should be used to monitor the extent, patterns and consequences of drug use. In Europe the data and data collection methods of these indicators have been standardised by the EMCDDA and today the countries of the (extended) European Union already collect these indicator data at national level. In this context your local monitor could be simply a copy of the national monitor.
Although we recommend that a local drugs monitor is consistent with the national monitor, consistency does not imply that a local monitor needs to be identical to the national monitor. On one hand the RSA might reveal that some standard indicators are less relevant at local level because the objects they describe do not exist or are not related to the local objectives for monitoring, which can be different from the national objectives. On the other hand the local situation and the local objectives might call for the surveillance of aspects or details that are not (yet) covered by the indicators of the national monitoring system. Information about specific aspects that has been collated and reported in the past can be a sign that these aspects are important at local level. Also, if applicable, the urge for consistency with existing local data might be stronger than the drive to adhere to national standards.
The RSA will provide arguments on WHAT to monitor, to decide which aspects of the local drugs situation a surveillance system are appropriate and which indicators should be used to do so.
The results of the RSA can also be helpful in identifying priorities in the development of indicators and data collections. Priority will often be given to the development of indicators that relate to aspects that show the most problems or public concern or that directly relate to existing policy initiatives. But you should also remember that ensuring continued commitment of your network requires that the local monitor can show results within a reasonable time and this may imply that the current state of knowledge and capacities should also be considered in defining priorities. It is wiser to start with the less complicated aspects, which can build upon existing knowledge and capacities, than to start with more complex aspects, even if they are the most important from a policy perspective.
The RSA can also provide a baseline as reference or benchmark for the results of the local monitor in the future. For this purpose the RSA is structured on the basis of topics and indicator data that are likely to be considered as elements of the local monitor to be developed. Keep in mind however that the extent to which the RSA can be used as a baseline will depend on the scope and quality that can be achieved. If the RSA cannot present much information about the drugs situation today, there is not much baseline to refer to in the future.
Finally, the RSA exercise can enhance the commitment of the network of experts and stakeholders. Most of them will be involved in the RSA process and composing and discussing a report that describes the state of affairs as far as possible on the basis of existing information and opinions. This is a better way to start the development of the local monitor rather than first engaging in rather technical discussions about data specifications and data collection methods. At the same time the exercise will be a check on the results of the Information, Needs and Resources Assessment (INRA) if that exercise has been carried out prior to the RSA.
Essentially the RSA tries to collate information about the local drugs situation that is already available in policy papers, reports of local agencies, research reports, local registers or databases, etc., including the knowledge of local experts and people working in the field, that has not been published or recorded. In the INRA you will have obtained an overview of relevant information sources and experts. The RSA will filter and structure this information into a coherent situation report. In some cases you may have to retrieve data from existing registers, because they have not yet been published or reported in the format you want, and in some cases it makes sense to collect additional data, for example to allow better situation estimates, but in principle the collection of new primary data is not part of the RSA.
The general theoretical orientation in the RSA is that of induction, which refers to the process of developing hypotheses and searching for information that confirms, denies or modifies them. In general you do this by bringing information from various sources together until, adding more sources does not generate significant new information. The original hypotheses may be taken from an existing report or expert opinions about the local situation, or from the assumption that the situation in your city would be the similar to the known situation elsewhere.
Although for practical reasons you need a coordinator and a small team to carry out the RSA, the exercise is meant to involve the members of the network(s) that you have created to develop the local monitor. Network members have access to the data sources identified in the INRA; they know the limitations and biases of this information; if applicable, they can retrieve data from existing registers; and most of them will be the informed experts whose opinions you need when quantitative data are lacking or difficult to interpret. In the preparation of the local monitor the RSA is ideally the situation assessment by the network, not an assessment by an external consultant.
The name itself qualifies the character of the assessment. Speed has the advantage of keeping your network committed and interested and it avoids that the RSA turns into lengthy discussions, which cannot be solved before you have a sophisticated local monitor anyway, and a delay in the RSA will postpone concrete steps in building this local monitor. As the RSA only uses existing information and expertise, which is available or not, it should be possible to do this assessment as a rapid exercise. The RSA will identify areas where real efforts are needed to obtain necessary information, and these can become priorities in the development of the local monitor, but in general you don’t have to fill information gaps in the RSA process.
Obviously speed is a relative concept, but in general we recommend that the assessment should be completed within a period of three to four months.
Although the RSA is largely based on existing information, the assessment is not a mere summary of existing information. Instead of assessing and reporting what happens to be known and available, the RSA should answer if and to what extent information on pre-defined aspects of the local situation is available. This requires that the information to collate and present should be structured in advance by the themes to address and the pieces of information needed to describe these themes. In principle the main areas of drug policy and intervention will define the themes of the RSA. Report formats of commonly accepted indicators and other standard inventories will be used to identify relevant data and other information for description.
The RSA deals with both the local drug situation and the responses to that situation. Situation here refers to the extent, patterns and trends of drug use, drugs production and trafficking and drug-related health, social and other problems; the responses refer to policies, facilities and activities to reduce supply, demand and drug-related problems. In order to structure this complex assessment we recommend a thematic approach which links situations and responses as in the model scheme below.
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Situation |
Responses |
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Drug use |
Information, prevention, early intervention |
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Risky drug use, health consequences |
Information, prevention, harm reduction |
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Problem drug use |
Treatment, rehabilitation |
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Drug-related crime |
Law enforcement |
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Drugs availability, drugs market |
Interdiction, local by-laws and other responses |
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Attitudes towards drug use |
Information, education |
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Social and economic context |
Social and economic responses |
Obviously there will not always be a response to every aspect of the local situation and many responses are not simply related to only one aspect of the local drugs situation, but linking responses to situations from the start will make it easier later to discuss the objectives for local monitoring and to select appropriate indicators. After all, the main purpose of a local surveillance system is to respond to observed changes in the local situation.
The responses addressed in the RSA do not only include “local” responses that are initiated and controlled by the local authorities or locally based non-governmental or civic organizations, but also national responses, which are related to and implemented in your city or region. It is important however to differentiate between local and national responses, as situations related to local responses are more likely to become a priority object for local monitoring
The scheme above is only a model example for structuring your RSA. The actual themes to cover should be adapted to specific local realities and demands. For example, if your city already has a formal drug policy or intervention strategy, your RSA may have greater impact if you follow the themes addressed in the local policy or strategy.
Instead of making a summary of all available information, you should apply a purposive search and look for concrete pieces of information that have proven to be relevant and appropriate to describe situations and responses. Relevant topics and types of information can be found in the report formats of commonly accepted standard indicators for the extent, patterns, trends and problems of drug use and forms and questionnaires designed to make inventories or evaluations of policies and responses.
For information about the extent, patterns, trends of drug-use and drug-related problems the RSA uses the Multi-city Annual Reports Questionnaire (MARQ) of the Pompidou Group as a guideline for topics and data (Annex I). In principle you will already have used the MARQ as a checklist in the context of the INRA. For the inventory of policy responses in the field of demand reduction you can make use of a limited and adapted selection of the so-called biennial questionnaire of UNODC supplemented by some formats that have been used previously in the Multi-city Study of the Pompidou Group (Annex 2). These forms cover most of the information you may need for the situation assessment. As the report formats are consistent with those of EMCDDA and UNODC, which are used in national monitoring systems, the added advantage is that many formats are likely to become incorporated later in the indicators of your future local monitor and the formats make it easier to identify shortcomings in existing information and data sources. The approach will also allow to use the RSA as a baseline for future monitoring and to compare the results of the RSA with national reports on the drugs situation.
However, as a practical approach we suggest that you choose the following working procedure:
1. Try to complete the model forms on the basis of existing information and expert opinions.
As the MARQ is an existing annual reporting format designed for a different purpose, its formulations are not always appropriate for the RSA. Most questions refer to the one specific year, usually the “past year”, being the reporting year; for the RSA the referral time span can be flexible, for example referring to “recent years” and whenever possible you should report time series to illustrate trends instead of only presenting the latest figures. Depending on the results of the pilots among the participants of the Local Monitoring project, the model form of the MARQ might be adapted to suit better the aims of the RSA. With regard to responses, the model forms presented in Annex 2 and 3 have already been adapted to the purposes of the RSA.
2. Use the recorded information and data as input for your RSA report, as graphs and tables or figures in the text. Keep in mind that the forms are only tools to organize and structure the assessment. You cannot report a situation assessment by simply presenting completed forms.
All of the quantitative and some of the qualitative information of the RSA will be based on existing reports and data sources. These sources have been identified in the INRA. In some cases you may have to organize that specific data are retrieved from the data sources because the data you need have not yet been reported.
Existing information sources will have varying quality, coverage and reliability. In such cases you should make choices by a process of induction, preferably in consultation with your network. In several cases you will not find information that corresponds with the topics indicated by the model forms. Although identifying what information is missing is part of the exercise, you should try to remedy the gaps by informed expert opinions as an alternative, otherwise your situation report might become obsolete for the purpose of making choices about why and what to monitor. A conclusion that there is no information on a specific topic available does by itself not imply that this topic should be included in the local monitor and that data collection activities have to be organized.
If no data exist the natural response would be to collect data, in other words to start a primary data collection. So one could start a survey on drug use or a collection of treatment data from administrative files. Apart from the resource problems these activities require a lot of time, which is contradictory to the concept of a rapid situation assessment. Besides, in many cases the information that is relevant for an insight in the current situation does not consist of figures for a specific moment in time, but of trends and developments that are revealed by a series of data collection over a longer period.
Implementing a Rapid Situation Assessment should only include primary data collection if this can be carried out quickly and when not trends but the current situation is important for the assessment. A common example is the implementation of simple surveys among samples of treatment clients or snowball surveys among known drug users to reveal characteristics of drug use and drug users or to produce prevalence estimates on the basis of overlap between two or more data sources.
It is appropriate to collect informed expert opinions when quantitative data are not available and statistical estimates are not possible or when realistic and meaningful information requires field expertise. Expert opinions however are not an alternative to quantitative data. In general you will not seek expert opinions to get absolute figures, but to obtain relative figures or qualitative information. When you use the MARQ to structure your information search, expert opinions will be asked on the following types of information:
- Occurrences. For example, does the use of crack cocaine occur or not.
- Rank orders. For example, are drug-related deaths more associated with the use of heroin than with the use of cannabis.
- Trends. For example, is the trend cocaine related treatment demand going up or down.
- New developments and qualitative aspects. For example, developments that cannot yet have been recorded or observed in reports, etc. or information on sets, sites and settings, which would be difficult to cover and understand by (only) quantitative data.
In exceptional cases and depending on the available local expertise it makes sense to ask experts for an estimate of an absolute figure, when such figure, even if not based on a formal statistical estimation procedure, plays an important role in shaping local policy and practice. For example, some notion about the number of problem drug users can be crucial for the allocation of resources for treatment and harm reduction interventions.
You need to identify first who should be consulted about specific aspects of the situation that you want to describe. Experts can be prevention, treatment or outreach workers, local police, researchers and others depending on the type of information you need. Ideally you would have more than one informant on the same issue. If they all more or less agree about some situation, for example the percentage of intravenous users among the local drug users, you can safely put that percentage in your report as long as you mention that it is an expert estimate and not an estimate based on sound statistical procedures. When experts give different estimates you have the following options.
You try to bring the different views together by presenting all estimates, including the underlying arguments, to each expert with the request to review his or her original estimate considering the views of others. This might result in a consensus estimate. Such a procedure is called a Delphi method. An effective way to do it is by organising a meeting where all experts exchange their views, but the method can also be implemented in the form of a (repeated) consultation by post or email.
You evaluate different views on the basis of the arguments provided and/or the position of the expert. Some arguments might be more convincing to you than others and the position or function of one expert compared to the other might give you more confidence in his or her estimate. In such case you might choose what you consider the “best” estimate to include in the report but you should mention that some experts have provided different estimates.
You list all estimates or the range of estimates in your report. This seems a safe solution but it is not always very practical, for example when policy and practice require a clear statement, being it true or not, to be able to develop interventions or to allocate resources.
Editable Word format of the original MARQ; not yet adapted for use in the RSA. Distributed as a separate protected document; there is no password, so the protection can be easily removed (Tools > Unprotect document) for editing or translation.
Selection of adapted elements of the biennial questionnaire of UNODC on demand reduction, supplemented by some previous formats of the PG Multi-city Study.
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RESPONSES TO THE LOCAL DRUG SITUATION |
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PREVENTION INTERVENTIONS |
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11 |
Please indicate which types of prevention programmes have been implemented. Also indicate how well these programmes so far have covered the target group in the settings in which implementation has occurred, and whether the specific programmes have been evaluated. |
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Type of programme |
Setting |
Implemented |
Coverage |
Results evaluated |
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No |
Yes |
Low |
Medium |
High |
No |
Yes |
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Information and education about drugs and drug use |
Schools |
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Community-based action |
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Workplace |
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Correctional system |
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Health centres |
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Other (specify) |
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Life skills development |
Schools |
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Community-based action |
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Workplace |
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Correctional system |
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Health centres |
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Other (specify) |
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Providing alternatives to drug use |
Schools |
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Community-based action |
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Workplace |
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Correctional system |
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Health centres |
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Other (specify) |
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................................. |
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12 |
Please indicate if any of the following areas are causing difficulties for your city in implementing the action plan with respect to prevention interventions. |
Existing national legislation |
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Financial resources |
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Coordination / multisectoral cooperation |
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Technical expertise |
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Organisational difficulties |
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Lack of appropriate systems / structures |
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Other .................................................................... |
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TREATMENT AND REHABILITATION |
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13 |
Please indicate which types of treatment and rehabilitation programmes have been implemented. Also indicate how well the programmes have covered the target group in the settings in which implementation has occurred, and whether the specific programmes have been evaluated. |
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Type of treatment /rehabilitation |
Setting |
Implemented |
Coverage |
Results evaluated |
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No |
Yes |
Low |
Medium |
High |
No |
Yes |
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Detoxification |
General and psychiatric hospitals |
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Primary care and other health facilities |
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Correctional institutions |
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Community institutions |
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Specialised residential treatment |
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Specialised non-residential treatment |
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Social services |
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Other (specify) |
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...................................... |
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Substitution treatment, excluding short-term detoxification |
General and psychiatric hospitals |
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Primary care and other health facilities |
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Correctional institutions |
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Community institutions |
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Specialised residential treatment |
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Specialised non-residential treatment |
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Social services |
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Other (specify) |
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Non-pharmacological treatment (counselling, etc.) |
General and psychiatric hospitals |
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Primary care and other health facilities |
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Correctional institutions |
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Community institutions |
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Specialised residential treatment |
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Specialised non-residential treatment |
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Social services |
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Other (specify) |
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...................................... |
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Social reintegration |
General and psychiatric hospitals |
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Primary care and other health facilities |
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Correctional institutions |
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Community institutions |
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Specialised residential treatment |
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Specialised non-residential treatment |
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Social services |
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Other (specify) |
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...................................... |
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Other approaches (please specify) ........................... ........................... |
General and psychiatric hospitals |
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Primary care and other health facilities |
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Correctional institutions |
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Community institutions |
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Specialised residential treatment |
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Specialised non-residential treatment |
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Social services |
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Other (specify) |
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14 |
Please indicate if any of the following areas are causing difficulties for your city in implementing the action plan with respect to treatment and rehabilitation interventions |
Existing national legislation |
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Financial resources |
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Coordination / multisectoral cooperation |
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Technical expertise |
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Organisational difficulties |
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Lack of appropriate systems / structures |
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Other .................................................................... |
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REDUCING THE NEGATIVE HEALTH AND SOCIAL CONSEQUENCES OF DRUG ABUSE |
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15 |
Please indicate whether the following interventions have been implemented. Also indicate how well the interventions have covered the target group in the settings in which implementation has occurred, and whether the specific interventions have been evaluated. |
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Type of intervention |
Implemented |
Coverage |
Results evaluated |
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No |
Yes |
Low |
Medium |
High |
No |
Yes |
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Low-threshold services |
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Outreach work |
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Emergency shelters |
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Overdose prevention programmes |
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Dissemination of information on safe drug use |
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Needle and syringe exchange programme |
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Provision of cleaning agents |
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Testing for drug-related infectious diseases |
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Vaccination against Hepatitis |
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Condom distribution |
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Other (please specify) |
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16 |
Please indicate if any of the following areas are causing difficulties for your city in implementing the action plan with respect to reducing the negative health and social consequences of drug abuse. |
Existing national legislation |
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Financial resources |
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Coordination / multisectoral cooperation |
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Technical expertise |
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Organisational difficulties |
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Lack of appropriate systems / structures |
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Other .................................................................... |
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FOCUSING ON SPECIAL NEEDS |
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No |
Yes |
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17 |
Does service provision in your city take into account cultural diversity and specific needs, such as those relating to gender, age, and socially, culturally, and geographically marginalized groups in the population? |
Prevention services |
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Treatment services |
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Rehabilitation services |
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Other (please specify) |
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18 |
Does your city have any special programmes for specific at-risk population groups ? |
Young people |
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Homeless |
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Street children |
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Prostitutes |
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Young offenders |
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Other (please specify) |
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19 |
Have mechanisms been established in your city to involve specific target groups in programme development and implementation? |
Young people |
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Risk groups |
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Other (please specify) |
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20 |
Have demand reduction programmes for offenders been established in your city? |
In prisons |
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After release |
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21 |
Please indicate if any of the following areas are causing difficulties for your city in implementing the action plan with respect to focusing on specific needs. |
Existing national legislation |
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Financial resources |
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Coordination / multisectoral cooperation |
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Technical expertise |
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Organisational difficulties |
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Lack of appropriate systems / structures |
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Other .................................................................... |
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SENDING THE RIGHT MESSAGE |
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22 |
Does your local drug strategy or action plan include public information campaigns ? |
Yes No |
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23 |
Is training provided for social mediators in conveying appropriate and accurate supply and demand reduction messages ? |
Yes No |
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24 |
Please indicate if any of the following areas are causing difficulties for your city in implementing the action plan with respect to sending the right message. |
Existing national legislation |
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Financial resources |
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Coordination / multisectoral cooperation |
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Technical expertise |
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Organisational difficulties |
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Lack of appropriate systems / structures |
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Other .................................................................... |
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BUILDING ON EXPERIENCE |
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No |
Yes |
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25 |
Is training provided for planners and practitioners involved with service delivery? |
Drug-specialised services |
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Non-drug-specialised services |
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26 |
Are strategies and activities regularly monitored and evaluated to improve the local drug strategy? |
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27 |
Does your city participate in international coordinating mechanisms for the exchange of information ? |
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28 |
Please indicate if any of the following areas are causing difficulties for your city in implementing the action plan with respect to building on experiences. |
Existing national legislation |
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Financial resources |
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Coordination / multisectoral cooperation |
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Technical expertise |
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Organisational difficulties |
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Lack of appropriate systems / structures |
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Other .................................................................... |
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[1] Drug Abuse Rapid Situation Assessments and Responses, UNODC/ODCCP Studies on Drugs and Crime, Vienna 1999