National Survey on Low-Threshold (LT) Services

1. National Survey on Low-Threshold (LT) Services Hungary, March-June 2005

2. Methodology: definitions of LT 1.1 Definition given by Ministry of Health and Family Affairs on LT: • social services for addicts wishing to change • target group: addicts, peers, relatives • aims of services: • reach and consult addicts, friends, relatives • reduce the use and the harms of drugs (’szerhasználat’) • assist in launching changes • stimulate changes in client’s way of living • prevent recurrence 1.2 Definition provided by the National Drug Strategy: clear

3. Methodology: identification of LT 1.1 Before the survey: Book titled ’Druginfo’ used which contains names and accessibility of LTs 1.2 During and following the survey: • certain LTs found questions in the questionnaire irrelevant • responses revealed lack/deficiencies of/in LT-related services (e.g. no condoms distributed only consultation available)

4. Methodology: quantitative survey (self-filling questionnarire) 1.1 duration of questionnaire: 50-60 minutes 1.2 number of questions used in the questionnaire: 70 1.3 type of questions used: • yes/no questions • scales • open questions

5. Methodology: thematic units 1.1 General information on forms of operation, financial details, number and type of HR 1.2 Services: • type/form • staff • places where services are delivered • concrete data on syringe exchange 1.3 Risk assessment process, decision-making process, success criteria in treatment 1.4Quality assurance: trainings attended by staff, monitoring carried out by staff, development plans 1.5 Target group: description, coverage (based on estimation or real data), problems regarding clients 1.6 Evaluation of services, future plans

6. Methodology: origin of questions 1.1 EMCDDA recommendations: ● Structured Questionnaire 29 ● Standard Table 10 (syringe availability) 1.2 Ministry of Health and Family Affairs’ recommendations 1.3 Own ideas

7. Methodology: report structure on data towards EMCDDA 1. Responses to Health Correlates and Consequences 1.1 Prevention of drug-related death: • Overdose prevention (safer use training, first aid training, consumption rooms, antagonists, etc.) 1.2 Prevention and treatment of drug-related infectious diseases: • Prevention (vaccination, syringe provision programmes, paraphernalia and condom provision; information materials, educational approaches ‘safer use/safer sex’) • Counselling and testing • Infectious disease treatment 2. Responses to social correlates and cosequences 2.1 Social Reintegration: • Housing • Education, training, • Employment • Basic social assistance etc.

8. Methodology: pre-test Two low-threshold services requested to make comments → • certain questions removed • certain questions modified • certain questions added

9. Methodology: responses 1.1 motivating respondents: phone calls made to services in two phases 1.2 sixty-two questionnaires sent out to organisations defining themselves as LT (see Definition of LT) 1.3 four ceased operations, fourteen did not return the questionnaire as they found questions irrelevant 1.4 an additional fifteen organisations failed to return questionnaire for unknown reason 1.5 twenty-nine responses received altogether

10. Methodology: data procession with SPSS • frequencies • crosstables • variable aggregation/reduction • factor analysis

11. Methodology: qualitative Structured questionnaire (interviews) for syringeexchange LTs only 1.1 duration of interview: 1.5 hours 1.2 Number of questions used in the questionnaire: 80 1.3 type of questions used: • yes/no questions • open questions

12. Methodology: thematic units • Operations: financial resources, financing environment, level of independency • Main goals • Target groups: problems concerning how to reach them, special target groups, special services offered for them • Helping process and risk assessment, decision-making process regarding clients • Informing and educating clients: modes, places • Methods used at services • Evaluation: own and other LTs, problems, planned actions

13. Methodology: origin of questions • EMCDDA recommendations: structured questionnaire 29 • Own ideas

14. Methodology: data procession • Atlas.ti: software package for text analysis

15. Experiences: difficulties, problems – terminological aspects Definition and identification of LTs: a. Problems with the definition provided by the related ministry: • emphasis on social services • does not define taget group clearly (’addict’) • fails to define ’low-threshold’: why is it low-threshold? b. Problem: no generally accepted and agreed protocol as regards LTs

16. Experiences: difficulties, problems – operational aspects No national register on LTs • Whose task would it be to set up such a register? • Who would be held responsible for operating the register/system? National Focal Point? • Would it be possible to harmonize and carry out the operation of the register and datacollection at the same time?

17. Experiences: difficulties, problems - practical aspects Slow responses → bad timing, busy staff? → other surveys being carried out simultaneously? → no/little interest, indifference? → due to the lack of face-to-face situation, respondents postpone filling in the questionnaire? → mailing? IF slow responses are… …due to bad timing: when to time the survey? …due to simultaneous surveys: how to agree on different timing? …due to indifference: what is the reason? How to motivate respondents? Is DATA PROVISION OBLIGATION ITSELF the problem? …due to the lack of face-to-face situation: … …due to the difficulties of mailing (little time, inconvenient, money): is e-mail a possibility?

18. Experiences: difficulties, problems – methodological aspects Quality of data provided is irrelevant - RELIABILITY: → Qs have been misunderstood? → Qs do not cover LT programmes fully and properly? IF bad quality of data provision is due to… … questions that have been misunderstood, is it because of • undeveloped Qs? • unclear instructions? • unexperienced respondents? ... the fact that Qs do not fully cover LT programmes: how to make it suitable for everyone?

19. Experiences: difficulties, problems – methodological aspects Missing or small amount of data - GENERALISATION → indifferent respondents? → ’secretive’ respondents (afraid of giving data)? → no data available? IF missing data is due to… … indifferent respondents: how to motivate them? …secretive respondents: anonymity should be insured? …no data available: how to get that data? How to increase the chances of eliciting the data?

20. Experiences: difficulties, problems – methodological aspects Problems of interpretation - VALIDITY: • who/what is meant by ‘target group’? • what is meant by ‘success criteria’? How can you operationalize it? • what is meant by ’methods’ used at LTs? How can you operationalize it?

21. Conclusions 1.1 Make data collection as easy as possible for users: • develop questionnaire with respondents (user involvement: focus groups? general discussions?) • ask for continuous feedback • provide support if needed: make yourself available 1.2 Use qualitative and quantitative methods simultaneously → • different aspects can be approached • the questionnaire can be further improved on the basis of qualitative results (see problems of interpretation of terminology such as ’method’)