Evaluation of the Take Home Naloxone (THN) Project

1. Evaluation of the Take Home Naloxone (THN) Project Trevor Bennett Katy Holloway

2. THN Project and Evaluation • The THN project started in September 2009 • Initially in four areas • Swansea • Cardiff • Newport • North Wales • Community and prison based • The evaluation started about the same time • Data collection finished at the end of 2010

3. THN Project and Evaluation • Prison locations • HMP Swansea • HMP Cardiff • HMP Parc • HMP Prescoed • Community locations • Carmarthen • Swansea • Cardiff • Newport • Gwent (other than Newport) • North Wales • Wrexham • Anglesey • Flintshire • Denbighshire • Gwynedd • Conwy

4. THN Project and Evaluation • The project • Training opioid users and their family and friends • Use of naloxone • Signs of overdose • Other life-saving actions • Issuing users with a THN kit • Providing replacement kits when used

5. THN Project and Evaluation • The evaluation design • Outcome evaluation • Process evaluation

6. THN Project and Evaluation • Outcome evaluation aims • To determine whether THN training had a positive impact on clients • Improved recognition of OD events • Improved knowledge of treating OD cases • To monitor naloxone use

7. THN Project and Evaluation • Outcome evaluation methods • Questionnaires • Replenishment forms • Interviews with project staff

8. THN Project and Evaluation Naloxone training questionnaire

9. THN Project and Evaluation • Process evaluation aims • To determine implementation effectiveness • To determine the number of people trained and issued with THN

10. THN Project and Evaluation • Process evaluation methods • Monitoring records • Observations of training sessions • Interviews with project staff • Interviews with service users

11. THN Project and Evaluation Process evaluation methods

12. THN Project and Evaluation • Outcome evaluation results • Changes in knowledge • Changes in confidence and willingness to administer naloxone • Ability to manage overdose events

13. THN Project and Evaluation (A) Changes in knowledge

14. THN Project and Evaluation (B) Changes in willingness to use naloxone

15. THN Project and Evaluation (B) Changes in confidence to use naloxone

16. THN Project and Evaluation • The main questions were: • Are trainees able to use naloxone in real-life situations? • Will they rely solely on naloxone and neglect other life-saving methods? • Will OD cases who have received naloxone survive? (C) Managing overdose events

17. THN Project and Evaluation (C) Managing overdose events

18. THN Project and Evaluation (C) Managing overdose events

19. THN Project and Evaluation • Process evaluation • Monitoring records • Observations of training sessions • Interviews with project staff • Interviews with service users

20. THN Project and Evaluation • Monitoring records • Number of clients trained and kits distributed

21. THN Project and Evaluation Observations of training sessions

22. THN Project and Evaluation Injection training Delays starting Other observers Observations of training sessions

23. THN Project and Evaluation Management issues Recruitment Interviews with site leaders

24. THN Project and Evaluation The THN scheme as a whole The training sessions Interviews with clients

25. THN Project and Evaluation Recruitment Interviews with clients

26. Conclusions • In many ways, the demonstration project was successful • Knowledge about OD events improved • Willingness to take action improved • Naloxone was effectively used in real-life situations • The evaluation report recommended rolling out the programme nationwide

27. Conclusions • There were some problems that should be addressed • R2 Stronger guidance needed on implementation • R3 Sustainability independent of key individuals • R7 Recruitment methods to be reviewed • R9 Limit or eliminate observers from training sessions • R10 Shorten training sessions