A mixed method approach was adopted and a pragmatic behavioural insights framework was employed to inform the redesign of the service offer with the aim of making treatment uptake easy, attractive, timely and social (EAST). We explored factors affecting treatment uptake through a behavioural insights survey (Phase 1) collected between September 2018 and January 2019, and qualitative interviews (Phase 2) with HART service users conducted between October 2018 and May 2019. Recommendations were implemented between September and December 2019. We used routinely collected data to compare service uptake rates pre and post service redesign.
Recommendations were implemented between September and December 2019. We used routinely collected data to compare service uptake rates pre and post service
Hartlepool has the second highest rate of deaths from drug misuse and the highest under 75 mortality rates from preventable liver disease in the North East region. No matter how successful a treatment programme could be, its effectiveness is limited to those individuals who can be engaged in treatment. Hartlepool Borough Council (HBC) recognised this issue in their own treatment provision, identifying one of the best treatment outcomes for attendees but only a 56.5 per cent uptake rate for those assessed and offered support. The initial approach and early interactions with service users have a key role to play with research showing that 50% of clients fail to attend their second treatment session (Miller & Rollnick, 2002, White 2005).
The Behavioural Insights Team approach and the Easy, Attractive, Social and Timely (EAST) framework can be employed to identify and address further barriers to service uptake and increase the chances of behaviour change (Hallsworth et al., 2016).
To overcome the barriers identified by service users, a number of techniques were introduced to contribute to increasing retention rates once individuals were in contact with services. The nudges used included the consistent use of appointments card, displaying a timetable presenting all treatment options and displaying the cost of missed appointments. Additionally, practitioners proactively used motivational interviewing to engage service users in psychosocial interventions alongside the receipt of a medical prescription (for an opiate substitute). Recommendations for the wider service re-design included having a duty worker available to manage individuals contacting HART for an initial appointment and individuals presenting in crisis situations and securing alternative premises that could accommodate the differing needs of service users.
How is the new approach being sustained?
Hartlepool Borough Council are implementing a full-service re-design in June 2020, all of the recommendations presented from the behavioural insights project have been incorporated into the wider service transformation and will be implemented on an ongoing basis.
Some of the recommendations made were not within the scope of the project but they are being addressed within the wider service development plan due to be implemented from 1 June 2020.
If extra time and resources had been available, we would have conducted additional qualitative work with HART staff and service users to identify the impact of the changes that had been implemented that may not have been captured fully within the routinely collected NDTMS data.
Dr Hayley Alderson-