Critical Stages in Development - Evaluation

Methadone Maintenance Treatment: A Community Planning Guide

On this page:

• Development of an Evaluation Plan
• Impact of Service on Clients
• Impact of Service on the Community
• Recruitment of Additional Service Providers
• Improving the Service/Maintenance of Service

Development of an Evaluation Plan

The development of an evaluation plan is necessary to determine if the model is meeting its desired outcomes and objectives. The evaluation tools to be used could be developed by the working group with the assistance and approval of the service providers. Depending on the amount of resources available, the working group may want to develop an extensive evaluation plan. An excellent start is to survey the service users to determine whether the program is meeting their needs. The logic model can also form the basis of an evaluation plan.

Tips and Pointers
An evaluation plan can assist in showing the benefits of the program to resistant groups or individuals. Try and utilize local academics or graduate students.

Impact of Service on Clients

As a result of methadone treatment services now being a part of the local health care system, its impact on clients should be examined and recorded. Client satisfaction questionnaires could be used to obtain some of this information. In addition, information from service providers about the positive impact that the service has had on clients' lives could be documented (confidentiality would obviously have to be ensured).

For example, some workers from community service agencies may have seen some dramatic lifestyle changes in their clients (e.g. no longer involved in prostitution, going back to school, taking on more family and child care responsibilities). The program may also report that the number of needles that are being exchanged has decreased. They may attribute this statistic to the provision of methadone services in the community. It is important to record this type of information especially if anyone (e.g. resistant stakeholders) questions the utility or value of this service.

Another important aspect that needs to be reviewed focuses on service provision for the clients. If clients are being placed on waiting lists because physicians have reached their caseload limits, discussion about the expansion of services needs to be examined by the working group.

Tips and Pointers
Document all aspects of success including statistical and anecdotal information.

Impact of Service on the Community

Both positive and negative information from the community about the program needs to reviewed by the working group. Positive changes need to be documented while the negative effects should be discussed and potential solutions examined. For example, police services may be concerned about methadone clients loitering around local pharmacies. Some drug dealers have been known to frequent local pharmacies to try and make up for a decrease in "business." These dealers may try to entice methadone clients into buying drugs. The police may want to encourage pharmacies to explain to methadone clients that once they have received their methadone they should leave the pharmacy and not linger around the area. The same scenario can also occur at a methadone clinic. The issue of extra leisure time for the client may be best addressed in a counselling and/or support group setting.

As stated in a previous stage, there are many positives to report on the program since many methadone clients are now leading healthier lifestyles as may be noticed by the staff of addiction programs, police services or other social service agencies.

Tips and Pointers
Media may assist in sharing results with the community.

Recruitment of Additional Service Providers

The working group should monitor trends to see if additional methadone treatment slots should be opened up to meet client need or demand. The committee may want to recruit additional physicians since this will add more treatment slots and not put the onus on a few physicians to be responsible for treatment. Additional pharmacies may need to be recruited to help clients who have to travel long distances to get their methadone. Communication between the doctors and the pharmacists is helpful when clients transfer from one pharmacy to another.

Tips and Pointers
Use evaluation information to recruit other service providers. Existing service providers may assist in recruiting colleagues.

Improving the Service/Maintenance of Service

This stage begins as soon as the service is enacted in the community. As with any program, changes are inevitable to meet the needs of clients and the concerns of the service providers or community members. The working group can play a central role in identifying aspects of the program that need to be reviewed. The group may be able to provide potential recommendations or solutions for these problem areas. Communities may want to examine and evaluate various aspects of methadone service delivery including harm reduction vs. abstinence models, clinic vs. family practice model and large vs. small client rosters. It will be important for the working group to monitor the service to ensure that the model is providing effective and efficient treatment services for methadone patients.

Tips and Pointers
A continuous process which should not be taken for granted. Methadone treatment can be a controversial issue and working groups should not become complacent. Be aware of potential problem areas.

Next>> Continuity of Care for Methadone Patients

Methadone Maintenance Treatment: A Community Planning Guide

1. Preface
2. Introduction - How to Use the Guide
3. Methadone Maintenance Treatment - Rationale and Benefits
4. Methadone Maintenance Treatment - Service Components and Delivery Models
5. Critical Stages in the Development of Methadone Maintenance Treatment Services
   1. Identification and Verification of Need
   2. Establishment of a Community Working Group
   3. Methadone Maintenance Treatment Model Development
   4. Implementation
   5. Evaluation
6. Continuity of Care for Methadone Patients
7. Special Treatment Issues
8. Community Development Troubleshooting Guide
9. Appendix - Methadone Fact Sheet
10. References
11. Recommended Resources

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