1 evaluation of the take home naloxone (thn) project trevor bennett katy holloway

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Evaluation of the Evaluation of the Take Home Naloxone (THN)Take Home Naloxone (THN)

ProjectProject

Trevor BennettTrevor BennettKaty HollowayKaty Holloway

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• 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

THN Project and EvaluationTHN Project and Evaluation

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• Community locations• Carmarthen• Swansea• Cardiff• Newport• Gwent (other than Newport)• North Wales

• Wrexham

• Anglesey

• Flintshire

• Denbighshire

• Gwynedd

• Conwy

• Prison locations• HMP Swansea• HMP Cardiff• HMP Parc• HMP Prescoed


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• 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


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• The evaluation design

• Outcome evaluation• Process evaluation


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• 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


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• Outcome evaluation methods

• Questionnaires• Replenishment forms• Interviews with project staff


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Which of the following are the usual signs of an opiate overdose? Correct Not correct Bloodshot eyes Shallow/slow breathing Lips or tongue turn blue Blurred vision Loss of consciousness Fitting Deep snoring or gurgling sounds Pin-point pupils

Naloxone training questionnaireNaloxone training questionnaire


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• Process evaluation aims

• To determine implementation effectiveness

• To determine the number of people trained and issued with THN


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• Process evaluation methods

• Monitoring records• Observations of training sessions• Interviews with project staff• Interviews with service users


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• Process evaluation methods


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• Outcome evaluation results

(A) Changes in knowledge

(B) Changes in confidence and willingness to administer naloxone

(C) Ability to manage overdose events


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(A) Changes in knowledge


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(B) Changes in willingness to use naloxone


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(B) Changes in confidence to use naloxone


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(C) Managing overdose events


• 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?

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I put CH into the recovery position as I was unable to rouse him by shaking him or calling his name. I then took out my kit and prepared the naloxone which I had no trouble in using. I then injected CH in the thigh through his jeans. After about three minutes CH began to come round and the ambulance crew arrived and asked me to leave the room whilst they took over. CH was taken to hospital where he survived. I found the training prepared me well for this situation and I don’t feel that I need any extra training. I would use my naloxone kit again.

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• Process evaluation

• Monitoring records• Observations of training sessions• Interviews with project staff• Interviews with service users


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• Monitoring records

• Number of clients trained and kits distributed


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• Observations of training sessions


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• Observations of training sessionsTHN Project and EvaluationTHN Project and Evaluation

Delays starting

Other observers

Injection training

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• Interviews with site leaders


Management issues

The comments about the management structure were generally positive and most respondents were happy with the system as it is. There was clear support for the idea of having a national lead and a national working group. Respondents appeared to like the idea of having a clear structure and the possibility of interaction between the groups.

The main negative comments concerned the flexibility allowed in the design of the project at the area level which was interpreted by one respondent as where you ‘just sort of muddle through’.

The respondents generally agreed that there was a problem of low recruitment and most came up with ideas for improving the numbers of clients. These included improving advertising of the scheme and encouraging users to tell their friends about what is being offered. There were also suggestions for expanding the number of training outlets

Recruitment

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• Interviews with clients


The THN scheme as a whole

The training sessions

One interviewee commented on the size of the groups being trained. It was felt that if there were too many people in the session, the key workers would not be able to concentrate on each individual. One-to-one sessions were described as more comfortable for the trainee.

I think it’s the most wonderful thing in the whole world...

I’ve got to be honest, I’ve got nothing bad to say about it, it’s only good things ... it’s saving people’s lives, isn’t it, at the end of the day, it’s helping somebody, and if somebody can do that, all the better ...

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• Interviews with clients


Recruitment

Publicity about the project was an issue raised by two of the interviewees. One felt that there was a lack of knowledge about it, while another felt that knowledge was widespread

Another interviewee claimed that the only way to boost recruitment was to ‘push’ drug users into training. When probed how this might be done, he suggested that methadone scripts could be made contingent on attendance at THN training.

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• 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

ConclusionsConclusions

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• 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

ConclusionsConclusions

1 evaluation of the take home naloxone (thn) project trevor bennett katy holloway

Documents

project staffthn project

project staffinterviews

naloxonethn project

clientsthn project

usedthn project

knowledgethn project

demonstration project

thnthn project