The combined data from staff and service users is organized into two overarching themes, ‘Finding the right balance’ of remote and in-person services and ‘Resourcing a hybrid offer’. The accounts that staff and service users gave demonstrated a strong desire to retain remote service delivery options alongside the return of in-person provision once the pandemic restrictions eased. Remote service delivery was not right for everyone however, and not all aspects of service delivery work well remotely. The four sub-themes within ‘Finding the Right Balance’ characterize the core issues that need to sit behind decisions about for whom and how to offer remote versus in-person support in the future. The two sub-themes within ‘Resourcing a hybrid offer’ draw out the specific challenges related to the resources needed to provide or access support with drug and/or alcohol dependency, both remotely and in-person (see Table 4 below).
Table 4. Summary of themes and sub-themes
Main themes
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Sub-themes
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Finding the right balance
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- Lockdown and remote services: from supportive context to excuse to ‘go wild’
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- Maintaining therapeutic effects remotely: trust, rapport and motivation
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- Characteristics of people and components of service delivery
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- Efficiency and convenience of remote
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Resourcing a hybrid offer
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- Service users resource needs
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Finding the Right Balance
Experiences of remote versus in-person delivery of drug and alcohol services were intertwined with experiences of the pandemic and associated social restrictions. The first sub-theme represents how this unprecedented context was experienced in relation to substance misuse and recovery by service users.
Lockdown and remote services: from supportive context to excuse to ‘go wild’
There were a range of reflections from service users about their experiences during the most stringent pandemic restrictions; some people had found this beneficial to their recovery, whilst others had experienced it as detrimental, with some using it to avoid recovery services. Others made the best of it but felt that accessing support remotely lacked the full benefits of in-person support. In the following extracts, service users reflect on the positive impact of seeing fewer people when accessing services because of pandemic restrictions;
‘…it was like because they [other service users] were all hanging out outside [the service] and that, there’s a lot of people that I’ve used with, I used to struggle sometimes, especially overhearing them, you know, talking about things, so like now it’s they don’t have people hanging about there, they don’t have loads in the waiting room, so I do find it a bit easier.’ (Samantha, service user, focus group)
‘You always bump into people from your past, people who are still living in chaos and still using. This can be a trigger for me and I don’t need that! I am stable now, clean and I don’t want any potential triggers anywhere near me. I need to protect myself… So not having to go and just having a chat on the phone suited me.’ (Lily, vignette of sex worker experiences)
The reduced opportunities when accessing services remotely, to walk past pubs or shops selling alcohol, or see dealers, was also cited as making it easier to abstain from substance use;
‘…but by not leaving the house, I've then never had to risk walking past a pub and wanting to go in, or walking past a Tesco's, and wanting to go in to get drink and stuff. So I really think doing it [accessing support services] remotely helped me.’ (Hannah, service user, interview)
‘…with me the danger is going outside if I’ve got to go out three times a week I’m going to see people using drugs because I’m going to see other users, and the less frequently I see that the less I’m going to get that urge’ (Alex, service users, focus group)
Staff also described how the pandemic context and restrictions had facilitated some service users’ reduction in substance use and engagement with treatment. For example, access to illicit substances became more difficult for some, prompting an increased motivation to get help.
‘…and suddenly I’ve got a backlog of clients that want to get into treatment because the dealer’s never going to give them any credit, there’s no place to beg from because there’s nobody out to beg off, and all the shops have been closed so there’s no way to shoplift, so they were wanting to get into treatment which before … was sometimes a challenge … but when COVID kicked off initially they were all wanting to get on a script [prescription for opiate substitution medication].’ (David, Staff member, focus group 3)
Staff also commented that the lockdown had benefitted some service users by providing them with a break from normal routines and therefore space and time to make positive changes;
‘For some, it has been an opportunity to make a change that's been made easier, because the whole world was staying in… So for some, it has been the break they've needed to change, and we've got a handful of women who really made a positive change.’ (Lily, Staff member, interview 13)
The importance of the pandemic context is underlined by service users’ accounts of the impact of the easing of pandemic restrictions. Good weather during the summer of 2020 meant that when pubs re-opened, there was a lot of visible alcohol consumption. This was challenging for those attempting to abstain;
‘I've had it pretty easy staying sober over the lockdown period, because all pubs have been shut. Whereas now, the weather as it is you've got to walk past people sat outside enjoying themselves, and there's football on.’ (Louis, service user, interview).
In contrast to those who found the lockdown context beneficial to their recovery, the opposite was the case for some. One service user who had experienced a recent challenging life event talked about initially using that and the lockdown as an excuse to start drinking again;
‘I think that was a big part of it … seeing it as a bit of an excuse to allow myself to really go wild, because I had an extra excuse, apart from the pandemic, I had the [distressing life event] as well. So I think I gave myself a little bit of leeway to kind of go a bit more wild, and not feel as bad for it, or not feel like it was a problem that I had to tackle straightaway. I kind of felt like it was okay for me to be a mess for a bit.’ (Hannah, service user, interview)
For another service user, the restrictions meant less surveillance, making it easier to avoid detection when engaging in illicit drug use and easier to avoid engagement with support services;
‘I mean, apparently, we were in lockdown. I didn't know that, and none of the people that I associate with knew that there was a lockdown going on. All we noticed that there was no police on the streets, …and there was no one on the streets, which, to be honest, made things easier for us. So we were kind of like on the streets and doing everything blatantly, in the open. It felt as though we were invisible.’ (Francis, service user, interview)
In this case the return of more ‘normal’ circumstances, including a reinstatement of in-person support, led to Francis addressing his substance misuse again;
‘they've only just started getting back to obviously seeing people again. So now, I'm doing really well … because I'm back to seeing people again. But when I'm not having to see anyone, I can do whatever I like, and no one is going to know, do you know what I mean?’ (Francis, service user, interview).
Maintaining therapeutic effects remotely: trust, rapport, and motivation
Service users talked about the importance of building and maintaining a strong rapport with their main recovery support worker, regardless of mode of delivery, for the support received to be effective.
‘…to me, that relationship it's imperative, it's absolutely vital …. If you don't have such a great relationship with your worker, then you should use a different worker. Try working with somebody else until you can get that rapport going, where you feel confident and you trust the person’ (Francis, service user, interview)
They also talked about the need for the change to come from their own readiness to address their substance misuse.
‘I was really desperate. … I think I'd got to the lowest of low that I'd been for a long time, and I just really needed to address this problem, and I was itching to get into [Organisation A]. It was pretty quick from initially me being referred to [Organisation A], it was quite quick. So I was kind of geared up for it, because it's what I really wanted’ (Freya, service user, interview)
Service users have regular, often weekly, meetings with their support worker whilst in recovery. Before the pandemic, this was typically an in-person meeting at one of the service ‘hubs’. When the pandemic hit, this changed to telephone calls for most. It was clear that for many the telephone support worked well, and therapeutic effects were maintained;
‘I didn't feel cheated out of anything. Do you know what I mean? I didn't feel… And, in a way, it [telephone support] was a bit easier because, obviously, if you've got a face-to-face appointment, you've actually got to get to the place and have your appointment, and then get back. Whereas a phone call, you can be at home, do you know what I mean?’ (Poppy, service user, interview)
Those who were feeling ready to address their substance misuse were typically those who were able to make progress with the remote support offered during COVID. For example, Freya from the example above said that;
‘..once I'd got kind of used to it [remote delivery], I quite enjoy it. And you haven't got that worry as well about getting on a bus and going somewhere, because you're in your home surroundings. And you could be sat having a cup of tea, while you're in your meeting.’ (Freya, service user, interview)
While many got on well with telephone support, staff and some service users highlighted the detrimental impact it sometimes had on ability to develop and maintain rapport and the therapeutic alliance:
‘Yeah, it [remote delivery] does affect things. … the therapeutic alliance is not built up over the phone, and you can try your best to do that, but there's nothing better than seeing people, seeing reactions and how their body language is, and things like that. And you can't get that over the phone, and they can't get that from you as well. They can't see you, that you really care, and things like that, and they can't see that.’ (Staff member, interview 11)
‘…my worker left at the beginning of COVID so I had a new worker …She seemed nice but it’s hard to form a connection with someone you have never met.’ (Naomi, sex worker vignette)
Another component of service delivery is group work. Pre-pandemic these sessions happened in-person and moved to online videoconferencing during the pandemic. Many service users had similarly positive things to report about engaging in group work remotely, again demonstrating a maintenance of therapeutic effect. For example,
‘It [online group work] was absolutely fine right from the start. They always have two workers managing it, and everything. And I think the first week I went into… because I think the groups were really, really busy as well, because I think again, because with it being online, people can access them much more easily than if it's like a face-to- face.’ (Poppy, service user, interview)
A further major change involved provision of opioid substitution therapy (OST), with many service users required to take a seven-day supply of medication home and expected for the first time (for the individual and for services en masse) to consume the daily dose unsupervised. Staff commented on how this provided a new opportunity for establishing trust between staff and service users and there was a suggestion that the additional trust enhanced the staff and service user relationship.
‘Yeah. It’s about trust. I think trusting the service users now we’ve learnt they can be trusted more than we thought not to do daft things with the medication.’ (Richard, Staff member, focus group 3)
‘I pick up my methadone [OST] from the chemist once a week, so I'm weekly pick-ups. So when you're on week…you build your trust back up with them, so like you can go to the chemist every…But it does depend, because I pick up once a week, my trust is okay’. (Grace, service user, interview)
Staff also highlighted the potential benefits of the reduced frequency of OST pickup for service users’ experiences of the OST process. One said:
‘…some clients have liked having the relaxation on the supervised consumption, which I can completely understand. When you go to a chemist, and you see somebody having to take their methadone at the counter, because they haven't been given the dignity of going into a spare room, a separate room, things like that, they've probably quite enjoyed that relaxation, or that change.’ (Isabella, Staff member, interview 12)
‘Clients commenting on how much better it is that they don’t have to go to the chemist everyday as most are on a 3 day pick up or weekly pick up due to stay at home message.’ (Staff timeline 6, referring to April 2020)
Even though staff and service users commonly stated that a good standard of care had been maintained despite the changes necessitated by the pandemic, there were reports by some service users that they had made use of the remote delivery context to deceive staff.
‘I think, at first, it was very easy to lie about how much I was drinking, because she couldn't see. So, it was really easy to be manipulative with what I was saying.’ (Hannah, service user, interview)
‘…if all I've got to do is a phone call, I can fake anything over a bloody phone. Anybody can do that?’ (Francis, service users, interview)
Staff also discussed concerns they had about their ability to work with full efficacy, remotely. They felt it was difficult to assess wellbeing and substance use status when they were not able to meet in person.
'You're in that awful limbo of what is the right thing to do? We've got to trust what the server user is telling us, and evidence that somehow we've assessed that. That's, again, not an assessment face-to-face, and you'll know you have to assess, sorry, skin tone, the colour of somebody's eyes, is… Do they look jaundiced? Over Zoom, we even have people with filters on, on their cameras. And it's like, how do you get through all that to make a safe decision...’ (Charles, Staff member, interview 17)
“Concern regarding truthfulness of the information from patients about their drug use” (Staff timeline 19, referring to April 2020)
Characteristics of people and components of service delivery
There was a clear sense that although remote delivery worked for many, there were some people and some aspects of drug and alcohol support that are not suitable for delivery in remote formats. Staff identified several aspects of the service that were either impossible to deliver remotely or were simply better delivered in-person. These included taking blood samples, certain types of training for staff (e.g., naloxone training) and conducting clinical assessments and comprehensive assessments[5]. One staff member highlighted the difficulties that sometimes arose from trying to arrange remote support sessions with younger service users (i.e., teenagers and young adults).
‘Because, yeah, a lot of kids just say, look, I don't want to do it. I don't want to chat on the phone to you, when I don't know you very well. I don't have a relationship with you, you're brand new to me.’ (Charlie, Staff member, interview 1)
Another discussed the challenges of accurately assessing the needs of ‘at risk’ service users when supporting them remotely;
‘We've had a lady that - and it was actually the girl that I was working with who was high risk… It was just telephone conversations, and then the social worker asked me if I'd go and do a home visit with them… When I got to the home visit, she had a black eye, there were holes in the walls. You could tell that it was not a good environment from - just from looking around. Whereas over the phone, you can't see any of that.’ (Ava, Staff member, interview 11)
Another discussed the difficulties of delivering clinical services remotely:
‘But it was also a learning experience in itself, doing a clinic from home… There's an awful - this it's time-consuming and it is not a soft and easy option doing it over the telephone. Because, for one thing, you've only got one sense working on the person who is on the other end, which makes it far, far scarier.’ (Christopher, Staff member, interview 7)
Both staff and service users also talked about health and wellbeing characteristics that were relevant to how suitable a person might be for remote service delivery. Mental health and in particular social anxiety were cited as relevant to decisions about people’s suitability for remote support. For example, someone experiencing severe social anxiety may benefit from a remote service offer when leaving the house and engaging with other people feels too difficult.
‘I get bad anxiety, and just the thought of having to go somewhere, I can panic and panic and panic. And I'll panic that much, that I'll not go; I'll convince myself not to go. So it's - like, just having to answer the phone. It's not ideal, like, but it's better than the two, and I would prefer it if we just had phone calls. I'd never miss an appointment then.’ (Oscar, service user, interview)
‘Interviewer: Were you happier on the phone or going into the hub?
SU: Phone, 100000%
Interviewer: That's great! Why is that?
SU: I suffer from real bad anxiety and struggle to go outside’ (Alex, service user, text message interview)
Physical health problems were also identified as a reason why remote support could be suitable.
‘Also my legs are bad. So walking is hard. Sometimes to get to an appointment I would have to walk a long way and with my legs, that’s hard. So when we didn’t need to go and could do a phone one instead, I preferred that. Your script got sent to the Chemist. That was better for me. Also we didn’t need to go to the Chemist as often. Wish it could stay like that.’ (Sue, sex worker vignette)
Personal and home circumstances were also cited by staff as important considerations in whether remote services were suitable, with suitability sometimes varying between service users with ostensibly similar circumstances.
‘And it was a mixed bag with the engagement, some people really didn’t engage well over the phone, especially when there was vulnerabilities like domestic abuse or mental health issues, but other people who engaged really well over the phone because of the kind of anonymity that comes with it, that they were, maybe felt that they were better able to talk about things that they might have struggled to talk about face-to-face.’ (Rebecca, Staff member, focus group 5)
It was also noted however that only ever accessing remote care and not engaging in-person may be detrimental to recovery from mental ill-health and substance use. For some people, their recovery support was a much-needed reason to get out of the house;
‘they changed to online with Zoom… and I was still able to, it was still able to help me with my recovery, but personally if I don’t have that, I need to get up, I need to get dressed, I need to eat, I need to function in life to attend a meeting, otherwise, there’s the opposite of that is I’m going to get stressed out’ (Isla, service user, focus group)
The psychological capacity to engage with services and people’s social resources, including support from friends and family were also highlighted as important factors to consider. These characteristics of service users can present challenges or facilitate engagement for both in-person and remote support. In this first quote, Evelyn shares her daughter’s willingness to provide privacy at home as helpful;
‘It's just me and my daughter in the house, and everything. So she's [a teenager], and everything, and so it's like if I'm going on a Zoom call or something, then I'd just beforehand, I'm just telling her, is that all right, I'm going to be on this Zoom meeting, and then I tell her whether it's okay, or not okay to interrupt me. … But if it was - if I needed privacy, then I'd tell her, unless it's an emergency [don’t interrupt me], and she'll be fine, and she'll just go and watch a film upstairs, and she's more than happy.’ (Evelyn, service user, interview).
In contrast, a male focus group attendee shares how returning to the home environment following residential rehab was unhelpful;
‘I did do a week in detox, came out, had a drink straightaway nearly. Different reasons. Stayed at my flat. My life around me, it's just alcoholics… And, yeah, so at the beginning, it felt like I couldn't get anywhere, and that's why I ended up giving up and for not going to appointments’ (Jack, service user, focus group).
The perspectives shared demonstrate thatservice users need to be understood holistically when considering recovery support options. Our analysis suggests that health and wellbeing needs, capacity to engage, and environmental and social support should be considered.
Efficiency and convenience of remote and widening access
Service users and staff reported an increased efficiency of service delivery during the pandemic period. Service users commented on improved response times, being able to access more group-based support, being less likely to miss or be late for appointments and the convenience of not having to travel.
‘I think it - for me, it kind of sped, it sped everything up, because I was meant to be doing the community detox, and everything… Like I say, if I'd have had to go physically, I maybe wouldn't have accessed one or two meetings, in the time when I'd actually managed to access about four or five. And I actually stopped drinking ahead of - I ended up not having to do a community detox, because I stopped on my own’ (Poppy, service user, interview)
Staff and service users also found their ability to engage via the telephone meant that some service users whose lives tended to be quite chaotic, might be more likely to engage because a forgotten appointment was not necessarily missed.
‘What we’ve seen is for the ones who were more chaotic they’ve done much better, suddenly being able to access a script, suddenly things are on the phone so it is easier because they’re going to forget 2 o’clock on a Friday but ‘oh my phone’s ringin’, they can pick that up.’ (Lisa, Staff member, focus group 3)
‘Plus, when I’ve forgotten, they still call, so I miss less appointments, it’s easier and quicker.’ (Dee, sex worker vignette)
The remote offer also afforded people with caring and/or work responsibilities greater opportunity to access the support that they needed. For example,
‘Because one of the meetings, it's in the evening. It's an evening call, and everything, which is fine because I can make sure my [child] has had her tea, and she knows I'm on a… I mean, she's a teenager and she knows I'm in a meeting, do you know what I mean? Not to interrupt me, and everything. And that I'm in the house, and everything, whereas if I'd have had to go out to the meeting, I'd have had to arrange for her to be somewhere, or her dad to come over.’ (Poppy, service user, interview)
‘I think a lot of our clients, they work or they have commitments that then they'd sometimes struggle to come into the hub. For clients who work, for example, what we've been able to do is offer appointments on their lunchbreak, or on an evening. … I think a lot of clients have really responded well to that, and we've been able to engage some people that otherwise wouldn't, or couldn't engage.’ (Daniel, Staff member, interview 9)
Service users also talked about valuing the opportunity to choose between joining face-to-face sessions in-person or via a video link.
‘There's also the option of within that room to dial in, because there's a screen there now, which is great. And so if you can't make it, or it adds too much pressure, then you can dial in, but still be a part of that community.’ (Farah, service user, focus group)
Remote delivery was also said to be beneficial for widening accessibility where service users preferred to engage with group support discreetly or anonymously.
‘and people [service users] said, ‘I don’t have to go to somewhere where I’m scared people are going to see me going into that site because they might recognise me and suddenly it’s revealed that I’m an addict’… people have the option of coming in with their screen off, they have to option of coming off with it muted so, you know, nobody has to see them.’ (William, Staff member, focus group 3)
Resourcing a hybrid offer
Investing in hybrid; technology, training, sufficient staff and space
Data suggested a future mixed/hybrid service model would necessitate investment in technology, infrastructure, knowledge, skills, and staffing to operate effectively. Implementing hybrid requires more than simply swapping aspects of in-person delivery for remote; there are specific resource implications. For example, services were not prepared for the significant operational changes that the pandemic required. Staff described that at the start of lockdown, the IT equipment and infrastructure needed to delivery support services remotely were not in place.
‘…because to start off with, in the very early days, we were sending people to work from home without a device, without a phone, a work phone. So how were they meant to contact clients, and were having to tell them, use your personal number and 141 it, and all this sort of...’ (Christopher, Staff member, Interview 7)
The lead organization needed to provide staff with mobile phones and laptops, and ensure they had access to Wi-Fi. Staff highlighted the significant initial effort involved in ensuring adequate provision of resources that differed from those required for face-to-face delivery.
‘There was the issue of having to get everyone equipment, so they could work from home effectively. So trying to solve laptops, mobile phones, we definitely weren't prepared for this situation… because they work in an office and they didn't need them. So there was a lot of scrambling around to try and get people adequate equipment.’ (Daniel, Staff member, interview 9)
After the initial lockdown period the lead organization needed to ensure that IT, communication, and data systems were not only effective and accessible remotely, but that staff had the necessary knowledge and ability to use them effectively.
‘I think some of the staff have struggled to adapt to that [remote delivery], because, one, a lot of them, they struggle with IT anyway.’ (Christopher, Staff member, Interview 7)
‘And I guess, yeah, they've [staff] been given the tools to do it [use Zoom], and there was videoconferencing training that we put on through [organization’s name] as well. …But they've been given what they need, the tools and the training to do it.’ (Jacob, Staff member, Interview 6)
Ongoing investment in IT and technology is likely to be needed in order to ensure that technology effectively supports service delivery. For example, staff highlighted that even where they had been provided with IT equipment, internet connections are not always reliable. In some cases, this was a barrier to effective engagement with service users.
‘So technology can let us down …if you have a session with a client face-to-face and it seems to be getting intense you can actually have a 5 minute break, you know ‘just go have a fag outside’ or ‘I’ll check up on one of the things you’ve asked me’, you can bring them back in again and they’ve calmed down enough to finish the session, but if you’re in mid-flow with somebody and suddenly the technology lets you down, the client’s very frustrated, the keyworker’s quite frustrated because they may have been getting somewhere with that client.’ (David, Staff member, focus group 3)
It was also apparent that remote delivery meant that staff sometimes needed to develop new skills, which may require additional resources or formal training. For example, remotely assessing service users required different skills to assessing face-to-face.
‘More telephone consultations now, not able to make usual assessments, examination, testing etc. New skills needed to be developed.’ (Staff timeline 19, referring to April 2020)
Staff also stated that remote delivery sometimes required more staff. For example, remote group work sessions required two staff members whereas in-person required only one. Some staff highlighted the likely resource implications of implementing a hybrid service delivery model with office-based staff. For example, conducting remote and in-person support simultaneously from a hub building, may require additional private spaces within those buildings to hold confidential conversations, or additional technology for effective hybrid meetings. As one staff member stated:
‘… there's still some learning to be done … can we have a blended meeting room… But we know that we need really good speakers, … so when you're talking, they can hear you, and when they're talking, we can hear them. And we need a really good connection, because it's really annoying when you're in Zoom to give a presentation, and they haven't got the wi-fi strong enough.’ (Isabella, Staff member, Interview 12)
In addition, some staff highlighted the need for additional resource to enable service users to engage with remote support options. Additional resourcing, for example through loans of electronic devices or access to free Wi-Fi, were among the solutions that had proved successful and were suggested for the future.
‘We got through quite a lot of the very basic ten quid, from Argos, phones, that either come with a £5, a fiver's worth of data, or none at all. And we could give those to women who were saying to us, I just need to - you to be able to contact me, and I don't know where I'm going to be tomorrow.’ (Mia, Staff member, Interview 5)
Service users’ resource needs and out-of-pocket expenses
Although we heard many stories of success with remote service delivery during the pandemic from service users, some also discussed difficulties engaging with remote support due to lack of knowledge around web conference platforms or access to relevant technology. Service users and staff provided examples of service users’ digital access issues.
‘everything was done online. I kept trying to access any - again, there was no face-to-face meetings, and the facilities that they were using, something called Zoom. And I haven't got a clue about that, [unclear 10:37] I've got a £10 phone, and that's it. I've got no wi-fi or anything like that on my phone.’ (Oscar, service user, interview)
‘it's fine for you and I to use Zoom and Teams or whatever, or WhatsApp video or whatever, but a lot of our service user group they haven't got that facility, or they don't have access to a laptop, or the latest technology. So it's been difficult.’ (Christopher, Staff member, interview 7)
Whilst digital access issues were prominent at the height of the pandemic, it is worth reflecting that lack of resources to access services had existed pre-pandemic. Some service users experienced difficulty in finding the money to pay for bus fares or other forms of transport to enable them to engage with in-person services;
‘Because it [Bus fare] is, it's £7 - it's (almost £5), which is, it's significant, isn't it? It's your food, really.’ (Phoebe, service user, interview)
‘So that's why a lot of them end up do missing appointments and stuff, and then it makes them look like they're not engaging. But it's not that, it's just they haven't got the cash to get there. So then it makes them look bad, and then they fall off scripts and stuff like that, because, obviously, they can't get there’ (Lucy, service user, interview)
We also heard from some people that digital access is often prioritized now, even by those on very low incomes, in a way that it may not have been previously, suggesting digital access issues may be decreasing even among those with the least financial resourced.
‘Sometimes I didn't have credit to ring them [support services], so I had to go and either borrow a friend's phone, or my family's phone, or something. That was a ball ache as well. And now, like I say, now I've got one that has everything for £7 a month, so I should never, never be without credit.’ (Abigail, service user, interview)
Our findings suggest that regardless of the mode of delivery, service users’ physical resources need to be considered. Some may now prioritize internet connection and owning a device and find digital access easier than finding extra money for travel. For those who lack resources needed for remote access, and with the emerging understanding that internet access is becoming an essential resource, services may need to consider how to work with other partners and stakeholders to help service users engage with remote offerings.
[5] The ‘Comprehensive Assessment’ is a thorough, wide-ranging assessment conducted for each service on accessing the service. It includes assessment of areas such as physical and mental wellbeing, substance use history, and social needs, and informs the personalised care plan that is subsequently developed for the service user. Clinical assessment includes a range of screening and assessments that the service user may undergo through engagement with a clinician. These include blood testing or urine sampling for health screening or to assess substance use, and the use of validated assessment and screening tools to measure severity of dependence, symptoms, and associated risks.