Questions/Answers
Question 1
Please briefly describe the initiative, what issue or challenge it aims to address and specify its objectives. (300 words maximum)
In 2015, Phetchabun hospital has established a substance abuse screening center. Almost one third of users were adolescents; they were sent to the center by the police as the suspects. However, none of them were sent by the educational institutions or schools. In addition, there were late detection of substance use and re-entry for rehabilitation among adolescences who received the services. Furthermore, there was the difference of adolescent substance use information between the hospital and educational institutions that indicated the fragmentation of the system. Thus, it is necessary to develop the integrated adolescent substance abuse screening and treatment system which involves all stakeholders.
Aim
To develop integrated adolescent substance abuse screening and treatment school-based system which engages all relevant stakeholders in Phetchabun province, Thailand.
Specific objectives
1. To develop the substance abuse screening system based in schools targeting a high-risk group for substance abuse in order to enhance the access to substance abuse screening and treatment.
2. To increase the effectiveness of substance abuse treatment by using medical and social approaches.
Question 2
Please explain how the initiative is linked to the selected category. (100 words maximum)
This initiative is linked to coverage and equality in access to service focusing on adolescents with high-risk substance abuse. The integrated adolescent substance abuse screening and treatment school-based system aims to enhance access to service and effectiveness of treatment by involving relevant public stakeholders on the design and implementation processes, including monitoring and evaluation. The patient centred approach is applied in designing the delivery system. Expected goal is empowering School or Institute to take care their students and help them to achieve education.
Question 3
a. Please specify which SDGs and target(s) the initiative supports and describe concretely how the initiative has contributed to their implementation. (200 words maximum)
This initiative supports SDG goal 3 good health and well-being and target 3.5 strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. This is because the initiative aims to develop integrated adolescent substance abuse screening and treatment school-based system which could increase the coverage of screening and treatment among adolescents with substance use. In addition, this initiative also supports the implementation of other SDG goals such as goal 4 quality education, goal 8 decent work and economic growth and target 8.6 By 2020, substantially reduce the proportion of youth not in employment, education or training
During 2015-2019, the coverage of the initiative has been extended from 9 schools to 39 schools that could reach high-risk students more than 4,000 people per year and 501 drug abusers receive the treatment. In addition, this achievement leads to the development of coordination mechanism at the provincial level and has a potential to scale-up.
b. Please describe what makes the initiative sustainable in social, economic and environmental terms. (100 words maximum)
The initiative applies the existing resources and integrates into a daily routine of each public organizations. The important changes are working process and coordination across different public organizations. Importantly, all stakeholders involve in the design and implementation of the program. There is no external resource or funding required for the implementation. Thus, it can be sustained in the long-run.
Question 4
a. Please explain how the initiative has addressed a significant shortfall in governance, public administration or public service within the context of a given country or region. (200 words maximum)
In Thailand, due to the fragmentation of the adolescent substance abuse screening and treatment system, each public organization independently works on the same goal. To address this problem, the initiative integrates adolescent substance abuse screening and treatment system by engaging relevant stakeholders in the district to work together, including Phetchabun Narcotics Control Management Center, Phetchabun hospital, the police, and educational institutions. The Initiative decrease cost and higher effectiveness.
b. Please describe how your initiative addresses gender inequality in the country context. (100 words maximum)
The initiative targets the high-risk group for substance abuse and therefore, adolescents who need the service can equally access regardless of gender.
c. Please describe who the target group(s) were, and explain how the initiative improved outcomes for these target groups. (200 words maximum)
The target group is the adolescent with high-risk for substance abuse in the educational institutions, aged between 12-20 years old. Since 2015, the initiative covered adolescents totally 102,376 people. There were high-risk adolescents who received the behavioural change programme 12,169 people and drug addict adolescences were treated 501 people. There were the success cases of students who previously were drug sellers, but after continuing under the program, they can pursue the high education level and find their careers such as solider, engineer. In addition, there is health volunteer school program which is a jointed project between schools in 3 municipalities and Petchabun hospital and 7 program participants can enter the Faculty of Nursing in 2018. This indicates that job creates personal value.
Question 5
a. Please describe how the initiative was implemented including key developments and steps, monitoring and evaluation activities, and the chronology. (300 words)
Year 2015 - A substance abuse screening center has been established in Petchaboon hospital regarding to National Council for Peace
and Order (NCPO) No. 108/2015.
- The fragmentation of adolescent substance abuse screening and treatment system were addressed.
2016 - Design and implementation of integrated adolescent substance abuse screening and treatment school-based system which
involves all stakeholders in Muang district: Phetchabun Narcotics Control Management Center, Phetchabun hospital, the police,
and educational institutions. In addition, community and family are involved in the implementation.
2016 to present - Establishing the monitor system at provincial and operational level
- Evaluating the outcomes, for example, number of participating schools, risk group, and drug addict group, etc.
- Scale up to other districts in Phetchabun province from 2 to 39 schools
b. Please clearly explain the obstacles encountered and how they were overcome. (100 words)
The obstacles are as follows:
1. Negative attitude of staffs and society towards drug users
2. Different contexts in each area such as number of personnel and the size of schools
3. Differences between organizations in different Ministries i.e. the separated authorization and different working process
The solution guidelines are as the followings:
1. Using the policy and the goals based on people-centred care approach.
2. Build the driving organisms together with all operating and commanding levels.
3. Rely on the co-working value of evidence-based practice and build the learning organization concept.
Question 6
a. Please explain in what ways the initiative is innovative in the context of your country or region. (100 words maximum)
In Thailand, there is a fragmented of the adolescent substance abuse screening and treatment system. Each public organization independently works on this issue. There is no information sharing and collaboration across the different public organizations or institutions. Thus, integrate system which engages Phetchabun Narcotics Control Management Center, Phetchabun hospital, the police, and educational institutions has never been implemented before. This initiative creates the new way of working and collaboration across different public organizations which share the same goal.
b. Please describe, if relevant, how the initiative drew inspiration from successful initiative in other regions, countries and localities. (100 words maximum)
No
Question 7
a. Has the initiative been transferred and/or adapted to other contexts (e.g. other cities, countries or regions) to your organization’s knowledge? If yes, please explain where and how. (200 words maximum)
The initiative has begun from one district and then extended to other three districts in Petchaboon province.
In addition, the initiative has been disseminated to the government organizations in other cities via conferences and meetings, for example, Drug Prevention and Suppression Center in Uttaradit Province, Nakhon Sri Thamarat Technical College, the drug therapy conference organized by the National Medical Department of the Ministry of Public Health.
b. If not yet transferred/adapted to other contexts, please describe the potential for transferability. (200 words maximum)
-
Question 8
a. What specific resources (i.e. financial, human or others) were used to implement the initiative? (100 words maximum)
Human resource
1. Integrated care team which provides continuous care using family doctor approach includes:
1.1 Health care professionals: 1 doctor per 4 nurses/public health technical officer
1.2 School teacher: 1 teacher and 1 buddy per 10-15 drug addiction treatment adolescences
1.3 Policeman: 1 policeman per 1 school
Financing
The initiative uses the existing budget of each organization and pools them together as follows:
2.1 The budget of 2 million baht per year from the municipalities for the drug prevention camps in the schools.
2.2 The budget of 300,000 baht per year from schools and hospitals for home-visiting of the children and youths.
b. Please explain what makes the initiative sustainable over time, in financial and institutional terms. (100 words maximum)
The initiative applies the existing human and financial resources which are pooled together. The roles and responsibilities under the initiative are integrated into a daily routine of each public organizations. There is no external resource or funding required for the implementation. Thus, it can be sustained in the long-run.
Question 9
a. Was the initiative formally evaluated either internally or externally?
Yes
b. Please describe how it was evaluated and by whom? (100 words maximum)
1. Quantitative assessment by Phetchabun Narcotics Control Management Center and Phetchabun hospital
2. Evaluation of addiction treatment achievement conducted by Phetchabun hospital
3. Evaluation of student achievement conducted by the educational institutions.
c. Please describe the indicators and tools used. (100 words maximum)
1. Quantitative indicators: Number of participating schools, risk group, and drug addict group.
2. Achievement indicators:
2.1 Drug addiction test using KD-Assist developed by the Ministry of Mental Health.
2.2 Result of addiction treatment : Recovery and Relapse by Narcotic urine testing in drug treatment group.
2.3 Life assets assessment in drug treatment group using life assets assessment tool developed by Dr.Suriyadeo
Tripathi.
3. Student achievement
d. What were the main findings of the evaluation (e.g. adequacy of resources mobilized for the initiative, quality of implementation and challenges faced, main outcomes, sustainability of the initiative, impacts) and how this information is being used to inform the initiative’s implementation. (200 words maximum)
The outcomes and impact during 4 years of the program implementation (2015 – 2019) are as follows:
Outcomes:
• The screening programme identifies a risk group and 4,000 of them entering the care and prevention program. This program could reach the target in the education institutions approximately 30,000 per year.
• The programme early detects the number of risk and drug addict groups. The number of drug treatment programme participants have increased from 70 in 2017 to 268 in 2018.
• There were 12,169 high-risk adolescents who attended the behavioural change programme and 501 drug abusers were treated. About 75% is recovery rate of program participants change their behaviours and quite the substance use/drugs.
Impacts:
• The programme coverage has been expanded to 39 participating schools and plan to extend to other 20 schools.
• The participating schools goes beyond the conventional education and includes life skills teaching. The rise of number students who graduate from the participating school and could pursue the high education level.
• The awareness on the substance abuse screening in the community supported by the municipalities.
Question 10
Please describe how the initiative strives to work in an integrated manner within its institutional landscape – for example, how does the initiative work horizontally and/or vertically across different levels of government? (200 words maximum)
The relevant organizations collaborating in this initiative are as follows:
1. Phetchabun Narcotics Control Management Center
- Establishing the policy at the provincial level.
- Participating in planning and developing the guidelines for risk and addict groups.
- Establishing the framework and mechanisms using an active approach.
- Setting up the drug prevention training programmes in the schools.
- Conducting the evaluation together with the Provincial Education Office.
2. Phetchabun Hospital
- Adjusting the screening process in the schools by working together with the Police and Administration Department, the Ministry of Interior.
- Adjusting the therapy process using the holistic approach and developing an individual care plan based on social capital and family involvement
3. The Police
- Adjusting the drug inspection mechanism in the educational institutions by using the active approach.
4. Educational institutions and schools
- Surveillance survey both routine and occasional time.
- Working together with the Phetchabun Hospital in follow up the children and youths to attend the educational institutions.
- Launch Institute's policy for managment all school-based program.
5. Community, Municipality
- Support all program by Budget and some resources.
Question 11
The 2030 Agenda for Sustainable Development puts emphasis on collaboration, engagement, partnerships, and inclusion. Please describe which stakeholders were engaged in designing, implementing and evaluating the initiative and how this engagement took place. (200 words maximum)
The integration of the government organizations has been initiated from the national policy, i.e. the mandate of National Council for Peace and Order (NCPO) No.108/2014, which indicates the key issue on access to health service of the substance abuse suspects. The collaboration among stakeholders are as follows:
1. Providing the drug outbreak information and the prevalence of drug use at the district level.
2. Designing on working and care process with the integrated goals by the multi-profession team in order to follow-up and bring the children and youths out of the drug circle.
3. Developing a working mechanism as the steering team at the operational level in order to coordinate the information and monitoring the program.
4. The early evaluation showed the variations of the same information across the different organizations. This leads to the establishment of working mechanism at the provincial level. The policy monitoring and evaluation are directed by the provincial governor.
Question 12
Please describe the key lessons learned, and how your organization plans to improve the initiative. (200 words maximum)
Key lessons learned is the continuous care develops confidence and faith among high-risk adolescences, leading to the creation of life value. Collaboration with shared goals can comprehensively solve problems and create a value work, which leads to effectiveness, efficiency and sustainable development.
The initiative is going to be scaled up and expand to cover issues on adolescents: the prevention of mental health problems and teenage pregnancy.