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Rural & Urban services General comments Service provision in either urban or rural areas needs to aim to be cost-effective, evidence-based and highly accessible by individuals of any age or gender or socio-cultural background. Therefore, an assessment of needs, an existing service framework, and barriers for implementation of drug prevention initiatives should be carefully conducted, in order to develop effective service provision framework in either rural or urban areas. This report focused on discussing issues relatively unique to rural areas which could act as barriers for achieving programme success, since it has received a little attention in the past. Case studies were also described in order to illustrate project methods and some possible solutions to these barriers. Highlighting these issues or needs in rural service provision should help develop effective modernisation of service provision in either rural or urban areas. Evidence suggests that there is little difference in drug use among young people between rural and urban areas (Henderson, 1998). However, there are a number of drug-related issues, which are quite specific to rural areas. These issues can play a significant role in a success or failure of a drug prevention project. These issues can be summarised under three headings; geographical separation, community or non-individual level factors, and individual-level factors. Geographical separation has an impact on accessibility and cost of running services, which can negatively affect attendance rates and funding situations. Rural communities are often remote from large cities and health service provision tends to be sparse. This can cause burdens of high travel costs and long travel hours for both service providers and users, particularly where there is no good public transport system and/or travel conditions can be severely affected by bad weather. Several researchers found that travelling distance from home to GP surgery or hospital is negatively associated with attendance rates (Athana et al. 2002). The lack of public transport services is particularly an issue for drug prevention initiatives or drug services targeting young people (Mentor UK 2004; Cragg Ross Dawson 2003; Henderson 1998), as not all young people in rural areas not have access to frequent and reliable public transport services or a car. Asking for a lift from parents or friends to get to a specialist service may be resisted? if the young people wanted to keep their drug use private. Remoteness can also result in ineffective management and isolation of project workers, if managers and project workers are physically distant (Henderson 1998). It was explained that because of a relative lack of anonymity in rural areas, young people are highly visible and their public behaviour attract unnecessary focus from adults. Particularly, drugs or crime-related incidents in community could lead to a ‘panic’ or over-reaction in the community. These can adversely affect relationships between young people and adults in the community. Similarly, people who are not from community can be highly visible and project workers came from outside of the area are not an exception. They tend to be seen as ‘outsiders’ by community residents and achieving an ‘insider’ status may require some time and effort. Likewise, drug prevention projects brought into community by ‘outsider’ workers can be seen as ‘one-off’ and/or ‘imported’ initiatives and the community may be reluctant to support such initiatives. Moreover, there is a reluctance to recognise drug problems in the community and a tendency to attribute social problems to ‘outsiders’, which include drug using individuals. Furthermore, existing community groups are likely to be ‘traditional’ in a sense that they are not keen at acting on social issues. Individual-level factors tend to result from negative attitudes towards drug users and their families. Being stigmatised or labelled as a ‘drug user’ in a small-knit community probably has a significant adverse impact on every day life of the users and families. As a consequence, drug using individuals or family of drug users may not want to seek help or attend drug/alcohol prevention initiatives due to a fear of being labelled or stigmatised (Henderson 1998). Similarly, the stigma attached to drug use may prevent those young people to go to see their family doctors, reducing help/support seeking behaviour. Also, a study (Cragg Ross Dawson 2003) found that GPs tend to lack in knowledge of drugs/alcohol services and/or treatment (e.g. methadone prescription). Furthermore, some doctors do not want to have drug using individuals in their surgery. Likewise, some pharmacists may not want to dispense methadone. A consequence of these is that young people with alcohol/drug problems may not receive a referral to appropriate services. Substance use training for health professionals is also important to increase knowledge on drug treatment and services and foster positive attitudes towards those who use drugs. On the other hand, there is a low expectancies and awareness of services among people in rural areas due to the absence of local services, a lack of continued attention to rural areas by national policy, and under-developed service structure (Cragg Ross Dawson 2003; Henderson 1998). Henderson (1998) described four rural drug prevention initiatives in her report and these case studies illustrated that a variety of project methods have been used for community-based initiatives. The Somerset Parents’ and Rural Communities (SPARK) project in West Somerset was a National drug agency project with the aims of developing community drugs awareness, parent focused education, and parent support and counselling services. It provided parents with a range of services including advice and information sessions for parents’ groups, helplines, and family casework. Substance Misuse Prevention Development in Essex was a District Council project, aimed to create new and specific drugs prevention community initiatives. Its activities included production of guide for Parish and District Councils, parent support groups, drug awareness sessions for parents, peer education projects, and an information and advice bus. The Windmill Centre Drugs Education Project in Castle Donnington was a youth service project, developed in response to an increase in a local concern about drug use among young people in the area. It was a centre-based project and a number of activities were taken place, which included peer education groups/projects, art-based projects, development of a youth counselling service, and establishment of youth council. The Young People’s Mobile Advice and Information Programme was a youth work based mobile service in Sussex. There were five projects derived from this programme, which varied in the aims, formats, approaches, settings and durations. The ReachOut bus was one of the projects. It provided visitors with drugs and general information leaflets, posters and games, computers, and careers’ advice resources. It was equipped with a small kitchen facility and seating area and sold drinks and snacks. Also, drugs and sexual health sessions and peer education projects were held on the bus. The above mentioned projects were not evaluated for drugs use outcomes. However, a qualitative evaluation of these projects indicated that the communities and participants received a number of positive impacts from these initiatives (see Henderson 1998).
Secondly, it was explained that some projects were able to increase young people’s community involvement. For example, the youth projects provided young people with opportunities to be actively involved in their communities. Thirdly, changes in local structures and working traditions of local agencies and organisations were reported to be achieved. For example, it was explained that ReachOut model of working has significantly changed and extended local multi-agency working. Finally, positive changes in attitudes to and knowledge of drugs and drug issues among participants were reported, which could be attributed to the project effects. Multi-agency work The case studies (Henderson 1998) highlighted that multi-agency working plays an important role in development and maintenance of a drug prevention project in rural areas. Consultations with community and community leaders appear to be essential, in order to access vital local expertise and information for designing a meaningful programme for young people in the area. Personal contact including attendance at meetings and distribution of drugs information can provide opportunities for positive contact with the community. A problem with multi-agency work is that it can be expensive in terms of cost (e.g. travelling, administration) and time (building up trusting relationships with the community may take some time). In addition, there may be organisational restrictions which prevent collaborative working. However, building up good working relationships with community can help overcome a barrier of being ‘outsider’ and raise a profile of the programme. So, it accrues benefits over time, as implementation of the programme should then be more favourably accepted by the community. In addition, working with local media could increase a chance of successful implementation of a programme. The Windmill Project worked actively with local media, in order to raise an awareness of the project profile. A project team needs to have project workers with a wide range of skills. The four case studies illustrated that a successful project requires good networking, social, drug prevention related and evaluation/research/survey skills in project workers. Continuous support for project workers is important, particularly if their managers or colleagues are physically distant, they can experience psychological isolation and a lack of supervision (Henderson 1998). Hawkins et al. (2004) noted that there has been a long history of ‘parachute’ academics who ‘drop in’ to a Native American community to provide a prevention programme, who leaves as soon as data are collected. They emphasised an importance of building up a collaborative relationship with community and of providing long-term initiatives. Likewise, new initiatives in rural communities in the UK are also often seen as an ‘imported’ project (Henderson 1998). This indicates that a drug prevention programme should have a long-term perspective, in order for it to be effectively implemented and integrated in the community and its enduring outcomes to be assessed. Henderson (1998) provides a checklist of good practice for developing community based drug prevention in rural areas, which was based on conclusions and recommendations achieved from the four case studies. Some rural areas have transient and/or seasonal populations (e.g. tourists, dance or music festival attendees and travellers), which can affect local drug availability and/or drug use behaviour. Crew 2000 is an Edinburgh based drugs and sexual health information and advice service, which primarily target young people who use ‘dance drugs’ and those who work with young people (Parkin 1999). It is a peer education project, where volunteers lead the services. Apart from a drop-in drug and sexual health information service or ‘shop’ in Edinburgh, they also have delivered drug and sexual health information stalls and a crisis intervention service (Chill-out room) at youth/dance events (‘raves’ and festivals). The crisis intervention service involved volunteers giving verbal support to people who experienced acute negative responses to ingested drugs, for example, by giving them reassurance and distraction. These types of interventions may be able to minimise drug-related harm and prevent acute drug-related negative consequences among dance festival attendees, when rural areas host a music/dance festival. Asthana S, Halliday J, Bringham P, Gibson A (2002) Rural deprivation and service need: A review of the literature and an assessment of indicators for rural service planning. Bristol, South West Public Health Observatory Cragg Ross Dawson (2003) Drugs in rural areas: Qualitative research to assess the adequacy of communications and services. Report prepared for COI Communications and Home Office Hawkins EH, Cummins LH, Marlatt GA (2004) Preventing substance abuse in American Indian and Alaska Native Youth: Promising strategies for healthier communities. Psychological Bulletin 130: 304 - 323 Henderson S (1998) Drug prevention in rural areas: An evaluation report. London, Home Office Mentor UK (2004) Mentor UK rural youth project: Involving rural young people in evaluation. London, Department of Health |
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