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Health Drugs

Health - Drugs

Exit Survey

Which case study are you assessing?

Case study 1

Case study 2

Subject to a DRR?

Yes

On a scale of 1-10 how concerned are you about your drug use?

Not Concenered

Very Concerned

Which drugs do you use / have you used?

Have you ever injected or shared paraphenalia?

Yes

Have you ever been tested for blood-borne viruses?

Yes

Record description of testing and outcome

Would you like any support in getting tested?

Yes

** Vulnerabilities - Volunteer and Mentoring

Can you tell us more about the negative impacts of your drug use?

Record a description of the impacts

Where do you take drugs?

Who do you take drugs with?

Do you find that you are taken advantage of or hurt by other people due to your drug use?

Yes

Record details

**PW Flag - Vulnerable Person

**Home Visit may be required

What are the details of your current treatment provider?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

Phone :

Email Address :

Country :

Are you currently being prescribed any medication as part of your treatment?

Yes

Record medication in table format including whether it is being taken as prescribed and frequency (Dose and frequency)

	Name	Dose	Frequency	Taken as prescribed
Medication

Medication

Medication

Medication

Criminogenic Need Identified

Substance Misuse

CO/SSO?

Yes

Have you ever used drugs?

Yes

Is your drug use current?

Yes

On a scale of 1-10 how concerned are you about your drug use?

Not Concerned

Very Concerned

Which drugs do you use / have you used?

Has your drug use ever had a negative impact on you or anyone else?

Record description of impacts

Where do you take drugs?

Who do you take drugs with?

Do you find that you are taken advantage of or hurt by other people due to your drug use?

Yes

Record details

**PW Flag - Vulnerable Person

**Home Visit may be required

Are you currently in treatment?

Yes

Daily/almost daily use of any drugs indicated?

Yes

Current use of opiates and/or Crack?

Yes

Current use of Cannabis, NPS, Cocaine?

Yes

Were any negative impacts indicated?

Yes

What are the details of your current treatment provider?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

Phone :

Email Address :

Country :

Are you currently being prescribed any medication as part of your treatment??

Yes

Record medication in table format including whether it is being taken as prescribed and frequency (Dose and frequency)

	Name	Dose	Frequency	Taken as prescribed
Medication

Medication

Medication

Medication

Which drugs do you use / have you used?

Record details of previous drug use including how long ago and frequency of misuse

Has your drug use ever had a negative impact on you or anyone else?

Description of impacts

What supports you in your abstinence/recovery?

Who supports you?

First Name :
Last Name :
Relationship :

Who supports you 2

First Name :
Last Name :
Relationship :

Is there anything in addition to your treatment which supports you in your recovery/abstinence?

Have you ever used drugs?

Yes

Were you using drugs before you went into prison?

Yes

Did you continue using these drugs in prison or take any others?

Yes

On a scale of 1-10 how concernd are you about your drug use prior to custody?

Not Concerned

Very Concerned

Which drugs where you using before custody?

Has your drug use ever had a negative impact on you or anyone else?

Record details of impacts

Where did you take drugs?

Who did you take drugs with?

Did you find that you were taken advantage of or hurt by other people due to your drug use?

Yes

Record details

**PW Flag - Vulnerable Person

**Home Visit may be required

Are you currently in treatment?

Yes

Do you think that you are likely to return to drug use now that you are out of custody?

Yes

Would you like any support in maintaining your abstinence from drugs?

Yes

Would you like support in arranging or attending an appointment?

Yes

** Vulnerabilities - Volunteer and Mentoring

Daily/almost daily use of any drugs?

Yes

Current use of opiates and/or Crack?

Yes

Current use of Cannabis, NPS, Cocaine?

Yes

Were any negative impacts indicated?

Yes

What are the details of your current treatment provider?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

Phone :

Email Address :

Country :

Are you currently being prescribed any medication as part of your treatment?

Yes

Record medication in table format including whether it is being taken as prescribed and frequency (Dose and frequency)

	Name	Dose	Frequency	Taken as prescribed
Medication

Medication

Medication

Medication

On a scale of 1-10 how concerned are you about your drug use?

Not Concerned

Very Concerned

During your time in custody which drugs did you use?

Were there any negative impacts of your drug use?

Record description of impacts

What drugs did you use before you were in custody?

Have you ever injected or shared paraphenalia?

Yes

Have you ever been tested for blood-borne viruses??

Yes

Record description of testing and outcome

Would you like support to get tested

Yes

** Vulnerabilities - Volunteer and Mentoring

Were any negative impacts indicated?

Yes

Where do you take drugs?

Who do you take drugs with?

Do you find that you are taken advantage of or hurt by other people due to your drug use?

Yes

Record details

**PW Flag - Vulnerable Person

**Home Visit may be required

Are you currently in treatment?

Yes

Daily/almost daily use of any drugs?

Yes

Current use of opiates and/or Crack?

Yes

Current use of Cannabis, NPS, Cocaine?

Yes

Were any negative impacts indicated?

Yes

What are the details of your current treatment provider?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

Phone :

Email Address :

Country :

How often do you attend the treatment centre?

Daily

Almost daily

Weekly

Fortnightly

Are you currently being prescribed any medication as part of your treatment?

Yes

Record medication in table format including whether it is being taken as prescribed and frequency (Dose and frequency)

	Name	Dose	Frequency	Taken as prescribed
Medication

Medication

Medication

Medication

Did you use any drugs in prison?

Yes

On a scale of 1-10 how concerned are you about your drug use?

Not Concerned

Very Concerned

During your time in custody which drugs did you use?

Did you inject or share paraphenalia in custody?

Yes

Have you ever been tested for blood-borne viruses?

Yes

Record description of testing and outcome

Would you like any support to get tested?

Yes

** Vulnerabilities - Volunteer and Mentoring

Were there any negative impacts of your drug use?

Record description of impacts

Do you think you will continue to use drugs?

Yes

Do you feel confident that you won't use drugs again?

Yes

Would you like support in arranging or attending an appointment?

Yes

** Vulnerabilities - Volunteer and Mentoring

Are you currently getting support from a treatment provider?

Yes

Daily/almost daily use of any drugs?

Yes

Current use of opiates and/or Crack?

Yes

Current use of Cannabis, NPS, Cocaine?

Yes

Were any negative impacts indicated?

Yes

What are the details of your current treatment provider?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

Phone :

Email Address :

Country :

Are you currently being prescribed any medication as part of your treatment?

Yes

Record medication in table format including whether it is being taken as prescribed and frequency (Dose and frequency)

	Name	Dose	Frequency	Taken as prescribed
Medication

Medication

Medication

Medication

What drugs have you previously used?

Record details of previous drug use

Has your drug use ever had a negative impact on you or anyone else?

Description of impacts

What supports you in your abstinence/recovery?

Who supports you?

First Name :
Last Name :
Relationship :

Who supports you 2

First Name :
Last Name :
Relationship :

Is there anything in addition to your treatment which supports you in your recovery/abstinence?

Criminogenic Need Identified

Substance Misuse

Is Health - Drugs linked to

	Yes	No
Risk of Re-offending

Risk of Serious Harm

PW Assessment POC

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