national af tercare research project report year...

National Aftercare Research Project Report Year 1

Acknowledgements Addaction would like to take this opportunity to thank those service providers who participated in this survey for providing their views and insights into aftercare provision. We would also like to extend our appreciation to members of the project steering group for their guidance, expertise and support during the first year of the research.

Steve Cooke – Chief Executive, Nelson Trust

Wendy Dale – Divisional Director Newcastle, National Probation Service Northumbria Area

Jackie Kennedy – North East Area Manager, Addaction

Mal Maclean – Deputy Regional Manager, North East, NTA

Cath Pollard – Drug Strategy Unit, HM Prison Service.

Ian Robinson (Chair) – Chief Executive, EATA

Shereen Sadiq – Aftercare Lead, Drug Interventions Programme, Home Office

Dave Wadeley – Area Drug Strategy Co-ordinator (North-East), HM Prison Service

Anne Williams – Drugs Implementation Advisor, National Probation Directorate

Pauline Womack, Deputy Regional Resettlement Coordinator, East Midlands

Prison Service Area Office.

The author would like to thank a number of Addaction staff for their contribution to Year one of the project and for their ongoing support of the project. They include Leanne Davis, Sarah Drainey, Shaun Huxley, Sara Jones, Jennifer Rooney, Jerry Stokes and Natalie wood.

Proof Reading; Alex Clarke ([email protected])

'Aftercare is not only the job of substance misuse services. What such services can offer is severely curtailed if there is not a multiplicity of other provision – such as employment and housing'

CEO, NORCAS

National Aftercare Research Report Version 1 November 2004 Addaction © all rights reserved

Contents Introduction QuADS standards and key Addaction reference manuals

SUMMARY OF KEY FINDINGS

EXECUTIVE SUMMARY

CHAPTER ONE – INTRODUCTION Section 1.1 Understanding the context 1.2 Methodology 1.3 Review of the literature

CHAPTER TWO – PROFILE OF SERVICES Section 2.1 Introduction 2.2 CARAT Services 2.3 Community based services 2.4 Residential services

CHAPTER THREE – THE CLIENT PROFILE Section 3.1 Introduction 3.2 CARAT Services 3.3 Community based services 3.4 Residential services

CHAPTER FOUR – CLIENT CONCERNS WHEN ACCESSING AFTERCARE SERVICE: A PROVIDER’S PERSPECTIVE

CHAPTER FIVE – AFTERCARE: THE PROVIDERS’ PERSPECTIVE Section 5.1 Introduction 5.2 CARAT Services 5.3 Community based services 5.4 Residential services 5.5 Potential Improvements to the aftercare system 5.6 Examples of interesting practice

CHAPTER SIX – DISCUSSION

CHAPTER SEVEN – CONCLUSIONS AND RECOMMENDATIONS


APPENDICIES

APPENDIX 1 – CARAT SERVICE QUESTIONNAIRE

APPENDIX 2 – COMMUNITY BASED SERVICE QUESTIONNAIRE

APPENDIX 3 – RESIDENTIAL SERVICE QUESTIONNAIRE

BIBLOGRAPHY


Summary of survey key findings Profile of services

• 13% of responding CARAT (Counselling, Assessment, Referral, Advice and Throughcare) services do not contribute to the development of aftercare packages

• Nearly a quarter (24%) of responding providers of community-based services do not provide specific aftercare services for prison leavers

• Over half (54%) of the community-based providers that responded stated that there are no specific local plans in place to guide the provision of aftercare

• Less than a fifth of community-based providers that participated in the survey receive funding to provide specific aftercare interventions for prison/residential leavers

• Three-quarters of community-based providers who responded are not funded to provide specific aftercare interventions for prison/residential leavers

• Less than a fifth of community-based respondents have specified targets and outcomes for their aftercare service

• Only 10% of community-based services who participated in the survey have had their aftercare service externally evaluated

• A fifth of residential services that responded to the survey do not provide specific aftercare services

• Over half (56%) of residential service respondents do not receive specific funding for aftercare

• Only a quarter of participating residential services have specified targets and outcomes for their aftercare service.

Working together

• Over three quarters of participating CARAT teams felt that working links with prison departments/agencies could be improved

• 64% of CARAT teams that responded to the survey indicated that referral protocols and referral pathways could be improved between prison departments/agencies

• CARAT teams, self-referrals and the probation service were the principle referrers of prison/residential leavers to community-based providers

• 61% of community-based providers that responded to the survey have not developed any formal protocols with prisons/and or residential services

• Almost two-thirds (65%) of community-based respondents felt that referral protocols and pathways could be improved.


Barriers and blocks to providing effective aftercare services

• 44% of participating community-based services operate a waiting list to access services

• The lack of specific funding for aftercare services and the lack of housing provision for prison and residential leavers were two of the main blocks to providing effective packages of care

• Other issues raised specifically by community-based providers were poor communications and the lack of notice regarding the release of offenders from prison and the issue of waiting-times at some community-based services. The issue of waiting-times to access community-based treatment was also raised by CARAT services

• Concerns regarding housing and drug use were consistently highlighted as key issues for clients returning to the community.

Aftercare: the view from services

• The majority of respondents felt that aftercare services can be improved (89% CARAT, 78% residential and 63% community-based services)

• The majority of respondents felt that aftercare services were important (100% CARAT, 94% residential and 88% community-based services).


Executive summary 1.1 Introduction

Breaking the link between drugs and crime has been a key feature of government anti-drug strategies since the mid-1990s (UKADCU 2000). The thrust of government policy in this area has been aimed at ensuring that effective treatment is available for those accessing the criminal justice services.

For prisoners who want to address drug-related issues, at present, the main co-ordinating function of aftercare is conducted through CARAT teams. In every prison a team of CARAT workers provides a range of services to any prisoner with a drug problem. Prior to release, CARAT teams refer prisoners to appropriate services in the community. CARAT services therefore act as a bridge between prison and community service provision.

Prisoners, especially drug users, face a number of resettlement issues on release. Relapse, homelessness, unemployment and re-offending are potential difficulties that prisoners face on release. Without effective support mechanisms in place these areas of concern would be more problematic.

Good aftercare should be a tool that helps offenders back into the community after their prison sentence or after a drug treatment programme that has taken them away from the community for a period of time. Aftercare should be a continuation of the work carried out in prison but should have a particular focus on integrating the individual back into the community (Fox 2000). Aftercare provision should be a holistic, long-term approach to treatment that helps the individual establish effective, relevant links with community services that will ease the integration process. It should also be flexible and extensive enough to meet the diverse needs of all prisoners being released who have been identified as having a drug misuse problem. A comprehensive aftercare service would help support the individual following their release. This networked approach to treatment, which would include follow-up appointments, would ensure that all issues were being dealt with and would hopefully help the prison leaver successfully re-integrate into the community and reduce the risk of relapse.

The limited research that has been done into this important area of policy in the United Kingdom has highlighted the gaps in existing provision. At this key time in the development of the throughcare and aftercare elements of the Drug Interventions Programme (formerly known as the Criminal Justice Interventions Programme (CJIP)), this research aims to ensure that the concerns and insights of those currently working within the field have an influence on the unfolding aftercare agenda.

1.2 Methodology

A semi-structured, self-completion questionnaire was designed to gather information and views on areas relating to service delivery and a number of issues specifically relating to aftercare. Questions included:

• Information about current service provision

• Referral pathways/working links

• A profile of the agencies’ client-base


• Strengths/blocks/improvements. This section provided an opportunity for agencies to comment on the particular strengths of their services, offer opinion on barriers to the delivery of aftercare and give advice on how these barriers may be overcome.

1.2.1 Three postal surveys have been completed with CARAT services, community-based services and residential services. A total of 833 surveys were distributed. Response rates across the three areas were 56% for CARAT responders, 27% for community-based providers and 26% for residential services. An overall response rate was 36%.

1.3 Key survey findings

1.3.1 Profile of services

CARAT services

• Over three-quarters of CARAT services provide a needs-led service

• All CARAT services provide one-to-one support, advice and information

• 89% of CARAT services do not have a specific treatment philosophy

• 97% of CARAT services contribute to the release-planning of prisoners

• 80% of CARAT services have a role in the development of aftercare packages of prisoners

• 13% do not contribute to aftercare packages

• CARAT services reported that the establishment of community links, such as accommodation, employment, education and training links, through to specific support in relation to drug use itself, is key to the development of an aftercare package for prisoners.

Community-based services

• Nearly three-quarters (73%) of community-based services provide specific aftercare services for prison leavers

• Nearly a quarter (24%) of providers do not provide specific services for this client group

• 63% of community-based providers provide specific aftercare services for residential leavers

• 65% of community providers provide a needs-led package of care

• Over half (56%) of the community-based providers reported that their aftercare service did not target a specific group of clients

• Over half (54%) of the community-based providers that responded stated that there are no specific local plans in place to guide the provision of aftercare

• Less than a fifth (18%) of community respondents receive funding to provide specific aftercare interventions for prison/residential leavers


• Three-quarters of community-based providers are not funded to provide specific aftercare interventions for prison/residential leavers

• 80% of community providers deliver relapse prevention support and a range of other services. Over half of community providers provide housing advice and referrals. 10% of services provide prison gate pick-up on release

• Only 17% of community respondents had permanent funding, while 65% of respondents did not state whether funding was permanent or temporary

• 57% of community providers offer advice, information and support to families, 50% provide prescribing interventions, 56% provide housing advice and housing referrals and 42% provide education, training and employment advice

• 18% of community-based providers have specified targets and outcomes for their aftercare service

• Only 10% of community-based services have had their aftercare service externally evaluated.

Residential services

• All of the residential service respondents offered one-to-one and relapse prevention support, while 60% of respondents offered advice/information and support for families

• 69% of residential establishments do not specifically provide aftercare services to prison leavers

• Only 6% of residential services reported having specific funding to provide services to prison leavers

• 81% of residential services provide a specific aftercare service for those leaving their services and returning to the community

• 19% of residential services do not provide specific aftercare services

• Over half (56%) of residential services do not receive specific funding for aftercare

• Only 25% of residential services have specified targets and outcomes for their aftercare service.

1.4 Engagement with aftercare services

• The average length of engagement with community-based services was spread across the whole ‘time spectrum’ from 0 – two weeks, up to six months and over. However, over a quarter of prison leavers continued to access community-based services over six months from release. Over a fifth (22%) of prisoners disengaged from services between two and four weeks

• 37% of residential leavers continued to access community-based providers for six months or more following their return to the community.


1.5.1 Client concerns

• At first contact with services, respondents were asked to state the three main concerns of prison leavers/offenders. Drug use and housing were consistently rated highly and this remained the case prior to release or when leaving treatment. Family and financial issues were also of importance and mentioned most frequently along with drug use and housing.

1.6 Aftercare: the providers’ perspective

Working together

1.6.1 CARAT services

• Over 94% of CARAT teams have formal links with healthcare services. Nearly 60% have formal links with resettlement teams, and 43% have already developed formal links with CJIP teams

• Over three–quarters of CARAT teams felt that working links with prison departments/agencies could be improved

• 64% of CARAT teams felt that referral protocols and referral pathways could be improved between prison departments/agencies.

1.6.2 Residential services

• 78% of residential services refer on to community-based aftercare services, with over half of the respondents referring on to community-based services (59%), 59% to self-help groups, 55% to local colleges and 55% to housing-related agencies

• 75% of residential agencies had developed formal working links with social services

• 75% of residential services had developed informal working links with self-help groups

• 50% of residential services had developed specific links/pathways with HM prison establishments.

1.6.3 Community-based services

• CARAT teams, self-referrals and the probation service were the principal referrers of prison/residential leavers to community-based providers

• 61% of community-based providers have not developed any formal protocols with prisons and/or residential services

• Almost two-thirds (65%) of community providers felt that referral protocols and pathways could be improved

• 72% of community providers have developed formal working links with social services

• 44% of community-based services operate a waiting list to access services.


1.6.4 The importance of aftercare

• All of the CARAT respondents agreed that aftercare was important. CARAT participants felt that aftercare was important in ensuring that gains made in prison were sustained on release. Vulnerability to relapse and potential risk of overdose were also highlighted as key areas in aftercare provision. CARAT services also felt that aftercare was important in supporting clients gaining access to a range of practical services, including housing, benefits and other community-based services.

• 94% of residential services felt that the provision of aftercare services was important. Residential respondents also highlighted the need to reduce relapse and promote ‘recovery’ through this period. The promotion of independence, combined with appropriate support, was also an important balance to strike through this transitional period.

• 88% of community-based providers felt that it was important to provide aftercare services to prison/residential leavers. Relapse and overdose prevention were an important factor for community services, in addition for the need to support change and promote a continuation of treatment. Practical assistance and ‘signposting’ clients to a range of other community services (such as housing, benefits, education and employment) were also noted as significant for community providers.

1.6.5 The strengths of services

• Community-based providers felt that they had a number of key strengths in terms of service provision. Ease of access, in terms of immediacy and availability was highlighted as a key service strength. The commitment, knowledge and dedication of community-based staff and their excellent understanding of local services and resources was also highlighted as an advantage when ‘signposting’ clients to appropriate local services.

• CARAT respondents felt that their ability to liaise and work effectively with a wide range of partners was a specific key strength in the delivery of their service. CARAT participants also felt that the commitment and qualities of their staff were instrumental in their success, in addition to the ‘values’ held by the CARAT teams themselves.

1.6.6 Barriers and blocks to providing effective aftercare services

• The lack of specific funding for aftercare services and the lack of housing provision for prison

and residential leavers were two of the main blocks to providing effective packages of care

• Other issues raised specifically by community-based providers were poor communication and the lack of notice regarding the release of offenders from prison and the issue of waiting-times at some community-based services. The issue of waiting-times to access community-based treatment was also raised by CARAT services.


1.6.7 Potential improvements to aftercare services

• The majority of respondents felt that aftercare services can be improved (89% CARAT, 78% residential and 63% community-based services)

• Areas of improvement mentioned across all provider sectors were a) increased provision of suitable accommodation and housing and b) funding to provide specific aftercare services and employ specific workers. Also highlighted was the need to improve communication amongst agencies involved in delivering aftercare services to ensure continuity.

1.7 Discussion

1.7.1 Aftercare for offenders has recently been given an increased governmental priority, with additional funding and resources, via the implementation of the Drug Interventions Programme. The development of throughcare and aftercare provision is at the heart of the programme, in terms of bridging the gap for those drug misusing offenders leaving the criminal justice system and entering treatment in the community. Integrated multi-agency local drug teams, adopting a case management approach provide a focal point in the delivery of care to individuals within the criminal justice system. It has facilitated the development of specific teams/workers, offering access to treatment and support. Support begins at an offenders first point of contact within the criminal justice system and is then available through custody, court, sentence and beyond, into resettlement (Home Office, 2004). Implementation of the throughcare and aftercare elements of the Drug Interventions Programme has drawn upon good practice and has included key research and literature findings that will increase the effectiveness of provision by improving engagement with the service and ultimately treatment success.

1.7.2 Aftercare services (in their widest sense) have served communities for years. Many of the services are specific to the substance misuse field, such as community-drug agencies and clinical interventions. But most of the services involved in aftercare relate to all citizens, e.g. leisure facilities, access to GPs and primary care interventions, access to appropriate housing, employment, educational and training opportunities and access to community and support groups. Aftercare, in respect of those leaving prison and those in residential services, who have, or may still be, misusing substances is about ‘continuing care’ and building on any work undertaken within prison and within residential services. Therefore, two important points are a) having access to these services and b) ensuring that client services are co-ordinated and appropriate to client need.

1.7.3 As with Turnbull and McSweeney’s (2000) research, amongst respondents, there was a common agreement that aftercare is an important factor to treatment success. The need to sustain any gains made with clients throughout their stay in custody or their residential stay was considered to be important. Indeed, the effectiveness of aftercare in reducing re-offending and relapse rates is well documented (Fox;2000, Gossop;2001). Respondents also highlighted the key role that aftercare services can play in terms of ensuring that information relating to harm reduction and overdose prevention are consistently delivered. Aftercare, and specifically the role that community-based providers can play in terms of ‘signposting’ clients and supporting clients through this transitional period was also highlighted.

1.7.4 The issue of funding, and the funding of aftercare-specific services, was also raised within the research. Just over half of residential services receive funding for aftercare services and less than a


fifth of community-based providers stated that their funding was of a permanent nature. Given the timing of the research, it is possible that the advent and roll out of funding for the throughcare and aftercare elements of the Drug Interventions Programme, from April 2004 to all DAT partnerships in England and Wales, will impact on the further funding of aftercare services.

1.7.5 Although services may not have been established as an aftercare specific service, and where services are not in receipt of specific aftercare funding, the research highlights that many services provide aftercare in the community as an element of their service delivery. A number of respondents highlighted a range of examples of practice that have attempted to meet client need. Such examples give an insight into the innovation and commitment from services within the field. From the residential sector, examples included continued personal contact with a key worker, weekly ex-residents support meetings, resettlement workshops in the transition period, access to an aftercare group (with professional facilitation) and the provision of ‘move on’ accommodation. Examples from community-providers include proactive engagement from workers. Schemes such as ‘in-reach’ workers from the community meeting prisoners prior to release, ‘gate pick-up’ services to meet prisoners on their release and the provision of mentoring schemes were all being delivered by community-based providers.

1.7.6 Drug use and housing were consistently highlighted by services as a principal concern for both male and female clients when re-entering the community. The need for appropriate, flexible and responsive accommodation is seen as a key determinant of client success in goal achievement. As drug use also remains a key concern for clients, it is also essential that clients continue to engage with services that specialise in the delivery of treatment packages relating to substance use.

1.7.7 The research highlights the extensive and diverse working links within the field, both formal and informal. Nevertheless, almost two-thirds of community providers and 64% of CARAT teams felt that links and referral protocols could be improved. Specifically addressing the key relationship between CARAT teams and community providers, it is clear that in a relatively short period of time, relationships and arrangements between the two service types have developed apace. Many CARAT services highlighted their ability to build, sustain and develop relationship with a wide range of partners (internal and external) as a key strength of their service. However, community-based providers felt that poor communication was also a barrier to the delivery of an effective aftercare service.

1.7.8 CARAT services reported that the establishment of community links, such as accommodation, employment, education and training, through to specific support in relation to drug use itself, were key components in the development of an aftercare package for prisoners. However, a number of CARAT teams also highlighted their lack of information on local services as a barrier and also commented on the limitations on putting effective aftercare packages in place when working with prisoners who are returning to another area.

1.7.9 The importance of accessing services was also highlighted within the study. The research emphasised not only limited access due to geographical location, particularly issues related to transport and the lack of rural provision, but also access to treatment services because of waiting times. Both community-based services and CARAT teams cited waiting times as a key barrier to a ‘continuum of care’ and support. Indeed, 44% of community-based services operate a waiting list. Fixed agency appointment times, immediate client access and even the possibility of 24-hour access to community-based services were also proffered by CARAT teams as solutions to the problem.


1.7.10 The survey highlighted a dearth of information relating to clients who are referred to, or who attend, services for specific aftercare interventions. Nearly one-quarter of community-based responders to the survey reported that specific demographic information was not collected.

1.7.11 Many CARAT, community-based providers and residential services felt strongly that aftercare provision could be improved and agreed on the importance of aftercare provision. It is hoped that this commitment from all services, linked with increased resources and funding, of which the throughcare and aftercare elements of the Drug Interventions Programme is an important element, will ensure that the aftercare agenda continues to ‘move on’.

1.8 Conclusions and recommendations

1.8.1 Housing was consistently highlighted as a key component in the delivery of effective aftercare services. Action related to housing can be undertaken on a number of levels:

• At a local level, and in the short term, there is an opportunity for community-based drug teams and local housing providers to forge closer working relationships. The importance of housing highlights the needs for ‘housing specialists’ within community-based drug teams. Specialist housing workers can build strong links with local housing providers and remain focussed on local housing issues and availability, from a substance misuse perspective. A dynamic two-way relationship between housing providers and community-based providers has the potential for community-drug agencies to influence the local housing agenda and ensure that housing providers remain aware of the needs of those leaving prison and residential establishments and returning to the community. This will also enable community-drug agency workers to focus on ‘drug issues’, which, as reported in the survey, naturally remains a key concern for clients.

• The ‘Supporting People’ agenda is a key national strategic-driver in the area of housing, and has the potential to address local housing needs for those clients requiring accommodation following release from prison or leaving a residential service. The research has highlighted the significant and central role of housing within an aftercare context.

• It is therefore imperative that Drug Action Team Co-ordinators and Supporting People teams work in partnership to establish local housing need and formulate and develop local strategies for this client-group.

• In the medium to long term, it is essential that policy-makers remain aware of the need for further and continued investment in appropriate housing, and housing services, for prison and residential leavers.

1.8.2 The need to have a specialised aftercare service, or at the very least a co-ordinating agency, was also emphasised by many respondents within the study. Many community-based services felt that their local knowledge and signposting expertise was a particular strength of their service. Co-ordination and management of a clients’ ‘package of care’ is an important component within the aftercare element of the Drug Interventions Programme. In this respect, it is essential that the Home Office continues to monitor and review this aspect of the Drug Interventions Programme to ensure that it continues to meet the needs of clients.


1.8.3 Respondents consistently reported, for both male and female clients, family relationships, and childcare specifically for female clients, were key areas of concern. It is therefore important that community-based providers have the expertise, or can access such expertise through partnership agencies, in order to work holistically and systemically with families, when developing an individual’s aftercare support. It is the responsibility of local agencies to ensure that these arrangements are in place. At a local strategic level, Drug Action Teams and commissioners need to remain aware of the importance of services providing, or providing access to, such services.

1.8.4 The relationship between community-based providers and CARAT teams is key in terms of ‘bridging’ treatment within custody and within communities. Whilst this relationship has continued to develop since the inception of CARAT’s in 1998, the research has emphasised the need for a renewed educational and networking process between CARAT teams and community-based services. Area Drug Co-ordinators from the HM Prison Service and local Drug Action Teams have an opportunity to work together and develop partnerships to renew this process and further develop an understanding between these ‘key players’ at a local level. It is important that a joint working ethos, an ethos that is based on mutual understanding and respect, is developed locally between these pivotal agencies.

1.8.5 A lack of specific aftercare targets within the community is highlighted by the research. Less than a fifth (18%) of community-based providers confirmed that they have specified targets and outcomes for their aftercare services. A range of ‘hard’ and ‘soft’ targets are employed by community-based services to monitor outcomes. Many of the services stated that these targets were currently under review or being negotiated with Drug Action Teams, funders and commissioners at a local level. It is important that targets are consistently in place across services to ensure that all services delivering elements of aftercare are providing ‘effective’ aftercare options to prison and residential leavers.

1.8.6 While it is important to provide a holistic aftercare service (Harrison, 2002) the vast majority of community-based providers who responded to the survey were not specifically delivering an aftercare service, but had developed aspects of their service to incorporate an aftercare element, in line with client need.

1.8.7 The research provided a description of aftercare (see page 21) to guide responses to the questionnaire. In addition to specific drug-related aftercare interventions, the description highlighted the potential range of aftercare support available, thus enabling respondents the opportunity to address a wide spectrum of issues. Responses to the survey highlighted the variance in the content and extent of aftercare provision. For example, the majority of community-based respondents provided one-to-one work and relapse prevention (92% and 80% respectively). However, fewer respondents provided a wider range of aftercare provision. This included specific interventions, such as prison gate pick-up on release (10%) and the provision of primary healthcare (28%). Non-specific drug interventions tended to be provided in partnership with other agencies. Of interest, are the issues of housing advice/referral which is delivered in partnership by 59% of community-based respondents and education, training, employment advice and referrals (58%).

1.8.8 This disparity does highlight a need for a definition of aftercare provision to be developed. This may ensure consistency, for example, in the delivery of core, auxiliary and supporting services, and to allow national benchmarking and insights into good practice. Undertaken on a national scale, through the National Treatment Agency or through the Home Office, this clarification and consultation process would ensure that future targets and outcomes could be established at a national level, across all


services, not only aftercare services delivered within a criminal justice context. As a consequence of this exercise, there is the potential to initiate and embark upon, a national benchmarking exercise in aftercare services. A minimum data set of information, collected by all specific aftercare services, and a range of information collected by community-based providers providing aftercare services, and monitored on a regional or national level, would ensure that clients receive a consistently effective and high quality service from all providers.

1.8.9 The roll out of the throughcare and aftercare elements of the Drug Interventions Programme to all DAT partnerships in England and Wales from April 2004 should impact on this area of work and may provide an opportunity, also on a national level, to ensure that there is a consistency of recording data in terms of the delivery of aftercare and the monitoring of gains. This would help to develop an overall picture of effective practice and build up a broader and more consistent picture of ‘What Works’ on a national level. It is essential that this information is ‘cascaded down’ from the Home Office to local Drug Action Teams and ultimately disseminated to agencies at a local level.

1.8.10 A number of agencies within the research supported the view that user involvement should also play a key role in the planning and delivering of effective aftercare services. It is the responsibility of agencies to involve users and carers in the planning and development of services. Once again, at a local level, agencies have a responsibility to facilitate the involvement and consultation on service development with users and carers, and local commissioners and Drug Action Teams should also ensure that active involvement is encouraged through funding arrangements. At a regional and national level, the National Treatment Agency also have a responsibility in continuing to ensure that users and carers are involved in the development of aftercare services. National best practice linked with a strong ‘user voice’ at a local level should help to ensure that services remain relevant to local need.

1.8.11 Opportunities exist at all levels - local, regional and national - to maximise service potential for those clients accessing aftercare services. This report highlights the diverse nature of aftercare services that have developed nationally, to address the needs of local people. As previously discussed, it is hoped that many of the concerns highlighted by providers within the research will be addressed by the Drug Interventions Programme. However, a number of clients accessing ‘aftercare services’ following a residential programme for example, may not be a client within the criminal justice system. It is therefore important that policy-makers remain aware of the need to offer equity of access and equality of opportunity to all those clients wishing to build on the positive changes that they have made to their life.


Chapter One: Introduction

NVA

ational Aftercare Research Report ersion 1 November 2004 ddaction © all rights reserved

Introduction 1.1 Understanding the Context 1.1.1 Addaction was successful in securing monies to fund a national demonstration drug treatment aftercare

project. The remit of the work includes a research and mapping exercise in year one to profile existing aftercare provision and to identify models of good practice.

1.1.2 Dissemination of year one findings will be an important aspect of year two of the project. Through this process, the possibility of establishing a means of connecting services with an interest in aftercare will also be explored.

1.1.3 In year two the project will also study models of aftercare delivered in a number of DAT areas in the North east of England and, where possible, incorporate issues and findings from year one of the project to help guide the study for year two.

1.1.4 A steering group consisting of a number of individuals within key work areas has been convened during the course of the research to ensure that the project remains informed and focussed.

1.1.5 Year three of the project will incorporate a comprehensive dissemination programme, including a national conference and full report.

1.1.6 This report represents the first part of phase one of the project. A secondary phase that encompasses both year one and year two of the research involves prison leaver input. An extended Drug Interventions Programme aftercare survey involving the interviewing of 350 prison and DTTO leavers will ascertain their views on the development of aftercare services in general, and, more specifically, seek to engage them on their experiences, perceptions and needs from such services.

1.1.7 The aim of the research project in its entirety is to establish the following:

• The need for aftercare services for prison/residential leavers aged 18 years and over with drug misuse issues

• How aftercare services are currently delivered

• The nature and type of aftercare services available for prison/residential leavers with drug misuse issues

• The effectiveness of the current operating model


The research also aims to identify models of good practice in aftercare provision and ensure that learning will be disseminated throughout the field.

1.1.8 This report represents the findings of the first stage of the ‘mapping of current provision’, whilst also gauging an extensive ‘view from the field’ across three service types – community-based providers, CARAT teams and residential services.

The impact of the Drug Interventions Programme

1.1.9 Since the commencement of the research in 2003, there has been an increased government interest in aftercare and subsequent substantial investment in services. The investment is strongly linked to the Drug Interventions Programme agenda and will naturally lead to a renewed focus on the performance and effectiveness of aftercare.

1.1.10 At the end of the project’s first research year, it is important that the significant resource, investment and structural changes that have taken place are considered to ensure that the research can continue to maximise its potential, significance and relevance.

1.1.11 The period of transition and national development in aftercare services currently in progress provides an opportunity for the research to review the system of aftercare prior to the programme investment in throughcare and aftercare and to re-assess the impact of the changes.

1.1.12 There are elements of Addaction’s original bid that have gained an increased significance since 2003, whilst other elements of the bid may have been superseded by the Drug Interventions Programme investment.

1.1.13 Addaction’s research provides an ideal opportunity to assess the issues surrounding aftercare for CARATs, community-based providers and providers of residential rehabilitation programmes. The interviews with offenders remain relevant and are an exciting opportunity to map the needs and perceptions of prison-leavers.

1.1.14 This remains significant research which can further inform delivery and implementation of the throughcare and aftercare elements of the Drug Interventions Programme. It will be of particular interest to evaluate the development of such services in relation to the needs of offenders. It is also anticipated that the research may help to ‘widen the scope’ of aftercare and to build in components of aftercare that have not been covered by the Drug Interventions Programme. An additional element to the research will be the exploration of service development in order to deliver a national strategy, whilst also ensuring that services remain relevant to ‘local people’.


1.2 Methodology

How the consultation was carried out

1.2.1 A semi-structured self-completion questionnaire was designed to gather information and views on a number of areas related to service delivery, specifically relating to aftercare.

Areas covered included:

• Current service provision

• Referral pathways/working links

• A profile of the agencies’ client-base

• Strengths/blocks/improvements. This section provided an opportunity for agencies and services to offer their opinions on barriers to the delivery of aftercare, and how some of these barriers may be overcome.

1.2.2 The literature search provided key areas/issues that needed to be included in the questionnaires. Three semi-structured self-completion questionnaires were designed - one for community-based services, one for CARAT services and one for residential rehabilitation programmes. The questionnaires were piloted with nine Addaction projects and feedback was received from a number of the pilot sites. The questionnaires were also reviewed by the research project steering group whose members gave advice and suggestions on phrasing, content and layout. Amendments were then made and distributed accordingly.

Distribution of questionnaires

1.2.3 Mailing lists for the community-based services and residential services were compiled using the DrugScope database. The mailing list for prison-based CARAT services was developed using the drug treatment directory for prison establishments obtained from the Drug Strategy Unit.

1.2.4 A covering letter also outlined the purpose of the research, the services included in the national survey and how the information would be used. The survey included a total of 833 services, 575 community-based services, 133 CARAT services and 125 residential services. After the initial mail-out it became apparent that the mailing lists for the residential and community-based services are not 100% accurate and up to date. Where discrepancies were identified the mailing lists were updated.

1.2.5 A follow-up survey to boost the return rate was conducted six weeks after the initial survey was issued. A new covering letter explaining the follow-up survey was distributed, along with a duplicate survey.

1.2.6 A two-day telephone follow-up was also conducted in the week commencing 15th March 2004 and contact was made with over 50 agencies. This exercise enabled another ten returns to be included within the research whilst also increasing the profile of the research with the contacted agencies.


Response rate

1.2.7 When surveys were returned to Addaction, spreadsheets were updated to log the return date and whether the survey was completed. The response rate was monitored on a daily basis.

Table 1.2.7 Response rate

Service Type No. returned

% No. completed

%

Community-based services 169 30 158 27

CARAT services 74 56 74 56

Residential services 32 26 32 26

1.2.8 Response rates for the completed surveys across the three areas were 56% for CARAT responders, 27% for community-based providers and 26% for residential services. An overall response rate was 36%.

1.2.9 A geographical breakdown of the return questionnaires highlights the wide-ranging national context of the research. The highest responses from government regions were received from the Southeast and Midlands regions.

Government region % of responses

Southwest (Devon, Hampshire, Cornwall) 14

Southeast (Surrey, Sussex, Kent) 16

London 9

Midlands (Warwickshire, Leicestershire) 17

Yorkshire 10

Northeast (Northumberland, Cleveland, Durham) 7

Northwest (Manchester, Lancashire, Cumbria) 13

East (Essex, Norfolk, Lincolnshire) 14


Case Studies

1.2.10 A number of case studies have also been included within the report. These examples of interesting practice have been included to reflect the diverse nature of projects delivering aftercare services, whilst also highlighting a range of components that are at the core of successful aftercare services. Examples of practice were noted throughout the research process. Follow-up telephone calls were then made to the agencies for clarification and permission for inclusion within the report. Permission was then given verbally by all of the services included within the report.

Aftercare : A Definition

1.2.11 As there is a variance in what people understand by the term ‘aftercare’, for the purposes of this research, participants were therefore offered the definition of ‘aftercare’ as described below :

Aftercare is designed to offer a continuum of support to those who have been exposed to / involved in or have completed treatment or rehabilitative work for drug misuse. It aims to address the practical and personal developmental needs of clients and may include counselling, cognitive therapy, group work, family involvement and vocational training.

Aftercare also includes aspects of resettlement helping those individuals in treatment integrate back into society by assisting with practical life skills, and offering support in finding accommodation, education, and employment

The above definition includes a range of services that have generally been understood to form elements of aftercare. By using a broad definition of aftercare, it was anticipated that this would maximise the return of questionnaires for the research.

1.2.11 The terms Criminal Justice Interventions Programme and Drug Interventions Programme can both be found within this report. At the time that the research was conducted, the term CJIP was incorporated within the various questionnaires. At the time of writing the report however, CJIP had been re-branded, and is now known as the Drug Interventions Programme. Within the report itself, where the term CJIP was used by respondents and used within the questionnaires, this has not been changed. In other areas of the report, the term Drug Interventions Programme has replaced the term CJIP to reflect this name change.


1.3 Review of the literature

Drug use and crime

1.3.1 Individuals who misuse drugs are of particular concern within a criminal justice context, as they can find themselves with an array of complex needs. Figures from the HM Prison Service Drug Strategy found that 70,000 drug-misusing offenders pass through prison per annum, with 39,000 in prison at any one time (www.hmprisonservice.gov.uk/assets/documents/ 10000157drugstrategyGenBriefingNote171203.doc). As a result, prisons and probation services find themselves faced with a huge number of prisoners with problematic drug use (Mair & Barton, 2001; Hearnden & Harocopos, 1999). Such figures highlight the large number of offenders misusing drugs within the criminal justice system, therefore Harrison points out, this system serves as the ‘ideal place to organise and provide needed drug treatment services’ (2002, 52).

1.3.2 The relationship between criminal activity and drug use is widely recognised. Figures such as those presented by the National Treatment Outcome Research Study (NTORS) indicate that individuals using heroin are 10 times more likely to commit crime. Moreover, this study found that crime and regular drug use are interlinked. As Gossop et al claim ‘reductions in crime were facilitated by the reductions in the regular, dependent use of drugs’ (2001, 45). The exact nature of this relationship, however, is complicated. Hiller et al (1999) claim there is no doubt that a significant number of crimes are committed, either as a consequence of, or to help finance a drug habit. 85% of respondents from a study conducted in London said that before their arrest they had been committing crime to pay for their drug use (Hearnden & Harocopos, 1999). In contrast, Edmonds et al have discovered that there is little evidence to suggest that a causal link exists between committing acquisitive crimes as a way of funding drug use. This is only the case for a small proportion of illicit drug users. In short, although crime and misusing drugs are strongly interrelated, the underlying causes are not fully understood (1998, cited in Burrows et al, 2001).

1.3.3 Since the mid-1990’s, breaking this link has been a key feature of government anti-drug strategies (UKADCU, 2000). Evidence shows that those who use drugs in a problematic way experience frequent periods of imprisonment (Turnbull & McSweeney, 2000; Fox, 2000). Therefore it is imperative to get drug-misusing offenders into treatment to prevent a ‘revolving door’ syndrome.

A critical part of the Government’s strategy for tackling drugs has been the introduction of the Drug Interventions Programme and involves criminal justice and treatment agencies working together to provide tailored solutions to direct drug misusing offenders out of crime and into treatment (http://www.drugs.gov.uk/ReportsandPublications/CriminalJusticeInterventionsProgramme).

1.3.4 Beginning as a three year programme in April 2003, the Drug Interventions Programme was introduced to develop and integrate measures for directing adult drug-misusing offenders ‘out of crime and into treatment’. Recent announcements on expansion on a number of interventions areas do indicate that it is likely to be extended beyond its third year. Initially, in 2003/4, 25 Drug Action Team (DAT) areas across England, which cover 30 Basic Command Units (BCU) with high levels of acquisitive crime, (e.g. property crime, such as robbery, burglary and shoplifting) were required to deliver a package of ‘intensive’ interventions. Interventions included drug testing on charge, throughcare and aftercare, in addition to national initiatives, such as enhanced arrest referral and Drug Treatment and Testing Orders.


http://www.hmprisonservice.gov.uk/assets/documents/�10000157drugstrategyGenBriefingNote171203.doc

http://www.hmprisonservice.gov.uk/assets/documents/�10000157drugstrategyGenBriefingNote171203.doc

http://www.drugs.gov.uk/ReportsandPublications/CriminalJusticeInterventionsProgramme

1.3.5 Like enhanced arrest referral, from April 2004, the throughcare and aftercare elements of the programme, became nationwide elements for phasing in across England and Wales. Drug testing on charge has now been extended to a further 36 Basic Command Units (covering 22 DAT areas).

1.3.6 In essence, the Drug Interventions Programme uses every opportunity from arrest to sentence to get drug misusing offenders into treatment and ‘break the link between drugs and crime’ (Home Office, 2004; http://www.homeoffice.gov.uk/crime/drugs/cjip.html)

What happens on release?

1.3.7 Individuals misusing illicit drugs require a great amount of help and support when they are released from prison. Effective aftercare support is key to helping vulnerable groups with a wide range of resettlement issues. Studies report how aftercare services can have a dramatic impact upon post-prison drug use and re-offending rates (Turnbull & McSweeney, 2000). Therefore, continuing and expanding services, from the prison into the community, to look at resettlement issues, drug and health related issues and re-offending issues, is a crucial aspect of an individual’s progress to leading a healthy, drug-free life. A key element of the Drug Interventions Programme is the delivery of effective, needs-led aftercare support, which will be discussed further in this literature review.

1.3.8 For those prisoners who have sought help for their drug misuse while in prison and are now drug free, the threat of relapse is one of the main concerns on release. Relapse is most common in the first few weeks after release (Drugs in Focus, 2003). Furthermore, the Social Exclusion Unit (SEU) recorded that the mortality rate of prisoners under post-custody supervision is three and half times that of the general population, and one-quarter of deaths occur within the first four weeks of release (SEU, 2002).

1.3.9 Reducing drug-related deaths, caused through overdose and poisoning, is a major part of the governments’ drug’s strategy. The strategy aims to reduce drug-related deaths by 20% from 1999-2004 (www.drugs.gov.uk). In 1998, figures from the Advisory Council on the Misuse of Drugs report, ‘Reducing Drug-Related Deaths’, showed that between 1076 and 2997 deaths occurred as a result of overdose in England and Wales (ACMD, 2000). According to the Office for National Statistics (ONS), since 1993 heroin and morphine deaths have been on the increase, while methadone related deaths have been significantly decreasing (2003, Health Statistics Quarterly).

1.3.9 Deaths as a consequence of overdose are most common when individuals use opiate-based drugs, and the chances of overdose are made even higher amongst those leaving prison, or treatment prematurely, as they have a reduced tolerance to opiates (www.nta.nhs.uk/programme/drd2.htm). The National Treatment Agency (NTA), in partnership with the Department of Health, has published guidelines for drug treatment services, as part of the government’s reducing drug-related deaths strategy. Overdose, whether accidental or deliberate, is identified as one of the most common causes of drug-related deaths, particularly amongst those with a lowered tolerance through imprisonment or detoxification.

They argue that easier access to treatment, good assessment of people’s mental health status and better liaison between drug treatment and mental health services, coupled with well-managed methadone prescribing, can all help to reduce the numbers of deaths relating to overdose (NTA, 2004). Moreover, the ACMD argue that ‘it is crucial to prevention of drug-related deaths that the aftercare of drug using prisoners should be identified, community liaisons established, and individualised care plans put in place’ (2000, 82).


http://www.homeoffice.gov.uk/crime/drugs/cjip.html

http://www.drugs.gov.uk/

http://www.nta.nhs.uk/programme/drd2.htm

1.3.11 In terms of drug-overdose, the throughcare and aftercare elements of an individual’s care package are very important factors, as overdose is more likely to occur at this time of transition. However the benefits of throughcare and aftercare must not be limited to overdose prevention, but extended to the vast range of issues and concerns that will face an ex-prisoner misusing drugs once in the community.

1.3.12 Besides overdose and relapse prevention, there are numerous resettlement issues that ex-prisoners face on release, especially drug users, thus, this is an opportune time for proactive and robust aftercare systems to be established. The majority of the literature defines finding stable accommodation as the most difficult challenge that prisoners are confronted with on release. According to the SEU (2002) a third of ex-offenders find themselves homeless when released. In their study entitled ‘Reducing re-offending by ex-prisoners’ the SEU (2002) recommend that homelessness is such a problem for ex-offenders that they should receive housing benefit to enable them to find stable housing. Moreover, Bessant et al, claim that many benefits are associated with securing stable accommodation, particularly in other important areas of resettlement. ‘Access to secure and affordable accommodation enhances an individual’s capacity to make use of the social opportunities offered by education and employment’ (2003; 77).

1.3.13 Similarly, Supporting People, which has been introduced by the Office of the Deputy Prime Minister (ODPM), is a working partnership of local government, service users and support agencies. Supporting People aims to provide housing-related support services to a wide range of vulnerable groups, including those with recognised drug problems. According to its agenda for those misusing drugs, providing stable accommodation and support with housing-related issues, attached to an individual’s treatment programme, can produce greater outcomes in terms of an individual’s successful resettlement in the community (www.drugs.gov.uk/nationalstrategy/communities/toolkits).

1.3.14 The difficulties associated with ex-prisoners finding suitable accommodation can often lead to them returning to old neighbourhoods, or to family and friends for somewhere to live. Research conducted for the Australian Housing and Urban Research Institute documented that the possibility of relapse is increased greatly in familiar environments, as friends and family members can often be drug users themselves, and the availability of drugs is often therefore increased (Bessant et al, 2003). In addition, they also found that those misusing drugs were often offered housing provision in areas characterised by widespread drug use. As Bessant et al (2003) claim that this is often an inadequate use of resources as it places vulnerable individuals in an environment that could lead to further drug use.

1.3.15 Homelessness, unemployment and re-offending are potential difficulties that prisoners face on release. Without effective support mechanisms in place these areas of concern would be more problematic. Studies have shown that two-thirds of prisoners lose their jobs whilst in prison (SEU, 2002), and those prisoners with a history of drug use are also less likely to be successful in gaining employment on release (Fox, 2000). Therefore, it is suggested that prison leavers, especially those that have received treatment while in prison and are now drug-free, need a high level of support in the initial first few weeks. It is essential that aftercare support networks are readily available at this crucial time to help effectively tackle prevailing resettlement issues and personal needs.

The cost of re-offending

1.3.16 Examining both social and economic costs related to those who engage in criminal activities and, who misuse drugs is necessary for the allocation of resources. As Godfrey et al (2002) describe, economic


http://www.drugs.gov.uk/nationalstrategy/communities/toolkits

costs include criminal justice costs, treatment costs and health costs, and the social costs include the affects on individuals, their families, the victims of crime and society as a whole. Re-offending rates and the associated costs involved in dealing with this, are of significant importance to the government. In 1997, 58% of prisoners released from jail were convicted of another crime within two years, of which 37% were sent back to jail. These crimes committed by re-offenders cost the UK £11billion a year (SEU, 2002).

1.3.17 In their report ‘Reducing re-offending by ex-prisoners’, the SEU (2002) has identified nine areas that impact on re-offending, one of which is drug and alcohol misuse. Additional factors include education, employment, mental and physical health, attitudes and self-control, institutionalisation and life skills, housing, financial support, debt and family networks. Evidence suggests that these factors have a significant impact on the likelihood of a prisoner re-offending and elements of support in all of these areas should therefore be included in all aftercare provision.

1.3.18 According to NTORS, effective treatment to tackle drug misuse can also help to reduce offending behaviour. Of the offenders interviewed for the study, rates of acquisitive crime halved at each of the follow-up periods. In addition, the most active offenders accessing treatment were the participants who showed the greatest reductions in criminal activity (Gossop et al, 2001). Effective aftercare support, could in theory, reduce the number of re-offenders. As documented by the Drugs Misuse Group 1998, ‘releasing drug offenders undergoing treatment without appropriate aftercare (which should include accommodation, training and employment) is not cost-effective’ (Parliamentary All-Party Drugs Misuse Group, 1998).

Drug treatment in prisons

1.3.19 Many professionals (Mair & Barton, 2001; Harrison, 2002) view the period of a prison sentence as a unique window of opportunity to help treat people with substance misuse problems and, in so doing, reduce the effects that drug misuse has on the individual’s health and well-being. Removing an individual from their familiar environment, and the external pressures and temptations, can allow time for personal reflection and can make the drug treatment intervention process easier. It is believed that the term of a prison sentence, long or short, is one of the most opportune times to address the individual’s drug problem, especially for those people who have not previously accessed treatment or support.

1.3.20 At present, drug treatment provision for prisoners varies considerably across the United Kingdom. Treatment varies from detoxification, abstinence-based therapeutic communities, cognitive-behavioural programmes to counselling and advice through to interventions provided by CARAT services. However, Fox (2000) argues that every individual receives similar treatment options in prison to tackle their drug use. The needs of some users are not being fully met, because there is no

choice or flexibility within the treatment process. Rather than benefiting from a range of services that addresses their needs, prison drug users are receiving the only service that is offered to them (Burrows et al, 2001).

1.3.21 In respect of aftercare for those who are leaving prison, there has been very little documented research to outline what is available and what is working effectively. CARAT teams facilitate the main provision of aftercare that is available. In every prison, CARAT teams provide a range of services to all prisoners


with a drug problem. After completing an assessment of a prisoner, a CARAT worker then refers them onto a drug treatment programme in the prison or in the community, as appropriate. The CARAT services act as a bridge between prison and community service provision. However as the literature suggests, CARAT service provision cannot keep up with demand, and more work is needed to ensure that everyone who needs help is given the opportunity to see a CARAT worker. Additionally it has been documented that, effective contacts with relevant community services are established prior to a prisoners’ release.

1.3.22 The Drug Interventions Programme and the Prison Service have worked together to produce guidance that includes arrangements for integrated teams (Criminal Justice Integrated Teams (CJIT’s)) working with Healthcare teams and CARAT’s. These arrangements set out the single point of contact and continuity between the community and prison to ensure that clients don’t fall between the gaps and get ‘lost’ in the system. (www.drugs.gov.uk/WorkPages/CriminalJusticeInterventionsProgramme/ WorkingwithDATs/CJIPPrisonsGuidance.doc).

The need for aftercare

1.3.23 As stated previously, the theory behind good aftercare is that it should be a tool to help resettle people into the community after their prison sentence or after a drug treatment programme that has taken them away from the community for a period of time. According to Fox (2000), aftercare should be a continuation of the work carried out in prison but should have a particular focus on integrating the individual back into the community. Aftercare provision should be flexible and extensive enough in its capabilities to meet the diverse needs of all prisoners being released who have been identified as having a drug misuse problem.

1.3.24 It is documented in the literature that those involved in aftercare programmes are less likely to use drugs and re-offend than those who do not receive aftercare support. Those who have been involved in aftercare have a lower relapse and re-offending rate and have engaged in a number of treatment interventions were effective in reducing drug misuse, offending behaviour and other health risks (Fox, 2000; Gossop et al, 1998). Due to the problems ex-prisoners face on release, especially those with a history of drug use, it is vital that effective and comprehensive aftercare services are developed and available to all, immediately following release (Turnbull & McSweeney 2000).

1.3.25 As stated in the government policy on drugs, ‘Tackling drugs to build a better Britain’, it is important to ensure that drug misusers in prison have access to cost-effective and appropriate services during remand, when sentenced to custody, and if appropriate, after release (Home Office, 1998). The studies undertaken so far have suggested that it is always appropriate to have some kind of aftercare support available to those being released from prison. In 1998 the All-Party Parliamentary Drugs Misuse Group described throughcare and aftercare for those misusing drugs as ‘appalling’.

1.3.26 Defining aftercare can be difficult, as the needs of each individual will vary considerably, therefore, the range of agencies and services that individuals utilise will differ from client to client. Recent developments within the government’s drug strategy have ensured that more work is being carried out to continuously help, support and provide treatment for those individuals at all stages of the criminal justice system and beyond. Within a Drug Interventions Programme framework, throughcare and aftercare systems have been defined separately. Whereas the former is the continuity of services through arrest, sentencing and beyond, the latter is the holistic package, including delivering needs-led


http://www.drugs.gov.uk/WorkPages/CriminalJusticeInterventionsProgramme/�WorkingwithDATs/CJIPPrisonsGuidance.doc

http://www.drugs.gov.uk/WorkPages/CriminalJusticeInterventionsProgramme/�WorkingwithDATs/CJIPPrisonsGuidance.doc

assessments, referrals to relevant services and retaining the engagement of those misusing drugs in drug treatment services (www.drugs.gov.uk).

1.3.27 The throughcare and aftercare elements of the Drug Intervention Programme provides an opportunity to continuously review and develop aftercare services on a national basis. Hence, aftercare packages are not to develop as a rigid set of protocols, instead a distinct, flexible package is more appropriate in order to meet client needs. Established aftercare interventions allows those individuals dealing with drug dependency problems to continue to progress, as well as meeting the needs of those who have previously ‘slipped through the net’.

Gaps in existing aftercare provision

1.3.28 The recent growth of research into the effects of aftercare provision highlights the need for greater in-depth knowledge around the benefits, the pit-falls and what works, in order to bridge the gaps in existing provisions (ACMD, 2000; NTA, 2002; Government updated drug strategy, 2002).

Narrow remit

1.3.29 One of the main criticisms of current aftercare provision is that it is too narrow in remit (Mair & Barton 2001). The majority of the literature in the late 1990’s, suggested that the services available to prisoner’s pre- and post-release, were too rigid and needed to be more flexible. Furthermore, it was reported that the services did not take into account the environmental influences and pressures when prisoners were released (Mair & Barton, 2001). Burrows et al (2001) claimed that prisons’ aftercare provision needs to be more outward looking and community focused.

1.3.30 The provision of aftercare in the past has offered very little choice to those individuals who require it. It is highlighted in the literature that there has to be more choice, as the rigid and focused style of aftercare provision has failed to meet the needs of those ex-offenders who are referred. Recovery and rehabilitation is a long and variable process that no single treatment approach will fix (Mitchell & McCarthy, 2001). The complex nature of drug addiction requires a similar complex, yet flexible approach that is part of a continuum of care (Mitchell & McCarthy, 2001). Since the updated government strategy in 2002, it is apparent that more is being done to provide more flexible, needs-led approaches to aftercare. The introduction of the National Treatment Agency’s (NTA) Models of Care (2002) and the Drug Interventions Programme (2003), have been ways forward in planning, delivering and commissioning effective aftercare packages (www.drugs.gov.uk).

Responsibility for aftercare

1.3.31 Another area in the provision of aftercare services that has been subject to improvement is the issue of accountability and responsibility amongst its stakeholders. There is a lack of defined boundaries, aims and objectives with regard to what the key agencies should be providing. In order for treatment programmes to function adequately they need to have clear targets (Burrows et al, 2001). Clear targets and objectives cannot be defined if there is confusion over what agency/service is responsible for what aspect of the drug treatment of prisoners. As there has been ongoing conflict and negotiation from professionals on aftercare provision, this has meant that services in the past have had difficulty delivering good quality programmes (Burrows et al, 2001).




1.3.32 More recently, the NTA Models of Care (2002) has provided guidelines to ensure that confusion over where the responsibility lies is limited, in terms of implementing Models of Care and commissioning and delivering drug treatment services in the community. Drug Action Teams are responsible for the implementation of the national drug strategy at a local level, however joint commissioning strategies between health, social care and criminal justice agencies are in place to ensure greater partnership working and more effective service delivery. It is the responsibility of commissioners to ensure that all individuals in need of drug treatment have access to services across all four treatment tiers and that the vast range of client needs are being met by drug treatment agencies. In addition, the categorisation of drug treatment services into four tiers, allows each agency/service to understand their role in providing drug treatments (NTA, 2002).

Profile of those requiring aftercare support

1.3.33 In order to provide effective aftercare, it is vital that we have a clear understanding of the people who need the support. Profiling the prisoners who have been identified with a drug problem will help formulate an aftercare system that will be relevant to those who will be referred on release. A huge variety of people in prison can be found with significant drug problems. Although the majority of prisoners are white male, there are certain groups of people who have a history of being disadvantaged in terms of service provision and groups who have particular accessibility needs and should be recognised in the provision of aftercare.

1.3.34 A study investigating ‘substance use in remand prisoners’ concludes that ‘prevalence of substance misuse in newly remanded prisoners is high. Few receive a detoxification programme, so that many are left with the option of continuing to use drugs in prison or facing untreated withdrawal’. (www.ncbi.nlm.nih.gov). Prison-based treatment should be implemented at this stage, as appropriate assessments can identify drug misuse needs. As the throughcare and aftercare elements of the Drug Interventions Programme provides help and support at each point of the criminal justice system, this enables prisoners to receive the appropriate treatment at a crucial time (www.drugs.gov.uk).

Prisoners serving short sentences

1.3.35 In recent research, and literature, there has been particular reference made to those individuals who are serving short sentences and the disadvantages they experience with regards to treatment while in prison and on release (HMip 2001). It is paramount that this group of prisoners are not excluded when it comes to aftercare provision on release.

1.3.36 The duration that these prisoners are in custody can have various drawbacks in terms of drug treatment provision. The short time available for intervention creates difficulties for those concerned (Fox 2000). Treatment programmes can often last longer than some prison sentences, it is therefore difficult to develop detailed care plans in the timescales available.

1.3.37 In addition, those serving sentences of less than one year do not require supervision by the probation service on release (SEU, 2002). As a result they are often released in an unmanaged fashion and little preparation has been made for their release back into the community (SEU, 2002). Short-term prisoners are neglected, when sometimes their needs are greater. Two-thirds of prisoners are serving sentences of one year or less (Fox 2000). Those offenders serving short sentences often have the highest levels of resettlement need and usually receive the minimum intervention in and after prison (HMip 2001).


http://www.ncbi.nlm.nih.gov/


Women

1.3.38 Addressing the needs of women pre- and post-release is also important. Women, more than men, are more likely to report their drug use and are therefore more likely to attend drug treatment services in prison (Henderson, 1998; HMip, 2001). An effective referral process would then mean that a high proportion of women would be seeking aftercare support. Literature also states that the number of women entering prison with a drug problem is on the increase. Between 1993 and 1997 offenders who use drugs accounted for 50% of the increase in the female prison population (Henderson 1998).

1.3.39 Evidence suggests that the dynamics of women’s drug-taking is different to that of men, which in theory would require a different approach to treatment. For women, mental health problems, family influences, abuse, self-esteem and issues with children, have been identified with female inmates more than male. Furthermore, it is also documented that female prisoners have more health problems than male prisoners (Stover, VonOssietzky & Merino, 2001). It is therefore vital that aftercare services are tailored to meet the needs of women as well as men, for example, incorporating such aspects as child-care and health into the treatment programme.

1.3.40 In addition to women having different treatment needs to men, women are also more likely to be serving short sentences (Stover, VonOssietzky & Merino, 2001). Research shows that two-thirds of women are serving a sentence of less than 12 months.

1.3.41 Research indicates that similarly to men, the ethnic background of women can also have an influence on their drug-taking. For example, a study undertaken by the Home Office (2003), reiterates that white women have a reported higher drug use than women from black or mixed race backgrounds (Borrill et al, 2003). White women are also more likely to use opiates than black women, who, research shows, are more likely to use crack cocaine. These findings would suggest that black women need more treatment focused on crack use rather than opiate use (Borrill et al, 2003).

1.3.42 The study undertaken by the Home Office indicated that just over one-third of women dependent on drugs reported receiving some kind of advice or education from CARAT workers during their period in prison (Borrill et al, 2003). However, this did not always mean that women’s treatment needs within prison were being met. When asked what treatment interventions women misusing drugs needed, Borrill et al, identified that there was a strong urge for counselling or ‘someone to talk to’ (2003, p. 16). Figures showed, however, that medication and detoxification were the main sources of help received by female prisoners. Borrill et al conclude that ‘one of the negative factors {impacting on the treatment of women with drug problems} is the unmet demand for treatment services after the initial assessment and detoxification’ (2003, p. 63). This data would imply that there is perhaps the need for gender-specific treatment and more services available for women pre- and post-release (Henderson 1998.

Black and minority ethnic groups

1.3.43 The limited research on this topic implies that there is a widely held belief that black and minority ethnic drug users find treatment services less accessible than the rest of the population (Borrill et al, 2003). Sangster et al (2002) identify the needs and important issues facing black and ethnic-minority groups, and they aim to provide ways in which mainstream drug treatment services should be tailored to meet the needs of these communities. They recommend that these groups should be represented in the managerial structure and workforce of services, to ensure that the changing needs of clients to be met by services.


1.3.44 In addition, drug use among black and minority ethnic users must be looked at within the context of the different cultures. An important issue raised by Sangster et al (2002), is the tendency by services to focus treatment on the injecting behaviour of clients. This serves as a prime example of how the majority of services are designed to meet the needs of white clients, as this client group is more likely to inject heroin, whereas south Asians, for example, are more likely to smoke opiates. Within black and ethnic minority communities, and between white and minority ethnic groups, there are distinct differences in type and patterns of drug use (Borrill et al, 2004). Issues such as this, need to be addressed in order to include, and reflect the range of client need. Additional factors in ethnic minority group’s drug use must also be taken into account, for example, discrimination, deprivation and social exclusion. These factors should be considered in the design of aftercare treatment.

The implications for aftercare

1.3.45 The diversity of people in prison, and the increase in those misusing drugs, has created problems in providing drug treatment both in, and post prison. Historically, the range of people within the criminal justice system has not been taken into consideration in treatment planning. The diverse range of people now seeking aftercare means that effective aftercare should be flexible in its design and delivery, in order to channel its programmes to meet the identified needs of every individual.

1.3.46 Equally, aftercare treatment needs to be in place when the prisoner is leaving prison, to ensure that care packages can be continued from the prison to the community. Clients need to be referred, as seamlessly and easily as possible, from one agency to another (Burrows et al, 2001).

A model aftercare package

1.3.47 In order to effectively resettle individuals into the community, aftercare packages must first and foremost recognise the specific individual needs of clients, and secondly, ensure that these needs are met through an all-encompassing range of services. As noted by Brown et al, commenting on aftercare in the United States, ‘aftercare programmes have typically provided some mix of group and/or individual counselling; skills building for relapse prevention; case management to access needed community resources; and peer support activities’ (2001, 185). This tends to reflect the nature of aftercare packages that have developed across the field in England. The government’s guidelines on the Drug Interventions Programme suggests effective aftercare practice consists of a variety of interventions, such as providing tier two interventions - relapse prevention and counselling – along with a case management and care co-ordination approach to meet client needs (http://www.drugs.gov.uk/ReportsandPublications/CriminalJusticeInterventionsProgramme). Within the UK, great emphasis is placed on designing care packages to meet client needs, including the needs of female clients and ethnic minority groups, as this is recognised as a vital tool of delivering effective aftercare.

1.3.48 The U.S Centre for Substance Abuse Treatment (CSAT, 1998) places a vast amount of importance on the benefits of community services, in terms of helping individuals remain drug-free and supporting them with their additional needs. They argue that in-prison treatment should be seen as a ‘stepping stone’ towards treatment provided by community, or aftercare, services. In the UK, the NTA support the viewpoint that aftercare, if properly co-ordinated, is necessary to benefit those re-entering the community. The Drug Interventions Programme and the NTA’s ‘Models of Care’ (2002) have contributed to the notion of a seamless package of treatment and support. Models of Care guidelines outline that established integrated care pathways between the four treatment tiers serves as the most



efficient mechanism by which all those misusing drugs can be quickly identified, appropriately referred and maintained, in community-based treatment. The modalities indicate how non-specific drug agencies, services and, specialists, as well as organisations directly involved in drug work, play a part in the big picture of providing continuous resettlement and aftercare packages.

1.3.49 A model aftercare package is often being described as the means by which help, support and treatment is ‘seamlessly’ delivered across a multitude of services and agencies (NTA, 2002; ACMD, 2000). In order to accomplish a ‘continuity of services’, several interventions, such as Integrated Care Pathways (ICP), have been introduced. The NTA define an ICP as ‘the nature and anticipated course of treatment for a particular client. It should also be able to provide access to a range of services and interventions that meet an individual’s needs in a comprehensive way’ (2002, 26). An ICP approach is a means of establishing working relationships and protocols with a broad range of agencies, to ensure that gaps in service provision can be identified and eradicated.

1.3.50 To support effective implementation and delivery of throughcare and aftercare, a case management approach has been incorporated into the working practices of the Criminal Justice Integrated Teams (CJIT). This allows for easier referrals, as well as greater information sharing between agencies. Adopting such an approach has reinforced the importance of aftercare packages remaining robust and holistic, by ensuring that clients are receiving carefully planned, needs-based support upon release.

1.3.51 Additionally, by incorporating an integrated approach of community-based CJIT’s, this has further enabled a seamless aftercare service to be delivered to clients. The role of the CJIT’s is to provide a full range of tier two interventions, such as access to rapid prescribing services, harm reduction, advice/information and triage assessments, in line with the NTA Models of Care guidelines. Coupled with this, care planning is implemented as an integral part of a case management approach. A ‘single point of contact’ within each CJIT, ensures a specific contact and referral routes between criminal justice agencies and treatment services, and a 24-hour ‘phone line for clients.

1.3.52 Throughcare and aftercare elements of the Drug Interventions Programme aims to provide continuity of care and support at every point of the criminal justice system. It ensures that client’s needs are continuously addressed through ongoing reviews and monitoring processes. Moreover it allows for flexible and creative interventions to be formulated at a local level, as it does not set out rigid guidelines. Instead, it promotes the diversity of interventions to recognise individual and local needs. These elements are key to the Drug Interventions programme success in delivering a seamless service of treatment and support for those misusing drugs.

Flexible and responsive

1.3.53 An effective aftercare system needs to be flexible to ensure that the diverse spectrum of needs and issues are managed during the period of the intervention. The history of a person’s drug taking and the effect prison has had on them is unique. However, effective aftercare should not only focus on the drug problem and crime committed, but also address the wider issues and concerns that the offenders may have - both before and after their experience of prison.

1.3.54 As discussed in the report ‘Through the Prison Gate’, it is vital that aftercare allows the opportunity for the underlying reasons for drug-taking to be explored with each client (HMip, 2001). The focus on drug use only, is not the most appropriate way forward in the delivery of aftercare. A history of issues and


needs must also be addressed (Burrows et al, 2001). In addition, aftercare services need to look at motivation levels and decide what part it plays in aftercare (Fox, 2000). Lack of motivation should not exclude a prisoner from treatment options while in prison and on release. On the contrary, the lack of motivation and issues surrounding this should be incorporated into the client’s treatment plan.

Agency networking

1.3.55 As discussed, the complex needs of drug users are great, and those who have experienced prison life will have additional needs that will require response. Established links with key agencies ranging from drug treatment services, criminal justice agencies, health services, voluntary organisations and local authorities will enable the aftercare service to make appropriate referrals that will help meet the variety of needs of each of their clients. Collaboration with ‘wrap-around’ services, such as local housing associations, can help to address the issue of homelessness that, for many ex-offenders, is a crucial step in securing a stable life and reducing the risk of relapse. It is argued that effective delivery of resettlement work can be improved by stronger prison, probation and voluntary sector partnerships. This view is supported by Mitchell & McCarthy, who claim that ‘creating a bridge from prison to community by pre-release planning in prisons holds considerable potential’ (2001).

1.3.56 Research has shown that the speed of response to the needs of prisoners being released is important (Sibbet, 1996). Similarly, Mitchell and McCarthy commented in their London study, that the time between release and first post-release appointment was critical to the impact that aftercare intervention has on the individual’s rehabilitation process (2001; 214). As discussed, the NTA guidelines (2002) suggest that agency networking is crucial in referring clients with speed and ease.

1.3.57 The NTA advises that, ‘the establishment of effective interfaces between services across all tiers of service provision requires communication and collaboration between services. Central to this are joint commissioning of services, common assessment/referral protocols that are appropriate to each tier and the establishment of robust service level agreements’ (NTA, 2002; 56).

1.3.58 Edmunds et al investigated inter-agency work related to the referral of clients between criminal justice organisations and drug treatment agencies, in terms of problems and barriers affecting working practices. They conclude that if partnership working is to be effective then, ‘there needs to be a well-designed mix of trust building initiatives and training, combined if possible with co-location or other means to maximise informal contact’ (1999, 54). CJIT’s, as part of the Drug Interventions Programme services, provide a single point of contact to ensure that referrals for clients coming into the service, and for referrals between agencies, can be made far more quickly and easily (www.homeoffice.gov.uk).

Support

1.3.59 Established working links with relevant key agencies could help the aftercare of ex-prisoners by creating a systematic network of support. Literature indicates that support from agencies, key workers, family and friends are a fundamental component in the success of aftercare (Stover, VonOssietzky & Merino, 2001). Recent research strongly suggests that, family involvement in particular, appears to be a dominant influence for ex-offenders in relation to relapse. It is highlighted in the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Scientific Report, ‘An overview study: Assistance to drug users in European Union prisons’ that maintaining family links is an essential element of intervention (Stover, VonOssietzky & Merino, 2001). Family support is also mentioned in the report


http://www.homeoffice.gov.uk/

published by the SEU, where it is stated, ‘not enough has been done to engage prisoners, their families, victims, communities and voluntary and business sectors in rehabilitation’ (SEU, 2002).

1.3.60 The literature argues that aftercare services should be ‘making use of agencies and organisations appropriate to the client’s needs and interests, involving family members and addressing work place issues and peer relationships’ (Brown et al, 2001). Moreover, the conclusions drawn by Mitchell and McCarthy (2001) also underline that aftercare provision should not only look at the individual but also the system of support around that individual (Mitchell & McCarthy, 2001).

The bigger picture

1.3.61 The emphasis on aftercare, within this document, has been with treating an offenders’ drug use and consequently, to reduce the higher rate of re-offending. Literature suggests that in order to improve the effectiveness of aftercare a more holistic approach must be taken (Harrison, 2002). Harrison also argues that instead of looking to treat the ex-offender for their drug use only, aftercare should be looking to treat the whole person and all their issues and concerns. A comprehensive aftercare service would help support the individual following their release. This networked approach to treatment, which would include follow-up appointments, would ensure that all issues were being dealt with and would hopefully help the ex-prisoner to successfully integrate into the community and reduce the risk of relapse.

1.3.62 In Scotland, as part of the revised drug strategy, the Scottish Prison Service Transitional Care Initiative, has been employed to manage this particularly difficult period of transition between prison and the community. This is achieved by gaining easier access to existing services for those prisoners misusing drugs about to be released. A transitional care worker is assigned to a client and face-to-face contact is usually arranged prior to release or post release. Once a needs assessment has been conducted, the transitional care worker’s role is to link that client up with external services, such as housing agencies, benefits agencies, drug treatment agencies and other relevant providers. The results from this interesting practice were generally positive, in terms of clients being linked to the services and finding the services helpful, however this is only the case if ex-prisoners attended their appointments http://www.drugmisuse.isdscotland.org/eiu/eiu.htm).

1.3.63 New aftercare services should ensure that those leaving prison and treatment avoid the revolving door back into addiction and offending (Fox 2000). As in Sweden and Austria, aftercare should be built into the sentence plan (Stover, VonOssietzty & Merino, 2001). Research undertaken by Turnbull and McSweeney (2000) investigated drug treatment in prisons and aftercare in 26 European countries. It found that 19 of those countries had incorporated throughcare and aftercare elements into their policies, focusing on referrals to appropriate services, social reintegration, relapse and overdose prevention work and counselling. Six of the countries (Spain, Czech Republic, Latvia, Malta, Portugal and Sweden) have outlined the duration of aftercare treatment, with the Swedish policy recommending a time-scale of 12 months.

1.3.64 Bullock (Ramsey, ed, 2003) examines the effectiveness of different drug treatment models in prison. The Key-Crest model, implemented in a U.S prison, has shown positive results, in terms of those involved remaining drug and arrest-free 18 months later. This encouraging outcome has been connected to the continued aftercare aspect of the treatment package. The benefits of prison-based treatments with effective throughcare into the community, coupled with flexible, needs-led aftercare packages, is becoming widely recognised as an effective way of helping those misusing drugs. Due to


http://www.drugmisuse.isdscotland.org/eiu/eiu.htm

the complex needs of drug using prisoners, aftercare provision must address, not only the side effects of drugs, but the side effects of prison itself, which can be different for each individual (Fox 2000 and Hearnden & Harocopos 1999).

1.3.65 Contemporary literature has suggested that contact with a wide range of ‘wrap-around’ agencies specifically targeted at those misusing drugs, such as housing (Supporting People - www.odpm.gov.uk, 2003), coupled with appropriate referrals between agencies, relapse prevention advice and care co-ordination/planning approaches (NTA, 2002) creates positive outcomes in terms of providing an effective aftercare package.

New research will continue to evaluate such systems and programmes, such as the throughcare and aftercare elements of the Drug Interventions Programme, in order to assess working practices, which will inevitably inform government policy on reducing drug-use, drug-related deaths and offending. Recognising and highlighting local models and interesting practice is invaluable in terms of disseminating this information throughout the field. It is hoped that such practice can be duplicated in other areas, or built upon according to local need. Research can also provide relevant information on interlinked topics such as how housing and employment policies can be improved for those misusing drugs, as well as ensuring that treatment services are delivering high quality services. It must be noted that more research needs to be conducted into drug treatment provision for hard-to-reach groups, such as black and minority ethnic communities.


http://www.odpm.gov.uk/

Chapter Two: Profile of Services

NatVerAdd

ional Aftercare Research Report sion 1 November 2004 action © all rights reserved

Profile of Services

2.1 Introduction

2.1.1 All three service provider types, CARAT teams, community-based services and residential services were asked a range of questions relating to the services that they provide. A number of these questions were directly related to the specific provision of aftercare, whilst other questions were related to general interventions that they delivered. An understanding of the services available and the range of interventions available will help to map both the extent and breadth of services available.

2.2 CARAT Services

2.2.1 In response to whether CARAT Services provided a standardised package of care to prisoners or if their service interventions were based on individual client need, over three-quarters of the services provided a needs-led package. Thirteen of the respondents (18%) provided a mixture of a needs-led package and a standardised package of care.

2.2.2 Exploring this further, respondents were then asked to identify the service interventions that they provided to prisoners that were referred to their service.

Table 2.2.2 Service interventions provided by CARAT services (N=74)

Service intervention N %

One to one support 74 100

Advice/information/support 74 100

Relapse prevention 73 99

Group work 66 89

Complementary therapies 45 61

Parenting skills 8 11

Other service 28 39

2.2.3 All of the respondents provided one-to-one support, advice and information. In addition, an overwhelming majority provided information on relapse prevention (99%) and group work provision


2.2.4 (89%). Complementary therapies were also provided by over half of CARAT services. 11% of services specifically provided interventions relating to parenting skills, whilst 39% of services provided a range of other services to their clients. These services included health promotions, hepatitis C groups, peer support drop-ins and pre-release groups.

2.2.4 CARAT services were then asked if they had a specific treatment philosophy. The example of working with ‘drug-free prisoners’ was given as guidance for respondents. 89% of CARAT respondents stated that they do not have a specific treatment philosophy.

2.2.5 An example of some of the philosophies given are detailed below:

‘Work with anyone who presents as a problematic drug user’

‘Work with those who have used, are using or are at risk of using drugs and wish to look at their issues’

‘Offer work to anyone who considers themselves to be a problematic drug user’

‘CARAT services must provide services to drug users. This includes drug users who misuse alcohol. CARAT services should not provide services to those who only misuse alcohol’.

2.2.6 Participating CARAT services were asked if they contributed to the release planning of drug-using prisoners that they were working with. The vast majority of CARAT services (97%) confirmed that they do contribute to this process.

2.2.7 The majority of CARAT services (80%) stated that they had a role in the development of aftercare packages of prisoners who had accessed their service, whilst, rather surprisingly, 13% stated that they did not have a role in this area of work.

2.2.7 CARAT respondents indicated that there are a number of key components to an aftercare package for a prisoner who has identified an issue with drugs. Respondents identified the establishment of community links and re-establishment of these links as significant. This included accommodation and housing services, employment, education and training links, through to specific support in relation to the drug issue itself – the accessing of community treatment and ongoing community support. Other CARAT teams highlighted the possibility of accessing pre-release courses that include harm reduction, relapse prevention and overdose prevention work as important in terms of preparatory work.

2.3 Community-based services

2.3.1 Nearly three-quarters (73%) of community-based services provide specific aftercare services for prison-leavers. In relation to providing specific aftercare services for those who are leaving residential services, a majority (63%) of community-based services provide a specific service for this client group.

2.3.2 Of those that say they do not provide a specific aftercare service, a number of respondents commented on their services aims to offer equality of access to all, including prison and residential leavers.

‘Aftercare is provided through relapse prevention casework. Referrals are made to other services providing training, accommodation, etc.’


‘To provide a continuity of support for those leaving residential services or prison to maintain their progression’

‘We provide maximum support to those leaving prison or residential services to ensure a smooth transition. We aim to pick up work that has been done and continue at this point to avoid repetition. We take a holistic approach and will help with practical aspects of leaving custody’

‘We don’t offer specific services, but aim to arrange an appropriate package of care’

2.3.3 Community providers were asked to specify the type of package that they offer to clients. 65% of community-based services provide a needs-led package of care, 2% provide a standardised package of care and 29% of the respondents provide a mixture of a needs-led package and a standardised package of care.

2.3.4 Over half (56%) of the community-based respondents confirmed that their aftercare service did not target any specific groups, whilst around a third (30%) of the providers stated that their service does target specific groups. Services such as the provision of services to female sex workers, benzodiazepine users and drug users in general were cited, in addition to clients that had been working with CARAT teams in prison.

2.3.5 Respondents were then asked if they work towards an aftercare specification that is part of local plans. Examples such as Drug Action Teams and CJIP (now re-branded as the Drug Interventions Programme) specifications were given as a guide to participants. Over one third (39%) of community-based respondents currently work towards an aftercare specification that is part of local plans, with over half (54%) reporting that no specific local plans are in place to guide provision of aftercare.

2.3.6 Less than a fifth (18%) of respondents receive funding to provide specific aftercare interventions for prison/residential leavers. Three-quarters (75%) of community-based providers who responded are not funded to provide these specific interventions.

2.3.7 The issue surrounding the funding of services was then explored with community providers in further detail. The response rate to the question regarding the permanent or temporary nature of funding was poor. Less than a fifth (17%) of respondents stated that their funding was permanent, while 9% stated that funding was temporary and another 9% stated that funding was a mixture of permanent and temporary. However, nearly two-thirds (65%) of participants failed to respond to the question. Perhaps this figure reflects the confusion within the field regarding funding, or it may be due to the fact that Addaction was undertaking the survey and the nature of the question might have been interpreted as being of a confidential and sensitive nature.

2.3.8 Community-based providers were then given the opportunity to record the types of service interventions that they provide for prison and/or residential leavers. Service interventions were also broken down into two categories - services that are delivered internally and those services that are delivered in partnership with other agencies. The table below details the types of internally delivered services provided by responding providers.


Table 2.3.8 Services delivered (N=131)

Service intervention delivered N %

One-to-one support 120 92


Advice/information/support for families 75 57

Housing advice/referral 73 56


Prescribing interventions 65 50

Group work 52 40

Education/training/employment advice/referral 55 42

Primary health care 36 28


Prison gate pick-up on release 13 10

Other service 12 9

2.3.8 The majority of community-based responders internally provided one-to-one support (92%) and relapse prevention (80%). Advice, information and support (57%), housing advice and housing referrals (56%) and complementary therapies (51%) such as acupuncture were also delivered by community-providers. A range of other services, such as group work (40%), prescribing interventions (50%) and education, training and employment advice (42%) were also internally delivered. The table below details those interventions provided in partnership with other agencies.


Table 2.3.9 Services delivered in partnership (N=97)

Service intervention delivered N %

Housing advice/referral 57 59


Primary healthcare 46 47






Group work 32 33


Prison gate pick-up on release 12 12

Other service 2 2

2.3.10 Housing advice and referral (59%) and education, training and employment advice and referral (58%) were delivered in partnership by over half of the community-based respondents. Other services, such as primary healthcare (47%) one-to-one support (46%), relapse prevention (41%) and work with families (39%) were also delivered in partnership by a significant number of services.

2.3.11 Community-based providers were asked if they had specified targets and outcomes for their aftercare service. Less than a fifth (18%) of community-based providers confirmed that they have specified targets and outcomes for their aftercare services, whilst 65% of community providers confirmed no specific targets in this area. However, a number of those surveyed who do not currently have targets stated that this was currently under review, either with negotiations with their local Drug Action Team, or via the CJIP service (now re-branded as the Drug Interventions Programme) or through negotiations with commissioners and funders.

2.3.12 Community providers were asked to define how they monitor the effectiveness of their aftercare services. Responses were diverse and interesting. They varied between those agencies that monitor effectiveness qualitatively in terms of specific targets achieved by individuals and those who monitor targets quantitatively, in terms of the number of people the service has engaged with. The range also included those that monitor effectiveness through ‘soft’ outcomes and those that monitor effectiveness through ‘hard’ outcomes. Examples of the range of responses are detailed below:


‘All our outcomes are kept on our database and are automatically transferred to our commissioning body’

‘Currently being negotiated with funders’

‘Helping people avoid relapse – getting people on courses, get them into college, etc.’

‘This is dependent on individual treatment plans’

‘Based on the outcome needs recognised by clients’

2.3.13 Specifically related to the monitoring of gains, services were asked to indicate in which areas gains are monitored by their agency. The table below shows the gains monitored.

Table 2.3.13 Monitoring of individual gains (N=123)

Gains measured N %

Drug and alcohol misuse 97 79

Mental and physical health 72 59

Reduction in relapse 64 52

Employment 59 48

Housing 56 46

Attitudes and self-control 47 38

Family networks 41 33

Reduction in the number of overdoses 39 32

Education 37 30

Financial and debt support 25 20

Institutionalisation and life skills 24 20

Do not record 19 15

2.3.14 As one would expect, gains made in the area of drug and alcohol misuse were monitored by the majority of agencies (79%). The monitoring of gains in mental and physical health was also prominent (59%) and relapse reduction (52%) was also a high priority. Rather surprisingly, given the current funding climate, 15% of respondents stated that gains were not recorded.

2.3.14 The issue of externally evaluated services was then pursued with community providers. Only 10% of community-based services stated they have had their aftercare services externally evaluated, whilst


70% of those who responded stated that their aftercare services had not been evaluated. A number of these respondents however, did state that they did not provide a separate/specific aftercare service. Therefore the figure of 70% reporting non-evaluation is not a true picture as it is tempered by the fact that some do not provide distinct aftercare services.

2.4 Residential Services

2.4.1 Residential services were asked about the type of interventions that they provide as part of their programme.

Table 2.4.1 Services delivered (N=32)

Service interventions delivered N %



Group work 30 94




Primary health care 17 53



Other service 9 28

2.4.2 All of the residential providers that responded to the survey stated that they offered one-to-one support and relapse prevention. Group work was provided by a large proportion of services (94%) and complementary therapies (63%) were also delivered by a majority of residential services. In relation to the aftercare needs of clients, 72% of respondents offered education, training and employment advice, and prominence was also given to advice, information and support to families (59%).

2.4.3 A quarter of the residential establishments that responded to the survey stated that they provided specific services for prison leavers, whilst 69% confirmed that they did not provide services for this client group.

2.4.4 Out of the 32 residential services that responded to the survey, only 10 responded to a question relating to whether they were specifically funded to provide services to prison leavers. Of these, only 2 agencies (6%) stated that they did receive specific funding for this purpose, whilst the remaining 25% stated that that they did not specifically receive funding for this purpose. As indicated, a significant number of


services, 22 in total, representing 69% of participants, did not respond to this question. Once again, it is not known if the poor response was due to lack of knowledge of the funding source or whether respondents were unsure of the provision of these data regarding service confidentiality.

2.4.5 Residential services were then asked to highlight any specific services that they provided for prison leavers. From the responses given, it was clear that a number of services have developed a variety of services that are specific to their prison leaver clients. A sample of these practices have been detailed below:

• floating support scheme for ex-offenders with substance misuse

• accessing the prisoner whilst in prison to conduct assessments and interviews

• direct access to their rehabilitation programme from prison

• mentoring scheme

• resettlement service for prisoners who have completed a prison ‘therapeutic community’ programme.

2.4.6 The vast majority of residential services (81%) stated that they provided a specific aftercare service for those leaving their services and returning to the community. Interestingly, a fifth of residential respondents claimed that they did not provide a specific aftercare service.

2.4.7 However, the concept of aftercare, and service responses to aftercare within the residential sector appears to be well developed and diverse. Services were asked to list specific aftercare provision that they delivered. From the responses received a range of support services have been established to ensure that residential leavers are supported through this transitional period. Examples of some of the services available have been detailed below :

• weekly ex-residents’ support group

• one-to-one support on release

• ‘move-on’ accommodation

• continued personal contact with a key worker

• job-finding support

• appointments with the service up to six months following a resident’s move, after this time, support is given on an ‘as and when’ basis

• resettlement workshops in the transition period

• telephone support


• access to an aftercare group – with professional facilitation

• full-time resettlement staff in place

• resettlement service in place – proving information and advice, housing advice, support and a drop-in facility.

2.4.8 Over a quarter (28%) of residential services reported that they received specific funding to provide aftercare services, whilst over half (56%) of the residential services reported that they did not receive specific funding for the provision of aftercare services. This implies that as these services are providing aftercare with no funding, aftercare is therefore delivered as an essential ingredient of the residential service package.

2.4.9 Residential services were also asked to stipulate the type of care package that they offered. The response was evenly balanced, with 38% of respondents providing a needs-led package of care and 31% providing a mix of a standardised package of care and a needs-led package. Nearly a third of respondents (32%) did not define the package of care that they delivered.

2.4.10 A quarter of the residential services indicated that they have specified targets and outcomes for their aftercare service. When prompted to expand on the services specified outcomes and targets, it appears that targets were not specifically service driven, in relation to capacity, volume, etc, but client-driven, in terms of individuals achieving individual targets. An example of some of the targets and objectives given by respondents included the following:

• outcomes based on users own aims and objectives

• client to continue voluntary work

• secure full-time accommodation

• improve quality of life

• improvements in family relationships, budgeting/financial ability

• sustained health care

• continued abstinence

• improve relationships

• ensure lapse does not result in relapse.

2.4.11 Residential services also monitor effectiveness in a range of formal and informal means. Once again, these are both hard and soft targets and qualitative and quantitative. Examples cited by residential respondents are given below:


• clients work to a care plan

• regular meetings with client

• questionnaires/evaluation forms

• percentages remaining drug-free after six months

• maintaining links with ex-residents and inviting them back into service via service user consultation

• quarterly DAT reports.

2.4.12 Residential services were then asked to define how their service monitored any gains made by clients. The table below represents these findings.

Table 2.4.12 Monitoring of individual gains (N=22)

Gains measured N %

Drug and alcohol misuse 12 55

Education 10 46

Family networks 10 46

Mental and physical health 10 46

Attitudes and self-control 10 46

Housing 9 41

Employment 9 41

Reduction in relapse 8 36

Institutionalisation and life skills 7 32

Financial and debt 6 27

Reduction in the number of overdoses 2 10

Do not record 7 32

2.4.13 Gains made in the area of drug and alcohol misuse were monitored by over half of the residential services that responded to the survey (55%). The monitoring of gains in education, family networks, mental and physical health and attitudes and self-control were also prominent (all 46%). Housing and employment (both 41%) were also a high monitoring priority. Nearly a third (32%) of residential services stated that gains were not recorded.


Chapter Three: The Client Profile

NVA


The Client Profile

3.1 Introduction

3.1.1 In order to gain an insight into the levels of clients accessing all three services over a specified period of time (April 2003 – September 2003), agencies were asked to provide statistics and data on clients. Providers were then asked to break down data into a range of these groups (young people, women with children, etc.). A question relating to the substances used by clients was also included. Further sector-specific questions were then asked relating to each services clients. Details are given in the sections below.

3.1.2 The response rate to questions relating to the client profile was limited and this has naturally impacted on data analysis. High returns of ‘unrecorded’ or ‘unstated’ data were received from community-based providers and residential services in this area of research.

3.2 CARAT services

3.2.1 CARAT services were asked to detail the number of individuals who accessed their services from April 2003 to September 2003. Table 3.2.1 summarises this information.

Table 3.2.1 Client caseload details

Male clients (N=74) Female clients (N=74)

Number of clients No % No %

0- 50 8 11 30 40

51-100 6 8 1 1

101-150 3 4 2 3

151-200 8 11 - -

201-250 5 7 1 1

250+ 18 25 5 7

Not stated 26 33 36 48

3.2.2 A quarter of CARAT services stated that they had a male client caseload of over 250 male prisoners during the reporting period. Over a third of respondents did not give details of the number of male


clients on their caseload. This compares with those CARAT teams who work with women prisoners, where nearly half (48%) did not provide any information on caseload.

3.2.3 The data received from the survey in respect of the substances used and a further breakdown of the clients into a range of different sub-client groups were of insufficient quality to analyse and draw firm conclusions from.

3.3 Community-based services and residential services

3.3.1 As previously discussed, returns for the client profile section of the survey were not sufficient in quantity to enable comprehensive analysis. Perhaps significantly, a consistent 20–30% of community-service providers and residential services regularly stated that they ‘did not record’ the data requested. This information included data on clients from the black and minority ethnic communities, women with children and those with housing and accommodation needs.

The same figure, 20–30% also indicated that they ‘did not record’ information related to the substances that their clients used.


3.3.2 Information provided by community-based services that remains relevant within the study has been collated below. Through the stated period (April 2003-September 2003) over a quarter (26%) of community-based services reported that up to 10 male prison leavers had accessed their aftercare service.

Table 3.3.2 Client caseload details (prison leavers)

Male prison leavers

(N=158)

Female prison leavers (N=158)

Number of clients No % No %

0- 10 39 26 49 31

11-20 7 4 4 3

21-30 1 1 - -

31-40 3 2 - -

41-50 6 4 - -

51+ 4 2 1 1

Not stated 57 35 65 41

Not recorded 41 26 39 25


3.3.3 Through the stated period (April 2003-September 2003) over a quarter (31%) of community-based services reported that up to 10 female prison leavers had accessed their aftercare service.

3.3.4 Community-based services were also asked about the average length of engagement of residential and prison leavers who had accessed their service. Table 3.3.4 details responses.

Table 3.3.4 Length of prison leavers engagement with services (N=46)

Length of engagement N %

Up to one month 16 35

2 months 6 13

3 months 8 17

4 months 2 4

5 months 1 2

6 months + 12 26

Other 1 2

3.3.5 The average length of treatment episode varied. Over a quarter (26%) of prison leavers continued to access community-based services six months following their release from prison. Over a fifth (22%) of prisoners disengaged from services between two and four weeks.

Table 3.3.5 Length of residential leavers’ engagement with services (N=28)

Length of engagement N %

Up to one month 5 18

2 months 3 11

3 months 3 11

4 months 5 18

5 months 2 7

6 months + 10 36

3.3.6 Over a third (36%) of residential leavers continued to access community-based services for six months or more following their return to the community.


Chapter Four: Client Concerns

NVA


Client concerns when accessing aftercare services: a provider’s perspective

4.1 CARAT Services

4.1.1 Respondents were asked to rate the top three concerns identified by both male and female service users. As many respondents did not specifically rate the three concerns and just ticked the three principal concerns, results have therefore been compiled using the number of positive counts against each particular issue.

4.1.2 CARAT services were asked to identify the top three concerns identified by male drug-using prisoners at the point of first contact with the service (see table 4.1.2). Drug use, housing and family relationships were the top three concerns.

Table 4.1.2 Top three concerns at first contact – male prisoners (N=62)

Area of concern N %

Drug use 56 31

Housing 40 22

Family relationships 29 16

Physical health 10 6

Mental health 9 5

Employment/training 8 4

Legal 8 4

Partner 5 3

Illegal activity 5 3

Financial 2 1

Other 10 6


4.1.3 CARAT services were then asked to identify the top three concerns identified by male prisoners prior to release.

Table 4.1.3 Top three concerns prior to release – male prisoners (N=61)

Area of concern N %

Housing 56 31

Drug use 50 27


Family/relationships 23 13

Financial 11 6

Partner 3 2


Physical health 1 1

Mental health 1 1

Legal 1 1

Other 4 2

4.1.4 On first contact with CARAT services within prison, the principal concerns of male prisoners were their drug use (31%), housing (22%) and family relationships (16%). Prior to release, drug use (27%) and housing (31%) had remained an issue for prisoners, whilst employment and training had increased in significance for the male prisoner.

4.1.5 CARAT services were also asked to identify the top three concerns identified by female drug-using prisoners at the point of first contact with their service.


Table 4.1.5 Top three concerns at first contact – female prisoners (N=10)

Area of concern N %

Housing 8 28

Drug use 8 28

Childcare 4 14


Legal 3 10

Mental health 2 7

Physical health 1 3

4.1.6 CARAT services were asked to identify the top three concerns identified by female drug-using prisoners prior to release.

Table 4.1.6 Top three concerns prior to release – female prisoners (N=10)

Area of concern N %

Housing 9 30

Drug use 9 30


Childcare 1 3

Partner 1 3

Physical health 1 3

Financial 1 3

Other 1 3

4.1.7 At first contact with CARAT services within prison, the principal concerns of female prisoners were their housing (28%), drug use (28%) and childcare (14%). Prior to release, drug use (30%) and housing (30%) had remained an issue for female prisoners, whilst family relationships (23%) had increased in significance. Concerns related to childcare had also declined in importance as an issue for female prisoners. A concern for 14% of women at first contact, whilst a concern for only 3% of women prior to release.


4.2 Community-based services

4.2.1 Community-based providers were also asked to identify the top three concerns of male prison and/or residential leavers at first contact with their service.

Table 4.2.1 Top three concerns at first contact – male prison leavers (N=99)

Area of concern N %

Drug use 85 30

Housing 80 28

Financial 40 14




Partner 5 2

Physical health 5 2

Mental health 5 2

Legal 3 1

Childcare 3 1

Other 2 1

4.2.2 Community-based providers were also asked to identify the top three concerns by female prison and/or residential leavers at first contact with their service.


Table 4.2.2 Top three concerns at first contact – female prison leavers (N=88)

Area of concern N %

Drug use 71 29

Housing 64 26

Financial 28 11



Childcare 17 7


Partner 6 2

Mental health 6 2

Physical health 4 2

Other 2 1

4.2.3 The three principal concerns identified by male and female prisoners and residential leavers when accessing community-based services were concerns relating to drug use (male 30%, female 29%) housing (male 28%, female 26%) and financial concerns (male 14%, female 11%). Concerns relating to employment and training (male 9%, female 7%) and family relationships (male 6%, female 10%) were also of significance to both genders. Issues related to childcare had an increased importance with female clients (7%), with only 1% of services claiming this as a significant concern for male clients.


4.3 Residential services

4.3.1 Residential services were also asked to identify the top three concerns identified by male residents at first contact with their programmes (see table 4.3.1).

Table 4.3.1 Top three concerns at first contact – male residents (N=25)

Area of concern N %

Drug use 22 31

Housing 13 18


Employment/ training 7 10

Physical health 6 8

Mental health 4 6

Financial 4 6

Partner 3 4

Legal 2 3



4.3.2 Residential services were asked to identify the top three concerns identified by male residents on leaving their programme. Table 4.3.2 shows the top three responses.

Table 4.3.2 Top three concerns upon leaving – male residents (N=28)

Area of concern N %

Housing 22 27

Drug use 15 18

Financial 14 17



Mental health 2 2

Legal 2 2

Partner 1 1

Physical health 1 1


Other 2 2

4.3.3 At first contact with residential services, the principal concerns of male residents were their drug use (31%), housing (18%) and family relationships (13%). Prior to release, housing (27%) and drug use (18%) had remained an issue for residents, whilst concerns surrounding finance (17%) and employment and training (13%) had increased in significance for the male residential leavers.


4.3.4 Residential services were asked to identify the top three concerns identified by female residents at first contact with their programmes.

Table 4.3.4 Top three concerns at first contact – female residents (N=20)

Area of concern N %

Drug use 15 27

Housing 8 14

Childcare 7 13


Physical health 6 11

Mental health 4 7

Financial 3 5


Partner 2 4

Legal 1 2


4.3.5 Residential services were asked to identify the top three concerns identified by female residents on leaving their programmes. Table 4.3.5 details the top three concerns.

Table 4.3.5 Top three concerns upon leaving – female residents (N=22)

Area of concern N %

Housing 15 23


Drug use 12 18

Financial 11 17


Childcare 5 8

Mental health 2 3

Partner 1 2

Physical health 1 2


Other 1 2

4.3.6 At first contact with residential services, the main concerns of female residents were identified as their drug use (27%), housing (14%) childcare (13%), family relationships (13%) and issues relating to physical health (11%). Prior to leaving the residential service, housing (23%) drug use (18%) and family relationships (18%) had remained an issue for residents, whilst concerns surrounding finance (17%) had a reported increase in significance. Concerns regarding physical health, reported as 11% at first contact had naturally declined as a concern (2%) on leaving residential services.


Chapter Five: Aftercare: The Provider’s Perspective


Aftercare: The Provider’s Perspective

5.1 Working together: referral pathways

CARAT services

5.1.1 In order to achieve a ‘continuum of care’ and the delivery of a ‘seamless service’ it is imperative that effective working relationships have been established between agencies. Referral pathways and working links are often highlighted as important areas in achieving a ‘continuum of care’. It was therefore important that this area of work was researched within the study. All services were asked about the development and establishment of links between their service and other agencies. In addition to the question relating to the identification of these links, further investigation explored the development of ‘informal’ links or arrangements between agencies.

5.1.2 CARAT teams had established formal protocols with a range of both internal and external services. The vast majority of CARAT respondents had developed formal links with healthcare (94%), whilst sentence management, probation and resettlement teams were also identified as key service partners. It is also significant that at a time of national development of throughcare and aftercare integrated teams (CJITs), 43% of respondents already have formal protocols with this service.


Table 5.1.2 Formal working links (N=72)

Agency type N %

Healthcare 68 94

Sentence management 49 68

Probation service 44 61

Resettlement teams 43 60

Community-based drug/alcohol services 34 47

CJIP team 31 43

Community-based residential rehabilitation 23 32

Youth offending service 7 10

Other 8 11

5.1.3 CARAT services were then asked to identify the informal links they have established with community-based providers. Over three-quarters (76%) have developed informal links with community-based drug and alcohol services and 66% have links with community-based residential rehabilitation. Table 5.1.3 details responses.

Table 5.1.3 Informal working links (N=66)

Agency type N %

Community-based drug/alcohol services 47 76

Community-based residential rehabilitation 41 66

Resettlement teams 29 47


Sentence management 22 36

CJIP team 18 29

Youth offending service 14 23

Healthcare 8 13

Other 9 15


5.1.4 CARAT services were also asked if they felt that working links with prison departments and agencies could be further improved. Over three-quarters (77%) of CARAT services that responded to the survey felt that working links with prison departments/agencies could be improved. 11% of the respondents felt that working links couldn’t be improved.

5.1.5 Continuing on the theme of working with other agencies, CARAT services were asked if referral protocols and pathways could be improved. 64% of CARAT respondents felt that referral protocols and referral pathways could be improved, whilst 22% felt that these links were already adequate. Comments included:

‘Improving communication between the services so there is greater understanding of what each other does’

‘We have worked to build strong relationships’

‘There is a need for overall co-ordination of services’

‘Outside agencies could visit CARAT teams to encourage networking’

‘Often poor communication between prison departments’

‘Protocols need to be in place and effective links developed’

‘Better understanding of how each department/agency work and what the limitations are’

‘Links with prison and the community have dramatically improved, there is always room to improve effective communication in the client’s best interest’

‘Due to the number of prisoners from a wide geographical area, it is often difficult to link into service prior to release’.

Community-based providers

5.1.6 Community-based service providers were also asked to identify the agencies that referred prison and residential leavers to their service.


Table 5.1.6 Referral sources (N=143)

Agency type N %

CARATs 111 78

Self-referral 110 77

Probation 106 74

Residential services 67 47

Structured day care 29 20

Other 62 43

5.1.7 CARAT services, self-referral and probation were the predominant referrers to community-based providers (78%, 77% and 74% respectively). Residential services were also prominent referrers to community providers (47%), with a fifth of referrals coming from structured day care services. Respondents also stated that a significant number of referrals (43%) came from ‘other’ routes. These included arrest referral services, GP’s, housing providers and social services.

5.1.8 28% of community providers have developed formal links with residential services and prison services. However, the majority (61%) of community-based services have not developed any formal protocols with prisons and/or residential services.

5.1.9 When asked to specify if referral protocols and pathways could be improved between agencies, almost two-thirds (65%) of community providers felt that they could. A small number of respondents (7%) felt that referral protocols and pathways were already satisfactory and could not be improved upon.


5.1.10 Table 5.1.10 details those agencies with which community-based providers reported as having developed effective formal working links with.

Table 5.1.10 Formal working links (N=117)

Agency type N %

Social services 84 72

Community mental health services 79 68

Primary care services 77 66

Job centres 51 44

Housing 51 44

Self-help groups 24 21

Benefits 23 20

Local colleges 17 15

Citizens advice bureau 7 6

Other 29 25

5.1.11 Community-based providers have established formal protocols with a range of services. The prominence of the development of formal links with statutory agencies is particularly evident. Social services (72%), community mental health teams (68%) and primary care services (66%) being key partners. Over a fifth (21%) of community-based providers have also established formal links with self-help groups.


5.1.12 Community providers were then asked to state the services with which they had developed informal working links. Table 5.1.12 provides details of those informal links.

Table 5.1.12 Informal working links (N=117)

Agency type N %



Housing 71 57

Benefits 66 53


Job centres 57 46




Other 22 18

5.1.13 The development of ‘informal’ protocols or arrangements exist with a range of providers. Many of these can be directly related to aftercare provision in terms of accommodation (57%), benefits and finance (53%), self-help groups (58%) and education and employment (48% and 46% respectively).

5.1.14 44% of community-based agencies currently operate a waiting list to access their service, whilst 48% of respondents stated that they do not operate such a list. The length of the waiting list, where operated, varied considerably from agency to agency, from one week to twelve weeks, with most agencies operating a waiting list of between 2 and 4 weeks.

Residential Services

5.1.15 Following completion of a residential programme, 78% of residential service respondents confirmed that they referred clients onto community-based aftercare services. However, nearly a fifth (16%) of participants stated that they did not refer leavers onto any community-based services.


5.1.16 The survey then went on to explore the detail of the community-based services that residential services referred on to. Table 5.1.16 details the range of referral services.

Table 5.1.16 Referral services (N=29)

Agency type N %

Community-based services 17 59



Housing 16 55

Job centres e.g. progress2work 13 49

Benefits 12 41






Other 12 41

5.1.17 Residential services refer residential leavers to a breadth of services within the community. The referrals are aimed at a number of services that respond to a range of client needs. Over half of the respondents refer onwards to community-based services (59%), self-help groups (59%), local colleges (55%) and housing services (55%).


5.1.17 Respondents were then asked to state with which services they had developed effective formal working links. Table 5.1.18 details this information, clearly showing that formal links had been developed with a number of agencies.

Table 5.1.18 Formal working links developed by residential respondents (N=20)

Agency type N %



Housing 11 55

Benefits 10 50



Local colleges 6 30




Other 4 20

5.1.19 Three quarters of the residential services that responded to the survey had developed formal working links with social services and more than half of the participants had developed formal links with the probation service (65%), housing (55%) and benefits services (50%).


5.1.20 Table 5.1.20 details the range of agencies with whom residential services had developed informal working links.

Table 5.1.20 Informal working links developed by residential respondents (N=24)

Agency type N %



Housing 10 42

Benefits 10 42







Other 3 13

5.1.21 Three quarters of the respondents had developed informal working links with self-help groups, with over half (54%) of residential services setting up informal links with local colleges. A range of other services, including benefits (42%), housing (42%) job centres (29%), community mental health services (25%) and social services (25%) have also developed informal links with residential services.

5.1.22 With regard to specific links with HM Prisons, half of the residential services that participated in the research had developed specific links and/or pathways with these establishments. Over a third (34%) of respondents claimed that they had not developed any links or referral pathways to date with HM Prisons.

5.2 The importance of aftercare

CARAT services

5.2.1 CARAT participants responded with an unequivocal ‘yes’ when asked if they felt that aftercare was important to prison leavers. Many of the comments received from CARAT participants related to the sustainability and continuation of work undertaken within prison. Over 27 respondents indicated that aftercare was key to ensuring that gains made in prison were built upon in the community. Thirteen CARAT participants highlighted the vulnerability to relapse when returning to the community, and the


possibility of overdose following release from custody. Twelve comments were received specifically relating to help with practical issues as being an important part of the aftercare service. These included help with getting to appointments, help with housing and benefits as areas of need for prison leavers.

‘Any positive developments started in custody should be continued and this information passed on to the relevant agencies. A prisoner may be drug-free and motivated upon release but this is unlikely to be continued at the prison gate’

‘Where aftercare has been provided a higher proportion of clients are engaging with external drug services’

‘To try and prevent people from entering the ‘revolving door’’

‘More fluid community links addressing the full spectrum of needs. These include training, employment and housing’.


5.2.2 Once again, the vast majority of community-based providers that responded to the survey (88%) felt that it was important to provide aftercare services to prison/residential leavers. Many of the community providers (24 comments) were very focussed on the harm reduction and the harm minimisation agenda. This included issues around the avoidance of overdose and relapse prevention strategies for prison leavers. Community providers confirmed that aftercare was important in ensuring that there is a continuation of ‘treatment’ and supporting change (19 comments). 21 comments were received in relation to the importance of practical assistance and signposting clients to services (such as housing, benefits, employment, training and education). Nine providers also felt that access to prescribing services should be an important ingredient of aftercare services.

‘This group is at the highest risk of accidental overdose – this is also a prime opportunity to restart given the appropriate resources’

‘After leaving prison, the community can seem very frightening – a structure needs to be in place to prevent relapse’

‘We need to offer support at a vulnerable time’

‘Intervention and continued intervention reduces the risk of relapse, behaviour lapse and long term success of clients’ treatment’.


5.2.3 The vast majority of residential respondents (94%) felt that it was important to provide aftercare services to prison/residential leavers. The remaining 6% of respondents were either unsure or had not stated their reply. Nine respondents emphasised the need to reduce the risk of relapse and to promote recovery and the potential vulnerability of the aftercare period as being key reasons for the provision of effective aftercare services. Four respondents also emphasised the significant role that aftercare has to play in the promotion of independence for those experiencing a time of transition and significant change when leaving residential services. It was necessary to achieve a balance between the provision of


support for the client and ensuring that the clients’ needs are met whilst also ensuring that client independence can be maintained and built upon.

‘Greater support minimises the potential for relapse’

‘Aftercare can provide continuing support whilst encouraging independence’

‘Self worth, self esteem lost when in bed sit, no job – this undermines the rehab process’

‘You are shooting yourself in the foot if you don’t provide aftercare’

‘After a supported environment, residents can feel alone and vulnerable’.

5.3 Service strengths

5.3.1 CARAT services and the community-based providers were given the opportunity to identify the strengths of their particular service. The broad and varied range of replies perhaps indicates that services have been responsive to client demands and were developed in order to meet the needs of their local population.

5.3.2 As the responses were so broad, strengths have been brought together under overarching themes.

CARAT services

5.3.3 CARAT strengths were related to a number of areas. Once again, these have been sub-divided under appropriate headings.

The prison population

5.3.4 Six CARAT services that responded to the survey emphasised the opportunities that were available when working with the client group in prison - opportunities that may not always exist to those working with clients in the community. This included the perception that the majority of clients were not currently using drugs and had a limited access to illicit substances and the fact that clients ‘always turn up for appointments’.

Working with partners

5.3.5 Thirty CARAT services emphasised the working networks and working relationships developed by CARAT services as a key service strength. Multiple working relationships and the need to communicate effectively with a range of agencies is an important part of the CARATs role.

New opportunities

5.3.6 The opportunity to access clients that may not be engaging within the community and to re-engage with previously disengaged clients was emphasised by eight of the respondents. The opportunity to disseminate harm reduction and overdose avoidance information was also highlighted as an important part of the CARAT service – especially to clients who may not, ordinarily, access community provision.


Staff

5.3.7 Twenty-one CARAT respondents highlighted the commitment and qualities of CARAT staff as a particular service strength. The enthusiasm, dedication and commitment of CARAT workers were qualities that were regarded as instrumental to CARAT service success.

Values

5.3.8 Twenty-two respondents felt that the values of the service were an important part in the strength of CARAT provision. The examples of a needs-led approach and the confidential ethos of the service were cited as key elements of this approach.

Access

5.3.9 Twelve CARAT respondents indicated that the issue of access was particularly important strength of the CARAT service to prisoners. A range of issues relating to access were given, and these included the fact that access to the service is voluntary and that there is equity of access. Other examples of practice included the opportunity that CARATs have to identify prisoner needs on their arrival within a custodial environment.

Other examples

5.3.10 The breadth of the service provided by CARATs to clients was also highlighted within the study. Respondents stated that they could provide a range of interventions and that a full range of treatment was available. The fact that the CARAT service is a nationally available service, thus bringing an element of consistency and uniformity, was also seen as particular service strength.


Access

5.3.11 Over 36 comments were received from community-based services relating to access as a key strength in their provision. Access was indicated in terms of ease, immediacy and availability.

Flexibility

5.3.12 The ability of the service to be flexible in meeting the demands of its clients was also highlighted by providers as a key strength of the services. Nineteen community providers emphasised flexibility as a service strength in terms of the ‘package’ available to clients. Flexibility, in relation to appointment times, and in terms of the service being delivered on a ‘needs-led’ basis.

Signposting

5.3.13 The ability to work with other agencies and to have a good understanding of other local services was an area in which community-based services felt they had a key strength. Twenty-one comments from participants emphasised their important role in accessing a range of other services on behalf of their client, sign-posting clients to alternative services and the provision of ‘effective care-co-ordination’.


Range of services

5.3.14 The variety and range of services were highlighted as key service strengths by a number of community-based providers (8 comments). Whilst the diversity of services in general was highlighted by the survey returns, it was also evident that services felt that the range of service they provided was an important part of their delivery remit. Examples of services provided included practical help with housing and benefits, supporting access to education and training, in addition to counselling, complementary therapies, prescribing services and a variety of client support.

Staff

5.3.15 Over 18 community providers specifically highlighted issues related to the staff employed by providers as a key strength in community-based provision. The quality, enthusiasm, knowledge- base, approachability, dedication and professionalism of staff were all highlighted as positive factors in service provision.

Relationship building

5.3.16 The ability to build relationships with clients and provide ongoing services and support were emphasised by 11 community-based providers.

Aftercare specific

5.3.17 Nine respondents felt that their service had a particular strength in the delivery of aftercare. Participants cited a number of practice examples undertaken by their agencies as positive work in this area. Some of these examples are given below:

• Relapse prevention work with prison leavers

• Pro-active engagement with the prisoner prior to release

• Package of care in place for the prisoner prior to release and continued support on release.

Prescribing service

5.3.18 The ability to prescribe to prison leavers was highlighted by 11 community-based respondents as an important factor in their agencies service provision. This was also closely tied with the ability to prescribe quickly and ‘immediately’ in a number of cases.

Values

5.3.19 Ten community-based providers felt that the principles upon which services were delivered was also a key strength in service delivery. The principles of a client-led/needs-led approach was important to a number of the respondents. Participants also felt that work undertaken in an approach that was essentially non-judgemental was also an important element to the strength of their service delivery.


Other issues

5.3.20 Two comments received from agencies highlighted the significance of services being developed and planned in line with client need and with the input of user involvement. One particular agency stated that it was important for their agencies’ development to be planned – ‘based on research and continual user involvement’. Services also alluded to ‘support’, in very general terms, as a particular strength and positive facet to the service they deliver.

5.4 Barriers to improvement and blocks to providing effective aftercare services

5.4.1 All three agency types were asked to highlight the main barriers to improving aftercare services in their area or to stipulate the three main blocks to providing effective aftercare. Once again, there was a wide range of responses to this question and examples have been brought together under broad themes.

CARAT services

Resources

5.4.2 CARAT teams highlighted a number of ‘resource-related’ issues that were identified as potential barriers to effective delivery of aftercare. These were defined within either a financial, structural or human context.

• Housing-related issues (26 responses). Many of these issues were principally concerned with the lack of appropriate/suitable housing and accommodation for the client-group

• Lack of funding (11 responses)

• Lack of a specific aftercare service (8 responses)

• Lack of employment opportunities (5 responses).

Access

5.4.3 Access to services in the community was also raised as an area of concern for CARAT teams. Issues include the following:

• Waiting times to access community agency (19 responses)

• Limited range of services in area of release (10 responses)

• Lack of access to rehab post-release (6 responses)

• No fixed appointments by local services (6 responses)

• Capacity within community-based agencies (5 responses)

• Lack of information on local services (3 responses)

• Limitation of agency opening times (1 response)


• Limited day care services (1 response)

• Lack of consistency in services (1 response).


5.4.4 Three CARAT respondents also highlighted problems related to the sharing of client information with community-based providers as a barrier to effective aftercare provision.

Prison-related issues

5.4.5 CARAT teams also identified a number of issues that were specifically related to working within the prison environment.

• Issues related to geography (6 responses). A key concern in this area was the fact that a number of prisoners had been released to areas of the country that CARAT teams were not familiar with services in that locality.

• Time limitations with clients/remand/HDC prisoners (4 responses)

• Lack of Liver Function Tests/Naltrexone treatment (4 responses).

Other Issues

5.4.6 Eight additional comments from CARAT respondents referred to client-specific issues that provided barriers to aftercare access. These included ‘client motivation’ and ‘client drop-out’ rates following their release from prison.

Community-based providers


5.4.7 Issues related to working links with other agencies and services (including CARAT teams) were given prominence by community-based providers as a barrier to the improvement of aftercare services. Issues raised included:

• Poor communication (31 responses)

• Lack of notice from prisons (10 responses)

• Lack of CARAT knowledge on local services (7 responses)

• Poor referrals/pre-discharge planning (7 responses).

Resources

5.4.8 As with a number of CARAT respondents, community-provider participants also highlighted a number of issues related to ‘resources’. Once again, these have been defined within either a financial, structural or human context. Particular emphasis has been placed on the lack of appropriate housing for those leaving prison and residential services.


• Issues relating to housing (44 responses)

• Lack of funding (31 responses)

• Inadequate staffing (10 responses)

• Lack of a specific aftercare service (8 responses)

• Benefits/finance-related (5 responses)

• Poor rural services (4 responses)

• Lack of daycare services (4 responses)

• Poor transport links (3 responses).

Treatment services

5.4.9 Community-based providers also highlighted issues related to treatment as a potential barrier to the delivery of an effective aftercare service.

• Waiting times to access treatment (10 responses)

• Lack of Naltrexone treatment provision options in custody (5 responses)

• Lack of GP access (3 responses).

Client-related

5.4.10 Community providers also highlighted a number of issues relating specifically to the client group itself.

• Lack of engagement post release (6 responses)

• Lack of training/employment opportunities (5 responses)

• Client returns to their home community (3 responses)

• Poorly motivated clients (2 responses)

• Relapse (2 responses).

Other

5.4.11 A number of general issues were also highlighted as potentially problematic that may impact on service delivery. These include limited resources within rural areas, poor transport links, lack of an appropriate IT ‘tracking system’ and the constant changes in personnel within services.



5.4.12 Residential services provided a number of blocks and barriers that impacted on the delivery of aftercare services. These included:

• Finance/funding (14 responses)

• Resources (8 responses)

• Lack of appropriate accommodation (5 responses)

• Lack of staffing (5 responses)

• Client finance/benefits (3 responses)

• Lack of specialist services (2 responses)

• Lack of employment opportunities (2 responses)

• Lack of access to community services (1 response)

• Client returning to home area (1 responses)

• Waiting list for community agencies (1 response).

5.4.13 Residential services’ suggestions for improvement were broad and related to the many facets of aftercare. Increased investment in services and resources, including specific aftercare services and the development of appropriate housing for the client group were key elements in a successful aftercare strategy. The development of the throughcare and aftercare elements of CJIP (now re-branded as the Drug Interventions Programme) was also identified as an indicator of potential progress within this area.

‘We need to develop a better understanding of the constraints between different organisations’

‘To organise formal/informal networks prior to discharge’

‘There are not enough accommodation projects providing a forward-thinking, empowering service. Hence, we often run with long waiting lists and clients end up in inappropriate accommodation in the meantime’

‘Some prisons will not initiate Naltrexone prescribing prior to release. Some prisoners find it difficult to maintain a drug-free status once released’

‘Until recently we had a high population of prisoners who needed aftercare arranging 100 miles away’.

5.5 Potential improvements to the aftercare system

5.5.1 CARAT teams and residential services were asked if they felt that aftercare services could be improved in general, whereas the community-based providers were asked a more specific question relating to the aftercare improvements that could potentially be made in their local area. The areas of improvement


and development tended to reflect blocks and barriers. However, a number of responses from a range of participants across all sectors, indicated that the implementation of the aftercare element of CJIP (now Drug Interventions Programme) was welcomed as a progressive and positive step towards improving communication and aftercare services.

CARAT services

5.5.2 89% of CARAT services felt that aftercare service provision could be improved, with only 1% of the returns stating that there was no room for improvement in aftercare services. There was a breadth of suggestions from CARAT services and these have been detailed within broad ‘umbrella’ categories.

Resources

5.5.3 Resources were again listed as an area within which positive changes could be gained.

• Access to appropriate accommodation (22 responses)

• Increased funding (13 responses)

• Specific aftercare service/workers (14 responses)

• Employment opportunities available (4 responses).

Access

5.5.4 Access to community-based services was listed as an area that could be improved. Improvements stated are listed below:

• No waiting times to access services (9 responses)

• Immediate access to services (4 responses)

• Out-of-hours access (3 responses)

• Fixed agency appointments (2 responses).

Treatment

5.5.5 Areas specific to the delivery of treatment were also highlighted by CARAT services within the survey. These included:

• Quicker access to treatment (4 responses)

• Widen availability of Naltrexone (3 responses)

• Improve GP access (1 response).



5.5.6 Working with partner agencies and specifically community-based providers and the services that they provide was an important factor for CARAT teams. A number of suggestions regarding improved working with partner agencies were mentioned.

• Access to rehab on release (5 responses)

• Ensure continuity of care (4 responses)

• Wider range/more community services (4 responses)

• Better links between agencies (4 responses)

• Simpler referral systems (2 responses)

• Closer work between agencies (1 response).

General issues

5.5.7 A number of general suggestions for the improvement of services were also detailed by CARAT teams. One respondent highlighted the need for better stimulant services in the community, another highlighted the possibility of introducing a mentor scheme to prisoners, whilst another suggested the availability of a website on local areas with the services available and constantly updated information on availability within the locality. Comments included:

‘Aftercare does not seem to be streamlined or consistent. This can make it confusing’

‘CJIP is a good stepping stone’

‘Recognise that this is a highly labour-intensive and invest in staff training and in resources’

‘Take aftercare and resettlement seriously to provide the practical resources needed’

‘CARAT workers and community workers need to work closer together’.


5.5.8 The majority (63%) of community-based providers that responded to the survey felt that aftercare service provision in their local area could be improved to enable their service to ‘make a difference’. Only 3% of the respondents felt that aftercare services within their area could not be improved, whilst 34% were either unsure or did not reply to the question.

Resources

5.5.9 Community-based providers felt that increased resources in a number of areas would be beneficial. Areas for improvement in this area include the following:


• More appropriate housing provision (28 responses)

• Specific aftercare services/care co-ordinator (12 responses)

• Increased resources (5 responses)

• Increased educational/training opportunities (5 responses)

• Increased staffing levels (4 responses)

• Increased day-care facilities (4 responses)

• Benefits-related support/access (2 responses).

Service-related

5.5.10 In relation to the development of community services in improving the delivery of aftercare, a limited number of suggestions were given. The continual and on-going involvement of users within service development (2 responses) was highlighted as an area for expansion and further work.


5.5.11 This area related to working with partner agencies.

Views raised included:

• Better communication/links with partners/CARATs (10 responses)

• Better joint-working with partners (9 responses)

• Clear/common referral pathways (5 responses)

• Better planned discharges/more notice (5 responses)

• Community worker to see the client prior to release (3 responses)

• CJIP (3 responses)

• More relapse prevention work (2 responses)

• Training for tier 1 staff (1 response).

Other examples

5.5.12 Suggestions that do not readily ‘fit into’ any of the groups outlined above included the need to involve families, ready access to support groups and improved family support systems.



5.5.13 78% of residential services felt that aftercare services needed to be improved. No respondents felt that services didn’t need improvement, whilst 22% were unsure or did not give a response.

Resources and services

5.5.13 A number of issues relating to services, resources and opportunities were raised by residential services as potential areas of improvement. These included:

• Increased funding (10 responses)

• More appropriate accommodation/housing (6 responses)

• Joint-working/better links (5 responses)

• Increased resources (5 responses)

• Better employment/training opportunities (3 responses)

• Increased aftercare staffing (3 responses)

• More user involvement (2 responses)

• Immediate community support (1 responses)

• Effective co-ordination (1 response)

• More aftercare services (1 response).

5.6 Examples of interesting practice

5.6.1 Throughout the course of the research, it was evident that across the country, services had developed a range of aftercare interventions that were relevant to the needs of their clients. Organisations, and individuals within those organisations, had a commitment towards the continual development of services that ensured that the ongoing needs of clients were reflected in service delivery. Elements of service delivery contained within some of the following examples have been included within the recent guidance for the development of throughcare and aftercare. Particularly interesting examples of practice from the case studies include the following:

• joint release planning between prison link workers, CARAT workers and prisoners

• out-of hours telephone contact

• ‘drop-in’ services that ensure flexibility and responsiveness with no waiting list to access a keyworker

• continued agency support through episodes of transition


• user involvement in service planning and service delivery

• continued agency support in ‘non-drug’ specific areas, such as housing and employment

The small selection of case studies reinforce and support the need for services to continually develop and reflect the needs of their local community. They also highlight a range of principles, such as partnership working, adopting a user-friendly ‘customer care’ philosophy, continued support, multi-disciplinary working practices and responsiveness, that must be key features of any successful aftercare service.

5.6.2 In Newcastle, Addaction provides a specific Aftercare and Resettlement service. The service aims to provide a resettlement package for offenders with substance misuse problems who are being released into the Newcastle area. The project has built many effective links with a range of partner-agencies in the locality, whilst offering care-planned one to one support, pre-release appointments, gate-collection scheme and an out-of-hours telephone support service.

5.6.3 The First-Stop Centre in Braintree, Essex, provides a unique and comprehensive ‘drop-in’ service that is available to all members of the local community. The service provides advice on benefits, housing, debt management, education, whilst also offering activities and meals. They also have a needle-exchange located within the service, engage in harm reduction work and have established close-links with detox clinics. As the service is delivered on a ‘drop-in’ basis, this ensures flexibility of access and is ‘user-friendly’.

5.6.4 Hammersmith & Fulham Social Services, via the Drugs and Alcohol Team, offer aftercare provision. The service aims to assist clients complete their recovery, re-integrate into the local community, provide support services and facilitates links into local colleges, leisure facilities and voluntary work. They provide this service to all clients that have completed funded treatment, anyone leaving prison and clients wanting to remain abstinent. The service is immediately available post-residential/prison. Provision is planned on the basis of client-feedback, user involvement, research and the recruitment of ex-users to run aftercare provision. The team also supports FIRM (Fun in Recovery Management), an organisation for clients, ran by ex-users, that arranges regular ‘social club’ events. The club forms an important part of aftercare provision within the service.

5.6.5 In Derbyshire, Addaction’s Criminal Justice team provides a seamless service of care for individuals with substance misuse issues, who have engaged within the Criminal Justice system. The team aims to make available an initial assessment prior to release from custody – or within two working days of release and provides treatment on release. Liaison with Probation Hostels ensures that screening and assessment takes place. A treatment plan is completed with the user and goals are the set than can be worked towards. The service also incorporates an Enhanced Arrest Referral Scheme, which enables the service to offer a seamless support network from arrest, to release and beyond. In terms of aftercare specifically, the project provides a drop-in service and is available to clients who have accessed the criminal justice system within the previous three months. The drop-in service offers a range of services – from advice and information to the option of accessing higher levels of intervention. There is no waiting list to access a key worker.

5.6.6 In Liverpool, The Bosco Project (a homeless residential unit) provides a holistic support package for individuals with substance misuse problems. They offer counselling, training facilities on-site, encourage


healthcare and offer a structured programme of activities. Support is available seven days a week, 24-hours a day. A number of aftercare options are available for residents, including ‘move-on’ flats, which offer a semi-independent living option and the project have also secured a number of permanent properties, which are available at a low-rent to ex-residents. An outreach worker is also employed to support residents through periods of transition. A number of workers and volunteers within the project are ex-clients and are also active within the on-going development of the service.

5.6.7 In Bournemouth, CLOUDS Continuing Care offers a ‘post-treatment support service’. The service offers a 12-week group setting/support for people who have completed a course of first-stage treatment. The course runs for 12-weeks and is one day per week. The days are described as ‘therapeutic’, are participatory on a workshop/lecture basis and each day is ran on a theme, such as recovery, relapse and self-esteem issues. The course is ran by CLOUDS on a ‘stand-alone’ basis. User feedback is used to continually develop the service. Whereas the service was initially for clients that had completed treatment within CLOUDS, access has recently been ‘opened-up’ so that non-CLOUDS clients can become active in the group.

5.6.8 A Phoenix House aftercare service in Hastings, East Sussex, is a continuation of care for residential-leavers. A comprehensive care-plan is developed between the client and an aftercare worker. Aftercare, in its widest sense, is addressed within this stage of the work. Issues such as housing, health, legal status, criminality, employment, education, family relationships and relapse prevention are all addressed and reviewed. Appropriate referrals to other agencies are then made. The aftercare worker also facilitates a weekly aftercare group with interested clients.

5.6.9 The Rotherham Aftercare Service is a dedicated aftercare team and is part of the local community Drug Team. The multi-disciplinary team includes health professionals, workers from Turning Point and also works in partnership with the ‘Safer Rotherham Partnership’. The service ‘fast-tracks’ naltrexone prescribing for those released from prisons. The service also provides ongoing support to clients, with an emphasis on relapse prevention, occupational therapy, complementary therapies and life skills. The service is flexible and needs-led and can priority-refer clients back into the Community Drug Team should a client relapse.

5.6.10 The Ley Community, located near Oxford, provides a 12-month residential programme. The programme is underpinned with a ‘peer support’ philosophy and has established an extremely successful system of aftercare. At Stage Five, which is the last three months of the programme, residents find full-time employment on the open job market whilst renting one of two of the communities’ independent houses. Residents participate in bi-weekly therapy sessions with a dedicated resettlement officer. After three months within this setting, residents, in groups of two, three or four, move into the private rented market in Oxford. Residents, at this stage of the programme, are still regularly encouraged and supported by the Ley Community resettlement officers and their peers. One of the achievements of the Ley Community is that it can boast that every resident that has successfully completed the programme has found full-time employment when returning to the community. Ex-residents have also made a significant contribution to the voluntary sector within the Oxfordshire area.

5.6.11 St. Luke’s Aftercare Service, ran by the West London Mission Social Work Ministry, provides continued care for clients who have completed residential/day programmes. They provide support in negotiating re-entry into the community. A structured day care programme supports clients in consolidating work that has already started in primary treatment. They also provide supported housing. The service


specifically targets ‘vulnerable’ and marginalized groups, giving them opportunities to access supported housing, whilst also working in partnership with their families.

5.6.12 In Worksop, The Nottinghamshire Healthcare NHS Trust, offers the ‘Aftercare Project’. This service offers treatment support to those returning to North Nottinghamshire from periods in custody. Staff from the service include provision for a specialist women’s worker and for a worker to lead on meeting the needs of those under 21 years old returning from Young Offender Institutes. The service offers prescribing via their own clinic to support their interventions.

5.6.13 In Hanley, Stoke-on-Trent, Druglink employ a prison link worker. In post since January 2003, the worker supports prisoners with drug issues who are currently in prison serving custodial sentences with impending release. She works in partnership with the CARAT team and the prisoner in negotiating a release plan that reflects the prisoners needs before the prisoners release date. The prison link worker has invested time in building relationships with CARAT teams within her catchment area. She also draws on local volunteer services to meet prisoners at the gate, if this is a requirement of their release plan, and will, on occasion, meet prisoners at the gate herself.

5.6.14 The above examples are just a small number of the interesting, responsive and innovative practices that are currently being undertaken within the field. It is essential that opportunities to share such practices are developed, so that projects are not locally re-inventing the wheel, in isolation, but are drawing on the experiences of other workers in the field.


Chapter Six: Discussion

NVA


Discussion

6.1.1 Aftercare for offenders has recently been given an increased governmental priority, with additional funding and resources, via the implementation of the Drug Interventions Programme. The development of throughcare and aftercare provision is at the heart of the programme, in terms of bridging the gap for those drug misusing offenders leaving the criminal justice system and entering treatment in the community. Integrated multi-agency local drug teams, adopting a case management approach provide a focal point in the delivery of care to individuals within the criminal justice system. It has facilitated the development of specific teams/workers, offering access to treatment and support. Support begins at an offenders first point of contact within the criminal justice system and is then available through custody, court, sentence and beyond, into resettlement (Home Office, 2004).

Implementation of the throughcare and aftercare elements of the Drug Interventions Programme has drawn upon good practice and has included key research and literature findings that will increase the effectiveness of provision by improving engagement with the service and ultimately treatment success.

6.1.2 Aftercare services (in their widest sense) have served communities for years. Many of the services are specific to the substance misuse field, such as community-drug agencies and clinical interventions. But most of the services involved in aftercare relate to all citizens, e.g. leisure facilities, access to GPs and primary care interventions, access to appropriate housing, employment, educational and training opportunities and access to community and support groups. Aftercare, in respect of those leaving prison and those in residential services, who have, or may still be, misusing substances is about ‘continuing care’ and building on any work undertaken within prison and within residential services. Therefore, two important points are a) having access to these services and b) ensuring that client services are co-ordinated and appropriate to client need.

6.1.3 As with Turnbull and McSweeney’s (2000) research, amongst respondents, there was a common agreement that aftercare is an important factor to treatment success. The need to sustain any gains made with clients throughout their stay in custody or their residential stay was considered to be important. Indeed, the effectiveness of aftercare in reducing re-offending and relapse rates is well documented (Fox;2000, Gossop; 2001). Respondents also highlighted the key role that aftercare services can play in terms of ensuring that information relating to harm reduction and overdose prevention are consistently delivered. Aftercare, and specifically the role that community-based providers can play in terms of ‘signposting’ clients and supporting clients through this transitional period was also highlighted.

6.1.4 The issue of funding, and the funding of aftercare-specific services, was also raised within the research. Just over half of residential services receive funding for aftercare services and less than a fifth of community-based providers stated that their funding was of a permanent nature. Given the timing of the research, it is possible that the advent and roll out of funding for the throughcare and aftercare elements of the Drug Interventions Programme, from April 2004 to all DAT partnerships in England and Wales, will impact on the further funding of aftercare services.


6.1.5

6.1.6

6.1.7

6.1.8

Although services may not have been established as an aftercare specific service, and where services are not in receipt of specific aftercare funding, the research highlights that many services provide aftercare in the community as an element of their service delivery. A number of respondents highlighted a range of examples of practice that have attempted to meet client need. Such examples give an insight into the innovation and commitment from services within the field. From the residential sector, examples included continued personal contact with a key worker, weekly ex-residents support meetings, resettlement workshops in the transition period, access to an aftercare group (with professional facilitation) and the provision of ‘move on’ accommodation. Examples from community-providers include proactive engagement from workers. Schemes such as ‘in-reach’ workers from the community meeting prisoners prior to release, ‘gate pick-up’ services to meet prisoners on their release and the provision of mentoring schemes were all being delivered by community-based providers.

Drug use and housing were consistently highlighted by services as a principal concern for both male and female clients when re-entering the community. The need for appropriate, flexible and responsive accommodation is seen as a key determinant of client success in goal achievement. As drug use also remains a key concern for clients, it is also essential that clients continue to engage with services that specialise in the delivery of treatment packages relating to substance use.

The research highlights the extensive and diverse working links within the field, both formal and informal. Nevertheless, almost two-thirds of community providers and 64% of CARAT teams felt that links and referral protocols could be improved. Specifically addressing the key relationship between CARAT teams and community providers, it is clear that in a relatively short period of time, relationships and arrangements between the two service types have developed apace. Many CARAT services highlighted their ability to build, sustain and develop relationship with a wide range of partners (internal and external) as a key strength of their service. However, community-based providers felt that poor communication was also a barrier to the delivery of an effective aftercare service.

CARAT services reported that the establishment of community links, such as accommodation, employment, education and training, through to specific support in relation to drug use itself, were key components in the development of an aftercare package for prisoners. However, a number of CARAT teams also highlighted their lack of information on local services as a barrier and also commented on the limitations on putting effective aftercare packages in place when working with prisoners who are returning to another area.

6.1.9 The importance of accessing services was also highlighted within the study. The research emphasised not only limited access due to geographical location, particularly issues related to transport and the lack of rural provision, but also access to treatment services because of waiting times. Both community-based services and CARAT teams cited waiting times as a key barrier to a ‘continuum of care’ and support. Indeed, 44% of community-based services operate a waiting list. Fixed agency appointment times, immediate client access and even the possibility of 24-hour access to community-based services were also proffered by CARAT teams as solutions to the problem.

6.1.10 The survey highlighted a dearth of information relating to clients who are referred to, or who attend, services for specific aftercare interventions. Nearly one-quarter of community-based responders to the survey reported that specific demographic information was not collected.

6.1.11 Many CARAT, community-based providers and residential services felt strongly that aftercare provision


could be improved and agreed on the importance of aftercare provision. It is hoped that this commitment from all services, linked with increased resources and funding, of which the throughcare and aftercare elements of the Drug Interventions Programme is an important element, will ensure that the aftercare agenda continues to ‘move on’.


Chapter Seven: Conclusions and recommendations

NVA


Conclusions and Recommendations 7.1.1 Housing was consistently highlighted as a key component in the delivery of effective aftercare services.

Action related to housing can be undertaken on a number of levels:

• At a local level, and in the short term, there is an opportunity for community-based drug teams and local housing providers to forge closer working relationships. The importance of housing highlights the needs for ‘housing specialists’ within community-based drug teams. Specialist housing workers can build strong links with local housing providers and remain focussed on local housing issues and availability, from a substance misuse perspective. A dynamic two-way relationship between housing providers and community-based providers has the potential for community-drug agencies to influence the local housing agenda and ensure that housing providers remain aware of the needs of those leaving prison and residential establishments and returning to the community. This will also enable community-drug agency workers to focus on ‘drug issues’, which, as reported in the survey, naturally remains a key concern for clients.

• The ‘Supporting People’ agenda is a key national strategic-driver in the area of housing, and has the potential to address local housing needs for those clients requiring accommodation following release from prison or leaving a residential service. The research has highlighted the significant and central role of housing within an aftercare context. It is therefore imperative that Drug Action Team Co-ordinators and Supporting People teams work in partnership to establish local housing need and formulate and develop local strategies for this client-group.

• In the medium to long term, it is essential that policy-makers remain aware of the need for further and continued investment in appropriate housing, and housing services, for prison and residential leavers.

7.1.2 The need to have a specialised aftercare service, or at the very least a co-ordinating agency, was also emphasised by many respondents within the study. Many community-based services felt that their local knowledge and signposting expertise was a particular strength of their service. Co-ordination and management of a clients’ ‘package of care’ is an important component within the aftercare element of the Drug Interventions Programme. In this respect, it is essential that the Home Office continues to monitor and review this aspect of the Drug Interventions Programme to ensure that it continues to meet the needs of clients.

7.1.3 Respondents consistently reported, for both male and female clients, family relationships, and childcare specifically for female clients, were key areas of concern. It is therefore important that community-based providers have the expertise, or can access such expertise through partnership agencies, in order to work holistically and systemically with families, when developing an individual’s aftercare support. It is the responsibility of local agencies to ensure that these arrangements are in place. At a local strategic


level, Drug Action Teams and commissioners need to remain aware of the importance of services providing, or providing access to, such services.

7.1.4 The relationship between community-based providers and CARAT teams is key in terms of ‘bridging’ treatment within custody and within communities. Whilst this relationship has continued to develop since the inception of CARAT’s in 1998, the research has emphasised the need for a renewed educational and networking process between CARAT teams and community-based services. Area Drug Co-ordinators from the HM Prison Service and local Drug Action Teams have an opportunity to work together and develop partnerships to renew this process and further develop an understanding between these ‘key players’ at a local level. It is important that a joint working ethos, an ethos that is based on mutual understanding and respect, is developed locally between these pivotal agencies.

7.1.5 A lack of specific aftercare targets within the community is highlighted by the research. Less than a fifth (18%) of community-based providers confirmed that they have specified targets and outcomes for their aftercare services. A range of ‘hard’ and ‘soft’ targets are employed by community-based services to monitor outcomes. Many of the services stated that these targets were currently under review or being negotiated with Drug Action Teams, funders and commissioners at a local level. It is important that targets are consistently in place across services to ensure that all services delivering elements of aftercare are providing ‘effective’ aftercare options to prison and residential leavers.

7.1.6 While it is important to provide a holistic aftercare service (Harrison, 2002) the vast majority of community-based providers who responded to the survey were not specifically delivering an aftercare service, but had developed aspects of their service to incorporate an aftercare element, in line with client need.

7.1.7 The research provided a description of aftercare (see page 21) to guide responses to the questionnaire. In addition to specific drug-related aftercare interventions, the description highlighted the potential range of aftercare support available, thus enabling respondents the opportunity to address a wide spectrum of issues. Responses to the survey highlighted the variance in the content and extent of aftercare provision. For example, the majority of community-based respondents provided one-to-one work and relapse prevention (92% and 80% respectively). However, fewer respondents provided a wider range of aftercare provision. This included specific interventions, such as prison gate pick-up on release (10%) and the provision of primary healthcare (28%). Non-specific drug interventions tended to be provided in partnership with other agencies. Of interest, are the issues of housing advice/referral that is delivered in partnership by 59% of community-based respondents and education, training, employment advice and referrals (58%).

7.1.8 This disparity does highlight a need for a definition of aftercare provision to be developed. This may ensure consistency, for example, in the delivery of core, auxiliary and supporting services, and to allow national benchmarking and insights into good practice. Undertaken on a national scale, through the National Treatment Agency or through the Home Office, this clarification and consultation process would ensure that future targets and outcomes could be established at a national level, across all services, not only aftercare services delivered within a criminal justice context. As a consequence of this exercise, there is the potential to initiate and embark upon, a national benchmarking exercise in aftercare services. A minimum data set of information, collected by all specific aftercare services, and a range of information collected by community-based providers providing aftercare services, and monitored on a regional or national level, would ensure that clients receive a consistently effective and


high quality service from all providers.

7.1.9 The roll out of the throughcare and aftercare elements of the Drug Interventions Programme to all DAT partnerships in England and Wales from April 2004 should impact on this area of work and may provide an opportunity, also on a national level, to ensure that there is a consistency of recording data in terms of the delivery of aftercare and the monitoring of gains. This would help to develop an overall picture of effective practice and build up a broader and more consistent picture of ‘What Works’ on a national level. It is essential that this information is ‘cascaded down’ from the Home Office to local Drug Action Teams and ultimately disseminated to agencies at a local level.

7.1.10 A number of agencies within the research supported the view that user involvement should also play a key role in the planning and delivering of effective aftercare services. It is the responsibility of agencies to involve users and carers in the planning and development of services. Once again, at a local level, agencies have a responsibility to facilitate the involvement and consultation on service development with users and carers, and local commissioners and Drug Action Teams should also ensure that active involvement is encouraged through funding arrangements. At a regional and national level, the National Treatment Agency also have a responsibility in continuing to ensure that users and carers are involved in the development of aftercare services. National best practice linked with a strong ‘user voice’ at a local level should help to ensure that services remain relevant to local need.

7.1.11 Opportunities exist at all levels - local, regional and national - to maximise service potential for those clients accessing aftercare services. This report highlights the diverse nature of aftercare services that have developed nationally, to address the needs of local people. As previously discussed, it is hoped that many of the concerns highlighted by providers within the research will be addressed by the Drug Interventions Programme. However, a number of clients accessing ‘aftercare services’ following a residential programme for example, may not be a client within the criminal justice system. It is therefore important that policy-makers remain aware of the need to offer equity of access and equality of opportunity to all those clients wishing to build on the positive changes that they have made to their life.


Appendices

Appendix One: CARAT Service Questionnaire


National Aftercare Research PCARAT service questionnaire

Code n

Due to an increasing awareness of the gap within the government’s aim of a ‘continuum ofservices in relation to aftercare and resettlement, the Department of Health under Section 6Health Act has awarded Addaction funds to conduct a research project within this area.

For the purposes of this research aftercare is described as follows:

“Aftercare is designed to offer a continuum of support to those who have been exposed to completed treatment or rehabilitative work for drug misuse. It aims to address the practicaldevelopmental needs of clients and may include counselling, cognitive therapy, group workand vocational training.

Aftercare also includes aspects of resettlement helping those individuals in treatment integby assisting with practical life skills, and offering support in finding accommodation, educatemployment”.

The aim of the research project is to establish:

• the need for aftercare services for prison/residential leavers aged 18 years and oveissues

• how aftercare services are currently identified • the nature and type of aftercare services available for prison/residential leavers wit• the effectiveness of the current operating environment • identify models of good practice in aftercare provision • the learning from this research will be disseminated throughout the field.

In order to collect your views on aftercare provision we have designed a short questionnairwill take time to complete. Please return the completed questionnaire in the pre-paid envelfor the attention of Sarah Drainey, Research and Quality Officer of the Directorate of DevelImprovement. Should you wish to discuss any particular issues in more detail please do nocontacting:

Directorate of Development and Improvement, Addaction , 67–69 Cowcross Street, LonTel: 0207 017 2727

Thank you for your time


o.

roject

care’ of treatment 4 of the 1968 Public

/ involved in or have and personal , family involvement

rate back into society ion, and

r with drug misuse

h drug misuse issues

e that we hope you ope provided marked opment and t hesitate in

don, EC1M 6PU

Name of service:

Service type:

Organisation:

Contact details:

Including e-mail and telephone

Role/position:

Date of completion:

Section 1: Services provided

1.1 Please provide a brief description of the main aims of your service:

1.2 Does your aftercare service provide a standardised package of care or are service interventions provided based on individual client need?

Standardised package of care Needs led Mixture of both None of the above

1.3 What types of service interventions do you provide for prisoners who have identified a problem with drugs?

please tick ( ) as appropriate

One to one support Group work Relapse prevention Complementary therapies Parenting skills Advice/information and support Other service (please specify)


1.4 Do you have a specific treatment philosophy e.g. only work with drug-free prisoners?

Yes (please specify below) No

1.5 Do you to contribute to the release planning of the drug-using prisoners you are working with?

Yes No Unsure

1.6 Do you have a role in the development of aftercare packages for prisoners who utilise your services?

Yes (please go to question 1.7) No (please go to question 1.9) Unsure

1.7 What are the key components of an aftercare package for a prisoner who has identified an issue with drugs ?

1.8 Over the past six months (April 2003 – Sep 2003), approximately how many aftercare packages has your service developed?

1.9 How do you monitor the effectiveness and impact of your aftercare package?

Section 2: Referral pathways / working links

2.1 With which of the following departments/community-based agencies have you developed effective working links? (please tick ( ) as appropriate)

Formal links e.g. protocols Informal

sentence management healthcare resettlement teams probation service community-based drug/alcohol services community-based residential rehabilitation Youth Offending Service CJIP Team Other service (please specify below)


2.2 Do you feel that working links with prison departments/agencies could be improved?

Yes (please specify how below) No Unsure

2.3 Do you feel that referral protocols/pathways could be improved?


3. Client profile

3.1 Over the last six months (April 2003 – Sep 2003) approximately how many of your caseload of drug-using prisoners fall into the following groups?

Client caseload-group No. of individuals Not recorded ( ) as appropriate

Male

Female


Young people (19 and under)

Women with children

Housing/accommodation needs

Short-term prison leavers/drug users*

Long-term prison leavers/drug users**

Other

3.2 Over the last six months (April 2003 – Sep 2003) approximately how many of your caseload used the following drugs?


Drug of use No. of individuals Not recorded ( ) as appropriate

Heroin

Crack cocaine

Cocaine

Amphetamine

Cannabis

Benzodiazepines

Alcohol

Poly-drug use

Other drug (please specify below)

3.3 Over the last six months (April 2003 – Sep 2003) approximately how many of your caseload was drug free upon release?

No. of males No. of females Information not collected

3.4 What are the top three concerns identified by both male and female drug-using prisoners at first contact with your service? (Please rate top three concerns)

Concern Male Female Concern Male Female Housing Physical health Employment/training Mental health Childcare Legal Family relationships Financial Drug use Illegal activity Partner Other (please specify right)


3.5 What are the top three concerns identified by both male and female drug-using prisoners prior to release? (Please rate top three concerns)

Concern Male Female Concern Male Female Housing Physical health Employment/training Mental health Childcare Legal Family relationships Financial Drug use Illegal activity Partner Other (please specify right) Sect I 4:

4.1 In your opinion do you consider it important to provide aftercare services to prison leavers?


4.2 What do you feel are the strengths of your service?

4.3 In your opinion what are the three main blocks to providing effective aftercare services for prison leavers?


4.4 In your opinion do feel that aftercare service provision needs to be improved?

Yes (please list your three main areas of improvement) No Unsure

4.4 Are you aware of any other aftercare services that should be included in this research?

Yes (please specify below) No Unsure

4.5 P

National AfVersion 1 NAddaction ©

Contact details:

lease note any further comments in the space provided:

tercare Research Report ovember 2004 all rights reserved

Appendix two: community – based service questionnaire


National Aftercare Research Project Community-based service questionnaire

Code n






• the need for aftercare services for prison/residential leavers aged 18 years and oveissues

• how aftercare services are currently identified • the nature and type of aftercare services available for prison/residential leavers wit• the effectiveness of the current operating environment • identify models of good practice in aftercare provision • the learning from this research will be disseminated throughout the field.

In order to collect your views on aftercare provision we have designed a short questionnairwill take time to complete. Please return the completed questionnaire in the pre-paid envelfor the attention of Sarah Drainey, Research and Quality Officer of the Directorate of DevelImprovement. Should you wish to discuss any particular issues in more detail please do nocontacting: Directorate of Development and Improvement, Addaction , 67–69 CowcrossEC1M 6PU Tel: 0207 017 2727

Thank you for your time


o.




r with drug misuse

h drug misuse issues

e that we hope you ope provided marked opment and t hesitate in Street, London,

Name of service:

Service type:

Organisation:

Contact details:


Role/position:

Date of completion:

Section 1: Services provided

1.1 Please provide a brief description of the main aims of your service:

1.2 Do you provide aftercare services for prison and/or residential leavers?

Prison leavers Yes No Residential leavers Yes No

If yes, please describe in brief the aim of your aftercare services


1.3 Do you provide a standardised package of care or are service interventions provided based on individual client need?

Standardised package of care Needs led Mixture of both None of the above

1.4 Does your aftercare service target specific groups?


1.5 Do you work towards an aftercare specification that is part of local plans e.g. Drug Action Team and CJIP Team?

Yes No

1.6 Are you funded to provide specific aftercare interventions for prison and/or residential leavers?

Yes No

1.7 Is the funding?

Permanent (e.g. rolling contract) Temporary Mixture of both of the above

1.8 What type of services interventions do you provide for prison and/or residential leavers? (please tick ( ) as appropriate)

Internally In partnership with other agencies

One to one support Group work Relapse prevention Primary health care Prescribing interventions Complementary therapies Parenting skills Advice/information/support for families Housing advice/referral Education/training/employment advice/referral Prison gate pick-up on release Other service (please specify below)


1.9 Does your aftercare service have specified targets and outcomes?

Yes (please describe specified targets and outcomes) No

1.10 How do you monitor the effectiveness of your aftercare service?

1.10(i) Does your service monitor gains in the following areas (please tick ( ) as appropriate)?

reduction in relapse reduction in the number of overdoses education employment drug and alcohol misuse mental and physical health attitudes and self-control institutionalisation and life skills housing financial and debt support family networks do not record

1.11 Has you aftercare service been externally evaluated?

Yes (please specify whether there is a report available) No

Section 2: Referral pathways / working links

2.1 Which of the following agencies refer prison/residential leavers to your service? (please tick ( ) as appropriate)

residential services CARATS probation

self-referral structured day care other agency (please specify)

2.2 Have you developed any formal referral protocols with prisons and or residential services?



2.3 Do you feel that referral protocols/pathways could be improved between agencies?


2.4 With which of the following agencies have you developed effective working links? (please tick ( ) as appropriate) Formal links e.g. protocols Informal

Local colleges Primary care services Job centres e.g. progress2work Citizen’s advice bureau Housing Benefits Social services Community mental health services Self help groups Other specialist services (please specify)

2.5 Do you operate a waiting list for your community-based service?

Yes (please specify approximately how long) No


Section 3: Client profile

3.1 Over the last six months (April 2003 – Sep 2003) approximately how many individuals from the following groups have used your aftercare service?

Client profile No. of prison leavers

No. of residential leavers

Not recorded ( ) as

appropriate

Male

Female



Women with children




Other

* sentenced for less than 12 months **sentenced for more than 12 months

3.2 What was the primary substance of use for those individuals?

Substance No. of prison leavers


Not recorded ( ) as

appropriate

Heroin

Crack cocaine

Cocaine

Amphetamine


Cannabis

Benzodiazepines

Alcohol

Poly-drug use

Drug free


3.3 Over the last six months (April 2003 – Sep 2003) approximately what number of prison and/or residential leavers contacted your service ‘unplanned’ upon release/discharge?


3.4 What are the top three concerns identified by both male and female prison and/ or residential leavers at first contact with your service? (please rate top three concerns)

Concern Male Female

Housing Employment/training Childcare Family relationships Drug use Partner Physical health Mental health Legal Financial Illegal activity Other (please specify below)


3.5 How long on average do prison and/or residential leavers engage with your service? (please tick ( ) as appropriate)

Timeframe No. of prison leavers


Not recorded ( ) as

appropriate

0 – 2 weeks

2 – 4 weeks

2 months

3 months

4 months

5 months

6 months and over

Other (please specify below)

Section 4: Strengths / blocks / improvements

4.1 In your opinion do you consider it important to provide aftercare services to prison leavers/residential leavers?


4.2 What do you feel are the strengths of your aftercare service?


4.3 In your opinion what are the three main barriers to improving aftercare services for prison and/ or residential leavers in your local area?

4.4 In your opinion do you feel that aftercare service provision needs to be improved in your local area to enable you to make a difference?

Yes (please list your three main areas of improvement below) No Unsure

4.5 Are you aware of any other aftercare services that you feel should be included in this research project?


Contact details:

4.6 Please note any further comments below:


Appendix Three: Residential Service Questionnaire


National Aftercare Research PResidential service questionnaire

Code n






the need for aftercare services for prison/residential leavers aged 18 years and over wissues

how aftercare services are currently identified the nature and type of aftercare services available for prison/residential leavers with dr the effectiveness of the current operating environment identify models of good practice in aftercare provision

the learning from this research will be disseminated throughout the field.

In order to collect your views on aftercare provision we have designed a short questionnairwill take time to complete. Please return the completed questionnaire in the pre-paid envelfor the attention of Sarah Drainey, Research and Quality Officer of the Directorate of DevelImprovement. Should you wish to discuss any particular issues in more detail please do nocontacting: Directorate of Development and Improvement, Addaction , 67–69 CowcrossEC1M 6PU Tel: 0207 017 2727 Thank you for your time


o.

roject




ith drug misuse

ug misuse issues

e that we hope you ope provided marked opment and t hesitate in Street, London,

Name of service:

Service type:

Organisation:

Contact details:


Role/position:

Date of completion:

Section 1: About your service

1.1 Please provide a brief description of the main aims of your residential rehabilitation programme:

1.2 What types of service interventions do you provide as part of your programme?

please tick ( ) as appropriate

One to one support Group work Relapse prevention Primary health care Prescribing interventions Complementary therapies Parenting skills Advice/information/support for families Education/training/employment advice/referral Other service (please specify)


1.3 How long is your residential rehabilitation programme?

1.4 Do you provide any specific services for prison leavers?

Yes (please go to question 1.5) No (please go to question 1.8)

1.5 Do you receive specific funding for this aspect of service provision?


1.6 What specific services do you provide for prison leavers? Please list below.

1.7 Have you developed specific links and/or referral pathways with HM prisons?

Yes No

1.8 Do you operate a waiting list for your residential rehabilitation programme?

Yes (please specify approximately how long) No

1.9 Over the last six months (April 2003-Sep 2003) approximately how many male and female prison leavers have attended your residential rehabilitation programme?


1.10 Over the last six months (April 2003 – Sep 2003) approximately how many prison leavers on your caseload fall into the following categories?

Client caseload-group No. of residents Not recorded ( ) as appropriate



Women with children





Other

* sentenced for less than 12 months **sentenced for more than 12 months

1.11 Over the last six months (April 2003 – Sep 2003) approximately what number of this caseload has reported using the following drugs?

Substance No. of residents Not recorded ( ) as appropriate

Heroin

Crack cocaine

Cocaine

Amphetamine

Cannabis

Benzodiazepines

Alcohol

Poly-drug use

Drug free


1.12 Over the last six months (April 2003 – Sep 2003) approximately what number of prison leavers on your caseload were drug free at first contact with your service?

No. of individuals Information not recorded


1.13 What were the top three concerns identified by both male and female residents at first contact with your programme? (please rate top three concerns)

Concern Male Female Concern Male Female

Housing Physical health Employment/training Mental health Childcare Legal Family relationships Financial Drug use Illegal activity Partner Other (please specify right)

Section 2: Referral to community-based aftercare services

2.1 Do you refer residents onto community-based aftercare services upon completion of your programme?

Yes (please go to question 2.2) No (please go to section 3)

2.2 Which of the following community-based services do you refer residential leavers on discharge? (please tick ( ) as appropriate)

community-based services Youth Offending Service Probation service Local colleges Primary care services Job centres e.g. progress2work CAB Housing Benefits Social services Community mental health services Other specialist services Self help groups Other service (please specify)

2.3 Which of the above has your service developed effective working links (please tick ( ) as appropriate)?

Formal links e.g. protocols Informal

Community-based services Youth Offending Service Probation service Local colleges Primary care services Job centres e.g. progress2work Citizen’s advice bureau Housing Benefits Social services Community mental health services Self help groups Other specialist services (please specify below)


2.4 What are the top three concerns identified by both male and female clients on leaving your programme? (please rate top three concerns)

Concern Male Female

Housing Employment/training Childcare Family relationships Drug use Partner Physical health Mental health Legal Financial Illegal activity Other (please specify below)

Section 3 Provision of specific aftercare services

3.1 Does your service provide any specific aftercare services for residential leavers on their return to the community?

Yes (please go to question 3.2) No (please go to section 4)

3.2 What specific aftercare services does your service provide?

3.3 Do you receive specific funding to provide these services?


3.4 Does your aftercare service provide a standardised package of care or are service interventions provided based on individual client need for residential leavers?

Standardised package of care (please describe below) Needs led Mixture of both None of the above

3.5 Does your aftercare service for residential leavers have specified targets and outcomes?


Yes (please describe specified targets and outcomes) No

3.6 How do you monitor the effectiveness of your aftercare service?

3.7 Does your service monitor gains in the following areas?

reduction in relapse reduction in the number of overdoses education employment drug and alcohol misuse mental and physical health attitudes and self-control institutionalisation and life skills housing financial and debt support family networks do not record

3.8 What do you feel are the strengths of your aftercare service?

Section 4: Strengths / blocks / improvements

4.1 In your opinion do you consider it important to provide aftercare services to prison/residential leavers?


4.2 In your opinion what are the three main blocks to providing effective aftercare services for prison/residential leavers?


4.3 In your opinion do feel that aftercare service provision needs to be improved?

Yes (please list your three main areas of improvement below) No Unsure

4.4 Are you aware of any other aftercare services that should be included in this research?


4.5 P

National AfVersion 1 NAddaction

Contact details:

lease note any further comments in the space provided:

tercare Research Report ovember 2004

© all rights reserved

Bibliography • Advisory Council on the Misuse of Drugs (2000) Reducing drug related deaths The Stationery Office:

London

• Bessant, J., Coupland, H., Dalton, T., Maher, L., Rowe, J. and Watts, R. (2003) Heroin users, housing and social participation: attacking social exclusion through better housing Australian Housing and Urban Research Institute, Melbourne

• Borrill, J., Maden, A., Martin, A., Weaver, T., Stimson, G., Farell, M. and Barnes, T. (2003) Differential substance misuse treatment needs of women, ethnic minorities and young offenders in prison: prevalence of substance misuse and treatment needs Home Office: London

• Brown, B. S., O’Grady, K. E., Battjes, R. J., Farrell, E. V., Smith, N. P., Nurco, D. N. (2001) Effectiveness of a stand-alone aftercare program for drug-involved offenders Journal of Substance Abuse Treatment, Vol. 21

• Bullock, T. (2003) Key findings from the literature on the effectiveness of drug treatment in prison. In Ramsay, M. (ed.) Prisoner’s drug use and treatment: seven research studies, Home Office Research Study 267: London

• Burrows, J., Clarke, A., Davison, T., Tarling, R. and Webb, S. (2001) Research into the Nature and Effectiveness of Drugs Through-care Home Office: London

• Drugs Prevention Initiative (1998) Drugs Interventions in the Criminal Justice System – Guidance on Good Practice Home Office: London

• Edmunds, M., Hough, M., Turnbull, P. J. and May, T. (1999) Doing Justice to Treatment: referring offenders to drug services DPAS: London

• Fox, A. (2000) Prisoners’ Aftercare in Europe: a four-country study The European Network for Drug and HIV/AIDS Services in Prison: London

• Gossop, M., Marsden, J., and Stewart, D. (2001) Changes in substance use, health and criminal behaviour during the five years after intake, Bulletin 5. The National Treatment Outcome Research Study: London

• Godfrey, C., Eaton, G., McDougall, C. and Culyer, A. (2002) The Economic and Social Costs of Class A drug use in England and Wales, 2000 Home Office Research, Development and Statistics Directorate: London

• Halloway, K. and Bennett, T., (2004) Drug use and offending: The results of the first two years of the NEW-ADAM programme Home Office: London


• Harrison, L. D. (2002) The Revolving Prison Door for Drug-Involved Offenders: Challenges and Opportunities. In Crime and Delinquency, Vol. 47, No. 3. Sage Publications: London

• Hearnden, I. And Harocopos, A. (1999) Problem Drug Use and Probation in London Research Findings No. 112; Home Office Research, Development and Statistics Directorate: London

• Henderson, D. J. (1998) Drug abuse and Incarcerated Women Journal of Substance Treatment, Vol. 15

• Hiller, M. L., Knight, K. and Simpson, D. (1999) Prison-based substance abuse treatment, residential aftercare and recidivism Society for the Study of Addiction to Alcohol and Other Drugs: Texas

• Home Office (2004) Key Messages for the Drug Interventions Programme (previously CJIP) – October 2004 (unpublished) Home Office: London

• HM Inspectorate of Prisons (2001) Joint working to improve resettlement and reduce re-offending HM Inspectorate of Prisons

• Mair, G. and Barton, A. (2001) Drugs Through-care in a Local Prison: a process evaluation Drugs: education, prevention and policy, Vol. 8, No. 4

• Matrix MHA and Nacro (2003) Evaluation of drug testing in the criminal justice system in nine pilot areas Home Office: London

• National Treatment Agency for Substance Misuse (2002) Models of Care National Treatment Agency: London

• National Treatment Agency for Substance Misuse (2002) Commissioning services to reduce drug-related deaths: Briefing paper 11.2

• National Treatment Agency for Substance Misuse (2004) Reducing drug-related deaths: Guidance for drug treatment providers National Treatment Agency: London

• Office for National Statistics (2003) Drug related mortality ONS, Health Statistics Quarterly, No.17

• Sangster, D., Shiner, M., Patel, K. and Sheikh, N. (2002) Delivering drug services to Black and ethnic-minority communities Home Office: London

• Stover, H., VonOssietzky, C. and Merino, P. P. (2001) An overview study: Assistance to drug users in European Union prisons European Monitoring Centre for Drugs and Drug Addiction: Lisbon


Internet Sources • Drugs in Focus (2003) Treating drug users in prison – a critical area for health promotion and crime

reduction policy URL: www.emcdda.eu.int Accessed July 2004

• Guardian Unlimited (2001) Aftercare ‘failing’ ex-prisoners URL: http://society.guardian.co.uk/crimeandpunishment/story/0,8150,584316,00.html Accessed May 2004

• HM Prison Service (2003) The Prison Service Drug Strategy URL: www.hmprisonservice.gov.uk/assets/documents/10000157drugstrategyGenBriefingNote171203.doc Accessed July 2004

• Home Office (2003) The Criminal Justice Interventions Programme (CJIP) URL: http://www.drugs.gov.uk/ReportsandPublications/CriminalJusticeInterventionsProgramme Accessed April 2004

• Home Office (2003) The Criminal Justice Interventions Programme – Prisons Guidance URL: http://www.drugs.gov.uk/WorkPages/CriminalJusticeInterventionsProgramme/WorkingwithDATs/CJIPPrisonsGuidance.doc Accessed August 2004

• Home Office (2003) National Strategy – Communities URL: www.drugs.gov.uk/nationalstrategy/communities/toolkits Accessed August 2004

• Mason, D., Birmingham, L. and Grubin, D. (1997) Substance use in remand prisoners: a consecutive case study as cited on URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9233320&dopt Accessed August 2004

• Murray, L. and Malloch, M. (2004) Evaluation of the Scottish Prison Service Transitional Care Initiative, INTERIM FINDINGS – Four Month Client Interviews, Effective Interventions Unit as cited on URL: http://www.drugmisuse.isdscotland.org/eiu/eiu.htm Accessed August 2004

• National Probation Service (2004) Reducing Crime, Changing Lives URL: http://www.probation.homeoffice.gov.uk/output/Page214.asp Accessed August 2004

• Office of the Deputy Prime Minister Creating Sustainable Communities – Supporting People URL: http://www.odpm.gov.uk/stellent/groups/odpm_housing/documents/page/odpm_house_602057.hcsp Accessed August 2004

• The All-Party Parliamentary Drugs Misuse Group (1998) Prisons and drugs Misuse as cited on URL: http://www.drugscope.org.uk/uploads/goodpractice/documents/Prisons.pdf Accessed July 2004

• The National Treatment Agency for Substance Misuse (2004) Drug-related deaths URL: http://www.nta.nhs.uk/programme/drd2.htm Accessed August 2004


http://www.emcdda.eu.int/

http://society.guardian.co.uk/crimeandpunishment/story/0,8150,584316,00.html

http://www.hmprisonservice.gov.uk/assets/documents/10000157drugstrategyGenBriefingNote171203.doc


http://www.drugs.gov.uk/WorkPages/CriminalJusticeInterventionsProgramme/WorkingwithDATs/CJIPPrisonsGuidance.doc

http://www.drugs.gov.uk/WorkPages/CriminalJusticeInterventionsProgramme/WorkingwithDATs/CJIPPrisonsGuidance.doc

http://www.drugs.gov.uk/nationalstrategy/communities/toolkits

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9233320&dopt

http://www.drugmisuse.isdscotland.org/eiu/eiu.htm

http://www.probation.homeoffice.gov.uk/output/Page214.asp

http://www.odpm.gov.uk/stellent/groups/odpm_housing/documents/page/odpm_house_602057.hcsp

http://www.drugscope.org.uk/uploads/goodpractice/documents/Prisons.pdf

http://www.nta.nhs.uk/programme/drd2.htm

• Social Exclusion Unit (2002) Reducing re-offending by ex-prisoners as cited on URL: http://www.socialexclusion.gov.uk/publications.asp?did=64 Accessed July 2004

• Turnbull, P. J. and McSweeney, T. (2000) Drug treatment in prison and aftercare: a literature review and results of a survey of European countries Council of Europe Pompidou Group as cited on URL: http://www.pompidou.coe.int/English/penal/prison/dmop-e041.htm Accessed July 2004

• United Kingdom Anti-Drugs Coordination Unit (UKADCU) (2000) Tackling Drugs to Build a Better Britain as cited on URL: http://www.archive.official-documents.co.uk/document/cm39/3945/3945.htm Accessed July 2004


http://www.socialexclusion.gov.uk/publications.asp?did=64

http://www.pompidou.coe.int/English/penal/prison/dmop-e041.htm

http://www.archive.official-documents.co.uk/document/cm39/3945/3945.htm

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