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Drug Treatment and Testing Orders: Evaluation of the Scottish Pilots
CHAPTER EIGHT: CONCLUSIONS
INTRODUCTION
8.1 In this final chapter we summarise the key conclusions that can be reached on the basis of the evaluation to date and identify a number of issues that will require consideration in the event of a national rollout of DTTOs.
CONCLUSIONS
8.2 The main conclusion of this study is that DTTOs had become well established in the pilot areas as an additional option for the courts in dealing with drug-related offending. Consensus was found to exist between various professionals involved in the operation of the pilot schemes that DTTOs were appropriate for those whose offending was directly related to their use of drugs and who would, therefore, be unlikely to continue offending if their drug use was addressed. DTTOs were viewed by all key stakeholders as differing in purpose from existing options - such as probation orders with drug treatment requirements - in their direct emphasis upon drug use as an indirect means of reducing the risk of re-offending. The relatively high use made of probation (with or without additional requirements) with unsuccessful DTTO referrals suggests that a clear distinction between DTTOs and probation orders was being maintained.
8.3 In both areas there was evidence that the pilot schemes were working well. In time, a steady flow of referrals was being achieved in both study sites. Sentencers believed that DTTO assessments were of a high quality. The very high conversion rate of positive recommendations for a DTTO to actual orders would, indeed, appear to indicate sentencer confidence (including the confidence of the High Court) in the assessments and in the services that would subsequently be provided. The criminal histories of those given DTTOs and the comments of sentencers would suggest that the orders were being used as a high tariff disposal, with offenders who would, in all likelihood, have otherwise received a custodial sentence. However, whilst orders appear to have been made on 'appropriate' offenders, the limited available information about offenders who did not get DTTOs made it impossible to assess how they compared (in terms, for example, of criminal history and history of drug use) with offenders given alternative disposals.
8.4 Multi-agency working was, perhaps, the biggest challenge faced by the DTTO schemes. DTTOs required not only that different professionals work together in a co-ordinated way but that there was some blurring of established roles and responsibilities (for example, DTTO social workers had responsibility for case management but not for direct service or treatment provision). The practical arrangements for the operation of schemes - including the number, type and location of different members of staff - was determined on essentially pragmatic grounds and with regard to existing structures, such as the number and location of courts and the population and demography of the areas covered by the schemes. In Fife, where the scheme served courts in three locations and where it was possible, therefore, to have a more devolved arrangement, the opportunity to have DTTO staff and treatment providers located together in teams appeared to have facilitated communication and helped to clarify roles. A similar arrangement was not possible in Glasgow and in this pilot site occasional tensions appear to have arisen regarding communication and role clarification.
8.5 The ultimate test of the DTTO was its effect on drug use and associated offending, especially since in comparison with other community-based disposals, it is not a particularly cheap option. The available data point to DTTOs having had a positive and dramatic impact on drug use and offending which was sustained for at least six months into the orders and which offset the relatively high costs per offender of a DTTO. Overall, the incidence of positive drug tests for opiates decreased with time and reported expenditure on drugs decreased from an average of 490 per week pre-sentence to an average of 57 per week after six months on an order. In this respect the findings are similar to the findings from the evaluation of the DTTO pilots in England and Wales (Turnbull et al. 2000). However, there is a need for a lengthier follow up of offenders given orders (especially since so few orders had ended by the conclusion of the research) to assess the effectiveness of DTTOs in comparison with alternative sentences in the longer term.
8.6 The treatment that was provided to offenders given DTTOs - in most cases methadone prescription and counselling - appeared to have been the most important single factor in helping them reduce their use of illegal drugs. However the system of testing and reviews also appeared to have encouraged reductions in drug use and offending, either through their motivating potential or through their deterrent effect.
ISSUES ARISING FROM THE PILOT
8.7 Whilst the evaluation of the English pilot DTTOs schemes concluded that only one of the three schemes had implemented a viable DTTO programme, the Scottish experience has, on the whole, been positive and it was difficult to assess whether there was potential for greater use to be made of DTTOs within the pilot areas. Some sentencers had made use of DTTOs on several occasions, some less often and some not at all. Sheriffs suggested that some of their colleagues had reservations about making orders, which they feared might be in contravention of the European Convention on Human Rights. As with all new sentencing options, active steps will be required to maintain the profile of DTTOs with those who might potentially refer offenders for assessment and to ensure that orders are being appropriately targeted on those offenders for whom they are intended to be used.
8.8 The interim findings from this evaluation were sufficiently encouraging to enable the Scottish Executive to announce, in September 2001, that a process of phased national rollout of DTTOs would begin, with further schemes being established in seven additional local authorities (Edinburgh, Dundee, Perth and Kinross, Angus, Renfrewshire, East Renfrewshire and Inverclyde) from Spring 2002. 20
8.9 Interim Guidance on DTTOs has also been issued by the Scottish Executive (Scottish Executive, 2001c) and it addresses some of the procedural issues identified in the evaluation of the pilots. The relative success of the DTTO pilots has, in addition, helped pave the way for the introduction of Scotland's first Drug Court in Glasgow in October 2001, with a second Drug Court due to be established in Fife in the summer of 2002. It is anticipated that DTTOs will form a central plank of the repertoire of sentences imposed in this important and innovative development.
8.10 We therefore conclude by discussing some of the issues that have been identified by the evaluation as requiring further attention by the existing schemes or that have implications for the rollout of orders. These overlap to a considerable degree with the issues identified in the evaluation of the pilot schemes in England and Wales (Turnbull et al., 2000).
Range of available treatments
8.11 In both pilot areas there was a restricted range of treatment services available to offenders on DTTOs (and, indeed, to other potential service users). This raises the question of how effectively offenders given DTTOs were being matched to appropriate treatments. In particular, it suggests that matching to treatment may have been determined more by the treatment services available than by the treatment needs of offenders made subject to DTTOs. This conclusion seems strengthened by the observation that the types of treatment accessed by offenders on DTTOs was very different in England and Wales, with markedly more use being made of residential rehabilitation by the English DTTO schemes (Turnbull et al., 2000).
8.12 The somewhat limited range of available treatments, services and interventions also meant that some offenders were unable to access services that might help keep them occupied and away from environments in which the temptation to use drugs was high. The effectiveness of existing and future DTTO schemes is likely to be enhanced, therefore, if treatment is needs led rather than resource led and if a range of other services can be accessed that both occupy offenders and help promote their inclusion in society.
The resource implications of DTTOs
8.13 The review process appeared, on the whole, to be operating effectively and it appeared that in most cases a degree of continuity was being achieved with respect to the sentencers involved in successive reviews for the same offender. However, attendance at reviews placed heavy demands on DTTO staff time, even though the reviews themselves were very brief. This was because sometimes reviews that were scheduled for a particular time of day were delayed, with the result that staff had to wait until the review was re-scheduled later in the day. Whilst court delays are not unique to DTTOs, the frequency of reviews meant that the impact of delays was particularly salient in respect of DTTOs. Delays of this kind are sometimes inevitable, but it is important that mechanisms for minimising them are explored, such as scheduling reviews prior to the commencement of the main court business. Local authorities, when undertaking planning for new DTTO schemes, also need to take account of the impact of factors such as delays to make a realistic estimate of the staffing levels required to support a particular throughput of orders.
The limitations and significance of drug tests
8.14 Concerns were also raised by treatment providers and DTTO staff that testing - by only indicating whether or not a substance had been used and not how much of it had been used - could mask real progress made by offenders towards achieving a reduction in their use of drugs. Of particular concern was the possibility that sentencers might fail to appreciate this shortcoming of testing and assume that the absence of clean tests reflected a lack of progress. Similarly, treatment providers were concerned that the frequency of testing was unnecessarily high and that this might ultimately have a negative influence upon offenders' motivation to comply with their orders. Clearer guidance was therefore needed on the appropriate frequency of testing at different stages in an order. This has been addressed through the Interim Guidance published by the Executive, which stipulates twice-weekly tests for the first month of an order, weekly tests for the second to fifth months and fortnightly tests reducing to monthly tests from the sixth month onwards. At each stage in the order, at least one test per month should be on a random basis, to make it less likely that offenders could disguise ongoing substance misuse (Scottish Executive, 2001b).
The effectiveness and efficiency of drug testing
8.15 The operational arrangements for testing were proceeding smoothly with some treatment providers, but with others unhelpfully lengthy delays were encountered between the urine test and the receipt of the result by DTTO staff. Where delays of this kind were occurring, treatment providers had indicted that they were committed to reducing the turnaround time. However, if delays of two or three weeks were being encountered with the existing caseload of offenders on DTTOs, these would be likely to increase rather than decrease if there was a marked rise in the number of orders made.
8.16 In Glasgow a trade-off had been made between efficiency and accuracy of testing, with the substitution of dipstick testing by the more accurate method of laboratory testing. However, the latter was associated with higher costs and slower turnaround times for results. A more efficient arrangement had been developed in Fife, involving a combination of dipstick and laboratory testing. This arrangement was associated with lower costs and more speedy results, with the option of a laboratory test being conducted in the event of a disputed dipstick test result.
8.17 Future DTTO schemes will clearly wish to strike a balance between efficiency and effectiveness of testing procedures. The Interim Guidance from the Scottish Executive will be of some assistance in this respect since it delineates the frequency with which, and circumstances within which, dipstick and laboratory tests should be used (Scottish Executive, 2001b). For example, the Interim Guidance suggests that dipstick tests should be used at the assessment stage, with a laboratory test substituted in the event of a contested result. Once an order has been imposed, at least one test per month in the first six months and one test per fortnight thereafter should be subjected to laboratory analysis. As such, the Interim Guidance provides a balance between over-reliance on either dipstick results (which are less accurate) or laboratory results (which are slower and more costly).
Enforcement of orders
8.18 The breach and revocation rates in the two pilot sites were very low, particularly in comparison with the pilot schemes in England (Turnbull et al., 2000). The absence of a detailed monitoring system prevented the researchers from having access to data relating to enforcement practices in the schemes, though interviews with staff suggested that a fairly flexible approach was adopted towards enforcement, which has been interpreted by a small number of other professionals and offenders as insufficiently rigorous.
8.19 The dilemma faced by DTTO staff was that of striking a balance between adopting a stringent approach to enforcement and recognising drug use as a relapsing condition and responding accordingly. This was an area in which guidance was urgently required, since it had the potential to undermine the credibility of DTTOs with the courts. On the other hand, as Turnbull et al. (2000) have observed, if offenders on DTTOs were subjected to the standards of enforcement that apply in respect of probation orders, the majority would fail. Again, the Interim Guidance published by the Executive provides advice in respect of enforcement by attempting to balance a consistent response to instances of non-compliance with regard to the wider pattern of compliance across the various requirements of the order.
8.20 While differing enforcement procedures may have accounted for the differential breach rates between the Scottish and English pilots, it is unlikely that this factor alone could have been solely responsible for the wide differences observed. Instead it is likely that some other variations between the pilots were accountable, at least in part, for the differences in outcomes. For example, drug testing at the assessment stage may have enhanced the quality of DTTO assessments for the court and its absence from the English pilots may help explain why a high proportion of DTTOs there broke down in the early stages of the order. The ability of Scottish courts to issue warrants in the event of an offender's non appearance for a review may also have served to reinforce how seriously the court viewed the order and encouraged improved compliance as a result.
Monitoring and evaluation
8.21 Effective gate-keeping and targeting are dependent upon schemes having access to systematic data which enable them to monitor the characteristics of offenders referred, assessed and given orders, the progress of offenders on orders and their outcomes. Both of the pilot schemes collected information for monitoring purposes but the data they collected and the way in which they categorised them were not consistent across the two pilot sites. Despite the schemes' reported commitment to developing an electronic monitoring database that could provide management information and, at the same time, a range of information of value to the research, these had not materialised by the end of the main fieldwork period. This was unfortunate in that not only did it limit the information that was available to the researchers, but it also meant that there was not a common basis for comparing the operation of the pilot schemes. We would strongly encourage a consistent approach to monitoring in the national rollout of DTTO schemes to ensure that comparable data are being generated that will enable further lessons to be learned about what contributes to the efficient and effective operation of DTTO schemes.
CONCLUDING OBSERVATIONS
8.22 As the foregoing discussion will have made clear and as the evaluation of the pilot DTTO schemes in England and Wales illustrated vividly, there is no substitute for careful planning prior to the introduction of new DTTO schemes. The amount of effort that this will require should not be underestimated and should be taken into account in any timescales that are projected for the development of a scheme. For example, both in this research and in the evaluation of DTTOs in England and Wales (Turnbull et al., 2000), some tensions arose from the multi-agency approach that DTTOs required. This was more evident in Scotland in the Glasgow pilot, where tensions occasionally arose between DTTO staff and treatment providers with respect to communication at different stages in an order and between different types of DTTO staff with respect to their respective roles and responsibilities in relation to the DTTO. These problems were less evident in Fife where the different professional groups comprising the DTTO team were located in the same premises and where it was therefore easier for a sense of common ownership of the scheme to be established. Developing effective inter-agency protocols for the operation of DTTO schemes is, therefore, essential and the energy invested in this at the developmental stage will pay dividends in terms of the subsequent operation and management of orders.
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