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Chapter 1: Introduction and Background
Attempts to reduce the social, political and economic problems associated with substance misuse have led to a growing recognition of the need for a co-ordinated response (Scottish Office 1999; Scottish Executive 2000, 2001). While all areas of society have a role to play in tackling substance misuse, the criminal justice system is of particular significance. The Scottish Prison Service ( SPS) has been clearly identified as presenting an opportunity to identify substance misusers and to provide a resource for reducing and/or ending problem substance use (Ministerial Drugs Task Force, 1994; Scottish Affairs Committee, 1994; Scottish Prison Service 1994, 2000; Scottish Office, 1999). Many prisoners with substance abuse problems may not have had any prior contact with treatment services before receiving a custodial sentence and levels of substance use among prisoners are high. For example, in October 2000, 75% of prisoners tested positive for drugs on entry to prisons (Scottish Prison Service, 2000) though data provided by SPS suggest that this figure had reduced to 66% by 2002/3.
Subsequently the Scottish Executive and the SPS have acknowledged the importance of bringing substance users into contact with services during their period of imprisonment and substantial resources have been directed towards the provision of treatment and support services in custody. The SPS launched its revised drug strategy in June 2000 aiming to keep drugs out of prisons, to bring prisoners into drug treatment, to keep them in contact with treatment services and to effectively manage the transition between prison and communities 1.
It has been acknowledged that for services to operate effectively in reducing drug-related harm, it is essential that these provisions continue following release from prison. The transition from prison to the community can be difficult for prisoners, particularly for those who have received some form of treatment within prison and who may be drug free when released. Treatment received in prison may be jeopardised on release unless community-based support is made available. Many ex-prisoners return to the communities from which they originally came, and to the same problems they faced prior to imprisonment. Their resolve not to use drugs on release may disappear quickly. Relapse may result in a return to drug use and to drug-related crime. Furthermore, those who resume drug use on return to the community may be at risk of overdose given their reduced tolerance to drugs. Structured after-care provision can help reduce the likelihood of relapse though, as recent research in England and Wales has demonstrated, the provision of effective throughcare services is a complex task (Burrows et al., 2001). 2
The SPS Drugs Strategy (Scottish Prison Service, 2000) set out one of its key objectives as being to increase the proportion of identified substance misusers taking part in successful Transitional Care after release from prison. In 2000, with the support of the Scottish Executive, the SPS was able to expand drug treatment resources in prisons and to establish improved services to facilitate offenders' transition between prison and the community. In particular, continuity of provision was to be introduced for short-term and remand prisoners (Scottish Executive 2001). The Transitional Care arrangements were designed to assist SPS to meet this key objective 3.
The Transitional Care Initiative
The Transitional Care initiative was established to alleviate problems associated with the uneven provision of services throughout the penal estate and to co-ordinate and enhance ex-prisoners' access to community based services on their release from prison. The main aim of Transitional Care was to facilitate access to pre-existing community services based on an individual's assessed needs. Support was provided during a 12-week period immediately following their return to the community. Transitional Care aimed to bridge the gap between prison and a return to the community, a period which is crucial in terms of establishing and maintaining contact with appropriate support services for individuals leaving custody.
Transitional Care was voluntary on the part of prisoners. Transitional Care arrangements were designed to support prisoners with an identified drug problem and intended to substantially expand existing provision for short-term and remand prisoners. Long-term prisoners (those who receive a custodial sentence of four years or more) were already catered for through the provisions of the Sentence Management System 4 (Scottish Prison Service, 2001). Transitional Care therefore focused upon remand prisoners and those serving sentences of less than four years.
The Transitional Care service was provided by Cranstoun Drug Services under contract to SPS. Prison-based caseworkers employed by Cranstoun were responsible for conducting prison-based assessments that identified the key needs of individuals and for co-ordinating service provision while the prisoner was in custody. They were also responsible for liaising with community-based Transitional Care workers and, for those prisoners who chose to participate in Transitional Care, facilitating case conferences prior to their release. Community-based Transitional Care services were provided by Cranstoun and by a range of sub-contracted voluntary agencies operating in the drug and criminal justice fields who, by offering ex-prisoners three appointments over a period of 12 weeks following their release, aimed to enable ex-prisoners to access relevant services on their liberation.
Transitional Care was introduced on a phased basis. Some areas began to provide a service in January 2002 and most schemes were operational by April 2002. However, Transitional Care was an evolving service and throughout the course of this evaluation aspects of the service were modified in the light on ongoing experience. This means that many of the issues identified at earlier stages of the research were subsequently addressed through operational changes, which are highlighted at relevant points in this report. It also means that ascribing outcomes to specific aspects of Transitional Care is not possible since features of the service changed over time. It should also be noted that the Transitional Care initiative formally ended in July 2005 with the introduction of a new national Throughcare Addiction Service ( TAS) for prisoners with drug problems in Scotland. This development is being taken forward as part of a wider range of throughcare services for priority groups being developed by the Tripartite Group comprising representatives of the Scottish Executive, The Scottish Prison Service and the Association of Directors of Social Work. While the findings of this research can no longer shape the Transitional Care initiative per se, they can nonetheless inform current and future developments in throughcare for prisoners with drug problems.
Objectives of the evaluation
The principal aim of the research was to evaluate the effectiveness of the Transitional Care arrangements in facilitating access to pre-existing community services based on an individual's assessed need. The evaluation therefore included an analysis of the process and outcomes of Transitional Care and the identification of potential areas where practice may be improved. The specific objectives of the study were to:
- examine the operation and appropriateness of the assessment process
- consider the effectiveness and efficiency of the referral procedure
- identify and assess the role of key workers
- analyse the characteristics of those who opt out and of those who continue to utilise Transitional Care
- identify stages in the Transitional Care process where individuals are dropping out
- examine the level of non-completion and consider how this can be minimised
- examine the effectiveness of Transitional Care arrangements
- compare outcomes between those who complete Transitional Care and those who do not and between different groups of ex-prisoners in respect of whom services are provided ( e.g. young offenders and women)
- analyse key aspects of service delivery in order to assess their contribution to the effectiveness of Transitional Care.
The Scottish Executive, SPS and the Inspectorate of Prisons for Scotland have regularly drawn attention to the increase in substance abuse among young prisoners and women prisoners. Successive reports have highlighted the need to provide focused interventions for young people (Scottish Office, 1999; Scottish Executive, 2001) and women prisoners (Scottish Office 1998; HM Inspectorate of Prisons for Scotland, 2001). There is a clearly identified need to enhance prevention and early intervention for these groups, community disposals and provisions, and effectively coordinated aftercare (Scottish Executive, 2001; Ministerial Group on Women's Offending, 2002). While Transitional Care was focused on the needs of the individual, the evaluation process also examined how the service impacted on the experiences of young offenders and women.
Organisation of the report
The remainder of this report is organised into five chapters. Chapter Two describes the methods used in the evaluation while Chapter Three focuses on the organisation of Transitional Care services. Chapter Four considers ex-prisoners' engagement with Transitional Care while Chapter Five examines the effectiveness of Transitional Care in linking clients into services and achieving other outcomes. The main findings and conclusions are presented in Chapter Six.
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