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Chapter 3: Organisation of Transitional Care Services

Introduction

This chapter focuses on the organisation of Transitional Care, with particular emphasis upon the arrangements for providing a 12-week period of post-release support in the community. As indicated in the introductory section of the report, the evaluation of the Transitional Care initiative was concerned principally with the services provided to prisoners in the 12-week period immediately following release. However, the effectiveness of Transitional Care was likely to be influenced by the assessments and referrals undertaken in prison. For this reason we begin with a discussion of the prison-based element of the Transitional Care process drawing upon analysis of documentary material and interviews conducted with professionals based in prisons and in the community. It should be noted that the present Chapter draws essentially upon qualitative data, reflecting the perspectives of the various stakeholders involved it is operation. Subsequent Chapters (Four and Five) examine the operation of Transitional Care using, in addition, quantitative information derived from monitoring and survey data.

The prison-based element of Transitional Care

The aims of prison-based work

The broad aim of casework provision within the prisons was to assess the needs of all prisoners serving less than four years with substance misuse issues and to co-ordinate the referral process based on those assessed needs. Cranstoun Drug Services were brought in specifically to bring more substance misusing prisoners into contact with prison-based addiction services, to link clients to community-based Transitional Care services and to free up prison staff to deliver addiction related services. The way in which these aims were pursued was through the assessment and referral process.

The prison-based Cranstoun caseworkers were responsible for conducting assessments on all short term and remand prisoners to identify the key needs of individuals with substance misuse issues and for co-ordinating service provision for those individuals. If clients had previously been in contact with community agencies, the caseworker would liaise with those agencies to promote information sharing and joint planning.

Assessment

The Common Addictions Assessment Recording Tool ( CAART) was the main tool used for recording client information and assessing clients' needs. It was intended to be the main source from which a client's care plan was derived. It was also the main source from which a client's care would be co-ordinated. It was held in and formed part of the client's case management file ( CMF) to be discussed by the caseworker with a member of the Addictions team and actioned as appropriate. Where the required interventions were not available, this should be discussed with the Addictions team and noted in the CMF.

The CAART tool was perceived by caseworkers to be a general and brief tool. Most caseworkers reported using the space on the form for additional notes to record information that would not otherwise be elicited. However some questioned the merits of doing so partly because they were sceptical as to whether this would be used to identify (and address) gaps in service provision and partly because of a concern to safeguard the confidentiality of sensitive information.

Many caseworkers found the process of completing the CAART to be repetitive and believed that it had obvious 'gaps'. Some of those 'gaps' related to the inability of the tool to address the specific needs of particular groups such as young offenders or women. Two specific complaints about the CAART concerned the number of client signatures required (up to six) and the amount of paperwork and administrative workload that the assessments generated. Caseworkers reported that for every assessment undertaken (usually lasting around 60 minutes) there was at least an hour and often an hour and a half of subsequent administration.

Although Transitional Care workers did not carry out the actual assessments they nevertheless had views about the assessment tool and the assessment process. There was a feeling that this model did not necessarily lend itself to identifying the needs of women and young or first time offenders. The Transitional Care workers also believed that the caseworkers were under a great deal of pressure to meet their targets with respect to the numbers of assessments they had to complete and that the emphasis on targets led to a focus on quantity rather than quality in the assessment process. Transitional Care workers shared the view with caseworkers that clients were over-assessed as a result of different agencies working in prison carrying out their own assessments.

The CAART was in part designed to identify gaps in service provision. However, many caseworkers expressed concern about whether the resulting care plan was resource or needs led and had doubts about how adequately and systematically this information would be used to effect changes in the programmes and services offered in prisons. The scope of prison based interventions, programmes and external agencies providing services was not uniform, with some establishments appearing 'better off' in this regard than others. Some of the caseworkers believed that referral to programmes and other services was influenced more by availability than by clients' needs. Several voiced concern about the lack of counselling available and expressed the view that many clients were 'assessed to death': in addition to undergoing assessment by the caseworker they were also assessed by other external agencies working in the prisons and by programme providers. Many reported that programmes were difficult to access, largely as a result of their infrequency, which meant that they were often not available within the time frame of clients' sentences.

While Transitional Care was intended to provide a much-needed resource for women and young people, it was evident to most managers that this was not happening in practice. The difficulties in engaging with women suggested to many managers that a different system was required to identify women's needs ( CAART was not able to identify 'deeper' needs or experiences of trauma) and to provide a different service. Sub-contracted managers in Glasgow agencies indicated that the service which had previously been provided for women (Turnaround) had been perceived very positively and this may have adversely affected relationships with Transitional Care. However, Cranstoun managers believed the service needed to be marketed more effectively in Cornton Vale and plans had been put in place to 'sell the service' within the prison. Nevertheless, as we shall see, the take-up of Transitional Care by women was in practice similar to the take-up by men.

The process of referral and assessment appeared to be significantly affected by the caseworkers' physical location within the prison and by the existing lines of communication. It was also reported by caseworkers as being influenced by the established level of collaboration between the Cranstoun team and SPS personnel (particularly the Addictions team and the Drug Strategy co-ordinator), by their relationship with other external agencies operating within the prisons and by their level of access to prisoners. The assessment process was reported as operating more smoothly where more positive, co-operative relationships had been developed.

Generally those teams who were integrated within Throughcare Centres or within Addictions teams found the assessment process less problematic: lines of communication were more open and more regular, and communication with other agencies better. Those teams who were located separately from the other agencies and SPS staff had more difficulties with communication and the process of assessment and referral. Access to prisoners varied from establishment to establishment but where there was better access, the caseworkers reported being less pressurised and appeared more productive in terms of the quantity and quality of client interaction. This was because less time was spent negotiating access to prisoners, freeing workers up to devote themselves to the task at hand.

One of the aims of the caseworkers was to meet with clients once a month to review and monitor their progress and to undertake one-to-one work such as motivational interviewing, relapse prevention and harm reduction incorporated into these sessions. Some teams endeavoured to see clients once a month but these were teams who had better access to prisoners and lower numbers. More usually, caseworkers suggested that convicted clients were, for the most part, seen two or three times during their sentence unless they were deemed vulnerable or to have complex and high needs, in which case they would be seen more often. If clients participated in prison programmes or were serving long sentences their case was usually 'suspended' and a further assessment undertaken when they completed their programmes or were nearing the end of their sentence. Workers acknowledged that the assessments could provide a good basis for motivational and relapse prevention work, but this required both initiative and time. Many of the workers reported feeling under tremendous pressure to meet assessment targets at the expense of therapeutic interventions. As a consequence, some reported feeling deskilled and disempowered by what was perceived as an 'admin job'. On the other hand, some caseworkers also believed that there was a lack of basic drugs knowledge within many of the casework teams.

Caseworkers reported a fairly low rate of refusals by clients to being referred to Transitional Care. It was estimated that between 10-20% of clients refused to be referred. Caseworkers reported that when clients did refuse, it was usually because they did not perceive themselves to have a need for Transitional Care, they were already receiving support from community agencies or they wanted a specific service that could be accessed more directly through a social work referral. It was suggested by caseworkers that that Cornton Vale and Polmont had a higher rate of refusal than other prisons. The caseworkers reported that most women were already linked into existing service provision (most often social work), though analysis of the monitoring data (see Chapter Five) suggested that women were as likely to participate in Transitional Care as men. In the case of young offenders, many already had a social worker (as a result of having been on supervision as an adult or having been looked after as a child) or felt that their drug use was not so problematic as to require any further intervention or support. Analysis of the monitoring data confirmed a lower take-up of Transitional Care in the community by young offenders (see Chapter Four).

Referral to Transitional Care

It was expected that referrals by caseworkers to Transitional Care would, where possible, be made 28 days prior to the prisoner's release, though where a prisoner was incarcerated only for a short time, the assessment could start on admission. The timing of caseworker assessments was to enable Transitional Care workers to conduct a case conference and a pre-release meeting with the client to discuss and agree their care plan. These meetings were aimed at confirming that the client's assessed needs were still pertinent. The case conference also provided an opportunity for the Transitional Care worker to meet the client prior to release since it was believed that face-to-face interaction between Transitional Care workers and prisoners would increase the likelihood of the client attending Transitional Care appointments on release. The pre release meeting additionally provided an opportunity for the Transitional Care worker to inform prisoners of what steps had been taken to facilitate access to the services they were identified as needing on release. An appointment should also be made for the first post-release meeting - preferably with an agreed time and location - and this should take place within 5 working days of the clients' release.

Most Transitional Care workers pointed out that clients' needs change throughout their sentence and particularly on release. Many felt that as a result of their incarceration, clients were often idealistic about what their needs would be on release. For this reason it was important for the case workers to be able to spend more time with clients working through these issues and for Transitional Care workers to participate in case conferences and pre-release meetings.

In order to inform clients of local services and to establish contact as early as possible, Transitional Care workers stated that they would visit clients in prison, and/or attend case conferences where possible. All respondents noted that they would attend a high number of case conferences for individuals who had been referred to the Transitional Care service, reporting that they attended between 50-100% of referrals (and averaging approximately 80% of referred cases). The case conferences that were not attended by workers from local Transitional Care schemes were said to be those where workers had not been given sufficient notice, or where clients had been released before the details of the referral had been passed to local schemes. One worker indicated that they anticipated problems in attending case conferences if the number of referrals increased, due to the time and resources which would be required to maintain high levels of attendance.

The caseworkers suggested that the 'better' Transitional Care agencies were those who attended as many case conferences as possible, who provided feedback on clients, who were knowledgeable and who were practical about making clients' arrangements. Conversely some caseworkers believed that some agencies were less inclined to make the effort to attend case conferences and appeared not to be particularly knowledgeable about existing resources. That said, caseworkers acknowledged that the Transitional Care agencies often had long distances to travel to attend case conferences. They also recognised that it was more practical to send one member of the Transitional Care team to cover all the case conferences held on a particular day even if this meant that clients may not meet their allocated worker.

Case conferences

There was clearly a definitional issue regarding what constituted a case conference and what was marked as a case conference or a pre-release meeting on the monitoring logs. The terms seemed to be used interchangeably by staff across the spectrum of Transitional Care: for instance reference was made to 'a pre release case conference', while another worker explained that 'we do the case conference as a pre release meeting, we wouldn't have time to do both'. This in part may account for the apparent inconsistencies that were identified in the monitoring logs.

It was clear that most agencies and workers therein endeavoured to attend case conferences with as many convicted clients as they possibly could. Moreover most were under the impression that they were near to or surpassing their contract target of 80% (for convicted clients only). Those Transitional Care agencies receiving high numbers of remand referrals were likely to have a lower proportion of case conferences because of the practical difficulties involved in arranging case conferences with remand clients.

The majority of Transitional Care workers felt that the more they could engage with the client prior to release, the greater the likelihood that the client would attend for the first post-release appointment. The case conference was seen as particularly important, partly because it provided an opportunity to obtain the client's signed consent to participate in Transitional Care.

Case conferences were also viewed by caseworkers as a crucial element in the referral process. A number of the caseworkers felt that the effectiveness of the case conference could be enhanced if the community-based Transitional Care worker had more time to see the Case Management File ( CMF) and there was more scope for liaison work prior to meeting with the client. Caseworkers also suggested that the take-up of Transitional Care would be improved if Transitional Care workers could see clients more often prior to release though they recognised that this had to be balanced against the meeting of targets. Indeed, caseworkers themselves did have the time to facilitate enhanced levels of contact between clients and Transitional Care staff without this impacting upon the time available to undertake assessments. This meant that if Transitional Care agencies wanted to see a client other than for a case conference, they had to make the necessary arrangements through the agents' visits system. Pre-release meetings between clients and Transitional Care workers were viewed by caseworkers as desirable but not practical within the current system.

The type and amount of contact Transitional Care workers could have with prisoners prior to release varied from agency to agency and from establishment to establishment. Some agencies placed more emphasis on pre-release work than did others and some establishments were more flexible than others with respect to access to prisoners. For example, some workers stated that to achieve their targets it was not feasible for them to visit any prisons other than those in their locale.

Other Transitional Care agencies tried to get to the national establishments (Polmont, Cornton Vale) as well as to their local establishments, though this often meant sending a member of the team rather than the actual person who would be working with the client:

"There's quite a few prisons far away, so we'd do a day for Cornton Vale and Polmont for travelling reasons. It's not always possible to go in and look at six files before you see the clients, it would be nice to see the care plan before we go but. We introduce the team rather than the person, it's not ideal."

Access to and within the various establishments also varied:

"Before we could go into the halls, guys would come over and speak to you and finding out about us but now with the Throughcare Centre we're only seeing the guys getting brought to us."

"We don't have case conferences with clients, we don't have the facilities, we can't go into the halls either, so we go through the agents visits system."

Pre release meetings

Transitional Care workers observed that visiting a client more than once prior to their liberation would put additional pressure on the caseworkers if the latter were required to devote time to making the necessary practical arrangements. Access to conduct pre-release meetings was consequently arranged through the agents visits system, making it more time-consuming for Transitional Care staff. The time, distance and budget implications of undertaking pre-release meetings also had to be taken into account. As one Transitional Care worker explained:

"We do just the one meet, the case conference, no pre-release meeting and that's a budget issue, travelling costs."

That said, the majority of Transitional Care workers saw the benefits of pre- release meetings.

"It's important to do pre release meetings otherwise people are just numbers you've never met and you're just sending out letters."

"It would be good to go back face to face and say I've done this or that, 'cos a letter is just a bit of paper, but to go back and reassure them and saying I'll meet you here at a certain time would be good for the prisoners."

'If someone has high needs we'll go in and do a pre release, so we endeavour to see all once and as many as possible twice."

The extent to which agencies undertook pre-release meetings was variable. Some appeared to undertake as many as possible, some undertook them more occasionally and opportunistically while others did not, it seems, undertake them at all.

Pre release information

Transitional Care workers would receive a copy of the care plan when a referral was made. They could also have access to the client's CMF while visiting clients prior to release although most found that in practice there were few opportunities to scrutinise this information. Opportunities were constrained by the fact that both the caseworker and the Transitional Care worker were not always present at case conferences and by restrictions on time available to spend at prison establishments.

A few Transitional Care workers stated that it was quite common that they did not see the client's care plan prior to their release. However, it would appear that most of the time Transitional Care workers did have sight of the client's care plan either through it having been forwarded with the referral documents or being made available at the time of the case conference.

Nevertheless some workers found the quality of information in the care plan to be insufficient to action some of the client's needs:

"We get referrals regularly that say 'needs housing support'.. but you don't know why - is it that they're barred from housing, they've got rent arrears?"

Remand clients

There was wide consensus among Transitional Care workers that at least one meeting with the client was essential prior to release in order that they might establish what the client's needs were and could begin the process of facilitating appropriate support. The fact that referrals for Transitional Care were made 21 days prior to the prisoner's release facilitated the convening of case conferences for convicted clients. Some Transitional Care workers stated, however, that referrals often did not come 21 days in advance of the release date and that this problem was particularly acute with remand clients. Even where referrals were made to Transitional Care in a timely fashion, many community agencies would not accept referrals for or give appointments to clients who were still in prison or who were of no fixed abode ( NFA). This meant that Transitional Care workers often found themselves having to wait until the client's day of liberation or until s/he was allocated a hostel or B&B place before they could action much of the care plan.

Caseworkers and Transitional Care workers associated with one establishment (Barlinnie) reported that Cranstoun had requested that case conferences and pre-release meetings were not offered to remand clients. Remand clients in this establishment were rarely seen more than once by caseworkers - for assessment - and they found it almost impossible to arrange further meetings prior to release. This was very much related to the brevity and/or uncertainty of the period of incarceration, with the result that remand clients would often be released before the caseworkers could inform their colleagues in the Transitional Care schemes.

More generally, referrals to Transitional Care for remand clients could rarely be made 28 days prior to release. Often this meant that Transitional Care workers were informed about a referral only a day or two before release and in some cases only after the client had been released. When this occurred, the client would usually only have the telephone number of the Transitional Care scheme or, on occasions, the name and address of the Transitional Care worker or agency. The onus was on the client to contact Transitional Care, despite their having had no prior contact with the agency or the individual worker. The ability of the Transitional Care workers to follow up clients was reported to be further constrained by the fact that a significant number of remand clients were NFA on release from prison, in which case workers would endeavour to meet the client on the day of release.

"Most of the ones from Barlinnie are remand so you don't see them before they come out. Most of the ones that don't turn up are the Glasgow ones, the remands. We would see them before and we have in the past but Barlinnie don't want us to do that, they just want us to send an appointment for them on release."

"Remands, they may be needing help with benefits, registering with a GP, looking for a meth script, but you never see that person. …. It was decided we were not going to see the remands unless the guy was no fixed abode."

The absence of a case conference meant that the client might not have had an opportunity to provide their signed consent to participate in Transitional Care. This sometimes resulted in situations such as the one described below:

"The ones we don't see in case conference might phone up and say they're in crisis, but we can't contact anyone till we've met them and got their consent signed. They've been given your name and number in gaol and told to contact us if they need help, they do and I have to say well I can't help you till I see you, that's a bit of a stickler".

Changes to the prison-based element of Transitional Care

Subsequent to the conduct of the professional interviews, a number of important changes were introduced into the prison-based element of Transitional Care aimed at addressing some of the key areas of difficulty identified in the early stages of the initiative. These included:

• changes to the CAART assessment tool were introduced in April/May 2003 to make the assessment easier to conduct and to reduce the amount of administration. From April 2004 further changes were introduced, including the removal of the Christo scale, which would further reduce the time required for administration.

From April 2004 Caseworkers became involved in the induction process for all short-term prisoners, delivering a Harm Reduction Awareness session and taking direct referrals from prisoners who were expected to be incarcerated for 31 days or less. Under this new model of Crisis Transitional Care, the induction sessions took place within seven days of incarceration and would be followed in relevant cases by a full CAART assessment and intervention plan. The changes put Cranstoun caseworkers in a better position to assess remand prisoners and enabled them to make better use of a range of skills:

• from April 2004 Transitional Care become more narrowly focused on addiction and housing and would be encompassed within the Link Centres that were being established within all prison establishments. The Link Centre would be staffed by multidisciplinary teams and would address some of the integration/duplication issues that had been identified by caseworkers
• at a more general level, the Scottish Prison Service's focus on abstinence and detox was changed to encompass Harm Reduction, stabilisation, maintenance, abstinence and detox.

Community-based Transitional Care

Organisational arrangements

As indicated in Chapter One, Transitional Care services in the community were provided by a range of agencies that were sub-contracted by Cranstoun Drug Services. For management purposes, the schemes were organised into two sectors reflecting the parts of the country that they covered (North-east and South-west). Tables 3 and 4 indicate the areas covered by local Transitional Care schemes, identify the service-provider and the focus of the agencies' service provision and show the staff how much staff time was allocated to the Transitional Care service. These data relate to the initial Transitional Care arrangements and were amended following a review of community-based service provision by Cranstoun Drug Services in 2003.

Local schemes became fully operational in providing a Transitional Care service at slightly different times. Some areas began to provide a service in January 2002 (Lothian, Highland, Renfrewshire and Inverclyde) and most schemes were in place by April 2002. However CLCS did not begin providing Transitional Care to North Lanarkshire and the Forth Valley until 1 ^st June 2002 while PARC was fully operational by 27 June 2002.

In all local schemes the Transitional Care workers' posts were new posts, although in Tayside the senior post was a secondment, while two posts were secondments in Grampian (alongside two new posts). In Highland, an already existing part-time post was adapted to a Transitional Care post. In some cases, workers had been appointed to Transitional Care posts from within the service-providing agency, having applied for the newly created posts of Transitional Care worker with new contractual arrangements. Transitional Care workers had a varied range of previous work experiences and qualifications. They had considerable experience in a number of related professions including: social work (6), mental health (3), drug and alcohol services (15), nursing (2), housing and homelessness support (8), prison service (4), other institutional care (3), work with offenders (3) and counselling (3) ¹¹.

In the majority of cases, Transitional Care staff were based in local communities, and were provided with accommodation in the offices of the agency service-provider. The exception to this was Cranstoun staff, both of whom were located in Dumfries prison and saw most of their clients as caseworkers. Given the wide geographical areas covered by the scheme, workers met ex-prisoners in a variety of locations. Where possible, contact was arranged in agency offices (if they were central to the locality), but this was not always possible. Frequently meetings were held in community centres, drug projects, council offices, job centres, housing agencies/hostels and health centres. In a few cases, meetings took place at the clients' home address. Local schemes would continue to provide services in prison to individual clients who were re-imprisoned.

Local Transitional Care services received referrals from a wide range of prison establishments. Individuals who were referred to local schemes were those who were going be released into the local area and accordingly it was possible that referrals to local schemes could come from any prison in Scotland. The exception to this was Kilmarnock prison which did not initially have a Transitional Care caseworker located in the prison and which appeared to make all referrals to the local Ayrshire scheme in the first instance. Workers in Ayrshire were often required to visit clients in HMP Kilmarnock and to provide information and advice to prisoners there.

An audit of Transitional Care services was carried out by Cranstoun in early 2003, focusing upon the operation of the initiative between January and March 2003 (Cranstoun Drug Services, 2003). The resulting report identified a number of operational issues. These included a lower than anticipated level of referrals to Transitional Care, variations across areas in attendance at case conferences and in the take-up of Transitional Care and variations across areas with respect to the development of links with other relevant agencies. The audit also resulted in a reconfiguration of the staffing of the Transitional Care initiative to better meet demand (with some areas receiving an increase in staffing and others a decrease) and in the termination of the contract with one agency that was considered not to have met the required standards. As part of the re-configuration, service provision to Glasgow and Dunbartonshire was combined, the level of management of Transitional Care by Cranstoun was increased and systems were put in place for all referrals to Transitional Care to be channelled through a Transitional Care Co-ordinator located at HM Prison Barlinnie. Previously, caseworkers in individual establishments liaised directly with the Transitional Care providers in the communities into which prisoners would be released.

Management structures

As a result of the contractual framework for the provision of Transitional Care, the organisational arrangements were inevitably complex. Both groups of service delivery staff - the caseworkers in prisons and the Transitional Care workers in the community - were accountable both to the organisation that employs them and to the organisation by whom they had been subcontracted to provide Transitional Care.

There was ongoing contact between sub-contracted agencies and Cranstoun. Regular meetings took place with Cranstoun Area Managers and sub-contracted Service Managers. Training and conferences provided opportunities for workers and managers to meet at regular intervals, enabling discussion between agencies, Cranstoun and SPS. Agency Managers noted that as well as using formal channels for communication, they were also able to contact individuals within Cranstoun on a more informal level to discuss issues as they arose. Contact with Cranstoun was viewed positively by sub-contracted agency managers.

"There has been good communication, a lot of clarity, this doesn't look like an easy contract for Cranstoun considering it is national and I have to say I think they've handled it really well."

Some staff suggested that the arrangements for Transitional Care - with prison based caseworkers undertaking the assessments and referring in most prisons to Transitional Care workers located within existing agencies in the community - felt somewhat disjointed. Some suggested that continuity of service might be improved through the use of mixed teams working within the prisons, with some staff undertaking assessments while others focused on the co-ordination of the referral process and maintained contact with clients when they returned to the community. Whilst such an arrangement might facilitate the co-ordination of services provided by external agencies in prisons and in the community, it would only be feasible for those clients being released locally: for others it is difficult to envisage how services could be provided other than through arrangements similar to those that actually pertained.

Cranstoun managers indicated that there had been problems with some of the sub-contracted services in terms of the quality of service provided. However, they also recognised that there had been problems in the initial structure of the service. Cranstoun managers believed it would be helpful if they had more direct oversight of the operation of individual agencies. SPS did not have direct contact with agencies, however agencies could be 'spot-checked' by the SPS Contract Manager. SPS had established close working relationships with Cranstoun and there was reported to be considerable communication in relation to contract compliance between SPS and Service Managers in Cranstoun.

While agencies considered it to be generally helpful that Cranstoun took on the role of negotiator with SPS, it was also noted that it would be useful if agencies were able to inform SPS of the 'real situation' in the community, in relation to resources for example. For the subcontracted agencies, uncertainty about contract renewal and future developments in Transitional Care provision was compounded by uncertainty about long-term plans for criminal justice in the context of proposals that had been put forward for the creation of a 'single agency' bringing together prison and community-based services. How this might have affected services such as Transitional Care was unclear.

Training

Cranstoun and the Scottish Prison Service were the key agencies involved in the development and organisation of Transitional Care. Some of the sub-contracted agencies considered the regular workshops, which their staff attended, as providing opportunities to input into the ongoing development of Transitional Care. One manager suggested that while workshops were useful for bringing workers together they could be structured more effectively. More generally, however, the induction and training provided by Cranstoun was considered to be useful and thorough by all sub-contracted agencies. Many of the agencies provided training to their workers in addition to that provided by Cranstoun.

The vast majority of Transitional Care staff felt adequately trained to do their work, but some felt overqualified. They felt they could access adequate training through both Cranstoun and their own agency. The only training issue that arose for both caseworkers and Transitional Care workers was with respect to the drugs knowledge and related expertise possessed by some of the caseworkers. This, it was suggested, had occasionally resulted in some lack of clarity regarding identified needs.

Targets and resources

There appeared to be a significant amount of pressure on agencies to meet targets that were set, although these had been revised since the inception of Transitional Care. The initial targets were described by one SPS Manager as ' fairly unrealistic'. They had not taken into account the number of clients who did not want to take up Transitional Care, not did they consider the people who were in and out of prison so quickly that they were not being included. However, targets and expectations were constantly being reviewed as the service developed.

Several workers indicated that the low number of referrals during the first year of operation of Transitional Care was causing them some concern being much lower than expected, particularly when considered alongside the low number of clients who were actually attending for Transitional Care services. However, for some workers the high volume of clients was a major issue - particularly given the lack of administrative support available to workers - as was the disparate nature of service-provision.

Responding to clients following release

The Transitional Care worker was expected to provide facilitating support for the client for a 12-week period after release. The aim of this support was to ensure that the client was linked effectively to community service providers who could address the client's assessed needs. The Transitional Care worker should endeavour to accompany the client to the first appointment with each relevant agency, unless s/he is already an existing client of that agency. If the client was attending independently the Transitional Care worker would endeavour to check whether the client attended the appointment given. All but one of the ex-prisoners who had contact with Transitional Care following release reported that they were seen within a week (including two on the same day as they were released). The other suggested that he had waited one month after release before being given a Transitional Care appointment.

The Transitional Care worker was expected, within 10 working days of a referral, to confirm with the named person in the community agency to which the client has been referred that the client has had their needs addressed or is still in contact with the agency. Where contact had not been maintained the Transitional Care worker should take follow up actions such as telephone calls, letters etc. to re-establish contact with the client, with these actions documented in the client's file.

At the end of the client's contact with the Transitional Care service a report (monitoring log) would be completed and returned to the caseworker in the establishment from which the client was released. The CMF would be updated accordingly and the monitoring log returned to Cranstoun central office. The end of the client's contact was defined as being when the client contact was lost and could not be renewed; the client's needs in relation to the care plan had been met; the 12-week maximum contact period had been reached; the client had been readmitted to prison; or the client had died.

The monitoring system overall was recognised as problematic with a lack of consistency in the ways in which information was recorded:

"We need to have better guidelines on how people complete the paperwork because some agencies are completing it differently, some people are getting forms signed at different stages than others."

SPS and Cranstoun recognised that the monitoring by sub-contracted agencies had to be given increased priority after the initial emphasis on getting the casework aspect of the service right at the beginning of the initiative.

The issue of the paperwork associated with Transitional Care (the monitoring logs) was raised consistently. The monitoring log is a substantial 9 page booklet that takes the worker through a number of key areas - Health, housing, benefits/finance, education and training, employment, social issues. They are also required to complete the Christo inventory and an appointment log at the end. In each key area the worker has to document what services the client has been offered, has had made available and has achieved at each appointment. The Transitional Care workers complained that the log was repetitive, inflexible and unrepresentative of the work undertaken with clients.

"I don't like the logs they're cumbersome, the paper work could be cut right down. All these tick boxes - what are the reasons? Is it just for stats. There's no guidelines on how the paperwork should be done. Is it all down to numbers and contacts? Is this really what it's about?"

"I don't think it captures the work going on, it's bums on seats stuff, it will record if and how often clients are seen but it's basic figures, its not going to evaluate the quality of the service."

Most of the Transitional Care workers believed that the quality and quantity of contact they had with clients prior to release impacted on whether clients turned up for their first appointment. However that was only one factor that they felt impacted on a client's engagement with Transitional Care. The main issue for the vast majority of Transitional Care workers was their ability to meet their clients' needs in terms of facilitating access to service provision. Many of them also suggested that how community-based agencies responded to clients impacted on their take up of Transitional Care.

Most Transitional Care workers felt that the sooner they could meet the client the better. They believed that clients' take-up of Transitional Care could be improved, if they were able to meet clients at the prison gate and take them to their first appointment, if they could meet clients on their own 'territory' and if they could facilitate access to the support services they required.

It appeared that the majority of agencies attempted to see clients who were NFA on the day of release and other clients within 72 hours. Most also endeavoured to accompany clients to their first appointment. However the manner in which this was done varied from agency to agency: occasionally an agency would transport clients in their cars; or undertake home visits; or on a rare occasion undertake a gate pick-up for a particularly vulnerable client while most others could not. The agencies' working philosophies and the prior experience of workers had an apparent impact in terms of how, where and when staff interacted with clients. Newer, less experienced staff had a preference for being office-based on the basis that this was in the interests of their health and safety.

"Our availability, where we can see people, I mean if we can see people right outside their door they are more likely to turn up than if they have to travel. If you can see someone on the day of release or the day after."

"We pick them up or offer them an appointment on the day of release, make sure they're accommodated. If you expect somebody who's got low literacy skills, poor social skills, chaotic drug behaviour to come to you and seek a service, well that's just not the client group we work with."

"We try and do gate pick-ups for vulnerable clients but distance means we can't do it for most. Nobody NFA comes out without an appointment on the day of release and for the others its 72 hours. We do take people in our cars, we go and see clients in their own homes, that's the way we work although if we had not met pre-release I would not be happy to do a home visit for the first meeting."

"At the start we were trying to meet people at the job centre but people weren't turning up, so what we've started doing is if we've met the person and feel comfortable we first visit at their house and that's working better. Like we use our cars too and that makes life easier - 'cos rather than me standing waiting and him not turning up for appointments, we go to them. It's not taking anything away from them because if they didn't want to see you they wouldn't answer the door or tell you and I've had that. It makes life easier all round."

Some staff, on the other hand, who had previous experience of providing community-based services acknowledged that there were other ways of working that may be more productive and that may increase client uptake, but reported being prevented from doing so by the agency's rules. Those who could not undertake home visits or have clients in their car found it necessary to arrange meeting places. This had proved problematic, particularly outside of the big towns and cities.

"Getting access to clients in areas where they can see us, often they need to travel to see us, we've got offices we can use in bigger towns but we can't set up interview space in a mass of small towns and that means they have to get a bus and that's going to cost them."

"I think a client needs a service where they can sit down and talk to us. I don't think just catching them jumping out from behind a pillar at the benefits office saying 'hi how you doing' is actually an appointment but Cranstoun are quite keen for us to do this."

It was acknowledged by managers that the costs of interviewing clients in the community had not been built into the service, and in some areas travel costs were considerably underestimated. While SPS considered this to be Cranstoun's responsibility, Cranstoun managers were clear that this was an issue for sub-contracted agencies, who had been advised to ensure that travel costs would be accounted for. Funding was not available to reimburse clients who had to travel to access services, a particular problem in rural areas.

This illustrates an underlying question of whether the Transitional Care agencies perceived their staff as office-based workers or community outreach workers. It also begs the question whether it was more productive to work with clients on their 'territory' or to ask clients to attend office-based appointments. Some Transitional Care workers believed that taking the services to the client rather than asking/expecting the client to come to them did increase take up. For instance, some clients were reluctant to go to the Transitional Care office because it was in an area that they wanted to avoid. Moreover the Transitional Care workers who were able to operate in this way felt that clients were more likely to engage not only with the Transitional Care service, but with the services that Transitional Care was referring them to. There was a perception that it was not only more practical to work in this way but, because it allowed the client to engage on their own terms and increased take up, it diffused the worker's position of authority:

"If I refuse to meet you in your home, in the local community centre, your local café and say you must come to my office - who is that alienating? It's putting up barriers that needn't be there. Whereas if I send appointments and wait for them to come to the office, they default, I'll no see them."

"I know like different agencies go to people's homes and that would maybe increase the figures, better places to meet, places convenient to them. If we could pick them up at the gate and get them the services they need. If we could get more appointments made, go down with them, be more active than right here's a GP, more hands on but when its just 'advise to present' they (client) are sitting there saying 'well I could have done that myself."

While the low attendance at appointments in the community was a concern for all, it was evident that this issue was being examined by Cranstoun and SPS. Sub-contracted agency managers believed that more pre-release meetings, more proactive contact with clients in the community such as gate pick-ups, and accessible central meeting places would increase client attendance rates.

Facilitating support in the 12-week post-release period

Many Transitional Care workers felt that they were in a better position to mediate, diffuse and advocate for clients if they accompanied them to as many appointments as possible. However, they often found that the three appointment system did not lend itself to that way of working.

"Be less of a referral agency and more of a supporting agency. Be more welfare, go out to them take them places give them support more. The number game to be played less."

"I think the advocacy side, you can mediate and advocate for them in their appointments 'cos they have poor social skills, they're not good at dealing with stuff, so it helps them to build on those and help establish a relationship with them. You know it's about being the bridge between two people as opposed to being the bridge between services 'cos if that was the case the Cranstoun workers could just fill out a form."

Indeed the issue of how often Transitional Care workers were able to meet clients within the 12-week period was consistently raised. Many of workers felt that three appointments was often just not enough to facilitate access to services and to support the client through this period of transition. Most of the Transitional Care workers believed that there should be more flexibility to meet clients according to their needs rather than according to contract specification. However it must be said that because in most areas the number of referrals had been considerably lower than expected, most Transitional Care agencies had been able to meet with clients over and above the minimum three appointments. They had therefore been able to work with more 'vulnerable' clients more intensively in the beginning of the 12-week period when their needs were highest.

There were a number of interrelated issues that consistently arose regarding the 12-week post-release period. The main difficulty identified was that of being able to facilitate access to community services within this 12-week period, especially if the aim of 'effectively linking' clients with existing services was intended to mean more than simply referring clients on. Workers suggested that it was difficult to ensure that community agencies were actively supporting clients within 12 weeks:

"I don't think our role is floating support and although we can't get people supported by services in the 12-week period."

"The 12 week period is fine for some but many tend to have very complex needs and I think they are going to have to look at extending the 12 week period. I think it's inappropriate that someone could be told that their help has stopped because they've reached a certain date in the month, I just can't get my head round that. There has to be a cut off point it should either be extended or the government will have to tackle the waiting lists. And ***** [agency] is apparently quite good compared to other places. In theory I think Transitional Care is fantastic but they have to tailor the contract to reality, we are catching some but the majority need longer."

"12 weeks is just too short, especially if a prescribing agency waiting list is 13 weeks, you will not be able to do anything else with that client until they've got the script. They are focussed on only the house or the script and if they've not got that sorted, the chance of you being able to do anything is slim to none."

The majority of Transitional Care workers felt that the 12-week period should be extended though how long it should be extended for varied depending on how long clients had to wait to receive active support from community agencies. Many considered it unprofessional and inappropriate to leave clients 'in limbo', having been referred to but not yet being seen by an allocated worker and being still in need of support.

There were one or two Transitional Care staff who felt that the 12 week post-release period was adequate but they were based in areas where the most requested services provided active support through housing support workers and outreach drug workers within the 12 week period.

Services required following release

This brings us to the services most needed and/or requested by Transitional Care clients. Overwhelmingly clients were reported to be in need of support with housing and drug problems. Given the large numbers of Transitional Care clients leaving prison with no fixed abode and, perhaps more obviously, drug problems, their support needs from the community service providers working in these areas were high.

All agencies indicated that they would contact a wide range of services for Transitional Care clients. Local services provided a range of provisions which were available to Transitional Care clients relating to: accommodation support, addiction/drugs and alcohol support, benefits, healthcare, blood testing, employment and training, relationship advice, day care and counselling/relapse prevention. All Transitional Care service providers indicated that they would link clients with services providing support with housing/accommodation and drug/alcohol services.

The range of drug services provided in local areas was broad, with a number of service-providers operating alongside local GPs and other health-care services. Thus clients were generally able to access prescribing services and/or broader support services through Community Drug Problem Services and/or local drug/alcohol agencies and substance misuse teams.

Perceived gaps in services varied across areas. For example while most workers indicated that a range of drug services were operational, this was not the case in Dumfries and Galloway. Several workers indicated that services were available, although there may be gaps at times ( e.g. in Borders, Tayside). However in such cases the main problem that workers were experiencing was linking people into services. Similarly, it was noted that drug services were operating, but it was the lengthy waiting lists which were causing problems for Transitional Care (Tayside, Lothian, Edinburgh, North Lanarkshire, Forth Valley, Renfrewshire, Ayrshire, Glasgow, South Lanarkshire, Grampian). As one worker noted, the

"main problem is not in terms of gaps, but in the capacity of existing services to meet demand".

Lack of accommodation was identified as a major problem (Edinburgh, East Dunbartonshire, West Dunbartonshire, Dumfries and Galloway, Ayrshire, Mid Lothian, Highland, Glasgow) particularly as the local authority had no legal obligation to house individuals released from prison. It was noted that there is a lack of support for drug users on the streets, with housing and prescribing identified as the key requirements for stability. Problems with accessing GPs who will prescribe was also identified as a problem for workers in Glasgow. Lack of residential rehabilitation spaces was noted by workers in the Borders and Glasgow.

Anger-management was identified as a gap in service-provision in North Lanarkshire, the Forth Valley, and South Lanarkshire as clients were requesting this service which could only be accessed through social work. Services for clients over the age of 25 was identified as a problem in Ayrshire, where services catered more effectively for younger clients, despite the fact that older clients may be more ready to deal with substance-use problems.

One worker noted that there were geographical gaps in service provision (Glasgow) as some Social Inclusion Partnerships ( SIPs) would not provide funding outwith their area. Workers (South Lanarkshire and Highland) noted that there were gaps in services which offered clients day services, alongside drug support. In Highland, it was noted that more 'localisation' of services was required.

Only one of the managerial respondents believed that there were adequate resources in the community to meet the needs of Transitional Care clients. Other managers indicated that while some geographical areas were better resourced than others, there was a general problem with access to services, notably accommodation and support for drug problems. While employment and training were key areas which Transitional Care was intended to provide help with, some agencies believed that this was over-emphasised and it was the more basic needs which individuals required support in obtaining:

"People are being offered appointments and that's the good bit, but they are being offered appointments for waiting lists, which is the bad bit because at the end of 12 weeks some of these people will still be sitting on waiting lists and that means the advocacy role is gone and we don't know after that whether they uptake that service or not, so that's frustrating".

"It means that what we're doing is dropping clients just when they most need a little bit of support to get them into the service and that was supposed to be the purpose of Transitional Care and yet we drop them when they're most vulnerable sometimes."

The lack of existing programmes to deal with re-offending behaviour was noted by managers. It was suggested that a centralised drop-in service where individuals could access a range of services on release from prison might go someway towards addressing perceived gaps in existing services and the difficulties that clients were reported to experience when moving between them.

Drug services

There were two main kinds of drug support that clients seemed in need of: substitute prescribing and counselling/support for their drug related issues. Both of these seemed to be problematic to access within the 12-week period and often for much longer.

Many workers identified areas of good practice (Turning Point Outreach Service, Signpost) indicating that services were effective and efficient, although there was variation between and within regions. It was also noted that it would benefit clients to have access to a wider range of services (including those with a more client-centred approach) and that more services were needed for clients who were not using (Renfrewshire). One worker indicated the

"difficulty with accessing support for those who are clean - same waiting list for assessment whether client requires methadone substitution, naltroxine or purely support - can take weeks".

Workers in Glasgow, Fife, Dumfries and Galloway mentioned the lack of counselling services which again limited the 'treatment' options available to clients:

"Counselling services are lacking. Most services seem to offer clinics/activities but not a comprehensive counselling service. Social work can take up to 3 months to allocate a counsellor".

Workers in rural areas such as Highland, indicated that more services were required throughout the region to minimise the travel required.

The perception of the Transitional Care workers was that in most areas - the exceptions being the more mixed rural/small town areas such as Grampian, Ayrshire, Dumfries and Galloway and the Borders - there were enough drug agencies. However, their ability to deal with the volume of potential work undermined not only their ability to take clients on but also their capacity to offer interactional support. The waiting list for substitute prescribing was said by Transitional Care workers to vary from six or seven weeks to more than a year.

In many areas, workers indicated that drug services had lengthy waiting lists for assessment and referrals (Lothian, Tayside, Edinburgh, North Lanarkshire, Forth Valley, Renfrewshire, Ayrshire, Glasgow, South Lanarkshire, Highland) which meant that clients could wait for considerable periods of time before being given a place with services. In some cases, the waiting lists (up to 11 months in one Tayside service, 13 weeks in Edinburgh, up to 18-24 months in Grampian) meant that clients on Transitional Care were unable to access services during the 12 week Transitional Care period, or that clients were waiting for considerable periods of time to access services.

It appeared that in the areas that had outreach workers, community workers working with GPs' clients were able to access substitute prescribing services more quickly, often within 14 weeks (Edinburgh, Mid, East and West Lothian, West Dumbartonshire). It appeared that in those areas with centralised prescribing agencies and little or no outreach, and little or no community or GP liaison work, the waiting lists were more than four months, sometimes eight months (Ayrshire) and in a couple of areas more than a year (Aberdeen, Tayside). This obviously impacts hugely on Transitional Care: if clients are unable to access the services they need through Transitional Care they are unlikely to use the service in the first place or if they go through the system again.

Waiting lists also operated for access to GPs who were prepared to prescribe and for dispensing chemists in some areas. Prescribing services, according to one respondent:

"have strict contracts which can be very inflexible to individual needs".

One worker noted that existing services were:

"fine but everyone has their waiting lists of assessments. Clients have to access social workers first for funding".

The waiting lists for counselling and/or general drug support appeared similar. In some areas the drug support and/or counselling went hand in hand with prescribing services while in others they appeared to be completely separate. Many of the Transitional Care workers were of the opinion that even if the client received an allocated worker and a substitute prescription, the amount of counselling and/or support that complemented it was woefully inadequate. This was particularly the case in areas that offered a more centralised prescribing service (such as Glasgow, Tayside and Aberdeen):

"Getting on the waiting list, a year for an appointment for assessment, it's a year before they're given any help at all. Maybe they are assessed within the year but they're not given any help."

This sometimes meant that clients were being returned to prison before they could access services:

"The biggest one we come across is people looking for scripts. They were coming back in before they were getting a service. They were going out and getting assessed in about 3 weeks but there was no space at the doctors and they ended up back in crisis, started using again and ended up coming back (to prison). They were holding it together for two or three weeks and then talking to their mates that had been in two months before and still not getting a service so they were away back to their old habits. I'm not making excuses for them but they weren't getting a service."

Moreover in some areas substitute prescribing agencies removed those who were imprisoned from their waiting lists. In effect this could mean a Transitional Care client being assessed by a substitute prescribing agency within the 12 week period, being put on their waiting list for treatment, beginning to use drugs illicitly again, being re-incarcerated and being taken off the waiting list, only to start the whole process over again on release.

The waiting lists for active support from drug services appeared to be a constant problem. Transitional Care workers were often frustrated by not being given a specific appointment date for their clients and not knowing when a 'closed' waiting list would be re-opened ¹². Many of the Transitional Care workers pointed out that although addiction services claimed not to have waiting lists this was only partly true. A duty worker would often see clients within 24 hours but thereafter clients may have to wait weeks or months before being allocated a key worker, or given active support. The Transitional Care workers perceived this situation to result from insufficient capacity to deal with the volume of clients who needed support from an addiction service.

Related to this, many Transitional Care workers perceived there to be a number of gaps in services. For example, drug counselling and general supportive one-to-one counselling was often requested but was difficult to access. Some felt that there was a lack of group-based programmes, including groupwork but also more practically-orientated interventions such as those that focused on life skills or activities. A few suggested that these services should be offered locally, within drop-in centres, which were also reported to be scarce. A number of workers specifically mentioned anger management as a service that they often felt their clients were in need of but that was rarely available. In general Transitional Care workers believed that what was required was 'real' services that were adequately staffed.

Housing services

Housing was also an area that was problematic for many clients in receipt of Transitional Care, with their accommodation status impacting upon their ability to access drug treatment services and vice versa:

"The most important thing for the people we pick up are their housing and the addiction services, but we can't tie them into services until they are accommodated."

This meant that accommodation had to be the first priority for the vast majority of clients. Many of the workers mentioned how the changes made to the housing legislation in 2002 had improved clients' access to emergency accommodation. However clients rarely wanted to go into hostel accommodation since hostels often had a significant proportion of residents who had substance misuse issues. For clients released from prison, returning to a situation in which problematic drug use was endemic was unappealing. B&Bs were seen as the 'next step up' but as presenting similar problems:

"The main problem related to their offending is their drug use, until you get that sorted they are going back into the system over and over again and this brings it back to the waiting lists. Another thing is the lack of safe secure housing, supported temporary accommodation. Sending someone to a hostel or a B&B where drugs are rife is not ideal, so we need more half way houses and supported accommodation."

This raised a related issue in that if services were inaccessible, this could limit the perception that Transitional Care had something to offer:

"If things go well they tend to turn up again, like if you can get them a B&B instead of a hostel. … if they turn up and they get put back in a hostel, nothing has changed, they've had someone there to sit and talk with but nothing has changed - if you are not able to do anything for them they are unlikely to turn up again. If they stand to gain something they will link in to that contact but the services just don't work quickly enough."

Unfortunately despite these changes, all the Transitional Care workers reported that the housing departments had little or no housing stock available. It was rare to find Transitional Care workers who referred to housing departments that could offer supported accommodation and/or tenancies within the 12-week period. However it was not always appropriate to put someone with complex needs, including substance misuse issues, straight into a tenancy even if there was one available. This was in part because there was a reported lack of housing support workers:

"Housing is a big one. We have a really good housing officer and we had three or four who got tenancies straight from prison but it didn't work. One had absolutely no furniture and had been sleeping on floor boards for 5 days before he got in touch. Another didn't pick up the keys, another did but didn't move in and the other moved in successfully. Nobody will go to a bare flat and agencies can't help them overnight. If somebody gets out at 8 am they can't be settled in by 8 pm that night. If you are setting them up with a tenancy - why set them up to fail? Why not look at the bigger picture and say this guy will need support."

The issues of what kinds of service provision clients needed and requested, the waiting lists for such services and the perceived gaps in provision were the most consistent and perhaps most significant issues that the Transitional Care workers raised. Transitional Care workers felt that in some ways they were unable to facilitate access to services for clients because clients were simply 'advised to present'. This meant that they would be seen by a duty worker, who would take basic details and ask them to return for a 'proper' appointment at a later date.

Many workers also expressed concern that some of their younger, more vulnerable clients were only being offered hostel places and often preferred to sleep rough. Despite Transitional Care workers enjoying good working relationships with housing agencies, there was a lack of available supported accommodation that could be accessed quickly.

The role of other agencies

Obtaining information from other agencies was often problematic. It was noted that community based services outwith Transitional Care did not always understand its objectives. Indeed there had been some hostility towards Transitional Care. This appeared to be based on a lack of understanding of the advocacy role that Transitional Care workers were expected to provide, and that they were referring clients onto services - not drawing them into their own organisation.

Social work services had also apparently raised concerns about the potential increase in their workload that could arise from Transitional Care:

"One of the great anxieties about Transitional Care, particularly from the local authorities was, and I actually had letters there that evidence this from fairly senior people in social work, you're going to create a need that we can't meet. Well absolutely not. We're not creating any need. What we're doing is identifying needs that are already in existence...That said however, there never were sufficient resources or sufficient range of service in the community to start with."

Managers suggested that there was a need to publicise the aims and objectives of Transitional Care to other agencies. There was some hostility towards Transitional Care sub-contractors due to other agencies misunderstanding of how they operated and their roles and responsibilities within the remit of Transitional Care. Early lack of consultation with statutory services was said to have led to a lack of co-operation, particularly from social work departments.

"I think that the problems with it initially were that there had been no real consultation with the statutory agencies who were dealing with this, if you like the social work departments who were vehemently opposed to this system being introduced because they had no ownership of it."

"Local authorities have not welcomed this service with open arms and I think that's been very shortsighted of them. There has been open hostility and resentment at the fact that we've chosen voluntary sector agencies to partner the subcontracting and I have a suspicion that their ( SW) proposal for their throughcare service for all prisoners is a direct response to them not getting the contracts locally to do this at local level."

Transitional Care workers perceived the main communication difficulties to be the lack of co-ordination within and between prison and community services. This was often about the communication between agencies in prisons and agencies in the community which in some cases involved the same agency working in both environments. With a number of agencies working in the prison, duplication of effort was said sometimes to occur. Transitional Care workers sometimes found that the agencies to which they were referring clients had already received a referral from another agency working in the prison. There appeared no system for co-ordinating who clients saw whilst in prison and what referrals were made by the other agencies working there. This raises a question about whether Cranstoun should have had the remit to co-ordinate referrals only to Transitional Care or the overall co-ordination of referrals and service provision between prison and the community.

Agencies reported often having experienced difficulties engaging with SPS as a whole. This was acknowledged by SPS respondents who indicated that different governors attached different levels of importance to Transitional Care, something which was reflected in practice. Availability of resources for addiction work, and co-ordination of this work, was not uniform throughout SPS.

As one agency manager noted, all the referrals came from Cranstoun so sub-contracted agencies could only respond to the referrals that come to them. There was some indication that the passing of information from prison caseworkers to Transitional Care workers was not always as effective as hoped, but this was an element of provision that was starting to improve as the service developed. As one SPS respondent observed, "the dedication of Cranstoun and our Transitional Care partners has been immense".

Summary

Prison-based Cranstoun caseworkers were responsible for conducting assessments on all short-term and remand prisoners to identify the needs of individuals with substance misuse problems and to co-ordinate service provision. The Common Addictions Assessment Recording Tool ( CAART) was employed to assess prisoners and to develop a care plan, though it was found to be cumbersome to administer and ill-suited to particular groups of prisoners and caseworkers believed that the resulting care plans were resource- rather than needs-led.

There were differences between prisons in the extent to which casework was co-ordinated with other service provision and in the ease of access to prisoners, both of which, along with caseloads, impacted upon the ability of caseworkers to engage with prisoners prior to their release.

Most prisoners were reported to have agreed to being referred to Transitional Care. In these cases caseworkers liaised with community-based Transitional care workers in sub-contracted agencies. The extent to which Transitional Care workers attended pre-release case conferences appeared to vary across the country. More generally, pre-release contact was influenced by the emphasis placed by the agency on this aspect of the work and the accessibility of prisoners in individual establishments. Pre-release contact was, however, universally regarded as important not least as a means of encouraging take-up of the service once the prisoner returned to the community.

Remand prisoners presented particularly challenges because of the brevity and uncertainty of their period of incarceration and because many would be of no fixed abode on release. Amendments made to the Transitional Care initiative - which reflected its evolutionary nature - included the introduction of Crisis Transitional Care aimed at those who were expected to be incarcerated for 31 days or less. Other important changes included amendments to the CAART assessment tool to reduce the administrative burden and the re-focusing of Transitional Care upon a narrower range of needs (addiction and housing) to reflect the introduction of Link Centres within all prison establishments.

Transitional care services in the community were provided by a range of non-statutory agencies that were sub-contracted by Cranstoun Drug Services, which meant that Transitional Care workers had a varied range of previous work experiences and qualifications. Most were based in local communities with the exception of Transitional Care staff employed by Cranstoun who were based in HMP Dumfries and who undertook both casework and work following release.

The organisational and management arrangements for Transitional Care were complex, requiring relevant training and ongoing contact and negotiation between the relevant parties. Concerns about the quality of sub-contracted provision resulted in a re-configuration of staffing to better meet identified need. Targets and expectations were constantly under review and it was acknowledged that initial targets for the service had not been realistic.

The Transitional Care workers were expected to provide facilitating support to ex-prisoners by offering three appointments in the 12-week period following release aimed at referring them to existing community-based services. Although Transitional Care workers believed that contact with prisoners prior to release impacted upon their subsequent engagement with the service, they also suggested that the take-up of Transitional care could be enhanced through adopting a more proactive approach.

The system of three appointments within 12 weeks was regarded by workers as too inflexible to address complex needs and to ensure that ex-prisoners were effectively linked into services as opposed to simply being referred on.

Substance misuse and housing were the services most often said to be requested by Transitional Care clients. However, the range of services available varied across the country (tending to be less extensive in more rural areas) and even where they were available there were often length waiting lists. This applied both to drug services and to accommodation. It was rare for ex-prisoners to be offered anything other than transitory accommodation within the 12-week post-release period. The ability of Transitional Care workers to link e-prisoners effectively to resources was also hampered by lack of understanding of and in some cases hostility towards the initiative on the part of other agencies.

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