The Scottish Government

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AUDIT OF THE THROUGHCARE ADDICTION SERVICE (TAS)

MAY 2007

Acknowledgement

1. The Scottish Executive, is grateful to Criminal Justice Groupings/Unitary Authorities, the Scottish Prison Service and Phoenix Futures for their responses to and assistance with the Audit.

Background to the Throughcare Addiction Service (TAS)

2. The Throughcare Addiction Service commenced on 1st August 2005 when the Scottish Prison Service (SPS) Transitional Care contract ended. TAS forms part of the revised guidance (March 2005) for voluntary aftercare services, which is often referred to as "Phase 2" of the Enhanced Throughcare Strategy [1]. The priority groups for Phase 2 are [2] :

• High risk offenders, and
• Throughcare Addictions Service offenders.

3. The Throughcare Addiction Service aims to provide a continuity of care for those leaving custody who wish to go on to receive addiction services in the community. TAS seeks to achieve a seamless transition from substance misuse work undertaken during the custodial period through the immediate post-release period onto the provision of substance misuse work in the community. The intention is to motivate the prisoner, during the custodial term, to tackle substance misuse by having in place, pre-release, a Community Integration Plan (CIP) which establishes a clear and agreed pathway forward to continue the work in the community.

4. The Throughcare Addiction Service works with the offender in the 6 week period prior to release from custody through the 6 week period post-release. During this period, the TAS worker attempts to develop an effective working relationship with the offender. The period following release from custody can be a period of major vulnerability to the offender in terms of re-settlement and the lowering of tolerance to the substance of misuse. It has also been recognised that in the past it was also a period of significant fall out of service provision. The TAS worker helps the offender address their addiction (and associated) difficulties and link them into appropriate services.

5. The successful resettlement of an offender within the community is possibly one of the best ways of helping reduce reoffending. The enhanced arrangements aim to address addiction issues both pre-release and post-release, to prevent the often chaotic lifestyles that lead to increases in reoffending.

Background Information on the Audit

6. The Throughcare Implementation Sub Group of the Tripartite Group agreed that there should be an Audit of the Throughcare Addiction Service (TAS). The Audit's aim was simply to begin the process of collecting, (and obviously thereafter analysing), data and to set a baseline from which to measure future progress. This Audit was therefore designed to be fairly simple to complete from data readily accessible to local authority staff. The Throughcare Implementation Sub Group concluded its business and disbanded in 2006. For the purposes of this Audit, the Multi Agency TAS Group, which has representation from the Scottish Executive Justice Department, the Scottish Prison Service (SPS), the Association of Directors of Social Work (ADSW) and Phoenix Futures, agreed to undertake the review of the findings. Appendix A contains a list of the members represented of the Multi-Agency TAS Group.

7. The Audit papers were sent out to Criminal Justice Groupings/Unitary Authorities in December 2005 with a "return by" date of 31 January 2006. It was agreed that once the data had been collected and analysed, the findings would be fed back to local authorities/Community Justice Authorities, who would then circulate the results more widely. The Audit provided an opportunity to take stock of, and reflect on, progress made in establishing a Throughcare Addiction Service across the country.

Audit Data Requested

8. The Throughcare Implementation Subgroup and the Social Work Statistics Liason Group (Criminal Justice Subgroup) agreed that data relating to the Throughcare Addiction Service should be collected in two parts: through the Aggregate Return of Criminal Justice Social Work (CJSW) statistics (submitted to the Justice Department Statistics Unit) and a separate Annual Return (submitted to Community Justice Services Division). Both returns were distributed to local authorities at the same time, along with a covering letter explaining the reasons for this. Copies of the return proformas are attached at Appendix B.

9. The Aggregate Return requested information on the number of TAS cases and the number of individuals who received a TAS service. This differentiation was in recognition of the fact that an individual might be offered a TAS service on more than one occasion, if they had more than one period of short term custody in the reporting period. The information requested was to be delineated to show the take up amongst adult males, young males and females. This was aimed at providing information on the priority groups for TAS.

10. The Annual Return contained nine questions about those individuals who received a Throughcare Addiction Service. Those questions were primarily about the TAS worker's contact with the individual at the Community Integration Plan meetings and in the community, as well as the type of agencies to which TAS clients were referred. This was aimed at showing, amongst other things, if TAS was able to sustain the offender's motivation to address addiction and associated difficulties post release and the type of services to which offenders were being referred.

11. Data was requested for the period 1 August 2005 to 31st March 2006 from local authorities/unitary authorities. Similarly, SPS agreed to provide data on TAS referrals and Community Integration Case Conferences, collated by the Enhanced Addiction Service Provider, Phoenix Futures, in each establishment for the same reporting period. This is in accordance with the national contract performance measures.

Presentation of the Findings

12. Appendix C provides a table showing the responses to the questions posed in the Annual Return. Appendix D also amalgamates this data to give a picture of practice at the Community Justice Authority level.

Findings

Aggregate Return

Throughcare Addiction Service (TAS) (1,2,3) - 1 August 2005-31 March 2006

Number of cases commenced and number of individual who recieved TAS service

Table 81

1. TAS commenced on 1 August 2005. This is therefore the first year of data collection and figures should be treated with caution.
2. Information was not available for North Ayrshire and Edinburgh in 2005-06
3. TAS had not commenced in Aberdeenshire as of 31 March 2006

* The table above is an extract from the recently published Scottish Executive Criminal Justice Social Work Statistics 2005-2006 (2007)

13. Four hundred and twenty seven TAS cases were commenced in the period 1/8/05 to 31/3/06. Eighty-nine per cent of TAS cases commenced were for males, 5 per cent related to young male (under 21) prisoners serving under 31 days, 80 per cent related to adult male prisoners (aged 21 and over) and 4 per cent related to females serving sentences of under 31 days. Three hundred and eighty eight individuals received a TAS service in the same period. It should be noted that a small number of local authorities were unable to provide data in relation to the above.

Annual Return

14. A number of local authorities submitted "nil returns" for the Audit [3]. Some did not make clear at the time of the Audit whether this was because they had no TAS individuals/cases or because they did not have appropriate data collection processes in place to record TAS data.

Question A: Number of CIP meetings attended by TAS worker

15. Two hundred and eighty-one Community Integration Plan meetings were attended by TAS workers in the period. Nine per cent of these CIP meetings were with women (n=26). The TAS service operating in the North Strathclyde Community Justice Authority (CJA) carried out 44% (approx.) of the total number of CIP meetings (n=123).

Question B: Number of TAS clients registered with a GP by a TAS worker either before or after client left custody

16. Fifty six individuals were referred to a general practitioner either before/after release from custody. Eleven per cent were for female offenders (n=6). TAS operating in the Fife and Forth Valley CJA referred 66% of the total number of individuals (n=37).

Questions C, D & E: Number of TAS clients who attended first appointment post release, attended at least one appointment post release, or attended all six appointments

One hundred and ninety-five individuals attended their first community based appointment with their TAS worker, on release from custody. Seventeen per cent of these individuals were female (n=34). A slightly higher number (n=210) attended at least one appointment in the community with their TAS worker; 17% of this group were women (n=35). However, only 73 individuals - of which 17 were women - managed to keep all six appointments with their TAS worker (as per the guidance standards for the service). TAS operating in the Fife and Forth Valley CJA consistently showed positive results across these three questions: 43% (n=83); 40% (n=84); and 48% (n=35) respectively.

Question F: Number of TAS clients referred by TAS worker to community based drug/alcohol agency

17. One hundred and ninety-eight individuals were referred by TAS to a community based drug/alcohol agency. Thirteen per cent of these referrals were for women (n=25). Of those referred in total, 38% were from the North Strathclyde CJA area (n=75) and 28% were from the Fife and Forth Valley CJA area (n=56).

Question G: Number of TAS clients who were referred by TAS worker to a housing provider

18. One hundred and seventy-seven individuals were referred to a housing provider by their TAS worker. Of those referred, 16% were women (n=28). Thirty per cent of the total number of individuals were referred by TAS in the Fife and Forth Valley CJA area (n=53), 27% referred were from TAS in the North Strathclyde CJA area (n=47) and 23% were referred from the Tayside CJA area (n=41).

Question H: Number of TAS clients referred by TAS worker to a community based employment or further education provider

19. Ninety-nine individuals were referred by TAS to a community based employment agency or further education provider. Of those referred, 13% were women (n=13). The TAS operating in the North Strathclyde CJA and the Fife and Forth Valley CJA areas together referred 59% of the total number (n=58).

Question I: Number of TAS clients referred by the TAS worker to another community based organisation

20. Eighty-five individuals were referred by TAS to another community based organisation. Data relating to the type of organisation was limited but included bereavement counselling agencies and adult learning services. Twenty-two per cent of those referred were women (n=19).

Information from SPS

21. Information from SPS indicates that there were 716 referrals for TAS in the period. This figure is reached by adding the total figure for >31 day referrals and <31 days referral. In addition, SPS has advised that 473 Community Integration Case Conferences (CICs) were held during the period. Table 1. (below) provides more information. It should be noted that the Community Integration Plan meeting (CIP) is called the Community Integration Case Conference (CIC) by SPS as this term fits with its Integrated Case Management (ICM) model of service delivery. However, these meetings are one and the same thing.

22. It should be noted that TAS is available to all prisoners who meet the eligibility criteria. However referral data from HMP Kilmarnock has not been supplied during this reporting period. SPS has agreed to request and include this data for information and analysis in future.

Table 1.

Referrals to TAS and CICs: Yearly Report ( August 2005-March 2006)

Analysis

• Difference in figures from local authorities and SPS

23. There are notable differences in the figures provided by SPS and those provided by local authorities around the number of TAS referrals and the number attending the Community Integration Plan meetings: The referral figures from SPS are higher than those provided by local authorities/unitary authorities. This is because the SPS data is inclusive of TAS referrals, voluntary throughcare requests and other referrals made direct to external agencies, where TAS was not available (e.g. to community addiction teams). This was to ensure that vulnerable individuals were not released from custody without vital support networks being in place. Referral figures from SPS may also have included cases which were subsequently considered by the TAS provider as not meeting the set criteria.

24. The Community Integration Case Conferences data from SPS include all meetings that took place between the Phoenix Futures caseworker, the prisoner and the TAS worker, rather than just the pre-release case conference meeting which is stipulated in the guidance. The discussions that have taken place at the Multi-Agency TAS Group meetings confirm that the discrepancies have occurred because of uncertainties over what constituted a CIP meeting of the three pre-release contacts.

25. The Multi-Agency TAS Group has taken action to promote a clearer understanding of the referral criteria and the referral process in order to reduce the risk of these discrepancies occurring in the future; for example by promoting the use of standard TAS forms.

• Take up of TAS

26. It appears that of the 388 individuals who received a TAS service [4]:

• 281 (72%) had a CIP meeting at which the TAS worker was present;
• 210 (54%) actually kept at least one appointment in the community; and
• 73 (19%) kept all six appointments.

27. The high proportion of CIP meetings at which a TAS worker was present is an encouraging development, especially in view of the fact that some CIP meetings would have been arranged within limited timescales for prisoners serving very short sentences. The data suggests that the majority of prisoners are receiving contact from community based TAS prior to their release and that plans are being made for their resettlement. For a service which was in the process of development (in the reporting period) this is a good baseline from which to build.

28. However, there also appears to be a fair degree of referral attrition, that is to say, not all those prisoners who had contact with TAS prior to release managed to maintain that contact on release. Evidently, there is scope for significant improvement especially in view of the policy aims and objectives that underpin the service (i.e. providing a continuity of care). TAS also has a strong motivational ethos and it appears that further work is required on this particular aspect in order to make sure that individuals stick with the service.

• Female Prisoners and Young Offenders

29. The guidance issued to local authorities makes clear that females and young offenders are considered a priority for TAS. However, it seems that the TAS take up amongst these groups is low. Given the significant numbers within these groups who have ongoing addiction issues, TAS providers will wish to examine in more detail how rigorous and accessible their processes are for engaging these young offenders and female prisoners. Of course, it is recognised that some will not fulfil the TAS criteria, for example, because they are on remand.

• Referrals to other agencies

30. It appears that referrals to community based addiction services and housing providers are high for TAS clients, whilst referrals to community based employment/further education are moderate. The rate of referrals to these agencies is another positive feature of this Audit, in as much as it shows that TAS is making progress in connecting individuals into appropriate service provision. It should be noted that Phoenix Futures were also making referrals to other community based agencies via the prison Link Centres, where TAS was not available in the reporting period.

• Data Collection

31. A number of local authorities submitted "nil returns" for the Audit. As noted previously some did not make clear at the time of the Audit whether this was because they had no TAS individuals/cases or because they did not have appropriate data collection processes in place to record TAS data. Further contact with these authorities indicates that poor data collection processes was the most common reason given for the "nil return". TAS providers will wish to ensure that their performance monitoring systems are sufficiently robust to allow for appropriate data collection in the future.

Comparison with the Evaluation of SPS Transitional Care

32. The evaluation of the Scottish Prison Service Transitional Care Initiative (MacRae, McIvor et al., 2006) [5] concluded that there were lessons to be learned from its experiences of delivering throughcare to prisoners with identified drug problems that could inform the new arrangements. A direct comparison between the evaluation of Transitional Care and this audit of TAS is not appropriate given the differences in, amongst other things, service delivery models and the evaluation/audit methodology. However, the Multi Agency TAS Group do believe that there is value in looking at two data sets available from both the audit and the evaluation, bearing in mind the limitations therein.

33. Firstly, of the respondents interviewed for the Transitional Care evaluation at the 4 month interview stage, 64% said that they had met their Transitional Care worker while they were still in prison. The TAS Audit shows that 72% of TAS clients had a Community Integration Plan meeting at which their TAS worker was present. Secondly. 28% of Transitional Care clients attended their first appointment following release whereas 195 of 388 TAS clients (50%) attended their first appointment following release.

34. The evaluation concluded that overall the Transitional Care Initiative was reasonably effective in linking clients with services. From the results of this first Audit it appears that TAS is making equally positive strides in engaging clients and linking them with appropriate community based services.

Conclusion

35. This Audit sought to gather data in order to provide a baseline for the Throughcare Addiction Service. The data collected in the first eight months of TAS' development shows that there is significant room for improvement nationally. Some TAS services in CJAs appear to have made a good start and are performing well, whilst others need to make more obvious progress. The priority attached to TAS, both from a policy and practice perspective, means that this remains an important area of work.

Community Justice Services Division

May 2007

[1] See http://www.scotland.gov.uk/Resource/Doc/47021/0025175.pdf for further information on the Enhanced Throughcare Strategy.

[2] See http://www.scotland.gov.uk/Topics/Justice/criminal/16910/tas for more information on Phase 2.

[3]The following authorities provided "nil returns" for this part of the Audit: the Ayrshire Criminal Justice Partnership; Dumfries and Galloway; Glasgow; Shetland; and the Western Isles. SACRO provided TAS data for Edinburgh City Council. Information available indicated that there was no specific TAS in Ayrshire, Dumfries and Galloway and Glasgow during this reporting period apparently due to difficulties in recruiting staff and setting up the service. However, it is understood that TAS referrals were being made direct to appropriate community based organisations.

[4] see Aggregate Return

[5] For more info, see http://www.scotland.gov.uk/Publications/2006/02/08110928/0

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