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CHAPTER 2: PLANNING AND IMPLEMENTATION OF THE SCHEMES
Planning of the Pilot Schemes
Local Implementation Groups
2.1 At the start of the pilots, a local implementation group was set up in each area with membership from the police, assessors' organisations (usually the city council or local social work), Drug Action Team ( DAT) representatives, including the Health Board, and representatives from the Crown Office and Procurator Fiscal Service ( COPFS). The purpose of the groups was to make clear the responsibilities of each of the main partners in delivery (the police, assessor and treatment agencies) and to put in place the accommodation, staff and other resources required to make the pilots operational from June 2007. Details of the meetings of these groups are provided in Appendix E.
2.2 Across all schemes, the planning and implementation meetings seem to have provided a clear forum for discussion of emerging issues as the pilot has progressed. There has, however, been limited involvement from the Crown Office and Procurator Fiscal Service at these meetings, and this absenteeism has, in the eyes of some of the other people involved in delivering the pilots, been disappointing. Importantly, there appears to have been no formal or regular feedback to the police, assessors or treatment providers regarding the numbers of people charged under the Act for non-compliance with either the drugs tests or attendance at assessment. Many of those interviewed in the consultation stages of the evaluation suggested that it would have helped them to understand the 'whole' process more fully had COPFS representatives played a more active and visible role in the schemes planning, operation and ongoing monitoring. A more detailed discussion of the impact of limited engagement from COPFS on the pilots operation is presented in Chapter Four.
Accommodation for the Pilots
2.3 In each of the sites, legislation permits that initial assessments may be carried out either at the site of detention (ie police offices) or off-site, at a time and date agreed with the participant, the police and assessor organisations.
2.4 In Aberdeen, it was decided that on-site assessments would have to be carried out in the then Aberdeen District Court interview rooms, adjacent to the custody suite. These rooms are also used by solicitors to conduct interviews with their clients, and on occasion, assessments have had to be conducted quickly in order to assure solicitors can also conduct their interviews before the client's court case is called. Both interview rooms were refurbished for the purpose of the MDTA scheme. Secure custody 'booths' (including a wired partition) were installed, preventing any kind of physical contact. Off-site assessments are also undertaken in a central location, at Gallowgate, Aberdeen.
2.5 In Edinburgh, plans were put in place for assessments to be carried out in the Nurses Room at St Leonard's police station (a room usually reserved for Nurses completing paperwork, storing paperwork, and team meetings). A nurse is onsite 7pm - 7am weekdays and from 7pm Friday until 7am Monday. A small window on the door of the Nurses Room was installed when the MDTA scheme began to allow for better reassurance of security for the assessors during an assessment. There was some early discussion of a panic alarm being installed in the Nurses Room, however, when this issue could not be resolved, personal attack alarm were issued for each assessor instead. The use of the room meant that assessments were sometimes delayed as nurses were using the room for meetings. Off-site assessments are undertaken near the police station, in the Turning Point Office in Forrest Road, Edinburgh.
2.6 In Glasgow, assessors were initially invited to use an open office located in the police station. This presented some difficulties in terms of it being awkward to navigate arrestees from the cells to the room, and, more importantly, from a police perspective, contravened health and safety rules since it provided no separation of arrestees from assessors. This meant that police staff had to guard the door of the room while assessments were underway; a resource demand which could not be sustained. As the pilot progressed, the MDTA staff started to use the same room as Arrest Referral staff working at Glasgow London Road which caused some complications with overlapping shifts, but was more fit-for-purpose with regards to safety. This facility consists of two small rooms, separated by a wall of glass with an intercom system linking the two. Off-site assessment in Glasgow are carried out the East Community Addiction Team offices in Parkhead, just a short distance from London Road police office.
Recruitment and Staffing
2.7 In each of the pilot areas, there was need to recruit staff for delivery of the schemes. Specifically, it was identified that the police would require additional Police Community Support Officers ( PCSOs) to handle the day-to-day administration of the MDTA scheme, whilst existing police Constables and Custody Sergeants would also need to be trained in the testing and administration procedures to provide back-up support and to maximise delivery of the scheme.
2.8 In each of the three areas, resources were also allocated to existing assessor and drug treatment agencies, to enable them to advertise and appoint staff specifically to the pilot schemes for the length of its delivery.
2.9 In Aberdeen, it was intended that PCSO interviews were to be held during the first week of May 2007, with an intended start date of 2 July 2007. The PCSOs were not in place for the beginning of the pilot and initially police officers carried out the drug tests until the PCSOs were trained. PCSOs commenced training on the 2nd July and were operational by the beginning of August 2007. In total 16 PCSOs were employed (15 full time and 1 part-time).
2.10 For the assessor post in Aberdeen, job advertisements were placed in April/May 2007, but it was thought that initially, on-site assessments would be provided by DTTO staff on an overtime basis during evenings and weekends. There had been only three suitable applicants for the four assessors' posts and two persons were selected. There were potentially suitable candidates amongst the applicants for the Arrest Referral posts. In May 2007, it was decided that due to the time needed for the Disclosure Certificate process, the new MDTA assessment staff would not be in place for 12 June 2007.
2.11 The later advertisement of positions in Aberdeen compared to the other pilot sites, coupled with the perceived lack of suitable assessment staff in Aberdeen, meant that DTTO staff undertook assessments in Aberdeen on an overtime basis until appropriate assessors were recruited and trained to start in July 2007.
2.12 In Edinburgh, the Scottish Government funded 85 per cent of four PCSO posts. Recruitment of new PCSOs at St Leonards was part of a major change in custody staffing, totalling 20 new PCSOs. This recruitment was undertaken in two phases, the first phase being 12 new PCSOs (including four for MDTA) who started on 15 June 2007, on shift after training on 2 July 2007. The second phase of recruitment started on 30 July 2007. Therefore, staffing at St Leonards was increased by one PCSO per team. However, prior to the 12 June pilot start date, there were at least four members of staff on each team who were trained, and one member of staff on each team who was designated as a trainer, to cascade the training to the new staff. All PCSOs at St Leonards have been trained to carry out the drug testing.
2.13 Turning Point, who undertake the assessments in Edinburgh, planned for five full-time assessors posts, backed up by administrative support from existing Turning Point staff. In March 2007, four assessors' posts had been advertised and Turning Point stated they were seeking people with a higher level of skills and experience to maximise the opportunity for high quality assessments. By June 2007, Turning Point had undertaken two rounds of recruitment, and had identified suitable candidates. Training was carried out the week beginning 11 June 2007, and assessors were available to carry out assessments by the end of that week.
2.14 In Glasgow, at the planning stages, a request was made to the Scottish Government for four PCSOs, but only two posts were funded and recruited. One officer started in October 2007 and the other started in December 2007. Up to this point, mandatory drug testing was undertaken by the Custody Sergeants and bar officers, and other conventional PCSOs alongside their usual duties.
2.15 In Glasgow, job advertisements for a Practice Team Leader, a Senior Addiction Worker and four mandatory drug testing addiction assessors were placed in February 2007. Resources were also made available for a medical officer and two addictions nurses to work on the pilot, and for one clerical officer and one administrative assistant. All posts were filled in time for the start of the pilot, with the exception of the Practice Team Leader and the Medical Officer, who both came into post in November 2007. The clerical officer who was originally appointed left the scheme early on. This post was not re-filled until the second year of the pilot.
Training
2.16 Training on how to use the oral fluid testing equipment was provided to police staff in each of the three pilot sites. Operator training sessions were carried out by the appointed contractors at each pilot site, with further training available if required. Each pilot site was provided with two electronic readers and all other necessary equipment to carry out tests in-house.
2.17 At the start of the pilots, there were some problems with the performance of the drug testing equipment, but these were resolved within the early months by additional training.
2.18 Assessors and police staff in each pilot were also provided with policy background information, with further training for assessors and treatment staff given at the discretion of those providing the service in each area.
Information Provision
2.19 In preparation for the pilot's launch, information leaflets were produced by each of the three pilot site assessor organisations. These were designed to provide information to arrestees on the background and rationale for MDTA, provide an explanation who was involved in running the service, explain the benefits of participation and outline the consequences of decisions to attend or not attend assessments. Further contact details for support were also provided.
2.20 The information leaflets were designed to be placed with the belongings of arrestees on release, or to be handed to arrestees by assessors at the time of assessment.
Anticipated Throughput Numbers
2.21 The financial memorandum accompanying the Police, Public Order and Criminal Justice (Scotland) Bill ( SP Bill 46) asserted that the MDTA pilots in Scotland might achieve some 6000 tests per year. This forecast was based on a combination of information about the numbers of trigger offences that might be expected in busy city police stations, and on management information from the England and Wales pilots of on charge drug testing.
2.22 At the planning stages for the pilot's implementation, this figure had changed to an anticipation that up to 15,000 people a year (based on 420 per month) across the three sites would be tested, and that around 50% of these would test positive. It was also anticipated that around 50% of those would go on to engage in treatment.
2.23 The staffing and resource allocation for the pilots were based on these assumptions. It became apparent, however, as the pilot progressed that the estimated numbers were greatly overestimated. The actual numbers of tests carried out are presented in Chapter Three below, and issues around the initial over-estimation of eligible arrestees to be tested are presented in Chapter Four.
Implementation of the Schemes
2.24 It was hoped that each of the pilot schemes would be operational from the 12 June 2007, and would run for a full 2-year period. In Aberdeen and Glasgow, the police began testing on 12 June, whilst in Edinburgh the scheme began on 14 June.
Core Pilot Processes
2.25 Despite some variations in the organisations responsible for carrying out the initial assessments and for providing treatment to arrestees, each of the three pilots follows the same core model. Figure 2.1 provides a pictorial representation of the main processes involved in the MDTA pilots and the stages of engagement with each of the main organisations involved in delivering the pilots.
Figure 2-1 Summary of the MDTA Processes and Roles of Key Partners in Delivery
2.26 The figure shows that, once up and running, three main stakeholder groups were involved in the delivery of the scheme, these being:
Police - responsible for arrest of persons committing trigger offences, safe custody of eligible arrestees in police cells, identification of those meeting the eligibility criteria for the MDTA pilot, carrying out the mandatory drugs test and making initial referrals for assessment to those carrying out assessments in each area. The police are also responsible for dealing with disputed drugs test results and sending these for confirmatory testing to the Scottish Police Services Authority ( SPSA). Those with positive test results are notified of the requirement to attend assessment, by the police. The police also provide details of arrestees who fail to comply with the mandatory drug test of assessment to the Procurator Fiscal.
Assessors - responsible for carrying out the initial MDTA assessment, as well as more detailed assessments for those who choose to engage further. Assessors also refer persons requiring further treatment to relevant treatment provider agencies/colleagues.
Treatment Providers - those offering drug treatment services and continued engagement with arrestees following their initial assessment. This includes medical staff as well as social work staff and others in both the public, private and voluntary sectors, as appropriate to the needs of drug users.
2.27 In addition to these core partners in delivery, the Crown Office and Procurator's Fiscal Service play a role in processing those who fail to comply with the mandatory requirement of the MDTA pilot.
2.28 The SPSA play a role in providing confirmatory feedback regarding disputed test results ie those testing positive for either heroin, cocaine or both, as well as testing samples taken from individuals who declare that they have taken medication which may have affected the test result. The SPSA also carry out a key role in checking a random 2% of all samples taken by the police for quality assurance purposes, irrespective of the test result.
2.29 In addition to these key staff, each of the pilot schemes has involved a number of 'other' partners in running the scheme. These include, for example, staff working in aligned service provision for some of the most vulnerable and at risk groups identified through the MDTA scheme.
2.30 While the procedures for drug testing and initial referral by the police for assessment is the same in each site, the models of service delivery for assessment and voluntary uptake of treatment, differs in each of the three pilot areas. Specific details regarding the assessment and treatment provision in the three areas is provided in Appendix F.
Changes over Time
2.31 As each of the pilots progressed, some changes occurred to both the staffing and the ways in which the schemes were being delivered.
2.32 In Aberdeen, recruitment and training of PCSOs was not operational until August 2007, where police officers were carrying out drug tests until the PCSOs were fully trained. Assessors were not in place until July 2007, and took over the assessment work which had been carried out by DTTO staff as an interim measure. Due to lower than anticipated numbers referred to both the MDTA scheme and the Arrest Referral scheme, the two MDTA assessors are now also able to carry out Arrest Referral assessments until the vacancies for the Arrest Referral posts are filled. Treatment for arrestees who wanted to engage further with the scheme in Aberdeen did not begin until April 2008.
2.33 In Edinburgh, not all PCSOs were able to be trained by the time the pilot commenced, and were gradually trained over the first few months of the pilot. Due to the anticipated arrestee throughput numbers at the beginning of the MDTA pilot, four assessor posts and two employability link-up worker posts were created. In addition, a part-time Service Co-ordinator was appointed in January 2008. However, as uptake of the scheme was not as anticipated, the employability link-up worker posts were made redundant in June 2008. While long term sickness was a notable issue among assessors in Edinburgh, resignations among assessors was the major problem, with temporary staff brought in to cover assessor posts towards the end of 2008.
2.34 In Glasgow, two main changes occurred during the life of the pilot. The first was with the police for whom an independent and non-pilot related review of police resources in custody suites meant that the Police Bar Officer role was removed. At the start of the pilot, the Bar officers had all been trained to perform MDTA tasks, but, as the role became redundant at the higher level, this meant that MDTA was taken on exclusively by the Police Community Support Officers ( PCSOs).
2.35 Additionally, a Sergeant who was originally working in the Glasgow pilot, and who provided a clear link between the police and Glasgow Addiction Services ( GAS), moved post after just a few months of operation. This meant that the administrative link was lost between the two organisations and there was also a loss of important information regarding the set up and operation of the scheme, as well as in the training capacity for other officers who had previously been trained by him.
2.36 The two dedicated PCSOs who were appointed at the start of the pilot, work in two shifts - one works 10am to 6pm and the other 6pm to 2am. There is no cover on a Sunday or on a Monday before 6pm. Originally, there was hope that all the testing could be done by the two PCSOs, but as time went on it became apparent that the time testing took made it completely unsustainable for PCSOs to do it alone. Although other PCSOs have been trained in testing and referral, they undertake the activity infrequently and so are less proficient at it and this has resulted in some cases where MDTA is not performed if one of the dedicated PCSOs is not available. Periods when there is no cover include the times when the MDTAPCSOs have to attend court, are on annual leave or absence through sickness. At these times, the ability to test is greatly reduced.
2.37 The second major change in Glasgow was in the role of the drugs assessor staff appointed for the pilot. Lower than anticipated referral numbers at the start of the pilot meant a redefining of the MDTA team's roles in the early stages to include care management and care of other GAS clients in their portfolios. This meant that the social work staff were engaging more fully with the arrestees after their initial assessments than had been expected, but this has, perhaps, been a beneficial outcome of the lower than expected throughput numbers and is discussed, as such, in Chapter Four.
Ongoing Operation and Monitoring
2.38 At the start of the pilots, it was intended that a central database would be set up to hold data from each of the three pilot sites and to allow for monitoring and evaluation of the schemes. This Management Information System, which would be managed by the Scottish Government, encountered problems early in the pilot due to software complications, and so individual schemes were instructed to collect and store information locally until it was resolved. At the time that the evaluation was carried out, the central database had not become operational and data were instead still being held on individual and bespoke databases created and managed by the police and assessors in each of the three sites.
2.39 The lack of a centralised data management system and different administrative processes in each area meant that the data that was actually captured and held was somewhat ad hoc. The biggest gap, perhaps, was in the information being routinely logged by the police in respect of the pilot. In particular, in each area, there does not appear to have been any regular recording of the numbers of people who were arrested for trigger offences at each site and who were subsequently charged or not charged. Information was also not routinely recorded for the total number of arrestees eligible to be tested (regardless of their eventual participation). This made it difficult to extract numbers retrospectively for the evaluation and, in Glasgow, the scale of the task was too great to be achieved.
2.40 It is important to stress that the requirement for this data had not been made clear at the start of the pilots and therefore should not be considered as a failing on behalf of the police in delivering the scheme. It is noted simply as it presented a gap for evaluation purposes.
2.41 Similarly, at the start of the pilot, it was intended that all MDTA participants who went on to engage in drug treatment services as a result of MDTA, and who were previously unknown to drug treatment services, would be formally recorded as such on the Information Services Division ( ISD) Scottish Drug Misuse Database ( SDMD). Information Services Division collect data on new entrants to drug treatment via service providers completing the SMR25 form for all new attenders. This information explicitly identified Arrest Referral, for example, as a route into service provision.
2.42 At the time of the pilots' implementation, the SMR25 form had not been modified to allow Mandatory drug Testing of Arrestees to be included as a specific entry route, however, an 'other' box on the form under the category of criminal justice referral could be used that would allow a free text field to be completed to identify MDTA clients. The data held by ISD show, however, that this was not used in Edinburgh and, although used in Glasgow and Aberdeen, the information held by ISD may be an underestimate because of the incomplete source of referral text field information on many forms. This may be explained either by a lack of training or awareness on behalf of the treatment providers in each area of the need to complete this field.
2.43 The absence of information collection for those at both the start of the pilot process (ie arrested and eligible but not tested) and those engaged at the end of the pilot process (ie those engaging with drug treatment services for the first time), has, to a certain degree, been problematic, since it makes calculations of the true effectiveness of the pilot less reliable.
2.44 With these information gaps in mind, the following chapter presents the monitoring data that was collected by each of the partner organisations to provide an account of activity undertaken by each of the main stakeholders, and explores in detail the profile of those referred into MDTA in each of the three pilot sites.
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