Summary Document: Rapid Appraisal of the Liverpool Drugs Intervention Programme January 2005

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1 Ayesha Khundakar, Centre for Public Health, Available on line at Castle House, North St, Liverpool, L3 2AY Summary Document: Rapid Appraisal of the Liverpool Drugs Intervention Programme January 2005 Contents: Introduction 1 Evaluation of 1 DIP Rapid Appraisal 2 Of Liverpool Custody suites Rapid Appraisal 3 Of the BSS Future 5 Evaluations References 5 Recent 6 Developments Contacts 6 Introduction The Drugs Intervention Programme (DIP), formerly known as the Criminal Justice Interventions Programme (CJIP) was introduced to Liverpool in April The DIP was developed in response to the Updated Drug Strategy (2002), aimed at reducing crime committed by drug users. This strategy arose from empirical evidence suggesting that the use of drugs (such as heroin and crack cocaine) are strongly associated with acquisitive crime and the more drugs that are taken in combination, the greater the levels of illegal income and thus the higher the rate of offending (Bennett, 1998). Research has also highlighted substantial decreases in illegal income as a result of entry into drug treatment (Gossop et al., 2003). The Updated Drug Strategy (2002) placed renewed emphasis on the need to break the cycle of crime and drugs by ensuring there were sufficient opportunities for drug using offenders to access drug treatment. The DIP forms a major part of the measures in the Updated Drug Strategy (2002). It aims to reduce drug related offending by moving drug using offenders through criminal justice interventions whilst retaining them in treatment. This programme comprises several elements to develop a more integrated approach to working with those drug users entering and leaving the Criminal Justice System. The DIP highlights the need to join up initiatives in the Criminal Justice System more effectively and develop an end to end model from arrest through to sentence and after release by establishing a comprehensive throughcare and aftercare system for those leaving custody and community treatment. By having a coordinated framework for drug treatment between community and custody, the projected outcomes of the DIP are a reduction in reconviction rates, drug related offending and drug related deaths, prevention of relapse, the engagement of offenders in treatment until they are ready to become independent and the provision of a bridging service to move the offender from custody to the community. Evaluation of the DIP The Centre for Public Health, Liverpool John Moores University, is carrying out an ongoing evaluation of the Liverpool DIP. The evaluation has set out to gauge the effectiveness of the continuity of care and support from arrest to court through to sentence and release. The first two evaluations have concentrated on the operation of the arrest referral (AR) and drug-testing pilot in Liverpool custody suites and the operation of the Liverpool Bail Support Scheme (BSS) respectively.

2 Rapid appraisal of Liverpool DIP Page 2 of 6 Rapid appraisals of Liverpool custody suites and Liverpool Bail Support Scheme Rapid Appraisal of Liverpool Custody Suites The DIP built on the provisions of the Criminal Justice and Court Services Act (2000) to include the extension of on-charge drug testing. Drug testing on-charge has been limited to trigger offences, usually acquisitive crimes with close relation to drug use. It was anticipated that such testing would enable a more targeted method of identifying those offenders for whom arrest referral services may be appropriate and would provide a route into treatment that some detainees may have otherwise not sought or accessed. The DIP has also resulted in the introduction of enhanced arrest referral. This involves the already established arrest referral staff in custody suites and courts taking on the case management and care planning of their clients until they enter treatment. A rapid appraisal was carried out to investigate the effectiveness of drug testing and arrest referral within the custody suites. Drug test on charge Interviews were conducted with key stakeholders, AR staff from all custody suites in Liverpool and custody staff. Observations of the three custody suites (St. Anne Street, Wavertree Road and Bellevale) were conducted on different days and times of the week. Recorded observations were seen as a useful way of validating and crosschecking findings from interviews. Trigger offence data revealed an anomaly between the desired and actual percentages of people being tested and moving onto AR and treatment. Interviews conducted with the key stakeholders and AR staff revealed several explanations for the smaller than expected number of people being tested and moving onto AR and treatment services. Findings from interviews revealed concerns about the recruitment of drug testers, which had lead to the lack of 24-hour drug tester coverage in some of the custody suites. This had resulted in not all those charged with trigger offences being drug tested. This problem has been addressed since the writing of the original appraisal. Further drug testing staff are going to be recruited to Liverpool custody suites. Custody Assistants and Officers now receive drug testing training, meaning that all custody staff will have the ability to drug test detainees. The appraisal interviews also highlighted the problem in offering AR following a drug test, after the person had been charged. The person being drug tested had to be informed of their status prior to test. Therefore, a person about to be bailed would be unlikely to wait in custody after a positive test to talk to a member of the AR team. The AR staff thought that there had been a lack of cooperation from the Magistrates, which had led to the DIP process breaking down before AR clients entered treatment. The findings of the appraisal revealed a perception that the Magistrates were unwilling to bail AR clients to the Bail Support Scheme (BSS) (the main route of referral into treatment used by arrest referral), resulting in several DIP clients being lost before their entry into tier 3/4 treatment services. This matter has been addressed since the conduction of the appraisal. Several training sessions were organised by Liverpool DAAT and DIP. These sessions were conducted by members of the BSS team within Liverpool Magistrates Court. These training sessions were designed to give Magistrates and Legal Advisors further knowledge of the work conducted by BSS and to raise the profile of the scheme within the court. It was stressed that the BSS played a particularly important role with the proposed introduction of the pilot Restriction on Bail (RoB), commencing in January The observation sessions of the Liverpool custody suites revealed a good relationship between the custody and AR staff. This good relationship allowed the AR staff to conduct their work easily during the observation

3 Rapid appraisal of the Liverpool DIP Page 3 of 6 sessions. All AR staff were allowed to conduct cell sweeps, contacting the detainees and offering their service whilst in their cells. AR staff were also able to target all those arrested for trigger offences, although usually all arrestees were contacted during their cell sweeps. However, the observation sessions also revealed a lack of consistency between suites, especially in provision of staff. Whilst the largest custody suite, St. Anne Street, was covered by AR and drug-testing staff during observation sessions, there were times of the day when neither a member of the AR staff nor drug tester were available within the other two custody suites. The lack of cover by AR staff at certain points of the day could have resulted in those testing positive not having immediate access to AR. It could also have resulted in a detainee not taking up the offer of AR due to a drug tester, rather than a member of the AR team, putting forward the idea of referral, perhaps giving the impression that the scheme was police-led. The major findings of the appraisal were that, whilst drug testing staff and AR staff were available, the process of these two schemes appeared to run relatively smoothly. Whilst the AR staff s job was reliant on the custody sergeant, they were usually allowed to work in the manner that they wished with very little objection from the custody staff. When the AR staff and drug testers were on duty, detainees would have at least two opportunities to access the AR staff, once in their cell and once on charge during their drug test. Several recommendations arose from the findings of the rapid appraisal of the custody suites. These included the recruitment of more drug testers to guarantee that all those charged with a trigger offence would be drug tested, along with the introduction of a telephone to the drug testing facility to ensure direct access to AR after a positive drug test. This measure was recommended to ensure that that the perception of the arrest referral process would remain independent of the police. It was also recommended that the proposal of AR be incorporated into the booking in procedure for detainees. It was envisaged that the offer of arrest referral at this stage would move the process of arrest referral forward and mean the AR staff would not have to introduce themselves to the detainee whilst in their cell. It was also recommended that the remit of trigger offences be widened to include offences such as attempted crimes (attempted robbery, theft and burglary) to increase the potential pool of clients that would be suitable for these types of interventions. Finally, it was recommended that a restriction on bail project be introduced to Liverpool. This scheme would give courts the power to order drug assessment and treatment conditions of bail. This was recommended to hopefully increase the number of people taking up the offer of AR and treatment after a positive test result. A number of key developments have occurred since the appraisal was conducted. As mentioned previously, there has been further recruitment of drug testing staff, along with the training of all custody staff to address the issue of the lack of drug testing on a 24-hour basis. A single point of contact telephone line has also been introduced to the custody suites. This gives the detainee the ability to contact a DIP team member even when no AR staff are available in the suite. On a national level, the remit of trigger offences has been widened and new powers have been introduced to allow drug testing on arrest (see recent national developments, page 6). Rapid Appraisal of Liverpool Bail Support Scheme (BSS) The Liverpool BSS provide local courts with the option to bail an offender to the community so that they can address their drug using and offending behaviour. The BSS works in partnership with arrest referral, to case manage clients from charge until they enter tier 3/4 services. The appraisal was conducted to gauge the effectiveness of this interaction and to evaluate the scheme s effectiveness in targeting suitable clients and offering them an appropriate treatment intervention. Interviews were conducted with key stakeholders, staff and clients from the BSS, a Magistrate, District Judge and legal advisor from Liverpool Magistrates Court and members of the Probation service. Observations of the BSS were also conducted, which included those of the clinic sessions in

4 Rapid appraisal of the Liverpool DIP Page 4 of 6 which clients receive methadone prescriptions from the BSS doctor. The rapid appraisal revealed that, although DIP funding had increased the capacity of the BSS by 50%, it had failed to reach capacity since the introduction of the programme. A number of those put forward for the BSS had either been remanded in custody or given conditional bail (with no BSS conditions). In interviews with the key stakeholders, this shortfall was attributed to the unwillingness of the Magistrates court to bail potential clients to the scheme. Whilst the key stakeholders and staff within the BSS felt that the Magistrates were unwilling to bail people to the scheme, the appraisal revealed that some Magistrates and District Judges were aware of the scheme and believed it was a useful bail option. However, interviews showed that Magistrates would have to take into consideration the seriousness of offence and their history of offending before they could decide whether an offender would be suitable for the BSS. The appraisal revealed that none of the Magistrates interviewed had seen a breach case for non-attendance at the BSS and that the results of a drug test at the point of custody were never used at court to inform court decisions. The appraisal identified that the BSS relationship with the local Magistrates Court was not ideal. The BSS staff commented that there were often difficulties in obtaining information on potential clients from the courts. Some of the staff stated that this had led to the BSS remaining unaware of a potential clients bail status several days after the court date. If the scheme does not know the status of a client until several days after their court appearance, a client could be in breach of their bail conditions without the scheme s/ client s knowledge. Interviews with some of the current BSS clients revealed that they were heavy users of both heroin and crack cocaine but had little prior treatment history. All were committing crime to fund their drug use. All those interviewed stated that they had not ceased their drug using and offending behaviour but had dramatically reduced both activities since being enrolled on the BSS. Several of those interviewed attributed this to the stabilising effects of the methadone prescription provided by the BSS. Whilst the majority of those interviewed were satisfied with the provision of methadone, one client had not accepted the prescription and felt that the scheme placed too much emphasis on this form of treatment. This client had been referred to another treatment provider for alternative medication, but was placed on a waiting list for this. Observations confirmed that the clients within the BSS were heavy users of heroin and crack cocaine, committing crime to support their drug use. It also confirmed that the majority of clients placed a great deal of emphasis on the provision of methadone by the BSS. Virtually all of those due for appointments during clinic sessions attended to receive their methadone prescription. However, several clients failed to attend appointments for counselling sessions, with several breached during the observation period. This reveals the difficulty to engage some of these chaotic clients and also shows the willingness of the scheme to breach its clients for non-attendance. Overall, it would seem that the BSS has had difficulty in operating to capacity since the advent of DIP. This did not appear to be because of difficulty in the recruitment of those willing to be bailed to the scheme. For those who are referred to the scheme, client interviews revealed that the majority were satisfied with the treatment intervention they received and the level of supervision and care provided by the staff. Whilst the number of clients breached by the scheme had been high, it seemed that the scheme had helped to reduce drug use and crime among many of its clients. A number of recommendations were suggested as a result of this rapid appraisal. These included a need for increased awareness by all Magistrates of the breach conditions of the BSS. It was suggested that if the Magistrates were more aware of the stringent breach proceedings within the BSS they may be more willing to bail a person to the scheme due to its strong supervisory element. Another related recommendation was an improvement in how information is relayed between the Courts and the BSS. It was recommended that the BSS be informed of bail conditions by the Court on the day of a potential client s hearing so that the BSS are aware of who have, and have not, been bailed

5 Rapid appraisal of the Liverpool DIP Page 6 of 6 Rapid Appraisal of the Liverpool BSS continued... to the scheme. It was also recommended that the Magistrates have access to custody suite drug test results to make a more informed decision as to a client s suitability for the BSS. It was recommended that a bail plus scheme be introduced to Liverpool. A bail plus scheme would bail a person straight to the BSS from the custody suite, thereby removing the Court s role in the process of referral. It was envisaged that the introduction of such a scheme would increase the number of suitable clients being referred to the BSS. Finally, it was also recommended that an alternative form of DIP case management be considered. At the time of writing, DIP clients picked up via AR could only be tracked if they were bailed to the BSS. However, many referred to the BSS are remanded or bailed without BSS conditions. Therefore, many DIP clients could have been lost before entry into tier 3/4 services. A number of developments have arisen from the evaluation of the BSS. Several training sessions, organised by Liverpool DAAT and DIP and conducted by members of the BSS team, have been carried out at Liverpool Magistrates Court. These training sessions were designed to give Magistrates and Legal Advisors further knowledge of the work conducted by BSS and to raise the profile of the scheme within the court. The evaluation highlighted the problem of breach of BSS conditions failing to reach court. Whilst the breaching process has been rigorously conducted by the BSS, there appeared to be a clear failure to enforce these breaches. This matter has been addressed and the DIP partnership are seeking to address this issue as a matter of urgency in preparation for the restriction of bail pilot (see recent developments, page 6). Future Evaluations of the DIP In future appraisals, the Centre for Public Health, Liverpool John Moores University, will evaluate other aspects of the DIP. These will include the operation of the police-led Fairway scheme (a scheme that offers the incentive of treatment services but also the threat of police targeting for noncooperation) and probation-led Liverpool Intensive and Supervision and Monitoring scheme (LISM). The evaluation will also focus on the activity of the CARAT (Counselling, Assessment, Referral, Advice and Throughcare) teams within prisons, along with the Assertive Liaison Outreach Team (ALOT), responsible for referral to aftercare for DIP clients on release from prison. Future appraisal reports will use similar techniques as the previous evaluations in order to gain information about the particular project in question. Therefore, the appraisals will, on the whole, rely on interview and observation data collection. References Bennett, T (1998). Drugs and Crime: the results of research on drug testing and interviewing arrestees. Home Office Study 183, London, Home Office Criminal Justice and Court Services Act (2000). London, Home Office Gossop, M, Marsden, J, Stewart, D, Kidd, T (2003). The National Treatment Outcome Research Study (NTORS): 4-5 year follow-up results. Addiction, 98, Updated Drug Strategy (2002). London, Home Office

6 Rapid appraisal of the Liverpool DIP Page 6 of 6 Recent National Developments There have been some important national developments since the writing of these two appraisals. The majority of these developments have resulted from the publication of the Government document, Tackling Drugs, Changing Lives (2004). These recent developments have included: The expansion of trigger offences to include attempt offences (attempted theft, robbery, deception), begging and persistent begging. Offenders charged with these offences are now required to produce an oral fluid sample for drug test. On-charge testing and AR for young people (14-17 year olds) with dedicated wraparound services being piloted in ten of the intensive programme areas from August 2004 (including Liverpool). The expansion of the intensive DIP to 30 more areas by The extension of the restriction on bail pilot to 39 new areas by April Ten of these pilots, including Liverpool D(A)AT, will go live in January Restrictions on bail allow court bail to be withdrawn if a defendant refuses a drug assessment and any recommended follow-up treatment after testing positive for the use of opiates and/or cocaine/crack. New legislation to require drug testing on arrest (instead of on charge) and require drug assessments for those who test positive for opiates and/or cocaine/crack. Introduction of a new civil order that will run alongside Anti-Social Behaviour Orders (ASBOs) for adults to tackle drug issues. The launch of five pilot sites in December 2004 requiring young offenders (aged 10-17) to attend drug treatment as part of a community sentence. Rapid Appraisal of Liverpool DIP Produced by Ayesha Khundakar Centre for Public Health Faculty of Health and Social Sciences Castle House North Street Liverpool L3 2AY Tel (0151) Fax (0151)

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