Probation Circular

EFFECTIVE MANAGEMENT OF THE DRUG REHABILITATION REQUIREMENT (DRR) AND ALCOHOL TREATMENT REQUIREMENT (ATR)
PURPOSE
To provide areas with guidance on delivering the Drug Rehabilitation Requirement (DRR) and Alcohol Treatment Requirement (ATR).

REFERENCE NO: PC57/2005 ISSUE DATE: 1 August 2005 IMPLEMENTATION DATE: Immediate EXPIRY DATE: June 2006 TO: Chairs of Probation Boards Chief Officers of Probation Secretaries of Probation Boards ACOs - Substance Misuse CC: Board Treasurers Regional Managers DTTO/DRR SPOs/Managers AUTHORISED BY: Sarah Mann, Head of Interventions Unit Richard Mason, Head of Criminal Justice Act Implementation Unit ATTACHED: Annex A: DRR guidance Annex B: ATR guidance

ACTION
Chief Officers and Assistant Chief Officers are asked to ensure that this circular is drawn to the attention of all relevant staff, in particular SPOs, offender managers and interventions staff who work with substance misusers.

SUMMARY
The community order of the Criminal Justice Act 2003 is available to courts for adult offenders who have been convicted of offences committed on or after 4th April 2005. The Act provides a more flexible sentencing structure, which enables the court to order a number of different requirements under the community order to provide an overall programme of interventions. The attached documents provide guidance to staff on how to take forward the management and delivery of two of these requirements, DRRs and ATRs. It is not expected that staff will read the entire documents but rather to use them as reference guides to assist with specific problems. The guidance is issued jointly by the Intensive Interventions Team and the Criminal Justice Act Implementation Team within NPD and should be read in conjunction with a complementary circular on managing intensive community orders, which is being issued simultaneously (PC56/2005 - Delivering Intensive Community Orders Under the Criminal Justice Ac 2003).

RELEVANT PREVIOUS PROBATION CIRCULARS
PC 18/2005 PC 15/2005 PC 56/2004 PC 55/2004 PC 52/2004 PC 51/2004 PC 49/2004 PC 41/2004

CONTACT FOR ENQUIRIES
Drug and Alcohol Interventions Manager: Fiona Bauermeister, 020 7217 0768 fiona.bauermeister@homeoffice.gsi.gov.uk (for DRR enquiries) Drug and Alcohol Policy Developer: Robert Stanbury, 020 7217 0767 robert.stanbury@homeoffice.gsi.gov.uk (for ATR enquiries) Head of Intensive Interventions: Claire Wiggins, 020 7217 8646 claire.wiggins3@homeoffice.gsi.gov.uk

Horseferry House, Dean Ryle Street, London, SW1P 2AW

National Probation Directorate 1

Meeting the Targets: Effective Management of Community Orders with a Drug Rehabilitation Requirement (DRR)

Index Page 4. 4. 5. 6. 6. 7. 8. 8. 8. 9. 13. 13. 13. 14. 14. 15. 15. 16. 16. Introduction DRR Target Group Assessments in the Community Assessments in Custody Prolific and other Priority Offenders (PPOs) Drug Interventions Programme (DIP) and Criminal Justice Integrated Teams (CJITs) Restriction on Bail Communication with the local CJIT Drug Interventions Record (DIR) Pre- sentence reports (PSRs) and Sentencing Proposals for a Community Order with a DRR Date of Offence: Pre or Post Criminal Justice Act 2003 Use of unpaid work requirement Accredited Substance Misuse Programmes (ASRO and OSAP) Treatment under a DRR Residential Rehabilitation Treatment Contact Levels Recording levels of contact Home visit
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16. 17. 18. 18. 19. 19. 21. 24. 24.

Enforcement Breach Transfer of DTTOs/ Community Orders with a DRR Funding a Community Order which includes a DRR Provisions for 16-17 year olds Court Reviews Drug Testing Steering Groups/Forums Useful Reference Material

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Introduction This document aims to support managers and practitioners who are involved in the delivery of community orders with a drug rehabilitation requirement (DRR). It applies predominately to offenders who are aged 18 years and over, although there is a short section on arrangements for 16/17 year olds. The guidance has been subject to wide consultation and we are grateful for the feedback received. Particular thanks is due to representatives from the Drug Interventions Programme (DIP), the Prison Service, National Probation Directorate (NPD) and National Treatment Agency (NTA) Regional Managers, representatives from probation areas, the Criminal Justice Implementation Unit at NPD and the NTA Criminal Justice Manager. DRR Target Group The target group for the DRR is broader than for the Drug Treatment and Testing Order (DTTO), as it encompasses all the community sentencing bands from low to high seriousness. The DRR should capture many of the current drug users on Community Rehabilitation Orders (CROs), with or without a condition to attend a substance misuse accredited programme, and those subject to Drug Abstinence Orders (DAOs) and Drug Abstinence Requirements (DARs) in the pilot areas, in addition to those on DTTOs of higher or lower intensity. Offenders with an Offender Assessment System (OASys) score of 4 and above on the drug assessment section should be referred for a DRR assessment (such a score generally indicates that they are currently using a class A drug on at least a weekly basis). It should be noted, however, that a score of 4+ is only one method of selection. Those offenders with a score below 4 could also be suitable, as could those already accessing treatment through the Drug Interventions Programme (DIP) or another treatment provider. The amount of drug treatment delivered under a DRR can be tailored to individual treatment needs, providing the overall restriction on liberty reflects the seriousness of the offence. The community order, including the DRR, can be packaged so as to give an equivalent of the DTTO (higher or lower intensity) at the medium and high seriousness community sentencing bands. The DRR can also be used in the low seriousness community sentencing band, where it should generally be proposed as a stand alone requirement, usually of no more than 6 months duration (the minimum period). An offender manager will need to be allocated to manage the order, including enforcement work. The content and duration of the total community order, including the treatment proposed under the DRR, should be commensurate with the seriousness of the offence, even if treatment needs are high. A minimum length DRR should be proposed in cases of low offence seriousness but high drug treatment need. The treatment provider and/or offender manager should work towards motivating the offender to continue treatment on a voluntary basis on completion of the short DRR. Offender managers should work to gain offender consent to a DRR. They should proactively promote DRRs to offenders. Lack of offender motivation should not be a reason for failing to propose a DRR. Unless an offender makes it very clear that they will not comply, a DRR should be

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proposed if the other criteria are met (sentencing band, level of drug use etc) and there are no other factors e.g. mental health of sufficient seriousness that would preclude the offender’s suitability. Assessments in the Community The offender should be made aware of the purpose of the assessment, the assessment process and the specific roles of those undertaking the assessment at the outset. The DTTO/DRR requirements should be clearly explained to offenders by probation staff so they fully understand what will be expected of them and the possible sanctions if they fail to comply. Suggested guidance is that this is done at the outset of the assessment and also reiterated to the offender by the offender manager after sentence. Offenders assessed as suitable for a DRR/DTTO need to sign prior to sentence that they consent to the requirement/order. Suggested good practice would be for this to be done at the end of the assessment process. Joint assessments (where probation and treatment staff conduct the assessment at the same time) can be good practice but are not essential., Where assessments are not jointly conducted, areas must be sure that treatment and probation staff are working to the same criteria regarding suitability and that they liaise regarding the outcome of the assessment. This is particularly important under the new legislation, as the criteria for those suitable for a DRR are wider than for a DTTO. If they have not already done so, areas should make their providers aware at the earliest opportunity of this widening of the criteria. In the unlikely event that there is disagreement between probation and treatment staff regarding the suitability of an offender for a DRR, the matter should be raised with respective line managers. Many of the current assessment processes will remain the same, although areas should plan to deliver a higher number of assessments given the wider suitability criteria and the higher target (13,000 commencements in 2004/5 and 16,000 commencements for 2005/6). If a DRR is going to include substitute prescribing the offender should be assessed by the relevant clinical personnel as to his/her suitability for such treatment. This clinical assessment is generally in addition to the usual probation/treatment provider assessment. There are times when it is difficult to arrange a clinical assessment prior to sentencing. In such cases, it is good practice for the Pre-Sentence Report (PSR) author to state that the person responsible for prescribing is agreeable to the DRR being made without prior assessment as to the suitability of the offender for substitute medication, in order to ensure that the court is aware of this. Issues around dual diagnosis (i.e. both enduring mental health and drug problems present) need to be addressed at the assessment stage. As much information as possible should be obtained about an offender’s mental health (if this appears to be an issue) e.g. contact with relevant mental health professionals, access to psychiatric reports etc., in order to fully assess if a DRR is a suitable requirement. Offenders not assessed as suitable for any of the drug treatment modalities under a DRR (see ‘treatment’ section of this guidance) or who decline consent to a DRR should be considered for alternatives, which might include a supervision requirement

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or a supervision requirement plus a programme requirement. It should be made very clear to offenders who are not prepared to consent that any requirement(s) imposed instead of a DRR are likely to be as restrictive and equally punitive. A DRR can also be a requirement of a suspended sentence order (custody minus) for offences committed on or after 04/04/05. Requirements as part of a suspended sentence should be less intensive given the more serious sanction for noncompliance. Assessments in Custody Areas need to ensure they have some flexibility to be able to offer assessments in custody. Treatment provided in prison should be taken into account as part of a DRR assessment. A large number of this particular offender group will have been in contact with CARAT teams and other prison drug treatment. Assessments, clinical services and CARATs casework may have already taken place: some of those on remand will have accessed the Short Duration Programme (SDP). CARATs are in a prime position to motivate offenders to take up treatment and can help to promote DRRs as a sentencing option. It is therefore important that (with offender consent) information is shared between CARAT workers and DRR assessors. It is good practice to establish good working relations with CARAT teams in prison and develop mutually agreed protocols regarding sharing information on those offenders with whom CARATs have had contact. For example, CARATs could (with offender consent) flag up potential DRRs that have been assessed by CARATs so probation staff could track these offenders. Initial contact is best affected through the Area Drug Co-ordinator (ADC) who can ensure consistency of approach. CARAT workers also need to be made aware of the “widening” of the criteria for DRRs to enable them to discuss DRRs at the earliest opportunity with all potential offenders. Prolific and other Priority Offenders (PPOs) A high proportion of those identified as PPOs, particularly in the highest crime areas, are problematic drug users committing volume acquisitive crime to support a drug dependency. As such, many offenders who are PPOs will be eligible for and/or subject to a DRR (even those in the low seriousness community sentencing band). Areas need to ensure that all PPOs with a drug problem are assessed for a DRR. Areas (particularly those which have a designated PPO team) should look at the early identification and management of these cases in relation to DRRs. PPOs in custody will have been treated as priority for CARATs and other non-clinical drug treatment. It is therefore important that the relevant links are made with CARATs (as outlined above in ‘Assessments in Custody’). This early identification of a PPO with a substance misuse problem could mean that an assessment for a DRR could be carried out earlier in the PSR process. This does not apply to PPOs on licence, as a DRR cannot be a condition of a licence. It should be noted that drug testing as part of a DRR is separate from arrangements

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for and guidance on testing PPOs on licence (see PC 34/2005). Drug Interventions Programme (DIP) and Criminal Justice Integrated Teams (CJITs) The Drug Interventions Programme (DIP) (which was formerly known as the Criminal Justice Interventions Programme or CJIP) is a large-scale programme, established in April 2003 as a critical part of the Government’s Updated Drug Strategy (2002). Its principal focus is to reduce drug related crime by engaging with problematic drug users and, using a case management approach, moving them into appropriate treatment, retaining them in treatment and supporting them through and after treatment, whether in a custodial or community setting. Interventions such as drug testing on charge for trigger offences and drug workers being based in police custody suites means that increasingly drug related offending will be identified pre-sentence through assessments undertaken by Criminal Justice Integrated Teams (CJITs) in custody suites and/or courts. Areas need to discuss effective working protocols with local CJITs relevant to the particular way in which DRRs/DTTOs are managed in their locality. Areas have different approaches to working with CJITs and these are at different stages of development around the country. Some probation areas are more engaged with CJITs than others. In some areas Probation Officers are part of the CJIT e.g. they have been seconded to work as a member of the team. It is important to note that interventions delivered by CJITs through the Drug Interventions Programme (DIP) are an important route into a DRR and that they are not competing interventions. Where an existing CJIT client appears to be a suitable candidate for a DRR (if a community order with a DRR is going to be proposed at court for an existing CJIT client), the CJIT can continue to case manage the offender and help prepare him/her for a DRR e.g. begin rapid prescribing or undertake motivational work to reduce the risk of the offender dropping out of treatment whilst waiting to be sentenced. This is a crucial time and the quicker an offender can be engaged in some form of treatment before the DRR is imposed the better, as it may result in more offenders being reluctant to give consent to a DRR. There may be instances where offenders are reluctant to consent to a DTTO/DRR. For example, offenders who have been participating in substitute prescribing or other voluntary community treatment prior to sentence may fear that a DRR will result in more intensive treatment and more frequent drug testing. In the main, such offenders should be suitable for a DRR and staff should work with them to gain their consent to the DRR. Their treatment should be taken over by the DRR treatment provider(s) once the community order has been made. Probation should manage this ”handover” of treatment as part of the planning and implementation of the order. Probation will take over responsibility for case (offender) management from the CJIT at the point the DRR is made and the offender’s treatment will be taken over by the relevant contracted DRR treatment provider(s). With the consent of the offender, CJITs will also pass relevant paperwork to the offender manager. Where an offender is on the CJIT caseload, the CJIT will usually suspend the case during the period that the Probation Service is responsible for offender management. Probation will subsequently liaise with the CJIT when the offender is coming to the end of the DRR and they still have ongoing drug related needs or in the event of an

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unplanned exit from treatment. It is suggested good practice that the CJIT is contacted if an offender is transferred to another probation area or leaves residential treatment (either planned or unplanned) in order for the CJIT to identify what action they need to take. Drug related crime should be dealt with by drug related punishment (DRR). The focus of the DRR is treatment but it is still within a criminal justice framework and the more intensive treatment and testing practices reflect this. Restriction on Bail Probation need to ensure they work with CJITs in the Restriction on Bail pilots in identifying suitable DRR candidates and developing effective referral processes for DRRs. Offenders subject to Restriction on Bail should be particularly targeted for DRRs. Compliance with restriction on bail conditions can also assist in identifying potential DRR candidates and working on their motivation. Under the restriction on bail provisions, in certain cases, where a defendant has tested positive for heroin, crack or cocaine the court, if it grants bail, has a duty to impose as a condition of bail that the person undergoes an assessment of their drug misuse and/or participates in any relevant follow up proposed. Communication with the local CJIT Irrespective of the working arrangements which are established in the locality, it is crucial that, at a minimum, areas establish lines of communication with the CJIT regarding:• Where an offender appears to be a suitable candidate for a DRR, CJIT workers should take every opportunity to raise awareness about the DRR and encouraging offenders to give consent for the workers to share information with probation in order to facilitate early identification of potential DRR cases. Information sharing protocols between CJITs and probation. Arrangements for DRR exit plans (planned or unplanned). With regard to continuity of care, CJITs could, where appropriate, work with offenders who still need treatment after the DRR finishes and those who leave treatment. The "widening" of the criteria for DRRs under the Criminal Justice Act 2003 (CJA 2003) and ensuring that CJIT/DIP workers are discussing DRRs at the earliest opportunity with potential suitable offenders.

• •

Drug Interventions Record (DIR) The DIR has three main roles. These are to:• Facilitate and improve standards of continuity of care for drug users and minimise duplication of assessments, especially when they are moving between custody and community but also when information is passed between case managers and/or treatment providers. Support the monitoring and research functions around DIP in line with the Programme’s, and other related, performance management frameworks.

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Be the Substance Misuse Triage Assessment form to be used by all CARATS cases, whether or not they are likely to become DIP cases.

The DIR is now in use in all DAT areas in England and all prison establishments across England (it is expected to have phased introduction within the community in Wales during 2005/06). Most Probation staff will not complete any of the DIR. The main exception to this will be where a Probation Officer is a member of the CJIT. Pre-sentence the DIR will usually be started by CJIT staff (e.g. in police custody suites or court) in the community. A CARAT worker (where contact has been made in custody) will start the DIR pre-sentence if an offender on remand in custody has not been seen by a CJIT worker. Arrangements set out in related guidance (DIR Context Guidance) highlight when the DIR is shared between CJITs and CARAT workers to inform what action is needed when the offender is remanded or sentenced to custody. The CJIT will usually suspend the case of an offender already on the CJIT caseload at the time the DRR is made during the period that probation are responsible for case management. Probation staff will subsequently liaise with the CJIT when the offender comes to the end of the DRR if there are ongoing drug related needs. CJITs have been advised how case suspension is recorded using the DIR and the related activity form. Probation staff can be assisted in identifying those offenders who may be suitable for a DRR through the CJIT assessment and use of the DIR. With the offender’s consent, the DIR can be passed to probation to inform the DRR assessment. Pre-sentence reports (PSRs) and Sentencing Generally, those offenders with a high offence seriousness would have a full PSR prepared (exceptions to this are outlined in the “Criminal Justice Act 2003 -New Sentences and the New Report Framework” - Annex A to PC 18/2005). A fast delivery report could be prepared in those cases where the offence is in the low seriousness band (and full risk analysis is not required) or medium cases where the Offender Group Reconviction Scale (OGRS) score is less than 41 and the risk of harm screening does not indicate that a full risk analysis is required. It is suggested that staff managing the Restriction on Bail Scheme should be contacted for relevant information about the offender where he/she is subject to Restrictions on Bail. It may be possible to have an assessment for a DRR available quickly if an offender is already in treatment with a local treatment provider and/or Probation are seconded into the local CJIT team, in order to be able to make a proposal for a DRR in the fast delivery report. It may be more likely, however, that a fast delivery report has been requested for example on a low seriousness offence and it is clear that a DRR is/may be appropriate but the assessment is not able to be completed within the five day guidance limit for preparing fast delivery reports. In this case, the fast delivery report could request an adjournment in order to have a DRR assessment. An addendum could be prepared with the outcome of the assessment (avoiding the preparation of a full PSR).

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In order to assist fast delivery report writers in quickly identifying potential DRRs, it may be useful to complete the drug assessment section of OASys. Any offender with a score 4 and above should be assessed for a DRR. This is irrespective of what type of report is prepared. A full PSR will normally need to be prepared in those cases where a mental health issue has been identified. The report should include: • A statement that the offender has been assessed as being dependent on or having a propensity to misuse drugs and the offender’s dependency or propensity is such as requires and may be susceptible to treatment. A proposed plan of treatment The name and address of the treatment provider and whether the treatment is residential or non- residential (this information needs to be specified in the order). Confirmation that arrangements for this treatment are in place. The suggested length of the requirement bearing in mind the seriousness of the offence and treatment needs (this should be decided in conjunction with the treatment provider). That the offender has signed to confirm that the requirements of the order and the consequences of a failure to comply have been fully explained by the responsible officer and that the offender is willing to comply with the order and consents to the order being made. Date of the proposed first court review (this should be in accordance with National Standards for court reviews). A proposal for the minimum frequency of drug testing (low seriousness DRRs only need to be tested a minimum of once a week) The date of the first appointment with the treatment provider (which, as for the DTTO, should be arranged to take place within two working days of the order being imposed) and the date of the first appointment with the offender manager (within one working day). Any anticipated sequencing with other requirements of the order. Sufficient information about the offender’s pattern of drug use to ensure that the appropriate length of DRR is made e.g. nature of drug misuse, extent and length of use, previous treatment episodes.

• • • •

• • •

• •

Areas differ in the amount of information there is in a PSR regarding “specific drug assessment” (some include a more thorough drug assessment). This is more relevant now given that the court determines the initial level of offence seriousness but probation staff propose the length of the DRR depending on the offender’s treatment needs. Previously a DTTO was a sentence in its own right and an offender was therefore

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either suitable or not for a DTTO and a proposal was made in the PSR depending on the outcome of the assessment. Under the CJA 2003, the DRR is only one of a number of requirements of a community order. It is important therefore that PSR authors agree any other requirements that they are considering proposing with those probation staff managing DRRs. Similarly, it would be good practice for DRR staff to liaise with treatment providers regarding any additional requirements that are being considered, especially the inclusion or otherwise of a substance misuse accredited programme.

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Model combination of requirements as outlined in CJA 2003 ‘National Implementation Guide’ adapted to reflect model requirements in cases where a community order with a DRR is appropriate
Low seriousness Model 6 Likelihood of reconviction: low-medium Risk of harm: low-medium Maximum nos. of requirements: 1 Levels of contact: One contact per week (no minimum hours specified) during first 16 weeks. Short DRR (6 months). No additional requirements. A 6 month DRR would be appropriate for either low, medium or high treatment need, as any longer DRR would not be commensurate with the offence. Offenders with medium or high treatment needs but low offence seriousness should be encouraged to continue treatment voluntarily (possibly through the CJIT or other relevant treatment provider) after the 6 month DRR has ended. Supervision + DRR + accredited programme (or residence or activity). Example depending on treatment need:Low treatment need- 6 month DRR, 12-18 month supervision, ASRO/OSAP or Think First/ETS (or possibly activity). Medium treatment need- 6-12 month DRR, 12-18 month supervision, ASRO/OSAP. High treatment need- 9-12 month DRR, 12-18 month supervision, ASRO/OSAP. High seriousness Model 10 Likelihood of reconviction: high Risk of harm: low-high Nos. of requirements: 2+ Levels of contact: minimum 15 hours per week during the first 16 weeks (for total requirements not just DRR). Supervision + DRR + (any of the following requirements, if appropriate – unpaid work (use infrequently), programme, activity, residence, prohibited activity, exclusion, curfew). Examples depending on treatment need:Low treatment need- 6 month DRR, 12 month supervision, ASRO/OSAP or Think First/ETS, activity. Med treatment need- 9-12 month DRR, 12-36 months supervision, ASRO/OSAP, activity. High treatment need- 12-36 months DRR, 12-36 months supervision, ASRO/OSAP, activity. High seriousness / intensive control Model 12 Likelihood of reconviction: high Risk of harm: low-high Nos. of requirements: 3+ Levels of contact: minimum 15 hours per week during the first 16 weeks (for total requirements not just DRR). Supervision + DRR + programme + activity (and any of the following requirements if appropriate – unpaid work (use infrequently), mental health treatment, residence, prohibited activity, exclusion, curfew) This is likely to be similar to the package suggested in "High seriousness" see above.

Medium seriousness Model 8 Likelihood of reconviction: medium-high Risk of harm: low-medium Maximum nos. of requirements: 3 Levels of contact: Minimum 8 hours per week during first 16 weeks (for total requirements not just DRR).

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Proposals for a Community Order with a DRR The equivalent of a high intensity DTTO would include four requirements: supervision, DRR, programme and activity. Proposals for DRRs in the medium-high seriousness band should be accompanied by a proposal for a supervision requirement. A supervision requirement is not always necessary in the low seriousness band, where the proposal should normally be for a singleton DRR. In these cases, however, an offender manager will need to be appointed in order to manage enforcement, liaison with treatment providers etc. The length of the requirements should vary depending on the needs, risk, and seriousness of offence. For example, a shorter length DRR, but possibly a higher punishment and/or other rehabilitation requirement, could be proposed for an offender with a high seriousness of offence but a low-medium treatment need. Alternatively, a longer DRR requirement with shorter other requirements could be proposed for an offender with a medium seriousness of offence but a high treatment need. An offender with a high treatment need but low seriousness of offence should have a short DRR proposed but be encouraged to remain in treatment on a voluntary basis at the end of the DRR where there is a continuing treatment need. Whilst the length of treatment under a DRR should be matched to individual need, the total length of all the requirements of the community order i.e. the restriction of liberty has to be commensurate with the seriousness of the offence(s). The requirements proposed by a PSR author should be based on offence seriousness, any stated purpose of the sentence e.g. punishment or rehabilitation, the needs of the offender and the risk of reoffending/harm, taking into account the views of the treatment assessor and all other relevant information/assessments. Treatment under a DRR has to be arranged to start within two working days of the order being made. Any additional requirements should usually be worked alongside the DRR. Requirements other than the supervision requirement can be sequenced to start after the DRR (or at some point during the DRR).If it is considered, however, that to start them in conjunction would either hinder treatment under the DRR or the offender needs to be stabilised before being able to realistically comply with the other requirements, the requirements should be appropriately sequenced. The court should be made aware in the PSR of all cases where sequencing is likely and it should also be stated in the Sentence Plan. Date of Offence: Pre or Post Criminal Justice Act 2003 If an offender is being sentenced for a number of offences which were committed either side of 04/04/05 the PSR should invite sentencers to sentence on the most serious offence (even if this was committed prior to 04/04/05 and could subsequently result in a DTTO being imposed). If the offences are of equal seriousness the courts should be invited to sentence on the offence(s) that were committed on or after 04/04/05. Use of unpaid work requirement It is unlikely that an unpaid work requirement will be proposed in conjunction with a DRR. There may, however, be some cases where unpaid work may be appropriate but these will probably be limited to those offenders with low treatment needs and a high seriousness of offence. Each case needs to be looked at individually and should

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be balanced against the offender’s level of treatment intervention and an assessment as to his/her realistic capacity to comply with an unpaid work requirement. Accredited Substance Misuse Programmes (ASRO and OSAP) ASRO/OSAP tackle a range of thinking and social skills but are unlikely to be sufficient on their own to tackle the wide range of needs of drug misusing offenders. In view of this, a community order plus an accredited substance misuse programme (ASRO or OSAP) without a DRR should be proposed in relatively limited circumstances. ASRO/OSAP should generally be proposed in the medium to higher sentencing bands alongside a DRR. A separate programme requirement must be specified in the community order where an accredited programme is to be delivered with a DRR. This includes where the accredited programme is to be delivered as an integral part of the structured day care programme. Most of the programme requirements used alongside a DRR will be substance misuse programmes (e.g. ASRO, OSAP). General accredited offending behaviour programmes (e.g. ETS, Think First etc) will need to be used in those areas that do not have access to an accredited substance misuse programme. The supervision requirement, where applicable, needs to be long enough to accommodate the completion of any accredited programme requirement or any other requirement of the order. Alongside ASRO and OSAP, there is also PRISM, which is an accredited programme delivered on an individual basis. It has not been rolled out nationally. Treatment under a DRR Treatment delivered under a DRR should be structured treatment as outlined under NTA Models of Care. This should include one or more of the following:• • • • Structured day care Care planning Substitute prescribing and detoxification (residential or community based) Residential rehabilitation

It is anticipated that many DRRs will consist of the same treatment packages as are currently delivered under a DTTO. Areas may want to consider reviewing the current treatment they commission from external drug agencies to reflect the new National Standards and CJA 2003. For example, areas might consider commissioning either a low, medium and high intensity treatment intervention to reflect different sentencing bands or alternatively two levels of treatment intensity. This is with particular reference to structured day care provision and care planning i.e. areas may not need the high number of treatment hours per person as they did under a DTTO. It is anticipated that more DRRs should be made but some will be for fewer minimum treatment hours than under a DTTO.

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It is the total number of hours of all the requirements of the community order which must total the minimum hours required by National Standards not just the "treatment" time under the DRR. Residential Rehabilitation Treatment Generally, DRRs with residential treatment as the main treatment modality/intervention would fall within the high seriousness of offence sentencing band given the restriction of liberty residential rehabilitation involves. It may be appropriate to propose a minimum length DRR in cases when offenders have a low seriousness of offence but a high treatment need and they themselves wish (and could possibly already be in the process of applying) to access residential treatment. Areas may wish to draw the court’s attention to the fact that the "punishment" was more restrictive and not commensurate with the original offence if the offender subsequently breaches the DRR e.g. unplanned exit from the rehab facility. Where an offender moves to another area for residential treatment, it is the area where the treatment takes place that holds the order. These cases cannot be supervised temporarily and the order must be formally transferred to the area where the offender is residing (see PC 52/2004 for more guidance on case transfers). Contact Levels Under the revised National Standards, levels of contact are dependant upon the community sentencing band (high, medium, low) and also the particular case management tier the offender falls into. The contact levels outlined below are the total contact required across all the requirements of the community order (not just the DRR requirement). Community Sentence Band Low Offence Seriousness First contact DRRs must be seen within one working day of sentence by probation and treatment must start within two working days of sentence. As above Minimum level of contact during first 16 weeks One contact per week (no minimum hours specified) After 16 weeks Contact levels thereafter shall be defined by the offender manager following an OASys review (see below)

Medium Offence Seriousness

Minimum 8 hours per week

Same as above

High Offence Seriousness

As above

Minimum 15 hours per week

Same as above

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National Standards state that offenders in tiers 2, 3 and 4 must be seen weekly by the offender manager during the first 16 weeks unless other weekly requirement contacts have been arranged. Thereafter, contact must not fall below once every four weeks (with offender manager or other designated contact). The offender manager must have at least two contacts during the whole order in tier one cases in addition to any requirement contacts. These are minimum levels of contact and it is expected that under the DRR (together with other requirements) the contact levels will be significantly higher depending on the sentencing band and case management tier. Whilst most of the required contact hours may be met by the treatment provider (depending on local treatment delivery arrangements), offender managers should assess what level of contact they personally have with the offenders (there may be locally agreed guidance on this). This contact needs to be sufficient to manage risk, enforce the Order, monitor the offender’s progress and to prepare the court review reports. Offender managers also have a role in working to increase and maintain offender motivation and in increasing retention. Levels of offender manager contact with offenders should reflect these aims and be detailed in case management recording systems National Standards do not give guidance about the levels of contact after the first 16 weeks of the order but leave it to the offender manager based on an OASys review. Given that the DRR is about treatment, contact levels (with both offender manager and the treatment provider) on the DRR after 16 weeks should be based on offenders’ treatment need. Contact with the offender manager should be based on a wider range of factors, including other requirements of the community order, risk of reoffending and risk of harm. National Standards are minimum reporting requirements and contact under a DRR is likely to be in excess of the minimum. Anything that is to be counted as a "contact" needs to be in the sentence plan and have an audit trail (i.e. can be checked). Collecting substitute medication and testing can both be counted, as can travel if offenders have to travel over half an hour (each way). Additional factors, such as offenders living in rural areas who have to travel many hours to get to a treatment delivery centre, should be considered on an individual basis and a decision made locally regarding how many travelling hours can be counted towards contact time. Recording levels of contact It is crucial that the offender manager records all contacts (arranged and achieved) properly across all the requirements of the order. Performance against the contact requirement for DTTOs has been unacceptably low and evidence suggests that this has been due, at least partly, to poor recording of the total number of hours in integrated case management systems. Home visit A home visit must be undertaken by the offender manager within 10 working days of the order being made in tier 3 and 4 cases if the risk of harm posed by the offender is identified as high or very high. This should be subject to local guidance on health and safety/risk and home visiting. Enforcement National Standards for enforcement of the community order with a DRR remain the

16

same as for the DTTO. A failure to report etc. is considered as an unacceptable failure to comply only once in respect of any one day, regardless of the number of contacts arranged for that day. The order is taken as a whole for the purpose of breach, with an unacceptable failure to comply in relation to any requirement counting as one unacceptable failure to comply with the whole sentence. Good practice would suggest that all enforcement decisions are discussed with treatment providers i.e. acceptable/ unacceptable absences and decisions regarding whether or not to propose revocation or to continue the order. This may have more significance with DRR cases, as the breach may be in respect of another requirement and not specifically about treatment. There may be differences in opinion regarding the proposed outcome of breach proceedings between probation and treatment staff. If this is the case, good practice would suggest that any unresolved differences in opinion should be taken to the respective line managers. In all cases, NPS has the overriding decision in all matters regarding enforcement. Breach Under the CJA 2003, a court cannot take "no action" on a breach or use a financial penalty as a means of dealing with a breach. It can only amend the community order so as to impose more "onerous" requirements or revoke and resentence. If the court revokes the order it can impose a custodial sentence of up to 51 weeks even if the original offence was not punishable by imprisonment. The removal of a fine or "no action" as options for breach may have a significant impact on the DRR target group. Areas should not generally recommend to the court that DRRs/DTTOs be revoked and the offender resentenced on the first or second breach, unless of course the offender indicates he/she will not comply with the order, there are significant risk issues or the order is clearly not working. The proposed outcome of the breach should be based on an offender’s compliance, response to and progress on an order and the point in the order where the breach occurs. Areas can deal with breaches where the order could be allowed to continue by proposing:• • • One of a residence, prohibited activity, curfew or exclusion requirement. Any other requirements, if relevant, or An extension in the length of one or more of the original requirements (if this is a DRR the offender must consent to any amendment).

The Sentencing Guidelines Council states that " There may be cases where the court will need to consider re-sentencing to a differently constructed community sentence

17

in order to secure compliance with the purposes of the original sentence, perhaps where there has already been partial compliance or where events since the sentence was imposed have shown that a different course of action is likely to be effective." Any amendment to the requirements must not exceed the maximum length available for that particular requirement e.g. a DRR cannot be extended beyond 3 years (2 years for suspended sentence orders-custody minus). The length of the proposed extension to a requirement should be commensurate with the seriousness of the breach e.g. a very short extension for a minor breach. The Act does not stipulate or give any guidance on what "onerous" means. In effect, it could be an extension to current requirement(s) or the imposition of an additional requirement(s), within the legislative restrictions on the operational periods allowed for each type of requirement and the overall length of the order. If an offender reoffends on a DTTO on or after 04/04/05 and the offender manager wants the offender to continue to be subject to statutory drug treatment, probation staff could propose that the court revoke the DTTO and effectively take no action in respect of the revocation (i.e. the court is not resentencing on the DTTO) and impose a community order with the relevant requirements, in respect of the new offences. Transfer of DTTOs /Community Orders with a DRR PC 52/2004 should be referred to regarding transfer of orders. A DTTO/DRR should not be temporarily supervised and areas need to be able to respond quickly to requests for transfers and pick up the offender’s treatment without any significant gap in treatment delivery. Funding a Community Order which includes a DRR Commissioning and funding arrangements for treatment and testing under the DRR will be the same as for the DTTO. This means that in 2005/6, as previously, NPS has made a central contribution to the Department of Health Pooled Treatment Budget. This has been allocated to DATs by the NTA according to the York Formula. PC 06/2003, which was agreed with the NTA, will continue to apply. In Wales treatment and testing for the DTTO/DRR is commissioned directly by probation areas from the treatment provider and the areas are directly responsible for managing the contracts. • • Treatment and testing under the DRR (in England) will be commissioned and funded by the DAT. Exceptionally, a community order with a DRR might include a programme requirement which is not primarily aimed at reducing/addressing drug use. For example, drug use may be a disinhibitor for offences of domestic violence or sex offending. The DAT would not be expected to fund a domestic violence or sex offender programme. Joint assessments and close liaison between CJITs, the treatment assessor and PSR author should enable agreement to be reached on a case by case basis, but, as a general principle, if a DRR is combined with a substance misuse accredited programme (or a generic thinking skills programme, where no substance misuse programme is available), the programme should be funded via the DAT (as is currently the case with a DTTO). Accredited programmes proposed for sexual or violent offending should be funded by the probation area.

18

The accredited programme will be funded by the probation area where the community order includes an accredited programme (substance misuse or other programme) but there is no requirement for a DRR. ‘Wrap around’ services – e.g. interventions (or referrals to other agencies) to address accommodation, health, education, training and employment needs (ETE), which are part of a structured day care or other treatment programme, will be covered by the DRR (i.e. no additional requirements need to be specified for these interventions). Structured day care and other treatment packages will be commissioned by the DAT as part of the DRR. An activity requirement will need to be included in the community order, in addition to the DRR, where ‘wrap around’ services are delivered as a specific and separate intervention from the DRR and it is not part of the commissioned treatment programme e.g. an offender is required to attend x number of ETE sessions. Packages delivered as part of an activity requirement will not usually be funded via the DAT. Probation areas and DATs will need to be clear when a ‘wrap around’ intervention is being delivered as part of a treatment programme. The content and likely duration/intensity of the treatment proposed by the treatment provider therefore needs to be sufficiently detailed for the PSR author to determine exactly which requirements should be included in the community order. • • It is important that probation staff of an appropriate level play an active role in DAT business. There should be robust processes in place in order to performance manage commissioned treatment providers.

Provisions for 16-17 year olds The CJA 2003 for community orders does not currently apply to offenders under 18 year of age. This means 16-17 year olds will continue to be made subject to pre-CJA 2003 orders (CROs, CPOs, DTTOs) for offences committed on or after April 4th 2005. Areas need to discuss continuing DTTO arrangements for this age group with local YOTs. The Youth Justice Board has advised, however, that juveniles should continue to be proposed for juvenile sentences (e.g. Supervision Orders) in most cases. 16-17 year olds on DTTOs will usually be managed by the local YOT, although this will be determined by existing local arrangements and may need to be considered on a case by case basis. Court Reviews There are two changes to the court review process:• The Act requires reviews to be held only where the DRR is over 12 months (unless requested by the court). National Standards, however, require reviews to be proposed for DRRs of 12 months length and over. National Standards require that the offender manager submits a written progress report to the court once every four weeks for the first 16 weeks and a minimum of 16 weeks thereafter where reviews are mandatory or requested by the court.

Consideration should be given to proposing reviews in all cases, irrespective of the

19

length of the DRR, where the offender:• • • is a PPO is assessed at the time of sentence as being high or very high risk of harm has an OASys score of 100 or more.

Areas could consider holding reviews: • • bi-monthly after the first 16 weeks for the next third of the order with one final review in the last third of the order (this is based on a 12 month order and could be amended depending on the length of the requirement).

It remains good practice to have, at the very least, one magistrate from the previous review(s) sitting at the next one in order to have continuity for both the offender and the review panel. Many areas have specific review panels of magistrates in order to facilitate this. The court review report should include:• • • • • • The views of the treatment provider as to the progress of the offender in respect to treatment. Test results The record of the offender in keeping all appointments Judgements by the offender manager as to the offender’s attitude and response to the order as a whole. Any further charges, convictions or breaches. Information regarding progress on any other requirements that the offender may be subject to alongside the DRR.

At a review hearing the court, after considering the content of the progress report, may amend the order so far as it relates to the DRR. The court can only amend the DRR if:• • The offender expresses his/her willingness to comply with the proposed amendment. The amendment does not reduce the requirement below the minimum length (6 months).

The offender must consent to any amendment if an appeal against the order is pending. In most cases, if the offender is not willing to comply with the proposed amendment the matter would need to be adjourned to a properly constituted court where the prosecution would be present and the offender has the opportunity to seek legal representation. A properly constituted court can:-

20

• •

Revoke the order or the suspended sentence order to which it relates. Deal with the offender, for the offence in respect of which the order was made, in any way in which the offender could have been dealt with for that offence by the original court at the time of sentence. If this course of action is taken, the court must take into account the extent to which the offender has complied with the requirements of the order and may impose a custodial sentence (if the original offence was punishable by imprisonment).

There are different powers for those under 18 set out in the CJA 2003. It is possible to have a review without a hearing (where the offender manager prepares the review report but the offender does not have to attend the court hearing). The court makes the decision regarding these cases. If the review report indicates poor progress etc. the court can then require the offender to personally attend the next review. Good practice would suggest that offenders should attend all the reviews during the first four months of the order and then be excused attendance if they are progressing well. In practice, however, offenders often want to keep attending reviews, particularly when they are doing well. The court responsible for the order should hear the reviews (i.e. the court the order is made out to). A magistrates’ court that makes the order can make another magistrates’ court responsible for the order and the reviews i.e. where the order is made in an area outside of where the offender resides. Good practice would suggest that if two orders are running concurrently (one Crown and one magistrates) the offender only needs to appear at the Crown Court and the magistrates are given a copy of the review report, if required. An order made at the Crown Court should have reviews held at Crown Court. An order made on appeal is taken to mean that the order was made at the Crown Court. The above information regarding court reviews also applies to suspended sentence orders with a DRR. Drug Testing Frequency of testing Offenders sentenced to a DRR for a low seriousness offence i.e. where the DRR is the only requirement of the order, have to be tested only once per week throughout the requirement. Those offenders in the medium and high seriousness bands need to be tested a minimum of twice a week for the first sixteen weeks of the requirement, with discretion for this to be reduced to once per week thereafter if the offender manager evidences that sufficient progress has been made. Those offenders in residential rehabilitation treatment centres need to be tested only once a week during their time in rehab. Corrections to National Standards have been agreed to support this guidance. There should usually be at least two clear days between screening tests. Offenders should not normally be tested on fixed days of the week. The testing requirement may also be varied when probation staff are satisfied that

21

the offender has an acceptable explanation for missing a test, for example due to a child care emergency, or a test result is deemed void due to the offender’s inability to provide a sample. Where the offender has missed a test, or the test is deemed void, a second test should be carried out on the next working day. Who carries out tests? Testing is to be carried out “by the responsible officer or by the person specified as the person by or under whose direction the treatment is to be provided” i.e. probation or treatment staff. A full record of all tests (including failures to attend, failures and refusals to produce a sample and results of confirmation tests) carried out on offenders must be kept for the duration of the order. The results of any tests carried out by the treatment provider must be communicated to the supervising officer. This should usually be done within two working days of the test taking place. Type of testing The only forms of testing which may be used as part of a DRR, without prior written authority, are urine and/or oral fluid testing. These two modalities should not be viewed as mutually exclusive. In fact, there could be positive benefits in using both for DRR testing. For instance, greater flexibility (e.g. if an offender proves unable to provide one type of sample the other form of testing could be used) and adulteration will be more difficult if offenders do not know in advance how they are going to be tested. If oral fluid tests are used there may be more benefits to having a supplier that provides an immediate screening test result. As with DTTOs, areas will still require prior permission in writing from the NPD Interventions Unit, however, to use any other modality for DRR testing, as some forms of testing that are available are likely to be insufficiently robust or unsuitable. Observation Urine tests no longer have to be routinely observed, as was the case for DTTOs. Care should be taken, however, to ensure that, as far as possible, samples are unadulterated. For example, by the use of temperature pots, ensuring the offender hands the sample directly to the staff taking the test in order to feel temperature (should be body temperature), checking the colour of the sample, ensuring that the offender takes his/her jacket or coat off, leaves any bags outside etc. There may be some situations when it could be an option to observe urine tests e.g. if there is genuine suspicion that an offender is adulterating samples or for clinical/medical reasons. Where practicable, the decision to observe any urine test should be decided in conjunction with clinical treatment staff. Oral fluid tests have to be observed. If the supervising officer/treatment provider is concerned about false tests then the offender could be tested again, possibly by a random test. Which drugs to test for Offenders should usually be tested for drugs which are most closely associated with their offending.

22

Probation/treatment staff have the discretion to require tests for other drugs that offenders may be taking, as well as for substitute medication, if this is appropriate. Use of confirmatory testing (lab test) It would be expensive and unnecessary to send samples for confirmatory testing after every positive screening test. A confirmatory test could be used in those cases where the offender disputes a test result; however this needs to be balanced against the fact that failed drug tests in themselves are not grounds for breach. Confirmatory tests should be conducted to chain of custody standards (i.e. that there is a trail of evidence that shows that the sample has not been tampered with). Provision of samples The only circumstances in which offenders shall not always be required to provide a sample is if they have admitted drug use in advance of the test and are willing to sign a form to this effect (SS 8.13 of National Standards refers). Areas need to ensure they record admitted drug use. Good practice would suggest that an offender is only allowed to sign (and not be tested) on two consecutive occasions before being required to be tested again. Definition of “failure” to provide a sample “Failure” in SS8.14 of NS means refusal to provide a sample. Inability to provide a sample for genuine medical reasons should not be considered as an unacceptable failure to comply with the order and is therefore not grounds for breach. If an individual repeatedly cannot comply for reasons beyond his or her control, e.g. if they suffer from Paruresis (also known as "shy bladder syndrome") or dry mouth and there is no other form of testing available for use then the DRR should be regarded as unworkable. The case should be returned to court on those grounds and it would then be for the court to determine how it should be dealt with. Implications of positive tests for breach Taken in isolation drug test results are rather a blunt instrument by which to measure progress. Many offenders who continue to use drugs while on the order will do so in greatly reduced quantities and on a much less frequent basis but will still provide positive samples. The results of drug tests therefore need to be considered, alongside other indicators, in the context of the offender’s overall progress on the order. Failed drug tests are not grounds for breach proceedings taken in isolation but can be indicative of a failure to engage in the programme. If, for example, an offender is not engaging in other aspects of the DRR (and has also possibly reoffended) and is therefore in breach, failed drug tests may then be used as added justification as to why the order should be revoked and the offender resentenced. There are, however, situations when repeated failed drug tests could lead to an order being taken back to court and deemed unworkable. In those cases where offenders are attending appointments and otherwise complying with the DRR but continuing to take drugs and making little or no effort to stop, the DRR could be revoked and/or the offender re-sentenced if it appears to the court that "having regard to circumstances which have arisen since the order was made, it would be in the interests of justice" to do so. Legal advice is that consistent positive tests over a period of time would constitute such “new” circumstances.

23

Before any order is taken back to court as unworkable, everything possible must have been done to encourage the offender to produce negative drug tests. The review court should be kept informed throughout as to the offender’s progress and it has an important role to play in motivating the offender. The review court should be party to any decision (or anticipated proposal) to return the offender to court and apply to revoke the DRR on the grounds of unworkability. Steering Groups/Forums Areas have developed various forums and meetings (both locally and regionally) to provide oversight, review the multi-agency operations of local DTTO programmes and/or to bring practitioners and/or managers together to discuss best practice, inform commissioning etc. Areas (and regions) need to evaluate the most effective meeting structures that meet their local needs. Good practice would suggest that (over and above any local performance monitoring forums - of treatment providers) some form of meeting at a regional level is beneficial. It is important to have links and good communication channels with local CJITs and Prison Area Drug Co-ordinators on both a strategic and operational level in order to maximise the identification, engagement and retention of potential DRRs from arrest to sentence and also at the end of a DRR if there are ongoing drug related needs. It is also important to have relevant links with agencies that can assist with other criminogenic factors e.g. housing/ETE/Learning and Skills. Useful Reference Material • Drug Interventions Record Context Guidance • DIP and NOMS Case Management of Offenders (Annex G to PC 55/2004). Currently being revised. • Mental Health Policy Implementation Guide: Dual Diagnosis Good Practise Guide • NTA: Models of care for treatment of adult drug misusers (presently being revised) • Sentencing Guidelines Council Guidance: Overarching Principles: Seriousness and New Sentences: Criminal Justice Act 2003.

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Managing the Alcohol Treatment Requirement (ATR)

Index Page 3. 3. 4. 4. 4. 5.
5. 6. 7. 7. 7. 8.

General Legal requirements ATR Target Group Assessment Pre-sentence reports (PSRs) Treatment
Models of Care for Alcohol Misusers (MOCAM)-the 4 tier model of alcohol treatment Meeting the six months ATR minimum Prison Service Model Treatment framework Limited treatment provision – implications for start of ATR and working with DAATs to address the gaps Change of treatment provider Revocation for good progress

8. 8. 8. 8.

Use of accredited programmes Testing Court reviews Enforcement

General

2

NPS is developing an Alcohol Delivery Strategy for offenders under probation supervision based upon evidence of best practice. A detailed framework is in place and the results of research commissioned to inform strategy development are expected shortly. In the meantime, areas may find the following interim guidance on the Alcohol Treatment Requirement (ATR) helpful. Legal requirements Section 212 of the Criminal Justice Act 2003 makes available to the courts an ATR as one of the possible requirements of a community order. This replaces and largely replicates paragraph 6 of Schedule 2 to the Powers of Criminal Courts (Sentencing) Act 2000 (the old Schedule 1(a) (6)), which allows courts to make it a requirement of a community rehabilitation order (CRO) or community punishment and rehabilitation order (CPRO) for an offender to receive alcohol treatment. These pre-CJA measures continue to be in force for offenders committing offences before the 4 April 2005 and for juveniles.1 The main differences with previous provision are that: - an ATR can be made part of a community order or a suspended sentence order for a minimum of six months and maximum of three years. - to impose an ATR the court does not have to be satisfied that the offender’s dependency on alcohol caused or contributed to the offence(s) for which he has been convicted; and The ATR is available to courts as a sentencing option for offences committed on or after 4 April 2005 by offenders aged 18 or over. The ATR obliges the offender to submit to “treatment by or under the direction of a specified person having the necessary qualifications or experience with a view to the reduction or elimination of the offender’s dependency on alcohol”. Under Section 212 of the Act, a court can impose an ATR provided: • the offender is dependent2 on alcohol • this dependency is such as requires and may be susceptible to treatment • arrangements have been or can be made for the treatment intended to be specified in the order (including arrangements for the reception of the offender where he is to be required to submit to treatment as a resident) and • the offender expresses his willingness to comply with its requirements. The treatment required by an ATR for any particular period must be either: • as a resident in such institution or place that may be specified in the order • as a non-resident in or at such institution or place, and at such intervals, as may be so specified or • by or under the direction of a person having the necessary qualifications or experience as may be so specified but the nature of the treatment shall not be specified in the order except as above.

ATR Target Group
The National Implementation Guide for the Criminal Justice Act 2003 community sentence provisions (Edition 2, Version 5F) provides further information. 2 See following section of this guidance on ATR target group for definition.
1

3

The ATR is targeted at much the same group of offenders who were previously suitable for a CRO or CPRO with an alcohol requirement, although, as stated in the previous section, for an ATR to be made the offender’s dependency does not have to be linked to the index offence(s). Legal advice suggests that “dependency” under the Act does not mean simply clinical dependence characterised by “psychological dependence” with an increased drive to use alcohol, difficulty controlling its use, despite the consequences, and in more severe cases physical withdrawals upon cessation of use. It could also include hazardous and harmful drinkers3. Assessment When alcohol misuse has been identified as an issue in OASys the offender should first be further assessed using a specific alcohol assessment tool e.g. Alcohol Use Disorders Identification (AUDIT), Christo Inventory for Substance Misuse (CISS), Short Alcohol Dependence Data (SADD). This will help to identify the offender’s alcohol related needs and the type and level of intervention that should be used to tackle them. This level of assessment can be carried out by suitably trained probation staff (of any level) or treatment staff depending upon local arrangements. Offenders assessed at this stage as requiring treatment for their alcohol related problems, as opposed to information or advice, should be referred for assessment, in line with Models of Care for Alcohol Misusers (MoCAM)4 and any local Care Pathway, by staff competent and designated to undertake such assessments. This is to identify the seriousness of their problems, the urgency with which they require treatment and in the case of those with the most serious problems, enable an individual care plan to be prepared. Pre-sentence reports (PSRs) An ATR can be proposed wherever the PSR author is satisfied that the requirements of section 212 of the Act (above) are met. In addition, PSR authors should bear in mind the Sentencing Guidelines Council advice5 that “the decision on the nature and severity of requirements to be included in a community sentence should be guided by: (i) the assessment of offence seriousness (LOW, MEDIUM OR HIGH); (ii) the purpose(s) of sentencing the court wishes to achieve; (iii) the risk of re-offending; (iv) the ability of the offender to comply; and (v) the availability of requirements in the local area. The resulting restriction on liberty must be a proportionate response to the offence that was committed."

The World Health Organisation’s tenth revision of the International classification of diseases (ICD-10) defines:hazardous use of a psychoactive substance, such as alcohol, as an “occasional, repeated or persistent pattern of use…which carries with it a high risk of causing future damage to the medical or mental health of the user but which has not yet resulted in significant medical or psychological ill effects” ;and harmful use of a psychoactive substance, such as alcohol, as “a pattern of use which is already causing damage to health. The damage may be physical or mental.” 4 Consultation document available at www.nta.nhs.uk. 5 Page 9 of the Guideline on New Sentences: Criminal Justice Act 2003 available from www.sentencing-guidelines.gov.uk.
3

4

The guidelines also say: "There will clearly be ... requirements of a rehabilitative nature, such as a treatment requirement or an accredited programme, which may be appropriate depending on the specific needs of the offender and assessment of suitability. Given the intensity of such interventions, it is expected that these would normally only be appropriate at medium and high levels of seriousness, and where assessed as having medium or high risk of reoffending." In addition to the requirements set out in National Standards, a PSR or fast delivery PSR recommending an ATR must include: • the results of any assessments undertaken (OASys and/or alcohol assessment) indicating that the offender is dependent upon alcohol and that this dependency requires and may be susceptible to treatment • a treatment plan, including the type of treatment (residential or non-residential), the name and address of the provider and for non-residents suggested intervals of treatment, if appropriate. • evidence that arrangements for this treatment are in place or can be put in place • a signed statement from the offender that he/she is willing to comply with the ATR • the suggested length of the ATR, taking into account the views of the provider • an indication as to when the ATR will start and, if there is likely to be any significant delay, any work that will be done with the offender in the interim • any anticipated sequencing with other requirements of the order Treatment Like the drug rehabilitation requirement (DRR), the amount and type of treatment delivered under the ATR should be tailored to the offender’s assessed need providing the overall restriction on liberty imposed by the community order in its totality is commensurate with the seriousness of the offence(s). An ATR will usually be combined with a supervision requirement (and possibly other requirements) at the medium and high seriousness bands of the community sentence. The ATR can be used as a stand alone requirement for those in the lowest band of the community sentence but an offender manager will still be needed for enforcement and general compliance with the order. Models of Care for Alcohol Misusers (MOCAM)-the 4 tier model of alcohol treatment Alcohol treatment can be broken down according to the 4 tiers identified in MOCAM. These are: Tier 1: Screening, brief advice and referral. This is defined as provision of identification of hazardous and harmful drinkers and those who drink in excess of the sensible drinking limits; information on low risk drinking; ‘brief advice’ to reduce alcoholrelated harm; and referral of those with alcohol dependence or harm for more intensive interventions. Tier 1 interventions include targeted screening for those drinking in excess of Guidelines on Safer Drinking (DH)6, provision of brief advice to hazardous drinkers and referral of those requiring more than brief advice for services in higher tiers. These will often be delivered in non-alcohol specialist settings by non-specialists e.g. probation, nurses with the necessary Drug and Alcohol National Occupational Standards (DANOS) competences.7

6 7

www.dh.gov.uk. Available at www.skillsforhealth.org.uk/danos/competences.php.

5

-

Tier 2: Open access support to reduce alcohol-related harm, assessment and referral services. This is defined as provision of open access facilities and outreach delivering alcohol-specific advice information and support, brief interventions to reduce alcohol-related harm; and assessment and referral of those with more serious alcoholrelated problems for care-planned treatment. Interventions also include mutual aid groups e.g. Alcoholics Anonymous, assessment and low threshold prescribing for assisted withdrawal. This may be offered in non-alcohol specialist settings if the required competencies are available and will generally be appropriate for hazardous and harmful drinkers who have not responded to brief advice. Tier 3: Community based care-planned treatment. This is defined as specialised alcohol misuse assessment, care planned treatment and care co-ordination, when required. Interventions provided include evidence based psychosocial therapies and support, interventions for assisted alcohol withdrawal “detoxification”8 and pharmacotherapies to address alcohol misuse. These interventions should be provided within specialist substance misuse services or within non-alcohol specialist settings with the necessary expertise and resources for treating alcohol misusers and will be generally appropriate for moderately dependent drinkers. Tier 4: Residential/inpatient care-planned treatment. This is likely to be suitable for those who have severe dependence or alcohol dependence with other problems and may be provided by practitioners with the necessary specialist competence, in community or residential settings, as appropriate. Tier 4 also includes in-patient assisted withdrawal – typically a relatively brief intervention lasting 7-10 days (and sometimes less if treatment starts in-patient and is completed in the community). In-patient assisted withdrawal is indicated when service users would be at risk if treatment were provided in the community. Assisted withdrawal can also be provided at the start of a residential treatment placement.

-

-

An ATR can include some Tier 2 provision and interventions in Tiers 3-4. Interventions in Tier 1, including alcohol education or information, brief advice and support which can be delivered by probation staff to offenders with very low level alcohol problems, should not form part of an ATR but be delivered routinely as part of a supervision requirement or activity requirement. However, all offenders who are recommended to the court for an ATR should have received screening and brief advice prior to being referred to the assessment which confirmed the appropriateness of the ATR. All probation staff involved in delivering these Tier 1 interventions must be trained & competent to the relevant DANOS standards. Meeting the six months ATR minimum It is envisaged that areas will continue to use whatever alcohol treatment provision they already have in place to deliver the ATR, although we acknowledge that the requirement for an ATR to last a minimum of six months could create problems in some areas where existing contracts with providers do not cater for that length of treatment and there is insufficient funding to extend provision. There may also be offenders assessed as suitable for an ATR who require less than six months treatment. Constructing an ATR of at least six months duration may not present too great a problem at the medium/high seriousness bands of the community sentence where there will generally be other requirements running alongside the ATR, which could be sequenced alongside ATR provision to cover the whole of the minimum time period. It may be more difficult to resolve, however, at the low seriousness band where the ATR is a stand alone requirement.

8

Otherwise known as “prescribed medication.”

6

Wherever meeting the six months ATR presents a problem, areas should consider arranging a frequency of appointments with the treatment provider which allows the total treatment episode to be spread over the minimum ATR duration. For example, a 12 weeks treatment programme could be delivered on a fortnightly basis for six months. In this scenario, to meet the minimum NS contact requirements, offender managers (OMs) would need to schedule additional appointments for the first 16 weeks with offenders in the medium/high seriousness band of the community sentence to take place in weeks in which there were no treatment appointments. Alternatively, on completion of the agreed treatment programme, additional sessions could be arranged, including less intensive treatment, relapse prevention work or re-referral for treatment in the event of a relapse. Under an ATR, anything specified in the supervision plan can be counted as contact providing there is an audit trail. This might include motivational work or work on related activities such as housing, finance etc. Some areas may be interested in a short motivational package (8 sessions) that is being piloted by the programmes team. Prison Service Model Treatment framework Areas may find it helpful to refer to the Prison Service model treatment framework, as there are many parallels between effective treatment interventions in custody and the community. The framework is included in the “Alcohol Treatment/Interventions Good Practice Guide.”9 Limited treatment provision – implications for start of ATR and working with Drug and Alcohol Action Teams (DAATs) to address the gaps We recognise that alcohol treatment provision is limited in some areas and that waiting times can be lengthy, which may have implications for when the ATR can start. Where the ATR is just one requirement of a community order, work can be done with the offender relating to other requirements until the ATR component can begin within the timings of the community order. This will need to be reflected in the sentence plan. The NPD commissioned research due for publication in September should provide information about the gaps that exist in some areas regarding the provision of services for alcohol users and more detail about the gaps nationally. In the meantime, areas should work with local Drug and Alcohol Action Teams (DAATs) to ensure a comprehensive assessment of local need is available and the DAAT commissions services to meet these needs. This requires probation areas to play a full and active role in all the business of the DAAT, not just in the commissioning of treatment for DTTOs/DRRs and ATRs. Areas may also address some shortfalls in provision by partnership funding of appropriate services. Probation areas are well placed to provide information on the extent of alcohol related offending in their area and such information should be bought to the attention of the Crime and Disorder Reduction Partnership (CDRP). ROMS and NPD regional managers should ensure gaps in provision are addressed under the drugs and alcohol pathways of the regional reducing re-offending resettlement strategies. Change of treatment provider Where the treatment provider assesses that treatment can be better or more conveniently carried out by another suitably qualified provider not specified in the ATR e.g. in-patient or community based detoxification, then he may with the consent of the offender make arrangements for such treatment to be provided. The person making the arrangements must notify the supervising officer of the change, specifying where and by whom the treatment is

9

Available at www.hmprisonservice.gov.uk/news/index.asp?id=2173,22,6,22,0,0.

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now being carried out. For residential treatment, the guidance on case transfers set out in PC 52/2004 applies. Revocation for good progress The supervising officer or offender may apply for the ATR to be revoked early for good progress or for responding satisfactorily to supervision or treatment where this is applicable. Use of accredited programmes If an offender is assessed as likely to benefit from a substance misuse programme (ASRO/OSAP/DIDS) or any other offending behaviour programme instead of or in addition to alcohol treatment, this must be delivered through a programme requirement. It cannot be part of the ATR. The offender’s suitability for an accredited programme therefore needs to be assessed separately from suitability for an ATR. The sequencing of interventions will be determined by the use of the selection matrix and availability of treatment. Details of the accredited programme should be specified in the PSR, sentence plan and be delivered in accordance with National Standards and NPS programme performance standards. Accredited programmes such as ASRO/OSAP should generally only be used alongside an ATR for offenders in the medium/high seriousness community sentencing band. Offenders who have committed drink drive offences and are suitable for the Drink Impaired Drivers Scheme (DIDS) should be recommended for a programme requirement. An ATR should only be added where this can be justified by the seriousness of the offence and offender need. Testing Human rights issues preclude the imposition of mandatory testing (a requirement of a DRR) for alcohol. However, alcohol misusing offenders under probation supervision can still be tested on a voluntary basis at the discretion of the supervising officer or treatment provider when this is considered helpful as a way of assessing their progress in treatment. Court reviews Unlike the DRR, court reviews are not applicable to the ATR as part of a community order but the court has discretion to decide that a suspended sentence order be subject to periodic review, including those with an ATR10. Enforcement Existing National Standards apply in respect of attendance and behaviour.

10

Section 5.6 of the National Implementation Guide provides advice on Reviews of Orders.

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