Working with Alcohol Misusing Offenders – a strategy for delivery

Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1. Why have a strategy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.2 Alcohol and crime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.3 Aims and objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2. Key elements of the strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.1 Targeting, screening, referral and assessment . . . . . . . . . . . . . . . . . . . . . . 6 2.2 Brief interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.3 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.3.1 Probation and the ‘Models of Care’ approach . . . . . . . . . . . . . . . . . 8 2.3.2 Offending Behaviour Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3.3 A new focus on resettlement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.4 Addressing diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.5 Inter-agency working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.6 Training and development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.7 Performance monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Glossary of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Contact for enquiries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

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Foreword
The National Probation Service (NPS) has a long history of working with problem alcohol misusers, although in recent years the Service has concentrated on drug misuse in line with Government priorities. More recently, the Government has focused more closely on alcohol misuse as a factor in offending behaviour and as a community health issue. It has made it a priority to tackle two major problems associated with alcohol misuse: crime and anti-social behaviour in town and city centres; and harm to health as a result of binge and chronic drinking 1. NPS has an important part to play in tackling alcohol misuse within its wider role of protecting the public and preventing further offending by rehabilitating offenders. A great deal of good work is already being done. This strategy aims to develop more consistent and co-ordinated delivery.

The Strategy will give the Probation Service a coherent approach to tackling alcohol misuse which is evidence-based. It contains a number of actions for the centre and recommendations for areas to improve provision. In developing the strategy, we have worked closely with colleagues in the Community Integration Unit (CIU) and Drug Strategy Unit (DSU) 2 of the National Offender Management Service (NOMS) and the National Treatment Agency for Substance Misuse (NTA), as well as other key stakeholders e.g. Alcohol Concern. The emphasis will be on consolidating the work already being done across the service and building on best practice within available resources. The strategy aims to improve our ability to get best value from what we presently deliver, essential if further resources are to be secured.

Roger Hill Director of Probation May 2006

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Prime Minister’s Strategy Unit (2004) Alcohol Harm Reduction Strategy for England, London, PMSU. Formerly HM Prison Service Drug Strategy Unit.

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Working with Alcohol Misusing Offenders – a strategy for delivery

Why have a strategy?
1.1 Introduction
Alcohol is enjoyed by many without causing problems and has significant economic benefits. Yet alcohol can also affect people’s behaviour so that they act in a criminal or anti-social way. They may under-perform at work or have difficulties gaining employment; they can run into debt; their social and family relationships can deteriorate; and they may suffer health problems 3. This Strategy aims to: • Establish a consistent approach to tackling alcohol-related offending across the Probation Service based upon evidence of best practice. • Complement the Alcohol Harm Reduction Strategy for England and the Prison Service Alcohol Strategy 4 to make a coherent NOMS strategy.

• Complement the Five Year Strategy for Protecting the Public and Reducing Reoffending 5, the NOMS drugs strategy and the programme of resettlement activity set out in The National Reducing Re-offending Delivery Plan 6. • Complement Models of Care for Alcohol Misusers (MoCAM) 7 and related work under the Department of Health’s (DH) Programme of Improvement for Alcohol Misuse 8. • Be consistent with the developing role of the Regional Offender Managers (ROMs) in commissioning on a regional basis. Wales does not have either a drug or an alcohol strategy and has for the last ten years been working to a combined substance misuse agenda. The National Assembly for Wales produces its own specific documents in respect of guidance for the commissioning, managing and performance monitoring of substance misuse. Parts of this strategy will not be transferable to Wales, although the underlying principles will apply.

3 4 5 6

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Prime Minister’s Strategy Unit (2003) Interim Analytical Report. HM Prison Service (2004) Addressing Alcohol Misuse – A Prison Service Alcohol Strategy for Prisoners, London, HMPS. See also the accompanying Alcohol Treatment/Interventions Good Practice Guide and Alcohol Testing for Prisoners Manual of Policy and Procedures. The Five Year Strategy, published in February 2006, set out the direction for NOMS and its partners, including the National Probation Service. It includes a commitment to “give offenders better access to alcohol interventions, especially where their offending is linked to alcohol”. NOMS published the National Reducing Re-offending Delivery Plan (NRRDP) on 22 November 2005. It reviewed the achievements made on the reducing re-offending pathways contained in the Reducing Re-offending National Action Plan, including drugs and alcohol, and mapped the way forward, setting out targets and commitments for the next eighteen months. The National Probation Service committed to producing an Alcohol Delivery Strategy. MoCAM will provide “an optimum local framework for the commissioning and provision of interventions and treatment for adult alcohol misusers in England”. The Programme of Improvement is a commitment from the Alcohol Harm Reduction Strategy and the Choosing Health White Paper, both published in 2004. Along with MoCAM, supportive publications included in the Programme of Improvement are the Alcohol Needs Assessment Research Project (ANARP), Review of the Effectiveness of Treatment for Alcohol Problems and Alcohol Misuse Interventions – Guidance on developing a local programme of improvement.

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1.2 Alcohol and crime
Alcohol misuse contributes significantly to crime 9. Alcohol features specifically in some offences, such as drink-driving. Alcohol can also act as a disinhibitor or be used as an excuse, or result in crime because the individual has a drinking problem. It features prominently in violent offences, including domestic violence 10, and is often associated with anti-social behaviour. Research also shows that those who frequently drink to excess are more likely to offend than those who don’t 11. It is no surprise that many offenders under probation supervision have alcohol problems linked to their offending behaviour. The OASys Data Evaluation & Analysis Team (O-DEAT) carried out an analysis of data drawn from over 120,000 Offender Assessment System (OASys) assessments 12 in 41 probation areas between 1 April 2004 and 31 March 2005. This found that over one-third (37%) of offenders had a current problem with alcohol use and a similar proportion (37%) with binge drinking. Nearly half (47%) had misused alcohol in the past. 32% had violent behaviour related to their alcohol use. 38% were found to have a criminogenic need relating to alcohol misuse, potentially linked to their risk of reconviction 13. Research 14 has found that alcohol had been consumed prior to the offence in nearly threequarters (73%) of domestic violence cases and was

a ‘feature’ in almost two-thirds (62%). Furthermore, almost half (48%) of these convicted domestic violence offenders were alcohol dependent.

1.3 Aims and objectives
The overarching aim of the Strategy is to reduce re-offending and alcohol-related harm and protect the public by meeting the following objectives: • To identify alcohol misuse and offending needs at an early stage of contact with the NPS and refer offenders to appropriate interventions. • To ensure that staff are fully competent to deliver brief advice and support to alcohol misusing offenders under their supervision. • To improve the advice and information provided to offenders about the risks of alcohol misuse and about help that is available locally. • To develop and promote the delivery of evidence-based interventions to meet the needs of the full range of alcohol-misusing offenders. • To increase the consistency of what is delivered across the NPS based upon evidence of best practice.

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The overall annual cost of crime and anti-social behaviour linked to alcohol misuse is calculated to be £7.3bn – Prime Minister’s Strategy Unit (2003) Interim Analytical Report. 1.2m violent incidents (around a half of all violent crimes) and 360, 000 incidents of domestic violence (around a third) are linked to alcohol misuse – Prime Minister’s Strategy Unit (2003) Interim Analytical Report. Matthews, S. & Richardson, A. (2005) Findings from the 2003 Offending, Crime and Justice Survey: alcohol-related crime and disorder. Findings 261. London: Home Office. OASys is the offender assessment tool used by NOMS. Alcohol misuse is one factor used in the assessment. Section 9 of OASys asks 5 questions related to alcohol misuse. Each question is scored between 0 (no problems), 1 (some problems) and 2 (significant problems) and the scores added together to produce an overall section score ranging from 0 to 10. Scores of 4 or more indicate a criminogenic need relating to alcohol misuse. Gilchrist, E., Johnson, R., Takriti, R., Weston, S., Beech, A. & Kebbell, M. (2003) Domestic violence offenders: characteristics and offending related needs. Findings 217. London: Home Office.

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Working with Alcohol Misusing Offenders – a strategy for delivery

2. Key elements of the strategy
2.1 Targeting, screening, referral and assessment
Problem drinking can broadly be broken down into three categories: hazardous, harmful and dependent (including moderately and severely dependent) drinkers 15, which evidence suggests are likely to require very different types of intervention. Hazardous and harmful drinkers, whose criminal activity is often directly alcohol-related (drink drivers, violent offences whilst intoxicated), are more likely to respond to low-level advice, information and support, often delivered by non-specialists e.g. probation staff. Those with a habitual alcohol dependency are likely to need specialised and intensive care-planned alcohol treatment. Accurate and early identification of those with established alcohol problems and their referral into appropriate treatment is one of the main aims of the Harm Reduction Strategy. In addition to OASys, there is a need for: • Specific alcohol screening and/or assessment which accurately identifies the nature and extent of alcohol misuse by offenders, whether or not it is directly related to their offending.

• Appropriate targeting criteria linked to local service provision and programme availability. • Clear and consistent brief interventions for misusers at an early stage in their contact with probation and referral for further assessment, where applicable. • Those assessed as requiring some form of intensive treatment to be referred without delay into the most appropriate available treatment. OASys covers alcohol problems in relation to risk of re-conviction, risk of harm and as a possible criminogenic factor that may need to be addressed if offending behaviour is to be reduced. Once alcohol misuse has been identified as an issue by OASys, however, the offender should be screened using a specific alcohol screening tool 16 to assess the health aspects of alcohol misuse. Brief interventions should be provided immediately following the screening and those with moderate to severe alcohol problems referred for a more comprehensive alcohol assessment undertaken by specialist staff, in line with the three levels of screening and assessment set out in MoCAM. MoCAM also recommends the development of local systems of screening and assessment involving the use of standardised procedures and tools, development of clear referral criteria and adequate

15 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”. MoCAM states that dependence is 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. 16 Examples include the Alcohol Use Disorders Identification Test (AUDIT), Fast Alcohol Screening Test (FAST), Paddington Alcohol Test (PAT), Michigan Alcoholism Screening Test (MAST), Five-shot questionnaire, Alcohol Related Aggression Questionnaire (ARAQ), Short Alcohol Dependence Data (SADD), The Rapid Alcohol Problems Screen (RAPS), CAGE, TWEAK and T-ACE.

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sharing of information between agencies, e.g. prisons, probation and the voluntary sector. NPD will: • Support areas in implementing the recommendations in MoCAM relating to screening and assessment. Areas should: • Ensure that when alcohol misuse has been identified as an issue through OASys the offender should always undergo screening and, where relevant, further assessment using any locally agreed tools. • Ensure that anybody undertaking an initial screening is able to determine if alcohol is an issue, provide an immediate and appropriate response and identify those individuals who need onward referral. • Work with their drug (and alcohol) action teams (D(A)ATs) to develop local systems of screening and assessment.

of its effectiveness in the probation context. There is no reason, though, to presume that the effective use of brief interventions 18 successfully deployed in other settings cannot be replicated across the probation service, when delivered by fully trained and competent probation or other staff (see section 2.6). Information should address the physical, social and psychological harms of alcohol; cover health promotion and harm minimisation and ‘triggers’ for drinking; and should be realistic and believable. It should be targeted primarily at those offenders identified through OASys and/or alcohol screening as hazardous or harmful drinkers, rather than delivered to every offender or only made available in offices through displays or leaflets. The need for greater consistency of delivery needs to be balanced, however, against differences in local service provision and the flexibility required to meet individual needs. NPD will: • Identify and inform areas of the material that is currently being used and determine what needs to be developed to fill any gaps in provision. Areas should: • Provide appropriate information, advice and support to all those offenders at risk of developing serious alcohol problems and identified by the screening process as hazardous or harmful drinkers.

2.2 Brief interventions
Information, brief advice and support for behavioural change may, if targeted appropriately, help to encourage responsible drinking and reduce risks to health 17. It may also help to reduce offending related to alcohol misuse. However, only around half of areas currently offer any preventative information and there is generally a lack of evidence

17 Heather, N., Raistrick, D., & Godfrey, C. (2006) Review of the Effectiveness of Treatment for Alcohol Problems, to be published later in 2006. 18 Brief interventions are carried out in community settings and are delivered by non-specialist personnel. There are two main kinds of brief interventions. Brief advice or simple brief intervention is usually provided by a competent practitioner in about five minutes, immediately following a screening assessment or in another “teachable” moment. Brief support for behavioural change or extended brief interventions typically takes 20-30 minutes to deliver and can involve a small number of repeat sessions.

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Working with Alcohol Misusing Offenders – a strategy for delivery

• Link with local crime and disorder reduction partnerships (CDRPs), primary care trusts (PCTs) and D(A)ATs to develop a communitywide approach that fits within current partnerships e.g. parallel work with prolific and other priority offenders (PPOs), and Supporting People. • Ensure that all staff know how to make a referral directly to an alcohol service, where appropriate.

pattern and context of a person’s drinking although some misusers may never be able to achieve control over their drinking and will therefore need to abstain from alcohol completely. MoCAM sets out a four-tier treatment framework from low level interventions, often provided by generalists, to intensive specialist treatment. Local commissioners should work towards ensuring that alcohol misusers have access to a full range of interventions and treatment to meet their needs and can move between them. MoCAM advocates a ’Stepped Care’ model of treatment, where the intensity of intervention is increased only as needed. Current provision across NPS, frequently delivered in partnership with a range of voluntary and statutory agencies, broadly consists of: • Delivery of services in Tiers One and Two of MoCAM e.g. interventions comprising alcohol screening, advice and information and referral into mainstream specialist interventions in Tiers Two to Four 20 where appropriate. This can include the use of mutual aid groups such as Alcoholics Anonymous (AA) 21. • Offending behaviour programmes (see 2.3.2). • Resettlement/lifestyle assistance e.g. education, training and employment (ETE), learning and skills and help with accommodation, which link in with the pathways of the Government’s National Reducing Re-offending Delivery Plan.

2.3 Treatment
2.3.1 Probation and the ‘Models of Care’ approach Treatment should be allocated according to individual need, subject to availability, and linked to an offender’s motivation. OASys data indicates that over a quarter (27%) of offenders had problems with motivation to tackle their alcohol misuse 19. Probation staff have a key role in building and sustaining motivation. Alcohol dependence and other problem drinking behaviours are susceptible to change once the misuser has acknowledged and understands that there is a problem, though this is often very difficult. A successful intervention is one that leads to a reduction in alcohol-related problems not necessarily the number of units of alcohol consumed. The desired outcome may be achieved by changing the

19 Taken from the same O-DEAT analysis as the figures referred to in the second paragraph of Section 1.2. 20 These range from low threshold easy to access services to structured services which are aimed at individuals with a high level of presenting need including e.g. weekly counselling, structured day programmes, alcohol detoxification or stabilisation services and residential rehabilitation units. 21 Where no arrangements presently exist, areas should make contact with their local AA inter-group in order to develop a process for referring offenders. The AA Conference has recently approved the Thames Valley Probation/AA Liaison Model, which allows for referrals to be picked up 24/7, as the model of best practice. This model is now being adopted by other probation areas e.g. Derbyshire, Wiltshire.

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Probation areas will provide or broker the provision of: • Motivational work. • Screening, brief advice and information and referral for further assessment/to specialist interventions. • Accredited programmes, where appropriate. • Relapse prevention. Careful consideration, within the sentence planning process, needs to be given to the sequencing of interventions 22. This is particularly important for those leaving prison to ensure that there is the right kind of follow up to interventions begun in custody and that progress made is maintained upon release, (although in prisons, as in the community, alcohol services have not developed as comprehensively as for illicit drugs). This is likely to require close links with CARAT teams and the Drug Interventions Programme (DIP) for those with polysubstance misuse (including alcohol) problems. Also, offender managers should ensure that all alcohol interventions, whether delivered directly or brokered from other providers, should routinely be followed up to determine whether or not they have been effective and if further intervention will be needed.

NPD will: • Review guidance on the implementation of the alcohol treatment requirement (ATR) of the community order in light of MoCAM and the Review of the Effectiveness of Treatment for Alcohol Problems. • Use the relevant NOMS Sub-Boards on reducing re-offending to ensure that partners are aware of any issues concerning the availability, quality and quantity of treatment for offenders in the community. • Work with NOMS CIU and other key partners to support the commissioning process at PCT, D(A)AT/CDRP, regional and area level. Areas should: • Work with their D(A)ATs and PCTs to ensure a comprehensive assessment of local need is available and the D(A)ATs/PCTs commission services to meet these needs. • Provide information on the extent of alcoholrelated offending in their area and bring it to the attention of CDRPs • Consider the use of additional licence conditions 23 e.g. to address alcohol

22 A cohort study (ITTSI – Investigating the Targeting, Tailoring and Sequencing of Interventions) is currently underway with offenders on community orders which will include data on the level and frequency of drinking, severity of dependence, perceptions of treatment needs, contact with alcohol services and how these are sequenced in relation to other interventions. Another study (SPCR – Surveying Prisoner Crime Reduction) is examining similar issues with offenders in prison. 23 PC 28/2004 – Criminal Justice and Court Services Act 2000: Drug testing as a licence condition and further guidance on licence procedures for short term offenders refers.

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Working with Alcohol Misusing Offenders – a strategy for delivery

problems, where appropriate, to support post-custody interventions building upon what is delivered in prison. 2.3.2 Offending Behaviour Programmes The Probation Service has available a suite of accredited programmes aimed at addressing offending behaviour. A gap in existing provision has been identified in relation to those whose alcohol misuse needs are not sufficient to lead to a referral to the existing substance misuse programmes 24. This includes those on other programmes, such as violence and domestic violence, assessed as having alcohol misuse needs and those whose Offender Group Reconviction Scale (OGRS) score is too low for accredited programmes generally. A further programme 25, the Lower Intensity Alcohol Module (LIAM), is about to be piloted to meet this gap. NPD will: • Continue to develop and implement LIAM. 2.3.3 A new focus on resettlement Social factors such as accommodation, education and employment are significantly associated with re-offending 26 and need to be addressed in conjunction with alcohol misuse for effective outcomes. This is reflected in the National Reducing Re-offending Delivery Plan and regional resettlement strategies.

Regional Offender Managers (ROMs) are developing regional strategies which respond to the profiled needs of their regions. ROMs will have service level agreements (SLAs) in place with the prisons and probation areas which make up their regions. These SLAs will include performance management and delivery of interventions and will set out the contribution to be made to regional reducing re-offending strategies. Joined-up delivery is critical at regional and local level and requires effective partnership working. To support this work, a strategic partnership board will be commissioned in every region with appropriate representation from NOMS and its partners. Reducing re-offending is included within guidance on local area agreements (LAAs), and local strategic partnerships (LSPs) are encouraged to consider this to ensure successful rehabilitation of offenders is achieved within local communities. It is important, therefore, that we ensure that the need for effective alcohol services is on the agenda at local, regional and national level. The development of the Offender Management Model 27 provides for one offender manager to plan and manage interventions for offenders throughout their sentence whether or not they are in custody or the community. This should provide, among other things, for treatment/intervention needs to be identified while the offender is in custody and for treatment undertaken in prison to be built on upon release into the community. All offenders should be

24 Addressing Substance Related Offending (ASRO), Offender Substance Abuse Programme (OSAP) and Programme for Reducing Individual Substance Misuse (PRISM). 25 See PC 70/2005 – Substance Misuse Modules for more information. 26 Social Exclusion Unit (2002) Reducing re-offending by ex-prisoners, London, ODPM. Available online at: http://www.socialexclusion.gov.uk/page.asp?id=263 27 The Offender Management Model is being piloted in the North West. It is the case management framework, which is evidence-based, and designed to ensure better screening and assessment, co-ordination, targeting, brief interventions and brokering into treatment and offending behaviour programmes.

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allocated an offender manager who has overall responsibility for developing and reviewing the sentence plan during the offender’s journey through the correctional system. There are significant gaps in current provision such as the availability of services during evenings and weekends when offenders are most vulnerable and at risk, and how best to continue motivational work with individuals completing programmes. Mutual aid and self help groups such as AA can provide a useful resource here 28. NPD will: • Work with the relevant NOMS Sub-Board to maximise the accessibility and availability of alcohol services for offenders. • Support the ROMs in their role of implementing the regional reducing re-offending strategies. Areas should: • Ensure sentence plans take into account alcohol interventions undertaken in custody as part of end-to-end offender management. • Assess alcohol as a potential risk factor when preparing the risk of harm assessment and risk management plan (where applicable).

• Where relevant, be involved in joint care plan reviews to have input into issues such as whether or not the offender needs aftercare, AA or any other treatment.

2.4 Addressing diversity
Many of the same groups that are underrepresented in drug treatment also have difficulty in accessing alcohol services. For example, the social stigma attached to women’s alcohol misuse may act as a barrier to the referral of women to treatment 29 and many people from ethnic minorities feel disinclined to approach alcohol services, which are perceived to be unreceptive to their needs 30. There are often additional problems such as language, childcare, and strong ties to lifestyle and social networks revolving around drinking. While overcoming such barriers can be resource intensive, Probation Areas have experience which can be brought to bear widening access to services 31. Many alcohol misusers have multiple needs. Alcohol misuse and mental ill-health are frequently interlinked; around a quarter of drug misusers also misuse alcohol 32; and alcohol misuse is associated with problems such as homelessness. Alcohol can also have multiple impacts e.g. a woman offender who is a mother, where there might be child protection concerns and who is a victim of domestic violence. Perpetrators of alcohol related domestic violence may also require co-ordinated interventions

28 AA is available nationally 24 hours a day, 7 days a week and offers a highly integrated model of ongoing support and care using the 12 step approach. However, AA promotes abstinence which will not be appropriate for everyone. 29 Alcohol Concern (2001) Women and Alcohol Summary. 30 Purser, B. et al, (2001) Drinking in second and subsequent generation black and asian communities in the English midlands, Alcohol Concern. 31 For example, in the provision of child care for women offenders to be able to carry out community punishment (now called unpaid work). 32 Prime Minister’s Strategy Unit (2004) Alcohol Harm Reduction Strategy for England, London, PMSU.

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addressing a range of problems. It is important, therefore, that interventions tackle the full range of assessed needs. Many Areas monitor referrals and run specific schemes for hard-to-reach groups but there is limited evidence that such provision is working successfully. Evidence that is available and helpful includes monitoring and feedback from the providers and users, increased engagement of the targeted groups, and higher rates of completion of interventions. Services must be appropriate and relevant to the needs of diverse populations. For ethnic minorities, these needs include providing services in the person’s first language, being sensitive to religious responsibilities/traditions and cultures, and recruiting more ethnic minority workers into the treatment sector. It does not follow that this means separate interventions. For women one solution might be the greater use of female staff at key stages of assessment and treatment delivery. NPD has developed a Working with Women Offenders Policy and Strategy, which includes a section on substance misuse, and has a number of practice aims to improve equality of outcome of services for women offenders. More could be done to provide a holistic response to offenders with multiple needs, rather than

treating them separately. More effective partnership arrangements need to be established between agencies, particularly the alcohol treatment sector and mental health services 33. In addition, better training needs to be provided for those nonspecialists who might have to deal with offenders with other problems. It is the responsibility of local commissioners to develop integrated care pathways (ICPs) for those with complex needs but protocols could usefully be identified for how probation refers into and liaises with health and treatment services. NPD will: • Use information from OASys and secondary screening tools, such as AUDIT, to examine the pattern of alcohol misuse and offending within specific groups and, where appropriate, develop links with other agencies that share responsibility for these groups to improve access to treatment for everyone. • Work with ROMs to ensure that service specifications for providers include positive actions to promote diversity e.g. services for women, ethnic minority offenders; that good practice expectations are reflected in SLAs with providers of treatment; and that information is available to evidence whether treatment services’ outcomes are equitable.

33 The Department of Health’s Dual diagnosis good practice guide (2002) identifies ideal approaches to the commissioning and provision of treatment for those with substance misuse and severe mental illness. Mental health services should take the lead in instances where there is a diagnosis of serious mental ill-health.

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• Make those accredited offending behaviour programmes used in Wales available through the medium of Welsh language. Areas should: • Ensure that staff have the knowledge and skills to deal with cultural and educational differences. • Monitor the effectiveness of provision for diverse groups and take the appropriate corrective action, where needed.

• regular case conferences and inter-agency meetings, • joint training. Some areas have reported that basing specialist treatment staff in probation offices has proved very effective in terms of the number of offenders seen and in fostering effective working relationships 34. LAAs can facilitate a more flexible response to offender management at a local level. They also present an excellent opportunity for local partners engaged in offender management to work closer together to achieve shared outcomes and reduce costs. LAAs should therefore be used to consider ways in which different partners and partnerships involved in reducing offending and re-offending can work better together. Many solutions to crime, disorder and offending are rooted in issues like health, housing, education and environmental design so there are huge benefits from LSPs and those involved in reducing offending working closer together. Reducing re-offending has now been accepted as a core indicator within LAAs. Many of the second phase of LAAs have identified alcohol issues which will be addressed at the local level. NPD will:

2.5 Inter-agency working
The majority of current alcohol provision is delivered in partnership with voluntary and statutory agencies, which provide interventions ranging from specialist counselling to residential detoxification. Alcohol is also often linked with a number of other problems which may need to be treated by a relevant specialist service. In addition to local alcohol agencies, probation areas engage with D(A)ATs, PCTs, CDRPs, police, prisons, agencies responsible for housing and employment and alcohol arrest referral schemes. Establishing effective inter-agency arrangements is vital. This could involve; • sharing information between agencies, • an agreed referral process, • a clear lead agency on each case,

• Work closely with key partners such as Alcohol Concern, NTA, DH etc. to ensure provision is consistently on the agenda.

34 Typically, a treatment worker is attached to each probation office a different day of the week and time of day to undertake assessments, identify any incidence of alcohol misuse, and assist the officer preparing the Pre-Sentence Report (PSR); work with probation after sentence on sentence planning in relation to alcohol misuse; deliver alcohol programmes; and be available on a consultancy basis to probation staff to discuss particular cases. Several quadrants in London Probation Area are employing Alcohol Liaison Workers (ALWs) based in probation teams. ALWs carry out full alcohol assessments and refer offenders into treatment, where appropriate.

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Areas should: • Have an alcohol policy lead responsible for making links with local alcohol services and understanding the types of services available. This person should also act as the main contact point for services. • Work with key partners (PCTs, D(A)ATs, CDRPs) to ensure that there is sufficient alcohol and supporting provision e.g. accommodation, ETE locally.

the nature of addiction; and the knowledge to assess and refer offenders. This could be achieved through specific alcohol awareness training run in-house; shadowing a provider or going on job secondment; specialist alcohol services providing the training; or on a multi-agency basis as part of workforce planning to develop local alcohol treatment systems. Training should be linked to the Drugs and Alcohol National Occupational Standards (DANOS) 35 Adherence to DANOS will ensure: • Recruitment of staff with the necessary knowledge, skills and experience. • Development of appropriate job descriptions and person specifications. • Appropriate induction and training. NPD will: • Ensure that the standards and training for new probation officers are consistent with DANOS. Areas should ensure that: • All probation staff involved in delivering and managing (or directing) Tier One and/or Tier Two interventions, including alcohol education or information and brief advice and support, are trained and competent to the relevant DANOS standards and more specific/specialist training is provided for those who need it.

2.6 Training and development
The Harm Reduction Strategy proposed “improved training of staff to increase awareness of likely signs of alcohol misuse” as one of a number of measures to improve the early identification and treatment of alcohol problems. Across the Probation Service training is variable; for example, only in some areas is an alcohol component included in staff induction. Many areas have no specific alcohol training in place and a significant proportion of staff do not feel adequately trained to work with alcohol-misusing offenders under their supervision. Staff need to be able to identify a problem with alcohol misuse; offer basic advice on safe drinking levels; challenge offenders about the impact that drinking has on all aspects of their lives; and know how to refer an individual with a problem. Basic training for all staff working with alcohol misusing offenders should allow them to develop motivational skills; techniques for working with offenders with different needs; an understanding of

35 DANOS specifies the functions carried out in tackling alcohol misuse, the standards of performance required of individual workers and the knowledge and skills they require. Where non-alcohol specialist professionals work with drinkers, relevant DANOS competencies are drawn into the standards for their own profession.

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• Staff have sufficient knowledge of sentencing options and appropriate treatment provisions and who to target for what type of sentence/intervention. • Any additional training is designed around the DANOS competencies.

2.7 Performance monitoring
NPD presently monitors the use of the ATR and the range of accredited programmes in dealing with alcohol problems, compliance with orders and the use of additional licence conditions. Areas also need performance data to inform future decisions about the commissioning and delivery of services, although this needs to be balanced against the operational burden of data collection. In the longer term, performance monitoring is likely to be included in the remit of the ROMs. NPD will: • Review the data on the use of the ATR to identify any potential problems and agree remedial action and continue to monitor alcohol related interventions more generally within existing performance monitoring arrangements. • Work with RDS-NOMS to develop and implement arrangements for monitoring the delivery of the strategy and assessing its success against its aims and objectives. The Strategy will be reviewed in light of wider developments in the alcohol field, including the implementation of the Alcohol Harm Reduction Strategy.

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Working with Alcohol Misusing Offenders – a strategy for delivery

Glossary of terms
AA ATR AUDIT CARATs CIU CDRPs D(A)ATs DANOS DIP DH DSU ETE ICPs LAAs LIAM LSPs MoCAM NOMS NPD NPS NTA OASys O-DEAT OGRS PCTs PPOs RDS ROMs SLAs Alcoholics Anonymous Alcohol Treatment Requirement Alcohol Use Disorders Identification Test Counselling, Advice, Referral, Assessment and Throughcare services Community Integration Unit (NOMS) Crime and Disorder Reduction Partnerships Drug (and Alcohol) Action Teams Drugs and Alcohol National Occupational Standards Drug Interventions Programme Department of Health Drug Strategy Unit (NOMS) Education, training and employment Integrated Care Pathways Local Area Agreements Lower Intensity Alcohol Module Local Strategic Partnerships Models of Care for Alcohol Misusers National Offender Management Service National Probation Directorate National Probation Service National Treatment Agency for Substance Misuse Offender Assessment System OASys Data Evaluation & Analysis Team Offender Group Reconviction Scale Primary Care Trusts Prolific and other Priority Offenders Research, Development and Statistics Regional Offender Managers Service Level Agreements

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Acknowledgements
NPD Interventions Unit would like to thank all the individuals and organisations who contributed to the development of this strategy. In particular, we would like to express our gratitude to the following for their assistance and helpful input: Alcohol Concern Alcoholics Anonymous (AA) Department of Health (DH) National Offender Management Service (NOMS): Community Integration Unit (CIU) Drug Strategy Unit (DSU) Research, Development and Statistics (RDS) NPD OASys Data Evaluation & Analysis Team (O-DEAT) National Treatment Agency for Substance Misuse (NTA) Various Alcohol Treatment Agencies Various Probation Areas Particular thanks are due to: Eric Appleby (former Chief Executive, Alcohol Concern) Patricia Best (National Policy Development, NOMS CIU) Caroline Bonds (Drug Treatment Team Leader, NOMS DSU) Dr. Gemma Harper (Programme Director, RDS-NOMS Research & Evaluation Programme) Philip Howard (Senior Research Officer, O-DEAT) Trevor McCarthy (Senior Policy Officer: Alcohol, National Treatment Agency) Don Shenker (Director of Policy and Services, Alcohol Concern) and all current and former colleagues within NPD, the Home Office and across the Probation Service who worked on or contributed to the strategy during its long gestation.

Contact for enquiries
For further information about the strategy contact: Robert Stanbury Drug/Alcohol Policy Developer NPD Interventions Unit Tel: 020 7217 0767 Email: Robert.Stanbury@homeoffice.gsi.gov.uk

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Working with Alcohol Misusing Offenders – a strategy for delivery

References
Department of Health (2005) Alcohol Misuse Interventions – Guidance on developing a local programme of improvement, London, DH. Available online at: http://www.dh.gov.uk/PublicationsAndStatistics/Publi cations/PublicationsPolicyAndGuidance/PublicationsP olicyAndGuidanceArticle/fs/en?CONTENT_ID=41232 97&chk=lLGV84 Drummond, C. et al, (2005) Alcohol Needs Assessment Research Project (ANARP): The 2004 national alcohol needs assessment for England, London, DH. Available online at: http://www.dh.gov.uk/PublicationsAndStatistics/Publi cations/PublicationsPolicyAndGuidance/PublicationsP olicyAndGuidanceArticle/fs/en?CONTENT_ID=41223 41&chk=WlR9wX Heather, N., Raistrick, D., & Godfrey, C. (2006) Review of the Effectiveness of Treatment for Alcohol Problems, to be published later in 2006. HM Prison Service (2004) Addressing Alcohol Misuse – A Prison Service Alcohol Strategy for Prisoners, London, HMPS. Available online at: http://www.hmprisonservice.gov.uk/news/index.asp? id=2173,22,6,22,0,0 Home Office (2005) A Five Year Strategy for Protecting the Public and Reducing Re-offending, London, TSO (The Stationary Office). Available online at: http://www.noms.homeoffice.gov.uk/news-publicati ons/policy-consultation/ NOMS (2005) The National Reducing Re-offending Delivery Plan, London, NOMS. Available online at: http://www.noms.homeoffice.gov.uk/news-publicati ons/policy-consultation/

NOMS (2005) Strategy for the Management and Treatment of Problematic Drug Users Within the Correctional Services. Available online at: http://www.noms.homeoffice.gov.uk/news-publicati ons/policy-consultation/ National Treatment Agency (2006) Models of care for alcohol misusers, to be published later in 2006. Information available online at: http://www.nta.nhs.uk/programme/guidance/moca m.html Prime Minister’s Strategy Unit (2004) Alcohol Harm Reduction Strategy for England, London, PMSU. Available online at: http://www.strategy.gov.uk/work_areas/alcohol_mis use/index.asp Prime Minister’s Strategy Unit (2003) Interim Analytical Report. Available online at: http://www.strategy.gov.uk/work_areas/alcohol_mis use/interim.asp Skills for Health (2005) Drugs and Alcohol National Occupational Standards (DANOS) – Guide. Available online at: http://www.skillsforhealth.org.uk/danos/

Relevant previous probation circulars
58/2003 Development of the NPS Alcohol Strategy 57/2005 Effective Management of the Drug Rehabilitation Requirement (DRR) and Alcohol Treatment Requirement (ATR) 70/2005 Substance Misuse Modules

This publication can be downloaded from the NPS website: www.probation.homeoffice.gov.uk Hard copies, where available, can be requested from: NPSpublications@homeoffice.gsi.gov.uk

NPD/AS1/2006