Strengthening Continuity of Care: New Zealand s Alcohol and Other Drug (AOD) Aftercare Worker Pilot

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1 Strengthening Continuity of Care: New Zealand s Alcohol and Other Drug (AOD) Aftercare Worker Pilot Caitlin Chester Senior Adviser Alcohol and Other Drugs Department of Corrections New Zealand

2 Department of Corrections - 17 Public Prisons + 1 Private Prison - 10,152 prisoners (growing) - 7,166 sentenced - 2, 986 remand - 7% women - 50% Maori - 11% Pasifika - 29,317 community based offenders - 8,000 staff

3 Offender population

4 Alcohol and Drug Use Among Prisoners Department of Corrections commissioned research in 2015 to establish the prevalence of substance use disorders among New Zealand prisoners. Main Findings The majority of prisoners had a lifetime diagnosis of a substance use disorder Just under half had a twelve month diagnosis of a substance use disorder Prisoners were 13 times more likely to have a twelve month diagnosis of a substance use disorder compared to the general population.

5 Alcohol, Drugs and Crime In New Zealand: Approximately 1/3 of all police apprehensions involve alcohol; Over 300 alcohol-related offences are committed every day; Over 20,000 illicit drug offences are recorded each year; Over 4,000 recorded offences for dealing or trafficking illicit drugs each year.

6 Opportunity Imprisonment offers a unique opportunity to provide treatment to a high need population, which could have profound effects on society. There is a growing consensus within the sector on what are considered evidence-based principles for effective substance use treatment for individuals within the criminal justice system (e.g., Belenko, Hiller & Hamilton, 2013; Fletcher & Chandler, 2006; Friedmann, Taxman & Henderson, 2007). Practice: The New Zealand Corrections Journal Evidence-based principles for prison-based alcohol and drug treatment

7 Evidence- Based Alcohol and Drug (AOD) Treatment for Prisoners Screening and Brief Motivational Intervention (1 session) using the - Alcohol, Smoking and Substance Involvement Screening Test (ASSIST: World Health Organisation, 2002) AOD Brief Intervention (2 weeks) AOD Intermediate Intervention (4 weeks) Intensive AOD Treatment Programme (ITP) (8 weeks) Drug Treatment Units (DTU) (3, 6 and 12 months)

8 Post-treatment Support for Prisoners: The Evidence Participation in a continuum of treatment is the most effective practice for drug involved offenders (National Institute of Health, 2014). Re-imprisonment rates are lower amongst offenders that attend aftercare activities following AOD treatment (e.g., Prendergast et al., 2004). 3 Year re-imprisonment rates: - 27% for those completing treatment and receiving aftercare - 79% for in-prison treatment completers without aftercare - 82% for in-prison treatment dropouts - 75% untreated prisoners Benefits of prison-based transitional treatment following intensive prison-based drug treatment has additional benefits over and above prison-based intensive drug treatment followed by community aftercare only (e.g., Butzin et al., 2002).

9 AOD Aftercare Pilot in New Zealand Prior to the 2014 election, the Government signalled in its manifesto agreement that it would provide community-based AOD support. The Department applied to the Justice Sector Fund in March 2015 and successfully obtained a total of $8.625 million over three years to develop a suite of AOD aftercare support.

10 Suite of AOD Aftercare Services AOD Support Line (Prison and Community) Intensive Treatment Programmes (Community) Live: 24 May Implemented AOD Aftercare Workers (Prison and Community) Implemented

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12 Intensive Community Treatment For community offenders and prisoners transitioning out Residential AOD Treatment (implemented) New, Corrections-specific beds to remove barriers to access and increase overall capacity across the country Intensive Outpatient Programmes (in development) New, Corrections-specific programmes with treatment tailored to meet the individual needs of our offenders All treatment options include pre-treatment and aftercare services.

13 AOD Aftercare Worker Service (Implemented) The aftercare worker is expected to support and guide each Offender to achieve their AOD related rehabilitation and reintegration goals. The role involves supporting the Offender to maintain the changes made during the DTU/ITP whilst in prison and upon release into the community.

14 Pilot Design Process Create and implement governance structure Determine key design principles Create high level design Consult with Service Providers Design Communications Plan Design Evaluation Framework Design Quality Monitoring Framework Develop detailed service specifications Create Implementation Framework Contract Service Begin implementation On-going action-learning

15 Implementation To ensure consistency across sites: Corrections developed practice guidance in collaboration with Service Providers; Corrections led a 2-day induction workshop for all AOD aftercare workers.

16 Success to Date The service went live on 4 July 2016: AOD aftercare workers were placed in 12 prison sites nationwide (at each ITP/DTU service); 1,167 active offenders in the service Through on-going action learning successes and barriers have been identified and actioned Additional service gap was highlighted with regards to ITP/DTU non-completers and a mini-pilot was developed.

17 Enhancing Continuity of Care What about the prisoners who exit early from AOD programmes? Early exits from prison based AOD treatment programmes range from 4% to 60%; More prisoners drop out during the first month compared to any other month. What can we do to help this group? A brief motivational intervention to identify the reason for exit, develop plan to address barriers to treatment, and elicit or enhance motivation for change. Outcome: the prisoner re-engages in an appropriate programme depending on their drop out reason, needs and motivation Start AOD Programme Early Exit from AOD Programme Brief Intervention Re-engage in appropriate programme

18 3 Month Process Review: Framework Methodology The framework methodology for the AOD aftercare worker process review consists of three components. The components are: Relationships Utilisation of the service Service delivery

19 3 Month Process Review: Findings Overall, the service appears to have embedded well into the Corrections AOD rehabilitation space. Successes Feedback from participants and practitioners was overwhelming positive - participant satisfaction rating of 88% The action learning process allowed the project team to quickly respond to areas of concern or ambiguity Relationships between provider and Corrections staff improved All participants entering the service were equipped with relapse prevention plans

20 3 Month Process Review: Findings Lessons Learned More emphasis needs to be placed on engaging whanau in the AOD programmes and aftercare Monthly reporting was challenging for providers There was frequent turnover among aftercare workers which effected service delivery

21 AOD Aftercare Worker Next Steps Review AOD aftercare worker caseloads and re-evaluate AOD aftercare worker demand and placement Implement the quality monitoring framework Implement and review mini-pilot for DTU/ITP non-completers. Conduct end of pilot evaluation.

22 AOD Aftercare in New Zealand Intensive prison-based AOD Treatment Transitional support in DTU s On-going prison-based AOD aftercare On-going communitybased AOD aftercare Intervention for noncompleters prison-based AOD Treatment