Turnaround Service

1
Turnaround Service

• September 2009

2
What we intend to cover?

• Background on Turning Point Scotland
• The context of the national drugs strategy in
  Scotland?
• Background to the Turnaround service
• Key aspects of services provided
• Challenges and issues going forward

3
What about Turning Point Scotland

• Roots lie in working with people with addictions
• Driven by social, cultural and value based
  principles
• Significant development over past 10 years
• Strong focus and experience in service delivery
• Good coverage across Scotland
• Positive reputation and profile

4
TPS has 36 services Throughout Scotland. Of
these, 12 are classified as substance misuse
services.
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Demographics incidence

• Estimated that 52,000 people in Scotland are
  problem drug users almost 1 in 50 of our
  population aged between 15 and 54. This number
  does not include recreational drug use such as
  cannabis, cocaine and ecstasy which are the
  three most commonly used illegal drugs.

6
Demographics incidence

• In 2007/08, the public sector spent 173 million
  on drug and alcohol services in Scotland, 84
  million specifically on drug services and 30
  million on alcohol services. Remainder spent on
  joint drug and alcohol services

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The Scottish Drugs Strategy The Road to
Recovery

• Preventing drug use.
• Promoting recovery.
• Law enforcement.
• Getting it right for children in substance
  misusing families.
• Making it work.

8
The Road to Recovery

• Need to move on from the abstinence v. harm
  reduction debate
• Promoting the concept of recovery
• Need to better organise and co-ordinate services
  across Scotland

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Background of Service

• Suicides in Corntonvale Prison (8 suicides over a
  18 month period)
• Safer Way Report 1998 (highlighted women who
  serve short term sentences could be dealt with
  better in the community)
• Better Way Report 2002 (not a lot of changes made
  in relation to community orders and 218
  established) both reports indicated that a high
  proportion of women going into custody had
  substance misuse and mental health issues)
• Highlighted that women could be dealt with more
  effectively in the community in particular for
  short term sentences
• 218 service was established for women as a direct
  alternative to custody (direct alternative to
  custody through residential and day service
  offers enhanced support to criminal justice
  orders
• Number of women from Glasgow placed in custody in
  Corntonvale has reduced

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Male Offending

• Recognition by TPS that a service for male
  offenders should be developed with success of 218
• TPS raised substantial funds through a range of
  discretionary funders and approached Scottish
  Executive to match funding
• Joint service with APEX/VENTURE TRUST and TPS
  agreed with Scottish Government (apex venture
  trust and TPS are working jointly to ensure a
  pathway for service users from chaos to
  stability. Venture trust (outdoor experience)
  APEX (employability) TPS (all issues in relation
  to offending behaviour)
• Longer term approach to offending behaviour
• Mapping exercise carried out to identify areas
  for service to be placed (Offending, Scottish
  Index of Multiple Deprivation)

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What areas do we cover?

• Day services open to those who are within base
  area
• Residential unit open to 10 local authorities
  covered by NS and SW CJA

12
Day Services

• 4 day bases situated in NCJA and SWCJA area
  Inverclyde, West Dumbarton, Irvine and
  Kilmarnock
• Every area may be supported in different ways in
  relation to where the service fits in e.g.
  Ayrshire Probation, West Dumbarton Constructs
  work
• Male 18-30
• Persistent offenders live connection with
  criminal justice system, warrants, bail, Deferred
  Sentence, DTTO, breach of orders, non engagement
  with orders, short term prison sentences,
  revolving door history, additional intensive
  support required
• Trying something different what's not worked
  with this group of men
• Intensive support programme to work with Courts,
  Criminal Justice Area Teams and other services to
  provide an enhanced support service to male
  offenders

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Residential

• Appropriate for the most chaotic, vulnerable
  offenders who cannot engage with services in the
  community
• 10 bedded residential unit
• Open to all local authorities
• Can be used as an alternative to custody
• Criminal justice order e.g.. Possible breach

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Structure of Unit

• Full comprehensive assessment drug use,
  offending, accommodation, benefits, mental,
  emotional and physical health, service support
• Fully structure programme
• One to one work daily
• Group work daily
• Weekly review of progress
• Maximum 6 week stay

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Structure of Residential

• Programme Content Daily group work focusing on
  issues relating to offending behaviour. Groups
  include Change, Anger management, Triggers,
  Victim awareness, Relapse prevention.
• Daily one to ones take place to cover all the
  above issues in depth and work through issues
  specific to individuals.
• Intensive work is complimented with alternative
  therapies such as acupuncture and various
  educational and recreational activities.
• Medical team on board to work with individuals on
  health and substitute prescribing needs.
• Partnership work with Apex and Venture Trust.

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Referral process

• Telephone referral taken
• Assessment can be completed by e-mail/fax
• Clear exit plan needed to ensure consistency in
  care when returned to the community of source
• Clear plan needed in relation to prescribed
  medication
• Clear plan in relation to support from referrer
  whilst in residential unit
• Clear plan in relation to early demission or
  service user leaving unit

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Expectations from CJ

• Sign up for clear exit strategy
• Sign up for contact whilst in residential
• Attend at least one review (minimum) mid way
  review
• Ensure communication channels are clear from both
  sides with clear roles and responsibilities in
  relation to the care plan
• Clear plan in relation to any visits or court
  dates (flexibility is needed)

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While deprivation and problem drug use are all
associated with poorer health, increase in
crime, they are also associated with poorer
service use......the challenge for service
providers is to provide care which is appropriate
to need and which they will want to use.
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Challenges

• Challenges that clients face include
• Issues with housing on return to the community
• Outstanding legal matters whilst staying in
  residential
• Returning to community- existing peer group,
  family support, building positive networks,
  maintaining daily structure.
• Stigma
• Barriers to accessing services such as healthcare
  services perhaps due to lack of engagement in the
  past
• Barriers to employment

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Recovery focused practice What next?

• We need funding targeted at providing support at
  each step of an individuals road to recovery,
  not just at primary care.
• We need to provide continued supports for people
  when they are stabilised or stopped their drug
  use.
• People need continued support as they move on in
  their journey into education, training or
  employment, to develop or re-build personal and
  social relationships.