Annex
SECTION 1
MODELS OF
SERVICES DRAWN
FROM TURNING
POINT'S
WORK
1.1 Alternatives to prison. Turning Point's
STEP Project in Wakefield
The STEP project was the first pilot in Britain,
targeting drug-related offending. It is run along similar lines
to American models and has been operating since 1998. The scheme
is now the main DTTO (Drug Treatment and Testing Order) provider
in West Yorkshire, but has maintained this unique drug court feature.
The main objective of the STEP project is to
deliver an effective drug court service linked to a specifically
designed treatment programme. The principal aims of the project
are to reduce offending, reduce drug dependence and be cost effective.
Phases of treatment include detoxification/stabilisation and rehabilitation.
Like DTTO's the STEP Project works with clients who are sentenced
in a Magistrates Court (High tariff option) and willing to comply
with both the treatment programme and the Probation Order.
Through the arrest referral process, STEP also
provides access to other community programmes and treatment facilities.
For example, rehabilitation includes mentoring support, literacy
and numeracy, education and vocational training.
Key features of the STEP project are the use
of specially trained magistrates and the use of the same court
and panel for a client's monthly review.
Advantages
— the views of service users and magistrates
indicates that both parties benefit from the consistency of the
panel in the drug court, from the initial sentence to subsequent
review. This means far more accountability for the offender as
well as the opportunity for positive feedback from the magistrates.
Consistency lends itself to building relationships and respect.
In other settings, client may see many different people in the
course of a DTTO;
— in Wakefield, reviews are held in
the Family court and clients often speak more freely because the
atmosphere is less intimidating than a Crown Court; and
— magistrates are specially trained
and also receive ongoing training.
This type of work gives them an insight into
the complexities around offending and drug use.
1.2 A Young People's Drug Service—the
SHED Project
Over the last five years, there has been an
increased emphasis on the need for separate services for young
people.
Advisory documents:
— Assessing Young People's Drug Taking:
Guidance for services 1999.
— Assessing Local Need: Drug Interventions
for Vulnerable Young People 1999.
— Policy Guidelines for Working with
Young Drug Users 1999.
— HAS Substance of Young Need 1996
(newly replaced by 2001 document).
The above documents identify the need for separate
policies, assessment and interventions specifically aimed at young
people.
SHED Young People's Drug and Alcohol Project
has based its service provision on such guidance resulting in
a service which includes:
Drop-in services providing low threshold access
to advice support, counselling and guidance. Immediate access
is essential as young people will often base their views of a
service on initial contact.
Ongoing support to young people, long and short
term. This includes a variety of interventions including brief
solution focused therapy, play therapy, cognitive behavioural
therapy and key-working approaches. Many of our clients will not
have undertaken long-term work, or are not sufficiently motivated
to attend ongoing programmes of care. This is often due to them
being at the start of their drug using career where the attraction
to continue is greater. It may also be due to the level of chaos
in their lives—this may include family breakdown, school
issues or sexual exploitation. SHED staff appreciate that some
young people will only attend the service for one session and
so will impart as much advice and information as possible without
overwhelming the client.
Education work: among all age groups from primary
age, secondary age and colleges. SHED feels it is important for
all young people to receive age appropriate drugs education along
the key stages. Drugs education is done on a primary, secondary
and tertiary basis with issues such as incorrect injecting practices,
inquiries about the physical effects of substances on the body,
the effects of mixing substances and a lack of understanding re:
legal implications, being common with individuals accessing the
service for one-to-one work.
Outreach work with young people including specific
groups who are considered socially excluded.
SHED aims to provide education and interventions
to young people wherever they are in their drug using careers.
This includes providing basic information to the first time cannabis
user on the physical, social and legal effects, to harm minimisation
advice around safer use to the long-term chaotic heroin user.
SHED's philosophy is that of harm minimisation.
We appreciate that the safest use of drugs is not to use at all
but this is unrealistic to many young people and fails to advise
and support those young people who will experiment and continue
to use drugs on whatever level.
Our experience is that intervention is most
successful if undertaken at early in the individual's drug-taking
career. Working with an individual who has already got a criminal
record, an infection such as hepatitis or HIV, or who has become
isolated from family, friends and support mechanisms, is never
as successful as undertaking preventative work to stop such problems
occurring.
Young People's drug services should incorporate
all aspects of treatment including support to those who are not
able to stop using. Services should also provide variety of interventions
as not all young people will respond to one type. Particularly
vulnerable groups also need to be catered for.
To this aim, SHED undertakes work, or is in
the process of developing work with:
— young people who are being sexually
exploited;
— young people in Local Authority Care—acquiring
a worker to be seconded to Looked After Children's Service;
— care leavers—Worker to be recruited
to work with young people leaving care;
— socially excluded young people;
— young injectors including the development
of young people's needle exchange;
— prescribing for young people;
— children of drug misusing parents—from
2002 SHED will be developing a therapeutic support group for this
client group; and
— young people in the criminal justice
system—YOT worker to be seconded from SHED to that team.
It is hoped that SHED will soon be an all encompassing
service where young people are not lost in a system of waiting
lists an cross referrals.
The most important aspect of working with young
people includes the need for separate policies around working
with young people, taking into account local child protection
procedures. SHED works within South Yorkshire Child Protection
Policies and Procedures and has a close working relationship with
the Area Child Protection Committee whilst maintaining its own
confidentiality and child protection procedures.
As seen above, SHED works with young people
from a variety of backgrounds. As young people often have a variety
of issues which impact upon their use of substances, to be successful
in any intervention, it is important that all these needs are
looked at, not simply focusing on a single issue. It is also essential
to understand that those interventions which work for adult substance
users cannot always be directly applied to young people. Young
people often have more complex issues, are less likely to engage
with services, require services to be more flexible, and need
workers with skills and a desire to work with this challenging
client group.
1.3 Druglink's Stimulant Service based in
Hammersmith and Fulham
Druglink's Stimulant Service provides a semi-structured
flexible day programme for stimulant drug users (75 per cent of
whom are Crack Cocaine users). It provides a menu of services—key-working,
structured groups, unstructured groups, complementary therapies,
practical interventions and an activities group—from which
clients select, in conjunction with a worker, the elements that
are most suitable for them (although there is an expectation of
each client selecting a minimum of three options. This Care Plan
is reviewed on a monthly basis, as well as being Outcome monitored,
using the Christo Inventory. The service operates on an holistic
basis seeking to address a range of social factors including housing,
education, training and employment physical and mental health.
The service is designed to work with crises,
ie relapse, normal hour long structured appointments are flexible
in order to accommodate individual need. The priority is to maintain
contact with service users, missed appointments will be followed
up by 'phone calls so as to minimise drop-out rates; often clients
engagement will be patchy for one to two months, but where contact
is maintained they are far more likely to engage fully in the
medium term. Where possible family members/partners are included
in order to enhance support networks.
Stimulant users have generally been neglected
by services in the past, therefore it is important to promote
services in more innovative ways. Long-term outreach is an integral
part of such a strategy, especially as the client group has a
tendency towards paranoia/anxiety; therefore using existing service
users as conduits into the using environment helps to build trust
and confidence. There are obvious links with the Criminal Justice
system, which need to be exploited particularly Arrest Referral
Schemes and Court based Outreach. The other significant access
issue relates to opening hours, the service operates a structured
group and appointments between 6 pm and 8 pm on Mondays and an
unstructured group and appointments 7 pm to 9 pm on Wednesdays.
Key issues
— flexible services that work with
the individual rather than trying to fit him/her into a structured
programme;
— working with chaos and relapse—providing
space and support when it is required by the client;
— strong links with generalist services—Mental
Health, Housing, ETE, Dyslexia;
— diverse staff teams reflecting the
community;
— sophisticated Outreach model involving
the Criminal Justice Services;
— involving family members;
— the service should be distinct but
not detached from other drug services;
— strong partnerships, including the
Police, Regeneration and Health Living projects;
— complementary service to support
younger drug users;
— skills in working with mental health
problems; and
— a service needs to be local to encourage
attendance but not right in the middle of a using area.
1.4 Effective community resettlement
North Tyneside Resettlement Project (NTRP)
Resettlement services are few and as far as
Turning Point is aware, this is the only one in the country whose
clients include those outside the criminal justice system. The
project provides a resettlement service for people returning to
North Tyneside who have had a history of drug use and acts as
a bridge in the transition from custody or rehabilitation to community
resettlement.
Clients are referred:
— from the criminal justice system;
— from rehabilitation services round
the country; and
— from detox services in local hospitals.
An independent evaluation by the University
of Northumbria and Newcastle has shown positive results for this
pilot (Minding the Gap: an evaluation of a re-settlement scheme
for drug users in North Tyneside by Peter Francis and Jamie Thompson,
November 2001). Paul Hayes has commended the service and the model,
so it is anticipated that this service and similar ones in the
future will be more closely linked to targets and outcomes within
the criminal justice agenda. This type of service is one that
should also be applied to people in a variety of situations.
The responsibility for ex-offenders and other
people leaving rehabilitation who require drugs services, often
falls between the relevant agencies. As a consequence of the lack
of support during this crucial transition stage and the non-specialist
support of what is available, the crucial links are not made.
There are problems with take up of referrals, missed appointments
and resettlement into the community that results in the loss of
treatment gains made in relation to substance use.
The NTRP is a project that from its early beginnings
has sought to address the gap in service provision to offer a
joined up and seamless approach to resettlement support. The NTRP
developed in late 2000 from the work of a Community CARAT worker.
Funded in 1999, for 18 months, the aim of the Community CARAT
worker was to work with re-settling alcohol/substance misusing
offenders to reduce re-offending.
It was originally set up by SRB 5 funding which
was part of a consortium (the Probation Service had secured the
funding and Turning Point, Women's Aid and Barnado's provided
the service). It is envisaged that the service is going to continue
to be funded by DA/AT pooled budgets.
There are now three full-time resettlement workers
and one fill-time community service volunteer. In the future,
staff are hoping to link the project with Turning Point's mentoring
scheme, and with local colleges and employment services, who have
identified learning and skills priorities to help find employment
for socially excluded groups.
SECTION 2
ADDITIONAL INFORMATION
2.1 Is cannabis a stepping-stone drug?
This section contains further information on
the "Stepping-stone" theory—the notion that cannabis
use "causes" further harmful drug use and the Gateway
theory based on the user's behaviour and environment, not on any
qualities or effects of the drug itself.
There appears to be no definite hierarchy of
drug use. There is no reason to think that drug use will increase
as a result of the reclassification of cannabis.
The "Stepping-stone" theory—the
notion that cannabis use "causes" further harmful drug
use has been dismissed by scientific inquiry and should be conclusively
rejected (DrugScope).
Whilst it is likely that many problem heroin
and crack/cocaine users would report past and present cannabis
use, recent research undertaken by Howard Parker indicates that
early tobacco smoking and alcohol use is far more predictive of
later hard drug use.
Background
Illegal leisure: The normalisation of adolescent
recreational drug use—Parker, Aldridge and Measham 1998.
This study confirms the link between heavier drinking and the
use of tobacco, illicit drugs and other risk-taking behaviour.
There is evidence from our interviews with young people of a blurring
of the legal and illicit in their "pick and mix" psycho-active
culture with the alcohol and tobacco acting as possible gateway
drugs through to the illicit range, in a literal sense, in that
they usually precede experimentation with illicit drugs, but more
particularly because of the relationship between heavy and frequent
drinking and drug use.
Also of relevance to alcohol's possible gateway
role is its physiological effect as a depressant or disinhibitor,
affecting or excusing young people's judgement, leading to alcohol
being considered to be a cause of unplanned drug use for some
respondents when they were intoxicated with alcohol. P81.
Alcohol also particularly dangerous drug because,
not only is it legal, but it is also socially acceptable behaviour
to consume large quantities.
(Earliest) risk taking behaviour is around smoking
and drinking and cannabis comes later with some young people.
Parker would support the gateway hypothesis.
The gateway hypothesis—drug use follows
a developmental sequence where those using illicit drugs will
invariably have used alcohol or tobacco but not all those using
illicit drugs will move onto using more harmful illicit drugs
such as heroin or cocaine. It is not dictating or predicting what
will happen to people using trying cannabis, it is an analytical
tool for understanding individual drug use.
The gateway theory is based on the user's behaviour
and environment and not on any qualities or effects of the drug
itself (DrugScope).
2.2 The need for closer integration of a drugs
strategy with neighbourhood renewal initiatives
Background: Robin Burgess, Policy lead in Home
Office Drug Strategy Directorate has said: "For the first
time an identifiable and large scale drug specific source of funding
exists (Communities against Drugs 2001 budget £220 million
over three years) to enable communities to resist drug use. CAD
funding allied to other regeneration spending such as the NRF,
offers real hope for some of the poorest communities. The CAD
funding supports this new willingness to join up the strategies".
Druglink November-December 2001.
However, Turning Point's observations are that:
— if there is a new willingness to
join up strategies, it is not demonstrated by a clear "drugs
focus" in neighbourhood renewal initiatives;
— in our own research—Stuart
Wilks-Heeg—Turning Point and Urban Regeneration October
2001, Turning Point was surprised that although the New Commitment
to Neighbourhood Renewal to have the goals of lower worklessness
and crime, better health, skills, housing and physical employment
and to narrow the gap of these measures between the poorest areas
and the rest of the country, it makes very limited reference to
substance misuse, although commitments 31-33 do address the issue
of tackling drug dependency in deprived areas;
— Turning Point's experience of Single
Regeneration Budget and other regeneration funding is that it
is extremely complex, time-consuming and bureaucratic. This was
borne out in another article in the same issue of Druglink by
Kate Davis, a DAAT team Co-ordinator for North Notts who comments
that: drugs schemes compete with more politically friendly bids
(school clubs, football pitches) and that despite increased evidence
of drug use among young people, there is reluctance to fund drug
projects through regeneration schemes and the intensity of paperwork,
bureaucracy and the need to match funding by at least 50 per cent
deters many substance misuse projects from applying; and
— within the general youth population,
those who are the most likely to try heroin are: "serious
drug users distinctively and away from the norm . . . on sensation
seeking. There is little doubt that if we add poor school performance,
and attendance, light parental supervision and growing up at the
wrong end of town, we are offering the basic identikit of the
most likely heroin user." Howard Parker: New Heroin outbreaks
amongst young people in England and Wales, p 44, 1998.
December 2001
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