Why won’t commissioners follow the evidence-base?

From 2013/14 newly elected Police & Crime Commissioners will have responsibility for community safety and Drugs Intervention Programme budgets and will be looking for new and effective ways to tackle drug-related problems. I’m hosting a series of posts from organisations who feel they have a successful model.

 

This week, Mike Trace, Chief Executive from drug treatment charity RAPt (and previously Deputy Drug Czar) describes a 12-step model with an impressive evidence base for cutting re-offending.

 

The Rehabilitation Revolution

This government has been right to announce a Rehabilitation Revolution– it knows that the key to cutting crime is bringing down re-offending rates amongst those already engaged in the system.

Ten per cent of offenders are responsible for half of all crime. Drug using offenders are heavily represented within this 10% – the constant need to get money to feed a daily addiction results in prolific patterns of offending.

Indeed, recent studies (Stewart 2008) suggest that over half of new receptions into English prisons are problematic drug users and that approximately half of all property crime is drug-related with a typical addict spending around £1400 per month on drugs (NTA, 2012).

What works

After almost 30 years working in the drugs and crime field, I am aware of only two broad types of intervention that have a solid evidence base for cutting the reoffending rates of drug or alcohol dependent offenders.

The first is good quality opiate substitution treatment (typically methadone or buprenorphine prescribing), which has limited impact in getting people off drugs but has been consistently proven to cut offending rates.

The second is intensive structured recovery programmes, which aim to help offenders achieve and maintain abstinence, through a programme of groupwork, casework and peer support.

RAPt run this sort of programme in 15 English prisons using a 12-step model that is based on international research evidence.

The programme has been refined over the last 20 years and is currently delivered to around 1200 prisoners per year.

The key success factors are that the programme has a clear set of steps that participants are asked to follow (in our case, this structure is provided by the 12-steps); that participants are supported to confront the root causes of their behaviour; and that ex-prisoners and addicts in recovery are prominent in service delivery.

Our staff are highly trained and carefully recruited and we place great emphasis on the importance of peer support and the development of recovery communities both in prison and on release.

The proof

In order to test the effectiveness of our programme, we have developed a long-term study that records case details of all programme participants, and checks them against analysis of Police National Computer (PNC) data relating to reoffending.

Our initial analysis of this database looked at 663 prisoners released between November 2004 and April 2009.

The study has two cohorts: a RAPt group consisting of individuals who graduated from the RAPt programme; and a comparison group consisting of individuals who were assessed as substance dependent in prison and who had completed a low intensity treatment programme – the accredited ‘Short Duration Programme’.

The study found that 73% of the comparison group, who received only low intensity treatments, reoffended during the period of the study. In contrast, fewer than half (44%) of the sample of drug addicted prisoners who accessed RAPt’s 12-Step intensive rehab re-offended – a 29% reduction in the number of ex-prisoners re-offending. In addition, those in the control group who re-offended committed more than twice as many offences on average as those from the RAPt group who re-offended, demonstrating even greater impact on offending.

The overall reduction in the amount of recorded crime was therefore an impressive 65%. We have looked around other impact studies, and cannot find any verified reductions in reoffending that comes close to this figure, across all intervention sectors.

The study is ongoing and we continue to monitor the reoffending rate of every prisoner who attends one of our intensive prison programmes.

The challenge

I take a great deal of pride in the fact that we can prove that the RAPt approach has such a positive impact on reoffending rates. But I am equally frustrated that we still struggle to get our programmes commissioned.

We provide our programme to 1200 prisoners per year and yet there are 70,000 new receptions to prison every year who have drug-related problems.

Around £110 million per year is spent on prison drug services – less than 5% of that is spent on intensive abstinence based programmes. When NOMS were in charge of commissioning these services, much greater proportions were directed at low threshold case management and short groupwork courses.

Now that it is Department of Health commissioners who are leading, the priorities and commissioning processes are changing, but we are still seeing no signs that evidence for reducing reoffending is seen as a key criteria for selecting providers. In all the prison tenders that we are currently responding to, not one gives any prominence to asking about the evidence base for the bidders proposed interventions, or the track record of the bidder in reducing reoffending.

We are so confident of our approach that we are willing to be paid by results.

We also have working capital available, which means that statutory budget holders only have to pay us if we succeed in reducing reoffending. However, despite all the political, professional and media interest in PbR, we haven’t succeeded in getting a single commissioner to purchase our services on what is essentially a “no lose” basis.

We all know that procurement has to be properly and fairly structured, but surely its prime objective is to direct resources at activities that deliver the desired objectives. In the field of drug and alcohol interventions for offenders, the evidence base is becoming clear – lets hope that the new commissioning arrangements (Offender Health, PCC’s and the Probation Review) are more effective in directing resources according to that evidence.

For more details about the work of RAPt, check out their website.

If your organisation has an effective approach to tackling drug-related crime, please get in touch. I’d be happy to host a post describing your model.

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