Better Outcomes through Linked Data
Yesterday (30 March 2023), the Ministry of Justice and Office for Health Improvement & Disparities jointly published experimental statistics on the pathways between probation and addiction treatment in England. The work is based on a data-sharing agreement that was secured as part of the Better Outcomes through Linked Data (BOLD) programme and focuses on offenders sentenced to a community order or suspended sentence order in England with an alcohol treatment requirement (ATR) or a drug rehabilitation requirement (DRR).
Background
The aim of the study was to assess whether the pathways between probation and treatment services are operating effectively and to describe treatment outcomes. It was based on 40,000 records from MOJ’s probation case management system, nDelius, of people sentenced to an ATR or DRR between August 2018 and March 2022. These records were linked with the National Drug Treatment Monitoring System (NDTMS) to estimate how many of these sentences resulted in people accessing treatment and to describe how these groups progress through treatment.
Main findings
Overall, 38.9% of offenders with ATRs or DRRs were engaged with treatment services on the dates they were sentenced or after being sentenced.
Offenders with an ATR appeared to engage more (45.9%) than those with a DRR (33.1%).
Looking at 3 weeks after the sentence date, 26% of offenders with an ATR were identified in treatment, compared with 20% of offenders with a DRR.
For offenders with an ATR who were identified as being in treatment:
- 68% reported alcohol as their only problem substance
- 24% reported non-opiates and alcohol as their problem substances
- 6% reported opiates (with or without concurrent alcohol problems) as their problem substance
- 1% reported only non-opiates as their problem substance
For offenders with a DRR who were identified as being in treatment:
- 68% reported opiates as their main problem substance
- 21% reported non-opiates as their problem substance
- 10% reported non-opiates and alcohol as their problem substances
- 1% reported alcohol only as their problem substance
Of the 15,121 offenders who engaged in treatment:
- 37% dropped out of treatment
- 35% successfully completed this treatment journey (by recovering from their substance misuse)
- 27% were still on the same initial treatment journey until the end of the observation period (March 2022)
- 1.4% died
For offenders accessing treatment, we saw substantial reductions in their main substance of use and in the frequency they reported using these substances.
Treatment discharge status is summarised in the infographic below, reproduced from the report.
ATR characteristics associated with accessing treatment
The analysis undertaken indicated a range of variables which were associated with a decreased likelihood of accessing treatment within an Alcohol Treatment Order. The main six were:
- being female
- being an older offender
- being from an ethnic minority
- being sentenced later in the data period (August 2018 to March 2022)
- scoring higher on the OGRS
- having a sentence terminated early
Conversely, two variables were associated with a greater likelihood of accessing treatment:
- being sentenced to an ATR with a main offence category of drink driving (compared with those with a main offence category of violence)
- having an accommodation status of either bail or probation accommodation, or were otherwise housed (compared with those in settled accommodation)
DRR characteristics associated with accessing treatment
Characteristics associated with decreased likelihood of accessing treatment as part of a DRR include:
- being female
- being an older offender
- being sentenced later in the data period (August 2018 to March 2022)
- having a main offence of theft
- having a medium score on the risk of serious reoffending metric, and a medium score on the OGRS
- terminating the sentence and recording it as ‘successful completion’ or ‘other reason’
The variables associated with an increased likelihood of accessing treatment include having:
- a longer community sentence
- an accommodation status of rough sleeping or ‘other housed’
Overall conclusions
This research provides a first insight into the engagement levels in treatment. It found that 45.9% of people sentenced to an ATR and 33.1% of people sentenced to a DRR engage in treatment.
It also found that most of this engagement happens early: 26% of people with an ATR access treatment within 3 weeks, compared with 20% of those with a DRR.
These findings suggest more work is required to optimise the pathways between probation and specialist addiction treatment services.
Thanks to Public Domain Pictures for kind permission to use the header image in this post which was previously published on Pixabay.
3 Responses
It’s another research project that suggests further research…. seems to me to lack a proposition of what ‘good enough’ looks like. So roughly 1/3 of people sentenced to ATR / DRR engage with treatment. Of this figure roughly 1/3 ‘successfully complete’ (so around about 1 in 10). Unless we define what we mean by ‘effective pathways’ these figures can look both disappointing at OK simultaneously. New drug strategy aims for every ‘offender’ to have a treatment place and 75% of prison leavers to be engaged by treatment services. These pathways certainly look like they need developing further to meet these aspirations.
1.4% of those in the study died – which I think roughly tracks the deaths in treatment figures – arguably with a client group with a more complex set of presenting needs.
But then – I’m not a researcher just a willing amateur and keen observer.
It is good to see OHID and MOJ linking the data sets to get a picture of how ATR’s and DRR’s are working, but the report begs many questions:
– Does the 40,000 cohort cover all individuals who were given an ATR/DRR over the 4 year period, or just a sub-set?
– Why is the engagement in treatment rate only 38.9%? Surely everyone on an ATR/DRR should be by definition engaged in treatment?
– Why does even that low engagement rate dip significantly 3 weeks after the order – surely dropping out of treatment that quickly would lead to breach of the order?
– What is the measure of ‘successfully completed treatment’, and at what point is it measured (at the end of the order)?
Who in OHID or MOJ is the contact point who we could put these questions to?
Hi Mike
It is true that the findings prompt more questions than answers. The BOLD team has commissioned Policy Lab to undertake qualitative work to evaluate current service provision by speaking with probation staff and users of treatment services. Policy Lab will then co-design potential new solutions with our stakeholders. Policy Lab is a government team that works with other departments to bring people-centred design approaches to policy making.
In terms of queries about the stats, readers are invited to email MOJ at bold@justice.gov.uk My experience is that most MoJ statisticians reply promptly…
Good luck