Liverpool Alcohol Treatment Requirement (ATR) Pilot

Background

Liverpool is piloting an Alcohol Treatment Requirement (ATR) programme under the provisions of the Criminal Justice Act 2003. Where an offender shows dependency on alcohol, the Judge at the local Community Justice Centre in Liverpool can include, as part of an offender’s punishment, a requirement that they undertake alcohol treatment. The offender must agree to the treatment which will last for six months and comprises a variety of treatment modalities. These modalities are determined by an alcohol specialist following an assessment of the offender’s needs. The alcohol specialist and offender managers from the Probation Service then work closely to establish a plan of treatment and to monitor compliance.

The project is based in the Community Justice Centre in North Liverpool. The court sits as both a Magistrates and a Crown Court staffed by a single judge. The judge is able to sentence across the range of both community- and custodial-based sentences. The Community Justice Centre also houses various support organisations that can assist with problems around substance misuse, education and employment.

What is the problem you are trying to solve?

Excessive alcohol use stimulates the likelihood that criminal acts will be committed because it reduces inhibitions, increases risk taking and alters the normal mental state. By supporting individuals to extract themselves from the cycle of harm, it allows progression to an improved lifestyle and, importantly, reduces the likelihood of them re-offending and causing harm to others. In addition to medical support and work on offending behaviour, assistance will be provided around housing, employment, and social interaction.

What local organisations are involved?

The National Probation Service Merseyside Area, the Liverpool Drug and Alcohol Action Team and Liverpool Primary Care Trust (PCT) worked together to design and fund the project. The PCT has been asked to fund the future treatment element of the initiative from mainstream budgets.

How many people are running this project and who are they?

An organisation has been commissioned to provide specialist workers to assess and treat referred offenders. This will equate to two full time alcohol misuse workers and a part time nurse. In addition, each offender will be allocated an offender manager who will monitor progress of the offender within the whole Community or Suspended Sentence Order. The offender manager will liaise closely with the alcohol specialist providing the care plan. Normal court and offender management functions will apply.

What local population are you targeting?

The Community Justice Centre deals mainly with people from Liverpool North. This area contains some of the most deprived superoutput areas designated by the Government. The area is in need of support to reduce health, employment, housing, and crime issues.

How many people are you targeting?

The pilot itself is small with 38 assessments resulting in 27 orders However, the Probation Service figures for the year 2005-6 indicate that 996 offenders in Liverpool require a specialist assessment with a view to assessing suitability for an ATR.

Interventions

What interventions are you using to address the problem?

The main intervention is one to one care planned counselling delivered by the alcohol misuse workers. If assessed as necessary, a community detox will be given by the nurse attached to the project. In patient detox and structured day care was also available and used for some of the offenders in the pilot.

Is the project design based on evidence? If so, please state reference.

No.

Outcome

What outcomes or planned outcomes are you measuring?

A final report at the conclusion of the pilot will summarise the levels of self report in relation to reduced alcohol consumption and offending behaviour during the ATR. The main outcomes measured were: changes in Alcohol Use Disorders Identification Test (AUDIT) scores pre- and post-completion of the ATR; changes in OASys (Offender Assessment System) scores; and change in arrest/reconviction data.

Do you have any outcomes or results yet? If so, what are they?

AUDIT scores:

The mean pre-treatment/sentence audit score was 25.6, with scores ranging from 14 to 40. The mode was 17 and the median was 24.

At the post-treatment stage, the values were as follows: The mean audit score was 9.6 with scores ranging from 0 to 35. The mode was 0 and the median was 9.

A statistical test of difference between the pre-treatment AUDIT score and the post-treatment AUDIT score reached a probability level of p<0.02. This reaches the standard level of statistical significance, and suggests that there is a real treatment effect being observed here.

This is very encouraging, as the AUDIT scale is a direct measure of alcohol use, and therefore is the measure most expected to be influenced by an alcohol treatment programme of this type.

Information received from the police regarding re-arrest and reconviction for any offence indicates that since being made the subject of an ATR, eight of the cohort have been arrested for further offences. Previous to the ATR all of the offenders in the group had committed at least one offence in the last 12 months. Sixteen of them had committed between two and five in the year before their sentence. The re-conviction of seven from a cohort of 25 able to reoffend is interesting when considered against a cohort total of 233 offences throughout the offending careers of these individuals, which means that each individual has an average of 9.3 convictions on their record before receiving an ATR requirement. The average number of offences per offender for crimes committed after the start of the ATR is 0.8. Of course, the full effectiveness of this measure will only become truly meaningful as more time passes, so that a follow up 12 months data can be compared to a prior 12 months data directly.

Is your project relevant to a government target or guideline?

The Criminal Justice Act 2003 which came into force in April 2005. It had to be confirmed to courts that treatment was available in their area prior to sentencing.

Feedback

What obstacles did you have to overcome to set up this project?

Initial concern was expressed at the possibility that, by fast tracking individuals into the available treatment services, we would discriminate adversely against the general public who also wished to access the services. In response, the number of referrals the judge was allowed to make was capped within a set period. Services were specially commissioned to enable the project to happen which meant that there was no impact on existing services.

What have you learned about the project so far?

Under Section 17 of the Crime and Disorder Act, if the court opts to impose an ATR and it is the Court’s view that that the ATR could result in a reduction in crime/re-offending, then the Crime and Disorder Reduction Partnership would be obliged to address this issue within their partnership business. It is therefore very important that all partners agree the capacity and funding level available prior to widening the availability for sentences in all courts.

What would you do differently?

More managerial time from the various agencies involved, dedicated to overseeing the project would have assisted to resolve some of the day to day difficulties which arose, usually linked to communications and expectations of the different workers regarding each others’ roles.