Development of a Risk Recovery Assessment Tool
Acknowledgements
I would like to thank all of those from a wide range of agencies who have provided help and support with the development of the Risk Recovery Assessment Tool. It is testament to the interest in and commitment to recovery focussed treatment services that people were willing to give their time and expertise to this project over a relatively short but intensive development period.
Fiona Young
2 Contents
1. Acknowledgements………………………………………………………………..1
2. Contents…………………………………………………………………………….2
3. Introduction…………………………………………………………………………3
4. Strategic Context…………………………………………………………………..4
5. Approach……………………………………………………………………………5
6. Definitions…………………………………………………………………………..6
7. Principles, Aims, Objectives and Scope…………………………………………8
8. Key Features of the Risk Recovery Assessment Tool………………………..10
9. Implementation of the Risk Recovery Assessment Tool……………………..12
10. Testing…………………………………………………………………………......13
11. Conclusion……………………………………………………………………..…..14
12. Appendices………………………………………………………………………...15
1. The RRAT………………………………………………………………...16
2. RRAT Guidance Notes ..………………………………………………..25
3. Components of Recovery Capital ..……………………………………31
4. Assessment Tool Review Template ..…………………………………34
5. Members of the Working Group and Consultees …..………………..36
13. References ..……………………………………………………………………….37
3 Introduction
The City of Edinburgh Alcohol and Drugs Partnership initiated work to develop an assessment tool to inform decisions about community and prison based drug treatment for clients within or leaving the Criminal Justice System which takes account of both recovery capital and risk of re-offending. The requirement identified is for a relatively simple core/common assessment tool that would be used in the first instance by a new Offender Recovery Service for the City of Edinburgh and Midlothian. The development of this tool was funded by Lothian and Borders Community Justice Authority.
A report to EADP in July 2012 proposing the establishment of an Offender Recovery Service[1] estimates that there may be between 61 and 89 potential clients in Edinburgh entering or exiting the CJS each month who would benefit from treatment services. Within this group are a smaller number of individuals who may be prioritised on the basis of need related to their problem drug use and high levels of offending. Many of these are short term prisoners (who would be offered voluntary through care) committing a high volume of drug related property offences.
A key issue in ensuring the tool is accepted and adopted by key stakeholders is its suitability and relevance to the work being undertaken and that its use does not present a significant additional burden of work to frontline staff in particular. A consensus based approach has therefore been taken to the development of the Risk Recovery Assessment Tool with the engagement of a working group of key stakeholders working together with a consultant to develop a tool which is informed by and is complementary to existing assessment methods and addresses the ADP objective to combine an assessment of treatment need and re-offending risk.
The members of this working group were identified by Edinburgh ADP as both stakeholders in the development of the tool and having particular expertise relating to assessment of clients within or leaving the criminal justice system that would benefit from drug treatment services. Partners have included: City of Edinburgh Alcohol and Drugs Partnership, City of Edinburgh Criminal Justice Social Work, Scottish Prison Service, Phoenix Futures, SACRO, NHS Lothian, Willow, Drug Treatment and Testing Order team. A list of working group members and consultees is provided at Appendix 6. The initial development phase for the Risk Recovery Assessment Tool was October to December 2012.
A number of benefits may be realised from the development of such a tool most particularly that it supports on-going improvements to the treatment system in Edinburgh and Midlothian by supporting the assessment of need in relation to treatment, recovery and reintegration services to improve outcomes for clients within or leaving the Criminal Justice System.
4 Strategic Context
Edinburgh Alcohol and Drugs Partnership Strategic Priorities and Commissioning Plan
The strategic priorities and commissioning plan of Edinburgh Alcohol and Drugs Partnership provided the context for the development of the Risk Recovery Assessment Tool. EADP acknowledges the significant impact that drugs and alcohol-related antisocial behaviour, violence and crime can have on the quality of life in our communities. Tackling offending behaviour, including any alcohol or drug dependency issue that sustains offending, is therefore a high priority. Addressing drug and alcohol issues is seen as contributing directly towards preventing a significant volume of crime and antisocial behaviour.
Outcome indicators set out by EADP include reducing drug and alcohol related crime and that professionals working in substance misuse services understand and support recovery. Further, the EADP commissioning strategy proposes a number of outcomes to help measure the positive effects and achievements that services deliver with service users and includes a specific outcome relating to reduced criminal activity including re-offending. The commissioning strategy also advocates the use of tools that will measure achievement of outcomes.
It is understood that the Risk Recovery Assessment Tool will be used in the context of a new tier 2/3 Offender Recovery Service to inform care planning and management and track outcomes for clients within or leaving the criminal justice system.
5 Approach
The approach to developing a Risk Recovery Assessment Tool included 7 main tasks:
1. With the agreement of EADP, establishing a consensus based approach to the development of the RRAT involving working with a group of key stakeholders with relevant expertise to develop a shared tool that is informed by and is complementary to existing assessment methods and addresses the EADP objective to combine an assessment of recovery capital and re-offending risk.
2. Reviewing relevant EADP information including the strategic plan, needs assessment and commissioning strategy and relevant background papers relating to recovery capital, risk and needs assessment;
3. Clarifying and confirming the underpinning principles, aims, objectives and scope of the proposed tool and key definitions, for example, of recovery capital in this context and the specific definition of this priority group of offenders with problem drug or alcohol use;
4. Identifying and reviewing tools that combine data on recovery capital and risk of re-offending to inform care planning decisions and allow progress to be monitored. This included reviewing a number of identified assessment tools currently utilised by key EADP partners/service providers in relation to the aims, objectives and scope agreed for a RRAT[2]. The review template is provided at Appendix 5;
5. Generating a long list of questions relevant to what the tool is intended to assess/measure;
6. Reviewing draft RRAT questions, format and approach to scoring and associated guidance notes with the working group and making initial revisions;
7. Providing a report to the ADP Lead including the proposed Risk Recovery Assessment Tool and key considerations for its implementation and review.
6 Definitions
Recovery Capital
EADP use the definition of recovery capital set out by the Scottish Government and this is reflected in the EADP strategy and commissioning plan:
A process through which an individual is enabled to move on from their substance use toward a substance free life as an active and contributing member of society. Furthermore it incorporates the principle that recovery is most effective when service user’s needs and aspirations are placed at the centre of their care and treatment.
Components of Recovery Capital
Cloud and Granfield (2009)[3] argue that recovery is a process and recovery capital may be defined as the sum of resources that facilitate the recovery process. They describe four components of recovery capital – social, physical, human and cultural capital. Social capital may include support from relationships with family, friends and social groups. Physical capital may include assets such as property or money. Human capital may include skills, good health and personal resources. Cultural capital may include pro-social values, beliefs and attitudes.
Partners considered the components of recovery capital for the purposes of the development of a Risk Recovery Assessment tool. The following list is drawn from the components of recovery capital as described by Best and Laudet (2010)[4] as “the sum of resources that may facilitate the (recovery) process”, and are reflected in a number of documents including the Scottish Prison Service offender outcomes and LS/CMI re-offending risk assessment tool used by Criminal Justice Social Work. Those components marked * are the 8 key factors associated with re-offending highlighted in LS/CMI. These components have informed the questions in the assessment tool and are as follows:
1. Sustained or improved physical health
2. Sustained or improved mental health
3. Sustained or improved sexual health
4. Reduced or stabilised alcohol misuse*
5. Reduced or stabilised illicit drug misuse or misuse of prescribed drugs*
6. Reduced or stabilised polydrug use*
7. Improved literacy skills
8. Education, training and employability prospects increased*
9. Maintained or improved relationships with families and peers*
10. Ability to access and sustain community support including linking to recovery support or mutual aid groups and services that provide continued and on-going care*
11. Improvements in self-esteem and motivation to change
12. Improvements in coping skills, particularly to cope with stress and temptations to use.
13. The ability to access financial and benefit advice and improved management of money
14. The ability to access and sustain suitable accommodation
15. Increased pro-social attitudes to offending*
16. Understanding of the impact of offending on victims and families*
7 Principles, Aims, Objectives and Scope
A number of principles underpinning the development of the RRAT were agreed by partners:
· It must be open, fair and accurate.
· It must be person centred and encourage the full participation and ownership of the client
· It must elicit all the information required to identify individual need
· It must respect confidentiality.
· It must aid progression.
It should also be:
· User friendly
· Avoid duplication of assessment where possible
· Support the assessment and care planning process
· Be carried out by appropriately trained/experienced staff
· Be designed to allow the transfer of accurate, relevant and up-to-date information
Overall Aim
The overall aim of the Risk Recovery Assessment Tool is to identify the needs and aspirations of individuals within or leaving the criminal justice system, taking account of recovery capital and reoffending risk, in order to inform decisions about treatment, care and support. The assessment tool should allow outcomes to be measured and compared in order to assist service providers and the client in identifying strengths and areas for development and assess progress made.
Objectives
· To identify an individual’s recovery capital and risk of re-offending and the type and level of need for treatment, care and support.
· To agree jointly with the individual, and other service providers as appropriate, an action plan for treatment, care and support.
· To identify and agree goals and arrangements for review and reassessment.
· To support communication of the outcome of the assessment to appropriate providers to allow arrangements for service provision to be made.
· To allow a review of progress made by the individual towards goals in strengthening key areas of their recovery capital including improvements in health, family and social functioning, reducing criminal behaviour, stabilisation/reduction in drug use, improvements in motivation and movement towards employability.
Scope
· Target client group – adults (18+) from the City of Edinburgh and Midlothian, within or leaving the criminal justice system that would benefit from drug/alcohol treatment, care and support.
· Settings – the RRAT would be used in both community and prison settings.
· Stages of assessment – the RRAT may be used following initial contact to support a comprehensive assessment, at regular reviews with the client, at transitions between services including from community to custody and custody to community and on exiting services.
· The RRAT will be used by agencies delivering the Offender Recovery Service
· The RRAT will support integrated care planning by developing a profile of the client which covers:
o The type and level of need for treatment, care and support that addresses aspects of recovery capital including their substance use and offending;
o Particular circumstances e.g. family problems, emotional and behavioural problems, housing, debt;
o Likely barriers to progress;
o Motivation;
o Aspirations and attributes, with particular attention to positives as well as areas for development;
o Goals – short term and longer term.
· To facilitate the management, delivery and co-ordination of treatment, care and support, the assessment may be shared with relevant service providers.
8 Key Features of the Risk Recovery Assessment Tool
The draft Risk Recovery Assessment Tool as agreed by the Working Group in December 2012 is included at Appendix 1 with Guidance Notes for its use at Appendix 2. Key features of the RRAT are described below.
Acronym: RRAT
Description: The RRAT has six main parts. The first section records administrative information including the personal details of the client. The following sections cover drug and alcohol use, offending and 4 key aspects of recovery capital:
Section 1 - Drug and Alcohol Use
Section 2 - Offending
Section 3 - Human (health, skills, personal resources)
Section 4 - Social (relationships, social support)
Section 5 – Cultural (attitudes to offending)
Section 6 – Physical (housing, money)
Sections 7 – 10 provide a summary of the assessment and actions to be taken.
Types of responses and measures
The RRAT is intended to be administered as an interview by a worker with a client. It should be utilised with the full participation of the client. It is not envisaged presently that collateral information such as input from carers or significant others would be incorporated into the tool. The tool elicits a range of responses and measures as follows:
· Timelines – invite the client to recall the number of days in the past month on which they did something – for example, the number of days they used heroin. These are then added to produce a total for the past month.
· Rating scale – a subjective 10-point scale is used for drug and alcohol use, offending and 10 other aspects of recovery capital. The client is invited to circle the scale in an appropriate place. Rating scales can be difficult to complete so workers are asked to emphasise that there are no right or wrong answers. If a client can’t select a single number they are asked for their best estimate, for example, “Would you say it was above or below the middle of the scale?”. This can then be broken down further by asking if they would be in the upper or lower range of that half of the scale and select the midpoint. For each rating scale additional guidance is given.
· Yes and no questions – a simple tick for yes or no.
· Narrative – several questions have space to record additional information.
Benefits
The tool allows a worker to create a baseline with a client at the start of a treatment journey and to assess progress at subsequent points in their treatment journey providing feedback to a client on progress made. The results of the assessment can be recorded on a simple chart using excel which will allow the client to see these changes visually. Visual feedback can be more effective than verbal feedback alone.