Strengthening continuity of care: Corrections' Alcohol and Other Drug Aftercare Worker Pilot
Senior Adviser, Service Development, Department of Corrections
Caitlin specialises in the design and implementation of alcohol and other drug (AOD) rehabilitation programmes. Caitlin has both worked on and led various AOD projects including residential AOD programmes, offender digital health services, the AOD Aftercare Worker Pilot and the Methamphetamine Strategy. Prior to her senior adviser role, Caitlin worked as a probation officer in Auckland.
The risk of relapse is a concern for anyone who has completed alcohol and other drug (AOD) treatment and hopes to achieve long term recovery from their addiction. Researchers and clinicians suggest that the risk of relapse can reduce if a participant undertakes aftercare following primary treatment (Inciardi, Surratt, Martin & Hooper, 2002). Inciardi et al. (2002) define aftercare as “a set of supportive and therapeutic activities designed to prevent relapse and maintain behavioural changes achieved in previous treatment stages”. Aftercare in the Corrections context can include transitional support following the completion of intensive prison-based AOD treatment as well as continued support and aftercare in the community following a prisoner’s release.
Research on aftercare is somewhat limited. However, there is some empirical support for the assertion that participation in aftercare activities is associated with better AOD treatment outcomes (Pelissier, Jones & Cadigan, 2007). A study from the United States showed that offenders are less likely to be re-imprisoned if they participate in aftercare activities following AOD treatment (Prendergast, Hall, Wexler, Melnick & Cao, 2004). The study’s re-imprisonment rates for the group that accessed aftercare support was just 27% compared to those who did not participate in any aftercare activities (79%). Relapse rates for those with alcohol addictions have also been lower for those engaged in aftercare compared to those who have not (Inciardi et al., 2002). In addition, aftercare has been linked to other positive outcomes such as better social stability, and improved cognitive and psychological functioning (Inciardi et al, 2002). Based on this evidence, ensuring offenders have access to post-treatment aftercare support in prison as well as in the community should ensure Corrections’ investment in AOD treatment programmes achieves the best outcomes.
Enhancing our AOD response
according to need
A Corrections’ review conducted in early 2015 highlighted some service gaps in the provision of AOD treatment and aftercare services across the Corrections estate. The review also emphasised the benefits of investing in aftercare from both a crime-reduction and a health perspective. In March 2015, the department applied to the Justice Sector Fund for funding to develop a suite of AOD aftercare support services and was successful in being awarded $8.625 million to invest over a three-year period.
The additional funding meant a suite of new AOD services could be deployed to strengthen Corrections’ response to individuals with specific AOD treatment needs. The enhanced AOD response included three key components: an AOD support line (RecoveRing), new intensive community AOD treatment services and a pilot of an AOD Aftercare Worker Service. Each service provided a different level of support, depending on the needs of participants. This article will focus on the AOD Aftercare Worker Pilot, and provide an overview of the service as well as the successes and lessons learned so far.
AOD Aftercare Worker Pilot
AOD aftercare workers were established to support and guide prisoners to achieve their AOD rehabilitation and reintegration goals. The role involves supporting graduates of the prison based Drug Treatment Programme (DTP) and AOD Intensive Treatment Programme (ITP) to practice their skills and maintain their treatment gains – while they are in prison and during their reintegration into the community.
The aftercare worker works alongside Corrections’ case managers, probation officers, custodial staff, health staff and other support workers. Specifically, the role of the aftercare worker is to:
- provide one-to-one counselling
- facilitate maintenance groups
- assist in the development of the relapse prevention plan (with the participant and AOD treatment staff)
- support the participant to develop resilience and self-efficacy
- build pro-social support
- engage with whānau, if appropriate, to support the participant's relapse prevention plan
- navigate the participant to community-based AOD support and services
- provide mentoring and resources to support healthy living.
The Aftercare Worker Pilot went live on 4 July 2016 at 11 prison sites. Existing Corrections’ contracted DTP and ITP providers recruited staff with the necessary skills and experience to deliver the AOD aftercare worker service at each site. Corrections worked collaboratively with the providers to develop the aftercare worker practice guidance and induction processes.
Three-month process review
A three-month process review of the AOD Aftercare Worker Pilot was completed. The process review had three components. The first component was relationships; assessing the quality and appropriateness of contact between the AOD aftercare worker and Corrections staff, whānau, and community-based AOD providers. The second component included an assessment of demand by the targeted client group and level of engagement with the service. The final component assessed the approach to service delivery and whether aftercare services are being delivered in a manner that meets the needs of the individual (including the identification of barriers and opportunities for success).
The process review suggested that the AOD Aftercare Worker Service has quickly become a key component in Corrections’ AOD treatment response. Feedback from both clients and practitioners has been very positive. Overall, 88% of participants reported feeling satisfied with the service they received. Feedback from interviewed participants was that the AOD aftercare service was making a positive difference in their lives. Participants reported that the service helped keep them on track following their release either back into a mainstream prison unit or into the community and ensured they remained focused on their goals and gains made during treatment.
The limited amount of negative feedback from participants was generally process related. These issues were often quickly addressed by the National Office project team. Awareness and understanding of the AOD Aftercare Worker Service amongst Corrections staff was initially an ongoing area of development. However, at the time of the review, it was reported by aftercare workers that considerable progress had been made in that area.
The review also highlighted a number of improvements that could be made to the service to make it more effective. For instance, the importance of whänau engagement needed to be emphasised to encourage aftercare workers to facilitate whānau visits more frequently, where possible. Service provider managers also needed to improve their understanding of the aftercare worker role so ongoing training, coaching and support of aftercare workers could be maintained for new and existing staff. Practice guidance for aftercare workers has since been updated to include more information about whānau engagement. An expansion of the service, as detailed below, will also increase the capacity of aftercare workers to conduct visits with whānau more frequently. The project team distributed the updated practice guidance to clinical managers (as well as aftercare workers) and completed audio visual link (AVL) meetings with the clinical managers to further develop their knowledge and understanding of the aftercare worker role.
Current state and next steps
Since its inception 1,400 people have accessed Corrections’ AOD Aftercare Worker Service. Recent workload analysis shows that aftercare workers’ caseloads grew swiftly during the first six months of service delivery. It appears that the increase can be attributed to fewer early exits from the DTPs and ITPs, the increased aftercare worker’s familiarity with the role, and the service becoming more embedded into the department’s overall AOD treatment response. Data shows that caseloads over the last six months have settled and are unlikely to increase due to the finite number of treatment programme graduates available.
Consultation undertaken as part of the workload analysis revealed that the number of participants on an aftercare worker’s caseload does not directly equate to their actual workload. Each participant has varying levels of need for support, which can be influenced by various factors including access to other support, progress made in treatment, and whether the participant lives in the prison or the community.
Despite the variance between caseloads and workloads among aftercare workers, the analysis concluded that some aftercare workers are managing high caseloads which is impacting on their capacity to continue to work with individuals who transition into the community.
In response, Corrections is funding a total of 6.5 additional aftercare workers for prisons where there are capacity issues with existing aftercare workers. This will strengthen the existing service and increase the capacity of aftercare workers to work with participants in the community as well.
In August 2017, Corrections hosted a training and development day for aftercare workers to provide a further opportunity to share good practice ideas and reinforce key practices. The day was a valuable opportunity for relationship building between the existing and new aftercare workers, as well as with Corrections staff managing the project.
Corrections is currently finalising plans to complete an evaluation of the suite of AOD aftercare interventions. This is due for completion by July 2018.
Inciardi, J. A., Surratt, H., Martin, S. S., & Hooper, R.M. (2002). The importance of aftercare in a corrections-based treatment continuum. In C. G. Leukefeld, F. Tims, & D. Farabee (Eds.), Treatment of drug offenders: Policies and issues (pp. 204-216). New York: Springer
Pelissier, B., Jones, N., & Cadigan, T. (2007). Drug treatment aftercare in the criminal justice system: A systematic review. Journal of substance abuse treatment, 32(3), 311-320.
Prendergast, M. L., Hall, E. A., Wexler, H. K., Melnick, G., & Cao, Y. (2004). Amity prison-based therapeutic community: 5-year outcomes. The Prison Journal, 84(1), 36-60.