Evaluation of the Court Integrated Services Program Final report

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Evaluation of the Court Integrated Services Program Final report

Dr. Stuart Ross, Melbourne Consulting & Custom Programs December 2009

Evaluation of the Court Integrated Services Program: Final Report

December 2009

Table of Contents Table of Contents ..........................................................................................................................2 Executive Summary .......................................................................................................................5 Program implementation findings...........................................................................................6 Program outcome findings.....................................................................................................12 Recommendations........................................................................................................................15 Part 1: Program description........................................................................................................20 Chapter 1 1.1 Chapter 2

Introduction ...........................................................................................................20 Description of the Court Integrated Services Program........................................21 Case flows & system load.....................................................................................24

2.1

Case flow and system load goals..............................................................................24

2.2

CISP program flow processes..................................................................................25

2.3

Referrals to CISP .......................................................................................................26

Repeat clients.......................................................................................................................28 Source of referrals...............................................................................................................28 2.4

Assessments and assessment outcomes..................................................................30

Assessment outcomes ........................................................................................................30 2.5

Case recommendations and outcomes ...................................................................31

Engagement rates................................................................................................................32 Consistency in allocation to program level .....................................................................33 Allocation to program level in relation to clients’ assessed risk...................................34 2.6

Use of judicial monitoring ........................................................................................35

2.7

Program completions ................................................................................................36

Court outcome at CISP exit ..............................................................................................38 Time on CISP ......................................................................................................................39 2.8

Commentary on CISP case flow and system load issues .....................................40

Meeting program case flow targets...................................................................................40 Case flow and judicial support ..........................................................................................41 Part 2: Chapter 3

CISP Case management and intervention model..................................................43 Client characteristics and service needs..............................................................44

3.1

Client demography.....................................................................................................45

3.2

Prevalence of drug problems ...................................................................................47

3.3

Prevalence of alcohol problems...............................................................................50

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Prevalence of mental health problems, ABI and intellectual disability..............51

Acquired brain injury..........................................................................................................53 Intellectual disability ...........................................................................................................53 3.5

Combinations of problems.......................................................................................54

3.6

SF-12 survey of client physical and mental health ................................................54

Pre-CISP physical health....................................................................................................55 Pre-CISP mental health......................................................................................................56 Comparing pre- and post-CISP scores ............................................................................57 3.7 Chapter 4 4.1

Comments on client characteristics and service needs.........................................58 CISP service model ...............................................................................................60 Clinical and procedural basis of CISP.....................................................................61

Multidisciplinary team approach.......................................................................................61 Workers’ roles......................................................................................................................62 Team leaders ........................................................................................................................63 Program venues...................................................................................................................64 4.2

Referrals and interventions.......................................................................................65

4.3

Client feedback...........................................................................................................69

4.4

Support systems .........................................................................................................71

Policy and procedures manual...........................................................................................71 Assessment process ............................................................................................................71 Platypus Systems Case Management System ..................................................................73 4.5 Chapter 5

Recommendations: ....................................................................................................74 Drug and alcohol services................................................................................76

5.1

Provision of drug and alcohol services ...................................................................76

5.2

Drug and alcohol service needs of CISP clients....................................................76

5.3

Service output measures............................................................................................78

5.4

Change in drug and alcohol problems during CISP engagement .......................80

5.5

Relationship between CISP and drug and alcohol agencies ................................81

5.6

Recommendations .....................................................................................................83

Chapter 6

Mental Health and Acquired Brain Injury Services..........................................84

6.1

Provision of mental health and ABI services ........................................................84

6.2

Mental health service outputs for CISP clients .....................................................84

6.3

Service relationships for mental health...................................................................87

6.4

ABI service outputs for CISP clients......................................................................88

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6.5

Service relationships for ABI ...................................................................................90

6.6

Recommendations .....................................................................................................90

Chapter 7

Accommodation support services ......................................................................92

7.1

Provision of housing services...................................................................................92

7.2

Housing service needs of CISP clients ...................................................................93

7.3

Service output measures............................................................................................94

7.4

Relationship between CISP and housing agencies................................................97

7.5

Access to housing services for CISP clients ..........................................................98

Chapter 8

Magistrate perspectives on CISP and Therapeutic Jurisprudence .............. 100

8.1

Magistrates use of CISP ......................................................................................... 100

8.2

Relationship to practice.......................................................................................... 102

8.3

Satisfaction with CISP services ............................................................................. 105

8.4

Future directions for CISP .................................................................................... 108

8.5

Recommendations .................................................................................................. 109

Chapter 9

Reoffending and compliance outcomes ..................................................... 110

9.1

Outcome targets for CISP ..................................................................................... 110

9.2

Outcome assessment methodology...................................................................... 110

9.3

Bail compliance ....................................................................................................... 111

9.4

Order compliance ................................................................................................... 111

9.5

Re-offending rates................................................................................................... 113

Proportion of recidivists ................................................................................................. 113 Time to re-offence ........................................................................................................... 114

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Executive Summary The Court Integrated Services Program offers a coordinated, team based approach to the assessment and treatment to defendants at the pre-trial or bail stage. It links defendants to support services such as drug and alcohol treatment, crisis accommodation, disability services and mental health services. The program commenced at the beginning of 2007 after an establishment period in late 2006. CISP operates at three Victorian Magistrates’ Court venues: Melbourne, Sunshine and Morwell and is managed within the Court Support and Diversion Services branch of the Magistrates’ Court of Victoria.

This is

the final evaluation report on the Court Integrated Services Program (CISP). The evaluation commenced in late 2006 and the findings presented here cover the implementation and operation of the program up to the middle of 2009. The project specification also included an econometric (cost-effectiveness) component. This was conducted by PricewaterhouseCoopers and is reported separately. Overall, the evaluation found that CISP: •

had achieved or exceeded its targets for the engagement and retention of clients,



was able to match the intensity of intervention to the risk and needs of clients,



achieved a high rate of referral of clients to treatment and support services.

Other key findings were: •

A study of CISP clients’ health and well-being showed they had much lower levels of mental health than comparable community groups and that their mental health improved during their period on the program;



Magistrates and other stakeholders showed a high level of support for the program and its outcomes; and



compared with offenders at other court venues, offenders who completed CISP showed a significantly lower rate of re-offending in the months after they exited the program.

This Executive Summary reports on the evaluation findings against each of the questions or issues specified in the project brief. Findings in relation to program implementation issues are presented first, followed by findings in relation to program outcomes. Each Melbourne Criminological Research and Evaluation

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finding is accompanied by chapter and section references showing where more detailed analysis is presented. The recommendations from the evaluation are presented at the end of this section. Details of the evaluation methods can be found in Appendix 2.

Program implementation findings

1.

Is the number of defendants being referred to the CISP reflecting those estimated by the demand modelling? If not, what factors are influencing the referral numbers and the apparent variations?

There were 2,004 clients referred to CISP in the 2008 year, which is 86% of the target of 2,316 clients set when CISP was established. Referrals at the Latrobe Valley venue exceeded the target by 50% (276 referrals compared with a target of 184) while Sunshine and Melbourne venues achieved 88% and 78% of their referral targets respectively. There was a gradual increase in referrals throughout 2007 and 2008, although these increases were apparent at Sunshine and Latrobe Valley, but not Melbourne (see Chapter 2.8). Generally, the characteristics of the CISP client population reflect the assumption made in the demand modelling for the program. The most significant variation from the demand estimates is in the high rate of clients with possible Acquired Brain Injury. (Chapter 6.4) 2.

From which source/s are referrals most commonly originating? Are engagement rates variable according to referral source? Are outcomes linked to referral sources?

The majority of referrals (75%) are made by clients’ legal representatives, with referrals by Magistrates accounting for a further 15% of referrals. Self-referrals make up around 5% of referrals, although it should be noted that some clients who wish to be referred to CISP may ask their legal representative to do this on their behalf. Clients referred by Magistrates have a higher engagement rate than those referred by their legal representative or self-referrals (see Chapter 2.5). There was no variation in program

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completion outcomes across the different referral sources. The key factors in determining program outcomes were the offender’s custody status and accommodation stability at program entry, and whether CISP was made a bail condition. 3.

Is the number and proportion of referred defendants engaging in the CISP reflecting those estimated by the demand modelling? If not, what factors are influencing the variations in engagement rates?

Overall, 64% of those referred to CISP become engaged clients. This is greater than the estimated demand modelling take-up rate for referrals of around 60%. Referrals were most frequently found to be unsuitable because the person failed to attend the assessment (41% of unsuitable outcomes), was referred to Forensicare (26% of unsuitable outcomes), or because the referral was withdrawn (22%). Overall, higher risk clients are less likely to become engaged clients. (Chapter 2.4) 4.

Are the deviations in referrals and engagement rates proportional across regions? What factors are influencing the variations? What has this highlighted about region-specific needs in relation to various aspects of the CISP?

There is significant variation in engagement rates between the three program venues. Engagement rates are around 40 % higher at Sunshine than at Melbourne and this variation cannot be accounted for by differences in clients’ risk profile or referral source. Proportionately more referred clients at Melbourne fail to attend their assessment, are referred to Forensicare or withdraw their referral application. However, it is unclear why these factors are more prevalent at this venue. (Chapter 2.5) The rate of referral to the Latrobe Valley program site is affected by transport access issues for defendants from communities away from the main Latrobe Valley, and to some extent within the valley. This is mainly an issue of equity of access rather than a limiting factor on overall referral rates at Latrobe Valley, which are higher than anticipated (see Chapter 4.1).

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December 2009

Is the CISP receiving priority access to treatment and support services? Is this access adequate and timely? Are there any changes to service-level agreements that would be beneficial?

In general, CISP clients receive appropriate and timely referral to treatment and support services. Their engagement with these services is constrained by issues of service availability that are common to all clients of forensic programs. The contracted service agreements have resulted in improved access to accommodation, mental health and ABI assessment services. Access to COATS drug assessment and treatment services is consistent with previous service arrangements under the COATS service protocols. Key problem areas for service access include: ƒ

Limited availability of places in residential drug and alcohol treatment programs (Chapter 5.5)

ƒ

Very limited availability of long-term housing under the Justice Housing Support Program, and limited availability of emergency and temporary housing in the community (Chapter 7.3)

ƒ

6.

Limited access to mainstream mental health service agencies (Chapter 6.3)

Are the existing court services that have integrated into the CISP working effectively? What barriers are evident in achieving a cooperative and co-ordinated response?

The CISP teams demonstrate a high degree of integration across the service areas of drugs and alcohol, mental health, disability, indigenous support and accommodation support. The primary barriers to effective team operation is the high level of staff turnover which inhibits the development of stable, productive relationships between team members, and the high level of work demand that means that cases are sometimes assigned to staff members on the basis of availability rather than expertise. (Chapter 4.1) One site-specific gap in the integration of contracted services exists at the Latrobe Valley site where there appears to be limited use of mental health screening services (Chapter 6.3) and limited contact with the accommodation support agency (Chapter 7.4).

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What assumptions have been made in the development of the CISP Service Delivery Model?

The CISP service delivery model is one of a range of clinical and support program service approaches currently operating in Victorian courts. The other examples include CREDIT/Bail Support, the Neighbourhood Justice Centre client services function, Drug Court, Koori Court, and the applicant and defendant support functions for the Family Violence Courts. Each is based on different assumptions and service models, and each involves some specific skill sets. However, underpinning all these services is a general body of clinical knowledge and technique and common case management, support and other court-based functions. It is proposed that there should be a general review of these approaches with a view to creating a court support services function that would provide the basis for the delivery of a range of clinical, support, referral, supervision and case management services to court clients. 8.

Are clients being assigned to their appropriate level of intervention? Is this being reflected in retention rates or other outcomes?

Engagement at the three program levels is matched to defendants’ risks (higher risk defendants are engaged at higher program levels). Based on the risk assessment component of the CISP Screening Assessment, clients assigned to the Community Referral program stream are low risk, while those assigned to the Intermediate and intensive stream are medium and high risk respectively. (Chapter 2.5) There is consistency in engagement patterns across the three program venues (Chapter 2.5). Clients assigned to the Intensive program level have a lower completion rate than those assigned to the Intermediate level, but this is consistent with their generally higher level of risk.

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Do Magistrates’ Court staff, support staff, stakeholders and clients have an awareness and accurate understanding of the CISP?

There is a high level of support by Magistrates for the CISP. This is demonstrated by the high rate of agreement between workers’ recommendations and case outcomes as determined by the court (Chapter 2.8), and an increasing preparedness by Magistrates to refer defendants directly to the program. Overall, external stakeholder knowledge about the CISP is good, with awareness about the program increasing over time. Lawyers continue to be the primary source for referrals to the program, and their engagement is critical to the program’s success. There are real differences in approach between CISP and the treatment and support services, especially in relation to accommodation and mental health programs, and this limits the effectiveness of their engagement with CISP. Regular communication with external stakeholders about the program’s goals and achievements is required to ensure that stakeholders are able to respond appropriately to CISP’s service needs. (refer stakeholder feedback sections in Chapters 5, 6, 7, and 8) There are significant variations in the way that CISP services are incorporated into court operations. This is primarily the product of the extent to which different Magistrates adopt therapeutic jurisprudence practices. It is particularly important for CISP to communicate its goals and achievements to this audience. However, it must be recognized that the adoption of therapeutic jurisprudence approaches is ultimately the responsibility of the Magistracy, and CISP staff and management should be available to support these developments. (Chapter 8.1, 8.4) The falling rate of judicial monitoring is of concern, although this may represent greater confidence in the capacity of CISP case managers. (Chapter 2.6) 10.

Are the Courts satisfied with the quality and timeliness of reporting by the CISP team? Does the CISP meet defendants’ expectations of service?

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Overall, there is a high level of stakeholder satisfaction with the quality and timeliness of reporting by CISP team members. Where there have been problems, these are attributed by stakeholders to the high level of staff turnover in the program and the consequent inexperience of staff responsible for these reports. Case managers should be provided with more explicit criteria to guide decisions about program entry, and more detailed advice about client assessment and reporting procedures. (Chapters 4.3, 8.4) Feedback from clients in the program was generally very positive but the evaluation design did not provide for any systematic assessment of defendants’ expectations of service. 11.

What is the average and range of duration of client engagements by level of intervention? Do these vary by factors such as region or judicial monitoring?

The mean period of engagement for clients who completed CISP (from notification of a program place to exit date) was 110 days (3 months and three weeks). For noncompleting clients, the mean number of days from notification to exit was 62. There were no significant differences in time on the program between the three program venues, the Intermediate and intensive program levels, or between clients who were subject to judicial monitoring and those who were not. (Chapter 2.7) 12.

Has the integration of various services resulted in a reduction in duplication of assessments for clients, and a reduction in an overlap of referrals?

This question is difficult to assess as there are no clear benchmarks for assessment and referral overlaps prior to the program. There is no evidence of duplication in assessments or referrals in the current program. However, it should be noted that some service referrals (accommodation, mental health) need to be supported by continuing case management by CISP. (see generally Chapters 5, 6, and 7) 13.

Does the assessment tool utilised by the CISP team capture adequate information? Is the assessment being administered

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appropriately? What improvements could be made to the assessment tool? A review of the Screening Assessment in 2008 found that CISP staff members were administering it appropriately. The main weakness was in the collection of risk information, but this appears to have been rectified. A number of refinements were made to the instrument following the 2008 review. Staff members give generally positive reports of the screening instrument, but also report that they find assessment one of the most challenging aspects of their work. It is recommended that the CISP Policy and Procedures Manual should be supplemented with training and procedural advice on assessment procedures and working in a court environment. (Chapter 4.3)

Program outcome findings The key outcomes for CISP include individual client outcomes in relation to the needs addressed by intervention and support services, program completions, impact on court workload and other elements of the justice system, bail and order compliance, and reoffending. 14.

Do clients show an improvement in social and physical health and well-being, including a reduction in drug use and drug-related harms?

There are indications across a number of measures that clients showed improved health and social functioning as a result of involvement in CISP. The SF-12 health and wellbeing survey showed significant improvement in clients reported physical and mental well-being. Case manager assessments show reduced levels of problematic alcohol use. However, there are a number of factors that make assessing the impact of CISP on social, health and substance abuse factors problematic. CISP is a gateway to services, but for many clients the main outcome of their engagement with CISP is referral to a service agency, and looking for tangible outcomes is premature. This is most evident in relation to housing issues. While CISP was successful in referring clients to housing services, the waiting times associated with providing more stable accommodation are such that there

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was little change in actual housing status across the period of their engagement. A second problem is that outcomes are only known for those clients who remain engaged with CISP. (Chapters 3.6, 5.4 and 7.5)

15.

What factors are important in determining program completion?

Around six in ten engaged clients complete CISP successfully. Statistical models to predict completion outcomes were developed. The most important factors predicting non-completion were whether the offender was in custody at the time she/he was assessed for CISP, whether CISP was made a condition of bail, and the offenders’ level of accommodation stability at the time of CISP entry. Court location was also an important factor in predicting non-completion outcomes but it seems likely that this is an artefact of the generally higher completion rates at Latrobe Valley. 16.

What is the impact of CISP on court workloads?

Engagement in CISP affects court workloads in a number of ways. In order to be considered for CISP, offenders must go through a screening assessment, and this may involve some delay in hearing their bail application. Judicial supervision involving a return to court may involve additional appearances and may require adjustment to Magistrates’ work schedules. Positive impacts on court workloads include avoiding adjournments required to arrange services for offenders, and avoiding new court appearances associated with recidivist offending. Overall, Magistrates report that CISP does require additional work on their part, but that this is justified by the better results they achieve.

17.

Does involvement in CISP lead to lower rates of non-compliance on bail or Community Corrections orders?

For any pre-trial program, bail completion rates are obviously a key outcome. However, bail data is not currently able to be extracted in a manner that allows reliable and consistent analysis of bail outcomes for CISP clients and Victorian offenders generally.

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The absence of bail data constitutes a significant barrier to the evaluation of court programs in Victoria. Community corrections order compliance rates were not available for CISP clients as a group. Again, this represents a significant information gap in evaluating programs of this kind. Order compliance was examined for sample of 200 CISP participants, and 200 comparison offenders matched on gender, age, offence type and offence history. The overall successful completion rates for orders up to June 2009 were 49% for the CISP sample, and 45% for the control sample. While positive, this difference was not statistically significant. The successful completion rate for CCS orders state-wide in 2007/08 was 58%, however the sampling process means that these rates cannot be directly compared with one another. 18.

Does involvement in CISP lead to lower rates of re-offending?

Re-offending rates were examined for the same 200 CISP and comparison offenders as in the order compliance analysis. They were followed up for between 400 and 900 days and any further offences or new charges were recorded. For the CISP group, around 50% were classed as recidivists, of whom 40% had proven charges against them, and a further 10% had charges that had not been finalized. In the comparison group, 64% were classed as recidivists, with 50% having proven charges recorded and a further 13% having unfinalized charges. After 200 days around 30% of the CISP group and 32.5% of the control group had recidivated. By 400 days the degree of divergence was six percent (37% of the CISP group and 43% of the control group) and by 600 days it was eight percent (40% of the CISP group and 48% of the control group. The extent of divergence in re-offending rates reaches its maximum of ten percent by around 700 days.

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Recommendations Recommendation 1: Establish a review of court support programs with the aim of developing a general court support service model that provides statewide services to all the Victorian Magistrates’ Court at all its venues and across all specialist lists and divisions. The CISP program has achieved its primary output and outcome goals, including: ƒ

achievement of referral targets;

ƒ

exceeding the target rate for engagements;

ƒ

satisfying the requirement for level of engagement to be matched to need;

ƒ

achieving a high rate of program completions;

ƒ

achieving a high rate of treatment and support program referrals, and;

ƒ

demonstrating a high level of support from Magistrates and other stakeholders.

The program has received continuing funding for two years. The primary issue is therefore what should be the future of this program in the period after 2011? The CISP service delivery model is one of a range of clinical and support program service approaches currently operating in Victorian courts. The other programs include CREDIT/Bail Support, the Neighbourhood Justice Centre client services function, Drug Court, Koori Court, and the applicant and defendant support functions for the Family Violence Courts. Each is based on different assumptions and service models, and each involves some specific skill sets. However, underpinning all these services is a general body of clinical knowledge and technique and common case management, support and other court-based functions. It is proposed that there should be a general review of these approaches with a view to creating a court support services function that would provide the basis for the delivery of a range of clinical, support, referral, supervision and case management services to clients of the Magistrates’ Court of Victoria. This review should consider the following issues: ƒ

The contribution of court services to the continuing development of therapeutic jurisprudence practices

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The creation of functional specializations that can be applied across a range of court business streams and specialist lists and divisions. These might include: − Client assessment − Case management − Victim counselling

ƒ

The development of client services infrastructure for court services comprising: − Information management tools − Co-ordinated training and professional development − Clinical and case management tools and systems (for example, common assessment tools and procedures), and − Professional resource kits (for example, centrally maintained databases of service provider agencies).

ƒ

The development of a mobile service capacity appropriate for regional courts

Recommendation 2: Continue to develop and support the connections between CISP and therapeutic jurisprudence practices CISP is an integral element in therapeutic jurisprudence processes that commence at the bail stage and continue throughout the offender’s involvement in the court process and through into supervision under court order. For the full value of the interventions and support delivered through CISP to be realized there needs to be continued development of the program’s connections with post-sentence support and interventions. This may also include provision for ongoing judicial review in selected cases. Recommendation 3: Legislative or procedural amendments are required to allow defendants charged with serious indictable offences to be subject to judicial monitoring through CISP. Where a defendant is charged with a serious indictable offence and then bailed, there is limited capacity for a Magistrate to exercise judicial supervision with regular reviews of the defendant. Legislative or procedural amendments are required to allow defendants charged with serious indictable offences to be subject to judicial monitoring. This might require establishing reporting dates intermediate between the Filing Hearing and

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Committal Mention appearance that would apply to defendants placed on CISP. These legislative changes might also support the extension of the program to the County Court. Recommendation 4: The CISP Policy and Procedures Manual should be supplemented with training and procedural advice on assessment procedures and working in a court environment. The material on assessment procedures should include more detailed information about the clinical aspects of forensic practice, assessment criteria for the elements of the Screening Assessment, and the interpretation and integration of assessment information across multiple problem domains (especially substance abuse and mental health). The development of more explicit eligibility criteria may also assist staff by making such decisions more externally accountable. The material on working in a court environment should include advice on court processes, reporting in court, and the roles of other professional groups in the court (especially lawyers and police) and the development and management of effective relationships with them. Recommendation 5: The CISP Screening Assessment should be subject to regular review and staff should receive feedback on the aggregated results of assessments. It is important to maintain staff commitment to the structured assessment model for CISP. Two strategies for this are regular reviews of the assessment process (every second year) to ensure that the assessment content and procedures remain up to date and consistent with work practices, and demonstrating the value of the collection of assessment data through communication with staff about the results of assessments. Recommendation 6: Provide CISP staff with more explicit program eligibility and suitability criteria. Both Magistrates and case managers are aware that some referrals are made that are not appropriate for the program. This can be addressed by providing more explicit referral

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criteria that take into account factors such as the defendants’ previous bail history, any breaches of suspended sentences or Community Corrections orders, and other factors relevant to the court’s bail decision. One possibility would be to establish three referral outcomes: unsuitable and rejected referrals (as at present), referrals accepted for assessment, and referrals where a Magistrate’s approval should be sought before accepting the defendant for assessment

Recommendation 7: CISP program goals for drugs and alcohol should be concerned with effectiveness of the referral process and maintaining clients’ engagement with treatment programs. Improved drug and alcohol outcomes are part of the CISP goal set, however it seems inappropriate to hold the program responsible for treatment goals that are beyond its’ direct control. The key service delivery issues for CISP are how effectively it operates as a referral pathway and case management service. The indicators of success in this area should be whether drug and alcohol program referrals are based on a comprehensive assessment of clients’ risks and needs, and whether clients are provided with the support and supervision that ensures they satisfy the attendance requirements for drug and alcohol services. Recommendation 8: Review the Justice Housing Support program protocol to give greater weight to the needs of pre-trial defendants. It is recommended that the service level agreement for the JHSP should be reviewed to determine whether justice outcomes can be better achieved through greater focus on short-term accommodation. This review process should consider: •

The likely future availability of long-term housing places for justice clients taking into account patterns of intake and transition to permanent housing for justice clients; and



The need for short-term housing places for justice clients and the impact of availability of this form of housing on justice system outcomes, in particular bail and remand decisions.

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Recommendation 9: Review the provision of services to justice system clients with suspected Acquired Brain Injury The rate of suspected Acquired Brain Injury in program clients is much higher than allowed for in the demand modelling for CISP. This points to a high rate of ABI in justice client populations generally, and indicates that a comprehensive strategy to address this issue is required. While arbias 1 provides a high-quality assessment and service response for these defendants, the timescales involved are longer than can be accommodated in a pre-trial program. CISP case managers should receive additional advice on the management of such cases while awaiting full neuropsychological assessments. There should also be consideration of the continuing management of these clients as they progress through other stages of the justice system.

1

Alcohol Related Brain Injury Australian Service

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Part 1: Program description Chapter 1

Introduction

This is the final evaluation report on the Court Integrated Services Program (CISP). The evaluation commenced in late 2006 and the findings presented here cover the implementation and operation of the program up to the middle of 2009. This report is the fourth report on the CISP program arising out of the evaluation, and it incorporates some material presented in interim evaluation reports prepared in 2007 and 2008. A special report in 2008 examined the assessment of clients’ risks and needs. The evaluation approach used for CISP focused initially on the conceptualization of the program (that is, its theoretical and policy basis), followed by examination of program implementation issues. This final report is mainly concerned with the outcomes of the program, but where appropriate it makes reference to process and implementation issues. The evaluation had two primary objectives: ƒ

To determine the effectiveness of the CISP in meeting its overarching objective to reduce the re-offending rate of defendants

ƒ

To gather objective evidence to support future decision making by the Victorian Government in relation to the cost effectiveness of this initiative, and its expansion state-wide.

The project specification also identified six areas of program effectiveness and efficiency to be examined by the evaluation. These included: ƒ

Stakeholder satisfaction with services

ƒ

Program process efficiencies

ƒ

Reduction in re-offending rates

ƒ

Enhanced order compliance

ƒ

Reductions in drug use and drug-related harms, and improvements in clients’ health and well-being

ƒ

The impact of the program on justice system load

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The project specification also included an econometric (cost-effectiveness) component. This was conducted by PricewaterhouseCoopers and is reported separately.

1.1

Description of the Court Integrated Services Program

The Court Integrated Services Program (CISP) commenced at the beginning of 2007 after an establishment period in late 2006. The program represents a development of existing pre-trial and bail support program models, and in particular the CREDIT (Court Referral and Evaluation for Drug intervention and Treatment) and Bail Support programs, established in Victoria in 1998 and 2001 respectively. The CISP model diverges from traditional pre-trial programs in placing more emphasis on addressing the underlying causes of offending through: - Greater emphasis on individualized case management. Case management in CISP involves more therapeutic interactions between clients and workers, in comparison with the predominantly referral and advocacy approach of many pre-trial programs; - The CISP program teams are multi-disciplinary, and the referral and assessment process is intended to match clients’ needs with workers’ skills and expertise. CISP brings together a range of services that were previously available to defendants as separate services; - The case management model provides for three levels of service response (Intensive, Intermediate and Community Referral) and clients are intended to be directed to these levels of service response in a manner consistent with their assessed level of risk and need. - Establishing service agreements with housing agencies as part of the Justice Housing Support Program, with arbias for the provision of Acquired Brain Injury assessment and support services, and with the Community Offenders Advice and Treatment Service (COATS) for drug and alcohol assessment and referral services. CISP operates at three Victorian Magistrates’ Court venues: Melbourne, Sunshine and Morwell. The first two venues are metropolitan courts servicing inner Melbourne and the western suburbs respectively, while the Morwell venue services the Latrobe Valley, to the east of Melbourne. The program is managed within the Court Support and Melbourne Criminological Research and Evaluation

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Diversion Services branch of the Magistrates’ Court of Victoria, and has a staff complement of 26, including four team leader positions, 18 case manager positions and four administrative positions. Chapter 2 of this report gives more details of the volume and nature of the program’s case-flows, and Chapter 4 provides a more detailed description of the clinical and case management processes in the program. Readers of this evaluation report may find it useful to understand how CISP operates in a day-to-day sense. The following case study describes a typical case and illustrates the way the program interacts with court bail and sentencing processes.

A CISP case history A 32-year old male on remand was assessed, at his request, for CISP. The person had a very long history of offending, had served a number of gaol and Community Corrections sentences. At the time of his assessment he was facing two separate sets of charges involving burglary and theft, and was in breach of a suspended sentence. The most likely outcome for a defendant with this history would be a further gaol sentence. During the assessment, the CISP case manager noted that the person showed indications of an acquired brain injury (ABI) as well as other psychological issues. As part of his parole conditions, the offender had been attending Turning Point for counselling where he had established a beneficial therapeutic relationship with his counsellor which he wished to continue. However, the case manager ascertained that the offender was ineligible for CISP because he was currently serving a period of parole. Bail was granted with various conditions. The case was adjourned to a date after his parole expired. The CISP case manager liaised with the supervising Community Corrections Officer in relation to the issues identified for the offender, and Corrections worked with him on those issues for the rest of the parole period. On the return date, the offender reiterated his commitment to CISP and his bail was varied to include participation on CISP as a bail condition. While on CISP he continued his treatment at Turning Point, attended all appointments with CISP, found housing, maintained pharmacotherapy, remained abstinent from drugs, remained in a stable relationship, participated on a Personal Support Program through Centrelink and maintained psychological counselling as arranged through CISP.

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At the sentencing hearing a number of reports were tendered to the court from CISP, Turning Point, and the Centrelink PSP case manager, as well as a report on his parole from the Community Corrections Officer. The reports all attested to the effort that the offender had put in whilst on the program and the progress he had made. In all, the offender had been under court supervision for over eight months, including three months on bail while completing parole and five months on CISP. The magistrate imposed a further suspended sentence. It was deemed by the magistrate that it would be counter-productive to impose an immediate custodial sentence given the progress made by the offender and his prospects for long-term rehabilitation. The prosecutor was invited to make a submission in relation to the restoration of the suspended sentence. He indicated that in view of the offender’s excellent progress, he declined to make any further submissions. The magistrate made no further order on the breach of the suspended sentence.

At the conclusion of the proceedings, the offender asked to address the Court. He thanked the magistrate and his CISP case-manager for the opportunity and indicated that he was planning to attend TAFE to study social work.

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Chapter 2 2.1

December 2009

Case flows & system load

Case flow and system load goals

A number of the goals of the CISP are concerned with the way that clients are recruited for the program, enter and progress through the program, and finally exit. These processes are referred to as case flow, and the case flow goals set for CISP included: − The number of clients engaged at the three program venues would meet specified targets. These targets were set on the basis of case flows for the existing CREDIT/Bail Support, Disability Services and Aboriginal Liaison programs, plus an estimated number of new referrals. These case flow targets are shown in Table 2.1 below. − Clients would be allocated to the appropriate program level based on their assessed risk and needs. − Clients would spend up to four months on the program, with case management to monitor the defendant’s progress, address identified needs and provide access to support services, and plan for the client’s exit. − Judicial monitoring will be used where deemed necessary and appropriate by the judicial officer.

Case location Referral targets

Latrobe

Melbourne

Sunshine

Total

41

895

330

1266

143

581

326

1050

184

1476

656

2316

Valley

Existing ALO, CREDIT/BSP and DS referrals

New CISP referrals

Targets for CISP referrals

Table 2.1 CISP case flow targets (annual) This chapter examines the case flow outcomes of CISP, including: − Numbers and sources of referrals to the program,

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− Engagement rates by program level − Judicial monitoring rates − Completion rates and non-completion factors − Duration of engagement Except where stated, all information presented in this chapter is derived from the CISP Platypus Systems Case Management System (PSCMS).

2.2

CISP program flow processes

CISP begins when a person is charged with criminal offences. At this stage, the person may be in custody awaiting a bail hearing, already on bail, or summonsed to appear. The CISP case flow process includes the following stages: •

Prospective clients may be referred to CISP from a variety of sources, including their legal representative, police, another treatment or support program, court staff including the judiciary (via the court hearing as part of the bail application), family and friends or self-referred.



A referral application is completed to determine whether the person should be further assessed for the CISP via the screening assessment process. This referral application collects identifying information on the person and his/her legal representative, offence and legal status, indigenous status, and any issues or problems that might warrant assessment by CISP staff.



The information on the referral form is used to determine allocation to a case worker who completes a more detailed assessment. This Screening Assessment includes a more detailed criminal and legal history, an assessment of the person’s social and economic support needs, drug and alcohol use, and physical and mental health. At the end of the Screening Assessment a brief assessment of risks is also completed. Where a client is assessed as appropriate for a Level 1 (Community Referral) response, only basic information is collected at this assessment.

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December 2009

Following the screening assessment, the client may return to court where conditions associated with his or her involvement in CISP may be attached to the Bail Order. There is considerable variability in practice at this stage, with some Magistrates making a Bail Order with conditions relating to CISP engagement, while others recommend CISP engagement but without any court direction. Magistrates may also order the person to re-appear at a later date for a progress review.



When a client is engaged with CISP, the case worker prepares a case management plan that may involve referral to a range of treatment and support agencies, as well as continued supervision through CISP. Program exit occurs when the case management plan is completed, the client fails to satisfy the plan’s requirements, or other legal matters arise.

The CISP pathway is shown in Figure 2.1

Figure 2.1 CISP Process Map (March 2005) 2

2.3

2

Referrals to CISP

From CISP Service Delivery Model (Department of Justice, 16 March 2006)

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The CISP was launched in November 2006 at the Melbourne and Sunshine Magistrates’ Courts and the program took a small number of clients during the final months of 2006. In the first year of the program (2007), a total of 1,752 clients were referred to the program, and in 2008 this had increased to 2,004 referrals. Approximately 60% of referrals were to the Melbourne venue of the program, 27% were to the Sunshine venue, and 11% were to the Latrobe Valley venue. There was little evidence of a “ramp-up” phase for the program (a period when referrals increased rapidly over a period of months from an initial low level to a higher, more stable level), probably because the program was seen as being a continuation of the earlier CREDIT/Bail, Disability and ALO programs that were present at these venues. However, there is evidence of a gradual increase in the referral rate over the two years for the program as a whole, and for the Sunshine and Latrobe Valley venues. Figure 2.2 shows the monthly number of clients referred to CISP at each venue, and the linear trend lines for each venue.

Monthly referrals to CISP 250

200

150

100

50

Latrobe Valley Melbourne Sunshine CISP total Linear (Latrobe Valley) Linear (Sunshine) Linear (Melbourne) Linear (CISP total)

Ja nu ar y 2 M ar 00 ch 7 2 M 007 ay 2 Se Ju 007 ly pt em 20 0 N b ov er 7 em 2 0 07 b Ja er 2 nu 0 ar 07 y 2 M ar 00 ch 8 2 M 008 ay 2 Se Ju 008 l pt y em 20 0 N b ov er 8 em 20 be 08 r2 00 8

0

Figure 2.2 Monthly referrals at each venue The trend line for Melbourne is stable (that is, the slope is not significantly different from zero), but the trends for Sunshine, Latrobe Valley and the program as a whole all show significant positive slopes. There is some evidence of a levelling off in referrals in the last Melbourne Criminological Research and Evaluation

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Evaluation of the Court Integrated Services Program: Final Report

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six months of 2008 at each of the venues but it is too early to say whether this indicates stabilization in the rate of program referrals. It should be noted that the number of referrals to CISP reported in internal monthly reports cannot be validated from PSCMS case management system records. Over the 2007 and 2008 years an additional 499 additional referrals were reported in monthly reports, but these cannot be reliably identified from PSCMS referral records. Around half of these additional referrals were not assessed for the program, and none became program clients at program levels 1, 2 or 3.

Repeat clients A substantial number of CISP referrals involve clients who have been previously referred to this program or its predecessor (CREDIT/Bail Support). Of the 3,756 CISP referrals in 2007 and 2008, there were 2,710 defendants who were only referred once over the period, 384 who were referred twice, 73 who were referred three times, and 14 who were referred four or more times. Overall, 28% of CISP referrals involve defendants who have had previous contact with the program. Referrals are also cross-matched with client records from the CREDIT /Bail Support (CBS) program. In the first six months of the program, 19% of referrals were defendants who had previously been engaged with the CBS program, but by the second half of 2007 this had fallen to 12% and by 2008 less than 10% of referrals had prior involvement with CBS. Persons with significant criminal behaviour frequently go through repeated court episodes in a given period, and hence some level of multiple engagement in a program like CISP is to be expected. Since each referral constitutes a separate assessment and case management process, the remainder of this analysis will use referral episodes (“cases”) as the primary unit of analysis.

Source of referrals The most common source of referrals to CISP was the defendant’s legal representative. Eight in every ten referrals were from this source. Magistrates accounted for the next largest group (12.5%), and self-referrals accounted for a further 5%. Referrals from Magistrates were less frequently made at Latrobe Valley than at the other two sites, and while referrals by police were uncommon at all three sites, they were least likely at Melbourne. Within the “Other” category are nine referrals that were Crimes Family Melbourne Criminological Research and Evaluation

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Violence cases: eight of these were referrals from the Sunshine venue. Note that provision to record these CFV referrals on the CMS was only made in 2008. Prior to this these were recorded as Magistrate referrals, and the real number in this group is somewhat higher.

Case location Referral source Latrobe Valley

Melbourne

Sunshine

Total

N

368

1831

782

2981

%

86.4%

79.5%

76.1%

79.4%

N

19

291

163

473

%

4.5%

12.6%

15.9%

12.6%

Self referral/

N

17

122

42

181

family or friend

%

4.0%

5.3%

4.1%

4.8%

Treatment or support

N

11

34

9

54

agency/service

%

2.6%

1.5%

.9%

1.4%

Police member

N

8

4

13

25

%

1.9%

.2%

1.3%

.7%

N

3

21

18

42

%

.7%

.9

1.8%

1.1%

N

426

2303

1027

3756

%

100.0%

100.0%

100.0%

100.0%

Legal representative

Judiciary

Other

Total

Table 2.2 Source of Referrals by Venue The source of referrals altered somewhat over the two years, with referrals by legal representatives falling from 84% of all referrals in the first six months of the program, to 75% in the second half of 2008. Referrals by Magistrates increased from 10% to 14%, and self-referrals increased from 3% to 6% over the same period. Magistrate referrals were more likely where the defendant was female, and female defendants were also more likely to self-refer.

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2.4

December 2009

Assessments and assessment outcomes

There were 3,736 assessments of referred defendants made in 2007 and 2008, of which around 60% involved defendants who were in custody at the time. There were substantial differences between the three venues in the likelihood that a referred defendant was in custody. Two-thirds of defendants at Melbourne were in custody when they were assessed, but only half of those at Sunshine and a third of those at Latrobe Valley. This difference reflects the role of Melbourne as the central Magistrates Court, with custody facilities for holding defendants who have been refused bail.

Case location Assessed in custody? Yes

No

Total

Latrobe Valley

Melbourne

Sunshine

Total

N

141

1523

511

2175

%

33.1%

66.6%

50.0%

58.2%

N

285

765

511

1561

%

66.9%

33.4%

50.0%

41.8%

N

426

2288

1022

3736

%

100.0%

100.0%

100.0%

100.0%

Table 2.3 Assessments in Custody by Venue

Assessment outcomes Approximately 70% of those referred to CISP were assessed as suitable for the program and recommended for one of the three intervention levels, and one-quarter were assessed as not suitable for the program, with a further 3% found not suitable but offered consultancy services (provided with advice and referral to support or treatment services). Referrals were most frequently found to be unsuitable because the person failed to attend the assessment (417 cases, or 41% of unsuitable outcomes), was referred to Forensicare 3 (262 cases, or 26% of unsuitable outcomes), or because the referral was withdrawn (220

3

Offenders with a serious mental illness or who have other significant forensic issues are referred to

Forensicare for assessment and specialist case management.

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cases or 22%). A further 40 cases were not accepted onto CISP because they were adjourned to another jurisdiction or to the venue where CISP was not available.

Case recommendation

Case location

outcome Latrobe Valley

Melbourne

Sunshine

Total

Suitable, recommended for

N

334

1489

874

2697

CISP engagement

%

78.4%

65.2%

85.8%

72.4%

Not suitable - Consultancy

N

22

69

24

115

%

5.2%

3.0%

2.4%

3.1%

N

70

725

120

915

%

16.4%

31.8%

11.8%

24.6%

N

426

2283

1018

3727

%

100.0%

100.0%

100.0%

100.0%

Not suitable

Total

2.4 Case Recommendations by Venue The proportion of referrals found unsuitable was relatively stable over the two years, and the reasons for unsuitability were similarly stable over time. However, the proportion of those assessed as unsuitable was significantly higher at Melbourne (32%) than the other two venues (16% and 12% respectively). It is unclear why a greater proportion of referrals were found unsuitable at Melbourne, as there was little site-to-site variability in the reasons for assessments of unsuitability.

2.5

Case recommendations and outcomes

Following assessment, a report is made to the court on the defendant’s suitability for CISP, and if assessed as suitable, recommending engagement in one of the three program levels (Community Referral, Intermediate, Intensive). The Magistrate may accept or vary this recommendation. Overall, nearly 80% of workers’ recommendations were accepted by Magistrates. Over 95% of recommendations that a defendant was unsuitable resulted in a case outcome of unsuitability and over 85% of recommendations for the Community Referral level of CISP were accepted. The likelihood that a recommendation for engagement in CISP would be rejected by a Magistrate was higher for more intensive levels of the program. Twelve percent of recommendations for level 1 were ultimately found to be unsuitable, compared with 19% of recommendations for program level 2 and 26% of recommendations for program level 3. The level of agreement between Melbourne Criminological Research and Evaluation

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workers’ recommendations and case outcomes has remained stable over the two years 2007 and 2008.

Case outcome CISP worker recommendation

Level 1

Level 2

Level 3

Not suitable

Not

Community

Intermediate

Intensive

Consultancy

suitable

Total

Referral

Level 1

N

289

3

3

14

28

337

Community referral

%

85.8%

.9%

.9%

4.2%

8.3%

100.0%

Level 2

N

13

1700

47

28

372

2160

Intermediate

%

.6%

78.7%

2.2%

1.3%

17.2%

100.0%

Level 3

N

5

29

602

11

209

856

Intensive

%

.6%

3.4%

70.3%

1.3%

24.4%

100.0%

Not suitable –

N

2

1

1

52

14

70

Consultancy

%

2.9%

1.4%

1.4%

74.3%

20.0%

100.0%

Not suitable

N

1

0

1

10

292

304

%

.3%

.0%

.3%

3.3%

96.1%

100.0%

N

310

1733

654

115

915

3727

%

8.3%

46.5%

17.5%

3.1%

24.6%

100.0%

Total

Table 2.5 CISP Recommendations and outcomes

Engagement rates In the remainder of this chapter, clients who had a case outcome of Level 2 or Level 3 and who received case management through CISP are referred to as engaged clients. In the period July 2007 to June 2008, there were 1,833 clients who were assessed for CISP, of whom 1,140 were accepted onto Level 2 or 3 of the program, 175 went to Level 1, and 518 were found unsuitable, giving an engagement rate of 62.2%. In the six months to December 2008 there were 651 clients engaged at Level 2 or 3 out of a total of 1000 assessed, giving an engagement rate of 65.1%. The proportion of referred clients who became engaged clients was highest at Sunshine (77.3%) and lowest at Melbourne (56.5%). Clients referred by Magistrates were more likely to become engaged clients than those referred by legal representatives or self-referrals.

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Engagement rates by referral source

Proportion of referrred clients who engage

80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% .0% Self referral

Legal representative

Judiciary

Figure 2.2 Engagement rates by source of referral

Consistency in allocation to program level In the early stages of the evaluation substantial variations between the three venues were identified in the allocation of clients to program levels. Clients at the Latrobe Valley venue were much more likely than clients at the other two venues to be engaged at the Intensive program level, while clients at Sunshine were more likely to be engaged at the Intermediate program level. These variations could not be attributed to differences in the characteristics of clients. Program guidelines about allocation were reviewed in consultation with team leaders and by 2008 the level of site-to-site variation had greatly diminished. Across the two years the proportion of clients engaged at each level showed a high level of consistency between the three venues.

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Proportion of CISP clients at each program level: 2007 and 2008 70.00% 60.00% 50.00% Latrobe Valley Melbourne Sunshine

40.00% 30.00% 20.00% 10.00% 0.00% Community Referral (Level 1)

Intermediate (Level 2)

Intensive (Level 3)

Figure 2.3 CISP clients by program level

Allocation to program level in relation to clients’ assessed risk The CISP assessment requires case mangers to assess clients’ risk in relation to a series of risk criteria (see Screening Assessment at Appendix 3). These risk criteria were modified slightly following the assessment review in 2007. The total number of items identified provides an index of the client’s risk, and this index can be used to examine whether clients are allocated to program levels in relation to their assessed level of risk. Table 2.6 shows the mean risk index scores for 2007 and 2008 clients at each of the three program levels 4 . It can be seen that clients allocated to the Community Referral level program were on average low risk in that less than one risk item was identified for each client. Clients allocated to the Intermediate and Intensive program levels were of relatively higher risk, with an average of three and over four risk items identified respectively.

4

There were 277 clients who had no risk items identified. Without examination of the original assessment

forms it cannot be determined whether these were blank risk assessments or clients who demonstrated no risks.

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Evaluation of the Court Integrated Services Program: Final Report

Case recommendation outcome

Mean

December 2009

N

Std. Deviation

Level 1 Community Referral

.4871

310

1.59027

Level 2 Intermediate

3.0537

1732

2.06145

Level 3 Intensive

4.3645

653

2.61697

Total

3.0761

2695

2.41910

Table 2.6 Risk scores by program levels

2.6

Use of judicial monitoring

Where a magistrate directed that a defendant should take part in either Level 2 or Level 3 of CISP, he or she could also direct that this should involve monitoring of progress by the court (judicial monitoring). Information on judicial monitoring was recorded for approximately three-quarters of all engaged CISP clients. Judicial monitoring was most often used at the Sunshine venue, where 80% of cases had this recorded, and least used at Latrobe Valley where 26% of cases had judicial monitoring recorded 5 .

Case location Judicial Monitoring Yes

No

Total

Latrobe Valley

Melbourne

Sunshine

Total

N

51

537

488

1076

%

25.8%

53.3%

80.1%

59.3%

N

147

470

121

738

%

74.2%

46.7%

19.9%

40.7%

N

198

1007

609

1814

%

100.0%

100.0%

100.0%

100.0%

Table 2.7 Use of judicial monitoring by CISP venue Judicial monitoring was more likely to be required where the defendant had been referred to CISP by a Magistrate (77% of magistrate-referred cases received judicial monitoring) and least likely where the defendant was self-referred (30% of cases). There were no evident differences in the likelihood that judicial monitoring would be imposed on male versus female defendants, or Indigenous versus non-Indigenous defendants. However, there was a strong downward trend in the use of judicial monitoring throughout the life 5

The level of missing information about judicial monitoring was also highest a Latrobe Valley.

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Evaluation of the Court Integrated Services Program: Final Report

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of the program (Figure 2.4). In the first six months after commencement, over threequarters (77%) of all engaged clients were subject to judicial monitoring but by the second half of 2008 this had declined to less than half (43%). Magistrates were asked about this trend and their comments are reported in Chapter 8.

Proportion of engaged CISP clients receiving judicial monitoring 90% 80% 70% 60% %

50% 40% 30% 20% 10% 0% First half 2007

Second half 2007

First half 2008

Second half 2008

Figure 2.4 Proportion of engaged clients receiving judicial monitoring

2.7

Program completions

Of the 2,387 defendants who became engaged CISP clients in 2007 and 2008, over 85% had a program exit record 6 . Overall, around six in ten engaged clients completed CISP satisfactorily, while 17% were unable to complete because they were remanded in custody (either as a result of breaches of bail conditions or further offending), and 18% were terminated for non-attendance. A small number terminated voluntarily. Included in the ‘Other’ category were ten defendants who died while on the program. The

6

In theory, almost all clients who were engaged in 2007 and 2008 should have exited by the date of the

CMS extract on which these results are based (1 April 2009). The proportion of engaged clients with exit records did not vary greatly between venues.

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completion rate was highest at Latrobe Valley, where three-quarters of all engaged clients completed. Completion rates were higher for clients on the Intermediate program level than for those on the intensive level (61% versus 52%) and Indigenous clients were less likely to complete than non-Indigenous (46% versus 60%). However, there were no differences in completion rates for men versus women, clients with judicial monitoring versus those without, or across the main referral sources.

Case location Reason for exit Latrobe Valley

Melbourne

Sunshine

N

197

618

386

1201

%

74.6%

56.1%

56.5%

58.6%

Did not complete program -

N

19

157

166

342

remanded

%

7.2%

14.3%

24.3%

16.7%

Did not complete program-

N

35

234

106

375

non attendance

%

13.3%

21.3%

15.5%

18.3%

No longer wanted to

N

9

38

9

56

participate

%

3.4%

3.5%

1.3%

2.7%

Other

N

4

54

16

74

%

1.5%

4.9%

2.3%

3.6%

N

264

1101

683

2048

%

100.0%

100.0%

100.0%

100.0%

Completed program

Total

Total

Table 2.7 Reasons for exit by CISP venue Statistical models to predict completion outcomes were developed. These models and the development process are described in detail in Appendix 1. The key findings of this modelling process were that: •

Prediction of completion / non-completion outcomes yielded a more balanced model than one designed to predict non-completion as a result of nonattendance;



The most important factors predicting non-completion were whether the offender was in custody at the time she/he was assessed for CISP, whether CISP was made a condition of bail, and the offenders’ level of accommodation stability at the time of CISP entry;



Court location was also an important factor in predicting non-completion outcomes but this is mainly related to the generally higher completion rates at Latrobe Valley.

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Court outcome at CISP exit Over 60% of CISP clients had not had their court matters resolved at the time they exited the program. The majority of these were cases that had not yet been determined (980 cases or 48% of exiting clients), cases where a warrant had been issued (182 cases or 9% of exiting clients) and cases where the defendant had been committed for trial to a higher court (87 cases or 4% of exiting clients). There were significant differences in exit outcomes depending on whether clients exited after completing CISP. Clients who completed CISP were more likely to have their matters resolved at exit, less likely to be given a custodial sentence, and more likely to receive a community order, suspended sentence, fine or bond.

Completion Court outcome at CISP exit Completed

Not completed

N

17

79

96

%

1.4%

9.3%

4.7%

N

257

24

281

%

21.4%

2.8%

13.7%

N

139

9

148

%

11.6%

1.1%

7.2%

N

136

11

147

%

11.3%

1.3%

7.2%

N

69

55

124

%

5.8%

6.5%

6.1%

Matters not yet determined, warrant issued or

N

581

668

1249

committed for trial

%

48.5%

79.0%

61.1%

Total

N

1199

846

2045

%

100.0%

100.0%

100.0%

Custody

Community order

Suspended sentence

Fine, bond

Other penalty

Total

Table 2.8 Court outcome at CISP exit by completion status

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Time on CISP The mean period of engagement for clients who completed CISP (from notification of a program place to exit date) was 110 days (3 months and three weeks) 7 . For noncompleting clients, the mean number of days from notification to exit was 62. Clients who were exited as a result of being remanded in custody tended to exit faster than those who were exited for non-attendance or other reasons (50 days versus 64 days). There were no significant differences in time on the program between the three program venues, the Intermediate and intensive program levels, or between clients who were subject to judicial monitoring and those who were not.

Mean number of days on CISP

Days from notification to exit

120 100 80 60 40 20 0 Completed program

Did not complete program remanded

Did not No longer Client death Adjourned Matters complete wanted to to non CISP adjourned program- participate location to higher non court attendance

Figure 2.5 Mean number of days to completion by completion status

7

There are problems with accurate calculation of time on the program as some clients are placed on the

program but do not take up this place immediately. The 2% of cases with the longest durations (over 200 days) were deleted from the calculations of elapsed times.

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Evaluation of the Court Integrated Services Program: Final Report

2.8

December 2009

Commentary on CISP case flow and system load issues

Meeting program case flow targets CISP was established on the basis that there was a very large unmet need for specialized treatment and support services for defendants at court. The case flow targets for the program were set by taking the levels of activity across the existing CREDIT/Bail Support, Disability Services and ALO programs and adding an estimated flow of “new business” arising from the expanded scope of the program. In all of the three venues, this new business target was substantial when compared with the cases dealt with by the existing programs. Prior to CISP, the Latrobe Valley venue had been dealing with around 40 CREDIT/Bail Support, disability support and ALO cases a year, and it was estimated that the establishment of CISP would increase this to 180 cases per year (that is, a 450% increase). The estimated increase in case flow at Sunshine was around 100% (from 330 per year before CISP to 656), and at Melbourne 65% (895 pre CISP to 1476). Thus, when we ask whether the CISP program was able to meet these targets, we are also asking whether the proposition that there was a large unmet service need in the courts was valid.

Case location Referral targets

Latrobe

Melbourne

Sunshine

Total

184

1476

656

2316

150

1154

446

1750

276

1147

581

2004

150%

78%

88%

86%

Valley

Targets for CISP referrals

Annual referrals 2007

Annual referrals 2008

2008 referrals as a % of target

Table 2.9 CISP targets and actual referrals 2007 and 2008 The analysis presented here shows that CISP was able to generate large increases in the number of referred defendants over pre-CISP levels (Table 2.9). Overall, there were 2004 referrals in the 2008 year, equivalent to 86% of the target figure. The increase in case

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Evaluation of the Court Integrated Services Program: Final Report

December 2009

flow at the Latrobe Valley venue was very large. The 276 referrals in 2008 are half as great again as the target number of 184, and represent a seven-fold increase in referrals over pre-CISP levels. Increases at Sunshine and Melbourne were relatively smaller but nevertheless still represent large increases over pre-CISP levels. Both Sunshine and Latrobe Valley show significant upwards trends in referral rates. Case flow numbers in isolation provide only limited information about the effectiveness of a program. In order to make a judgement about whether CISP has achieved its goals it is also necessary to consider: − Whether the risks and needs of clients are appropriate? That is, were the additional clients who were referred and engaged the kind of people likely to benefit from the services and supports offered through the program? This issue is examined in detail in the next chapter of this report. − Is the case-flow consistent with the level of resourcing for the program? While this evaluation did not include an examination of staffing and workload issues 8 , it is relevant to note that the translation of referrals into engaged clients was relatively high (out of every ten referrals, seven became engaged clients), and that the period of involvement with clients was around four months for completing clients and two months for those who did not complete.

Case flow and judicial support The CISP model depends on achieving a high level of judicial support. There are two measures that indicate that this was achieved (agreement between worker recommendations and the referral of clients directly by magistrates) and one that is more difficult to interpret (the falling rate of judicial monitoring). In general, Magistrates endorsed the recommendations of CISP workers about program engagement. On the question of whether or not a defendant was suitable for the program, Magistrates endorsed around 90% of worker recommendation, and on the more specific issue of the level of program engagement, Magistrates confirmed workers’ recommendation in around 80% of cases. Over the period of the program, Magistrates showed an increasing preparedness to refer defendants directly. 8

These issues were the subject of a separate review carried out in 2008.

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It is unclear why there are such large differences between the three program sites in the rate of judicial monitoring, or why the rate of judicial monitoring has declined. Judicial monitoring is central to the idea of therapeutic jurisprudence, and the large fall in its use (from 77% of cases to less than half) is of concern. The decline in monitoring cannot be attributed to changing referral patterns, as the proportion of magistrate-initiated referrals increased from 2007 to 2008, and while self-referrals also increased they only accounted for 4% of all engaged clients. Other possible reasons include greater confidence by magistrates in CISP case management, increased work pressure on magistrates, and the difficulty in organizing review hearings experienced by magistrates who work at several court venues. It should be noted that there appears to be little if any relationship between the use of monitoring and program completion. These issues are taken up in more detail in Chapter 8 of this report.

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Part 2:

December 2009

CISP Case management and intervention model

A fundamental principle in therapeutic jurisprudence is that how courts respond to offenders should be targeted at the problems and disadvantages that give rise to criminal behaviour. For the CISP to work effectively it must identify these problems and disadvantages, provide the court with information about offenders that assists in decisions about bail, judicial monitoring and sentencing, and establish case management plans that respond to these issues. The CISP model is based on multi-disciplinary teams offering a range of specializations, the members of which work together to screen and assess defendants and respond their identified needs in a way that matches the level of intervention received to the level of risk and need of the defendant. A key element in the process is improving defendants’ access to, and the co-ordinated delivery of social and health services. This part of the evaluation report examines the case management and intervention processes within CISP. The analysis presented includes: ƒ

A description of the demographic and problem characteristics of CISP clients

ƒ

A description and critical analysis of the CISP assessment and case management model, and

ƒ

Detailed examination of the referral processes for three main forms of intervention: drug and alcohol programs, mental health programs and accommodation support.

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Chapter 3

December 2009

Client characteristics and service needs

Relatively little is known about the problems and disadvantages associated with defendants at court. While the health and associated problems of custodial population have been extensively and systematically studied, information about court defendants is patchy. Studies of arrestee populations (most notably, the DUMA research conducted by the Australian Institute of Criminology) show high rates of prevalence of drug, alcohol and mental health problems, but these studies have not (until recently) included samples of Victorian arrestees. This chapter reports on the demographic, substance abuse, health and mental health characteristics of CISP clients in order to address the following evaluation issues: − The demand for programs and services − The relationship between client needs and risks and program case flows and outcomes The demand modelling and service delivery model for CISP was based on assumptions about the characteristics of defendants, and this chapter also provides commentary on how the CISP model should evolve to take account of the knowledge of client characteristics that has accrued since the beginning of the program. Unless otherwise stated, the material presented here relates to the cohort of engaged CISP clients who took part in the program from its commencement in December 2006 until March 2009. The information presented here is derived mainly from the screening assessments carried out by case managers when clients are first referred to CISP. Most of the information collected is self-report (although case managers may be able to validate some information from other sources) and should not be regarded as diagnostic. The references in this report to drug, alcohol and mental or physical health problems should be read only as identification that these problems were regarded as appropriate as a basis for engagement in CISP. Where these problems are identified by CISP, offenders may be referred to clinical or other specialists who are able to make a more authoritative diagnosis or assessment. However, this information was not available to the evaluation team. Melbourne Criminological Research and Evaluation

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Note that only clients who were engaged with program levels 2 or 3 (Intermediate or Intensive) received a full screening assessment. Where appropriate, advice from agencies providing services to CISP clients is also reported. The assessment data is also compared with the results of a structured health and mental health survey conducted on a sample of 197 CISP clients.

3.1

Client demography

The prevalence of health problems and social service needs varies greatly within the population, and any assessment of these issues must begin with some consideration of which segment of the population forms the CISP client group. Around four in five CISP clients (81.4%) were male, and there was a high level of consistency in the gender mix of clients across the three venues (Figure 4.1). Female clients comprised 16.4% of clients on the Intermediate program level, and 24.3% of those on the Intensive program level. Clients had a mean age of 32.7 years, and again there were no differences in the age distribution of clients between the program venues or program levels. Half of all clients were aged between 26 and 37 years, with around one-quarter of clients aged under 26 years, and one-quarter aged more than 37 years. In some later analyses these groups are referred to as “young” (under 26), “middle” (26 to 37) and “older” (more than 37).

Sex of CISP clients by program venue 100.0% 90.0% 80.0% 70.0% 60.0% Male Female

50.0% 40.0% 30.0% 20.0% 10.0% .0% Latrobe Valley

Melbourne

Sunshine

Figure 3.1 Sex of CISP clients

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Clients who identified as indigenous (Aboriginal, Torres Strait Islander or both) comprised 8.1% of all CISP clients, but the proportion of indigenous clients was significantly greater at Latrobe Valley and Melbourne than at Sunshine (12.3%, 10.5% and 2.6% respectively – see Figure 3.2). Relatively more female clients were indigenous than male clients (11.7% female versus 7.3% male), and indigenous clients were also relatively more likely to be on the Intensive program level than the Intermediate level (11.4% engaged as Intensive versus 6.7% engaged as Intermediate).

Proportion of indigenous (Aboriginal or Torres Strait Islander) clients 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% .0% Latrobe Valley

Melbourne

Sunshine

Figure 3.2 Indigenous clients by program venue It is useful to compare these demographic characteristics with those of two reference groups: arrestees and prisoners. The arrestee data is the first Victorian data from the Drug Use Monitoring Australia research (Adams, Sandy, Smith, & Triglone, 2008) and the prisoner data is from the national prisoner census for 2008 (Australian Bureau of Statistics, 2008). Characteristic

CISP clients

Victorian arrestees

Victorian prisoners

% Female

18.6%

25.2%

5.6%

% Aged 26 or less

26.1%

29.0%

16.4%

% Indigenous

8.1%

n.a.

5.8%

Table 3.1 CISP client characteristics compared with arrestees and prisoners The CISP population has an age distribution that is generally similar to that of arrestees, and younger than prisoners. There are more indigenous and female offenders in the Melbourne Criminological Research and Evaluation

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Evaluation of the Court Integrated Services Program: Final Report

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CISP client group than in the prison population. While there appear to be fewer females in the CISP population than for Victorian arrestees, it should be noted that the Victorian DUMA sample is small (two quarters of data only) and amongst Australian arrestees generally around 16% were female.

3.2

Prevalence of drug problems

Drug problems are assessed according to a four-level classification that distinguishes between no use, use, abuse and dependence. The criteria for the most serious level of the scale (dependence) include: tolerance (the need for larger amounts of the drug over time), withdrawal (physical or psychological effects associated with cessation of use), and an inability to voluntarily cease or restrict use of the drug. The criteria for the second level of the scale (abuse) include recurrent use resulting in social, inter-personal or legal problems or physical hazards. Drug use involves irregular or regular use that does not satisfy the criteria for abuse or dependence. Assessments of drug problems are made for each type of illicit drug that the person reports using, and for any individual the severity of drug problems may vary greatly from one drug to another.

Case location Drug problems

Latrobe

Melbourne

Sunshine

Total

Valley Current use of drugs reported

Past or present IV drug use

Current pharmacotherapy

Overdose history

Total

N

190

868

639

1697

%

65.1%

68.5%

80.9%

72.2%

N

114

709

503

1326

%

39.0%

56.0%

63.7%

56.4%

N

27

299

268

594

%

9.2%

23.6%

33.9%

25.3%

N

45

261

143

449

%

15.4%

20.6%

18.1%

19.1%

N

292

1267

790

2349

%

100.0%

100.0%

100.0%

100.0%

Table 3.2 Clients with identified drug problems (2007 & 2008) by CISP venue Overall, around 70% of all engaged CISP clients reported some level of illicit drug use (Table 3.2). Drug use was more prevalent at Sunshine than at Melbourne, and Melbourne in turn recorded higher rates than Latrobe Valley. This pattern was evident

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across a range of measures of drug problems: rates of IV drug use; reported current engagement in pharmacotherapy; and overdose history. Where drug use was identified, clients were assessed in relation to each drug where use was reported. On average, clients reported using around 1.5 drug types. The most commonly reported drug was cannabis, and over half of those who reported using it were assessed as dependent. Heroin was the next most commonly reported drug, and again over half of those assessed were recorded as dependent. Amphetamines, methamphetamine and benzodiazepine use were also commonly reported and in each case between half and two-thirds of users were assessed as either dependent or abusers of the drug. This general pattern of drug use closely matches the pattern observed for arrestees in the DUMA research, where cannabis was found to be the most common drug detected through urinanalysis, followed by heroin and amphetamine/methylamphetamine and benzodiazepines.

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Level of Drug Use Drug type Use

Abuse

Dependence

None

Unknown

Total

N

266

144

475

7

14

906

%

29.4%

15.9%

52.4%

.8%

1.5%

100.0%

N

116

134

352

4

5

611

%

19.0%

21.9%

57.6%

.7%

.8%

100.0%

N

150

144

116

6

7

423

%

35.5%

34.0%

27.4%

1.4%

1.7%

100.0%

Methylamphetamine

N

55

70

96

1

2

224

(“Ice”)

%

24.6%

31.2%

42.9%

.4%

.9%

100.0%

Benzodiazepines

N

29

69

46

0

1

145

%

20.0%

47.6%

31.7%

.0%

.7%

100.0%

N

55

26

5

5

0

91

%

60.4%

28.6%

5.5%

5.5%

.0%

100.0%

N

27

52

52

0

4

135

%

20.0%

38.5%

38.5%

0%

3.0%

100.0%

N

698

639

1142

23

33

2535

%

27.5%

25.2%

45.0%

.9%

1.3%

100.0%

Cannabis

Heroin

Amphetamines

Ecstasy

Other

Total

Table 3.3 severity of drug problems by drug type Age was the most important demographic characteristic related to drug problems. Clients in the older age group (37 years or more) were much less likely to report drug problems than those in the middle (26 to 37) or young (under 26) groups. Women clients reported somewhat more drug problems than male clients. Women were more likely to report heroin use, IV drug use and a history of overdose, however these differences were small. In the case of indigenous clients, around one-quarter had an “unknown” status in relation to drug problems and it is therefore difficult to draw any conclusions about the prevalence or severity of drug problems in this client group.

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3.3

December 2009

Prevalence of alcohol problems

The assessment process for alcohol problems is similar to that for drug problems. Engaged clients are asked whether they currently use alcohol, and those who report any alcohol use are assessed to determine whether this constitutes abuse or dependence on alcohol. The screening process for alcohol problems examines self-reported problems with alcohol, the presence of alcohol-related offences (eg. drink-driving) and the involvement of alcohol in offending. There were very large differences between the program sites in the proportion of clients who were recorded as having any current use of alcohol (and who then went on to the next assessment stage), and in the severity of alcohol problems.

Case location Latrobe

Melbourne

Sunshine

Total

191

507

320

1018

65.4%

40.0%

40.5%

43.3%

Valley Any alcohol use?

Severity of alcohol problems Use

Abuse

Dependence

None Unknown

Total

N

62

182

90

334

%

32.5%

35.9%

28.1%

32.8%

N

46

201

68

315

%

24.1%

39.6%

21.2%

30.9%

N

81

97

158

336

%

42.4%

19.1%

49.4%

33.0%

N

1

17

1

19

%

.5%

3.4%

.3%

1.9%

N

1

10

3

14

%

.5%

2.0%

.9%

1.4%

N

191

507

320

1018

%

100.0%

100.0%

100.0%

100.0%

Table 3.4 Alcohol problems by venue Nearly two-thirds of Latrobe Valley clients (65.4%) were recorded as having any current alcohol use compared with around 40% at the other two venues (Table 3.4). However, there were no consistent differences between the three sites in the severity of alcohol problems. Overall a third of those assessed for alcohol problems were classed as dependent, but this varied from nearly half of those assessed at Sunshine to less than one-fifth at Melbourne. In our interviews with service providers, magistrates and case Melbourne Criminological Research and Evaluation

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Evaluation of the Court Integrated Services Program: Final Report

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managers, there was a consensus that alcohol problems are more prevalent at the Latrobe valley venue. Alcohol use was more prevalent amongst male clients and where present alcohol problems were more likely to be assessed as dependent. As with drug problems, the proportion of Indigenous clients with unknown alcohol use is high (around 20%) and this makes any comparison problematic.

3.4

Prevalence of mental health problems, ABI and intellectual disability

The screening assessment asks case managers to identify whether the client has any indications of mental health problems, acquired brain injury or intellectual disability. While the assessment questions include a range of known indicators of these conditions, their purpose is solely to identify clients who may require more detailed clinical assessment by a psychiatric nurse, disability worker or ABI clinician. Where serious mental illness is identified, responsibility for the client may be transferred to Forensicare or in the case of intellectually disabled persons charged with serious crimes, to Disability Forensic assessment and Treatment Services. Across the program, just over one-third of all clients were identified as having a possible mental health problem, and there was little variation between the program venues in the prevalence of these conditions. Where mental health issues were identified, the majority of these clients were receiving some form of treatment (39.8%), had received treatment in the past (14.2%) or had a current diagnosis of their condition (20.7%) (Table 4.5). Around one in ten clients with an identified mental health problem had never received treatment, been assessed but not treated, or were currently being assessed.

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Prevalence of mental health problems 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% .0% Latrobe Valley

Melbourne

Sunshine

Figure 3.3 Mental health problems by CISP venue Mental health problems were much more common in women than in men (48.4% versus 34.7%) and became more prevalent as clients got older: 30.5% of young clients had an identified mental health problem compared with 38.0% of clients in the middle age group and 42.2% of clients in the older age group. Mental health problem status was unknown for around one quarter of Indigenous clients.

Mental health treatment history

N

%

Currently receiving treatment

496

39.8%

Has a current diagnosis

258

20.7%

Received treatment in the past

177

14.2%

Requires assessment

138

11.1%

Current client of Mental Health Service

104

8.3%

Currently undergoing assessment

43

3.5%

Never received assessment or treatment

48

3.9%

Received assessment but no treatment

27

2.2%

Previously completed assessment

79

6.3%

No treatment required at this time

28

2.2%

Current client of Disability Services

4

.3%

1246

100.0%

Total clients

Table 3.5 Treatment status for mental health problems at CISP assessment

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Acquired brain injury The screening assessment included several items that are indicators of acquired brain injury (head injury, periods of unconsciousness, inhalant use, long term drug or alcohol use). A total of 174 clients or about one in ten (8.9%) was identified as having indicators of ABI. Full assessment for ABI is the responsibility of arbias and client ABI status was updated at the time of program exit, when a total of 141 clients were recorded with ABI status. The proportion of clients with ABI status was significantly higher at Latrobe Valley than at the other CISP venues (see Figure 4.4), possibly as a result of the higher level of alcohol abuse at that site.

There was no difference in the prevalence of ABI

indicators between men and women, but there was a significant relationship with client age. Only 3.2% of young clients were recorded as having ABI status compared with 6.8% of those in the middle age group and 10.7% of those in the older age group.

Acquired brain injury at CISP exit 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% .0% Latrobe Valley

Melbourne

Sunshine

Figure 3.4 Acquired brain injury at CISP exit

Intellectual disability A total of 87 clients were recorded as having intellectual disability, of whom 67 were clients of Disability Services.

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Evaluation of the Court Integrated Services Program: Final Report

3.5

December 2009

Combinations of problems

Around one third of CISP clients were recorded as having more than one offending related drug, alcohol or mental health problem 9 . The most common combination was drug and mental health problems, present in 16% of CISP clients. Drug and alcohol problems in combination accounted for a further seven percent of clients. Around five percent of clients were assessed as having all three problems.

Frequency

Percent

Drug and alcohol problems

172

7.2%

Drug and mental health problems

383

16.0%

Alcohol and mental health problems

137

5.7%

Drug, alcohol and mental health

126

5.3%

2387

100.0%

problems Total

Table 3.6 Combinations of offending-related problems

3.6

SF-12 survey of client physical and mental health

The SF-12 is a short (12 item) psychometrically valid instrument for measuring health status. The SF-12 allows the self-reported physical and mental health status of the surveyed group to be compared with values for other groups or for the same group over time. The items that comprise the SF-12 are shown in the table below. The instrument measures functional health status: that is, it asks about the impacts and consequences of health issues rather than clinical or diagnostic details. While the instrument is not itself diagnostic, it has been shown that it can reliably distinguish between groups that differ in the severity of their health problems. The primary output measures are summary physical and mental health scores, however the instrument also allows a health profile of eight scales to be measured.

9

Drug problems were defined as current drug use plus any of the following: current involvement in a drug

treatment program, a history of IV drug use or an overdose history. Alcohol problems were defined as alcohol use assessed as abuse or dependence. Mental health problems were defined as any identified mental health problem.

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For the CISP evaluation, the SF-12 was administered to 197 clients at the time they commenced the program, and 67 were re-tested at or near their exit from the program. Participation in the survey was voluntary, and the survey questions were administered verbally by case managers who also recorded the clients’ responses.

SF-12 scales

Number of questions

Physical functioning

2

Role limitations because of physical health problems

2

Bodily pain

1

General health perceptions

1

Vitality

1

Social functioning

1

Role limitations because of emotional problems

2

General mental health

2

Table 3.7 SF-12 scales

Pre-CISP physical health The first (pre-CISP) administration of the SF-12 provides a measure of how the physical health status of clients compared with other groups in the community. The instrument is constructed so that the general population mean for physical health is a score of 50 with a standard deviation of around 10. The mean Physical Component Score (PCS) for the CISP sample at program entry was 49.8 (with a standard deviation of 10.8). Figure 4.1 shows the CISP PCS score together with scores for comparison general population samples in Australia and the USA, and a sample of US homeless people. It can be seen that the CISP sample mean is essentially the same as that for the general population samples, and higher than that of the homeless group.

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Evaluation of the Court Integrated Services Program: Final Report

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Physical Component Score CISP 70

Australian Community

Mean Value

60

U.S. Community 50

Australian Clinical 40

U.S. Homeless 30 1

Figure 3.5 SF-12 mean physical component scores for CISP and comparison groups Women typically report slightly lower CS scores than men (around two points lower) and this was also the case with the pre-CISP samples, where men recorded a mean PCS score of 49.0 and women a PCS score of 46.6.

Pre-CISP mental health The SF-12 is constructed so that the general population mean for mental health is a score of 50 with a standard deviation of around 10. The mean Mental Component Score (MCS) for the CISP sample at program entry was 37.4 (with a standard deviation of 12.5). Figure 4.2 shows the CISP MCS score together with scores for comparison general population samples in Australia and the USA, and a sample of US homeless people. It can be seen that the CISP sample mean is much lower than the general population samples, and somewhat lower than that of the homeless group. MCS scores for women entering CISP were even lower (at 31.2), compared with 38 for men entering CISP.

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Mental Component Score

December 2009

CISP

70

Australian Community Mean Value

60

U.S. Community 50

Australian Clinical 40

U.S. Homeless 30 1

3.6 SF-12 mean mental component scores for CISP and comparison groups

Comparing pre- and post-CISP scores Clients who completed CISP were also asked to do the SF-12 again at or near the time of their exit from the program. Around 40% of those who are engaged as CISP clients do not complete, and of those who do a proportion exit before a final meeting with their case manager is scheduled (usually when they are sentenced). As a result, only 67 second round surveys were completed. A comparison of the pre- and post-CISP SF-12 Physical Component Scores showed an increase in the mean score from 50 to 54, and mean Mental Component Scores also increased from 38 to 45. Paired sample t-tests showed that both these increases were statistically significant 10 .

10

Pre- and post-CISP Physical Component Scores: t=3.56, df=66, p
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