Continuity of care for substance misusing prisoners released to a local community drug treatment system: A quantitative analysis of the systems approach.

Background: Continuity of care (CC) is associated with increased rates of engagement with drug treatment, and drug treatment is associated with reductions in crime. However, performance rates of CC reflecting the prison-to-community transition for substance misusing prisoners (SMP) are low and, although guidance is extensive, non-clinical quantitative research describing this key process point within the UK criminal justice healthcare pathway is limited. Objectives: From a systems perspective, utilising a bespoke prison-to-community CC counting mechanism, this study aimed to: establish whether CC is associated with improved rates of drug treatment engagement, reduced waiting times and rates of return-to-prison (RTP); evaluate the impact on those measures post the introduction of the reconfigured single service delivery model ‘InsideOut’. Also, given this study’s pilot introduction of the statutory drugs data collection system into the local prison, describe a ‘first look’ pre-incarceration client treatment outcomes profile (TOP). Design: Observational, encompassing a quasi-experimental (before and after) analysis of impact. Participants: Adult, male substance misusing prisoners (N = 808) transitioning from the prison system to a local community drug partnership between April 1st 2008 and March 31st 2012. Results: ‘System’ level prison-to-community CC was associated with increased rates of and reduced waiting times to drug treatment. The introduction of the InsideOut service was associated with a stepped change in performance. Compared to individuals engaged with community recovery, SMPs reported a significant deterioration in all outcome domains prior to incarceration. Conclusions: Whilst the increased rates of prison-to-community continuity of care reported here were supported by the UK Department of Health’s statutory reporting mechanism, the decreased rates of return-to-prison contradicted UK Home Office reoffending outputs. Analysis of the national administrative statutory health and crime datasets is suggested to address this and other issues associated with study power, confounding and validity.