Drugs Strategy; Implementation & the BME Prison

Population

Action Plan Report

Abd Al-Rahman
Drugs and Diversity Advisor
HMPS (London Area)

March 2004
Contents

Introduction 1-2

Workforce and cultural Competence 3-5

a) Procurement
b) Training

Monitoring and Evaluation 5-6

User consultation 6-7

Treatment Intervention 7-8

a) Crack Intervention
b) Rolling Programmes
c) Self-Help Groups

Drug Strategy/Diversity 8-9

a) RRLO/Diversity Officers
b) Training
c) Language
d) Diversity Training

Service Configuration Diagram 10

Action Plan for Drug Strategy and Intervention 11 - 14

Bibliography and Literature Review 15

Appendices 16 - 17

“Cultural Competence
requires that organisations
have a defined set of values
and principles and
demonstrate behaviours,
attitudes, policies and
structures that enable them
to work effectively cross-
culturally.”
National Centre for
Cultural Competence –
‘Conceptual
Frameworks/Models, Guiding
Values and Principles’
1
Audit Commission – Change Here, Managing Change to improve Local Services (2001)
2
See Appendix 0.03 for a summary
3
HMP’s Wormwood Scrubs, Wandsworth, Feltham, Latchmere House, Pentonville and Brixton
4
DSD – Updated Drug Strategy 2002
“Without knowing anything about the people who use your
service, how can you begin to understand their needs? Without
hearing what they want from you, how can you focus on the
areas that really matter to them? Without an accurate picture of
their experiences, how can you be sure that you fully understand
what works and what needs fixing, especially where your
contribution is part of an extended process involving other
agencies as well as your own?” 1
Introduction
The statement above, from the Audit Commission, is one of the
key principles that underpin this Action Plan Report. HMPS,
CARAT Teams, Prison Rehab services, Detox teams, DSC’s as
well as others involved in prison drug strategy and intervention
need to embrace this as their guiding principle if they are to
maximise their effectiveness in meeting needs.
This Action Plan Report draws together the findings and
recommendations2 from the six reports on London area prisons3
and sets out the initial actions required to assist a process of
change in the perception of BME inmates towards prison drug
services and therefore an increase in BME numbers accessing
provision. The change process is ongoing. As services interact
and consult with service users the way forward will become
increasingly clearer and inmates will feel that they have
informed and assisted the change process and, as a result, BME
service up-take will increase.
The report represents performance of the Drugs and Diversity
Advisor (London Area) in relation to the contractual outcomes
for the period October 2003 – December 2003. The Outcomes to
date can be measured by the requirements of the Key Targets
agreed with between HMP (London Area) and The Federation,
for the period outlined above. The Action Plan also compliments
The Federation Equality Health Check commissioned by the
London Area Prison Service.
The report supports the wider drive to enhance drug treatment
provision in prisons as outlined by the DSD4:
“Those entering prison will benefit from improvements in the quality
and coverage of prison-based treatment programmes which meet
national standards.”
In relation to Crack users the Updated Drug Strategy aims to:
1
 “Ensure access to effective treatment for crack and cocaine users.”
Also of relevance to this Action Plan, is the SMAS5
Commissioning Standard 9 focusing on service specifications
and Minority Ethnic Populations. Standard 9 states that:

“The particular service needs of minority ethnic problem alcohol and

drug users are reflected in service agreements, service specifications and
broader purchasing agreements and monitoring requirements.”

Standard 9 in the SMAS document gives guidance that is directly

relevant to the prison context, i.e. having in place consultation
mechanisms and Commissioners ensuring that treatment staff
are reflective, ethnically, of local populations all of which is
echoed by the NTA6

There are 5 inter-connected strands to the action plan as outlined

in fig.1. Under each of the five broad headings sit the
recommendations from the six reports mentioned previously.

Fig. 1. Areas of focus

for the change process

Background information and the strategic context are provided

on each area along with an explanation of how the work can be
taken forward. This is followed by the same headings in chart
form including timescales, benefits and responsibilities.

5
Substance Misuse Advisory Service – Commissioning Standards - drug and Alcohol treatment and care
6
NTA - Commissioning definitions and frameworks

2
 1. Workforce and Cultural Competence
a) Procurement.
“There is clear evidence
that issues of anti-
discriminatory practice in
employment and issues of
equity in service provision
for diverse communities
are, and should be
considered as, related and
not as separate issues”.
NTA – ‘RRAA 2000 –
Implementing good practice’
“A further point raised in
relation to service provision
for ethnic minority
prisoners was the present
shortfall in substance
misuse workers from Black
and Asian populations.
This shortfall was seen to
impact negatively on
prisoners’ willingness to
access services in general,
and rehabilitation Services
in particular.”
Home Office Online Report
33/03 – Differential
substance misuse needs of
women, ethnic minorities and
young offenders in prison
7,8,9,10
CRE – Public Procurement and Race Equality, Guidelines for public authorities.
8
Latchmere House and Feltham do not have rehab services.
The Race Relations Amendment Act makes it unlawful for
public authorities to discriminate in all of their functions
including procurement. The CRE states that:
“Where one or more of your functions is carried out by an external
supplier, you remain responsible for meeting the duty. Contractors
themselves must not discriminate, but they do not have the same
legal obligation to promote equality of opportunity. So you must
build relevant race equality considerations into the procurement
process to ensure each function meets your RRA requirements,
regardless of who is carrying it out.”7
Due to the un-representative nature of staffing within four of
the six CARAT teams and two of the four rehab services8 it is
necessary for HMPS to ensure that drug specific procurement
policies, procedures and monitoring are in place and that, as
a result of this, existing contract drug services are aware of
and will plan how they will need to evolve in order for
HMPS to fulfil its responsibilities. The CRE further states in
one of five key outcomes of achieving race equality in
procurement that:
“Contractors are representative of the local population, or of the
area from which the businesses are drawn, with respect to ethnic
diversity.”9
Also, in relation to roles and responsibilities of “officers
concerned with service review and improvement”:
“You need to ensure that services meet the needs of all users…Are
users and potential users consulted on the form services should
take?”10
As well as this those services planned for the future will need
to comply with these requirements in order to be considered
for contracts:
“Public authorities should check that potential suppliers are
competent and committed to complying with employment
legislation, including on race equality. Where race equality is a core
requirement, further probing should test if bidders have the policies
3

“Some prison officers are
on a humiliation tip. They’ll
say that so and so is on the
‘Junkie wing’ but they
should see this as positive
because inmates are
changing. Some of them
like to play mind-games.
Officers need training on
how to handle inmates who
are in recovery. – Inmate in
recovery”
Abd Al-Rahman – ‘Report
on Drugs Strategy;
Implementation & the BME
Prison Population
“Issues pertaining to
Diversity and BME inmates
within Drug Strategy
Meetings are often seen as
confusing to discuss due to
a lack of knowledge of just
how the areas play a role.
This is especially so if the
attendees are themselves
unrepresentative of the
prison population.”
Abd Al-Rahman – ‘Report
on Drugs Strategy;
Implementation & the BME
Prison Population
and expertise to meet contractual obligation to deliver an accessible
and responsive service.”11
The CRE publication, Public Procurement and Race Equality -
Guidelines for public authorities is a practical reference
document for implementing RRAA compliant procurement
policies and procedures and will assist in developing existing
and future drug service provision.
b) Training
One of the areas highlighted by prison officers, most contract
service managers and inmates as critical for achieving drug
treatment aims is that of staff training.
1. Training was seen as necessary for prison officers and
RRLO’s/Diversity Officers on drug awareness and recovery
in order for them to work in tune with contract drug services
and as part of the prison drug strategy. This would be ideally
two-day training sessions facilitated for officers identified by
the Drug Strategy Group. The training components would
include:
• Basic drug awareness.
• Attitudes to drug use/users and stereotypes
• Why do people use drugs?
• The road to recovery – ‘The Cycle of Change’.
• Drug use and recovery – the prison context.
• The rationale and aims of the Prison Drug Strategy.
Due to the high number of drug users in prisons this training
should become part of the overall training package for prison
officers. The DDA feels that staff from contract drug services
may be best placed to facilitate drug awareness and recovery
training provided they have training experience. This would
assist the aim of building a stronger working relationship
between treatment staff and officers and allow the latter to
become better acquainted with prison based treatment
practice.
2. Leadership Toolkit training has been developed in order to
enhance the practice of front line managers and incorporates
periodic Active Learning Circles (ALC) that enables
participants to establish an ongoing process of knowledge
sharing. This Toolkit has been approved by the Home Office –
Drug Strategy Directorate and is the first programme of its
kind to be introduced nationally to the entire drug and
alcohol sector and is underpinned by the Race Relations
(Amendment) Act 2000. Linked to the National Treatment
Agency’s (NTA) workforce strategy, Developing Careers
Improving Treatment, The Federation Toolkit aims to develop
the professional skills and competence of existing staff in the
drug misuse sector.
4

“Organisations develop
their own internal belief
systems that become
invisibly embedded in
everyday decisions and
behaviour. These
commonly include
assumptions about who the
customers are, what they
think about the
organisation, how and why
they use services and what
they want and value.”
Audit Commission –
‘Change Here’
2.
a)
12
COCA – Conference On Crack Abuse
13
NTA – Models of Care
Within the context of work within the Prison Service this
tailored training would prove invaluable for Detox, CARAT
and Rehab Managers as well as DSC’s. Alongside bringing out
innate leadership qualities through interactive learning the
training process would kick-start the cross-estate ongoing
sharing of good practice and resources in terms of experiences
and solutions.
3. There is a need across the Drug and Alcohol sector to build
on the numbers of practitioners who are experienced in
working effectively with crack users. The high numbers of
crack users within London Area prisons, a high proportion of
which are BME, calls for specialised training in Crack and
Cocaine use and recovery. This DANOS compliant training
would target CARAT and rehab staff and, in particular,
Detox staff. Specialist agencies with a track record of crack
specific work would facilitate. The emphasis would be on
how to transfer this learning into practice, particularly
around group-work. The DDA has already spoken to
COCA12 who has worked closely with the NTA in regard to
crack specific training and provision. As well as COCA The
Federation is aware of other agencies with the expertise to
deliver such training.
4. Identity and Cultural Competence training is specific to
each Drug Strategy Group. As an alternative it can be carried
out as a consultation exercise through attendance at a DSM
within each prison and facilitating an exploration of BME
inmates and Drug Strategy. This would include identifying
gaps (some are not directly apparent), examples, relevance,
championing, action planning, communication, feedback and
monitoring. From this DSM’s will become more pro-active
and more productive in meeting the needs of BME inmates.
Monitoring and Evaluation
The NTA13 states that:
“There is an increasing central imperative to monitor the activity,
cost and outcomes of substance misuse treatment and care services.
Structured community and specialist substance misuse service
providers are now expected to report at least some information
about how effective they are at helping people who present for
treatment. This reflects a desire to gauge the return on national
investment in treatment services and to ensure that resources are
directed to treatments that are effective.” P.196
5

“Staff and space shortages
and an emphasis on
performance measurements
which are numbers and
outputs, goes against
meeting needs and
outcomes. This is
compounded by a ‘one size
fits all’ approach to
problematic drug users
which ignores and
marginalises the need for
developing stimulant
specific and culturally
sensitive drug treatment
services for BME prisoners
who are misusing drugs”
P. Lamour – Equality
Health Check, HMPS
London Area
“Drug users in general, and
African Caribbean drug
users in particular, face a
lack of treatment options
for stimulant and cannabis
use.”
Sangster, et al – ‘Delivering
drug services to Black and
ethnic-minority communities.’
14
Task Force to Review Services for Drug Misusers – Report of an independent review of drug treatment services
in England (1996) DoH
15
i.e. improvement in employment status and fewer working/school days missed.
Within prisons it was found that there is an absence of
outcome data related to treatment interventions. As a result,
anecdotal evidence from staff and inmates as well as, for
example, ‘proxy’ outcomes on attrition rates is relied upon in
an effort to gauge outcomes. The Task Force Review of
Services for Drug Misusers14 defined treatment outcomes
under the headings of Drug use, physical and psychological
health and social functioning and life context. In prisons, like
within a community setting, it should be about quality of
provision somewhat more-so than about numbers,
particularly as service users are already under one roof.
While this report accepts that some of the outcomes stated in
The Task Force Review may not be directly applicable to
drug services within the context of prison 15 there should be
a greater emphasis on collating information on the outcomes
and effectiveness of prison drug treatment. Documented
evidences from User Consultation’s could form the bulk of
this as well as evaluation forms that relate to the work that
services are contracted to deliver.
b) All RRLO’s and Diversity Officers need to receive data on
prison drugs related intervention in order to assist in
bringing together the areas of Drug strategy/intervention
and diversity/BME inmates. Along with Drug awareness
training and being part of DSM’s this will serve to enhance
drug strategy groups and their ability to work effectively
with BME drug users.
3. User Consultation
a) Services as a whole would benefit from on-going feedback
groups that allow inmates to express what they want from
services and their perceptions of current services. As well as
informing the evolution of provision this process would lead
to an enhanced relationship between services and drug
users.
There should be particular focus on BME crack users within
the prison in order to find out what inmates have to say on
why they don’t access particular provision in sufficient
numbers and to find out what inmates think needs to be
done about the situation.
Consultation meetings, facilitated by two staff members, will
include inmates from all ethnic groups with particular
emphasis on BME inmate representation. Meetings would
not include all the same individuals at every session. The
Drug Strategy Group would monitor attendance. Inmates
6

4) Treatment interventions
a) Crack services and Detox
“Practitioners reported
different patterns of
substance use among white
male prisoners and men
from minority ethnic
populations.”
Home Office Online Report
33/03 – Differential
substance misuse needs of
women, ethnic minorities and
young offenders in prison
16
Home Office Online Report 33/03 – ‘Differential substance misuse needs of women, ethnic minorities and young
offenders in prison.
would put in requests to attend as well as being encouraged
to do so by services as a whole. The issues raised, themes,
trends and the general knowledge gained can be shared
across the prison estate. Translation of key findings into
points for action is necessary so that it is not just an exercise
without change. With training received by The Drug
Strategy Group and contract services (see 1. b) above) all
involved will be better equipped at the action phase.
In the DDA’s assessment of the available information a
problem has arisen due to the way in which a detox is viewed
by some staff within a prison context and what a detox is in
reality. When this is analysed, particularly in relation to crack,
a significant aspect of the problem becomes clear. In short,
detox is concerned with Opiate users, Alcohol addiction and
other substances than illustrate prominent and apparent
physical withdrawal symptoms that can be managed, to a
large extent, by medication. So what is happening is that an
inmate is being physically detoxed from a substance. A Home
Office Report16 on treatment needs states in relation to ethnic
minority prisoners that:
“Men using crack cocaine in the absence heroin were seen as less
likely to self-refer to services for several reasons. The absence of
pronounced physical symptoms on withdrawal from crack cocaine
and the lack of a prescribed substitute for this drug were two
reasons given for lower rates of self-referral to Detoxification
Services. It was also reported that users of crack cocaine were less
likely than heroin users to perceive their drug use as problematic.”
Crack ‘detox’ for most would be therapeutic groups and talk
therapy. This is why the crack group in Brixton was so
successful. Inmates do not detox from crack in the same way
that an alcoholic or heroin user would detox from their drug
of choice. The DSD states:
“…there is evidence that treatment for crack misusers is effective,
but that such treatment should focus on social rather than medical
interventions and on assisting misusers to deal with both
psychological and practical impact of the drug on their lives.”
Crack Specific Groups
• Pre-access information should be developed
informing inmates of provision for crack users and
the rationale for this specific provision.
7

b)
“Further developments
in CARAT teams should
concentrate on (1)
increasing the number of
places on therapeutic
programmes and (2) pre-
release planning to
address employment and
housing needs, and (3) to
establish ongoing contact
with services outside c)
prison”.
Home Office guidance
The Development and
Practice Report
5 Drug Strategy/Diversity
• An Officer assumes the role of outreach worker or
Substance Misuse Through-care Co-ordinator in
order to access those who are not in contact with
services in particular crack users.
• Prison Specific intensive therapeutic Crack groups
developed in line with The Blenheim Projects’ model
on the back of training and map out the link with
detox provision.
• Evaluation guidelines are developed in order to
assess effectiveness.
In the DDA’s assessment The Blenheim project or COCA are
best placed to assist with this process.
Within the community the nature of Rehabilitation services
allow for them to proceed on a rolling basis. As one person
leaves the next on the waiting list joins the programme.
Within prisons services need to evolve along these lines so
that interventions become more fluid and accessible
particularly in light of recent high attrition rates within some
establishments. Services should plan out the process through
which this would occur; timescales for this and an
assessment of the impact the process of change will have on
inmates. An evaluation of the extent to which inmates have
benefited from the changes should be carried out which is
assisted through the user consultation sessions.
User led Self-Help Groups provide an effective alternative to
AA and CA meetings and have been suggested in a number
of prisons. The group would be carried forward as an ‘open
group’ that enables inmates to discuss and gain peer support
for issues surrounding and underpinning drugs and
offending behaviour as well as relapse prevention. The
format would be similar to AA/CA because groups would
be based on discussion and support rather than training. The
facilitator or Chair would be there to direct and guide the
process allowing each to have their say and drawing on the
experiences of each member to identify examples of
learning. These groups would have a representative from a
contract drug service present in an observatory capacity. The
observer would coach facilitators from the inmate
population who have successfully completed treatment
programmes or who are currently acting as Listeners.
Facilitators would rotate allowing a variety of inmates to
gain from the experience.
Debrief sessions between the observer and facilitator would
form the ongoing learning aspect of the groups.
8
 a) In most prisons the RRLO or Diversity officer does not
attend DSM’s. This will need to change if prisons wish to
make a stronger link between ‘drugs and diversity’. This
issue was discussed during DDA prison visits and there was
broad agreement that this should take place.
b) There is no evidence that Diversity training is having an all
round positive impact on staff within prisons. Officers across
the estate receive, if at all, variable lengths of training with
variable degrees of quality. This is further compounded by a
lack of confidence within some prisons in regard to training
others on this sensitive subject. Diversity training, as many
officer see it, has had for too long an over focus on getting
participants to understand the other leaving participants
untouched in terms of exploring themselves. Hence, some
officers and treatment staff have left training sessions at best
de-motivated and, at worst, angry. There is a need for
Identity and Difference training to enhance the
awareness/theory process. The need is for facilitators to
have access to the time and space in which to explore
humanness, the balance between sameness/difference as well
as how best to facilitate others in exploring themselves.
Through this process one begins to look at others and the
diversity agenda through different eyes. Policy can then
have not only compliance but also understanding and
acceptance. (see also 1. Workforce and Cultural Competence
b) Training)

c) Within some prisons foreign nationals are as high as 41%. As

a result translated information is needed on:
• drugs awareness information. DrugScope17 are in the
process of developing information in 12 languages
and it is expected that this will be completed by
May/June 2004.
• Information on services available within each prison
has been translated in some establishments but not in
others. Information can be translated in a variety of
languages through contacts at The Federation.

17
DrugScope – Waterbridge House, 32 – 36 Loman Street London SE1 OEE

9
Fig. 2. Diagram of service configuration based on
recommendations.

10