The story of early and effective intervention

We have another excellent contribution this week from Justina Murray, South West Scotland Community Justice Authority and Chair of the Early and Effective Intervention (EEI) for Women Partnership.

Early and Effective Intervention (EEI) for Women was established in Ayrshire in October 2013, as one of sixteen women’s justice services funded by the Scottish Government in response to the publication of the Commission on Women Offenders in 2012.

EEI had been identified as a gap by South West Scotland CJA partners during discussions in 2012-13 on developing a local Whole System Approach for Women. Comparing arrangements for adult women to provision within the Whole System Approach for young people, we realised that many of the current or planned developments to support women in the justice system were targeted at the later stages of court, community sentence, custody and post-custody, rather than on early intervention and prevention. This was recognised as ‘failure demand’ in the words of the Christie Commission, by waiting until a situation has escalated before intervening, by which time the impact and costs for all are all the more severe, and solutions are inevitable less effective and more expensive.

We developed EEI for Women as an alternative to a police disposal, for those women who would struggle to engage positively and successful with this option. Our local Crime Management Unit could therefore refer to the EEI Coordinator any female who was aged 18 or over, resident in Ayrshire, had committed a crime in Ayrshire, and who had a range of other presenting needs. We deliberately kept restrictions to a minimum, but excluded sexual offences, offences involving a weapon, serious violent offences, domestic abuse and drug supply. Importantly, EEI was offered as a voluntary alternative to a police disposal only where police colleagues felt this was most appropriate, and we were careful not to ‘up-tariff’ women who would cope perfectly well with a fixed penalty notice or formal adult warning.

The EEI Coordinator was hosted by Sacro, and she worked alongside a part-time NHS Ayrshire and Arran occupational therapist (OT) to form the EEI team. This OT input was not originally part of the service design but grew from the experience of another Sacro service and the desire of the NHS OT service to make a preventative investment. In fact the criminal justice/ OT partnership became a defining characteristic of EEI for Women and is regarded as one of its biggest successes, bringing a broad skill-set, wider partner networks and access to both NHS and social work information systems.

The EEI team worked with the woman to confirm her willingness to engage (at times needing considerable persistence and tenacity) and to develop a joint action plan based on a holistic and collaborative assessment of needs and strengths. If the woman engaged positively with the development and delivery of this action plan, a positive report would be returned to the Crime Management Unit (CMU) who would close the case and take no further action. A charge would be recorded for a period, but not a criminal conviction. Conversely, refusal to engage (despite persistent efforts by the EEI team) would result in an update report back to the CMU who could take further action as appropriate.

The team worked with women with layers and layers of both presenting and underlying needs which proved to be complex and large scale. The women were often not known to services; or were working with a range of services who were unaware of each other’s involvement; or faced barriers to services due to either their co-presenting needs (e.g. mental health and addictions) acting as a bar to provision or their officially ‘low level’ needs falling below service thresholds (despite these needs having a chronic debilitating effect). Many had struggled to engage with services when the opportunity had previously been offered, for example finding formal correspondence overwhelming and impenetrable, failing to keep appointments, losing track of services as they frequently re-located their homes and lives; or not recognising their own need for support as they juggled competing and complicated family demands and commitments. For example a woman facing an initial charge of shoplifting (in fact the most common offence committed by women referred to EEI) in reality overlaid issues such as chronic health problems, terminal illness, bereavement, gambling and addictions.

Women engaging with the EEI service were not at immediate risk of custody. However it was clear that where underlying issues remained unrecognised and unmet, their precarious situation was likely to escalate, risking their home, family and community supports. The original model for the EEI Coordinator was of office-based coordination, but in reality women needed practical, hands-on, persistent support to navigate through and engage with other services.

EEI for Women was never intended to provide long term support for women, and cases were generally closed within 3-6 months, by which time a range of protective factors and support systems had been identified or developed to reduce their future re-offending. This included supporting women to take responsibility for managing a situation; navigate and establish relationships with mainstream services; increase their self-confidence and coping strategies; develop new skills and capacities; and be maintained in their own homes, families and communities. Longer term support was offered where appropriate via Sacro volunteers, who offered befriending, re-socialising, linking into community and social networks, and maintaining service links.

The challenge for EEI for Women was attracting sufficient referrals from the police, and following a promising start the referrals never reached a level to make the service economic or sustainable. During its operational period of 24 months, the team worked with 29 women and a further 61 people connected to these women (e.g. family members). In reality, our determination that this initiative should remain at the earliest possible stage of the system limited referrals to a single source (the CMU), and many cases were either deemed suitable for a police disposal or conversely had such a long criminal history or high tariff nature that referral to the PF was inevitable. In addition a number of other preventative approaches were being developed in tandem, including police-led Prevention First, Concern Hubs and community triage schemes as well as a national refresh of Recorded Police Warnings. These developments created new pathways to keep some cases out of the system which would previously have escalated up, and whilst this is a good thing, these initiatives are not necessarily able to offer the same intensity of support as EEI.

We developed EEI for Women as a national demonstration project to develop and test out a new upstream approach. To our knowledge this was a unique development in Scotland, intervening at the earliest possible point of police charge. While we did not attract the volume of referrals we anticipated, we are confident that this was a successful initiative that impacted positively and significantly on those women we worked with, as well as their families and communities. A snapshot in April 2015 found that of the initial 18 women engaging with EEI for Women, only 3 (17%) had come back into contact with the police following further charges.

It also acted as a positive demonstration project in terms of innovative and unique partnerships within justice. This was recognised at UK level when the initiative won the Integrated Care Delivery category at the UK Advancing Healthcare Awards in London in 2015, also scooping the overall Award across all 39 entries and 13 categories. Based on this experience we have now linked the NHS Ayrshire and Arran occupational therapy service into a number of other justice services.

Our Final Report includes an overview of the service; information on partners and our five shared principles; women’s issues and solutions; reflections on collaborative practice; case studies; EEI for Women in Numbers; feedback from women; sharing our learning (including our Recipe for Success); partners’ thoughts and reflections; our Top 10 Learning Points for funders, commissioners and service providers; costs and benefits; and a partnership development timeline. Copies of our Partnership Agreement and EEI for Women Procedure are also included.

I’ll leave the last word to one of the women who engaged with the service:

“I feel very sure that I will never reoffend as I feel it was such a frightening experience when I was contacted by Sacro as I thought I was going to court before I understood the support they were offering me. When I knew I was going to be helped it made all the difference”.

(Service User feedback form)