Prison to Rehab Protocol

Detailed Process

The forms required to complete a referral are available on the Scottish Goverment Website or by contacting PrisontoRehabPathway@gov.scot.

1.1 Step 1: Identification

SPS/ Prison Health Care staff and Community Services: Staff identify people who are due for release and may benefit from an abstinence based residential rehabilitation programme to support their recovery from problematic alcohol or drug use. This process can begin from reception and be kept under review during each individual’s time in prison. The ADP responsible for an individual should be informed at the earliest opportunity and have involvement, where necessary, in determining the most suitable rehab facility, taking into account SPS advice. Prison based staff often have built up a long-term relationship with individuals and may be more informed on how to support them, based on their knowledge of the person and their needs. Where necessary, the local drug and alcohol service should also be involved.

Family involvement should be discussed with the individual at this stage.

It is important to note that residential rehabilitation providers will need to have adequate time to carry out their assessment of need and that this can take from 2 to 4 weeks.

1.2 Step 2: Accessing the right programme

Annex A sets out relevant information about the range of residential rehabilitation programmes provided by organisations participating in this pathway. It is important that the person is actively involved in identifying the programme which best meets their needs.

Prison-based staff: staff to engage with the individual on key factors which determine suitability of rehab in general and may influence the choice of appropriate provider:

• Motivation for abstinence based recovery, including engagement with recovery activities.
• The Local Authority the individual is from and/or wishes to return to upon the completion of the residential rehabilitation placement. Where possible, providers local to the individual should be considered due to the benefits of well-connected aftercare pathways.
• The commitment required to complete a 12 week (or longer) treatment programme on release.
• Any previous experience in residential rehabilitation which may not have been at a suitable provider or of suitable length for the individual's needs. The responsible ADP should be able to provide this information in conjunction with any pervious local authority area.

The providers listed offer different programmes and may be able to offer different lengths of stay, however, the minimum stay is 12 weeks. If further information is required for the individual to make a decision on the preferred provider, contact details for each service are available in Annex A. The provider will be able to advise on the length of programme they offer through P2R and the aftercare support available.

1.3 Step 3: Referral

Prison-based staff: Once the most appropriate residential rehabilitation programme has been identified, staff should make contact with the provider to discuss availability. To make a referral to the chosen service, staff should complete the P2R Referral Form and submit this to the residential rehabilitation provider.

SPS / Prison Health Care Service will need to provide background information, some of which are listed below;

• Drug and alcohol history
• Physical health and mental health
• Offending history – it is recommended that the provider have this conversation directly with the individual, allowing them to gather context around what was happening in the individual’s life at the time of their offence(s)
• Current housing status
• Social background and family

Rehab provider: provider to advise if their service is initially deemed suitable for the individual and will provide information about the assessment process.

SPS / Prison Health Care: to notify key stakeholders to ensure ongoing support before and after placement and ensure the rehab provider is linked in to key stakeholders, including:

• Local Alcohol and Drug Treatment Service and Throughcare Service. Local treatment teams should be approached to be involved in the assessment process for the placement and can provide input on the suitability of available providers to the individual's needs.
• Social Work Team (care manager) as appropriate
• Community Justice Social Work Team
• Health Professionals (prescribing, medication and health issues and any 3^rd sector support service)
• Housing colleagues
• Lived experienced recovery organisations

It is vital to inform all relevant stakeholders as part of the referral process, these services will need to be aware of the placement in order to prepare for the person coming back to the local area once placement is finished.

1.4 Step 4: Assessment

Rehab provider: In order to ensure that they can meet the needs of the person wishing to access the service, the provider will carry out an assessment. Please note that assessment may take more than one session.

The provider will notify the individual, SPS / NHS Prison Health Care Services and the responsible ADP, of the decision, once the assessment process has been completed.

Once a provider is confirmed, a throughcare plan should be agreed between appropriate prison-based staff, the provider and the ADP. The plan should include:

• Consideration of the individual's housing arrangement post-rehab.
• The aftercare that will be available from the residential rehab.
• A referral to community services, to ensure continuity of care post-rehab.
• Support and management of risk in case of early discharge.

If the person is unable to access residential rehabilitation: please ensure that appropriate throughcare support is in place on release, including relapse prevention medication for people with Alcohol Use Disorder and access to Take Home Naloxone.

1.5 Step 5: Confirmation and notification

Rehab provider: the provider to confirm to Scottish Government that placement has been offered by completing the P2R Notification Form as early as possible. Date of admission should be based on the release date.

The form should be emailed to PrisontoRehabPathway@gov.scot

• This is to begin the process of accessing the funding for the placement.
• Please note that the finance cannot be released until the placement has been confirmed.

SPS and rehab provider: to agree transport arrangements for individual ahead of release. A transfer plan should be set and agreed by the provider and SPS and should include any prescription details, obtained from prison healthcare staff.

Additional funding can be provided by Scottish Government in cases where there are difficulties arranging suitable transportation or where the provider does not have existing capacity to pick up individuals on release. Rehab provider to discuss this with PrisontoRehabPathway@gov.scot where required.

At this stage, SPS and the provider should also consider the following:

• Application to DWP for benefits may be required at this stage (some rehabilitation programmes require this to be in place prior to admission).
• GP registration should be checked. A transfer to new practice/ GP may be required.
• Confirmation should be sent to all relevant stakeholders (social work, mental health teams, ADP, GP etc.)
• Housing / accommodation
• Link to recovery communities and mutual aid

Family involvement should be reviewed with the individual at this stage.

1.6 Step 6: Transfer

Person leaving prison should be transferred directly to residential service as per agreed transfer plan. Friday transfers should be avoided, where possible.

Further details on page 8.

1.7 Accessing Funding

Residential rehabilitation providers are eligible for funding for a treatment programme up to the cost of £20,000 per individual, per placement. The below conditions must be met to access funding.

• Each step of the process set out above has been considered and followed.
• The relevant Alcohol and Drugs Partnership has been notified of the placement and engaged as part of the assessment and admission process.
• For cases where the required placement (minimum 12 weeks) exceeds the cost limit, a partnership approach has been sought and agreed with the relevant ADP to fund the placement in conjunction with P2R.
• A placement has been confirmed by the residential rehab and accepted by the individual, with further confirmation from the residential rehab provider that the individual was admitted, and treatment has commenced.

1.8 Step 7: Transfer

• Person leaving prison should be transferred directly to residential service as per agreed transfer plan. Friday transfers should be avoided, where possible.
• Person leaving prison should receive support to remain in treatment for as long as requested as stated under MAT Standard 5
• Not all rehab providers have their own on-site doctor, therefore may rely on local addiction services to prescribe medication. It is therefore important to consider the following:
• The local prescribing team in person's area of residence may change if being liberated to rehab;
• Referral and communication with services local to rehab should be early to ensure continuation of treatment, including any medications;
• This may include a person having to be new or temporary resident with GP service prior to the community team agreeing to accept a new patient to their area if attending rehab;
• It is essential that good communication within the prison establishment to ensure all roles in this liberation to rehab are clear and timely;
• It is also essential that this communication is continued to all community partners.
• If for any reason the Residential Rehab provider can no longer accommodate the individual or if a clinical and/or health and safety risk is identified, the provider should ensure this is communicated directly to individual.

1.9 Step 8: Extension

• On completion of a Prison to Rehab placement, the individual and the provider may wish to extend a placement.
• For funding to cover the additional cost of an extension, you should contact the individual’s local authority area.
• Please contact prisontorehabpathway@gov.scot if additional costs of an extension cannot be met by their local authority area.