Review of the Aberdeen Problem Solving Approach: report

5 What are the emerging outcomes?

Key messages

• Participants – including those who were back in custody – were overwhelmingly positive about the PSA's overall impact on their lives.
• Professionals were also very positive about the PSA overall – while acknowledging that it was less successful for those with more entrenched problems and those who were not at a point where they were ready to change.
• Among the 35 participants whose cases had closed, 14 had completed their SDS and been admonished, two had completed their SDS but received another sentence and 19 had not completed their SDS (13 of these participants had received a custodial sentence). While this may not appear to be a high rate of successful completion, the profile of participants must be borne in mind – almost all were considered at risk of custody and most faced multiple problems. The fact that over half of participants were not in custody by the end of their involvement in the PSA must be considered against this background.
• Positive outcomes, reported by participants and professionals in the qualitative research, included: reduced reoffending; reduced substance use; improved housing situations; improved mental health and wellbeing; and improved social skills and relationships.
• The barriers to successful completion identified by professionals and participants were not, in the main, problems caused by the way the PSA operates. They were: the complexity of participants' problems; unstable substance use; unstable/unsuitable accommodation; the influence of family and associates; the intervention not coming at the right time in terms of readiness to change; and lack of access to services and support (such as housing and mental health services).
• A further barrier – which sheriffs and other court professionals were working to resolve – was the issue of the PSA being overridden by charges called in another court over which the PSA has no power. This could mean that an individual who was making good progress in the PSA could be re-arrested on an outstanding warrant and returned to custody.

This section reports on the emerging outcomes ^[25] for participants. We first consider what 'success' on the PSA might look like. We then report on participants' and professionals' overall perspectives on the PSA's impact, before looking at engagement and compliance with the PSA, and at outcomes relating to offending and the problems which are linked to offending. Finally, we discuss the barriers to achieving successful outcomes identified by the Review. The case studies throughout this report illustrate some specific outcomes in more detail.

The findings on emerging outcomes are drawn from the qualitative research (which explored perceptions of outcomes with both participants and professionals) and from the monitoring data (which provided social workers' assessments of participants' engagement and compliance). On the whole, there was agreement between participants and professionals on what the key outcomes had been.

Although professionals noted that there were some differences between the needs of women and men (see also section 4.3.1 and Figure 4.4), there was no evidence to suggest that the outcomes were perceived to be more positive for one group than the other. Comparisons are, however, difficult to make as the women's programme has been running longer than the men's and a greater number of women have, therefore, completed it.

5.1 What is 'success'?

PSA participants tend to have complex and varied problems. While there may be a number of commonalities in terms of the support they require, one of the PSA's key features is that support is tailored to individual needs. As problems and needs vary, so too do potential outcomes.

In line with the logic model, professionals were keen to point out that it was too simplistic to think of success for the PSA solely in terms of stopping participants offending altogether. Rather, the PSA aims to provide a framework to help participants address problems that may contribute to offending behaviours (such as poor housing situations and problematic use of alcohol and drugs). Improvement or stabilisation in relation to these problems would be viewed as a positive outcome. For participants with a number of significant problems, a notable improvement in one area could be considered a very positive outcome.

Both professionals, and participants themselves, acknowledged that progress was unlikely to be linear and that there may well be periods over the course of the PSA where progress stalled or setbacks occurred.

Similarly, the fact that a participant was not able to complete their SDS successfully does not mean that they did not benefit in any way from the PSA. As discussed below, even participants who were now back in prison were extremely positive about it and when they return to the community they could – potentially at least – build on some of the things they have learned. Conversely, of course, the fact that someone successfully completes their SDS does not mean that changes will be sustained.

5.2 Overall views of the impact of the PSA

Participants, including those who were back in custody, were overwhelmingly positive about the overall impact of the PSA on their lives.

It is helping me big time, it really is. [If it hadn't been for the PSA] I'd probably be back in jail.

(Female PSA participant)

Such a positive thing. [I would say to people] 'If you ever get [the PSA], make the most of it'.

(Male PSA participant)

It's one of best things I've ever done.

(Female PSA participant)

Professionals were also extremely positive about the PSA overall and thought it should continue – although acknowledging that it was less successful for participants whose problems and negative behaviours were the most entrenched and those who were not at a point where they were ready to change (see section 5.5 on barriers).

5.3 Engagement, compliance and case outcomes

Overall, participants' attendance at PSA reviews, compliance with the PSA plan and engagement with services was moderately good. Around three-quarters attended all, or all but one, of their PSA reviews and the majority complied at least 'fairly well' with their PSA plan. Most of the women 'often' or 'sometimes' attended appointments at the Women's Centre and the majority engaged 'well' with other services. Men's engagement with other services ( i.e. other than their social worker and support workers) appears less good – but data is based on very low numbers so far and, for that reason, it is not possible to draw comparisons between the women's and men's programmes.

Figures 5.1 and 5.2 illustrate some of the data on engagement and compliance and these are described further below.

Figure 5.1: Women's Engagement/Compliance

Note: 'Attendance at reviews' and 'Compliance with PSA plan' based on the 22 closed cases. 'Attendance at recommended activities…' based on the 30 women made subject to an SDS (including current cases).

Figure 5.2: Men's Engagement/Compliance

Note: 'Attendance at reviews' based on the 13 closed cases, 'Compliance with PSA plan' based on 12 of the 13 closed cases (data is missing for one case).

5.3.1 Attendance at PSA reviews

Among the 22 closed cases, over half the women had attended all the reviews that had been scheduled (13 women). Five had missed one review, two had missed two reviews and two had missed three reviews. Those who completed their SDS successfully were more likely to have attended reviews, and none of those who missed two or more reviews had completed their SDS.

Only four of the 13 men whose cases had closed had attended all of their reviews. A further four had missed one review, two had missed two reviews and three had missed three reviews. The numbers are very small but those who had successfully completed their SDS were more likely to have attended all their reviews. As was the case with the women, none of those who missed two or more reviews had completed their SDS.

5.3.2 Compliance with the PSA plan

Compliance with the plan agreed in court is also shown in Figure 4.1.

Unsurprisingly, those who completed their SDS successfully demonstrated higher levels of compliance than those who did not.

Among the women, all of those who completed their SDS were recorded as having complied well or fairly well, while most of those who did not complete their SDS were recorded as having poor (five cases) or very poor (two cases) levels of compliance. One woman, who was sentenced for further offences and did not complete her SDS as a result, was nonetheless recorded as having attended all social work appointments and complied very well with the plan agreed in court.

Although the numbers of men are very small, all of those who completed their SDS successfully (four cases) were said to have engaged at least fairly well. In contrast, only half of those who did not complete their SDS (four cases) were said to have engaged at least fairly well and the others (four cases) demonstrated poor or very poor compliance.

See 4.1.4 for a discussion of what motivated participants to comply.

5.3.3 Engagement with services

Supporting participants to access and engage with appropriate services is one of the key aims of the PSA.

Among the 30 women made subject to an SDS, there was a high level of engagement with the Women's Centre in Aberdeen. Sixteen of these women had also been referred to other services beyond the Women's Centre and CJSW. Most were recorded as having engaged well with these services although around a third were recorded as having engaged poorly ( Figure 4.1).

Only seven of the 35 men who were referred to the PSA were recorded as having been referred to services other than CJSW during their SDS (though seven other cases were still 'live' and may be referred to other services at some future date). Engagement data was available for six of these cases.

Participants and professionals alike spoke very positively about most of the services available and the support they had been able to provide (see section 4.1.5). In addition to the specific benefits that participants might receive from different services ( e.g. housing from housing services or addiction support from a drug advisory service), they reported a more general benefit of the appointments (including those with social workers and support workers) providing structure and routine. They liked the fact that the appointments gave a purpose to their days and allowed them to interact with people.

I needed it. My life was just so chaotic. I didn't have any structure in my life at all. Even though the appointments only lasted like an hour, I could have structure in that day.

(Female PSA participant)

5.3.4 Case outcomes

Table 4.3 (p 37 above) provides a summary of case outcomes. Among the 35 participants whose cases had closed, 14 had completed their SDS and been admonished and 19 had not completed their SDS (13 of these participants had received a custodial sentence). While this may not appear to be a high rate of successful completion, the profile of participants must be borne in mind: almost all were considered at risk of custody and faced multiple problems (see section 4.3.1). The fact that over half of participants (21 out of 35) were not in custody by the end of their involvement in the PSA is very encouraging – although assessing the extent to which this is sustained would require a longer evaluation.

Nineteen participants did not complete their SDS. The most common reason for this was failure to attend social work appointments (11 cases). Four participants were sentenced (in the PSA) for new offences and one was sentenced for new offences in another court. One person declined to participate. In the remaining two cases, the reason for non-completion was not recorded.

5.4 Offending and problems linked to offending: emerging outcomes

5.4.1 Reduced offending

While five (out of 35) participants were sentenced for new offences while they were on the PSA, we have no data on (known) offences committed by other participants or, of course, on any offences that were not known to the authorities.

However, there was evidence (based on participants' self-reports and the perceptions of professionals aware of individuals' reduced number of arrests and court appearances) of reduced offending among some participants – including those with long histories of offending. Some self-reported that their offending had reduced and others said that they had stopped offending altogether.

I haven't committed an offence since I've been on this Problem Solving. They kind of keep you on your toes because they would obviously know about it straight away.

(Male PSA participant)

Professionals gave examples – which they acknowledged were a minority of cases – of those who had stopped offending and ' completely turned their lives around' since being on the PSA. As one criminal justice professional observed, 'we've had two or three that have completely [stopped offending], and I have not seen again'. One such example, described by court staff and defence agents, was a woman who had accumulated a number of convictions over a short period of time and was perceived to be at high risk of custody. She was homeless and had complex needs including drug use and involvement in prostitution. She was on the PSA for a year and at the end had stopped offending, had obtained appropriate housing, was in employment and had visibly increased self-esteem – 'a triumph' (defence agent). The court staff felt that the fact her offending had been 'nipped in the bud' early was a key factor in enabling her to achieve positive outcomes.

5.4.2 Reduced substance use

Substance use was common amongst participants, particularly the women (see section 4.3.1), which professionals considered a key barrier to positive outcomes. Participants also acknowledged the importance of reducing their substance use and some had been able to do this through engagement with the PSA. Others had struggled to do so and continued problematic substance use was one of the main barriers to progress faced by participants.

Support was provided by participants' workers (drug and alcohol support workers and social workers) and/or specialist agencies. The balance of the support provided by workers versus specialist agencies cannot be measured but it appeared to be tailored to the needs/readiness of the participant. For example, in one case, the participant did not want to attend a specialist drug service but undertook work on this issue with her support worker.

5.4.3 Improved housing situations

Homelessness and housing problems were significant issues for PSA participants, and professionals considered improving participants' housing situations to be extremely important in the long term. Some participants talked about support workers helping them to secure a place in a hostel or obtain their own tenancy.

Women who did not complete their SDS were slightly more likely to have been assessed as living in unstable and/or unsuitable accommodation (8 out of 10 who did not complete their SDS compared with 5 out of 12 who did). This would point to housing insecurity as a potential barrier to compliance – and is consistent with what was said in the qualitative interviews.

5.4.4 Improved mental health and wellbeing

Some participants reported a number of positive outcomes in relation to improved mental health. Those with more severe mental health problems reported benefiting from referrals to psychiatrists or psychologists and a sheriff gave an example of a participant she felt had visibly 'blossomed' after receiving mental health support in the form of cognitive behavioural therapy and appropriate medication.

More generally, participants reported a number of positive outcomes linked to mental wellbeing including: feeling more positive about the future; having more 'get up and go'; and feeling less stressed.

Before I had never really had any 'get up and go' or never really had any want to go out and get a job or want to better myself but I do now. I'd like to get a job. It's just totally changed my mindset to be quite honest.

(Female PSA participant)

Professionals were also able to recognise positive changes in participants' mental wellbeing (which participants might not always recognise in themselves). Criminal justice social workers and support workers noted that increased confidence and self-esteem had been 'a big, big, thing'.

5.4.5 Improved relationships and interactions with others

Positive outcomes were also noted by both PSA participants and professionals in relation to:

• Improved personal relationships (including with family members). In some cases, improvements in the areas discussed above (offending, substance use, housing and mental health/wellbeing) helped improve participants' personal relationships because tensions over these issues, and behaviours which led to conflict, reduced. Direct work done with social workers and support workers ( e.g. on anger management) also helped.
• Increased trust in other people (in some cases this was increased trust in social workers and other professionals, in others it was increased trust in people more generally) ^[26] . This could come about through the positive relationships that social workers and support workers were able to build with participants, through specific work they did with participants to challenge negative assumptions about other people, and through increased interaction with different people ( e.g. at services, groups and new leisure activities).
• Improved social skills. This could come about through the positive relationships that social workers and support workers were able to build with participants, the modelling of appropriate behaviour by workers, and through increased interaction with different people (including the sheriff).
• Increased empathy and awareness of their behaviour's impact on others. For example, one participant talked about work she had done with her support worker which had made her realise the impact of shoplifting on shop staff. Other participants gave examples of workers and sheriffs encouraging them to think through the consequences of their actions on other people.

5.4.6 Employability

Although PSA participants themselves tended to feel they were still some distance away from employment, social workers did feel there had been progress. This included helping some participants to get Construction Skills Certification Scheme cards, arranging Jobcentre Plus appointments, or referring them to other employment support agencies.

Angela's Story

Angela is 41. She has served multiple previous community-based and custodial sanctions, with the last order being a community-based order. Angela has extensive complex needs and physical health issues, including living with addiction and a blood-borne virus. She does not have custody of her children, who have been adopted.

Angela is a current PSA participant and has been to several review hearings. She highlights the conversations in court as a positive feature of her experience. At one hearing, her defence agent said to her that her report for that hearing was "absolutely brilliant" and "fantastic." She has found the interactions with the sheriff particularly encouraging and motivating:

The judge said, "stand up, would you like to add anything?" My mind went blank, but I said "Yes. On the positive, I'm getting help with my housing, getting help with benefits, help with Council tax and other things, addiction with lapse and relapse and things." And she went, "that is really good. Better keep up the good work." Then on the second one, she just went, "brilliant, brilliant." Then again, "that's absolutely brilliant." Every time I go in, she says "that's a fantastic report you've got. Keep up the good work."

As part of the PSA, Angela has received multiple referrals and assertive case management to help her engage with other services, and she has found this very helpful. The meetings with her social worker as part of the PSA have also helped her recognise how the victims of offences she has committed have been affected.

Angela currently attends three social work appointments a week and speaks very highly of her social workers: "I'm not just saying things, this is God's honest truth: I just think they are so amazing and I'd be so lost without them. I would." Angela feels significant anxiety about completing and exiting the PSA because it means that she will not be able to see her criminal justice social worker and support worker as often. She cites them as "having a close bond" and says she chose to do the PSA because of the social work support offered.

Another professional involved in the PSA has gently challenged her about her reluctance to finish the PSA by reminding her that she is doing really well and suggesting that it would be great for her to be out of the criminal justice system but Angela still feels anxious.

When asked where she would be if she was not part of the PSA, she says "I'd probably be back in jail. I would, probably."

5.5 Barriers to success

The barriers to successful completion identified by professionals and participants were not, in the main, problems caused by the way the PSA operates. Rather, they were the barriers frequently identified in evaluations of interventions designed to reduce reoffending: the complexity of the problems faced by participants; unstable substance use; unstable/unsuitable accommodation; the influence of family, friends and associates; intervention not coming at the right time in terms of readiness to change; and lack of access to services and support (such as housing and mental health services).

I think in the first few months you tend to see a little bit of improvement, but with someone who is so entrenched in the system after a few months it just becomes too difficult for them […]

They've got to want to change, they have got to want to change the way that they live and they either don't really want to change or can't really change because of addictions or because of their problems or even family situations, you know. Living a family life in which being someone who commits offences is just part of the day to day life. We can only advise, it's really difficult, even with all the support that an order like that provides, it's still so difficult for them to work on.

(Defence agents)

I think that is probably very much an individual thing, that's my perception and for some people it becomes clear quite quickly that they're just not going to be able to engage, they're not ready to, they have maybe got out of control addictions […] maybe some people don't want to stop drinking or to stop taking drugs or to get it under control [...] Maybe they're in an inappropriate relationship.

(Sheriff)

The accounts of participants in custody, who had not completed their SDS, confirmed the points made above about the barriers. Like those still in the community, they were very positive about the PSA, but acknowledged that it would not always work.

It's good to do when you get into it – but they shouldn't expect miracles.

(Male PSA participant, in custody)

There was a further barrier, identified by both professionals and participants, which relates to the PSA's operation. This was the issue – discussed in section 4.1.4 above and which sheriffs and other court professionals were working to resolve – of the PSA being overridden by charges called in another court over which the PSA has no power. This could mean that an individual who was making good progress in the PSA could be re-arrested on an outstanding warrant and returned to custody.

5.5.1 Who struggled to comply?

Given the small numbers so far, there is a limit to what can be said about the characteristics of women who complete their SDS compared to those who do not. (The numbers of men are even lower so we cannot say anything at this stage about the characteristics of men that might predict success).

As noted under 'Improved housing situations' above, women who did not complete their SDS were slightly more likely to have been assessed as living in unstable and/or unsuitable accommodation (8 out of 10 who did not complete their SDS compared with 5 out of 12 who did). There were no other apparent differences in relation to adversities faced – possibly because levels of adversity, such as financial problems, were very high (see Figure 4.4).

The mean LS/ CMI scores on all domains were slightly higher for the group who did not complete the SDS. In most cases, however, the differences were relatively small. There was a difference in the total scores (indicating that those who did not complete were 'riskier' overall) driven primarily by differences in the education/employment domain. From the LS/ CMI data there is nothing to suggest that outcomes were any different among those with drug/alcohol problems.

Professionals agreed that, although success was less likely among those with more complex and long-standing problems, there were always 'surprises' and it was very difficult to predict who the PSA would work for.

Even if a person has got long history, you could get somebody that has been doing that for so long that gets on problem solving and thinks, you know what, I'm done with what my life has been, I want...you know, you hit the rock bottom. You never know when they might hit rock bottom and decide they want to change.

(Court staff)