COMMENDEE 2011-12: Peter is described as “inspirational” as manager of the substance misuse Counselling Assessment Referral Advice & Throughcare (CARAT) team at HMP & YOI Doncaster.

IN THEIR OWN WORDS

[Peter Jones gives his account of the work for which he was awarded a Commendation]

I received a Butler Trust Commendation for:

Implementing a best practice and innovative approach to providing structured and integrated drug and alcohol treatment services for offenders serving custodial sentences shaping and rebranding a quality service reactive to the changing needs of prisoners.

I took responsibility for the management of the CARAT service in March 2010 following a very poor recent audit score that had affected the overall prison weighted score card. CARAT is an acronym for:

• Counselling
• Assessment
• Referral
• Advice
• Throughcare

The target audience is all offenders assessed as having drug or alcohol issues upon reception to the establishment. This is a consensual service and prisoners choose whether or not to engage. Working closely with clinical providing teams, CARAT workers provide a case management and care coordination approach meeting the needs of service users with tailored interventions as part of a psycho-social care plan. CARAT workers provide psycho-social interventions, PSI, working under the guidance of the First 28 Days Psycho-Social Interventions guidance simply meaning they deliver structured 1-2-1 or group work as part of counselling or key work sessions. Given that the prison is a local remand and prisoners move through quite quickly, much of what is on offer is aimed at stabilisation and brief interventions providing harm reduction advice and guidance. Support is then transferred to community Drug Interventions Programmes, DIP’s; in each area provide a seamless transition upon release under the continuity of care guidance. Morale was very low and the service had been without a line manager for some time. In addition, in the absence of any structure or line management internal issues had begun to develop. The team were very suspicious of any new line manager and in some cases were fearful that staffing levels may be reduced due to poor performance results and prisoner engagement statistics.

I consider myself to be a very driven and motivated person and set out with a clear [personal vision, “To manage a highly motivated and well trained team of CARAT drug workers providing a quality service to prisoners”. Having myself been poorly managed in previous services I came into management from a place of frustration having been able to identify gaps in service provision which I thought would be easily filled should my line managers at the time have had the commitment to do so. Joining the CARAT team with this mind-set, my aim was to again identify gaps in the service, identify best practice and create leaner processes and systems of work.

At the time of my managing the CARAT team, a Data Quality Improvement Exercise was taking place supported by the National Treatment Agency, NTA. I took full advantage of the data quality reporting systems and RAG rated scoring matrix to identify specifically where the service was haemorrhaging statistics due to poor processes or human error. I narrowed this process down even further by identifying not only when data was being incorrectly gathered and submitted but also by whom. This was managed in a sensitive and constructive way and data error logs were created. Individual workers were approached during monthly supervision and their assessment forms were returned to be corrected. Common themes were identified and training sessions were provided for the group during team meetings. I reviewed all data collection and submission processes mapping each one out with my team leaders. Removing futile processes and replacing them with added value processes such as gatekeeping and quality control, we were able to produce process maps to support training and to display in key locations around the department for reference. As an end of month task I introduced a worker statistical consolidation tool which demonstrated a departmental overview of performance which again could be drawn down to individuals. This again helped demonstrate an epidemiological overview of where we needed to intensify our resources to increase our effectiveness.  I introduced a monthly administrative task that reconciled prison based service user data bases against the information stored on the National data base, DIRWEB. In doing so we were able to self-audit and self-govern data errors as a final gatekeeping check prior to the month end cut off. This soon resulted in the NTA announcing that HMP & YOI Doncaster was reporting a 1% error rate in data quality when all other establishments were struggling to hit the 10% acceptable national average. I received an e-mail from the NTA regional lead congratulating the Doncaster team on this achievement, an achievement un-paralleled by any other local remand establishment of its type. We were asked to share best practice processes and systems with other establishments which we freely did in the spirit of wanting all service users to receive the very best level of service across the estate. Recognition and notoriety gained was shared and congratulated publicly with the team in an effort to raise staff morale and celebrate the achievements from our hard work. This marked a turning point in the raised ambition and motivational levels of the team.

Having embedded systems and processes of work that were now managed in supervision and gatekeeping processes are was now free to concentrate my efforts on reviewing service delivery and the effectiveness of what we delivered. I asked for a full staff training matrix to be created identifying where our strengths and weaknesses lied. I informed the team that my priority was to achieve parity in the team’s training and skill mix developing all team members to at least level 2 Drug and Alcohol National Occupational Standards, DANOS. This we achieved along with the additional standards of everyone completing a Level 3 Health and Social Care NVQ and Level 1 Royal College of General Practitioners Course, RCGP, which I managed to source for free through the NTA.

Having completed the training matrix I identified that many team members had specialist skill sets or highly valuable knowledge and experience from previous roles. In an effort to harness this I introduced specialist lead roles in key areas such as Blood Borne Virus Lead, Steroid Lead and Children and Families Lead. Unlocking this potential, workers soon started to flourish and specialist groups and pieces of best practice began to emerge, often in conjunction with partnership services and agencies both internal and external to the team and establishment.  The specialist teams now provided new referral routes for CARAT workers to sign post prisoners to specialist groups or services particular to their needs. One example of this was a Narcotics Anonymous group which we supported to be facilitated within the prison. Engagement with this group provided a conduit for continuity of support upon release to the community.

Alongside developing the staff within the service I consulted with service users, initially as part of a BME focus group who we engaged to advise us how we could lower the threshold for prisoners accessing the service. As a result of our findings I re-wrote the prisoner induction power point presentation and included multi-language slides and voice over sections. I re-branded the service using flow charts and pictorial images for those with literacy skills or language barriers. I designed multi-language posters and leaflet packs with key information to sign post to interpreter services.  We revisited all our working base lines to ensure our referral procedures and service information adverts on in-cell TV were robust and were replenished monthly. I then asked for the BME focus group to be retained with a new terms of reference as a service user group providing a conduit for a voice from our service users and a consultation route for all new services, processes or systems we were seeking to introduce.

After several months, specialist lead roles became established and progressive and innovative pieces of work and best practice began to blossom. Team motivational levels increased and individuals were encouraged to develop and progress in a supported and constructive environment.

As a manager, this then provided me with the time capacity to focus upon strategic elements of the role such as developing joint working protocols between multi-disciplines, undertaking the annual CARAT needs analysis and also conducting my own tailored Service User Feedback Questionnaire and resulting Feed Back Report and Action Plan.

Additionally, as part of the service re-launch and rebranding, I held a Partnership Services Drug and Alcohol Fair in the prison with key note speakers, charity fund raising events with prisoners and over 40 stalls with both internal and external providers promoting their services to prisoners.

The efforts of the team were ultimately evaluated in the bi-annual Rehabilitation Services Group, RSG, audit and inspection visit. This resulted in a vastly improved score of 80% from a previous 56% reflecting on less than a year’s improvement work with many of the issues identified being quick fix and rectified before the auditors had left the site. One issue which was identified and held a heavy weighted score was relating to an activity not performed by a senior manager which had been identified but of which the management was out of my control and authority.

In addition to the improved audit score the CARAT team was acknowledged in the Serco Heart Awards winning an award for Innovation Through Creativity. The successes of the year were celebrated widely amongst the team who had come together remarkably during this period of time.

INSPIRE ARTICLE

[The following article appeared in issue 4 of the Butler Trust’s magazine, Inspire]

Peter Jones’ review of HMP and YOI Doncaster’s CARAT team has not only made it among the best performing teams within a remand setting within the country, but has also given many male prisoners the chance to access drug and alcohol services.

When Peter took on management of the team in March 2010 he carried out a complete review of operating systems and procedures and began transforming the team. He introduced quality processes that included procedures which significantly improved the data submitted to the National Treatment Agency (NTA)’s database and rewrote all muti-disciplinary departmental policies.

He improved joint working relationships and information sharing and tackled all poorly performing aspects of the CARAT service’s delivery. Positive changes were soon seen throughout the service, reflected in the next RSG audit score rising from 56 per cent to 80 per cent. A rebranding exercise running parallel to the improvements created a new identity for the service, with new induction processes and multi-language posters and information, and a large drug and alcohol services fair introduced prison and community services to prisoners face to face.

With the core business on track, Peter focused on staff development and created ‘specialist lead roles’ within the team, so staff could develop areas of the service that needed attention. The first of these was a service user group, which led to many more leads, including for children and families, young offenders, race equality and residential rehab. Peter also ensured that staff were trained beyond the expectations of the Drug and Alcohol National Occupational Standards (DANOS) and made it possible for them to complete NVQ level 3 Health and Social Care awards and the Royal College of General Practitioners (RCGP) Level 1 training. Peter’s director commented that he has not only motivated and inspired the team at Doncaster, but has also contributed significantly to best practice in other establishments.

For more information: contact HMP & YOI Doncaster