Continuity-of-Care for Substance Misusing Prison Leavers: A Quantitative Analysis of Service Delivery Models Within a Local Setting

Introduction: This study tests our assumption that prison-to-community continuity-of-care increases drug treatment engagement rates and reduces waiting times, hypothesis one (H1). Engaging with drug treatment services may improve health and crime outcomes for this vulnerable population. The study also aims to determine whether a single service delivery model, spanning both prison and community settings, improves these metrics, hypothesis 2 (H2). Method: Over a four-year period, the instances of continuity-of-care, prison release, and treatment start dates were recorded for individuals with substance misuse issues released to a local drug recovery partnership (n=808). All participants were monitored for 365 days after their first release (H1). A subset of this group (n=533), released through the local adult male prison to the local drug treatment services, were compared for the two years before (n=255) and the two years after (n=278) the implementation of the single service delivery model (H2). Data were analysed using right-censored Kaplan-Meier Survival Analyses. Results: There was a significant association between system-level prison-to-community continuity-of-care and higher rates of engagement and reduced waiting times for community drug treatment (p<.00001). The implementation of single service provision enhanced the performance of prison-to-community continuity-of-care. However, whilst treatment engagements through continuity-of-care increased from 5.4% to 12.7% and average waiting times decreased from 97 to 67 days, due to the small sample size, there was insufficient statistical evidence to support H2. Conclusions: This study confirms that, within our local setting, continuity-of-care care from the prison to community drug treatment leads to higher rates of treatment engagements and shorter waiting times (H1 - accepted). Additionally, although not statistically proven (H2 - not accepted), our a priori decision to implement a single-service delivery model appears to have been justified given the observed improvements in these performance metrics.