There has been a significant increase in crack cocaine use in England over the past 4-5 years. The needs of people who inject drugs who present in police custody are not currently met by the system of care. Police custody could provide an opportunity to accelerate access to a range of services. Devon and Cornwall Police have been commissioned by the Home Office to bring local partners together to reduce heroin and crack use and offending; identify current pathways to provide support to users and understand the drivers of the crack increase to provide recommendations for service enhancement. Devon and Cornwall Police have commissioned the evaluators to conduct a service evaluation of current provision, service user experience of provision and potential opportunities in custody and the community.
The overall aim of the evaluation is to measure current practice and assess need in relation to health and social care provision for injecting drug users in police custody.
The objectives are to understand:
- current criminal and social context of injecting drug use
- current service provision and engagement for injecting drug users who enter police custody in the light of increased availability and use of crack cocaine.
- health and social care needs of injecting drug users who enter police custody.
- injecting drug use behaviours.
Recruitment will take place in 14 custody centres in five police service areas. Injecting drug users of 18 years and over will be identified through routine risk assessments by the Custody Sergeant responsible for booking in. All those identified will be asked if they would be willing to speak to a privately contracted custody practitioner (trained in seeking informed consent) to discuss their potential participation in the evaluation. Written consent will be sought. Survey participants will be asked if they would be interested in taking part in an in person or telephone interview with an evaluator. Audio recorded verbal consent will be gained in the case of telephone interviews. Participants will be given the opportunity to ask any questions and it will be made clear that participation is voluntary and they can withdraw at any time.
Survey: People with lived experience are working with the evaluation team to develop a survey to ensure items are comprehensible and acceptable. Measures include drug use and injecting behaviour (UAM); health and social care resource use; GP registration; quality of life (EQ5D); Adverse Childhood Experiences; perceptions and experience of violence and drug related crime. A two week pilot with be carried out in one custody centre to ensure acceptability and feasibility of methods. We will conduct descriptive statistics to describe the level of current service provision, engagement and need.
Interviews: Five interviews will be conducted in each police service area (N=25). An interview topic guide is being developed with people with lived experience. Questions include history of injecting drug use; barriers and facilitators to service access; perceptions of crack use, and components of optimal service provision. Interviews will take place via telephone or in community settings. Data will be analysed using thematic analysis.
Findings will be used to develop internal recommendations for:
- developing and planning future service provision in each of the five target police force areas
- planning methods and measures for future evaluation of service to support quality and impact of service
- Developing a future application for funding for generalisable research
- Devon and Cornwall Police