Title: Liaison and Diversion Schemes - Outcome Evaluation
Funder: Department of Health and Social Care

Abstract: Text underlined indicates parts added or amended for the resubmission of this application in Apr-2016, in response to the request to add an additional research question looking at diversion from the criminal justice system. Background L&D schemes aim to identify and assess people with vulnerabilities (mental health, substance misuse, physical health) as they pass through the criminal justice system and refer them to relevant services. To improve the consistency of L&D services available, NHS England developed a National L&D Model which was launched in 10 sites in 2014 (wave1) and a further 11 sites in 2015 (wave2). The research team that have prepared this application are currently working on an evaluation of the National Model of L&D in wave 1 sites which will conclude in September 2015. The outcome evaluation outlined in this application extends the evaluation to wave 2 sites and addresses new research questions. Aims in relation to the issue to be addressed Building on the evaluation in wave1 sites, the Department of Health issued an Invitation to Tender (ITT) for an outcome evaluation of the L&D Trial Scheme implemented in 21 areas of England to address the following research questions: (i) What impact, if any, does the implementation of the National Model of L&D have on offending? (ii) What impact, if any, does the implementation of the National Model of L&D have on health service utilisation? (iii) If any impacts on offending and health care utilisation are found, what is the economic effect of those? (iv) How have any impacts of the National Model of L&D been achieved? (v)What impact, if any, does the implementation of the National Model of L&D have on diversion from the criminal justice system? Research plan and methods of investigation To address questions (i), (ii) and (v) we propose two approaches: For service users in wave1 and wave2, comparing outcomes for 12 months before and after implementation of the L&D service. For service users in wave 1 sites, comparing their outcomes to those of a matched-comparison group who have not received the National Model L&D service (a quasi-experimental design). We intend to access data from existing systems regarding convictions, diversion outcomes and health service utilisation. We will conduct a telephone interview in each of the 21 sites to understand the nature of service provision. Research team The outcome evaluation would be undertaken by RAND Europe. Members of the research team undertook an evaluation in wave 1 sites, and are familiar with L&D services, relevant data sets and stakeholders. The research team includes experts in multi-site outcome evaluation, research management, criminology, health, reconviction analysis. RAND research team includes: Dr. Emma Disley; Dr. Alex Sutherland; Dr. Mark Elliot The research team will be advised by an expert group: Prof. Mike Maguire (criminology); Peter Neyroud (policing/ reconviction analysis); Tim Millar (substance misuse/expert on NDTMS); Ed Wilson (health economist). Potential impact/influence on the relevant policy field, users and wider stakeholders L&D services have relevance to a number of current cross-government priorities including valuing mental health equally with physical health (NHS England, 2015a) and improving quality of health services and health outcomes for people in health & justice settings (NHS England, 2015c). L&D services are also an example of joined-up working between national and local government departments and services. While hypotheses have been generated about what impact L&D services might have, there is no systematic research into these schemes. The evaluation would gather evidence regarding impacts that would be directly relevant to practitioners and stakeholders implementing the scheme in other areas.

Lay abstract: Text underlined indicates parts added for resubmission of this application in Apr 2016, in response to the request to add an additional research question looking at diversion. Background L&D services aim to identify people experiencing mental health problems and learning disabilities (among other vulnerabilities) as they pass through the criminal justice system to ensure their health and other needs are known about and that they are referred to services to address their needs. NHS England has recently launched a National Model for L&D services to ensure consistent provision across the country. The National Model was launched in 10 sites in 2014 and another 11 sites in 2015. The research team who have prepared this application evaluated the implementation of the national model in the first 10 sites (referred to as the wave1 evaluation ). This application proposes an extension to answer additional research questions. Aim of the research The extended evaluation would aim to understand whether the National Model for L&D has any impact on conviction rates, diversion from the criminal justice system or the use of health services, particularly, A&E, drug treatment, mental health treatment and outpatient services. Research design and methods We plan to undertake two kinds of comparisons of reconviction rates, diversion rates and health service use by L&D service users: For service users in wave1 and wave2 sites, comparing reconvictions, diversion outcomes and use of healthcare services for 12 months before and 12 months after implementation of the L&D service. For service users in wave 1 sites only, comparing their outcomes to those of a similar group of people who have not received the National Model L&D service We will supplement this with telephone interviews in the 21 sites. Patient and public involvement The research team has an advisory board which includes two service users, who we will consult about the research design throughout the study. Dissemination Policymakers in NHS England/other government departments and L&D practitioners are key audiences. During the study we would keep these stakeholders informed about progress/emerging findings using monthly newsletters. Final dissemination would be through: clearly-written, policy/practice-oriented report; briefings; conferences (policy/practice/academic).

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE