Research project DR/12 (Research action DR)
1. Problem definition
Drug dependence is a complex phenomenon, closely related to various problems in other areas including unemployment, criminal behaviour, contacts with police authorities and the criminal justice system, psychological and physical complaints, social exclusion, relational problems, homelessness, etc. Substance abuse treatment in Belgium is characterized by fragmented authorities and a lack of programming, few delineation and communication between services and lack of coordination and continuity of care. Moreover, a big gap can be observed between the substance abuse treatment and criminal justice system.
To meet these characteristics of the target-group and services involved, the federal policy notes on “drugs” and “mental health care” stress the importance of co-operation between the criminal justice and substance abuse treatment system and individualised care and continuity of care. The establishment of an integrated treatment system for substance abusers and the development of case management are described as prerequisites to improve quality of care.
On the one hand can case management be considered as an additional intervention aimed at providing more individualised care to extremely problematic drug users (“case management in substance abuse treatment”), while on the other hand it could help to improve co-operation between the criminal justice and the substance abuse treatment system (“case management in the criminal justice system”). Also within the penitentiary policy is case management considered as a useful issue to ensure continuity of care both inside as well as outside prison for prisoners with drug problems.
2. Objectives of the research
• Conceptualisation of case management, focusing on occasional differences between case managers operating within the criminal justice system and those connected to substance abuse treatment.
• Conditions for the implementation of case management within the criminal justice- and substance abuse treatment system.
3. Description of the research
A. Literature study
A.1 Definition and profile of the case manager
For the conceptualisation of this intervention, the literature concerning the practice of case management (definition, characteristics, basic functions, models, legal framework,…) will be compared based on the theoretical frameworks of Moxley (1989), Van Riet & Wouters (1996) and Siegal (1998). The differences between case managers operating within the criminal justice system or substance abuse treatment system will be taken into account.
A.2 Legal embedment
Analysis of the Belgian legislation concerning the professional secrecy, protection of persons' privacy and patients' rights, the jurisdiction and legislation concerned. In addition, a practical model for the exchange of information is elaborated, including legal guarantees for all parties concerned.
A.3 Evaluation case management
Available literature concerning the evaluation of this intervention will be compared, looking for contextual factors, objectives and specific target-groups, models of case management, outcome-variables, etc..
A.4 Implementation case management
Study of the implementation of case management with alcohol and substance abusers within the criminal justice system and substance abuse treatment. Attention will be paid to the following aspects: motives for implementing case management; objectives and target-group; place of case management within, respectively, the substance abuse treatment- and the criminal justice system; choice of model of case management and prerequisites for implementation; requirements to be and expectations of the case manager; financing and continuity of case management projects, evaluation of this intervention.
B. Inventory of “good practices”
B.1 Redaction of a short questionnaire concerning the conceptualisation and implementation of case management projects in foreign countries
Attention will be paid to the outreach approach to clients, a planned and systematic problem approach, starting from the clients treatment demand and possibilities of the client, compulsary models of treatment (“compulsary” and “coercion”),...
B.2 Sending of the questionnaire to case management projects in the United States, the Netherlands and Germany
B.3 Elaboration of at least three of these projects by doing on-site study visits
C. Research on the desirability and feasability of case management within the criminal justice system and substance abuse treatment on the basis of a Delphi study
C.1 Written questionnaires to all the regional care co-ordinators and the co-ordinators of the so-called “houses of justice” (one per court district) on the basis of a short questionnaire in order to inventory the existing case management projects
C.2 Semi-structured interviews with key-persons and case managers of the existing case management projects
All the inventoried projects are contacted by the researchers in order to do a semi-structured interview with the co-ordinator and/or one or more of the involved case managers. The focus will be on the implementation, as well on the conceptualisation of this intervention.
C.3 Focus groups in order to test the feasability and the generalisation of the data resulting from the data of the literature study and the structured interviews
On the basis of the results of the literature study and the interviews, a number of theses will be formulated with regard to the implementation of case management with judicial and non-judicial clients. These will be presented during parallel focus groups in three urban areas (Antwerp, Ghent, Charleroi). The formulated theses will be further adapted on the basis of the results of the focus groups, and presented during mixed focus groups with key figures from the criminal justice system and substance abuse treatment in the same court districts. In function of the generalisation of the research results two additional focus groups will be organized with representatives of substance abusers (both persons within as outside the treatment) and with policy-makers.
D. Data-analysis and report
D.1 Data-analysis
The collected research material (data from literature, interviews, focus groups, …) will be processed and analysed using the software package WinMAX 98 Pro.
D.2 Report
The first part of the report is dedicated to the conceptualisation of case management (definition and profile of both types of case manager, legal embedment of the intervention, including the possibilities concerning professional secrecy and protection of persons’ privacy and co-operation possibilities between both types of case manager). The second part discusses the implementation of this intervention including ways this intervention can best be implemented in the present-day criminal justice- and substance abuse treatment-system. Following these parts, a manual will be developed for the implementation and practice of case management.
Tussen Droom en Daad : implementatie van case management voor druggebruikers binnen de hulpverlening en justitie : eindrapport = Entre Rêve et Action : implémentation du case management pour usagers de drogues dans le secteur de la santé et le secteur judiciaire : rapport final
Geenens, Kim - Vanderplasschen, Wouter - Broekaert, Eric ... et al Gent : Academia Press, 2005 (PB6115)
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Entre Rêve et Action: Implémentation du case management pour usagers de drogues dans le secteur de la santé et le secteur judiciaire : résumé
Bruxelles : Politique scientifique fédérale, 2004 (SP1422)
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Tussen Droom en Daad: Implementatie van case management voor druggebruikers binnen de hulpverlening en justitie : samenvatting
Brussel : Federaal Wetenschapsbeleid, 2004 (SP1423)
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Between Dream and Reality: Implementation of case management among drug abusers in the treatment and criminal justice system : summary
Brussels : Federale Science Policy, 2004 (SP1424)
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