Transcript Evaluation of the NSW Alcohol Magistrates Early Referral

Evaluation of the
NSW Alcohol Magistrates Early Referral
into Treatment (MERIT) Program
A Randomised Controlled Trial
OUTLINE

Previous research

Current research design

Agencies involved

Research aims

Procedure

Outcome measures

Research sites

Governance

Research timeline

Sample size
PREVIOUS RESEARCH
Rural Alcohol Diversion (Martire & Larney, 2011)
 Pre-post comparison of RAD completers (n = 119)
 Outcome measures: changes in alcohol use, psychological
distress, health
 Results:
 Reductions in past-month alcohol use at completion relative to baseline
 Reductions in psychological distress at completion relative to baseline
 Improvements in mental & physical health at completion relative to baseline
 Limitations: selection bias
PREVIOUS RESEARCH
Illicit drug MERIT: health outcomes (NSW Health, 2007)
 Pre-post comparison of MERIT completers (n = 1,470)
 Outcome measures: changes in drug use, psychological
distress, health
 Results:
 Reductions in drug use at completion relative to baseline
 Reductions in psychological distress at completion relative to baseline
 Improvements in mental & physical health at completion relative to baseline
 Limitations: selection bias
PREVIOUS RESEARCH
Illicit drug MERIT: recidivism (Lulham 2009)
 MERIT participants (n = 3,441) cf. non-MERIT offenders who broadly
met eligibility criteria (n = 23,960)
 Outcome measures: any reconviction, theft reconviction, drug
reconviction (2-year follow-up)
 Results:

4 percentage point reduction in any reconviction

4 percentage point reduction in theft reconviction

2 percentage point reduction in drug reconviction (p=.06)
 Strengths: strong research design relative to previous evaluations
 Limitations: statistical model relied on assumptions that cannot be
tested
CURRENT RESEARCH DESIGN


Randomised Controlled Trial (RCT) – the most rigorous
research design which overcomes methodological
limitations of previous research

Group 1 (‘treatment’ group): receive 12-week Alcohol-MERIT treatment.

Group 2 (‘control’ group): receive a brief psychological intervention about
substance abuse and a referral to appropriate non-MERIT community
health service.
Assuming sample size is large enough, random
assignment ensures groups equivalent on all factors
except the treatment type
CURRENT RESEARCH DESIGN
Ethical issues
 NSW Ministry of Health advised that demand at times
exceeds capacity
 Ministry adopted random assignment as a management
strategy in order to ensure fair and equitable access to the
program for all defendants
 This strategy presents a unique opportunity to evaluate the
effectiveness of the program under rigorous conditions
 Research described below is independent of this
randomisation procedure
AGENCIES INVOLVED
 Commissioned by the NSW Ministry of Health
 Conducted by NSW Bureau of Crime Statistics and
Research (BOCSAR)
RESEARCH AIMS
1. Does participation in Alcohol-MERIT improve health and
social functioning?
2. Does participation in Alcohol-MERIT reduce reoffending?
PROCEDURE
Intake & interviews
 Defendants invited to participate in research post-ballot

Consent = interviewed at follow-up and researchers access criminal records

No consent = no follow up and no access to records but treatment does not change
 Consent form sent to BOCSAR, researcher calls to arrange first
interview
 Three phone interviews – 2, 6, 12 mths post-assessment
 Each interview takes 30 to 45 minutes
 Defendants receive $40 supermarket gift card
OUTCOME MEASURES
 Health – follow-up phone interviews
 Changes in severity of alcohol dependence (SAD-Q)
 Changes in Q/F of recent alcohol and illicit drug use
 Changes in health and social functioning (SF-36)
 Changes in measures of psychological distress (K-10)
 Criminal justice – BOCSAR’s Re-Offending Database (ROD)
 Time to first new offence
 Sentencing outcomes for index offence
 Time spent in custody in 12 months following the Alcohol-MERIT
assessment
RESEARCH SITES
Local courts involved are:

Newcastle (Hunter/New England LHD)

Albion Park, Kiama, Port Kembla, Wollongong
(Illawarra/Shoalhaven LHD)

Hornsby, Manly, North Sydney, Ryde (Northern
Sydney LHD)

Fairfield, Liverpool, Campbelltown (South
Western Sydney LHD).
GOVERNANCE
Ethics Approval (Number HE11/352)
 University of Wollongong (UOW) and Illawarra/Shoalhaven
(ISLHD) Health and Medical Human Research Ethics
Committee (lead agency)
 Hunter New England Research Ethics & Governance Unit
 Northern Sydney Local Health District (NSLHD) Research
Governance Office
 South Western Sydney Local Health District (SWSLHD)
Ethics & Research Governance Office
GOVERNANCE
Evaluation advisory committee:
 BOCSAR
 NSW Ministry of Health
 MERIT managers and clinicians from 4 LHDs
 MERIT data manager
 Crime Prevention Division (DAGJ)
GOVERNANCE
Stakeholders:
 Magistrates, registrars in each of the relevant local
courts
 CEO, Legal Aid Commission
 Presidents of local Law Societies, local Legal Aid
offices and Aboriginal Legal Services
 NSW Police Force

Information sheets have been prepared and distributed
RESEARCH TIMELINE

Recruitment of defendants began on 10 April 2012

Projected completion date of recruitment: mid-2013

Defendants will be followed-up over 12 months
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Planned project completion: mid-2015
SAMPLE SIZE
 Sample size required to find a true effect = 540
by mid-2013
 Consent forms received to date = 41 (21 AM, 20 BI)
CONTACT DETAILS
For further information about this study, please contact the
BOCSAR research team:

Dr Don Weatherburn – Director

Mr Craig Jones – Research Manager

Ms Lily Trimboli – Senior Research Officer

Ms Susan Spratley – Research Assistant
on (02) 9231 9190