Adjustment to short-term imprisonment under low prison staffing.

AIMS AND METHOD: To understand experience of early imprisonment in one prison under low staffing levels. A researcher, independent of the prison, interviewed each prisoner soon after reception and 3-4 weeks later. The first question of the second interview was: 'I'd like to start by asking you about your experience of the last 3-4 weeks in prison'. Data are verbatim answers to this. Narratives were brief, so responses from all 130 participants were analysed, using grounded theory methods. RESULTS: The core experience was of 'routine' - characterised by repetitive acts of daily living and basic work, and little reference to life outside prison - generally resolved passively, towards boredom and 'entrapment'. CLINICAL IMPLICATIONS: This 'routine' seems akin to the 'institutionalism' described in the end days of the 1960s' mental hospitals. In an earlier study of similar men at a similar stage of imprisonment, under higher staff:prisoner ratios, experience was initially more distressing, but resolved actively and positively, suggesting that staff loss may have affected rehabilitative climate.

A randomized controlled trial of a Group psychological intervention to increase locus of control for alcohol consumption among Alcohol-Misusing Short-term (male) Prisoners (GASP).

BACKGROUND AND AIM: Reducing alcohol misuse by male prisoners is an important global issue. Control of drinking behaviour could be a useful target for intervention in this population, and locus of control could be a causal factor in this. We aimed to assess the effect of a clinical psychologist-facilitated group intervention on male prisoners' locus of control of drinking behaviour. DESIGN: A two-arm, single-site, open, randomized controlled trial. SETTING: A category B local training prison in South Wales, housing about 770 mainly sentenced men. PARTICIPANTS: Prisoners serving less than 2 years who met inclusion criteria for pre-imprisonment alcohol misuse, alone or with drug misuse. A total of 119 were allocated to the intervention arm and 119 to the control arm; 104 and 87, respectively, completed the post-randomization baseline interview and 68 and 60 completed a second interview approximately 4 weeks later, respectively, after intervention or treatment as usual (TAU) alone. INTERVENTION: Nine clinical psychologist-facilitated groups in the prison over 3 weeks. Range of participants per session was one to seven, with three to five most usual. MEASURES: The primary outcome was locus of control of behaviour (LCB); secondary outcomes included mental state generally (comprehensive psychiatric rating scale/CPRS) and specifically (Beck Depression Inventory/BDI). An integral process evaluation was conducted. FINDINGS: LCB scores decreased during the study, but without significant intervention effect [-1.7, 95% confidence interval (CI) = -5.1 to 1.6, P = 0.329]. Change among completers in the control group was from a mean score of 37.4 [standard deviation (SD) = 10.0] to 33.7[SD = 11.7] and in the intervention group from 37.4 (SD = 11.6) to 31.9 (SD = 11.8). Secondary outcomes, including change in mental state, did not differ between arms, but 686 (64%) sessions were lost, most because of 'prison issues'. CONCLUSIONS: A clinical psychologist-facilitated group intervention did not have a statistically significant effect on sense of control of drinking behaviour among men with pre-imprisonment alcohol misuse serving less than 2 years in a South Wales prison. The study proved coterminous, however, with 40% prison staff cuts which seem likely to have contributed to the high loss of group sessions and possibly overwhelmed any treatment effect. Intervention completion failures, previously cited as harmful, had no effect here, so the trial should be repeated when the prison climate improves.

Intensive Family Preservation Services to prevent out-of-home placement of children: A systematic review and meta-analysis.

BACKGROUND: Intensive Family Preservation Services (IFPS) are in-home crisis intervention services designed to help families with children at imminent risk of out-of-home placement. OBJECTIVES: To assess the evidence of the effectiveness and cost-effectiveness of IFPS in reducing the need for children to enter out-of-home care. PARTICIPANTS AND SETTING: Children <18 years and their families in the home setting. METHODS: A systematic review and meta-analysis was carried out by searching 12 databases and 16 websites for publications up to January 2019. RESULTS: 1948 potentially relevant papers were identified, of which 37 papers, relating to 33 studies, met our inclusion criteria. Studies reported outcomes at child or family level. There were significant reductions in relative risk (RR) of out-of-home placements in children who received IFPS compared with controls at child level at three, six, 12 and 24 months' follow-up (RR 0.57, 95 % CI 0.35 to 0.93, RR 0.51, 95 % CI 0.27 to 0.96, RR 0.60, 95 % CI 0.48 to 0.76, RR 0.51, 95 % CI 0.30 to 0.87 respectively). At family level, there was not a significant reduction in RR of placement. Economic evidence was limited to cost analyses or cost-cost offset analyses. CONCLUSION: The available evidence, at child level, suggests that IFPS are effective in preventing children from entering care up to 24 months after the intervention. Placement outcomes reported at family level did not demonstrate a significant reduction in out-of-home placements. The economic analyses suggest that IFPS could be cost-saving; however, evidence of cost-effectiveness generated by full economic evaluations is needed.