Evaluation of birth companions perinatal and peer support provision in two prison settings in England: a mixed-methods study.

PURPOSE: This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based charity) perinatal support in two prison settings in England. The initiative involved the provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. DESIGN/METHODOLOGY/APPROACH: A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n = 9); audio recorded interviews (n = 33) with prison and health-care staff, women in prison, peer supporters and BC staff; analysis of existing routinely collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. FINDINGS: BC provided instrumental/practical support, emotional support, information support, signposting to services and advocating for women to the prison concerning their perinatal needs and rights. Key themes revealed that support had an impact on the lives of perinatal women by creating a safe place characterised by meaningful interactions and women-centred approaches that facilitated access to wider care and support. The service made a difference by empowering women and providing added value for peer supporters, prison, health-care and BC staff. Key enablers and strategies for the care of perinatal women and the delivery of perinatal support are also detailed. ORIGINALITY/VALUE: Through longitudinal data and the involvement of a range of stakeholders, this study evidences the subtleties of support provided by BC and the potential it has to make a difference to perinatal women in prison and those volunteering or working within the prison system.

Producing food in English and Welsh prisons.

Most prison food research focuses on aspects of consumption rather than production yet farming, horticulture and gardening have been integral to the prison system in England and Wales for more than 170 years. This paper explores the interplay between penological, therapeutic and food priorities over the last fifty years through an examination of historical prison policies and contemporary case studies associated with the Greener on the Outside for Prisons (GOOP) programme. Findings are discussed in relation to how joined-up policy and practice can impact positively on whole population health and wellbeing within and beyond the prison setting.

Mental health and wellbeing benefits from a prisons horticultural programme.

PURPOSE: In the context of current prison safety and reform, the purpose of this paper is to discuss findings of an impact evaluation of a horticultural programme delivered in 12 prisons in North West England. DESIGN/METHODOLOGY/APPROACH: The programme was evaluated using quantitative and qualitative methods, including Green Gym© questionnaires, the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Biographic-Narrative Interpretive Method interviews. FINDINGS: Against a backdrop of high rates of suicide, self-harm and poor mental health, the horticultural programme studied proved beneficial to prisoner participants, the most marked effect was on mental health and wellbeing. In addition to data related to the original mental health outcome indicators, the study revealed multiple layers of "added value" related to mental health arising from horticultural work in a prison setting. RESEARCH LIMITATIONS/IMPLICATIONS: The main research limitations were the limited completion of follow-on questionnaires due to prisoners being released and the inability to conduct longitudinal data collection post-release. There was also concern about response bias and lack of resource to compare with the experience of prisoners not participating in the programme. SOCIAL IMPLICATIONS: Positive impacts on prisoners' mental health and wellbeing included increased confidence, social interactions with staff and other prisoners and gaining skills and qualifications and work experience, increasing potential for post-release employment. ORIGINALITY/VALUE: Benefits of horticulture work on health are well established. However, to date, there is little research concerning the effects this work may have on mental wellbeing of prisoners both within prisons and more so upon their release back into the community.

Growing health in UK prison settings.

Globally, prisoners tend to come from marginalized and socially disadvantaged sections of the society and exhibit a high incidence of ill health, linked to social exclusion and multiple complex needs. Prisons therefore offer an important opportunity to tackle inequality and injustice, through promoting health, reducing reoffending and facilitating community reintegration.This paper reports on and critically discusses findings from an evaluative research study, which aimed to identify and explore impacts of prisoners' participation in an innovative social and therapeutic horticultural programme, 'Greener on the Outside for Prisons' (GOOP), delivered in prisons in North West England. Focus groups with 16 prisoners and semi-structured interviews with six prison staff were conducted at five sites. Presented under three overarching themes (health and well-being; skills development, employability, and work preparedness; and relationships), findings suggest that engagement with and participation in GOOP were important in improving positive mental well-being, increasing physical activity and knowledge about healthier eating; developing skills and work readiness; and building relationships and catalysing and strengthening prosocial behaviours, important for good citizenship and effective resettlement. The paper concludes that - in the context of the current UK prison reform agenda and concern about the high incidence of violence, substance misuse, self-harm and suicide - prison-based horticulture can offer multiple benefits and make a significant contribution to the creation of safe, secure, supportive and health-enhancing environments. Furthermore, it contends that by joining up health and justice agendas, programmes such as GOOP have the potential to serve as powerful catalysts for wider systemic change, thereby helping tackle inequalities and social exclusion within societies across the globe.

Health-promoting prisons: theory to practice.

As a setting, prisons offer a unique opportunity to invest in the health of disadvantaged and marginalised populations and address health inequalities and social exclusion - thereby achieving sustainable improvements in well-being for offenders and their families and in turn, helping to reduce rates of re-offending. This article draws on English and French experiences and doctoral research to advocate a shift from a pathogenic model towards a salutogenic model of health as a helpful way to address inequalities and thus, by promoting joined-up working across justice and wider systems, impact positively beyond 'health' for the effective resettlement of prisoners. The paper utilises examples from horticulture to further argue the powerful role of nature in the prison setting in mediating aspects of culture particularly relating to processes of socialisation. Critical success lies in bridging across systems and a commitment to joined-up working at all levels across and beyond prison.

Probation as a setting for building well-being through integrated service provision: evaluating an Offender Health Trainer service.

INTRODUCTION: The NHS Health Trainer Programme was launched in England and Wales in 2005 with the aim of tackling health inequalities. While initially focusing on geographical communities, the initiative has extended its reach to particular population groups, such as offenders and their families, who experience high levels of physical and mental health needs and wider social exclusion. This paper reports on the evaluation of the Offender Health Trainer service delivered in probation settings in Bury, Rochdale and Oldham (Greater Manchester). This service has sought to improve the health of offenders, improve their access to mainstream services, and help reduce health inequalities - as well as facilitate rehabilitation and improve job prospects for ex-offenders through employment as health trainers. AIMS: This evaluative research study aimed to explore the delivery of the Offender Health Trainer service and examine its impact on service users. The study design and limited time frame meant that the research was focused on the journeys of service users rather than on long-term outcomes. METHODS: The evaluation used a mixed-methods approach, comprising two key elements: the interrogation and analysis of routinely collected quantitative data extracted from the National Health Trainer Data Collection Recording System (DCRS); and in-depth qualitative research using interviews and focus groups with clients and health trainers. RESULTS: The evaluation points to the overall success of the service in meeting its aims and impacting positively on the lives of offenders. It reveals promising trends in behaviour change and self-perceived health and well-being, articulating a rich narrative detailing how the service has helped probation clients tackle multiple interwoven problems and build hope and self-belief. Of particular importance was the health trainers' experience of the criminal justice system, which resonated with and inspired clients, developing trust and motivation to change. CONCLUSIONS: While the research inevitably had limitations, this study suggests that the health trainer model can be effectively implemented within the probation setting, making a valuable contribution to the improvement of offenders' health and well-being by working in ways that acknowledge the connections between personal lifestyle and wider determinants of health. Within the context of forthcoming probation reforms, it will be increasingly important to develop services that highlight these links and to invest in appropriate evaluation that can generate further learning about 'what works and why'.

Barriers and facilitators to a criminal justice tobacco control coordinator: an innovative approach to supporting smoking cessation among offenders.

AIMS: To examine the barriers and facilitators to effective operation of a regional tobacco control coordinator working within and across criminal justice and public health, whose goal was to raise tobacco control awareness and support the development of smoking cessation treatment for offenders. DESIGN: A reflexive, mixed-methods case study approach using in-depth interviews, project reports and observation of advisory board meetings. SETTING: The coordinator worked with prisons, probation and police custody, where there are high levels of social disadvantage and smoking. PARTICIPANTS: Interviews (n = 34) at different stages of project with the coordinator, project advisers and local stakeholders from criminal justice and public health. MEASUREMENTS: Analysis of facilitators and barriers and the coordinator role from different perspectives. FINDINGS: Readiness to develop cessation services was a critical predictor of different criminal justice settings' engagement with the coordinator role. The coordinator enhanced cessation service delivery in individual prisons where there was a requirement and infrastructure in place to provide such services. In police custody, where there was no central guidance or pre-existing requirements, efforts to establish smoking cessation on the local agenda proved ineffective. In probation settings, the coordinator documented examples of good practice and supported brief intervention training. Variability in willingness to engage limited the project's ability to create joined-up working across criminal justice settings. CONCLUSIONS: In the English criminal justice system, the prison service appears to provide a favourable context for development of smoking cessation support and a means of accessing hard-to-reach groups. Other criminal justice settings, most specifically police custody, appear less responsive to such activity. A coordinator role can improve smoking cessation support in the prison setting, and develop local improvements in tobacco control interventions in other settings such as probation, but as configured here, does not have the capacity to effect change across the criminal justice system.