Department of Public Health and Primary Care Health Needs Assessment in Prisons: The Professional...
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Department of Public Health and Primary Care Health Needs Assessment in Prisons: The Professional View and the Client View Helen Thornton-Jones ([email protected])
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Transcript of Department of Public Health and Primary Care Health Needs Assessment in Prisons: The Professional...
Department of Public Health and Primary Care
Health Needs Assessment in Prisons: The Professional View and the Client View
Helen Thornton-Jones
Department of Public Health and Primary Care
Background
Historical weaknesses in prison healthcare
Transfer of Prison healthcare to the NHS
Requirement for health improvement plans underpinned by needs assessment
Lack of suitable needs assessment tools
Department of Public Health and Primary Care
Traditional HNA in the NHS is
• Geared to large, stable populations of many thousands
• Mainly epidemiological
• Specialist-led (mainly Public Health Specialists)
• Not readily linked to planning
Department of Public Health and Primary Care
NEEDS ASSESSMENT IS NOT...
• Only about health and health care
• Only about counting how many people will benefit from a service
• Only about collecting data
Department of Public Health and Primary Care
Particular Prison Issues
• Small size and high turnover of population – measures of incidence and prevalence are not very meaningful.
• Different categories of prisons – not easy to generalise
• Lack of useful, available quantitative data
Department of Public Health and Primary Care
Priority Areas
Department of Health
• Primary care• Substance use• Mental health• Dental• Health promotion• Workforce development
HMP Hull
• Substance use• Mental Health• Communicable Diseases• Dental Services• Workforce development• IM & T
Department of Public Health and Primary Care
Evidence of need
• Expert opinion• Professional judgement• Results of audit• Adherence to authoritative
guidance
Department of Public Health and Primary Care
Develop a new approach to HNA • Recognise lack of data
• Recognise lack of research evidence
• Recognise alternative measures of “need”
• Focus on unmet need
• Note authoritative guidance in key priority areas
• Use adherence to guidance as a measure of need
Department of Public Health and Primary Care
SMALL-SCALE NEEDS ASSESSMENT AND PLANNING
Informs
planning
Potential evidence sources include:
Pro-active identification of need
Aspect A: Professional perspective e.g. stakeholders survey, staff survey, current provision
Aspect C: Local priorities e.g. review of previous needs assessments & plans etc or prison standards audit data
Aspect B: Prisoner perspective Direct e.g survey, focus group Indirect e.g BoV, chaplains, ex-prisoners, support groups
Aspect E: National priorities and imperatives
Aspect D: Externalities e.g changes within prison system, rising prison population etc.
Review against authoritative guidance
Drivers include:
New research evidence
e.g. evaluations of interventions in prisons or the community, systematic reviews etc.
Best practice examples e.g. published examples of evaluated initiatives within prison setting
Published Guidance
based on above
Department of Public Health and Primary Care
Defining the Planning Partnership
Range of
• Organisations (prison, PCTs, acute trust, community trust etc.)
• Professionals (custody officers, prison HC staff, doctors, nurses NHS managers etc.)
• Specialisms (MH, CDC, HP, HR, IT etc)• Special interest groups (charitable
organisations, prisoner representatives, advocates etc)
Department of Public Health and Primary Care
OUR APPROACH – round 1 (2002)
• Need identified by…
– Review of last health improvement plan
– Assessing current services in priority areas against authoritative best practice guidance
– Incorporated material from other sources that might reveal shortfalls in services e.g. prison standards audit
• Using a series of group interviews…
– Prison health steering group (PHSG)
– Input from expert witnesses
– ‘Conversation with a purpose’(Burgess, 1984)
– Recorded by research team …
Department of Public Health and Primary Care
Key questions
• Does this apply to HMP Hull?• Does HMP Hull comply with it?• If not, is alternative ‘good practice’ in
place? (and if so has it been evaluated)?• If not, what would make compliance
feasible?• What (if any) action needs to be taken,
by whom and by when?
Department of Public Health and Primary Care
EXAMPLE – DATA COLLECTIONAuthoritative guidance reference
Present situation- needs identification process
Implications Health improvement plan 2003 and beyond
Time-scales
National guidance: Changing the Outlook 3.3 pages 15.
Effective mental health awareness training
Presently there is no systematic mental health awareness training in place for wing officers. However, a member of Healthcare staff is appropriately qualified to deliver a series of 1-2 hour mental health awareness course to wing based staff. In addition, the HERCH trust is running a 5-day mental health awareness course that could be accessed by other members of the Healthcare team.
Resources implications in terms of releasing both the trainer and wing officers.
The Prison Service offers 6½ days training for all prison officers part of this will be used for mental health awareness training.
18-20 wing staff will have received mental health awareness training.
There will be a mental health liaison officer on each wing.
In addition, to the above two members of the Healthcare team are scheduled to receive formal training. Specifically, one member of staff will undertake the HERCH trust’s 5-day mental health awareness course and another a University run ‘mental health in a secure environment’ module.
By April 2004
By April 2004
By February 2003
Department of Public Health and Primary Care
Published Methodology
Thornton-Jones H, Hampshaw S and England P
“Health needs assessment in prisons”
British Journal of Healthcare Management
2005 11 (4) 105-110
Department of Public Health and Primary Care
Round 2 - 2005
• Is the method resilient given changes to staffing, establishment, policy etc
• How far is it possible to incorporate the client (prisoner) view
Department of Public Health and Primary Care
Patient Perspective
Focus group with 14 serving prisoners i.e.
– Prison listeners
– Patient forum
– Orderlies
– ‘frequent users’
Anonymous written comments via Healthcare
Department of Public Health and Primary Care
Issues in capturing patient view
• Representative sample• Ethics• Security
– Equipment– Presence of prison officer
• Support from prison staff• Respondent Validation• Feedback – what happened as a result
Department of Public Health and Primary Care
User Issues
• Waiting times• Low immunisation rates• Communication• Respect• In-possession medication especially
pain relief• Priorities (methadone)
Department of Public Health and Primary Care
Conclusions
• Effective means of needs assessment
• Importance of the patient perspective – similarities and differences between patient and staff views
• Helped by strong partnerships
Department of Public Health and Primary Care
Health Needs Assessment in Prisons: The Professional View and the Client View
Helen Thornton-Jones
