Occupational Therapy
in Prison
Establishments
Christine Balaba – Occupational Therapist
Emma Nicklin- Therapy & Service Development Lead
Outline
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Service context
Literature review
Research rationale
Research progress
Service Context
• Barnet Enfield and Haringey Mental Health
Trust
• North London Forensic Service
• Community Services
• 7 prisons
• Therapy services in each with OT’s
• 16 OT’s and 3 TI’s
Prison OT
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Inreach
Inpatient wards
Daycare
OPD services
Literature
• Sharp increase in evidence base for OT in
forensic mental health (in study numbers and
quality)
• Absence of studies relating specifically to
prison-based OT
• (Hitch, Hii and Davey 2016)
Literature Review
• Guided by the question “what evidence is
published about occupational therapy within
the prison service”.
• The search yielded eight articles and two
poster presentations (USA, Singapore,
Rumania, Canada and Australia)
• No peer reviewed articles on OT provision in a
UK prison were identified.
Literature Review
• Most studies focused on OT group interventions.
• Largely unclear if and what additional roles OTs
hold within prisons.
• Lack of focus of OTs working as part of a mental
health in-reach team or working in a more
generic role.
• All interventions evaluated focused on a mental
health prison population, rather than targeting
the general prison population.
Literature Review
• Use of outcome measures:
• Task Behavioural Scale (Tan, Kumar and
Deavarj 2015)
• Canadian Occupational Performance
Measurement (COPM)
• Occupational Therapy Leisure Skills
Questionnaire, Fundamental Interpersonal
Relations Orientation Behavioural Scale (Jones
and McColl 1991).
Literature Review
• OT programs often form part of an overall
rehabilitation program.
• Some studies appeared vague on how this is
managed in relation to data collation and
what other rehabilitative input the prisoners
had (Eggers M, et al. 2006) (Tan BL et al 2015).
Literature Review
• OT provision varies greatly across services
• Information is limited in relation to
assessments and interventions used.
• Data in relation to OTs working in prison
services is scarce and often poorly conducted.
Rationale
• Prison OT has a long way to go in terms of
proving their effectiveness and more research
is needed.
• OTs have the potential to provide a
fundamental role in delivering rehabilitative
programs within the prison service.
Experiences of prison work
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Rewarding
Engagement
High function
Generic working
Multiple client groups
Holistic working
Promotion and development of OT
Research Questions
• What are the experiences, processes
and outcomes of occupational therapy
in prison establishments?
• What are the experiences of occupational
therapists working in the prison service?
• What are the experiences of clients receiving
occupational therapy in the prison service?
• What assessments and interventions are
performed by occupational therapists?
• Are occupational therapy goals achieved?
Mixed Methods Approach
• (a) Analysis of interviews of occupational
therapists’ and clients’ experiences using
interpretative phenomenological approach
• (b) Thematic analysis of the Goal Attainment
Scale
• (c) Caseload analysis
Inclusion Criteria
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Client:
Prisoner who has received occupational therapy input in prison during their
current period of sentencing
Male
Adult (18-65 years old)
Able to understand written and spoken English well enough to read
consent forms and participate in an interview.
Must have capacity to give consent
Occupational therapist:
Registered occupational therapist with the Health and Care Professions Council
(HCPC)
Has worked at the current prison setting for at least six months and is employed by
Barnet, Enfield and Haringey Mental Health Trust (HMP Brixton, HMP Pentonville,
HMP Wormwood Scrubs)
Exclusion Criteria
• Client:
• Those prisoners who are likely to be released prior to engaging with the
research process (e.g. taking part in the interview).
• Behavioural instability and change in risk post recruitment
• Those prisoners who are secluded from other prisoners and day to day
activities due to offences committed whilst in prison, and who therefore
are not accessible to a researcher for taking part in an interview.
• Those diagnosed with a serious mental illness who have experienced a
psychotic episode within the last week
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• Therapist:
• Occupational therapists undergoing performance review
• Occupational therapists who are likely to leave their post prior to taking
part in the research process (eg. Locum posts).
Study Progress
Prison Research
2016
June
July
Aug
Sept
Oct
Nov
Dec
Feb
Mar
Apr
May
June
July
1Formulate research question
2 Literature Review
3 formulate design/method
4 Write research proposal
2017
Jan
5 Apply for Sponsorship
6 Complete Peer Review
7 Apply for ethical approval
8 Recruitment
9 Data collection
10 Data analysis
Aug
Sept
Oct
Nov
Dec
Experiences of the research process
• North London Forensic Service Research
Group
• NOCLOR
• IRAS (Integrated Research Application System)
• NOMS (National Offender Management
Service)
Thank you for listening
Questions?
References
• Eggers M, Munoz JP, Sciulli J, et al. (2006) The Community
Integration Project: Occupational therapy at work in a county jail.
Occupational Therapy in Health Care 20(1):17-27.
• Hitch, D Hii, QK and I Davey (2016) Occupational therapy in forensic
psychiatry: Recent develop[ments in our understanding (20072013). British Journal of Occupational Therapy, 79(4), 197-205.
• Jones, E J and M A McColl (1991) Development of Evaluation of an
Interactional Life Skills Group for Offenders. The Occupational
Therapy Journal of Research, 11(2), 80-92.
• Tan BL, Kumar VR, and Devaraj P (2015) Development of a new
occupational service in a Singapore prison. British Journal of
Occupational Therapy 78(8):525-529.