1. Identifying challenges and enablers to intervention retention and research follow up for participants following release from prison. Lynne Callaghan 1, Sarah Brand 1, Richard Byng 1, Tim Kirkpatrick 1, Charlotte Lennox 2, Cath Quinn 1, Jenny Shaw 2, Deborah Shenton 1, Amy Stewart 1 & Lauren Carroll 1. 1 Plymouth University, 2 University of Manchester

2. This study was funded by a National Institute for Heath Research (NIHR) Programme Grant for Applied Research (PGfAR) (grant reference RP-PG-1210-12011) and was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust (PenCLAHRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

3. Engager Intervention Inclusion – Adult males – Sentenced – 2 years or less – Within 4 and 16 weeks from release – Willingness to engage with intervention and research – Released to geographical area of the study – Current comment mental health problems, or previous problems that are likely to re-occur following release Exclusion – Remand, women – SMI / Severe PD (on caseload of offender PD pathway) – High risk of harm to researchers/practitioners

4. Core components include Shared understanding Shared plan Building Trust Liaison with services [pilot finding] Through the gate support [pilot finding] Early and sensitive planning for endings Supported by: – Mentalisation Based Approach – Ethos of flexibility

5. Intervention Delivery 2 prisons (1, South West and 1 North West England Practitioner team 2 practitioners 1 supervisor Bases in the prison and in the community Initial liaison work to develop a conducive context for the intervention Awareness raising Negotiation of remit and resources Supported by an Intervention Delivery Platform: Organisational agreements Manual Training Supervision Case management MBA

6. Pilot Trial Pilot trial (October 2014 - May 2015): n=60; randomised 2:1 to intervention or control 2 prisons (one in NW, on in SW) Researchers: – Recruit & baseline data collection 4-12 weeks pre -release, follow- up at 1 & 3 months post-release Practitioners: – first contact post randomisation (4-12 weeks pre-release). – Contact 1-2 times per week until release – Through the gate support if accepted – Continued contact 1-2 times per week in community for 2-4 months

7. Acceptability & retention Intervention delivered to 36 (3 transferred or released early / 1 decided he didn’t need it) Approximately 50% retained in 3 month follow up in both intervention and control group NW (n=19)SW (n=17) Mean no. contacts in prison4 (range 1-8)3.5 (range 0-7) N seen in community1513 Mean no. contacts in community9.3 (range 1-19)7.4 (range 1-17)

8. Challenges to retention Difficulty of access in prison – Barrier to building trust Rapidly changing/no contact details Rapid changes in circumstances and priorities – Prison: early release/moving prison – Community Change in services Geographical spread and service provision Return to prior routines, cycles

9. Researcher and Practitioner shared strategies for retention Informal contact Flexibility around appointments: – Assertive follow-up – Rearranging – Timing – Location – Return to prison Multiple contact points/methods – Regular updating & reminders – Information sharing with other agencies (supported by specific confidentiality agreements) Contact between appointments

10. Practitioner strategies for retention Aim: Trust focus whilst developing the shared understanding and fulfilling the shared action plan. Quick wins Close and continued liaison with services Liaison with family and friends Through the gate support Flexibility and crisis management/support with stressful events

11. Discussion Listened to Working alongside Realistic – Reliability – Realistic goals Flexibility Trust

12. www1.plymouth.ac.uk/ research/engager lynne.callaghan@plymouth.ac.uk