1. Evaluation of HMP Shotts Oral Health Improvement Project Celia Watt Senior Health Promotion Officer NHS Lanarkshire Celia.Watt@lanarkshire.scot.nhs.uk

2. Background Severe tooth decay 4 times more likely in prison population (Scottish Prisons Dental Health Survey, 2002). Dental Action Plan (2005) – development of oral health care preventive programmes for adults in most need such as … prisoners. NHSL – HMP Shotts collaborative 3 year pilot (2008-2011). Aim to pilot a whole settings approach to oral health improvement involving prisoners, their families and staff at HMP Shotts.

3. Evaluation objectives 1.Identify change in oral-health related knowledge, attitudes, behaviours. 2.Identify good practice within OHIP. 3.Explore challenges of working in prison environment and that impact of the OHIP on the prison environment, structures and systems. 4.Make recommendations for future health improvement involvement within prison settings.

4. Evaluation Methods University of Dundee Dental Health Services Research Unit. 107 self completion questionnaires (intervention and control). Focus groups (20 prison staff and 14 prisoners). 8 SPS/NHSL one-to-one interviews. Nuffield Partnership Assessment Tool.

5. Study population Age 21-60 years (mean age 34). 2011 mean length of time in prison = 2 years, 3 months. Less than a quarter had all of their own teeth with no teeth missing, while over 40% had some teeth missing. Pre prison - over a third of prisoners reported they only attended the dentist when they were in pain or in an emergency. Another third stated that they attended 6 monthly.

6. Prisoner Awareness/Participation in OHIP

7. Prisoner Knowledge of Oral Health Messages

8. Behaviours Some changes in behaviours were apparent but were not reported at a statistically significant level. Some strong qualitative evidence of behaviour change noted: –“there’s more guys buy fruit and veg in here than ever before”. –“Aye, just found out that you’re not meant to use a hard toothbrush, meant to soft…I got one fae [the HPO]”.

9. Evaluation objectives 1.Identify change in oral-health related knowledge, attitudes, behaviours. 2.Identify good practice within OHIP. 3.Explore challenges of working in prison environment and that impact of the OHIP on the prison environment, structures and systems. 4.Make recommendations for future health improvement involvement within prison settings.

10. 2. Good practice within OHIP Evidence based approach Whole settings approach NICE guidelines – dental recall, PHG6 Partnership and joint agenda setting

11. Empowerment and support “she’s been up sitting in the visits, and having a chat with them and showing them different bits and pieces. Stuff that was more geared toward the kids but allowed them [prisoners] to have an input in it. The guys really enjoyed that”. “I think it’s a clever approach…whilst the father as parent educator is involved in the process, he must be observing some of this message themselves”. “His family is the most important thing in his life…I think they see it as a chance to say [to kids] I am telling you how to eat, how to look after your dental hygiene”.

12. Partnership

13. Evaluation objectives 1.Identify change in oral-health related knowledge, attitudes, behaviours. 2.Identify good practice within OHIP. 3.Explore challenges of working in prison environment and that impact of the OHIP on the prison environment, structures and systems. 4.Make recommendations for future health improvement involvement within prison settings.

14. 3. Challenges Nature of the prison population. Attitudes towards OH improvement and health improvement generally – staff and prisoners. General restrictions such as security demands, resources made available to the HPO within the prison.

15. 3. Impact on environment, structures and systems Catering – availability of healthier choices HWL – involvement of staff. Routine OHI involvement in events, visits, induction. Availability of resources for OHI; toys, books for visits; involvement in health promotion events for staff, prisoners and families. Development of good working partnership between NHSL and HMPS.

16. Evaluation objectives 1.Identify change in oral-health related knowledge, attitudes, behaviours. 2.Identify good practice within OHIP. 3.Explore challenges of working in prison environment and that impact of the OHIP on the prison environment, structures and systems. 4.Make recommendations for future health improvement involvement within prison settings.

17. 4. Future direction in HMP Shotts Build on recommendations plus content on Better Health, Better Lives for Prisoners and National Oral Health Improvement Strategy for Priority Groups. Continue to focus on whole settings approach. Widen to encompass other related health topics under Common Risk Factor Approach. Focus on changing behaviour rather than information and knowledge. Link in with local and national parenting strategies/campaigns.

18. Priority Action Areas Build Health Public policy –Health impact assessment Create Supportive Environments for Health –Prisoner involvement –Staff training –Population level intervention and programmes –Secure commitment, leadership and partnership of senior prison staff Strengthen Community –Community level interventions and programmes –Events –Parenting Develop Personal Skills –Accessibility of resources and information –Individual level interventions and programmes –Families and children Reorient Health Services –Appropriate service models –Partnership with new NHS salaried dental service provision

19. Acknowledgements University of Dundee Dental Health Services Research Unit –Tahira Akbar, Steve Turner, Markus Themessl-Huber, Ruth Freeman. HMP Shotts - Staff and Prisoners