1. Occupational Therapy in Prison Establishments
Christine Balaba – Occupational Therapist
Emma Nicklin- Therapy & Service Development Lead

2. Outline Service context Literature review Research rationale
Research progress

3. 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

4. Prison OT
Inreach
Inpatient wards
Daycare
OPD services

5. 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)

6. 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.

7. 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.

8. 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).
However data collected is sparse

9. 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).
Within the prison service, OT input never exists in isolation but forms part of a varied interdisciplinary network.

10. 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.

11. 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.

12. Experiences of prison work
Rewarding
Engagement
High function
Generic working
Multiple client groups
Holistic working
Promotion and development of OT
5 years working from ½ post to 16, all staff said

13. 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?

14. 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

18. Inclusion Criteria 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)

19. 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
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).

20. Study Progress 1Formulate research question 2 Literature Review
Prison Research
2016
June
July
Aug
Sept
Oct
Nov
Dec
1Formulate research question
2 Literature Review
3 formulate design/method
4 Write research proposal
2017
Jan
Feb
Mar
Apr
May
5 Apply for Sponsorship
6 Complete Peer Review
7 Apply for ethical approval
8 Recruitment
9 Data collection
10 Data analysis

21. Experiences of the research process
North London Forensic Service Research Group
NOCLOR
IRAS (Integrated Research Application System)
NOMS (National Offender Management Service)

22. Thank you for listening Questions?

23. 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 ( ). British Journal of Occupational Therapy, 79(4),
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),
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):