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Community Based Health and First Aid in Action in Irish Prisons
Name: Community Based Health and First Aid in Action in Irish Prisons
Pages: 76
Year: 2013
Language: English
File Size: 3.52 MB
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2 Contents Acknowledgements ............................................................................................................................ 5 1.0 Introduction and Context ............................................................................................................ 6 2.0 Executive Summary .................................................................................................................... 7 3.0 Key Lessons Learned ................................................................................................................. 8 4.0 Recommendations..................................................................................................................... 10 5.0 Evaluation Methodology ........................................................................................................... 11 6.0 An Overview of the CBHFA Course Content ......................................................................... 13 7.0 A Description of the Prisons in which CBHFA in Action is operating.................................. 14 7.1 Wheatfield Prison, operational capacity 700 ............................................................................ 14 7.2 Cloverhill Prison, operational capacity 430 ............................................................................... 15 7.3 Shelton Abbey Open Prison, operational capacity 120 ............................................................. 15 7.4 Training Unit, operating capacity 120 ....................................................................................... 16 7.5 Dochas Centre Women s Prison, operating capacity 100.......................................................... 16 7.6 Mountjoy Prison, operating capacity 590 ................................................................................. 17 8.0 The Impact of the CBHFA in Action in Irish Prisons ............................................................. 18 8.1 Some of the Impact of Community Based Health and First Aid in Action in the Six Prisons During 2009 2012 ........................................................................................................................... 18 8.2 Community Assessment as the Basis for Action in the CBHFA in Action Approach and Baseline Assessments.................................................................................................................................... 18 8.3 Dealing with Major Emergencies .............................................................................................. 22 8.4 Responding to Relevant Emergencies and Disease Outbreaks.................................................. 22 8.4.1 Tuberculosis in Prisons.................................................................................................. 23 8.4.2 Seasonal Flu, Swine Flu and the Norovirus (Winter Vomiting Bug) ........................................ 24 8.4.3 First Responder Actions of Volunteers ....................................................................... 24 9.0 The importance of the Project work and an Overview of Those Being Undertaken in Irish Prisons ............................................................................................................................................ 25 9.1 Non Communicable Diseases (NCD s) ....................................................................................... 26 9.2 Drug Addiction .......................................................................................................................... 26 9.3 Violence Reduction Weapons Amnesty ................................................................................. 27 9.3.1 The Impact of the Weapons Amnesty project ............................................................. 27 9.4 Hygiene and Cleanliness............................................................................................................ 29 9.5 Hand washing Technique .......................................................................................................... 31


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3 9.6 Nutrition and Cholesterol Checks ............................................................................................. 32 9.7 Food Hygiene Providing covers for plated meals ................................................................... 32 9.8 HIV/AIDS and Anti Stigma ......................................................................................................... 33 9.8.1 Raising awareness about HIV AIDS ............................................................................ 34 9.9 Smoking Cessation .................................................................................................................... 35 9.10 Working with Probation Services ............................................................................................ 36 9.11 Newsletters and Prisoner Information Dissemination ............................................................ 36 9.12 Women s Health ..................................................................................................................... 37 9.13 Stroke Awareness ................................................................................................................... 37 9.14 Paracetamol Reduction Project ............................................................................................... 38 9.15 Adapting to new Environments and Orientation for New Prisoners ....................................... 39 9.16 The Emblem and Living the Humanitarian Principles .............................................................. 40 9.17 Restoring Family Links (RFL) .................................................................................................... 40 9.18 International Day of the Elderly on 1st October 2012 .............................................................. 42 9.19 Re Cycling Project ................................................................................................................... 42 9.20 Dental Health .......................................................................................................................... 42 9.21 Evidence of Personal Development and Changed Outlook ..................................................... 43 9.21.1 Environment .................................................................................................................. 45 9.21.2 Behaviours .................................................................................................................... 45 9.21.3 Capabilities .................................................................................................................... 45 9.21.4 Beliefs and Values ....................................................................................................... 46 9.21.5 Identity ........................................................................................................................... 46 9.21.6 Goals .............................................................................................................................. 46 Discussion ....................................................................................................................................... 46 9.22 Improved Relationships .......................................................................................................... 47 10.0 Aligning National Society Programmes to Strategy 2020 .................................................. 47 11.0 Profiling of the Irish Red Cross .............................................................................................. 48 12.0 The Alignment of the Programme to the IPS Strategy 2012 2014. .................................. 48 13.0 Focus on Mental Health and Addiction Services................................................................. 49 14.0. The Use of the Key Elements of the CBHFA Implementation Guide in planning and implementing the CBHFA in Prisons Programme........................................................................ 49 14. 1 Acknowledging the Five Components of Health Promotion and a Dynamic Model for Change ........................................................................................................................................................ 50 14.2 The Minimum Content and Requirements for CBHFA in Action ............................................. 51


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4 14.3 Management Support model for an Effective CBHFA in Action Approach to Health in Prisons ........................................................................................................................................................ 53 15.0 Ensuring the CBHFA approach is sustainable .................................................................... 54 15.1 Sensitization Workshops ......................................................................................................... 55 15.2 Lessons Learned Workshops ................................................................................................... 55 15.3 The Importance and the Community Health Committee ........................................................ 56 16.0 Health Care in the Irish Prison Service ................................................................................ 56 16.1 How the CBHFA in Action Volunteers have Assisted in Improving Operational Health Care .. 58 17.0 Community Development and Empowerment ..................................................................... 59 18.0 Conclusion ................................................................................................................................ 60 18.0 References ............................................................................................................................... 61 Annexe 1 ........................................................................................................................................... 62 Things Happening Differently ......................................................................................................... 62 Projects & Activities led by Irish Red Cross Volunteer Inmates ................................................. 62 Annexe 2 ........................................................................................................................................... 65 Trend in Prison Groups Changes in Outlook from Before Becoming an IRC Volunteer and After ..... 65 Annexe 3 ........................................................................................................................................... 67 Different Perceptual Positions ........................................................................................................ 67 Perceptions of Changes in Prisoner Outlook from Before to After Becoming Red Cross Volunteers from Amongst Discipline, Nursing, Teaching and IRC Staff in Two Mixed prison Groups ............................................................................................................................................... 67 Annexe 5 ........................................................................................................................................... 70 Irish Red Cross Post HIV Testing Survey ..................................................................................... 70 Annexe 6 ........................................................................................................................................... 73 Interview questions for choosing IRC Volunteer Inmates ........................................................... 73 Annexe 7 ........................................................................................................................................... 74 Guidelines for Irish Red Cross Volunteer Inmates ...................................................................... 74 Annexe 8 ........................................................................................................................................... 75 Community Based Health & First Aid Prison Programme .......................................................... 75 Briefing Guide for Irish Red Cross local branch CBHFA support volunteers ........................... 75 Annexe 9 ........................................................................................................................................... 76 Transcript of Training .................................................................................................................. 76


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5 Acknowledgements Deputy Governor Frances Daly, Wheatfield Prison for her dedicated commitment and work from a management perspective from its pilot stage in Wheatfield Prison to advocating with Governors of other prisons. Lydia O Halloran, CBHFA Manager, Irish Red Cross for her pioneering role in the de elopment of this programme and her expertise as editor of this report. Maeve Donnelly, CBHFA Programme Coordinator for the City of Dublin Vocational Education Committee for her pioneering role with the development of this partnership. Frances Nangle, Coordinator of Nursing, Irish Prison Service for her support of the programme within the healthcare sector. Stephen O Connor, Organiser of Prison Education, City of Dublin VEC for his support of the Schools involvement in this partnership. Donal Forde, Secretary General, Irish Red Cross Fintan Breen, Head of National Services, Irish Red Cross Assistant Governor Donnacha Walsh, CBHFA Programme Governor, Cloverhill Prison and subsequently St Patricks Institution Larry Keevans, Chief Nursing Officer, Cloverhill Emmett Conroy, Irish Red Cross Liaison Nurse, Cloverhill Joan O' Sheila, Head Teacher, Cloverhill Catriona McGrath (VEC), Irish Red Cross Liaison Teacher, Cloverhill Chief Officer Colm Hickey, Irish Red Cross Discipline Chief Liaison Officer, Cloverhill Prison John Flavin, Assistant Chief Officer, Cloverhill Prison Paul Quinn, Assistant Chief Officer, Cloverhill Prison Chief Officer Damien White, Irish Red Cross Discipline Chief Liaison Officer, Wheatfield Prison Assistant Chief Officer Lorraine McCarthy, Irish Red Cross Discipline Liaison Officer, Wheatfield Prison Ursula Norton, Chief Nursing Officer, Wheatfield Catherine Heave, Irish Red Cross Liaison Nurse, Wheatfield Brenda Fitzpatrick, Head Teacher, Wheatfield Bridget McKeever, Irish Red Cross Liaison Teacher, Wheatfield and the Training Unit Assistant Governor Jean Carey, CBHFA Programme Governor, Training Unit Margaret Joyce, Head Teacher Training Unit Greta Archibald, Irish Red Cross Liaison Nurse, Training Unit Eavan Harrington, Irish Red Cross Liaison Officer/CBHFA Trainer, Training Unit Go ernor Mary O Connor, CBHFA Programme Go ernor, Dochas Womens prison Laura Fitzsimmons, Irish Red Cross Liaison Nurse, Dochas Womens Prison Cathy O' Flaherty, Head Teacher, Dochas Centre Orla Brennan(VEC), Irish Red Cross Liaison Teacher, Dochas Womens Prison Noelle Ratty (VEC), Irish Red Cross Liaison Teacher, Dochas Womens Prison Governor Greg Garland, CBHFA Programme Governor, Mountjoy Prison Chief Officer Martin Galgey, Irish Red Cross Discipline Chief Liaison Officer, Mountjoy Prison Chief Nurse Officer Anne Collins, Irish Red Cross Liaison Nurse, Mountjoy Nurse Officer Dee x, Irish Red Cross Liaison Nurse, Mountjoy Ciaran Leonard, Head Teacher, Mountjoy Josephine Rice (VEC), Irish Red Cross Liaison Teacher, Mountjoy Governor Conal Healy, CBHFA Programme Governor, Shelton Abbey Prison Patsy Breen, VEC Head Teacher, Shelton Abbey Prison Claire Gough (VEC), Irish Red Cross Liaison Teacher, Shelton Abbey Chief Officer Robbie Gillespie, Irish Red Cross Discipline Chief Liaison Officer, Shelton Abbey Prison Last but not least, acknowledgement is given to the Irish Red Cross Volunteer Inmates whose remarkable work has contributed to the huge success of the CBHFA programme.


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6 1.0 Introduction and Context The Community Based Health and First Aid (CBHFA) in Action approach to improving health, hygiene and first aid in Irish Prisons began in June 2009 with a pilot project at Wheatfield Prison. This is a medium to high security closed sentenced prison of approximately 800 inmates. CBHFA in Action is an International Federation of the Red Cross (IFRC) approach to health education and first aid that was designed for use in communities around the world through the respective national Red Cross Societies of each country. It was particularly designed for developing countries where there is limited access to formal health care systems. Prior to CBHFA in Action the programme was the Community Based First Aid ( (CBFA) package that was designed in the 1990 s.The course was re designed between 2006 and 2008 and published in its current action learning form in 2009. The impetus for the change in methodological approach was to encourage community impact resulting from training which was not being realised with CBFA. Following a successful evaluation of the pilot at Wheatfield in 2010, the programme was extended to two other prisons Cloverhill Remand Prison and Shelton Abbey Open Prison. At the end of 2011 there was a lessons learned workshop involving inmate volunteers and staff from all three prisons. Lessons learned from this were used in 2012 as the programme was further extended to three additional prisons at the Mountjoy Campus. These were the Training Unit, the Dochas Centre Women s Prison and the main Mountjoy Prison. Each of these prisons are unique in that each are different and some such as remand and open prisons bring their own unique problems which must be addressed. Information about these differences and their associated problems are provided in the text. The health service in the Irish Prison Service has been going through change in recent years. Historically, the healthcare was provided by prison officer medics (trained first aiders) and visits from a prison doctor. Now each prison has a healthcare department with nursing staff and a Chief Nurse Officer as well as General Practitioners. In 2004 the Irish Prison Service (IPS) introduced the IPS Health Care Standards as a guide and benchmark for the delivery of more proactive and preventive healthcare in prisons. Achieving these healthcare standards is to a great extent linked to the existence of prisoner level health awareness and education to achieve these objectives successfully. The CBHFA in Action approach to health in prisons has been instrumental in making an impact at ground level through the use of the trained Irish Red Cross inmate volunteers reported in this evaluation document. The key to the success has been the very real partnership between the inmate volunteers as peer educators linked to the formal health care systems in place. It is important to recognize that these volunteers work as an auxiliary to professional nurses rather than trying to replace them. Evidence is being seen however, that there is a cost saving advantage in that more widespread and more effective health education is being provided than could be achieved by nurses alone. The structure of this evaluation begins with an executive summary, key lessons learned and some recommendations for future practice. These are followed by method of evaluation used and then an overview of each of the six prisons where CBHFA in Action is currently operating. The report then


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7 goes directly into the impact of the Prison based CBHFA in Action approach showing the different projects being undertaken and the results of these. Of particular interest is in how there appears to have been a change in prisoner outlook amongst those involved as inmate Irish Red Cross volunteers. There is then some comment on the positive effects of the approach not only on inmate staff relationships but also its potential for assisting in the Irish Prison Ser ices Integrated Sentence Management System and the Enhanced Regimes System. The report then comments on how this programme is assisting the Irish Red Cross to contribute to the global Strategy 2020 and to its own strategic directions. Then, particularly for global use, there is some discussion about how the Implementation Guide assisted in the introduction and development of the project in Irish Prisons. This is followed by an o er iew of the Irish Prison Ser ices (2004) Health Care Standards and the contribution of the volunteers to these and to health care in general. Finally, there are a number of annexes supporting the text in relation to the impact of the project and other important issues. 2.0 Executive Summary 2.1 Inmate Irish Red Cross volunteers have been established in six out of fourteen prisons in the State in the period 2009 to 2012. 2.2 Over 2000 prisoners in the six targeted prisons have been receiving relevant health awareness and safety messages. 2.3 Linked to these, in excess of 6000 people as staff, relatives and friends of prisoners have also had the benefit of the health care messages as volunteers and the prison community are encouraged to pass on their knowledge. 2.4 The International Federation of the Red Cross (IFRC) CBHFA in Action Implementation Guide has been a useful flexible tool as a guide to implementing the approach in a prison context in Ireland. 2.5 Community Based Health and First Aid in Action is a successful approach to introduce the WHO 2007 recommendation for the Whole Prison approach to Health in Prisons in Ireland. 2.6 The introduction and development of CBHFA in Action complements the IPS 2012 2015 strategy to improving Irish Prisons by targeting and linking with community organizations. 2.7 There has been a significant impact in developing health awareness and education relating to the IPS Health Care Standards in all six prisons targeted in the period 2009 2012 and on the basis of this 4 more prisons will be targeted in 2012/13. 2.8 CBHFA in Action has made a significant change in inmate olunteers outlook and beha iours contributing to the Irish Red Cross s support to the IFRC Strategy 2020 in terms of Saving Lives Changing Minds. 2.9 The CBHFA approach is addressing two out of three of the IFRC Strategic Directions and two out of three of the Irish Red Cross (IRC) key directions in its own strategy. 2.10 There is evidence that the process of participating as an inmate IRC volunteer through this approach has lead to personal changes and perceptions of confidence and self worth (see annexe 2).


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8 2.11 Management in all prisons currently supporting CBHFA in Action report a subtle positive change in relationships between prisoners and staff. 2.12 The CBHFA volunteer manual, whilst written with a non custodial context in mind, nevertheless was able to be successfully used with thought and imagination. 2.13 The CBHFA in Action in Wheatfield Prison is well established to a degree that operational health services actively seek out the assistance of inmate IRC volunteers to help make services work more efficiently through their peer to peer effectiveness. 2.14 The CBHFA in Action approach to community health and its inmate IRC volunteers have actively contributed to improvements in operational healthcare through their role as advocates for change. 2.15 In all six prisons there is evidence of improved personal and in cell hygiene emerging out of learning about topics on safe water, hygiene and sanitation. 2.16 The Prison based CBHFA in Action approach topics in the volunteer manual led to action projects around the prison leading to improved health, hygiene and relevant responses in first aid. 2.17 The report of the Inspector of Prisons (2010) has commended the CBHFA in Action approach to health and first aid in prisons and advocates for its wider implementation. 2.18 The successful implementation of CBHFA in Action approach in six prisons has demonstrated its replicability as a model for peer to peer health awareness and education in custodial contexts. 2.19 CBHFA in Action projects emerging out of HIV/AIDS topics have lead to two major projects which have resulted in over 50% of inmates in two prisons knowing their viral status in relation to HIV which was previously only around 2%. 2.20 A key short fall in the 2010 Evaluation was the fact that first aid skills learned in the classroom were not being transferred to the local prison community and this is now being achieved in most prison communities through a non equipment based approach to first aid response. 2.21 Non communicable diseases (NCD s) were a prominent feature of prison health awareness needs as identified in baseline assessments. 2.22 The Prison Based CBHFA in Action won a number of Awards. In 2011 the CBHFA prison programme won the World Health Organisation Award for Best Practice in Prison Health. In May 2012 it won the Biomis Irish Healthcare Innovation Award for Best Health Promotion Project and in November 2012 it won an Irish Medical Times Commendation Award for Public Health Initiative at the Irish Medical Times Healthcare Awards. 3.0 Key Lessons Learned 3.1 Whilst in the start up phase, each prison s projects were well connected to each of the partners of IPS healthcare School and Irish Red Cross, there needs to be better on going liaison with each of the partners at ground level over time. 3.2 Experience has shown that those prisons where there is more active healthcare department involvement do better in terms of productivity.


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9 3.3 Community Health Committees were not as active in a number of prisons as they should have been and this is directly linked to 3.2. 3.4 It is important to ensure that plans are in place to ensure that inmate volunteers are supported in their work equally as much in Prison School (VEC) holiday periods when the school is closed as in term time. This prevents the possibilities of a fall off of productivity over these periods. 3.5 Module 3 (Community Assessment) is more effective in open prisons such as the Training Unit and Shelton Abbey where it is focused as much on the external community as it is on the prison community. This is because prisoners in these institutions are themselves focused on leaving prison rather than ongoing living in it. 3.6 The CBHFA manual can be used successfully for a prison community provided the facilitators were able to help volunteers recognize the similarities and differences throughout the text. 3.7 Within the prison context, significant numbers of inmate volunteers were illiterate. With this in mind it was necessary to encourage buddy aid so that non readers were able to be helped by colleagues in the same group being taught. 3.8 Great care needed to be taken in the selection process for new volunteers to ensure that the Irish Red Cross and the Emblem remained protected. This was done through interview and security screening of each potential inmate volunteer through prison intelligence. 3.8 The problems identified in the 2010 Evaluation relating to the potential security difficulties in allowing first aid kits to be available for volunteers within the prison has been solved by changing the approach to first aid to be non equipment based first aid. 3.9 Baseline assessments in each topic being facilitated in the prison communities needs to be undertaken prior to the community awareness campaigns in all prisons as a routine. Such baseline assessments were undertaken prior to the FAST Stroke campaign at Wheatfield and certain other Topics in other prisons. This permitted a more effective measurement of the success of volunteer action in the community. Universal use of baseline assessment makes it easier to quantify Monitoring & Evaluation information for Federation indicator tools. 3.10 HIV knowledge and anti stigma awareness is much more widely dispersed in Cloverhill and Wheatfield because of the Mass Voluntary HIV testing campaign. Work in 2012/13 needs to focus on bringing the mass testing initiative and increased knowledge into other prisons. 3.11 Non communicable diseases need to be included in the CBHFA in Action package including tools for volunteers working with these health issues. 3.12 In 2011 the CBHFA prison programme won the World Health Organisation Award for Best Practice in Prison Health. In May 2012 it won the Bionmis Irish Healthcare Innovation Award for Best Health Promotion Project and in November 2012 it won an Irish Medical Times Commendation Award for Best Public Health Initiative at the Irish Healthcare Awards.


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10 4.0 Recommendations 4.1 The healthcare department in each prison needs to be well integrated in to the action projects and involved in the learning sessions 4.2 Ensure that there are monthly operational meetings between the programme management and the VEC school Head Teacher. 4.3 Whilst Community Health Committees (CHCs) exist in principle, there need to be a much more aggressive stance for this important driving force operating from the beginning of the course and into prison routine. One way of strengthening it is to ensure that there is a strong Health Department involvement in the CBHFA in Action approach in each prison. 4.4 Trained inmate CBHFA Facilitators need to be used more in the delivery of routine classroom sessions. This is to ensure that their skills are properly utilised and that programme staff are released to work on the set up of new prison sites in 2013. 4.5 The support set up in each prison must include a dedicated VEC teacher, a Governor for Health, a Chief Officer and two Assistant Chief Officers (ACO) one on each side of the roster. From Healthcare there needs to be two nurses one on each side of the roster who should take an attending role in each classroom. In addition to two nurses, there needs to be the buy in of the Chief Nurse Officer (CNO) at each prison, 4.6 Direct links need to be set up between each CBHFA prison group and Drug Addiction Counsellors such as with Merchant Quay Ireland to strengthen CBHFA volunteer action in Drug Addiction work. 4.7 In 2013, CBHFA in Action should be linked to institutions such as drug rehabilitation centres and other community based groups which could add to the benefit of prisoners in transition from prison to the community. 4.8 A preliminary pool of potential inmate volunteers should be drawn up by the Prison School Head Teacher who knows the potential of all school attending prisoners. To this pool should be added recommendations of potential participants from other sources such as Governors, chiefs, discipline, nursing staff and trained volunteers. This way a good baseline pool of likely volunteers can be developed from which to select inmate IRC volunteers for the CBHFA in Action course. This list of names should be shared with prison authorities for a security screening prior to an interview process which should include IRC input. 4.9 The interview guidelines should be used for the process of interviewing potential new inmate volunteers for the purpose of consistency. An example of this is shown in Annexe 6. 4.10 The CBHFA in Action Trainers Course should have a period of internship (observed facilitating) following course attendance before certification as a Trainer is given. This will provide greater quality assurance of facilitation standards. 4.11 Greater quality assurance needs to be provided by programme managers sitting in on inmate trainers classes on a random basis and lesson plans inspected. 4.12 The focus of the Assessment module (Module 3) in open and semi open prisons needs to be future paced towards the inmates home community and secondarily about the prison community.


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