Celebrating and promoting the best in UK prisons, probation and youth justice
COMMENDEE 2012-13: Senior Probation Officer: for contributions to the provision of effective health advice and support to offenders, including peer mentors.
[Jan Pearce gives her account of the work for which she won her Commendation]
Health Trainers working for Probation helping men and women change their lifestyles to be healthier and crime free. Trained Health Trainers who have been ex offenders themselves uniquely placed to share their past experiences to motivate others to change their lives for the better.
This was the aim of the Leicestershire & Rutland Probation Trust (LRPT) Health Trainer Service and I was privileged to be the one to start this new initiative.
I had just completed a prison secondment of 5 years in April 2009 and was getting to grips with leading the South Leicester offender management team when I was asked by my Director to also take on the challenge of creating our own health trainer service with start up funding secured from the local Primary Care Trusts (PCTS).
It took one year to research and design a model of service, longer than I planned due to my unexpected operation to fix a detached retina.
My first action was to recruit a part time admin officer as from pervious experience I knew that this would be foundational to the success of the project. Together we worked towards understanding the concept of NHS health trainers, created the processes needed, set up an office IT system to fit with LRPT’s case system and secured a place to begin to set up an office base. We then went onto to plan recruitment of four part time health trainers. To stretch the limited start up budget we sourced second hand office equipment and enjoyed the challenge of making an empty room at the city probation centre into a working office base for the new team.
I wanted to spend time in reviewing a number of different health trainer models to ensure the best chance of success, this lead to the decision to exclusively recruit those with first-hand experience of the criminal justice system, ex offenders who has successfully turned their lives around and could be role models. I believed that instead of their former experiences being a handicap, our trained team of health trainers would be uniquely placed to use their past life knowledge in supporting and motivating probation service users to improve their health and wellbeing, empowering them to want to lead healthier lives.
LRPT’s health trainer team’s overall purpose was to be able to bridge a widening gap linking our probation service users with services that inequality normally prevents them from reaching; helping them to become healthier and improve their lifestyles.
Individuals who had already become involved our LRPT’s peer mentoring schemes; were actively encouraged to apply for the health trainer posts. With support from my NHS commissioner I ran a taster evening event inviting the Hampshire Probation HTs, ex offenders themselves to explain their role of probation health trainer and answer questions in a ‘hot seat’ interview style format which appeared to work well. I ensured that application packs were prepared and handed out for those interested in applying.. Advertising was through the job centre, our partnership agencies and offender managers reviewing past successful cases. This was a cheaper and more targeted option than using the local newspapers/internet.
A Service Level Agreement was drawn up by myself and the NHS commissioner with agreed achievable targets to meet within the first year. This was signed off by our LRPT executive director
We successfully recruited three men and one woman who started in April 2010 as trainee health trainers, they attended training and all passed the Royal Institute for Public Health Level 2 Award in Understanding Health Improvement within the first two months of the project. They were then able to work on promoting the health trainer service and deliver an information and signposting service to our service users. I named this Type 1 casework, which consisted in helping offenders find and register with General Practitioners and dentists. They also provided information about local gyms, opticians and weight management services.
They learnt to use the national health trainer casework forms and the raw data was inputted by our admin officer into the national HT data system (DCSR) accessed by our commissioners.
The trainee health trainers then went on to study for their City and Guilds Level 3 Certificate for Health Trainers, the mandatory qualification for all health trainers which provided them with the qualification to offer offenders one to one tailored sessions, Type 2 casework called Personal Health Plans (PHP).. I took on the role of their placement mentor with support from the local college
Given the limited employment experience of the health trainers (HTS) I identified that they needed intense support and supervision as they got to grips with the reality of being employees of LRPT, learning their HT role and how their own past experiences could help in getting alongside and motivating those they work with.
LRPT staff also needed to be fully informed of the new project and assured that the HTs were fully trained, professionals, properly supervised and supported who were new LRPT employees, their new colleagues rather than seeing them just as ex offenders of the probation service given a job by the Trust. To address this I trained the HTs to deliver staff awareness sessions to teams around the Trust this helped overcome this barrier as staff got to know them as HTs and it also served as a conduit for staff to discuss their cases and make referrals.
With the health trainers qualified we decided now was the time to launch the LRPT health trainer service. This took place in Sept 2010 with a well attended event at the probation centre despite an earlier unexpected emergency building evaluation just before the start..
Now the HTs could offer one to one PHP. To make it as easy as possible to refer a cases I was able to set up a simple referral system of receiving email/phone call or verbal request from those referring to our admin officer who then allocated the case to the HTs who had access to the probation case systems providing all the information needed to contact the client direct offering HT support. They managed cases in accordance with the agreed referral criteria structure, Health Trainers with their clients created PHP that were tailored to meet the individuals need.
During their first year the Team also provided the following opportunities for staff –
I believed the HT team needed to be taught to understand and work within the Offender Management Model with public protection and reduction of re offending at its core. To their credit they worked hard at developing good working partnerships with our offender managers, who began to see the benefits of the HTs as they offered support/help/advice to their cases.
Health Trainers learnt the importance of inputting all offender contact information in the IT Case Management system. They also tailored the PHP with the understanding of the offender’s OASys risk management plan to work towards removing identified health related barriers, this contributed to reduced risk of re-offending and helped promote a healthier lifestyle.
Examples of HT input into the OASys Risk management plans –
As their manager I identified the need for the Health Trainer Team to be truly effective in their role, we had to develop our partnership working. It was my role to make initial contact and promote this new approach to health education; I worked alongside the Health Trainers training them until they were confident to take on this role without me always at their side. They developed in this role at different paces recognising who were natural leaders and who were strong in a co support role. As they began to grow in confidence and received positive feedback from network events with our Partners their enthusiasm was contagious. Through this work strong links with other relevant agencies such as STOP Smoking, Fit Active Bodies, Safer Leicester Partnership, Addaction, Mental Health Support Services, local Prison and Police services were formed.
It was a real encouragement to receive such feedback –
‘They have a fantastic rapport with clients. For us, working in partnership with the health trainers is absolutely excellent for getting the message over. They are connecting us with their clientele.’
‘It was a multi-agency meeting at which they were the newcomers. However, they more than held their own. All the work they delivered was timely and professional. The whole campaign was based on their idea of an electronic advent calendar. I’ve recommended them to a number of other people.’
The team wanted to offer volunteer opportunities so four health champions (HC) were also recruited predominantly from LRPT’s peer mentor scheme. Securing extra training funds they were offered the same training as health trainers up to qualified HT status. They supported the health trainers in a voluntary role but were well placed to apply for any HT vacancies with LRPT or the city NHS HT service or use the qualification to enhance their job opportunities please exercise caution on the use of acronyms
This decision to invest in our voluntary HC’s training paid off when one health trainer had to leave the service because of personal problems the vacancy was filled through one of the volunteer health champions successfully applying and joining the team in October 2010.
An encouraging career progression for them
Working for many years within probation’s evidence based practice I know the importance of measuring outcomes and showing targets achieved I needed to be able to measure the cost effectiveness of our HT Service to provide an evidence base to the commissioners to encourage them to consider continuation funding.
My search found a variety of recognised assessment tools to predict savings. I chose to use the Portsmouth Ready Reckoner which had been designed to be used for NHS HT services and further developed to incorporate calculations of saving with regard to the Criminal Justice System (CJS) for Probation run HT services.
In 2011, the results showed that the Health Trainer Team has saved the NHS in the region of £418,160. The assessment process calculates the savings of individuals going to a doctor or dentist rather than a hospital A&E Department, reductions in missed appointments, improved health through smoking cessation etc. with our data inputted the Portsmouth Ready Reckoner estimated the savings to CJS in the region of £3,474,124. Criteria used in this assessment reflected improved compliance and positive outcomes
To put this in context the main funding stream came from the cityCounty Primary Care Trust (PCT) with a little from the countyPCT.. Initially the first year’s start-up budget was £133,542 which enabled the individual health trainers to work part-time. Given the results of this Portsmouth Ready Reckoner it was encouraging to see that it showed a good return of the commissioner’s investment of £133,542..
However I am no expert in the field of evaluation and as this was a new venture for our Probation Trust it was important for the scheme’s credibility to seek outside evaluation to assess its positive impact on improving health – and the engagement of offenders with other aspects of their order. Therefore in the spring of 2011 with support from our commissioners we commissioned the Institute of Criminal Policy Research (ICPR) to evaluate our Health Trainer Service. The field work for the study was carried out in April and May 2011 with the final Evaluation being published in August 2011.
At the time of the study the Health Trainers had conducted a total of 73 drop-in and other community events between September 2010 and March 2011. Fifty-eight of these were focused on service users at which the team made contact with 890 individuals by delivering presentations to groups, handing out health information, and engaging with offenders by using promotional information on healthy drinking limits etc.
For the ICPR survey the authors undertook semi-structured interviews with 30 key stakeholders, including health and probation service commissioners, and 13 offenders with whom the health trainers were working at the time.
Three professional interviewees stated that service users seemed to hear health promotional messages much better from the health trainers rather than criminal justice or health professions. The following quotes from service users are taken from the survey:
“My Health Trainer is very supportive and helpful, always available and willing to answer questions. They are just like normal people, treat us normal, don’t look down on us. Very flexible and available.”
“Very helpful, very friendly, non-judgmental, flexible. Not just advice but support and mental ability. They always find time for you.”
“Very supportive if I’m struggling. I can text when I am craving, in between appointments. Very friendly.”
This was encouraging feedback.
Through this evaluation of the impact of the project the city PCT lead the way and allocated a further £70,000 which funded the team’s HT to work fulltime.
To quote the former Health Trainer Programme Manager for the city PCT, Pam Rees, explained: “We knew there was a need for this service. A report by the Social Exclusion Unit stated that the majority of prisoners have a history of drug and alcohol misuse. And 77% of male and 82% of female prisoners smoke. We were delighted at the progress of the Health Trainers, which is why we provided further funding for the project in the second year.”
The initial funding for the team has been running on a short-term two year cycle. Each Health Trainer knew that further funding would be dependent on performance.
The final figures for 2011, showed that the team had worked with 195 individuals:
– 135 involved signposting the service user to a doctor, and or dentist
– 60 involved designing a personal health plan with supporting engagement over eight sessions.
By the end of 2011, the Health Trainers had promoted their health messages to 2,018 individuals.
In late 2011, one health trainer left to work for REACH, LRPT’s employment advice service. There were three health trainers in post between January and May 2012; a fourth health trainer (previously a volunteer HC) was recruited and joined the team in June 2012. The calibre of the candidates was impressive so I took the decision to offer an extra post and appointed a further trainee health trainer (also a previous volunteer HC) who started work in Aug 2012 bringing the number of HTs to 5. This enabled the Team to cover Leicester, Leicestershire and Rutland, the aim to work towards offering a consistent HT Service to each of our probation county offices.
Taking on board certain key recommendations of the first evaluation the HT Service developed over 2012 supporting high need vulnerable clients with tailored PHPs and assigning a HT to each of the county probation offices.
In April 2012 we received a letter from National Offender Management Service (NOMS) Trust Chair regarding our Probation Award nomination although not reaching the finalist stage he wanted to highly commend the work of our HT Service. This was closely followed in May 2012 when we were encouraged to receive Recognition of Achievement certificates at the LRPT staff awards nominated by our peers.
The Team were further encouraged in Dec 2012 by successfully biding for an Innovation Challenge Project securing £20,000 to roll out a volunteer HC project for our offenders living in the Charnwood area.
I was able to share this all with our commissioners as further evidence of the effectiveness of our HT Service. This helped me in my task of opening further negotiations with both commissioners to bid for future funding of the HT Service.
After a number of meetings negotiating with both commissioners, the county PCT commissioner made the comment that he felt ‘shamed’ into finally funding the HT Service for 2012 given the fact that we had already begun to engage and work with vulnerable county clients with no support from him and clearly achieved a saving to his allocated NHS budget. This was a turning point to have the support of both city and county commissioners.
He has since willingly joined with the city PCT commissioner and myself into negotiations regarding further funding for 2013 and has become an advocate for our probation HT Service
Although this support from our PCT commissioners was encouraging the changes happening to the NHS in the national arena was going to have a great impact on our commissioners and therefore on us. To prepare for this I managed to negotiate a place on the county’s new Staying Health Board which fed into the newly formed county shadow Health and Wellbeing Board to raise the profile of LRPT and our HT Service. I also attended as many of the NHS Consultation Events for Stakeholders and regularly liaised with our commissioners receiving their updates.
Now that the LRPT HT Service had been running for just over 2 years we had two complete years of raw data to analyse I felt it was important to have a further independent evaluation carried out to identify our areas of strengths and weaknesses and what we needed to do to achieve sustainability of the HT Service. This I hoped would also be a useful tool as we prepare ourselves for the future challenge of having to tender bids in competition with the larger corporations which up until now we have not had to face. A daunting prospect.
We commissioned the same company to undertake the evaluation. This has just been completed and the results are encouraging as follows –
Performance in 2012 compared to previous year
The HTS has benefited from returning to full strength with the recruitment of a new health trainer in June 2012 and from its expansion by the addition of a trainee health trainer in August of that year.
This is reflected by monitoring data which saw the number of service users receiving a Type 1 (signposting) service increased from 139 in 2011 to 167 in 2012 and a much greater jump in the number of service users receiving a Type 2 (personal health planning) service from 60 to 147 over the same time period.
However, it should be noted that there was a decrease in the amount of health promotion work over this period although that is more difficult to quantify.
This evaluation has found that the health trainer service is well-established and highly regarded by both internal and external stakeholders and service users. We conclude the report by setting out our recommendations to develop the service further.
The overall encouragement for myself and the Team has been the unexpected Butler Trust Commendation which has raised the profile of our HT Service opening doors to local media interest and new partnership opportunities.
Other HT projects such as Hampshire were very supportive in helping me set up our HT Service and as we have developed we have willingly gone on to share our knowledge with other Probation Trusts interested in developing a HT Service for their own offenders to access
We are passionate in our belief that helping offenders to make positive health changes in their lives, shows that they can also make changes in other areas of their lives – to stop offending. Change is possible; my HTs are the real proof of that.
[The following article appeared in issue 5 of the Butler Trust’s magazine, Inspire]
A Senior Probation Officer at Leicestershire and Rutland Probation Trust, Jan Pearce has been commended for her work in managing the health trainer team – an initiative that engages service users in supporting offenders to improve their health.
Asked to develop the project, which began in September 2010, Jan built an effective and cohesive team from four health trainers, producing estimated savings of nearly £4m to the NHS and CJS. The health trainers came from chaotic backgrounds and three of the original team were ex offenders. She set about proving that with the right support and encouragement, change was possible and through her dedication she made a mutually supportive team that worked together to achieve the aims of the project.
Although they had been crime- free for some time, team members were not used to being regularly employed, so Jan had to work closely with each of them, helping them to understand their strengths and weaknesses. While helping them to build their skills, Jan also promoted the scheme to outside audiences to attract funding. Under Jans direction, the impact of the project was ‘so impressive’ that the PCT gave further funding for the team to work fulltime, as they were delighted with the health trainers’ progress.
The team soon showed that they were delivering results, engaging with men and women on community orders or post custody licences and showing them how to make positive changes in their lives. This in turn encouraged a more engaged approach with supervision and helped them to tackle other issues, such as employment.
The peer support element has proved highly successful, with service users appreciating that the health trainers treat them normally .
‘They have genuine empathy with people on probation supervision over their difficulties in accessing health services and starting to change lifestyles to develop a healthier approach’, says Jan. ‘They are seen as such positive role models.’
The philosophy of the project was to recruit a team of people who had previous first hand experience of the criminal justice system, she explains.
‘Instead of their former experience being a handicap, we knew that our trained team of health trainers would be uniquely placed to use their past life knowledge in supporting and motivating probation service users to improve their health and wellbeing, empowering them to lead healthier lives.’
Jan now encourages health trainers to look for new ways to engage, such as working with prisons, helping inmates to improve their general wellbeing. She believes that better health outcomes contribute to reducing reoffending and is passionate about providing the evidence to support it.
‘A defining moment for one of the team happened when he was invited into Leicester Prison for the substance misuse open day, she says. As a previous inmate of the prison, the staff were impressed that he was returning as an actual employee of probation and they witnessed the prisoners being far more open listening to a person who had been in their shoes.’
Jan is hoping to develop her work further in the direction of providing earlier interventions and has identified opportunities for offering health information and signposting to offenders under the age of 18. Receiving a commendation for her work has given a boost to the entire team, she says:
‘It sends such a positive message about the hard work and dedication of a team of people who were given a chance to prove their skills and dedication. They are such positive role models to other service users who are seeking change in their lives.’