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Crook R, Lennox C, Awenat Y, Edge D, Knowles S, Honeywell D, Gooding P, Haddock G, Brooks H, Pratt D. Development of the Prevention of Suicide Behaviour in Prisons: Enhancing Access to Therapy (PROSPECT) logic model and implementation strategies. BJPsych Bull 2024:1-9. [PMID: 38708568 DOI: 10.1192/bjb.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
AIMS AND METHOD This study aimed to develop and articulate a logic model and programme theories for implementing a new cognitive-behavioural suicide prevention intervention for men in prison who are perceived to be at risk of death by suicide. Semi-structured one-to-one interviews with key stakeholders and a combination of qualitative analysis techniques were used to develop programme theories. RESULTS Interviews with 28 stakeholders resulted in five programme theories, focusing on: trust, willingness and engagement; readiness and ability; assessment and formulation; practitioner delivering the 'change work' stage of the intervention face-to-face in a prison environment; and practitioner training, integrating the intervention and onward care. Each theory provides details of what contextual factors need to be considered at each stage, and what activities can facilitate achieving the intended outcomes of the intervention, both intermediate and long term. CLINICAL IMPLICATIONS The PROSPECT implementation strategy developed from the five theories can be adapted to different situations and environments.
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Affiliation(s)
- Rebecca Crook
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Charlotte Lennox
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Yvonne Awenat
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Dawn Edge
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Patricia Gooding
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | | | - Daniel Pratt
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
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Granados L, Suriá R, Perea C, Payá C, Sánchez-Pujalte L, Aparisi D. Effectiveness of a program for the development of socio-emotional competences in people admitted to a penitentiary center. Front Public Health 2023; 10:1116802. [PMID: 36703858 PMCID: PMC9871617 DOI: 10.3389/fpubh.2022.1116802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
The purpose of this paper was to evaluate the effectiveness of a program for the development of social and emotional competences and self-esteem among a group of inmates at a penitentiary center, as well as to determine the possible correlation between the variables of the program (social skills, emotional competences, and self-esteem). The objective was to equip inmates with social competences in emotional regulation strategies that would be useful to them in the penitentiary center and, at the same time, facilitate their future social inclusion. In order to measure the pre- and post- treatment variables, the Social Skills Scale, the Perceived Emotional Intelligence Scale (TMMS-24), and the Rosenberg Self-Esteem Scale (RSES) were administered to a group of 51 inmates in a penitentiary center. The experimental group consisted of 29 inmates, with 21 forming the control group. The pretest-posttest ANOVAs showed that the program led to a significant (p < 0.01) increase in: (1) positive social behaviors; (2) emotional competences; (3) self-esteem. Positive correlations were also observed between the three variables. The results suggest the importance of implementing programs for the promotion of the socio-emotional development of people incarcerated in penitentiary centers.
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Affiliation(s)
- Lucía Granados
- Faculty of Education, Valencian International University, Valencia, Spain,*Correspondence: Lucía Granados ✉
| | - Raquel Suriá
- Department of Communication and Social Psychology, University of Alicante, Alicante, Spain
| | - Carles Perea
- Faculty of Education, Carlemany University, San Julián de Loria, Andorra
| | - Claudio Payá
- Faculty of Education, Valencian International University, Valencia, Spain
| | | | - David Aparisi
- Faculty of Education, Valencian International University, Valencia, Spain
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Byng R, Kirkpatrick T, Lennox C, Warren FC, Anderson R, Brand SL, Callaghan L, Carroll L, Durcan G, Gill L, Goodier S, Graham J, Greer R, Haddad M, Harris T, Henley W, Hunter R, Leonard S, Maguire M, Michie S, Owens C, Pearson M, Quinn C, Rybczynska-Bunt S, Stevenson C, Stewart A, Stirzaker A, Todd R, Walter F, Weston L, Wright N, Taylor RS, Shaw J. Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial. Br J Psychiatry 2023; 222:18-26. [PMID: 35978272 PMCID: PMC10895504 DOI: 10.1192/bjp.2022.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse. AIMS This study aims to evaluate whether the Engager intervention improves mental health outcomes following release. METHOD The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3-5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT). RESULTS In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI -1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact. CONCLUSIONS Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
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Affiliation(s)
- Richard Byng
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Tim Kirkpatrick
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Charlotte Lennox
- Division of Psychology and Mental Health, University of Manchester, UK
| | | | - Rob Anderson
- College of Medicine & Health, University of Exeter, UK
| | | | - Lynne Callaghan
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Lauren Carroll
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Graham Durcan
- Centre for Mental Health, South Bank Technopark, London, UK
| | - Laura Gill
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Sara Goodier
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Jonathan Graham
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Rebecca Greer
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | | | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, UK
| | - Sarah Leonard
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, UK
| | - Susan Michie
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, UK
| | | | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, UK
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | | | - Amy Stewart
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Alex Stirzaker
- South West Mental Health Clinical Network, NHS England, UK
| | - Roxanne Todd
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Florian Walter
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Lauren Weston
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, UK and Greater Manchester Manchester Health NHS Foundation Trust, UK
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Weston L, Rybczynska-Bunt S, Quinn C, Lennox C, Maguire M, Pearson M, Stirzaker A, Durcan G, Stevenson C, Graham J, Carroll L, Greer R, Haddad M, Hunter R, Anderson R, Todd R, Goodier S, Brand S, Michie S, Kirkpatrick T, Leonard S, Harris T, Henley W, Shaw J, Owens C, Byng R. Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager. PLoS One 2022; 17:e0270691. [PMID: 35834470 PMCID: PMC9282559 DOI: 10.1371/journal.pone.0270691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background ‘Engager’ is an innovative ‘through-the-gate’ complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case study analysis part of the process evaluation, exploring how a sub-sample of prison-leavers engaged and responded to the intervention offer of one-to-one support during their re-integration into the community. Methods To understand intervention delivery and what response it elicited in individuals, we used a realist-informed qualitative multiple ‘case’ studies approach. We scrutinised how intervention component delivery lead to outcomes by examining underlying causal pathways or ‘mechanisms’ that promoted or hindered progress towards personal outcomes. ‘Cases’ (n = 24) were prison-leavers from the intervention arm of the trial. We collected practitioner activity logs and conducted semi-structured interviews with prison-leavers and Engager/other service practitioners. We mapped data for each case against the intervention logic model and then used Bhaskar’s (2016) ‘DREIC’ analytic process to categorise cases according to extent of intervention delivery, outcomes evidenced, and contributing factors behind engagement or disengagement and progress achieved. Results There were variations in the dose and session focus of the intervention delivery, and how different participants responded. Participants sustaining long-term engagement and sustained change reached a state of ‘crises but coping’. We found evidence that several components of the intervention were key to achieving this: trusting relationships, therapeutic work delivered well and over time; and an in-depth shared understanding of needs, concerns, and goals between the practitioner and participants. Those who disengaged were in one of the following states: ‘Crises and chaos’, ‘Resigned acceptance’, ‘Honeymoon’ or ‘Wilful withdrawal’. Conclusions We demonstrate that the ‘implementability’ of an intervention can be explained by examining the delivery of core intervention components in relation to the responses elicited in the participants. Core delivery mechanisms often had to be ‘triggered’ numerous times to produce sustained change. The improvements achieved, sustained, and valued by participants were not always reflected in the quantitative measures recorded in the RCT. The compatibility between the practitioner, participant and setting were continually at risk of being undermined by implementation failure as well as changing external circumstances and participants’ own weaknesses. Trial registration number ISRCTN11707331, Wales Research Ethics Committee, Registered 02-04-2016—Retrospectively registered https://doi.org/10.1186/ISRCTN11707331.
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Affiliation(s)
- Lauren Weston
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
- * E-mail:
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Cath Quinn
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Charlotte Lennox
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mike Maguire
- Department of Criminology, University of South Wales, Cardiff, United Kingdom
| | - Mark Pearson
- Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Alex Stirzaker
- South West Mental Health Clinical Network, Taunton, United Kingdom
| | | | - Caroline Stevenson
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jonathan Graham
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lauren Carroll
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Rebecca Greer
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Mark Haddad
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Rachael Hunter
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Rob Anderson
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Roxanne Todd
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sara Goodier
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sarah Brand
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Susan Michie
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - Tim Kirkpatrick
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Sarah Leonard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tirril Harris
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - William Henley
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christabel Owens
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Richard Byng
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
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Hunter RM, Anderson R, Kirkpatrick T, Lennox C, Warren F, Taylor RS, Shaw J, Haddad M, Stirzaker A, Maguire M, Byng R. Economic evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: a cost-utility and cost-consequences analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:193-210. [PMID: 34351533 PMCID: PMC8882099 DOI: 10.1007/s10198-021-01360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND People in prison experience a range of physical and mental health problems. Evaluating the effectiveness and efficiency of prison-based interventions presents a number of methodological challenges. We present a case study of an economic evaluation of a prison-based intervention ("Engager") to address common mental health problems. METHODS Two hundred and eighty people were recruited from prisons in England and randomised to Engager plus usual care or usual care. Participants were followed up for 12 months following release from prison. The primary analysis is the cost per quality-adjusted life year (QALY) gained of Engager compared to usual care from a National Health Service (NHS) perspective with QALYs calculated using the CORE 6 Dimension. A cost-consequences analysis evaluated cross-sectoral costs and a range of outcomes. RESULTS From an NHS perspective, Engager cost an additional £2737 per participant (95% of iterations between £1029 and £4718) with a mean QALY difference of - 0.014 (95% of iterations between - 0.045 and 0.017). For the cost-consequences, there was evidence of improved access to substance misuse services 12 months post-release (odds ratio 2.244, 95% confidence Interval 1.304-3.861). CONCLUSION Engager provides a rare example of a cost-utility analysis conducted in prisons and the community using patient-completed measures. Although the results from this trial show no evidence that Engager is cost-effective, the results of the cost-consequences analysis suggest that follow-up beyond 12 months post-release using routine data may provide additional insights into the effectiveness of the intervention and the importance of including a wide range of costs and outcomes in prison-based economic evaluations. TRIAL REGISTRATION (ISRCTN11707331).
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Affiliation(s)
- Rachael Maree Hunter
- Research Department of Primary Care and Population Health, University College London (UCL), Rowland Hill Street, London, NW3 2PF, UK.
| | - Rob Anderson
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tim Kirkpatrick
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Charlotte Lennox
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Fiona Warren
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rod S Taylor
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
- University of Glasgow, Glasgow, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | | | - Alex Stirzaker
- NHS England, South West Mental Health Clinical Network, Taunton, UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, Pontypridd, UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
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Lennox C, Stevenson R, Owens C, Byng R, Brand SL, Maguire M, Durcan G, Stevenson C, Shaw J, Quinn C. Using multiple case studies of health and justice services to inform the development of a new complex intervention for prison-leavers with common mental health problems (Engager). HEALTH & JUSTICE 2021; 9:6. [PMID: 33598771 PMCID: PMC7890896 DOI: 10.1186/s40352-021-00131-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND People in the criminal justice system have complex needs but often do not make use of services outside of prison, in many cases due to poorly joined up working between health and criminal justice services. The 'Engager' programme aimed to develop a complex collaborative care intervention for people leaving prison with common mental health problems that could support their transition into the community and facilitate joined up working between health, justice and social services. To augment our core intervention theory, we wanted to learn from innovative and forward-thinking services providing interagency support and/or treatment for people experiencing common mental health problems within the criminal justice system. We wanted to identify key elements of interagency practice to understand what was and was not effective in engaging people, maintaining their contact and improving mental health and other aspects of their lives. METHOD We used a multiple case study design with a focused ethnographic approach in four study sites. Data came from three sources (documents, field notes and semi-structured interviews) underwent a framework analysis. RESULTS We identified seven main themes, namely: collaboration, client engagement, client motivation, supervision, therapeutic approach, peers and preparations for ending. Engaging and motivating clients was dependent on the relationship built with the professional. This relationship was developed through building trust and rapport, which required time and respectful, open and honest communication. Professionals were often unable to build this relationship effectively if they did not work in effective interagency collaborations, particularly those which included shared practices and were supported by effective supervision. CONCLUSIONS The multiple case study design contributed insights as to how health and justice services work together. The main themes identified are well known factors in health and justice co-working. However, the novel insights were gleaned examining interdependence and interactions in complex, multifactorial phenomena and practice, in particular the importance of shared practice and supervision models. The approach of selecting a small number of cases representing identified knowledge gaps contributed a valuable addition to the program theory and delivery for an innovative complex intervention.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Rachel Stevenson
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Christabel Owens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA UK
| | - Sarah L. Brand
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL Wales
| | - Graham Durcan
- Centre for Mental Health, South Bank Technopark, 90 London Rd, London, SE1 6LD UK
| | - Caroline Stevenson
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA UK
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Promoting Learning from Null or Negative Results in Prevention Science Trials. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 23:751-763. [PMID: 32748164 PMCID: PMC7398716 DOI: 10.1007/s11121-020-01140-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There can be a tendency for investigators to disregard or explain away null or negative results in prevention science trials. Examples include not publicizing findings, conducting spurious subgroup analyses, or attributing the outcome post hoc to real or perceived weaknesses in trial design or intervention implementation. This is unhelpful for several reasons, not least that it skews the evidence base, contributes to research “waste”, undermines respect for science, and stifles creativity in intervention development. In this paper, we identify possible policy and practice responses when interventions have null (ineffective) or negative (harmful) results, and argue that these are influenced by: the intervention itself (e.g., stage of gestation, perceived importance); trial design, conduct, and results (e.g., pattern of null/negative effects, internal and external validity); context (e.g., wider evidence base, state of policy); and individual perspectives and interests (e.g., stake in the intervention). We advance several strategies to promote more informative null or negative effect trials and enable learning from such results, focusing on changes to culture, process, intervention design, trial design, and environment.
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Perry AE, Martyn‐St James M, Burns L, Hewitt C, Glanville JM, Aboaja A, Thakkar P, Santosh Kumar KM, Pearson C, Wright K. Interventions for female drug-using offenders. Cochrane Database Syst Rev 2019; 12:CD010910. [PMID: 31834635 PMCID: PMC6910124 DOI: 10.1002/14651858.cd010910.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This review represents one in a family of three reviews focusing on the effectiveness of interventions in reducing drug use and criminal activity for offenders. OBJECTIVES To assess the effectiveness of interventions for female drug-using offenders in reducing criminal activity, or drug use, or both. SEARCH METHODS We searched 12 electronic bibliographic databases up to February 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 13 trials with 2560 participants. Interventions were delivered in prison (7/13 studies, 53%) and community (6/13 studies, 47%) settings. The rating of bias was affected by the lack of clear reporting by authors, and we rated many items as 'unclear'. In two studies (190 participants) collaborative case management in comparison to treatment as usual did not reduce drug use (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.20 to 2.12; 1 study, 77 participants; low-certainty evidence), reincarceration at nine months (RR 0.71, 95% CI 0.32 to 1.57; 1 study, 77 participants; low-certainty evidence), and number of subsequent arrests at 12 months (RR 1.11, 95% CI 0.83 to 1.49; 1 study, 113 participants; low-certainty evidence). One study (36 participants) comparing buprenorphine to placebo showed no significant reduction in self-reported drug use at end of treatment (RR 0.57, 95% CI 0.27 to 1.20) and three months (RR 0.58, 95% CI 0.25 to 1.35); very low-certainty evidence. No adverse events were reported. One study (38 participants) comparing interpersonal psychotherapy to a psychoeducational intervention did not find reduction in drug use at three months (RR 0.67, 95% CI 0.30 to 1.50; low-certainty evidence). One study (31 participants) comparing acceptance and commitment therapy (ACT) to a waiting list showed no significant reduction in self-reported drug use using the Addiction Severity Index (mean difference (MD) -0.04, 95% CI -0.37 to 0.29) and abstinence from drug use at six months (RR 2.89, 95% CI 0.73 to 11.43); low-certainty evidence. One study (314 participants) comparing cognitive behavioural skills to a therapeutic community programme and aftercare showed no significant reduction in self-reported drug use (RR 0.86, 95% CI 0.58 to 1.27), re-arrest for any type of crime (RR 0.73, 95% CI 0.52 to 1.03); criminal activity (RR 0.80, 95% CI 0.63 to 1.03), or drug-related crime (RR 0.95, 95% CI 0.68 to 1.32). A significant reduction for arrested (not for parole) violations at six months follow-up was significantly in favour of cognitive behavioural skills (RR 0.43, 95% CI 0.25 to 0.77; very low-certainty evidence). A second study with 115 participants comparing cognitive behavioural skills to an alternative substance abuse treatment showed no significant reduction in reincarceration at 12 months (RR 0.70, 95% CI 0.43 to 1.12; low certainty-evidence. One study (44 participants) comparing cognitive behavioural skills and standard therapy versus treatment as usual showed no significant reduction in Addiction Severity Index (ASI) drug score at three months (MD 0.02, 95% CI -0.05 to 0.09) and six months (MD -0.02, 95% CI -0.09 to 0.05), and incarceration at three months (RR 0.46, 95% CI 0.04 to 4.68) and six months (RR 0.51, 95% CI 0.20 to 1.27); very low-certainty evidence. One study (171 participants) comparing a single computerised intervention versus case management showed no significant reduction in the number of days not using drugs at three months (MD -0.89, 95% CI -4.83 to 3.05; low certainty-evidence). One study (116 participants) comparing dialectic behavioural therapy and case management (DBT-CM) versus a health promotion intervention showed no significant reduction at six months follow-up in positive drug testing (RR 0.67, 95% CI 0.43 to 1.03), number of people not using marijuana (RR 1.23, 95% CI 0.95 to 1.59), crack (RR 1.00, 95% CI 0.87 to 1.14), cocaine (RR 1.02, 95% CI 0.93 to 1.12), heroin (RR 1.05, 95% CI 0.98 to 1.13), methamphetamine (RR 1.02, 95% CI 0.87 to 1.20), and self-reported drug use for any drug (RR 1.20, 95% CI 0.92 to 1.56); very low-certainty evidence. One study (211 participants) comparing a therapeutic community programme versus work release showed no significant reduction in marijuana use at six months (RR 1.03, 95% CI 0.19 to 5.65), nor 18 months (RR 1.00, 95% CI 0.07 to 14.45), heroin use at six months (RR 1.59, 95% CI 0.49 to 5.14), nor 18 months (RR 1.92, 95% CI 0.24 to 15.37), crack use at six months (RR 2.07, 95% CI 0.41 to 10.41), nor 18 months (RR 1.64, 95% CI 0.19 to 14.06), cocaine use at six months (RR 1.09, 95% CI 0.79 to 1.50), nor 18 months (RR 0.93, 95% CI 0.64 to 1.35). It also showed no significant reduction in incarceration for drug offences at 18 months (RR 1.45, 95% CI 0.87 to 2.42); with overall very low- to low-certainty evidence. One study (511 participants) comparing intensive discharge planning and case management versus prison only showed no significant reduction in use of marijuana (RR 0.79, 95% CI 0.53 to 1.16), hard drugs (RR 1.12, 95% CI 0.88 to 1.43), crack cocaine (RR 1.08, 95% CI 0.75 to 1.54), nor positive hair testing for marijuana (RR 0.75, 95% CI 0.55 to 1.03); it found a significant reduction in arrests (RR 0.19, 95% CI 0.04 to 0.87), but no significant reduction in drug charges (RR 1.07, 95% CI 0.75 to 1.53) nor incarceration (RR 1.09, 95% CI 0.86 to 1.39); moderate-certainty evidence. One narrative study summary (211 participants) comparing buprenorphine pre- and post-release from prison showed no significant reduction in drug use at 12 months post-release; low certainty-evidence. No adverse effects were reported. AUTHORS' CONCLUSIONS The studies showed a high degree of heterogeneity for types of comparisons, outcome measures and small samples. Descriptions of treatment modalities are required. On one outcome of arrest (no parole violations), we identified a significant reduction when cognitive behavioural therapy (CBT) was compared to a therapeutic community programme. But for all other outcomes, none of the interventions were effective. Larger trials are required to increase the precision of confidence about the certainty of evidence.
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Affiliation(s)
- Amanda E Perry
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Marrissa Martyn‐St James
- University of SheffieldSchool of Health and Related Research (ScHARR)Regent Court, 30 Regent StreetSheffieldSouth YorkshireUKS1 4DA
| | - Lucy Burns
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Catherine Hewitt
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Julie M Glanville
- York Health Economics ConsortiumMarket SquareUniversity of York, HeslingtonYorkUKYO10 5NH
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation TrustMiddlesbroughUKTS4 3AF
| | | | | | - Caroline Pearson
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
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9
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Callaghan L, Thompson TP, Creanor S, Quinn C, Senior J, Green C, Hawton A, Byng R, Wallace G, Sinclair J, Kane A, Hazeldine E, Walker S, Crook R, Wainwright V, Enki DG, Jones B, Goodwin E, Cartwright L, Horrell J, Shaw J, Annison J, Taylor AH. Individual health trainers to support health and well-being for people under community supervision in the criminal justice system: the STRENGTHEN pilot RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Little is known about the effectiveness or cost-effectiveness of interventions, such as health trainer support, to improve the health and well-being of people recently released from prison or serving a community sentence, because of the challenges in recruiting participants and following them up.
Objectives
This pilot trial aimed to assess the acceptability and feasibility of the trial methods and intervention (and associated costs) for a randomised trial to assess the effectiveness and cost-effectiveness of health trainer support versus usual care.
Design
This trial involved a pilot multicentre, parallel, two-group randomised controlled trial recruiting 120 participants with 1 : 1 individual allocation to receive support from a health trainer and usual care or usual care alone, with a mixed-methods process evaluation, in 2017–18.
Setting
Participants were identified, screened and recruited in Community Rehabilitation Companies in Plymouth and Manchester or the National Probation Service in Plymouth. The intervention was delivered in the community.
Participants
Those who had been out of prison for at least 2 months (to allow community stabilisation), with at least 7 months of a community sentence remaining, were invited to participate; those who may have posed an unacceptable risk to the researchers and health trainers and those who were not interested in the trial or intervention support were excluded.
Interventions
The intervention group received, in addition to usual care, our person-centred health trainer support in one-to-one sessions for up to 14 weeks, either in person or via telephone. Health trainers aimed to empower participants to make healthy lifestyle changes (particularly in alcohol use, smoking, diet and physical activity) and take on the Five Ways to Well-being [Foresight Projects. Mental Capital and Wellbeing: Final Project Report. 2008. URL: www.gov.uk/government/publications/mental-capital-and-wellbeing-making-the-most-of-ourselves-in-the-21st-century (accessed 24 January 2019).], and also signposted to other options for support. The control group received treatment as usual, defined by available community and public service options for improving health and well-being.
Main outcome measures
The main outcomes included the Warwick–Edinburgh Mental Well-being Scale scores, alcohol use, smoking behaviour, dietary behaviour, physical activity, substance use, resource use, quality of life, intervention costs, intervention engagement and feasibility and acceptability of trial methods and the intervention.
Results
A great deal about recruitment was learned and the target of 120 participants was achieved. The minimum trial retention target at 6 months (60%) was met. Among those offered health trainer support, 62% had at least two sessions. The mixed-methods process evaluation generally supported the trial methods and intervention acceptability and feasibility. The proposed primary outcome, the Warwick–Edinburgh Mental Well-being Scale scores, provided us with valuable data to estimate the sample size for a full trial in which to test the effectiveness and cost-effectiveness of the intervention.
Conclusions
Based on the findings from this pilot trial, a full trial (with some modifications) seems justified, with a sample size of around 900 participants to detect between-group differences in the Warwick-Edinburgh Mental Well-being Scale scores at a 6-month follow-up.
Future work
A number of recruitment, trial retention, intervention engagement and blinding issues were identified in this pilot and recommendations are made in preparation of and within a full trial.
Trial registration
Current Controlled Trials ISRCTN80475744.
Funding
This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 20. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Lynne Callaghan
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Tom P Thompson
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Siobhan Creanor
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Cath Quinn
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Jane Senior
- Faculty of Biology and Mental Health, University of Manchester, Manchester, UK
| | - Colin Green
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Annie Hawton
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Richard Byng
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Gary Wallace
- Trading Standards and Health Improvement, Plymouth City Council, Plymouth, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amy Kane
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Emma Hazeldine
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Samantha Walker
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Rebecca Crook
- Faculty of Biology and Mental Health, University of Manchester, Manchester, UK
| | - Verity Wainwright
- Faculty of Biology and Mental Health, University of Manchester, Manchester, UK
| | - Doyo Gragn Enki
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ben Jones
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Elizabeth Goodwin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lucy Cartwright
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Jane Horrell
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Jenny Shaw
- Faculty of Biology and Mental Health, University of Manchester, Manchester, UK
| | - Jill Annison
- Faculty of Business, University of Plymouth, Plymouth, UK
| | - Adrian H Taylor
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
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10
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Owens C, Carter M, Shenton D, Byng R, Quinn C. Engaging Without Exposing: Use of a Fictional Character to Facilitate Mental Health Talk in Focus Groups With Men Who Have Been Subject to the Criminal Justice System. QUALITATIVE HEALTH RESEARCH 2018; 28:2102-2114. [PMID: 30066600 PMCID: PMC6187490 DOI: 10.1177/1049732318785359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In an effort to encourage men with experience of being subject to the criminal justice system to contribute to focus group discussions on the sensitive topic of mental health, while also doing our utmost to protect them from discomfort or risk of exploitation, we used a novel technique involving the creation of a fictional character, supplemented by an audio-recorded vignette. We studied the role played by this technique in achieving our stated aims of "engaging without exposing." In this article, we report on the use of this technique in three focus groups, showing how in very different ways it shaped the interaction between participants and generated crucial insights into the lives and service needs of each group. We conclude that the technique may lend itself to being used in focus groups with other marginalized or seldom-heard populations.
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Affiliation(s)
| | - Mary Carter
- University of Exeter, Exeter, United Kingdom
| | | | | | - Cath Quinn
- Plymouth University, Plymouth, United Kingdom
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11
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Quinn C, Byng R, Shenton D, Smart C, Michie S, Stewart A, Taylor R, Maguire M, Harris T, Shaw J. The feasibility of following up prisoners, with mental health problems, after release: a pilot trial employing an innovative system, for engagement and retention in research, with a harder-to-engage population. Trials 2018; 19:530. [PMID: 30285825 PMCID: PMC6167907 DOI: 10.1186/s13063-018-2911-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background Following up released prisoners is demanding, particularly for those prisoners with mental health problems, for whom stigma and chaotic lifestyles are problematic. Measurement of mental health outcomes after release is challenging. To evaluate mental healthcare for offender populations, using high-quality randomised controlled trials, evidenced-based methods must be developed to engage them while in custody, to locate and re-interview them after release, and to collect potentially stigmatising mental health outcomes data. Methods We developed an initial theoretical model and operational procedures for collecting baseline and follow-up data informed by a literature search, focus groups, and case studies. Male prisoners from five prisons in two sites were invited to participate. The inclusion criteria included individuals who were above threshold on nine-item Patient Health Questionnaire, seven-item Generalized Anxiety Disorder, or post-traumatic stress disorder scales, or who had reported mental health problems in the past 2 years or had been assessed with a likely personality disorder. Potential participants were interviewed to generate baseline data and were re-contacted before their release. We then contacted them for a follow-up interview, which included repeating the earlier data collection measures 2–8 weeks after release. A qualitative formative process evaluation produced and refined a model procedure for the recruitment and retention of male prison leavers in trials, identified the mechanisms which promoted engagement and retention, and mapped these against a theoretical behaviour change model. Results We developed a flexible procedure which was successful in recruiting male prison leavers to a pilot trial: 185/243 (76%, 95% confidence interval (CI) 70–81%) of those approached agreed to participate. We also retained 63% (95% CI 54–71%) of those eligible to participate in a follow-up interview 2–8 weeks after release. Mental health outcomes data was collected at both these time points. Conclusions It is possible to design acceptable procedures to achieve sustained engagement critical for delivering and evaluating interventions in prison and in the community and to collect mental health outcomes data. These procedures may reduce attrition bias in future randomised controlled trials of mental health interventions for prison leavers. This procedure has been replicated and successfully delivered in a subsequent pilot trial and a definitive randomised controlled trial. Electronic supplementary material The online version of this article (10.1186/s13063-018-2911-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cath Quinn
- Plymouth University Peninsula Schools of Medicine and Dentistry, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
| | - Richard Byng
- Plymouth University Peninsula Schools of Medicine and Dentistry, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Deborah Shenton
- Plymouth University Peninsula Schools of Medicine and Dentistry, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Cordet Smart
- Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Susan Michie
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Amy Stewart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Rod Taylor
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Mike Maguire
- University of South Wales, Pontypridd, CF37 1DL, UK
| | | | - Jenny Shaw
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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