Context of Willow development
• women commit less crime, particularly less
serious crime
• Scotland continues to incarcerate women at a
disproportionate rate
• No evidence of increased incidence or
seriousness of crime committed by women
• Women in prison found to have ‘exceptionally
high levels of health need’
Context of Willow development
• Prison Health in Scotland (2007)
• Equally Well (2008)
• Scottish Parliament Equal Opportunities
Committee (2009)
• Lothian and Borders CJA commissioned and
published research about the specific profile of
women offenders locally (Barry and McIvor,
Chaotic Lives, 2009)
Distinctly Complex Needs
• Experiences of abuse and trauma
• High prevalence of mental ill health and
self harm
• Substance misuse
• Poverty
• Mothers as prisoners
• Relationships
• Health inequalities
A gender specific model of
service
• Requires input from a range of agencies
• Joint working across disciplines
• Key roles for health professionals and
criminal justice social work
• Contribution of the third sector is important
• Women should access services from any
point within the criminal justice system
(2010)
Willow aims to:
• Reduce offending behaviour
• Improve health, wellbeing and safety
• Improve women’s access to services
How we strive to respond
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Holistic intervention
Pro-active engagement
Strengths based
Crises responsive
Trauma informed
Relational approaches
Desistence differences
Social capital development
Women workers
PROJECT BOARD
NHS Lothian
City of Edinburgh Council Criminal Justice Social Work
SACRO
WILLOW SERVICE MANAGER
SACRO
SUPPORT
WORKER
SACRO
SUPPORT
WORKER
PSYCHOLOGY
ASSOCIATE
SACRO
SUPPORT
WORKER
(OUTREACH)
KEEPWELL NURSE
CRIMINAL
JUSTICE
SOCIAL
WORKER
CRIMINAL
JUSTICE
SOCIAL
WORKER
NUTRITIONIST
Partners
• Harm Reduction Team - addictions
• Caledonian and Working with Men –
domestic abuse
• Edinburgh Community Food Initiative –
healthy eating
• Edinburgh Festival Theatre – social capital
• Access to Industry - employability
Programme
• Phase 1 - assessment with key worker, nurse
and psychology; induction group
• Phase 2 groups – including the
– trauma group
– offending group
– health improvement group
– social capital activities
• Phase 3 groups – social capital activities and
moving on work
Phase 1 - Induction
• Assessment with key worker, the nurse for a health
check and to meet with psychologist.
• Interests and motivates women and look at what
realistic changes they want for their future.
• Information about our programmes and getting to
know staff and group members.
• Stabilisation work takes place
• The two day induction programme assists women to
quickly engage with the service.
Phase 2: Connections (adapted)
Programme that promotes attitudinal and
behaviour change to help women desist from
offending behaviour
• Recognising and exploring emotions
• Communication skills
• Problem solving
• Seeing the bigger picture
• The impact of offending
• Building confidence
Phase 2 - Survive and Thrive
• Psycho educational programme
• 8 sessions
• Understanding the NORMAL range of
reactions to trauma (some of which will
last for years or even decades) and learn
new ways of coping.
Includes:
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The effects of abuse and trauma
Keeping safe
Surviving skills
Understanding anxiety
understanding depression
Understanding flashbacks, nightmares and
dissociation
Health Improvement programme
• Nutrition
• Dentist and oral
hygienist
• Sleep
• Domestic abuse
• Sexual health &
BBV
• Drug misuse
• Alcohol misuse
To build social capital
To build cultural capital
Reaching Out
Reaching In
Reaching inside
yourself to think about:
-your hobbies interests
-things you have
achieved
-things you used to
enjoy
- your skills
Reaching outside yourself to
find:
-new places to visit
-new interests to try
-new people to spend time
with
-old hobbies you had
forgotten
-new or more developed
skills
Phase 3: Group Sessions
• Self efficacy, taking control
• Inspirational women; who can I
be and how will others manage
my change
• Presentation skills
• Confidence
• Money Management
• Employability
Phase 3: Qualifications & Interest Visits
Opportunity to gain certificates & increase
employability such as:
- Food Hygiene Certificate
- First Aid Certificate
And visits to demystify community facilities such as:
- Local Colleges
- Volunteer Centre
- Scottish Parliament
Outcomes
• Personalised goals for individual women
• Self report, observation and professional
assessment
• Standardised assessments:
– Clinical Outcomes on Routine Evaluation
(CORE)
– Post Traumatic Stress Disorder Checklist
(PTSD)
– Hospital Anxiety and Depression Scale
(HADS)
Observation, Professional Assessment &
Self Report
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Planned use of primary care services
Changes in diet
Positive changes in their relationships
Positive changes in how they view themselves
Reduction in frequency and seriousness of
offending
• Improved, stabilised, reduced substance use
• Participating in pro-social activities, some of benefit
to others
• Increased physical activity
Post Traumatic Stress Disorder
prevalence and outcomes
• 77% pre-intervention presented with
symptomology consistent with Post
Traumatic Stress Disorder
• all women (except 1) had clinical and
statistically significant improvements, post
intervention
• only 1 woman has remained symptomatic
post intervention
CORE Scores
All women (except 1) had clinical and
statistically significant improvements, post
intervention in the areas of
• Wellbeing
• Problems/symptoms
• Life functioning
Not in ‘Risk’
“Just thought it would be nice to drop you a wee letter as there is
a few things I would like to say to yous all.
Carina and Terry you turned my life right round. I am not saying everything
is perfect but you helped me to get the strength to cope much better than I
have in my whole life and I don’t have the words to tell yous how much I am
so grateful to you for this. I know people will say they will never forget
people but I know till the day I take my last breath the willow workers will
always be with me every day helping me cope better with every day life.
Sally, just to let you know I am still making your Sheppard's pie. My kids
love it. They ask me to make it every time they come through to visit. Thank
you for taking the time to teach me these skills. Sarah you gave me so many
coping methods that I still use today. I could never have got through some
of the things I have had to deal with in the past few months if it were not for
you.
I have started a course with transitions called Flash Beauty. I could never
have done this if it wasn’t for Willow. I really hope you keep going helping
the women who really need it. My biggest thanks is for never ever judging
us because that is something we all fear. Good luck to yous all in the
future”.
External Evaluation
• Saw a different version of themselves which was
more positive and hopeful about moving away from
offending
• Safe, supported and respected, much of which
related to the project being for women only and
workers’ attitudes
• Women, staff and external agencies felt Willow
offered a viable alternative to custody
This is supposed to be a punishment but it has been
the best thing that ever happened to me. This is the
only time I get to think about me, to take that
breathing space that up to now I have never had.
External Evaluation
I am learning to take care of myself and found out
that I was a diabetic. I had been dizzy in the past
and just thought it was normal but it's not.
.
I enjoy the company of the people in the
group and never had any reason to feel
unsafe, which is a good thing for me
I want to be alert and be able to hear what the women
are saying and interact. I asked the doctor to bring my
methadone down and for the first time in years I am
feeling more awake and I have a reason to be awake.
Costs
• £184k per year to work with up to
60 women completing the
programme
• 1 prison cell for 1 year costs £55k