Using peer educators to
deliver IBA (alcohol harm)in
offender
Sara Mitchell settings
Programme Lead
Project Context
 Unique settings/challenges
 Unique statistics to start from
 Explicit need
 Absolute fidelity-compelling evidence HTs /IBA (now
peer educators if no HTs)
Project Development
 Early brief adapted to fit need
 WCC/QIPP principles
Outputs
 Bespoke training tools
 Service specification
 Pathways
Outcomes
 Increased alcohol awareness in offender population
 Reduced alcohol related crime
 OASys
 Pre and adapted Post test Audit (quantitaive)
 Summaries/reviews (qualitative)
 Longtitudinal study…?
What is a Health Trainer?
Sue Green
East of England Health Trainer Lead
sgreen@s-norfolk.gov.uk
• A Health Trainer is someone recruited from a deprived
community (e.g. Prison or probation service) to work with
that deprived community to reduce health inequalities.
• They offer peer support.
• When trained to RSPH level 2 they signpost to services.
• At City and Guilds level 3 they are trained to do 1-1
behaviour change using psychological techniques.
Aims:- To Develop a healthy prison/ probation
population.
Through assessment, signposting and education
delivered by peers.
To help prisoners change their behaviours to a
healthier style.
To support them through these changes.
To address health issues highlighted in the
national targets and PSA indicators.
To provide prisoners with a transferable
qualification and work experience.
To help reduce re-offending, by employing exoffenders.
Health inequalities
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Health Trainers help people to work on:1. Reducing alcohol levels
2. Quit smoking
3. Exercise more
4. Eat healthier
5. Sexual health
How many Prison and Probation
services are there in the East of
England?
• Wayland (21), Chelmsford (10), Norwich (10), and
Littlehay (14) have active offender HT services.
• Peterborough, Whitemoor, Bedford, and the Mount have
all obtained Board permission to have a HT service and
are in the early stage of development.
• Norfolk has a Probation HT service employing 4 exoffenders (undergoing CRB checks).
Peer Led Alcohol Identification and Brief Advice
Pilot Brief and Evaluation
HMP/YOI Chelmsford
Eric Pudaloff
Eric.Pudaloff@midessexpct.nhs.uk
Background - HMP & YOI Chelmsford
• The Prison is used as a long-term category B &
Young Offenders Institution (18-21) and
local/remand prison (prior to court sentencing) for
adult males;
• The Prison has a capacity for 695 prisoners and is
consistently full or near to capacity;
• The average stay in YOI is 57 days, for adults in
Prison is 64 days;
Background - Health Trainer Champions
Peer led Health Improvement Brief Advice on various health
topics and sign post prisoners to relevant health services:
Current Focus:
– Alcohol Screening and Intervention;
– Smoking Cessation Brief Advice;
– Oral Health Advice;
– Health Needs Assessment:
– Sexual Health:
– Health Promotion as a whole with evidence of activity
in: Smoking Cessation, Healthy Eating & Nutrition,
Mental Wellbeing, Healthy Lifestyles including
Relationships, Drug & Other Substance Misuse;
Prison Care – Alcohol IBA Pathway
Health Trainer
Champions Trained in
Alcohol IBA
Locality
Resettlement
Centre
IDTS Wing
Gym
Other
Locality
Opportunistic IBA delivered by Prison Health Trainer
Prison Care – Alcohol IBA Pathway Continued
FAST
Score
4+
Score
0-3
Audit not
required
Score
4-7
Lower Risk
Score
8-19
Higher/
Increasing
Risk
IBA Alcohol Education
(Information Leaflet)
IBA Alcohol Education
(Information Leaflet)
AUDIT
Score
20+
Possible
Dependence
IBA Alcohol Education
(Verbal Brief Advice &
Information Leaflet)
Signpost to CARATs and
AAs
IBA Alcohol Education
(Verbal Brief Advice &
Information Leaflet)
The Research Experiment (1)
The primary objective of the research is to determine the
relative effectiveness of brief verbal and non verbal
advice/information provided by prisoner health trainers
to other prisoners. Advice intended to positively
influence prisoners’ future intentions concerning their
use of alcohol upon their release into the community.
The research project involved the participation of
prisoner volunteers being processed through the
Prison’s induction wing. Eligible participants were those
who scored 8+ on the FAST/Audit test and were divided
into two groups each of 40 prisoners.
The Research Experiment (2)
Group 1 (Experimental group) Participants received
feedback from a peer Health Trainer as to the meaning of
their FAST/audit scores and provided with brief verbal and
non verbal advice/information relating to alcohol use and
misuse. Approximately 14 days later, participants were
interviewed by the researcher and requested to complete two
questionnaires.
Group 2 (Control group) Participants received feedback
as to the meaning of their FAST/audit scores and were
immediately requested by the researcher to complete the
same two questionnaires given to Group 1 participants. Upon
completion of questionnaires participants were provided with
brief verbal and non verbal advice/information relating to
alcohol use and misuse.
Quantitative Questionnaire (Part 1)
A quantitative questionnaire comprising of 17 questions
using a Likert 0-6 scale i.e. from strongly agree (0) to
strongly disagree(6)
At the bottom of Part 1 Questionnaire: a test invited
participants to indicate how many units there are in: a
pint of strong lager, a large glass of wine and a double
vodka. Additionally: a request to name 3 negative
consequences of alcohol misuse.
Qualitative Questionnaire (Part 2)
A questionnaire comprising of 5 questions
1. Do you think that past behaviour linked to your drinking (alcohol) has
interfered with any of the plans you had for your life?
2. Do you think that past behaviour linked to your drinking (alcohol) may
have taken something away from what you once liked about yourself?
3. What intentions for your own future do you have in mind concerning the
role of alcohol in your life when you get out (upon your release)?
4. In the twelve months prior to your imprisonment, do you think that your
drinking was to a safe level?
5. Upon your release, what do you think are the barriers that might prevent
you from not drinking at all or drinking to a safe level and how
confident are you of overcoming those barriers?
Initial Results – Quantitative (1)
(Awaiting Independent Verification)
Regression analysis calculations were performed in respect to both the
Experimental & Control Groups using Q12 of Questionnaire Part 1 as the
outcome (dependent variable) i.e. the intention or otherwise to cut down or avoid
drinking in the future.
From the same Questionnaire, questions below were selected as predictors
(independent variables) of Q12 that focused on past reflections & future intentions
Q1
My past misuse of alcohol has harmed personal relationships:
Q3
I need to look at my future relationship with alcohol:
Q5
My drinking in the past has worked against me:
Q9
I am confident I can take better care of my health in the future;
Q16
I recognise that I have misused alcohol in the past:
Q17
I have a good understanding of the dangers of alcohol misuse;
Initial Results – Quantitative (2)
(Awaiting Independent Verification)
EXPERIMENTAL GROUP – SIMPLE REGRESSION
An R-squared of 0.705, meant that approximately 70% of the variance of
Q12 is accounted for by the predictors Q1,Q3,Q5,Q9,Q16 & Q17.
Q1 (My past misuse of alcohol has harmed personal relationships) was found to
be NS (b= -0.0367, p=0.057,), but only just. Next, the effect of Q3 (I need to look at
my future relationship with alcohol) is (b= 0.526, p= 0.000) was significant,
indicating a high proportion of participants in the experimental group saw the
need to look at their future relationship with alcohol. Q5 (My drinking in the past
has worked against me) was also significant (b=0.251, p=0.050). Q9 (I am
confident I can take better care of my health in the future) recorded a significance
of (b=0.421, p=0.001) indicated a good proportion of participants were confident
they would take better care of their health in future and Q16 (I recognise that I
have misused alcohol in the past) indicated the preparedness of a significant
number of participants to consider their misuse of alcohol in the past (b=0.406,
p=0.035). Q17 (I have a good understanding of the dangers of alcohol misuse)
was NS (b=0.088, p=0.661).
Initial Results – Quantitative (3)
(Awaiting Independent Verification)
CONTROL GROUP – SIMPLE REGRESSION
In respect to the Control Group, none of the independent variables
(Q1,Q3,Q5,Q9,Q16 & Q17) were found to be significant predictors
of Q12 (intention to cut down or avoid drinking in the future) i.e. the
dependent variable.
An R-squared of 0.355, meant that approximately only 36% of the
variance of Q12 was accounted for by the above predictors.
Results of conducted simple regressions appear to indicate
that brief interventions by peer health trainers influence
prisoner participants in the experimental group to positively
reflect upon their past behaviour and future intentions towards
alcohol consumption in comparison with the control group
that experienced no such interventions.
Initial Results – Qualitative (1)
The Experiment in Chelmsford HMP/YOI Prison had recently been completed and
analysis has only just began. Qualitative data has received only cursory attention.
However, in regards to qualitative data the following themes have become
apparent participants responses:
Q Do you think that past behaviour linked to your drinking (alcohol) has
interfered with any of the plans you had for your life?
Gone to jail, damaged relationships, lost job, not achieved goals (education).
Q Do you think that past behaviour linked to your drinking (alcohol) may have
taken something away from what you once liked about yourself?
Loss of confidence & self esteem, good behaviour, being likeable, lost happiness.
Q What intentions for your own future do you have in mind concerning the role of
alcohol in your life when you get out (upon your release)?
Going to stop, try and stop, not touch it again, cut down, go to support centres in the
community, I want to be councillor alcohol misuse.
Initial Results – Qualitative (2)
Q In the twelve months prior to your imprisonment, do you think that your drinking
was to a safe level?
A resounding NO with only a few exceptions - not surprising since the average
Fast/audit score of all participants was 26 (the threshold dependency is 20+).
Q Upon your release, what do you think are the barriers that might prevent you from
not drinking at all or drinking to a safe level and how confident are you of
overcoming those barriers?
Depression, lack of support, no where to stay, living on the streets, bad influences
from the past, going to night clubs, taking drugs, failed relationships, bad company.
The described experiment has been no more than a pilot conducted with
a limited number of participants. However, the initial indicators are
encouraging and would appear to support the effectiveness of Peer led
Health Improvement Brief Advice within the context of a prison
environment and the delivery of alcohol screening and brief intervention
Results from pre and post
training evaluation sheets
HMPS Norwich and HMPS and HMPS Wayland
N.B.
• The data has not been fully analyzed yet but the following
patterns are emerging:-
Wayland –pre training
• The health trainers felt they didn’t know enough
and were not confident to advise people.
• They didn’t feel proud of themselves, but at the
same time –kept positive and looked forward to
working with people who had alcohol based
problems.
• They were happy to ask clients questions and
felt clients would expect this .
• However they did not know how rewarding it
would be and couldn’t judge weather they liked
drinkers at that stage.
Wayland Post Training
• The health trainers felt they knew enough and
were confident to advise people with alcohol
based problems.
• They felt proud about what they were going to
undertake.
• They felt very positive and were happy to ask
questions about clients drinking patterns.
• They all felt the work would be rewarding.
• But their was no change to weather they felt they
liked drinkers or not.
Norwich –pre training
• The health trainers felt they didn’t know enough
–but were still happy to advise.
• They were not sure about how confident they
were.
• They didn’t feel a failure though and did want to
undertake this work.
• They were positive and felt they had the right to
ask clients questions and felt clients would
expect this.
• They expected the work to be rewarding and
were quite favourable towards drinkers.
Norwich –post training
• The health trainers felt they knew enough and were
happy to give advice. They were still not brimming with
confidence but didn’t feel a failure either.
• They were keen to undertake the work, but not so
positive as they were before the training.
• They felt they had the right to ask clients questions but
were less sure how these questions would be received.
• They were also not so sure how rewarding it would be,
but remained more favourable towards drinkers than
offenders at Wayland were.
A few interesting points
from other areas of the
questionnaire
• Wayland felt the training was all useful and over half
agreed it was highly useful. They enjoyed the role play ,
discussion and learning about units most.
• They felt Short concise adverts would promote IBA well,
as would the use of statistics [positive and negative].
Positive role models and success stories were also
recommended.
• Barriers to the success of IBA in prisons were lack of
motivation ,peer pressure, addiction, stress, lack of cooperation and general unwillingness to change.
• Communication problems and lack of information –were
highlighted as barriers the health trainers might
encounter whilst undertaking IBA.