Healthcare for adults on probation: learning from YOTs

Work with offenders on why we find it so difficult to improve healthcare for adults on probation

A new article in the current edition of the Probation Journal by Professor Charlie Brooker, Beth Collinson & Coral Sirdifield asks why we can provide access to healthcare for young people in the criminal justice system but not their adult counterparts. “Improving healthcare in adult probation services: Learning from Youth Offending Teams” reviews the development of the healthcare provision in youth offending teams (YOTs), and the implications of this for improving provision for adults supervised by probation.

The Crime and Disorder Act (1998) made healthcare funding a statutory requirement in YOTs, and healthcare presence in most YOTs was significantly boosted by the collaborative commissioning initiative. However, the researchers point out that there is no parallel commissioning initiative in adult probation services. Only a small proportion of NHS clinical commissioning groups make specific investment for this population. Pockets of healthcare provision in probation settings exist, but not consistently; given the disproportionately high (physical and mental) health needs of people on probation, the authors argue that this is a social inequality which needs addressing.

Findings

The researchers surveyed all YOTs in England via a Freedom of Information request and got responses from 70% (99/141) teams. All but six YOTs had access to a health worker and there were future plans for health workers in three of these. There were sixteen different types of health worker recorded by YOTs. The most common by far was a child and adolescent mental health nurse (CAMHS nurse) [n =87] followed by school nurses (n=45). Speech and language therapists were also relatively common (n= 18), with ten areas having a clinical psychologist available to children in contact with the YOT. On average across all the disciplines, the numbers of hours worked, per worker per week was 25 hours.

YOTs were very positive about the benefits of these health worker posts, expressing the view that as well as improving the speed and continuity of access to care for young people, health workers also played a vital role in developing YOT workers’ understanding of health needs and how to address them.

Alongside their role in assessment, referral, facilitating access, and developing staff, health workers were also reported to directly provide one-to-one therapeutic interventions and were perceived to have increased the use of trauma-informed care. Finally, they also supported integration of a focus on health within the wider planning around children and young people within the criminal justice system.

Implications for people on probation

The researchers demonstrate that the recent NHS Collaborative Commissioning Network (CCN) project has had a major impact, with 104 new projects being commissioned locally and responses from YOT managers suggesting that health workers are performing a valuable role which is resulting in improvements to staff’s understanding of health and inclusion of this in resettlement planning. In addition, the data suggest that this is producing improvements to health and criminal justice outcomes for children and young people who may otherwise have failed to engage with healthcare services.

In contrast, whilst the probation service clearly see the value of identifying and addressing health-related drivers of offending behaviour in the adult population and have produced a Health and Social Care Strategy detailing their commitments, their work is hampered by differences in relation to the mandate for health provision, how health needs are assessed, and how healthcare is commissioned and provided.

The research team highlight the fact that there is currently no statutory responsibility to have a health worker role within probation, meaning that probation staff must try to forge connections on a local level without always knowing how best to do this. Investment in such a worker could screen people under probation supervision to identify their health needs using tools that are recognised and understood by healthcare providers. This would provide vital data, which, with appropriate permissions and/or anonymisation could be shared with probation staff and healthcare commissioners to inform their practise and commissioning decisions.

A health worker could also provide brief interventions, and facilitate access to care, improving improve pathways into care from probation, and bettering probation staff’s understanding of these pathways and the use of trauma-informed care.

Commissioning of healthcare for those under supervision is currently the responsibility of CCGs, but previous research (also by Professor Brooker) shows that some are unaware of this responsibility, and few invest directly in healthcare for probation.

The researchers call for a collaborative commissioning initiative for probation in England and Wales to action the ambitions set out in the Health and Social Care Strategy. Without a dedicated initiative, the researchers are clear that the major social inequalities that we currently see are likely to remain in place. It will be interesting to see whether and how this suggestion fits in with the government’s “levelling up” initiative.