WOMEN PRISONERS AND OFFENDERS Somebody’s mother, daughter, sister, partner

1. WOMEN PRISONERS AND OFFENDERS Somebody’s mother, daughter, sister, partner 12 July 2012www.prisonersfamilies.org.uk

2. Presentation by Katherine Albertson, Research Fellow, Sheffield Hallam University www.prisonersfamilies.org.uk

3. Tackling health inequalities through developing evidence-based policy and practice with child-bearing women in prison:A consultation Dr Katherine Albertson (SHU) with Caroline O'Keeffe (SHU) Professor Mary Renfrew (Mother and Infant Research Unit, University of York) Cath Burke (York) and Georgina Lessing-Turner (York)

4. The HCCJ

5. Statement:"A prison is a good place for a baby" Four corners exercise: Strongly agree Agree Disagree Strongly disagree

6. Aims of the Consultation To scope the health needs and health care of childbearing women in prison Key objectives: • Talk to MBU staff and other relevant health and social care professionals about improving practice and tackling barriers to equity of health care • Identify good practice in this area • Produce an evidence base to inform policy and practice in this area

7. What we did • Workshops with MBU staff at HMP Askham Grange and HMP New Hall • Interviews with MBU Managers • Web-based Expert Panel (3 tasks to respond to) • Multi-agency 'final' consultation event/ solutions workshop

8. What is an MBU in prison? 2.1 An MBU is a designated separate living accommodation within a women’s prison, which enables mothers to have their children with them whilst in prison. It is a drug-free unit where, in order to promote healthy child development, a calm and peaceful environment is required at all times. The Unit safeguards the child’s welfare and allows the mother and child relationship to develop normally. 2.2 The Units exist first and foremost for the benefit of the children who are not prisoners and have committed no offence. Their best interests are the primary concern in all matters. REFS: HM Prison Service Order: Order Number 4801, The Management of Mother and Baby Units (3rd Edition 07/12/09). PHOTO: HMP Askham Grange (open prison) Acorn Children's Centre, run by Barnardos. Photograph from architects web page.

9. 7 Mother and Baby Units 77 places (on 12/06/12)

10. Mothers and Babies in Prison • It is estimated that more than 17,240 children were separated from their mother in 2010 by imprisonment (Prison Reform Trust, 2012). • It was estimated in 2005 that over 600 women receive antenatal care in prisons each year (North, 2005). • Between April 2005 and December 2008, 382 children were born to women prisoners (Prison Reform Trust, 2012). • More likely than the general population to experience perinatal and maternal mortality and morbidity, and they may also suffer separation and distress (Gregorie et al., 2010; Birmingham et al, 2006; Siefert and Pimott, 2001).

11. An MBU place Who can apply? The application process • 'all prisoners who are pregnant or who have children under the age of 18 months' • 'all sentenced women are eligible to apply regardless of their length of sentence and release dates because it may still be in the child’s best interests to be with its mother for some time' • Identification (on entry) • Satisfying application criteria • Application to Admissions Board • Including reports from: probation/social services/ security and separation plan if release date after child reaches 18 months

12. Mother and baby wellbeing Findings: • MBU residence as a significant transition point where both personal development and health promotion messages can be beneficial for both mothers and their babies • Mothers are required to leave babies in the crèche to attend education etc, when babies are 6-8 weeks old (which may be detrimental to wellbeing) Good Practice example: At HMP Holloway, Birth Companions offer a parenting group and a pregnancy group encouraging peer support amongst the women At HMP Askham Grange, part of the sentence plan for women on MBUs is to attend 'stay and play' sessions organised by the MBU nursery Future good practice: Attending capacity building classes could be incorporated into overall sentence planning (antenatal, parenting, budgeting, food preparation)

13. 'Realising' the benefits Findings: • Huge amount of experience, expertise and enthusiasm among MBU staff keen to provide benefits for both mothers and babies wellbeing • Lack of evidence base to demonstrate efficacy of provision. Lack of information to inform application decision Good practice example: HMP Holloway publishes a weekly pregnancy list which is shared with midwives and voluntary organisations. This flags up those women who may need support in making a decision about applying for an MBU place Future good practice: The collection of data from prisons and particularly from the women themselves regarding the challenges and benefits of MBU residency

14. Infant feeding choices and nutrition Findings: • Wide variation in the way the food and nutrition needs of childbearing women and their babies are addressed across the prison estate. • A largely bottle feeding culture exists amongst women in prison, including those on MBUs. • Healthy Start issues Good practice examples: At HMP Holloway (Birth Companions) and HMP New Hall (Little Angels) provide antenatal baby feeding information and support and have increased the number of women electing to breastfeed Future good practice: Provision of a tailored meal plan for pregnant and postpartum women and breastfeeding mothers. Where women have other children, arranging for family mealtime visits where families can cook and eat a healthy meal together

15. Communication and Collaboration Findings: • There were examples of effective communication channels existing between MBU managers and health / MBU staff • A general lack of systemic 'joined up' communication between relevant agencies Good practice example: At HMP Bronzefield mechanisms exist for the views of and needs of women prisoners to feed directly into the work programme of the local Maternity Services Liaison Committee Future good practice: Named person in each relevant agency (health, criminal justice, social care) to take overall responsibility for cases of childbearing women in the CJS. Increasing the involvement of third sector agencies to support the mother's and baby's wider family on the impact of imprisonment on the wider family network.

16. Resettlement Findings: • Transition from 'in to out' of custody as often difficult for women and their babies. • Families and partners are often provided with little information regarding issues during the resettlement period. Good practice examples: • At HMP Eastwood Park, as part of the resettlement process, the relevant Social Service department is informed of the impending release of any MBU resident • At HMP Askham Grange, voluntary sector agencies play a role in the resettlement process and support continuity for women and their babies re-entry into the community Future good practice: Ensuring effective referral systems between prisons, health services, and Women's and Children's Centres in the community, especially for those women released without statutory supervision. Ensuring the mother's and children's families and voluntary agencies are informed and engaged in the resettlement process

17. Recommendations: • Structured personal development programme for women on MBU's • Multi/cross-agency working (throughout the journey through CJS) • A mandatory set of national guidelines ensuring consistency and equity across the Criminal Justice System (Pregnancy Pathway?) • A national audit (what provision is available? Where?) • A structured on-going rolling programme of awareness raising (childbearing women coming into contact with the CJS) • A centralised evidence gathering and data collection strategy • Focus on future policy and practice agenda (identifying 'what works'/ what is 'best practice'), informed by audit and data collection strategy

18. Significant Reports: • The full report this presentation is based on is available at the following link: - http://www.cjp.org.uk/publications/tackling-health-inequalities/ • North, J (2005) Getting it Right? Services for pregnant women, new mothers, and babies in prison, the Maternity Alliance. • Edge, D (2006) Perinatal Healthcare in Prison: A Scoping Review of Policy and Provision, The Prison Health Research Network, Department of Health. • Caddle, D and Crisp, D (1997) Mothers in Prison, Home Office Research Findings no. 38, Home Office Research and Statistics Directorate. • 11 Million Report, Children's Commission: (2008): Prison Mother and Baby Units- do they meet the best interests of the child? E mail, Dr Katherine Albertson: k.albertson@shu.ac.uk

19. Potential for mother's and baby's in prison Many examples of excellent practice in MBU's " … there are features of provision and routine in the MBU's that can offer safety, stability and an opportunity to be with the baby - all of which were not always possible 'on the outside.'" (Baradon et al., 2008).