Evaluation of HMP Shotts Oral Health Improvement Project

1. Evaluation of HMP Shotts Oral Health Improvement Project Celia Watt Senior Health Promotion Officer NHS Lanarkshire Celia.Watt@lanarkshire.scot.nhs.uk

2. Background • Severe tooth decay 4 times more likely in prison population (Scottish Prisons Dental Health Survey, 2002). • Dental Action Plan (2005) – development of oral health care preventive programmes for adults in most need such as … prisoners. • NHSL – HMP Shotts collaborative 3 year pilot (2008-2011). • Aim to pilot a whole settings approach to oral health improvement involving prisoners, their families and staff at HMP Shotts.

3. Evaluation objectives • Identify change in oral-health related knowledge, attitudes, behaviours. • Identify good practice within OHIP. • Explore challenges of working in prison environment and that impact of the OHIP on the prison environment, structures and systems. • Make recommendations for future health improvement involvement within prison settings.

4. Evaluation Methods • University of Dundee Dental Health Services Research Unit. • 107 self completion questionnaires (intervention and control). • Focus groups (20 prison staff and 14 prisoners). • 8 SPS/NHSL one-to-one interviews. • Nuffield Partnership Assessment Tool.

5. Study population • Age 21-60 years (mean age 34). • 2011 mean length of time in prison = 2 years, 3 months. • Less than a quarter had all of their own teeth with no teeth missing, while over 40% had some teeth missing. • Pre prison - over a third of prisoners reported they only attended the dentist when they were in pain or in an emergency. Another third stated that they attended 6 monthly.

6. Prisoner Awareness/Participation in OHIP

7. Prisoner Knowledge of Oral Health Messages

8. Behaviours • Some changes in behaviours were apparent but were not reported at a statistically significant level. • Some strong qualitative evidence of behaviour change noted: • “there’s more guys buy fruit and veg in here than ever before”. • “Aye, just found out that you’re not meant to use a hard toothbrush, meant to soft…I got one fae [the HPO]”.

9. Evaluation objectives • Identify change in oral-health related knowledge, attitudes, behaviours. • Identify good practice within OHIP. • Explore challenges of working in prison environment and that impact of the OHIP on the prison environment, structures and systems. • Make recommendations for future health improvement involvement within prison settings.

10. 2. Good practice within OHIP • Evidence based approach • Whole settings approach • NICE guidelines – dental recall, PHG6 • Partnership and joint agenda setting

11. Empowerment and support • “she’s been up sitting in the visits, and having a chat with them and showing them different bits and pieces. Stuff that was more geared toward the kids but allowed them [prisoners] to have an input in it. The guys really enjoyed that”. • “I think it’s a clever approach…whilst the father as parent educator is involved in the process, he must be observing some of this message themselves”. • “His family is the most important thing in his life…I think they see it as a chance to say [to kids] I am telling you how to eat, how to look after your dental hygiene”.

12. Partnership

13. Evaluation objectives • Identify change in oral-health related knowledge, attitudes, behaviours. • Identify good practice within OHIP. • Explore challenges of working in prison environmentand that impact of the OHIP on the prison environment, structures and systems. • Make recommendations for future health improvement involvement within prison settings.

14. 3. Challenges • Nature of the prison population. • Attitudes towards OH improvement and health improvement generally – staff and prisoners. • General restrictions such as security demands, resources made available to the HPO within the prison.

15. 3. Impact on environment, structures and systems • Catering – availability of healthier choices • HWL – involvement of staff. • Routine OHI involvement in events, visits, induction. • Availability of resources for OHI; toys, books for visits; involvement in health promotion events for staff, prisoners and families. • Development of good working partnership between NHSL and HMPS.

16. Evaluation objectives • Identify change in oral-health related knowledge, attitudes, behaviours. • Identify good practice within OHIP. • Explore challenges of working in prison environment and that impact of the OHIP on the prison environment, structures and systems. • Make recommendations for future health improvement involvement within prison settings.

17. 4. Future direction in HMP Shotts • Build on recommendations plus content on Better Health, Better Lives for Prisoners and National Oral Health Improvement Strategy for Priority Groups. • Continue to focus on whole settings approach. • Widen to encompass other related health topics under Common Risk Factor Approach. • Focus on changing behaviour rather than information and knowledge. • Link in with local and national parenting strategies/campaigns.

18. Priority Action Areas • Build Health Public policy • Health impact assessment • Create Supportive Environments for Health • Prisoner involvement • Staff training • Population level intervention and programmes • Secure commitment, leadership and partnership of senior prison staff • Strengthen Community • Community level interventions and programmes • Events • Parenting • Develop Personal Skills • Accessibility of resources and information • Individual level interventions and programmes • Families and children • Reorient Health Services • Appropriate service models • Partnership with new NHS salaried dental service provision

19. Acknowledgements • University of Dundee Dental Health Services Research Unit • Tahira Akbar, Steve Turner, Markus Themessl-Huber, Ruth Freeman. • HMP Shotts - Staff and Prisoners