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Why can't dad come home?

07 November 2019

Health visitors Jo Lamb and Mel Griffiths on innovating practice to deliver the Healthy Child Wales Programme to fathers in prison.

An estimated 310,000 children currently have a parent in prison in England and Wales (Kincaid et al, 2019). Many children will experience significant negative effects when a parent is incarcerated, such as feelings of sadness and loss, and they have a greater risk of developing poorer emotional and mental health outcomes (Barnado’s, 2015).

The Farmer review (2017) was commissioned as part of the government’s plans to overhaul the prison service and recognised that strengthening family relationships should run like a ‘golden thread’ through attempts at reform. The importance of positive influences and interventions delivered by public health professionals can improve outcomes and help to reduce the chances of re-offending on release from prison (Finnie, 2018).

The Prison Advice and Care Trust (PACT), an independent UK charity that provides practical support for prisoners and families, aims to minimise the harm caused by imprisonment.

In 2016, PACT, which was based in a local prison, approached the professional lead for health visiting at the Abertawe Bro Morgannwg University Health Board with a proposal to deliver a pilot public health initiative in South Wales. The aim of this key initiative was to build stronger family relationships through health promotion. PACT identified a need to support fathers with parenting and turned to health visitors to work in partnership. Baybutt et al (2014) suggests that HVs could be motivators in assisting diverse communities such as prisons to reduce health risks by promoting health within the prison itself.

ACEs trauma

Early identification, prevention and intervention of health needs are key priorities of the Healthy Child Wales Programme’ (HCWP), which provides a universal health promotion service for children and families in Wales. The emphasis is on three areas of intervention: screening, monitoring and supporting child development and promoting immunisations (Welsh Government, 2016). There is significant evidence that children who have been exposed to adverse childhood experiences (ACEs) are more likely to experience poorer long-term health and social outcomes (Public Health Wales, 2016).

ACEs reflect a range of traumatic and stressful experiences such as parental substance misuse, mental health issues and domestic abuse (Bellis et al, 2014). HVs in Wales are aware of the importance of considering ACEs when working with families in order to build resilience and improve long-term health outcomes. A parent in prison is one such ACE; 65% of boys with a convicted father will go on to offend themselves (Barnado’s, 2015).

This new prison public health initiative is the first of its kind in the UK. The aims of the intervention were for HVs to deliver the HCWP to fathers of children under three years of age, in order to facilitate positive and loving interactions, through promoting bonding and attachment.

Planning and delivering

Generic HVs and community nursery nurses were selected through an expression of interest, following a presentation by the professional lead for health visiting. Initially, approximately 15 people responded. Following this, HVs, nursery nurses and managers met in the prison with members of PACT and prison personnel to discuss how the programme would be delivered and how the fathers would be recruited. Fathers were selected by the PACT team following discussions with the probation and child and family services.

Prison protocol was strictly followed with children; their carers and health professionals were all searched on arrival. A prison guard was allocated to each of the fathers who attended the group. The group on average consisted of two to five prisoners. The prison was responsible for purchasing equipment, such as weighing scales and developmental assessment tools that would be used routinely in practice. Weekly two-hour sessions were facilitated by two HVs and a nursery nurse, covering topics related to the HCWP. These include information on immunisations, child nutrition, dental care, growth and development and accident prevention. The sessions took place in a child-friendly environment with a large selection of age-appropriate toys. Practical hands-on advice was given in terms of healthy eating. Children were given their own toothbrush and toothpaste, allowing the HVs an opportunity to discuss the importance of good oral health with the parents. Creating a sociable, engaging and friendly ambience allowed the fathers to feel involved when carrying out practical demonstrations.

A bespoke and tailored approach to health promotion was required to suit the ages of the children. One father was tasked with bathing his four-week-old baby for the first time. In order to capture this special moment, the father was photographed by a PACT worker with his permission.

Other health promotion activities included demonstrating to fathers basic life support and choking management for babies and toddlers. Opportunities arose to discuss certain aspects of the HCWP, and anticipatory guidance was given to parents to have a better understanding of their own child’s next stages of development. These activities offered the opportunity to not only show practical skills, but also discuss what positive parenting might mean to them. At the end of each session, the fathers were involved in ‘rhyme time’, which ensured both the children and fathers left on a happy note.

One father was tasked with bathing his four-week-old baby for the first time, and the special moment was captured on camera

Feedback was sourced by PACT from fathers based on four questions:

  • What did you learn from the session?
  • Will this change anything you may do as a father and if so what?
  • Has this made you more confident and if so in what way?
  • Is there something else you would like us to teach you at the following sessions?

See Fathers’ feedback, below.


Fathers' feedback

‘We learnt first aid, which was amazing’ – Father of a six-month-old

‘My daughter was two weeks old when I came into prison and I wouldn’t have got to do the parenting things if it wasn’t for this’ – Father of a two-year-old

‘I had a chance to sing along with my children for the first time, do puzzles and watched them both learn new words. It was amazing’ – Father of 13- and 29-month-olds

‘Enjoyed rhyme time done by health visitors’ – Father of a nine-month-old


Working Challenges

The prison is a category B/C prison for adult males remanded into custody, as well as convicted and sentenced prisoners. This presented a challenge in itself: as many of the prisoners are incarcerated on a short-term basis, the turnover of fathers was high. In addition, if there had been an altercation or breach of rules prior to the session, the father would be stopped from attending, resulting in his family being turned away. Some of the fathers were from outside the local health visiting area, so it was essential they were informed that if any concerns in relation to safeguarding arose, local policies would be followed and the information would be shared with relevant agencies.

Behaviours are deeply embedded and are notoriously difficult to change (NICE, 2014). Building rapports, identifying barriers and being mindful of educational and social backgrounds were important factors to consider in overcoming such difficulties when forming relationships and motivating change (Bidmead, 2013).

Discussion

A fundamental principle of health visiting is to search for health needs (Naidoo and Wills, 2016). The awareness of the father’s own health needs and that of his children would also assist in delivering health promotion based on family requirements. HVs are in a key position to support health needs. This initiative has broken down barriers when speaking with families in how to deal with incarceration. Resources for prisoners and families alike were sourced from PACT: for example, a ‘William the Bear’ information card. This card helps to support mothers in dealing with questions their children may pose about their fathers being away from home. Cards have been sent out to all HVs within the trust.

Incarceration has socioeconomic implications on public health services. It is anticipated that encouraging fathers to develop bonds with their children will lead to a decrease in re-offending rates. It is hoped that such interventions will positively influence the upbringing and education of the fathers’ own children (Finnie, 2018).  

Jo Lamb is an operational lead generic HV and Mel Griffiths is a Flying Start HV, both at the Swansea Bay University Health Board.


Resources  

  • PACT has child-friendly resources, including animations, and a ‘William the Bear’ character who visits prison: prisonadvice.org.uk  
  • Barnardo’s supports children with a parent in prison: barnardos.org.uk  
  • The National Information Centre on Children of Offenders provides support to all professionals in contact with the children and families of offenders: nicco.org.uk

References

Barnardo’s (2015a). Children affected by the imprisonment of a family member: a handbook for schools developing good practice. 
www.barnardos.org.uk/16871_schools_handbook_prisons_2015_v4.pdf (accessed 9 October 2019).

Barnardo’s. (2015b) Locked out: children’s experiences of visiting a parent in prison. See: https://www.barnardos.org.uk/locked-out-report.pdf (accessed 9 October 2019). 

Baybutt M, Acin E, Hayton P, Dooris M. (2014) Promoting health in prisons: a settings approach. In: World Health Organization (ed). Prisons and health. See: 
http://www.euro.who.int/__data/assets/pdf_file/0018/249210/Prisons-and-H... (accessed 9 October 2019).

Bellis AM, Lowey H, Leckenby N, Hughes K, Harrison D. (2014) Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health 36(1): 81-91.

Bidmead C. (2013) The importance of relationship building in supporting families. Journal of Health Visiting 1(3): 1-10.

Finnie J A. (2018) Integrating prevention and health promotion in a London prison. BMJ Open Quality 7(1): e000097. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759718 (accessed 9 October 2019).

Farmer, Lord (2017). The importance of strengthening prisoners' family ties to prevent reoffending and reduce intergenerational crime. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploa...

Kincaid S, Roberts M, Kane E. Children of prisoners: fixing a broken system. See: https://www.nicco.org.uk/userfiles/downloads/5c90a6395f6d8-children-of-p... (accessed 9 October 2019).

Naidoo J, Wills J. (2016) Foundations for health promotion (fourth edition). Elsevier: London.

National Information Centre on Children of Offenders. (2019) Supporting all professionals to work with offenders’ children and their families. See: https://www.nicco.org.uk (accessed 9 October 2019).

NICE. (2014). Behaviour change: individual approaches (PH49). See: https://www.nice.org.uk/guidance/ph49 (accessed 18 October 2019).

Public Health Wales. (2016) Adverse childhood experiences. See: http://www.wales.nhs.uk/sitesplus/888/page/88504 (accessed 9 October 2019).

Welsh Government. (2016) Healthy Child Wales Programme. See: https://gweddill.gov.wales/topics/health/publications/health/reports/hea... (accessed 9 October 2019).

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