Factor humano

Mentoring describes the development of a relationship between two individuals in which the mentee is able to learn from the mentor, model positive behaviour and gain experience, knowledge or skills.167,168

Peer mentors, as defined by Finnegan and colleagues,168_{have a similar background or experiences to their}

mentee. Peer mentoring has been proposed as an approach to engage disadvantaged and excluded young people by offering role models to encourage and inspire them.169_{There are a number of peer mentoring}

schemes in UK prisons focused on education and training, such as the Learning Ladder,142_{and on}

resettlement and prevention of reoffending.

One study122_{reported quantitative findings relating to the effects of peer mentoring on prisoner health.}

The study used a one-group design and reported outcomes relating to substance use, employment and reoffending at 3, 6 and 12 months’follow-up.

One qualitative study147_{provided evidence on life coaches (many of whom were ex-offenders).}

Adherence

At 3 months, 38/44 participants (86%) were receiving outpatient psychiatric services and 40/44 (91%) were successfully managing their medication. At 6 months, 36/44 participants (82%) were medication compliant and 35/44 (80%) demonstrated symptom reduction. In total, 12/44 (27%) had not maintained sobriety at the 6-month time point.122

Reoffending

In the study by Goldstein and colleagues,122_{17/22 (77%) participants released for at least 12 months had}

not been rearrested.

A qualitative evaluation study of Routes out of Prison, which uses life coaches (many of whom were ex-offenders), showed positive effects on recipients’propensity to reoffend. Many attributed this change in attitude and behaviour to the relationship developed with the life coach and viewing the life coach as a credible role model.147

Behaviour

In total, 16/22 participants (73%) in the study by Goldstein and colleagues122_{who had been released for at}

least 12 months were abstinent in the use of alcohol or illegal drugs or the misuse of prescription drugs.

Employment

In total, 16/22 (73%) participants in the study by Goldstein and colleagues122_{who had been released for}

at least 12 months were employed, were enrolled in an educational programme or had completed the application process for disability benefits.

Housing

In the study by Goldstein and colleagues,122_{18/22 (82%) participants who had been released for at least}

around health behaviour change and/or signpost them to other services, some of which are also free at the point of delivery (see Health Trainers England website: www.healthtrainersengland.com’). Health trainers work with disadvantaged communities and are often recruited from those communities. They receive training to reach standardised competencies and are usually employed by the NHS.170_{The health trainer}

role was introduced in the 2004 public health White PaperChoosing Health2_{as a means of tackling}

inequalities by providing peer support around lifestyle change and in 2006 a health trainer initiative was piloted across three adult prisons, one YOI and one probation service.28_{The service has since expanded}

and there are now health trainer services in a number of prisons across England and Wales. Prison health trainers receive standardised training on health promotion, healthy lifestyles and mental health, with the training adapted for the prison setting and client group.

One study136_{reported quantitative findings on the effect of health trainers on prisoner health. This was a}

multimethod evaluation, including interviews, questionnaires, focus groups and analysis of monitoring data.

Confidence

Health trainers seemed most confident in signposting to exercise, smoking cessation and drugs services and least confident in signposting to self-harm, immunisation and dental services (Table 6).136

From qualitative research it was evident that training as a health trainer had been a huge boost to prisoners’confidence, self-esteem and self-worth,136_{although this was not specifically reported}

by prisoners themselves but by key staff involved in the programme. There was, however, evidence of health trainers bolstering other prisoners’reported self-esteem and confidence through listening and supporting individuals.136

Knowledge

Two qualitative studies showed that the health trainer training programme appeared to have successfully increased individuals’knowledge on a variety of topics, including drugs, sexual health, nutrition, alcohol and mental health issues.136_{Attitudinal change, often as a result of increased knowledge, was seen primarily in the}

area of smoking and diet136_{and this resulted in behavioural changes.}136,148_{For example, health trainers}

reported eating more fruit and vegetables and one health trainer had given up smoking.136,148

Improvements were seen in mean knowledge scores in all areas in one study136_{but it was not possible to}

ascertain whether or not these improvements were statistically significant as no measure of variance was given.

TABLE 6 Numbers of health trainers stating that they were_‘very confident_’in signposting to services136

Service n/N(%) Exercise 12/17 (71) Smoking cessation 11/17 (65) Drugs 10/17 (59) Healthy eating/diet 9/17 (53) Sexual health 8/17 (47) Alcohol 8/17 (47)

Mental health issues 7/17 (41)

Dental health 4/17 (24)

Self-harm 3/17 (18)

Attitudes

In one study136_{>50% of health trainers stated that their attitude had changed in the areas of healthy}

eating/diet, sexual health, smoking cessation, exercise and mental health. In total, 75% of health trainers stated that they would like to get a job as a health trainer on release from prison.

Prisoner outcomes: issues discussed with health trainers

Issues most likely to be discussed with health trainers were reported in one study136_{to be exercise, weight}

and healthy eating (Table 7).

Onward referrals

Health trainers in one study136_{were most likely to refer clients to gym staff or health-care staff (Table 8).}

Referrals were also made to Counselling, Assessment, Referral, Advice and Throughcare Services (CARATS), counsellors, dentists and opticians.

In total, 75% of clients stated that they would like another appointment with a health trainer.136

TABLE 7 Issues that clients discussed with health trainers

Issue Discussed by (%) Exercise 68 Weight 50 Healthy eating 50 Smoking cessation 23 Stress 11 Drugs 9 Dental health 6 Alcohol 5 Poor sleep 4 Mental health 3 Sexual health 2 Cancer 1 STIs 0

TABLE 8 Onward referrals from health trainers

Service

% of clients referred

No. of prisoners with no previous contact with any prison service Gym staff 59 38 Health care 23 9 Walking programme 10 9 CARATS 7 7 Counsellor 4 4 Dentist 4 3 Optician 1 1

reported for the health trainers than for the recipients of the programme.

Participants suggested that the skills developed in the health trainer role were applicable outside of the prison context and could be transferable to the community. Both health trainers and health trainer tutors reported that health trainers had developed effective communication and listening skills as well as fostering attributes essential for team working and future employment after release from prison.136_{It was}

reported that, for those prisoners who completed the health trainer course, the recognised qualification that they attained could support efforts to find employment as a health trainer post release.136

Other peer interventions