Understanding barriers and facilitators of implementing a new assessment and bridging tool to support those at risk of repeat self-harm in prison: the qualitative RAPPS study.

内容摘要

Rates of self-harm and suicide in prisoners in England and Wales are high, exceeding rates observed in the general population, of similar age and gender. Assessment, Care in Custody and Teamwork (ACCT) is the prison service's self-harm monitoring process. Closure of this process is a high-risk time where people may be at risk of self-harm. Mechanisms to manage risk, particularly following closure of the ACCT management process, mean that many people subsequently self-harm while not being monitored. This creates an opportunity to evaluate the examination of a new tool that could be used to assess ongoing risk after an incident of self-harm and closure of ACCT, and bridge ongoing support. To assess the acceptability of a new risk tool to clinicians, prison officers and people in custody, and subsequently, develop an operational implementation pathway to embed the risk tool in practice. A qualitative study using action learning groups. A total of five action learning groups were conducted in four male and one female prison sites. These included participation from six staff and eight people in custody. Four themes emerged from the thematic analysis, including establishing an effective implementation process, consistent administration and scoring, purposeful follow-up procedure, and meaningful engagement with people in custody. Two exemplar operational pathways were presented to identify how the risk tool could be incorporated into routine practice. Although this qualitative study used transparent and systematic methods, our sample size was small and may not be representative. Suicidal thoughts, behaviours and attempts in people in prison continue to be common, and there is a need for a structured approach to reduce repetition. Action learning methods identified barriers, potential solutions and how a new tool could work alongside existing risk management. Future research should focus on the development of the exemplar pathways. In the first instance, a stakeholder working group could review the tool to make initial refinements, followed by a wider implementation study to develop the processes of how the tool could work in practice. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/159/09. We know that the rates of self-harm and suicide in prisoners in England and Wales are high. This is a concern to health professionals and prison staff who support and manage those people in custody. Although the prison system in England and Wales supports people when they are feeling at risk, we know that when this support stops, people are more likely to harm themselves again. For this reason, our study is evaluating how a new tool developed in this project can help to support people in custody and staff to monitor people who might remain at risk after an incident of self-harm. This paper examines the different views of staff working in custody and people who are in custody (prisoners) to identify what they thought about the new tool. The discussions used a format referred to as an ‘Action Learning Group’ to work out how the group could be used in practice. These groups followed a semistructured process, with the facilitator guiding the flow of discussion using a pre-defined topic guide to encourage reflection, while group members have the flexibility to explore the topic, consider barriers and determine their own solutions. The findings from talking to people working and incarcerated in custody identified four key areas to consider. The four key ideas or themes included the need to establish a straightforward pathway with a clear starting point, a consistent administration process and scoring system, reliable follow-up actions to ensure the safety of people at risk of further self-harm, and they explored how staff working in custody could develop a meaningful way of engaging with people in custody. The individuals who contributed to group discussion talked about possible ways of how best to incorporate the new tool into routine practice. We recommend that because we only talked to a small number of people that more research is needed to include the views of more people to inform implementation.