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A prisoner looking out of her cell window at HMP Holloway, the main womens prison in London.
Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

Tackling violent offending by women

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Evaluation of the Choices, Actions, Relationships and Emotions (CARE) programme for women who have a history of violence and complex needs.

Last week (6 June 2019), the MoJ published a new evaluation of the Choices, Actions, Relationships & Emotions (CARE) accredited programme for women prisoners with a history of violence and complex needs.

The report, by Keely Wilkinson, Sinead Bloomfield and Sarah Ashcroft, is both a process and interim outcome study which was undertaken in 2015, focusing on 99 programme participants at New Hall and Foston Hall prisons.

The Programme

CARE is an accredited custodial intervention for adult women who have a history of violence and complex needs, and a medium to high risk of reconviction. CARE was designed to reduce reoffending, and the risk of harm women pose to themselves and others by helping them to gain insight into their thoughts, feelings and behaviours, equip them with skills to manage their emotions, problem-solve and help them to develop a pro-social identity.

The programme uses an integrated model of change to incorporate the bio-psycho-social model Risk, Need and Responsivity principles and desistance from crime literature. CARE has been specifically designed for delivery to medium to high risk of reoffending women prisoners, who have a history of violence and present with challenging rehabilitation needs. Women on the programme may have found engaging in rehabilitative interventions to be difficult previously due to their complex needs which can include substance misuse, trauma, poor mental health and self-harm/suicide attempts.

Whilst on the programme, the women work on the following targets; awareness, motivation and engagement, emotion management, coping skills, and social inclusion and resettlement. Work on these targets is achieved through a range of holistic, multidisciplinary and integrative techniques including cognitive behavioural therapy, narrative therapy, mindfulness, emotion approach coaching and pro-social modelling. Alongside the programme, a mentoring and advocacy service supports the women with resettlement plans in areas such as employment, accommodation, finance, and family services.

© Andy Aitchison

Findings

The overall results of the evaluation suggest positive short term outcomes for the CARE programme, as well as positive perceptions from both participants and staff.

  • Statistically significant differences between pre and post programme scores were found in the majority of programme targets (emotional management, coping styles and anger management), which were measured by two psychometric tests. The differences were in the desired direction and had small to large effect sizes.
  • Significant reductions were also found in the mean number of proven adjudications in the 12 months following programme completion, compared to the 12 months pre-programme. Reductions were also observed for incidents of misconduct, and incidents of self-harm but these were not statistically significant. All results had small effect sizes.
  • Programme participants gave positive feedback on their post programme questionnaires, with the vast majority (90%) of participants reporting they enjoyed CARE. Sessions on assertiveness, safe space and mindfulness were seen as most valuable. Three quarters of programme participants reported already using the skills learnt on CARE and all were confident of using the skills in the future. Most participants had set future goals following the completion of CARE including being more assertive, building confidence and getting out of prison.
  • Feedback from staff interviews and focus groups was very positive. Staff felt there was clear value to providing a programme designed specifically for women and their needs. The complex needs of the participants on CARE does make it a particularly challenging programme to run, however staff felt that the programme content and the multidisciplinary nature of CARE allowed participants to make progress and work towards their goals.

Limitations

The researchers acknowledge a number of limitations to the study, including the lack of a matched control group, a relatively small number of programme completers over a four year period and a low response rate to the post programme participant questionnaire. The study also does not measure the impact of the programme on longer term outcomes such as reconviction.

As always, reconviction rates will be the most important measure of the effectiveness of an accredited offending behaviour programme. The MoJ is committed to a reconviction study but is waiting for a sufficiently large sample which has completed the programme, been released and spent 3-5 years in the community.

Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here.

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