Using multiple case studies of health and justice services to inform the development of a new complex intervention for prison-leavers with common mental health problems (Engager)

Abstract

Background People in the criminal justice system have complex needs but often do not make use of services outside of prison, in many cases due to poorly joined up working between health and criminal justice services. The ‘Engager’ programme aimed to develop a complex collaborative care intervention for people leaving prison with common mental health problems that could support their transition into the community and facilitate joined up working between health, justice and social services. To augment our core intervention theory, we wanted to learn from innovative and forward-thinking services providing interagency support and/or treatment for people experiencing common mental health problems within the criminal justice system. We wanted to identify key elements of interagency practice to understand what was and was not effective in engaging people, maintaining their contact and improving mental health and other aspects of their lives. Method We used a multiple case study design with a focused ethnographic approach in four study sites. Data came from three sources (documents, field notes and semi-structured interviews) underwent a framework analysis. Results We identified seven main themes, namely: collaboration, client engagement, client motivation, supervision, therapeutic approach, peers and preparations for ending. Engaging and motivating clients was dependent on the relationship built with the professional. This relationship was developed through building trust and rapport, which required time and respectful, open and honest communication. Professionals were often unable to build this relationship effectively if they did not work in effective interagency collaborations, particularly those which included shared practices and were supported by effective supervision. Conclusions The multiple case study design contributed insights as to how health and justice services work together. The main themes identified are well known factors in health and justice co-working. However, the novel insights were gleaned examining interdependence and interactions in complex, multifactorial phenomena and practice, in particular the importance of shared practice and supervision models. The approach of selecting a small number of cases representing identified knowledge gaps contributed a valuable addition to the program theory and delivery for an innovative complex intervention.

Development and evaluation of a collaborative care intervention for male prison leavers with mental health problems: the Engager research programme

“…The organisational case studies article is published. 38 The organisational case studies aimed to augment our emerging core intervention theory by gaining learning from a range of promising services that provided support and/or treatment for people experiencing common mental health problems within the CJS. The organisational case studies also aimed to identify key elements of practice, for example what was and was not effective in engaging people and maintaining contact with the service.…”

Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial

“…21,22 Our ability to follow-up was based on extensive feasibility work and a substantial and proactive team of researchers. 10,11 Our pre-trial work developing a theoretically informed, [16][17][18] practically tested 11,18 and then adapted intervention 18 is a further strength. The explicitly flexible intervention designed to support personalised integrated care was developed with high fidelity to methods recommended by the Medical Research Council.…”

“…2 Feasibility work demonstrated the ability to recruit in prison and follow-up individuals in the community. 10 , 11 A theoretically informed intervention (‘Engager’) was developed combining therapeutic work and organisational support through mixed methods including a realist review, 16 case studies, 17 focus groups, peer-research involvement and adaptation in a formative evaluation during the pilot trial. 18 This paper reports the results of the RCT with the aim of investigating the effect of the Engager intervention plus usual care, compared with usual care alone, on psychological and social outcomes in men with common mental health problems in prison and in the months following release from prison.…”

Engagement with engager: what factors are associated with attendance in a complex intervention for men with common mental health problems, near to and after release from prison

“…We developed Engager, which is a complex collaborative care intervention for men serving short-term prison sentences and who have common mental health problems [7][8][9][10]. It is a manualized, person-centered intervention underpinned by a mentalization based approach.…”