Prison Staff attitudes towards ACCT documents

This research project will explore the prison staff attitudes on the use of the ACCT document towards management of self-harm/suicide and its efficacy. In particular the research focuses on the impact on staff attitudes in using the ACCT document. According to the HM Inspectorate of Prisons for England & Wales (2008-2009) the suicide/self-harm rate continues on downward trend and in 2008 saw the lowest number of self-inflicted deaths in prisons since 1995. McHugh and Snow cited in Ireland and Quinn (2007) stated that levels of self-harm behavior are reported to be higher among prisoner than suicides, with the number of incidences of self-harming behavior more frequent. Ireland and Quinn (2007) point out that Negative attitudes Towards Prisoners who engage in self harm is also evident, self-harm among prisoners is ignored or dismissed as a function of their personality or as evidence of manipulative behavior.

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The prisoners who are “at risk” are defined as the prisoner who present with a risk of self-harm /suicide. They are the prisoners who are vulnerable in the custody and present a challenge of maintaining their safety. In 2002 the Department of Health published National Suicide Prevention Strategy for England outlined government proposals to achieve a reduction of at least 20% in death rate from suicide by 2010. It also outlined strategies for prisoners who repeatedly self-harm, A Report by Manchester University, 2006. The HMCIP 1999 Thematic Review examining the then current state of suicide prevention in prisons at that time noted that there were faults with the policy. The use of F2052SH form (which was used to manage the prisoners at risk of suicide and self-harm) was heavily criticized as a paper exercise and its lack of care planning for the prisoners at risk, A Report by Manchester University, (2006). Furthermore since its inception there had been no reduction of self-inflicted deaths in prison (HMCIP 1996, Reed & Lyne 2000).

A project was then commissioned under Safer Custody Group, HM Prison Service in collaboration with Prison Health, Department of Health and with input on a consultancy basis from the research team at Manchester University and the Institute of Psychiatry, this the led to the introduction of the ACCT (Assessment, Care in Custody and Teamwork) document of managing prisoners who are at risk of suicide/self-harm. The underpinning ethos of this new document was the Care Programme Approach, which focused on the development of individualized care plans following a formal comprehensive assessment of health and social needs. The ACCT document was introduced in January 2004.

It has now been 7 years since the ACCT document was introduced in the HM Prison service and it has indeed bedded in. This has prompted questions to know if it’s a useful mechanism to manage the prisoners with a risk of suicide or self-harm. There is a growing interest to explore the attitudes of staff that are in the frontline of implementing the ACCT document.There is also a vital role played by the professionals in prison who have implemented these processes to manage the “at risk” prisoners. Therefore the author’s interest is to find out if indeed the introduction of the new system changed attitudes towards management of self-harm in turn leading to better management of prisoners “at risk”.

There is a paucity of evidence specifically addressing the attitudes of prison staff towards the implemented ACCT document. There have been studies which have looked at the staff and prisoners attitudes towards prisoners who present with a risk of suicide and self-harm. However in all these studies, Ireland & Quinn (2007), Kjelsberg et al (2007), and A Report by The University of Manchester, The Institute of Psychiatry and Imperial College, London (2006) there was no focus on staff attitudes towards the implemented ACCT document. The Report by The University of Manchester, The Institute of Psychiatry and Imperial College, London (2006) although discussed the ACCT document in its initial stages, as it was reviewing its piloting stage. It has not revisited the ACCT document to review staff attitudes towards using it.

The prevalence of self-harm, suicidal behaviour and suicide are higher in the prison population than the wider community (Singleton et al 1998) and they went on further to point out that the figures of attempted suicide rose by 2 fold in remand prison. It is important that the professionals who look after prisoners in the correctional facilities hold positive attitudes to the activities and documents which safe guard the vulnerable prisoners. Therefore the prison staff it is of interest to investigate the attitudes towards a document which is viewed as maintaining the safety of the vulnerable prisoners at risk of suicide and self-harm. As pointed out by Kjelsberg et al (2007) positive attitudes held by prison staff has been shown to be critical in facilitating change in prison inmates. In the studies looked at the knowledge regarding attitudes toward the implementation of the ACCT document lacking. Therefore the author wants to increase the knowledge in the field by conducting the study.

Working title provided

A study of prison staff attitudes towards implementation of ACCT (Assessment, Care in Custody and Teamwork) process in management of offenders who present with a risk of self-harm/suicide in a male remand prison.

Clear research question given

How the implementation of ACCT document has affected prison staff attitudes towards management of self-harm/suicide in prisons?

Objectives clearly described

To examine prison staff attitudes on the use of the ACCT document towards management of self-harm/suicide and its efficacy.

The ACCT document has been in place for the past 7 years and staff have had the opportunity to see it in action, discuss and critic it. The author intends finding out about the prison staff attitudes towards implementation of the ACCT document. The attitudes will be viewed in the light of managing prisoners who present with a risk of self-harm and suicide as the document sets out to manage this risk. The term prison staff will cover any of the professional who work in the frontline in the remand prison where the research is to be conducted.

In view of the objectives the author hopes to: provide an understanding of the prison staff attitudes towards management of “at risk” prisoners using the ACCT document. The findings will therefore cement the correctness of the management document at present or lead to evaluation of the document and inform in the design of new strategy.

Methods clearly described

A qualitative study involving semi structured interviews and a vignette will be carried out. A purposive sample of key informants will be identified and interviewed at the site of the research. This will include prison staff whose daily responsibilities bring them into daily contact with the management of prisoners “at risk”. The identified key informants will be the Safer Custody PO and Senior Officer, The Residential Governor (who deals with the safety and accommodation of the prisoners) and chaplaincy.

In order to elicit the opinions and experiences of those directly involved by the implementation of the ACCT document, a number of operational level prison staff will be interviewed. Interviews will focus on the ACCT document procedures and also explore the attitudes towards using it as a document to manage prisoners “at risk”. The interviews will be semi structured and will be taped (audio recorded) and transcribed. The interview is expected to last to 20-30 minutes and the author will conduct the interviews in the private area and independent of each other.

Methods appropriate for research question, in terms of:-
Study design

As highlighted above the author will use Descriptive design. This will be a Qualitative study employing the use of in-depth interviews. This design has been chosen as interviews in qualitative research are usually wide ranging, probing issues in detail. They seldom involve asking a set of predetermined questions, as would be the case in quantitative surveys. Instead they encourage subjects to express their views at length. This suits the project as the focus is to elicit the patterns of behaviour. The author will use critical incident study (vignette), in which subjects are asked to comment on real events rather than giving generalisations. This is hoped that it will reveal more about beliefs and attitudes and behaviour.

The author will also audit at least 10 closed ACCT documents for text analysis of the entries. The ACCT documents will be reviewed and cross referenced in line with thematic results from in depth interviews.

Sample selection, including inclusion/exclusion criteria

The sampling of the subjects will be from a local remand prison. The inclusion criteria will cover members of staff (both male and female) who have worked in the prison system between year 2003 and 2009. This will capture the members of staff who have experience of working with the ACCT document to manage prisoners who are “at risk”. The study will include the frontline staff up to the Senior Officer level as the Senior Officers are the managers of the wings ensuring that the ACCT document is fully implemented and adhered to. The author will want the subjects who have implemented the ACCT document for a significant period of time. The members of staff who meet the criteria will be identified with the help of the OMU Human Resources Department and letters of invitation sent to request and notify their participation in the research. The study will also include the multiple professionals who work with the ACCT document i.e. the Chaplaincy and CARATS workers.

The study will exclude members of prison staff who have less than a year in the prison service at the start of the project (2009). The governor’s level will be excluded as there are few governors in the local remand prison to justify any statistical significance. However they will be one of the informants in discussion interviews.

Sample size, including consideration of non-response

The author intends to conduct in depth interviews to 20 members of staff. The anticipated response rate is expected to be about 80-90%. There has been indication that members of staff responded well from the previous study which looked at the initial stages of the implementation of ACCT document in a report by The University of Manchester, The Institute of Psychiatry and Imperial College (2006).

Availability of subjects/data

The Governor has recently awarded Certificates to long serving members in the local prison; the number was above the required sample for this study to be carried out. The author has confidence that availability of subjects will not be an issue.

Piloting questionnaires/methods

The in depth interviews will be designed including the vignette and informally piloted among the members of staff who are not going to be involved in the study. The comments received from the piloting group will be included and also used to modify the research.

Data collection

The information collected will be the opinions and views of the prison staff during the face to face interviews. The data will be stored in a created Database and with unique Ids stored separately in a locked cabinet. The data might be affected by the years of experience of the subjects of having worked with the ACCT document and also of having worked with its predecessor document the F2052SH.

Data analysis

The resulting data will be transcribed then analysed using one of a variety of techniques for analysis development and interpretation on key themes. The ACCT closed documents will be reviewed against the themes received from the in depth interviews. A number of themes generated will be analysed compared to the findings from in depth studies.

Proposed approach is feasible in context of MSc project.

The approach of a qualitative methodology aimed to assess the impact of attitudes on the ACCT documents from a variety of staff working in prison service matched against documentations in ACCT documents so that a full picture could be developed is considered by the author as a feasible study for an MSc. The author is aware that they will be constraints in the level of staffing as currently the government has embarked on streamlining services to meet budgetary needs. This will have impact on interviewing sample subjects, the author will endeavor to fully interview 20 members of prison staff which will represent 60% of frontline prison staff employed at the establishment. The study period of a year will allow the missed interviews with staff to be re-arranged as this can be to sickness, annual leave and other work commitments.

Ethical issues and Approval

Full consideration will be given to the ethical implications of conducting the qualitative strand of this research project. Prospective participants will be provided with verbal and written information about the study, and will be advised that the decision to participate rested entirely with them. Assurances regarding participants’ anonymity will be made, and a written transcript of the interview will be made available on request and when transcribed it will be stored as coded. All participants must sign a consent form acknowledging their willingness to take part under the terms outlined to them.

Before providing consent, participants will be informed that the interview will be confidential with the following exceptions; if the participant provided information suggesting an immediate risk to their own safety, the safety of another person, or the security of the establishment. Participants will be informed of any occasion when the researcher will breach confidentiality for these reasons. It is acknowledged that this research on the ACCT document and the questioning of the participants will evoke emotional feeling as some of the participants will have witnessed several incidents of “death in custody” in their time of service. The author will negotiate therefore with the Governor that should a a case arise then the Care in Custody team (dedicated to looking after the welfare of prison staff) which always has a member of staff on call on site in our local establishment will be involved.

The author has already sought the permission of the Governor in the establishment to carry out the research. The author has also completed the request for ethical approval from OMU (Offender Management Unit) IRAS (Integrated Research Application System). I am waiting for this Research Protocol, from the R &D approval to fully submit it to the IRAS.

It is hoped that the research will train the author as a researcher and help to gain knowledge which may develop better theoretical models in the establishment to manage the prisoners “at risk” and possible contribute to further public policy.

Costs and Timetable

The project will involve a significant period of time as there is going to be the face to face interviews which will involve 20 prison staff. The interviews are also going to be audio taped and verbatim transcribed. The author intends to request the services of the PA to the Forensic Consultant for transcribing and it is understood that it may incur a charge of ?10.00. There will be additional nominal fees for inter library loans, printing, photocopying and this has also been set at approximately ?10.00. The author will also set aside another ?10.00 which will cover any arising cost as the project progresses. The investment in time will purely be from my time, the progression and completion of the project is displayed in the attached GNATT Chart.