1 / 24

A window of opportunity: psychological work in a women’s prison

A window of opportunity: psychological work in a women’s prison. Dawn Whittaker Health Adviser, Women’s Health Clinic, HMP Holloway 11th September 2009. Thanks. Teams, present and past Elizabeth Howell, my clinical supervisor. Outline. Work of WHC Range of counselling interventions

swartza
Télécharger la présentation

A window of opportunity: psychological work in a women’s prison

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A window of opportunity: psychological work in a women’s prison Dawn Whittaker Health Adviser, Women’s Health Clinic, HMP Holloway 11th September 2009

  2. Thanks • Teams, present and past • Elizabeth Howell, my clinical supervisor

  3. Outline • Work of WHC • Range of counselling interventions • Case study 1: HIV throughcare • Case study 2: brief one-to-one intervention • Case study 3: in-depth work informed by attachment theory

  4. Women’s Health Clinic • Sexual health clinic • Contraception • Cervical screening • Gynaecological assessments and referral • Breast examination and referrals • Facilitating HIV care • Facilitating Hep C treatment • Counselling and advice

  5. Vulnerable clients:findings Gabriel et al (2008) • Sample of 289 young women offenders (aged 17 to 21) at Holloway • 13.2% chlamydia prevalence • 80% no condom during LSI • 18% CSW • 53% previous STI • 63% previous pregnancy

  6. Further findings • 60% used crack cocaine • 42% injected heroin • 48% left school at 16 • 43% left school at 14 • 4% left school at 11

  7. Common presenting problems • New HIV diagnosis • Living with HIV (in prison and the community) • Hepatitis C • Risk-taking behaviour • Sex work • Sexual assault • Childhood sexual abuse • Sex trafficking

  8. Range of counselling interventions • Crisis intervention counselling • Contract-based time-limited counselling • On-going and intermittent supportive work • Advocacy and casework • Assessment and referral

  9. Key aspects of counselling • Sexual health is the primary focus • Type and level of counselling depends on patient need • Even information giving depends on use of counselling skills • Time frame that has to be worked within (Leach 2004, SSHA Manual)

  10. Window of opportunity

  11. Window of opportunity • Una McCluskey (2005) To be met as a person: the dynamics of attachment in professional encounters. Karnac. • Jeremy Holmes (2001) The search for the secure base: attachment theory and psychotherapy. Brunner-Routledge.

  12. HIV clients - audit data • Vulnerable clients, with complex medical, psychological, and social problems • 8/17 (48%) had a serious addiction • 7/17 (41%) had a severe and enduring mental health problem • 5/17 (29%) had a dual diagnosis • 7/17 (41%) were homeless (NFA) • 10/17 (59%) had immigration issues • 11/17 (65%) were irregular or non-attenders at their treatment centres

  13. HIV throughcare • A process from admission to release • Timely assessment • Identification and organisation of medical, psychological and social needs • Liaison, referral and advocacy • Counselling and advice • Pre-release planning

  14. Case Study 1 • HIV throughcare • Intermittent supportive work • Advocacy and casework • Assessment and referral

  15. Context for Case Study 2 • NICE guidelines (2007) - Identify high risk individuals - One-to-one structured discussion • Motivational interviewing - Clinical style for eliciting from patients their own good motivations for making behaviour changes in the interest of their health. - Guiding and listening. - Collaborative, evocative and honouring patient autonomy. (Rollnick, Miller and Butler 2008)

  16. Readiness for change • Importance (the why of change) • Confidence (the how of change) In brief conversations these two words are sufficient to access the motivational features, both restraining and encouraging change. (Miller and Rollnick 2002)

  17. Case study 2 • Brief one-to-one intervention • Risk reduction counselling

  18. Attachment theory • Three dimensions of insecure attachment laid down in infancy: Avoidant, Ambivalent and Disorganised • Template for how we negotiate relationships throughout life (Perry 2009) • Adult narratives reflect childhood attachment patterns (Holmes 2001)

  19. Case study 3 • In-depth work informed by attachment theory

  20. References Gabriel G, Burns T, Scott-Ram R, Adlington R, Bansi L. (2008) ‘Prevalence of Chlamydia trachomatis and associated risk factors in women inmates admitted to a youth offenders institute in the UK’ Int J STD AIDS;19(1):26-9. Holmes, Jeremy (2001) The search for the secure base: attachment theory and psychotherapy Brunner-Routledge Leach, George (2004) ‘Counselling’ The Manual for Sexual Health Advisers SSHA McCluskey, Una (2005) To be met as a person: the dynamics of attachment in professional encounters Karnac Miller, William and Rollnick, Stephen (2002) Motivational interviewing: preparing people for change Guildford Press Perry, Andrea (2009) ‘Insecure attachment and its consequences’ HCPJ, July 2009, 3-7. Rollnick, Stephen, Miller, William and Butler, Christopher (2008) Motivational Interviewing in Health Care Guildford Press

More Related