Static and Dynamic Non-Residential Intervention Service (OPD) - HMP Low Newton

Background:

Launched in 2011, the Offender Personality Disorder Pathway (OPD) is a jointly funded partnership between HMPPS and the NHS in England and Wales. It is a long-term change programme that commissions treatment and support services nationally for individuals with some of the most complex mental health needs linked to their offending. Whilst a diagnosis is not required to access services, these needs are characterised as a ‘personality disorder’. Services for people within scope are delivered across prisons, Adult Secure Mental Health Services, and community settings. The OPD is not a single service, but a connected system of interventions, activities, training, and staff support.

The OPD Pathway plans to commission a clinical provider for a non-residential OPD intervention service for women in HMP YOI Low Newton. Operating in partnership with HMPPS, the service will provide one of the progressive steps along the pathway for women who present the highest/ most immediate risk of serious harm to others and have the most complex needs who screen into the OPD Pathway.

The service is currently commissioned through a service level agreement (SLA) that was established prior to the formal development of the OPD programme.

The service in question will engage with up to 12 women on a static basis at any one time, and a smaller number on a dynamic basis (likely to be around 5 maximum). This is not a residential provision however the women are accommodated together on a specific wing at the prison to provide a psychologically safe milieu during their time in the OPD service. The static provision involves a day treatment model delivered at a specific location in the establishment. The dynamic spaces are in place for outreach work delivered to women on other locations in the prison who either need stabilisation, preparation for access to the static service, or post-intervention work.

The static day provision OPD treatment service is for up to 12 (twelve) participants meeting the criteria defined below.

The dynamic day provision OPD Treatment Service is for up to 5 (five) participants meeting the criteria defined below.

Organisational requirements:

• HMP YOI Low Newton provides the conditions for a sustained and consistent therapeutic operation evidenced by a service-level memorandum of understanding / partnership agreement between Low Newton (HMPPS) and the clinical provider;
• There are explicit governance arrangements to balance the demands of the treatment tasks and the wider operational requirements, these are evidenced via the service-level memorandum of understanding / partnership agreement between the clinical provider and HMPPS
• There is an integrated multi-disciplinary team which communicates across all staff groups and with participants;
• There is a sustained focus on staff training, reflective practice and regularised supervision appropriate to the specialist nature of the service and staff’s individual roles and responsibilities;
• There are an effective collaborative working agreement and operational arrangements between the partners for management, decision-making, problem resolution and service delivery, these are evidenced via the service-level memorandum of understanding / partnership agreement;
• The service develops and adapts on the basis of evaluation, audit, research, learning, experience and offender participation feedback;
• The clinical provider develops a training plan to increase, over time, the awareness levels, capability and confidence of all staff working with this population;
• There is designated administration provision to facilitate the work of the Service.

The treatment service will have specific features:

• Participants will complete a programme of psycho-social and learning activities, based on one-to-one and group work and identified via a formulation approach, that increases their motivation to engage in current and future treatment; increases and improves coping strategies; develops pro-social behaviour; and improves psychological health. The clinical leadership for this programme will fall to the health provider;
• The service operates an integrated model of care, involving health, criminal justice and social care professionals, as well as non-statutory partners as appropriate, which can inform and deliver treatment to meet the spectrum of need. The model is underpinned by the concept of relational security and a clear understanding of the importance of boundaries;
• There is a coherent philosophy of care devised and promoted by the clinical provider that is understood by staff and participants and supported by policy and operational practice documentation;
• Referral and assessment processes are designed to ensure that the service appropriately targets the participants and are integrated with other OPD service referral criteria;
• The service operates at the agreed contract capacity; namely 12 static places and up to 5 dynamic places at any one time with a minimum occupancy level defined in the contract, to be reported quarterly;
• The participant reports that the service is useful in helping them to make progress, and that they feel healthier, more stable, and increasingly motivated to engage in current and future treatment;
• Participants, staff, and visitors feel safe in a psychologically-safe, supportive and respectful environment;
• There is a reduction in adjudications, self-harm, and suicide attempts in this treatment service population;
• Plans are in place for each participant to make a progressive move post-treatment, and to enable appropriate follow-up, regardless of the move-on location.

Service User Groups:

Participants must screen into the OPD Pathway using the most recent Oasys assessment. Screening criteria may be checked using manual tools.

Once screened in, women become eligible for the intervention service as long as they are aged 18 years or over and have at least 3 years left of the custodial element of their sentence for a place in the static service or 6 months for the dynamic element. Other participants may be considered where there is a clinically justifiable reason for doing so that is related to their risk of serious harm to others. The provider will accept an agreed number of women on Restricted Status, as specified in the contract

Service Model:

The service will develop and implement an assessment and treatment model that works alongside a staff and workforce development plan, partnership agreement, and management, clinical and governance expectations. It should include the following features;

• A pathway approach covering outreach, stabilisation (where appropriate and needed), preparation, active interventions, practice, progression, and follow-up;
• A focus on the end from the beginning, affording full and safe preparation for the end of relationships and move on to a new service;
• It is based on a bio-psycho-social model of relational difficulties;
• It operates a joint service under collaborative clinical and operational leadership;
• It uses a formulation and outcome-based approach;
• It provides a range of group and individual interventions on an assertive ‘day treatment’ model;
• Gender-sensitive, it reflects the principles and criteria set out in the OPD Guidance for Women’s Services
• It provides training and develops and delivers a framework for reflective practice and clinical supervision to both HMPPS and clinical staff
• It has consistent and reliable operational support arrangements agreed with HMPPS and set out in a memorandum of understanding/ partnership agreement

Service Level Outcomes:

There is a further expectation that each participant in this service has an assessment, case formulation, and sentence/treatment plan which:

• enable staff to have a better understanding of the person, risk factors and effective management strategies;
• help the participant to better understand the risk scenarios and strategies she needs for managing those risks;
• help participants actively engage in evidence-based, gender-sensitive, trauma-informed group and/or individualised treatment activities focussed on improvements in their relational difficulties reduction of risk of serious harm;
• enable participation throughout the week in constructive, pro-social living activities that are designed to reflect likely experiences in the community and stable prison settings;
• enable appropriate interpersonal relationships to be developed between participants themselves and with staff which model skills required to make progress on their sentence, including working towards pathway progression, recategorization or release;
• result in participants, staff and visitors feeling safe in the treatment environment and across the establishment.

The proposal is to award a five year contract, subject to ongoing funding.