a window of opportunity: psychological work in a women’s prison dawn whittaker health adviser,...
TRANSCRIPT
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A window of opportunity: psychological work in a women’s
prisonDawn Whittaker
Health Adviser, Women’s Health Clinic,
HMP Holloway
11th September 2009
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Thanks
• Teams, present and past
• Elizabeth Howell, my clinical supervisor
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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
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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
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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
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Further findings
• 60% used crack cocaine
• 42% injected heroin
• 48% left school at 16
• 43% left school at 14
• 4% left school at 11
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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
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Range of counselling interventions
• Crisis intervention counselling
• Contract-based time-limited counselling
• On-going and intermittent supportive work
• Advocacy and casework
• Assessment and referral
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• 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)
Key aspects of counselling
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Window of opportunity
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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.
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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
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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
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Case Study 1
• HIV throughcare
• Intermittent supportive work
• Advocacy and casework
• Assessment and referral
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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)
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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)
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Case study 2
• Brief one-to-one intervention
• Risk reduction counselling
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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)
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Case study 3
• In-depth work informed by attachment theory
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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