Community Based Health and First Aid (CBH&FA) in Action

Wheatfield Prison (IPS) and Irish Red Cross () Partnership Project Community Based Health and First Aid (CBH&FA) in Action Improving prison community health awareness and education through Irish Red Cross Prisoner Volunteers as peer educators Version 2 09

Project Proposal Pilot Community Based Health & First Aid (CBH&FA) in Action Programme at Wheatfield Prison, Dublin, Ireland A Partnership between Irish Red Cross & Irish Prison Service Introduction and Context in the Irish Prison Service has been predominantly reactive and only in recent years has a healthcare management structure been implemented. The new approach to health is based upon the Health Care Standards of the Irish Prison Service (2004). These have laid the foundation for moving health from a reactive medical model to a proactive and preventive one concerned with the whole person. In addition, a multi-disciplinary approach is advocated in line with WHO (2007) Whole-Prison Approach to healthcare in prisons. At Wheatfield Prison, healthcare is provided from a Health Centre serving the prison community with a prison doctor and a group of qualified nurses. Specialist medical services in Dentistry, STI, Addiction and Forensic Psychiatry are available through an in-reach programme with visiting consultants of the Health Service Executive. Psychology and Addiction Counselling is also available to prisoners at Wheatfield. Health education and awareness has been provided mostly by first aid and healthy living instructors based at the Wheatfield. Some informal health awareness is provided by medical and nursing staff of the health centre. However, there has been a disconnection between service healthcare and the important health promotion work undertaken at Wheatfield. A recent partnership has been directed to look at ways of closing this gap between school and healthcare. It is recognized, however, that only a proportion of prisoners attend the Wheatfield and health awareness does not therefore reach all prisoners. Wheatfield Prison Health Care Service CBH&FA in Action Targeting Prisoners as Vulnerable People in the Community Wheatfield Prison Service (VEC) Irish Red Cross Model of the Partnership at Wheatfield Prison 2

Both the school and healthcare recognize that the most effective awareness could be addressed in the prison through a system of peer education and this project aims to develop this. The Irish Red Cross has recently started to engage with Wheatfield Prison Health and Services and it has been identified that the notion of Red Cross Volunteering, within the prison, might be the ideal way of introducing a bottom up approach to health awareness in prisons through developing peer educators. Rationale The purpose of this project is to create a mechanism for improving the health and wellbeing of prisoners as a vulnerable community group of Irish Society through the introduction of peer educators in the prison units. The Irish Prison Service Health Care Standards (2004) are designed to facilitate a change in the approach towards the more proactive and preventive. This requires a considerable input into health education and awareness which can be more powerful when provided through peers. A proven peer-educator system can be seen through the unique worldwide network of the Red Cross/Red Crescent Movement. Building on what is Already There Wheatfield prison has an effective and a FETAC accredited Occupational First Aid Course which has graduated 20 students. It is proposed to give these 20 students the CBH&FA course building on their first aid training which equates to Module 4 as the entry point to the programme. Aim of the Project To model out the new approach in a novel context likely to test the flexibility and robustness of the intended design as an IN ACTION approach to CBH and FA to provide the identified learning needs of prisoners towards better health. Objectives By the end of the project, 1. One full Action Learning cycle will be completed which identifies the assessment, planning, implementation and evaluation of the cycle. 2. Lessons learned will be documented for national, international and global relevance which highlight how the CBH&FA design content and process can be used in action. 3. The key elements of the flexible design identified in the Implementation Guide will be tested and demonstrated in practice 4. There will be a measurable impact made in developing Standard 5 and awareness related to other Standards of the Irish Prison Service Health Care Standards (2004) in conjunction with the Health Care Service of the prison. 5. A real-time example of how a national Red Cross/Red Crescent Society in partnership with school services can contribute to the corporate goals of part of a national health service. 6. Volunteers will engage with their prison community inmates through learning and doing during the course, improving knowledge of relevant health and first aid. Tangible Outputs 15 Prison-based Volunteers will complete the CBH&FA in Action Programme The programme entry point of a public health emergency (pandemic influenza), contributes to the prison community preparedness initiative. 3

Prisoner volunteers will become more empowered in their school work through participation in the project as RC volunteers. Prisoners involved in the programme will become better aware of humanitarian principles and the concept of volunteering, thus influencing for the better, the way they think about being part of society at large when they return to it. Prisoners will have potentially added to their future employability through their commitment as an volunteer. 400 prisoners will improve their knowledge of community based health and first aid relevant to their current prison community life and their previous home community context of living. Prisoners will learn from their past community-based living to better prepare them for returning to their community after their sentence is completed. Lessons learned will include how Red Cross Societies and Prisons can work together The pilot programme will be able to be extended to other Irish Prison sites and branches of the to contribute to the Health Care Standards (2004) nationally. The lessons learned whilst implementing this project in a prison context can be used in the development of similar partnerships in different contexts and cultures. Resources available Volunteer group and community of practice Wheatfield (VEC) teachers Lead Teacher in Health, Fitness and First Aid (FETAC accredited instructor) Health Care nursing practitioners General Medical Practitioner and specialist physician inputs Prison Health Care Manager (Irish Red Cross Volunteer coordinator and Federation experienced consultant in Health & Care, Disaster Preparedness, Organizational Development and Training). All equipment required for First Aid training to national FETAC standard Teaching classrooms 4

Draft Project Planning Matrix Wheatfield Prison-Irish Red Cross Partnership Initiative Introdu Pilot Community Based Health & First Aid In Action Indicator Sources of Verification Assumptions/ Risks Overall Goal A cadre of RC Special Volunteers are active in Learning by Doing in their local prison community about promoting health and first aid relevant to needs identified. Evidence of a change in the community that reflects healthier behaviours and knowledge. Good results in end of Topic tests The project is supported by Governors and Discipline Officers of Wheatfield Prison, the and IFRC Health & Care Geneva. Project Objective 1. 15 volunteers complete the CBH&FA course. 2. Communities in each unit of F and G Divisions have an increased awareness about relevant health and first aid issues. 1. 15 volunteers complete the course and receive certificates from /IFRC 2. Health Centre patients attend for prevention as well as reacting to health problems / Audit of clinic attendees and triage information Resources are available Volunteers are supported in their community peer education roles among the units. Prisoner community willing to accept the peer educators. 3. Post learning test/quizzes indicate improved knowledge Results of quizzes and tests Prisoners can read and write. Expected Results The prisoner community at Wheatfield has become proactively empowered instead of only reactive in health. More prisoners are interfacing with health centre nurses for preventive health instead of reactively seeking the doctor to cure. Triage / nurse-led clinic records. Statistics about nurse-led activity and health awareness. 5

Activities Resources Sources Preconditions 1. Train 15 Irish Red Cross Special Prisoner Volunteers in CBH&FA in Action 2. Promoting health and first aid among prisoner community. 15 volunteer prisoners Teacher for Health & First Aid practitioners Those who have completed FETAC OFA course. Wheatfield Wheatfield Health Centre. Governor continues to support the programme. /IFRC can issue certificates to prisoners. Special volunteer status can be given. 1.5 hours per week allocated in school for programme. Specialist medical input as necessary (HIV/Addiction) In-reach programme Consultants have time to participate in teaching/advising. Irish RC Instructor Programme coordinator G Betts-Symonds (Link between Wheatfield school, health service, Governors,, Federation Geneva) Wheatfield Governor/Chiefs support the role Classroom space continues to be available Classroom Community Learning Aids F and G Divisions /IFRC Course is run according to plan teaching on landings Federation Volunteer Manuals Manuals made available 1.1 Enter CBH&FA through a public health emergency need identified (Influenza A H1N1) 1.2 Accreditation of Occupational First Aid (FETAC). Community tools for Pandemic Influenza. Teachers/Health Practitioner. FETAC Teachers Federation Irish Health Service Executive /Health Centre Accredited course accepted by IFRC Geneva 2.1 Doing Pandemic Awareness Community Tools handouts IFRC Toolkit HSE Tools Prisoner Community accepts volunteers in the beginning 1.3 Undertake module 1 (Red Cross Knowledge) Volunteer manual /IFRC can undertake the training sessions 2.2 Doing RC Knowledge Volunteer manual available 1.4 Undertake Module 2 (Volunteering) Volunteer manual /IFRC can undertake the training sessions 2.3 Doing Volunteering Volunteer manual instructor available 6

1.5 Undertake Module 3 (Assessment Module as past, present and future) Teacher/Health Betts-Symonds Facilitator Governors support the assessment methodology in the Units. Prison Officers available to supervise. 2.4 Doing - Using the assessment tools in the prison community with their communities Betts-Symonds Facilitator/Teacher Governors support the assessment methodology in the Units. Prison Officers available to supervise. 1.6 Identify full learning programme of CBH&FA in Action at Wheatfield based on Module 3 (Assessment outcomes). Teacher/Health Programme Coordinator. approve the course content/structure on behalf of IFRC Geneva Health & Care Dept. 2.5 Doing dissemination of the content with their communities and checking back with needs identified Teacher/ Betts-Symonds Facilitators Methodological approach accepted by prison officers/governor 1.7 Module 4 Accredited by FETAC 1.8 Module 5 Teacher/Health Disaster Management instructors (Lydia & Graham) 2.6 Doing Table Top Exercise Disaster Management instructor (Betts-Symonds) Governors support the inclusion of this subject. Governors support the inclusion of this subject. Prison Officers available to supervise. 1.9 Module 6 (Public Health) Teacher/Health In-Reach specialists Health care 2.7 Doing public health awareness among local prison communities 1.10 Module 7 (Optional topics) 2.8 Doing Optional topics in prison communities 1.11 Evaluating volunteer learning 2.9 Evaluating awareness achieved in the prison communities Teacher/Health/ /Health Care/ Governor/Prison Officer support Teacher/Health /Health Care Optional subjects appropriate for prison setting Teacher/Health /Health Care Optional subjects appropriate for prison setting Teacher/Health/ /Health Care//IFRC Baseline information is planned Teacher/Health/ /Health Care//IFRC Baseline information is planned 7

Draft of Specific Course Content 1 Based on Adapting CBH&FA to the needs of a community of prisoners in a sentence prison in Dublin Ireland (Curriculum planning meeting between, Graham and Lydia of ) Module/ Topic number/date 1 / 1 14.7.09 1 / 2 14.7.09 1 / 3 21.7.09 1 / 4 21.7.09 2 / 1 28.7.09 2 /2 28.7.09 2 / 3 6.10.09 2 / 4 13.10.09 3 / 1 20.10.09 3 / 2 3.11.09 Topic Title Relevant (R)/ Irrelevant (I)/ Compulsory(C) Alternative relevant subject Course Material Source Facilitator &RC Movement C VM Graham Local Branch/ C VM plus Chapter/ Special material Lydia Groups developed for prison group CBH&FA in Action C VM Graham Volunteering C VM Lydia Communicating Building Relationships Organizing Communities Sensitizing the community to CBH&FA in Action Social mobilization and the community tools Assessing my community: an overview Community assessment: secondary information resources 3 / 3 Community assessment tools: direct observation, transect walk, community map and seasonal calendar C VM C VM Graham C VM Graham Lydia C Transect walk irrelevant in context. Needs to be adapted to the context of the prison and past experience reflection. VM Graham/ Time in hours 1.5 1.5 1.5 3 / 4 Community assessment tools: focus group discussions and household visits. 3 / 5 Performing the community assessment: learning by doing C Households in the prison context will be cells and units. VM Graham/ 3 / 6 Making sense of data C VM Also Data analysis section from VCA Toolbox 3 / 7 Preparing the action plan based on the assessment 3 / 8 Reporting on CBHFA activities in the community Graham/ 1 This Table is produced as an example but can only be finally confirmed after the community assessment of Module 3. 8

Module 4 Accredited through FETAC Occupational FA Course 5 / 1 Community mobilization in major emergencies 5 / 2 Public Health in Emergencies: preventing and responding to epidemics. R Red Cross/Red Crescent disaster stories from the field R Focusing on Pandemic flu emergency and other problems related to large numbers of people housed together. VM with adaptations to provide interesting information about RCRC volunteers in disasters VM with adaptations based on flu pandemic Irish HSE principles Lydia Graham included with session Module 6 Topic 14. 6 / 1 Community health R VM 1.5 education and promotion 6 / 2 Family Planning R VM 6 / 3 Safe motherhood I 6 / 4 Care of the newborn I 6 / 5 Nutrition R VM 6 / 6 Immunization/ Vaccination R Importance of I & V applied to prison context 6 / 7 Safe water, hygiene and sanitation 6 / 8 Diarrhoea and dehydration 6 / 9 Acute respiratory Infections 6 / 10 Malaria Prevention and Control 6 / 11 HIV and Sexually transmitted infections 6 / 12 Reducing stigma and discrimination about HIV 6 / 13 Tuberculosis R Applied to Ireland 6 / 14 14.7.09 Entry Point VM and adaptations from Health Care Department Nurse Lynch R VM R VM / R VM / I R VM Dr Fiona Lyons (GUIDE Clinic St James Hospital) R VM HIV Nurse GUIDE Clinic Avian Influenza I Influenza A (H1N1) Pandemic 1.5 VM Graham Irish HSE materials adapted to CBH&FA format 6 / 15 Dengue Prevention I and Control 6 / 16 Caring for the sick at I home 7 / 1 Road Safety I 7 / 2 Safe blood and R VM voluntary blood donor recruitment 7 / 3 Excessive substance abuse R VM and other local resources 7 / 4 Collection and burial of the dead I Adapt to drug and alcohol awareness Graham Dr Scully (Consultant in Addiction Psychiatry) 1.5 9

The exact design of the course cannot be confirmed until module 3 (assessment module) has been completed but this table has been produced to give an approximation of timings involve References IFRC 2009 Community Based Health & First Aid: A Volunteer Manual, International Federation of the Red Cross and Red Crescent Societies, Geneva. WHO (2007) A Whole Prison Approach to Prison Health, World Health Organization (European Section), Geneva IFRC (2008) Vulnerability & Capacity Assessment Toolbox, International Federation of the Red Cross and Red Crescent Societies, Geneva IPS (2004) Health Care Standards, Irish Prison Service, Longford, Ireland IFRC 2009 Community Tools for Pandemic Influenza, Health in Emergencies, International Federation of the Red Cross and Red Crescent Societies, Geneva. (IFRC.ORG website) HSEHPSC Algorithm for the management of persons with acute febrile respiratory illness who may have influenza A (H1N1), www.hpsc.ie, 21 st May 2009. 10