2. Context of Willow development
women commit less crime, particularly less serious crime
Scotland continues to incarcerate women at a disproportionate rate
No evidence of increased incidence or seriousness of crime committed by women
Women in prison found to have ‘exceptionally high levels of health need’
) the average daily prison population increased by 19%. In the same 10-year period, the female prison population increased by 90%,
over 5 times the growth experienced in the male prison population
Significant increase in last 10 years
Remanded in custody: 1176 in1999/00 to 2338 in 2008/09
Under direct sentence: 458 in1999/00 to 906 in 2008/09
Longer sentences: 228 – 271 days (McIvor and Burman, 2011)

3. Context of Willow development
Prison Health in Scotland (2007)
Equally Well (2008)
Scottish Parliament Equal Opportunities Committee (2009)
Lothian and Borders CJA commissioned and published research about the specific profile of women offenders locally (Barry and McIvor, Chaotic Lives, 2009)
Lesley Graham- A review of the health care needs of Scottish prisoners (Graham, 2007) reported “women have greater health problems than their male counterparts in all areas of their health”
Equally well ministerial task force on health inequalities – found that offenders do not have equality of access in health – women a particularly vulnerable group; should be given priority
Scott Parliament Equal opps - concluded that “much more needs to be done by the Scottish Government and other public bodies to address specific issues facing female offenders”
equal treatment for women does not equate to equal outcomes.

4. Distinctly Complex Needs
Experiences of abuse and trauma
High prevalence of mental ill health and self harm
Substance misuse
Poverty
Mothers as prisoners
Relationships
Health inequalities
Women involved in the criminal justice system experience systemic inequalities. They will have multiple complex needs and welfare orientated needs. Research at Cornton Vale, for example, found that women in prison not only suffered from tremendous social deprivation as well as physical and mental health problems, but also that they experienced a multiplicity of such needs (Loucks, 1998; Social Work Services and Prisons Inspectorate, 1998). Female offenders were more likely to have been victims of past or current abuse, to be in poverty, to have substance misuse problems, and to commit offences related to these circumstances. (Cortson 2007) Not all deemed to be criminogenic but research has highlighted that indirect factors are important in women's pathways out of crime (Fawcett 2004).
Abuse and trauma Women offenders are frequently serially victimised in childhood and into adulthood. Histories of sexual, physical and emotional abuse are well documented within this population 70-95% of scottish female prisoners; 1 in 4 scottish women will experience DA in their lives – Scottish govts. Safer Lives: Changed Lives A Shared Approach to Tackling Violence Against Women In Scotland Women in the justice system have increased vulnerability and are routinely subjected to domestic abuse higher prevelance than general population
Mental health and self harm 80% of women offenders have mental health problems (McLellan 2005 and Scottish Govt, 2008)
Mental health problems are also far more prevalent among women in prison than in the male prison population or in the general population - Corston (2007)
Blanchette and Brown (2006) examined numerous studies that highlight the greater prevalence of self-injury and attempted suicide (whilst in custody) in the female offender population
Some argue that the rate of mental health problems and self-harming behaviour amongst this group can be somewhat explained by their experiences of victimization as can their high rates of substance misuse (Gelsthorpe et al, 2007). Rates of suicide also increased dramatically for women placed in custody.
Substance misuse The rate of drug problems amongst women prisoners in Scotland has recently been reported at 98% (Scottish Government, 2008). Most women in HMP and YOI Corntonvale have (or have had) drug problems.
After mental health, drug and alcohol problems were found to be the most prevailing issue in the lives of women involved in the criminal justice system across the Lothian and Borders area (Barry and McIvor, 2008).
Different functions? served by men and women of commencing and maintaining drug use was examined by Hollin and Palmer (2006). They propose that women are more likely to use drugs as a coping mechanism to mask feelings and emotional pain, as opposed to the thrill seeking and pleasure functions identified in young men’s use of drugs (cited in Criminal Justice Social Work Development Centre, 2007).
Poverty greater financial inequalities Lack of access to income, reliance of welfare benefits and financial debts are problems long associated with women offenders (Fawcett Society, 2004; SCCCJ, 2006; Scottish Office, 1998).
The social structures and economic environments within which women function are significant in any efforts to improve their economic disadvantage.
Resource scarcity and subsequent survival strategies are strong tenets of established perspectives on women’s pathways into offending” (Bloom et al, 2004 cited in Criminal Justice Social Work Development Centre, 2007, p16).
This notion is supported by the work of Wormer (2010) who reports studies that correlate trauma with a later inability to cope with stress, resulting in the use of substances as an inappropriate means of coping.
Mothers as prisoners There are many more children with fathers in prison than mothers, but mothers in prison are more likely to have been living with their children prior to imprisonment Radosh (2004). Imprisoning these women had particularly dramatic consequences. For example, women in prison were more likely to lose housing and to lose custody of children. Rates of suicide also increased dramatically for women placed in custody (ibid.).
Women prisoners are far more likely than men to be primary carers of young children and Corston argues this factor makes the prison experience significantly different for women than men. women in prison were more likely to lose housing and to lose custody of children. Scottish Parliaments Equal Opportunities Committee concurred that the impact of imprisonment was greater for women as they were much more likely to lose their homes and responsibility for the care of their children
Also distinctive for female offenders is the higher likelihood of childcare responsibilities. The implications of childcare responsibilities are particularly notable for women. When a father goes to prison, any children usually remain with the mother. When a mother goes to prison, children remain in the family home in only 5-17% of cases (Gardiner, 2009; Social Work Services and Prisons Inspectorate, 1998). Children of women in prison are more likely to face a number of placements during their mother’s imprisonment (Gabel and Johnston, 1995; Seymour and Hairston, 1998; Centre for Children and Families in the Justice System, 2003), and children put into care frequently remain there for some time after their original carer’s release from custody (Wolfe, 1999). Probably because of this, problematic behaviour among children is more common when the mother rather than the father is imprisoned (Richards and McWilliams, 1996). Non-custodial options are therefore particularly important for female offenders where possible.
Wormer (2010) notes that women in prison have time to reflect on their failures as mothers and strong feeling of guilt and shame prevail.
In our society where enduring expectations regarding gender roles, stereotypes and particular expectations of women as mothers, remain.
Gender power imbalances in society, greater impact of this on women whose view of themselves is often distorted by previous experiences of abuse
Relationships evaluation of the Circle Project was that the women who had moved away from offending had often ended their relationships with their partners
In their evaluation of a number of treatment programmes with women offenders Dowden and Andrews (1999) found those targeting family process and relationships produced the greatest treatment effects.
Scottish study of young women, Bachelor (2005) found that family relationship functioning and family violence were noted as significant in the violent offending of young women.
the magnitude of the impact of women’s past and current relationships cannot be underestimated in any efforts to engage her in meaningful change
Health inequalities review of the health care needs of Scottish prisoners (Graham, 2007) reported “women have greater health problems than their male counterparts in all areas of their health” e.g. male prisoners severe dental decay 3x rate of general population; female prisoner 14 x greater than general population; highest rate of asthma in Scottish prison population found in female prisoners; highest proportion of prisoners requiring additional care for suicide and self harm (Graham 2007)
General Inequalities - there are particular areas of need that are distinctly different for female offenders, by the
considerably higher incidence within the population, the nature of the problem as it relates to the lives and experiences of women, or due to
women’s wider roles and responsibilities within society.
It is not always helpful for the needs of women to be considered in comparison to those of male counterparts, as if the needs of men are the standard against which women’s should be measured. The specific needs of women require careful consideration in their own right if service providers are to be appropriately responsive to them.

5. A gender specific model of service
Requires input from a range of agencies
Joint working across disciplines
Key roles for health professionals and criminal justice social work
Contribution of the third sector is important
Women should access services from any point within the criminal justice system (2010)

6. Willow aims to: Reduce offending behaviour
Improve health, wellbeing and safety
Improve women’s access to services

7. How we strive to respond
Holistic intervention
Pro-active engagement
Strengths based
Crises responsive
Trauma informed
Relational approaches
Desistence differences
Social capital development
Women workers

8. PROJECT BOARD WILLOW SERVICE MANAGER NHS Lothian
City of Edinburgh Council Criminal Justice Social Work
SACRO
WILLOW SERVICE MANAGER
SACRO
SUPPORT
WORKER
SACRO
SUPPORT
WORKER
SACRO
SUPPORT
WORKER
(OUTREACH)
CRIMINAL
JUSTICE
SOCIAL
WORKER
CRIMINAL
JUSTICE
SOCIAL
WORKER
PSYCHOLOGY
ASSOCIATE
KEEPWELL NURSE
NUTRITIONIST

9. Partners Harm Reduction Team - addictions
Caledonian and Working with Men – domestic abuse
Edinburgh Community Food Initiative – healthy eating
Edinburgh Festival Theatre – social capital
Access to Industry - employability

10. Programme
Phase 1 - assessment with key worker, nurse and psychology; induction group
Phase 2 groups – including the
trauma group
offending group
health improvement group
social capital activities
Phase 3 groups – social capital activities and moving on work

11. Phase 1 - Induction
Assessment with key worker, the nurse for a health check and to meet with psychologist.
Interests and motivates women and look at what realistic changes they want for their future.
Information about our programmes and getting to know staff and group members.
Stabilisation work takes place
The two day induction programme assists women to quickly engage with the service.

12. Phase 2: Connections (adapted)
Programme that promotes attitudinal and behaviour change to help women desist from offending behaviour
Recognising and exploring emotions
Communication skills
Problem solving
Seeing the bigger picture
The impact of offending
Building confidence
Eight session.

13. Phase 2 - Survive and Thrive
Psycho educational programme
8 sessions
Understanding the NORMAL range of reactions to trauma (some of which will last for years or even decades) and learn new ways of coping.
develop your own ‘survival kit’ using a selection of tried and tested ways of coping with your difficulties.

14. Includes: The effects of abuse and trauma Keeping safe
Surviving skills
Understanding anxiety
understanding depression
Understanding flashbacks, nightmares and dissociation

15. Health Improvement programme
Nutrition
Dentist and oral hygienist
Sleep
Domestic abuse
Sexual health & BBV
Drug misuse
Alcohol misuse

16. To build social capital
To build cultural capital
To build social capital

17. Reaching In Reaching Out Reaching outside yourself to find:
-new places to visit
-new interests to try
-new people to spend time with
-old hobbies you had forgotten
-new or more developed
skills
Reaching inside yourself to think about:
-your hobbies interests
-things you have achieved
-things you used to enjoy
- your skills

18. Phase 3: Group Sessions Self efficacy, taking control
Inspirational women; who can I be and how will others manage my change
Presentation skills
Confidence
Money Management
Employability

19. Phase 3: Qualifications & Interest Visits
Opportunity to gain certificates & increase employability such as:
Food Hygiene Certificate
First Aid Certificate
And visits to demystify community facilities such as:
Local Colleges
Volunteer Centre
Scottish Parliament

20. Outcomes Personalised goals for individual women
Self report, observation and professional assessment
Standardised assessments:
Clinical Outcomes on Routine Evaluation (CORE)
Post Traumatic Stress Disorder Checklist (PTSD)
Hospital Anxiety and Depression Scale (HADS)

21. Observation, Professional Assessment & Self Report
Planned use of primary care services
Changes in diet
Positive changes in their relationships
Positive changes in how they view themselves
Reduction in frequency and seriousness of offending
Improved, stabilised, reduced substance use
Participating in pro-social activities, some of benefit to others
Increased physical activity

22. Post Traumatic Stress Disorder prevalence and outcomes
77% pre-intervention presented with symptomology consistent with Post Traumatic Stress Disorder
all women (except 1) had clinical and statistically significant improvements, post intervention
only 1 woman has remained symptomatic post intervention
(for the women we have data on) September 2010 – December 2011
The PCL is a 17-item self-report measure of the 17 DSM-IV symptoms of PTSD. The PCL has a variety of purposes, including:
Screening individuals for PTSD, Diagnosing PTSD, Monitoring symptom change during and after treatment.
Improvement for all (bar 1) in all 3 areas of avoidance, re-experiencing and hyper-arousal

23. CORE Scores
All women (except 1) had clinical and statistically significant improvements, post intervention in the areas of
Wellbeing
Problems/symptoms
Life functioning
Not in ‘Risk’
The CORE outcome measure Clinical Outcomes on Routine Evaluation measures - the level of current psychological global distress - client self-report questionnaire designed to be administered before and after therapy. The client is asked to respond to 34 questions; how they have been feeling over the last week, using a 5-point scale ranging from 'not at all' to 'most or all of the time'.
The 34 items of the measure cover four dimensions: subjective well-being; problems/symptoms; life functioning; and risk/harm. The responses are designed to be averaged by the practitioner to produce a mean score to indicate the level of current psychological global distress (from 'healthy' to 'severe').  The questionnaire is repeated after the last session of treatment; comparison of the pre- and post-therapy scores offers a measure of 'outcome' (i.e. whether or not the client's level of distress has changed, and by how much).

24. “Just thought it would be nice to drop you a wee letter as there is
a few things I would like to say to yous all.
Carina and Terry you turned my life right round. I am not saying everything is perfect but you helped me to get the strength to cope much better than I have in my whole life and I don’t have the words to tell yous how much I am so grateful to you for this. I know people will say they will never forget people but I know till the day I take my last breath the willow workers will always be with me every day helping me cope better with every day life.
Sally, just to let you know I am still making your Sheppard's pie. My kids love it. They ask me to make it every time they come through to visit. Thank you for taking the time to teach me these skills. Sarah you gave me so many coping methods that I still use today. I could never have got through some of the things I have had to deal with in the past few months if it were not for you.
I have started a course with transitions called Flash Beauty. I could never have done this if it wasn’t for Willow. I really hope you keep going helping the women who really need it. My biggest thanks is for never ever judging us because that is something we all fear. Good luck to yous all in the future”.

25. External Evaluation
Saw a different version of themselves which was more positive and hopeful about moving away from offending
Safe, supported and respected, much of which related to the project being for women only and workers’ attitudes
Women, staff and external agencies felt Willow offered a viable alternative to custody
This is supposed to be a punishment but it has been the best thing that ever happened to me. This is the only time I get to think about me, to take that breathing space that up to now I have never had.

26. External Evaluation
I am learning to take care of myself and found out that I was a diabetic. I had been dizzy in the past and just thought it was normal but it's not. .
I enjoy the company of the people in the group and never had any reason to feel unsafe, which is a good thing for me
I want to be alert and be able to hear what the women are saying and interact. I asked the doctor to bring my methadone down and for the first time in years I am feeling more awake and I have a reason to be awake.
Methods – case files, interviews staff, women and referrers

27. Costs
£184k per year to work with up to 60 women completing the programme
1 prison cell for 1 year costs £55k