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Problem-solving training: assessing the feasibility and acceptability of delivering and evaluating a problem-solving training model for front-line prison staff and prisoners who self-harm
  1. Amanda Perry1,
  2. Mitchell Glenn Waterman2,
  3. Allan House3,
  4. Alexandra Wright-Hughes4,
  5. Joanne Greenhalgh5,
  6. Amanda Farrin4,
  7. Gerry Richardson6,
  8. Ann Kathryn Hopton1,
  9. Nat Wright7
  1. 1 Health Sciences, Unviersity of York, York, UK
  2. 2 Faculty of Medicine and Health, University of Leeds, Leeds, UK
  3. 3 Academic Unit of Psychiatry, University of Leeds, Leeds, UK
  4. 4 Clinical Trials Research Unit, University of Leeds, Leeds, UK
  5. 5 Sociology and Social Policy, University of Leeds, Leeds, UK
  6. 6 Centre for Health Economics, University of York, York, UK
  7. 7 Spectrum Community Health CIC, Wakefield, UK
  1. Correspondence to Dr Amanda Perry; amanda.perry{at}


Objectives Problem-solving skills training is adaptable, inexpensive and simple to deliver. However, its application with prisoners who self-harm is unknown. The study assessed the feasibility and acceptability of a problem-solving training (PST) intervention for prison staff and prisoners who self-harm, to inform the design of a large-scale study.

Design and setting A mixed-methods design used routinely collected data, individual outcome measures, an economic protocol and qualitative interviews at four prisons in Yorkshire and Humber, UK.

Participants (i) Front-line prison staff, (ii) male and female prisoners with an episode of self-harm in the previous 2 weeks.

Intervention The intervention comprised a 1 hour staff training session and a 30 min prisoner session using adapted workbooks and case studies.

Outcomes We assessed the study processes—coverage of training; recruitment and retention rates and adequacy of intervention delivery—and available data (completeness of outcome data, integrity of routinely collected data and access to the National Health Service (NHS) resource information). Prisoner outcomes assessed incidence of self-harm, quality of life and depression at baseline and at follow-up. Qualitative findings are presented elsewhere.

Results Recruitment was higher than anticipated for staff n=280, but lower for prisoners, n=48. Retention was good with 43/48 (89%) prisoners completing the intervention, at follow-up we collected individual outcome data for 34/48 (71%) of prisoners. Access to routinely collected data was inconsistent. Prisoners were frequent users of NHS healthcare. The additional cost of training and intervention delivery was deemed minimal in comparison to ‘treatment as usual’. Outcome measures of self-harm, quality of life and depression were found to be acceptable.

Conclusions The intervention proved feasible to adapt. Staff training was delivered but on the whole it was not deemed feasible for staff to deliver the intervention. A large-scale study is warranted, but modifications to the implementation of the intervention are required.

  • Prisoners
  • Suicide & self-harm
  • Feasibility
  • EDUCATION & TRAINING (see Medical Education & Training)

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  • Contributors AP, AH and MGW designed and conducted most of the study with considerable input from AKH. AWH and AF took the lead in performing the statistical analyses together and JG was the lead for analysing the qualitative interviews with AP. GR and NW led the development of the economic protocol and information on the study costs. NW supported access to the prison sites and all authors provided input into the writing of the manuscript.

  • Funding This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0211-24122).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was obtained for phase I from NHS REC approval (NRES, North East York, 28 October 2014) and NOMS (1 September 2014) and phases II–V (Bristol REC Centre, London South East, 6 January 2015) from NHS REC approval, NOMS (6 March 2015) and the Department of Health Sciences at the University of York for all phases (11 December 2014). As the material was adapted and developed for appropriate use within each prison, we were granted one substantive amendment to the project from all parties during July 2015.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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