CAMS is an intervention that is generally used within community-based settings by clinicians. Its use in detention and prison settings is limited to a few sites in the USA. Therefore, the team had to consider how CAMS would operate in these settings and if there would need to be any changes to the way that CAMS is deployed.
Secondly, implementing in a detention or prison site brings its own set of unique challenges. Access to the site is strictly controlled and entering a prison was daunting for some team members who had not been in contact with the justice system at this level. Gaining complete access to stakeholders is difficult, especially if planning to consult service users. Security and risk were important considerations for our partners.
The advent of the COVID19 pandemic further restricted access to the implementing sites and delayed the project. Whilst we had planned to meet with those detained the access restrictions imposed as a result of COVID meant this was not possible.
CES was asked to develop an implementation plan to support a CAMS pilot on several sites, followed by a scaling of the CAMS intervention into all Irish Prison Service sites.
The implementation plan reflected the multidisciplinary nature of the IPS workforce involved in the deployment of CAMS in prisons. Importantly, the implementation plan is strictly high-level, meaning individual IPS sites would be required to fine-tune the implementation plan more specifically to their own needs using their own implementation teams.
CES’ approach to this project combined robust methodology with involvement of stakeholder perspectives at all stages. The team involved was Aine Tubridy, Brianna Walsh, Andy Bray and Olivia O'Connell.
We reviewed national and international evidence relating to the implementation of CAMs, particularly in custodial settings. We also reviewed national policies and strategies around mental health and the prison service.
To achieve scalability, demonstrating acceptability and relative advantage to stakeholders is crucial to implementing the intervention. Therefore, engagement of stakeholders at all levels throughout the planning process was important to building buy-in and a sense of ownership of the implementation process
As part of the exploration and preparation stage of implementation, the CES team facilitated two-hour workshops with staff and management in three prison sites. Prison staff participating represented chaplaincy, healthcare, education, probation, prison management, psychology, prison officers, Integrated Sentence Management and addiction. We found that the Hexagon Tool was most useful for considering the ‘who, how, what and when’ in this exploration phase.
Each group identified potential factors that would help implementation (enablers) and hinder implementation (barriers). Possible strategies, or approaches, that could exploit enablers and eliminate barriers were then discussed.
Central criteria for implementing CAMs were also identified at this early stage, including communication strategies, assessments of the compatibility of CAMS with existing prison site culture, and buy-in from the work force.
Following the evidence review and stakeholder engagement activity, CES provided an initial implementation plan for piloting CAMs in the identified sites, followed by a review which then informed the final implementation plan.
A high-level implementation plan was created for the first year of implementation, consisting of three stages – Exploring and Preparing, Planning and Resourcing, and Implementing and Operationalising, with associated actions and timeframes.
CES used an integrated, stage-based framework to suggest two options for the scaling-up process – to roll out on a phased basis within each prison, or a cluster of prisons, or to implement the model across the prison estate in its entirety.
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