Evaluation Report - Ageing Well in HMP Shotts

‘Ageing Well in Prison’ Evaluation Report January to February 2025

“I have more control than I thought”.

Ageing Well in Prison programme participant.

Executive Summary Partners

Age Scotland (AS) Health and Wellbeing Team, Scottish Prison Service (SPS), and National Health Service (NHS).

Duration

7 week programme (14th January to 25th February 2025), with pre-programme focus group and visit to inform development.

Location

The Hub, HMP Shotts (North Lanarkshire)

Who?

A group of 8-10 male prisoners serving longer term sentences (4 years+), accompanied by up to 3 programme partners

Why?

Prisoners aged 50 and above are a growing population in HMP Shotts (25% of population currently) and have limited targeted support for their health and wellbeing.

By developing a tailored wellbeing intervention for an underserved population, this project contributes towards Age Scotland’s strategic aim of improving the health and wellbeing of older people in Scotland.

The rationale for the approach builds on findings from Scottish Government research on effective interventions for older prisoners (2022). We also drew from previous research conducted by academics from The University of West of Scotland in partnership with Alzheimer’s Scotland that explored the under-diagnosis of dementia in Scottish prison among older prisoners.

How? Using a Test of Change approach, the Health and Wellbeing Team co-created this comprehensive, in-depth, health and wellbeing intervention with prisoners and project partners.

Designed as a pilot, the programme was designed to be somewhat flexible, to respond to the needs and feedback of participants.

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Executive Summary Using a workbook format, the Ageing Well in Prison workshop programme provided prisoners with a comprehensive overview of different aspects of health and wellbeing. Each of the topics covered were chosen to reflect rigorous evidence on ageing well (e.g. The Five Pillars of Ageing Well, Open University). Through interactive activities, challenges, and reflection opportunities, this programme also supported habit formation to encourage long-term behaviour change.

Participant feedback The feedback received from participating prisoners through verbal feedback was positive, with areas for improvement and change identified (both during, and at the end of the programme).

“I have more control than I thought”.

“I enjoyed the sessions I came to. I was sorry I couldn’t come to more, but my visits come first”.

“I never usually leave the hall.

Coming here really G’s me up. I enjoy it”.

“The cell exercises feel do-able”.

“Your words have been in my mind all week. I want to start drinking water with my cup of tea”.

In addition, the prisoners were not all previously known to one another. However, during the programme the group began to cohere, and communicated that they saw real value in coming together as a peer group of older prisoners (something that was not previously available to them).

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Executive Summary Paul’s* story Paul* had rarely left his Hall (the area where the cells and leisure space is located).

Upon hearing about Age Scotland’s Ageing Well in Prison workshop programme through the prison information channel, and encouraged by his peers, Paul joined the first session in The Hub. Reflecting upon his habits during Session 1 on Building healthy habits, Paul shared that he drinks 10 bottles of fizzy juice per week. As part of the workshop, he committed to reducing how much he consumes. By the final week (Session 7), Paul had successfully and consistently reduced his consumption to 2 bottles per week. This was something that the group celebrated together.

Paul also had limited mobility and used a wheelchair to help him move around the prison. Prompted by Session 3 on Moving your body and supported by his peers in the programme, Paul walked from his Hall to The Hub to join that week’s workshop. Again, this was celebrated by the group of prisoners, the staff, and the Age Scotland team.

When asked about his experience of the Ageing Well in Prison workshops, Paul told the Health and Wellbeing Team: “I never really usually leave the Hall. Coming here really g’s me up. I enjoy it”.

Paul also shared with the team that he enjoyed looking at, and filling in, his workbook in his cell after each session. He had tried some of the cell exercises, however was still fearful that he may fall while doing them. The Health and Wellbeing Team offered reassurance that he should start slowly and use a chair as a support, building up to more regular movements if it felt okay for him.

*(a pseudonym)

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Executive Summary Partner feedback The feedback received from partners through a staff evaluation form, email correspondence, and a formal feedback session was overwhelmingly positive. There were some areas identified that they felt could be developed further. These are detailed within the report section on ‘key learning’. We have included some direct feedback below:

[The workbook] is “brilliant”

“We are pleased to see consistent numbers. These guys vote with their feet, so it means a lot that they keep coming back - they wouldn’t if they didn’t want to be here”.

“Paul* never leaves the hall. It’s a success to see him coming every week, and that he keeps coming back” “The programme was well structured with good discussions and physical activities which everyone took part in” “The prisoners engaged really well with the facilitators and with each other as the programme progressed”

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Executive Summary Key learning There is a need for, and value in, dedicated health and wellbeing interventions of this kind with older prisoners The approach we piloted for the above was, overall, effective and well-received. To our knowledge, this kind of in-depth health and wellbeing programme tailored to older prisoners has not been conducted before.

The 50+ targeting of prisoners is appropriate, given evidence of faster ageing in prison, and the limited resources that this specific population have access to As an organisation, Age Scotland is particularly well placed to offer support, advice, and tools to older prisoners, and the prison staff who work with them, across Scotland.

This pilot programme has provided an invaluable opportunity to better understand the needs and lived experience of older prisoners in Scotland, and has empowered participants to feel more control over how they age.

There are a range of opportunities to continue to support older prisoners in Scotland, as outlined in the latter part of this report

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Evaluation Report Introduction Based on detailed feedback from prisoners and staff at HMP Shotts, Age Scotland Health and Wellbeing Team (HWT) created a 7-week programme covering evidence-based key elements of wellbeing, framed by tools on how to build healthy habits for long-term behaviour change.

Reflecting the in-depth design of this programme, a workbook was developed for participating prisoners to fill in throughout the 7-week period. Each weekly session was approximately 60-75 minutes long, with an opportunity for social interaction included afterwards.

Background and programme rationale HMP Shotts is a prison for individuals serving longer term sentences (four years or more). Over 25% of the population of this male-only prison are over 50 years old, with this trend expected to continue. Following introductions via Age Scotland’s Community Development Team, the Health and Wellbeing Team identified an opportunity to work with a small group of HMP Shotts prisoners to support them with ageing well in a prison environment.

Working with HMP Shott staff and a NHS health improvement officer (positioned in HMP Shotts), the Health and Wellbeing Team also drew upon recent research that cited what works to support the health and wellbeing of older prisoners (Scottish Government, 2022) and the challenges of the prison environment for people living with dementia (which often goes unrecognised or undiagnosed)(University of the West of Scotland, 2024). Furthermore, it is estimated that prisoners’ biological age is approximately 10 years older than their counterparts in the community, in part due to the stressors associated with the prison environment (Prison Reform Trust).

The Health and Wellbeing Team presented their rationale and approach to our Expert Friends Panel (an advisory group who is made up of academics, health and social care practitioners, people with lived experience, third sector representatives and more). Panel members supported our programme approach offered advice and connections that fed into the development of this workshop programme.

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Evaluation Report Developing the programme Using a Test of Change approach, the Health and Wellbeing Team co-created this comprehensive, in-depth, health and wellbeing intervention with prisoners by conducting: an interactive focus group with 8 prisoners to understand their knowledge levels, what their daily life in prison looks like, and what matters to them in terms of health and wellbeing informal conversations with prisoners and partners via an additional visit (for example, a cell and hall tour).

The Health and Wellbeing team remained flexible throughout the programme duration to allow the workshops to respond to topics of interest during workshop sessions. For example, the prisoners were interested in hearing more about dementia as part of the brain health session which we facilitated. Likewise, there were concerns about emotional wellbeing and using the Samaritans phoneline within prison, which we returned to (with SPS staff) the next week.

Who? The group comprised of 8-10 male prisoners, aged over 50 years old and serving a long-term sentence (4 years or more) at HMP Shotts. The group members were predominantly unknown to each other prior to this programme.

With a range of education and socio-economic backgrounds, participating prisoners benefited from the HWT’s Plain English approach to sharing knowledge, information, and instruction. Notable examples of participant engagement include: A prisoner who was a wheelchair user attended every session, despite never usually leaving The Hall. This gentleman successfully challenged himself to walk from The Hall to The Hub one week, with the support of his peers.

A prisoner who was known to be quiet and unlikely to participate in discussions became animated and open to discussion by the final sessions.

A prisoner who was fit and exercised regularly in the prison identified that he needed to focus on his balance, challenging himself to do more balance-related exercises each day.

A prisoner who has previously been disruptive in other group settings, who attended every session (even when they realised it would not directly impact their parole outcome).

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Programme approach and content Using a workbook format, the Ageing Well in Prison workshop programme provided prisoners with a comprehensive overview of different aspects of health and wellbeing. Each session focused on one topic (see programme, right), providing time and space for discussion and knowledge sharing activities.

Each of the topics covered were chosen to reflect rigorous evidence on ageing well (for example, The Five Pillars of Ageing Well, Open University). These are: building healthy habits for ageing well, emotional wellbeing, moving your body, keeping your brain active, connecting with others, and exploring food and drink. We also drew from in-depth research conducted as part of our Research Café seminar series programme to ensure that we are using the most up-to-date evidence available across each topic. We used Age Scotland’s Health and Wellbeing in Later Life information guide as a supporting resource throughout the programme.

Through interactive activities, challenges, and reflection opportunities, this programme also intentionally supports habit formation to encourage long-term behaviour change.

Examples of workshop activities are included below:

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Findings Overall, all participating prisoners agreed that they learned at least one thing that they could use to support their health and wellbeing from the Ageing Well in Prison programme. Some of their reflections and learning is highlighted below:

Prisoner experience “your words have been in my mind all week, I want to start drinking water with my cup of tea”

[cell movements] “feel do-able” “I was surprised that my balance wasn’t as good as I thought” “I am healthier in prison than I was on the outside. Its the routine, and less unhealthy stuff”

As described in the quotes above, participating prisoners reflected upon their current wellbeing and were willing to be challenged, and try new things to support them to live as well as they can in prison. We observed that prisoners also: demonstrated their interest and engagement through their ongoing attendance, questions, and enthusiasm during discussions and activities felt free and safe to challenge facilitators, and responded well to the facilitators’ free flowing discussion approach formed a group amongst themselves over the programme duration, they did not know one another prior to joining brought back their handbook each week, using it to follow along with workshop activities A HMP Shotts staff member reflected that: “The prisoners really took onboard the new habits from week one and continued with them. Overall, I think they enjoyed being around prisoners their own age and mindset. Worthwhile having a group this age”.

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Findings As a pilot project, we reviewed each workshop immediately after its completion. Key learning about the workshops for any future iterations of this workshop programme:

Workshops Workshop length: the length of the workshops worked (60-70 minutes per workshop) as they allowed group members to explore topics, and for facilitators to deliver health and wellbeing knowledge and activities while feeling able to follow the thread of relevant discussions between prisoners.

Workshop ordering: the emotional wellbeing workshop needs to fall later in the programme to allow the solidifying of trust and rapport both between the group and the facilitators, and between group members.

Workshop content: being flexible and responding to feedback was central to the success of this workshop programme. For example, prisoners did not relate to the phrase ‘When I am 79’ as a way of challenging assumptions about ageing. Hearing this, we changed the activity to ‘When I am older’, inviting individuals to decide what that means for them. This was well received, and helped people feel more comfortable engaging in the activity.

Materials Workbook approach: prisoners and staff responded well to the workbook approach, with staff describing it as “brilliant”. This allowed prisoners to revisit topics and tools in their own time in the cell, alongside the instructions for each ‘weekly challenge’ we posed them. There was a good balance of information, inspiration, and tools that prisoners could use within the prison, and when they get out of prison. The workbooks allowed participants to document any notes or reflections. However, a future addition could be more dedicated space for notes.

Workbook layout: prisoners and staff responded well to the colourful and engaging materials that we developed. The workbook was designed to support the workshops, and provided additional information and tools for prisoners to use in their own time (for example, movements they could do in their cells).

Workbook content: we learned quickly that the education level of group members varied substantially. As such, future additions of the workbook could simplify language (for example, removing references to ‘psychologists’ in favour of ‘scientists, or explaining what we mean when we use the term ‘research’).

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Findings Materials continued Wellbeing packs: provided at the end of the programme alongside participation certificates (see more discussion about these below), Age Scotland’s wellbeing packs provided prisoners with inspiration to carry on changing their habits in a meaningful way, to support them to age as well as they can.

Facilitation Facilitator skills: the workshops worked well in part because of the skillsets of the experienced facilitators (Rebekah, Doug, and Janice). Having two facilitators work together allowed the group to feel like they were in a nonjudgemental space of curiosity and different voices, rather than a classroom environment with a strong power dynamic. A level of flexibility, active listening, a willingness to be light-hearted, and showing genuine interest in individuals was important to build trust and rapport. To run this workshop programme again with the same levels of success would require skilled facilitators with strong health and wellbeing knowledge and the ability to quickly build rapport and trust with a group who do not know one another.

A HMP Staff member provided feedback to this effect: “It is really pleasing to see an organisation come into the prison environment with such a helpful welcoming attitude and [your commitment] could clearly been seen by the work you delivered and by the responses of the guys in our care”.

Demonstration: facilitator and staff demonstration were an important part of making prisoners feel comfortable enough to participate (for example, showing how to do movements before asking the group to do them). Staff involvement (including in weekly challenges) was also helpful as it showed a willingness to learn from all of those involved (rather than just the prisoners being told information).

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Findings Prison specific learning There are a few points of learning raised that relate to the prison environment and norms that are central to ensuring a successful workshop programme: Assumptions (parole): some of the prisoners initially thought that the Ageing Well in Prison programme would assist them in their parole and/or progression. It is important that if this programme is re-run that this is made explicit prior to the programme start.

Limits of prison: through discussing different topics of health and wellbeing topics it became clear that there are significant limitations within the prison environment to applying some of the research-based changes that would support individuals’ wellbeing. For example, concerns around not feeling safe to share feelings or gratitude (“folk will see ‘saftness as daftness’” – taking advantage of perceived weakness), there is limited access to a breakdown of the food menu (for example, levels of salt, amount of protein), there is limited access to nature (for example, limited access to The Hub’s garden space). There were also concerns that doing movements in the cell may lead to injury and there may be delays in being seen to by staff or medical professionals (particularly at night, and at the weekend).

Focus on control well-received: while the prisoners acknowledged the limitations of what they could do to support their health and wellbeing in prison, they appreciated the focus of the Ageing Well in Prison programme on what they could control. As noted on the front page of this evaluation report, one participant stated “I have more control than I thought”.

Unpredictable nature of prison environment: due to visits, progression, and miscommunication within the prison, not all group members were able to attend every session. From speaking with staff, this is the norm and therefore was expected. The workbook provided some information on missed sessions, however, those who were unable to attend all sessions had further questions about what they missed.

Certificates and celebrations: it became clear very early that prisoners wanted something to ‘show’ for their participation. As such, a certificate was designed, printed, and laminated, for the prisoners (provided as part of the last session). Each certificate was handed out in turn, allowing group members to celebrate one another and their achievements within the 7week programme. Likewise, the Health and Wellbeing Team took the opportunity to share observations they had made about the progress and habit changes of group members. These were celebrated within the group, with the acknowledgement that social support is an important part of sustained behaviour change.

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Evaluation approach Prisoner evaluations Participating prisoners were provided with a ‘wellbeing questionnaire’ at the beginning of the workshop programme, which they completed in session. They placed these in envelopes to return to them during the final session. We provided a second wellbeing questionnaire, with an opportunity to ‘map’ their journey via a graph template, during the penultimate session.

This did not work effectively, as there was miscommunication about the final session and participants did not return their completed questionnaires. This provides learning for future sessions around completing evaluation activities during the workshops.

Instead, the facilitators collected verbal feedback during the final session, with the findings from this explained throughout this report.

Staff evaluations The facilitators hosted an informal feedback session with staff before the final session of the workshop programme. This involved asking about ‘pluses’, ‘minuses’, and ‘areas to improve’. The staff provided detailed verbal feedback which was documented at the time. Feedback was also received via staff evaluation form, email after the programme, alongside verbal feedback received throughout the workshop programme. Again, the findings from these evaluation activities are detailed throughout this evaluation report.

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Reflections - what next?

Developing the pilot further Re-develop materials: while most of the activities and materials were well received, there are areas for further development within this programme (for example, simplifying language, providing additional resources in the workbook, and changing the order of activities to cover the emotional wellbeing topic later in the programme).

Develop a ‘Supporting Older People to Age Well in Prison Workshop’: there is a gap in staff training that could be filled in part by engaging with Age Scotland’s ‘Supporting Older People to Age Well’ workshop. This would need to be carefully adapted to apply to the prison environment, using the learning from this workshop programme.

Long-term prisoners: this workshop programme is particularly well-suited to prisoners who are in prison for a longer duration as they will get most benefit from being able attend most, if not all, of the sessions. Our understanding from staff is that those on a shorter sentence are unlikely to complete a 7week programme. In those contexts, a one-off session would be most beneficial.

Other offers or areas to explore Dementia awareness training: staff and prisoners in HMP Shotts both expressed an interest in learning more about dementia awareness, and how this might be applied in a prison context.

A ‘Prisoners Guide to Later Life’: through this project we understood there are issues on release for older prisoners, particularly those who have been in custody for some time, that Age Scotland might be able to provide support with. In particular, navigating the landscape of support services for later life. A ‘Prisoners Guide to Later Life’ information guide could therefore be a worthwhile product to develop.

Signposting and supporting: there was interest among prisoners and staff in the continuation of a group for older prisoners only. Age Scotland may have a role in signposting to other community partners (e.g. therapeutic gardening) in the future.

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Reflections - what next?

Reflections and recommendations As an organisation, Age Scotland is particularly well placed to offer support, advice, and tools to older prisoners, and the prison staff who work with them, across Scotland. As an underserved population, older prisoners are growing in number and providing individuals with the tools to support themselves to age well in prison can help alleviate additional strain on the prison service and NHS in prisons.

Future interventions could be in-depth (as per the Ageing Well in Prison workshop programme), be targeted (for example, providing movement videos to be shown to prisoners directly on their prison TV channel), or more general (for example, providing training to staff who work with older prisoners, or helping to champion the need for a nominated ‘older prisoners champion’ in each prison who will help identify and advocate for the needs of older prisoners in their care). There is also room to explore supporting older people who have recently been released from prison.

Following the spirit of this programme, any future interventions or offerings would benefit from a collaborative, co-design, approach to ensure that any activities or resources effectively identify and meet the needs of older prisoners in Scotland.

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Project Partners The pilot Ageing Well in Prison workshop programme would not have been possible without our project partners and collaborators. The successes of this project are in no small part due to the support, openness, and dedication of the SPS and NHS Scotland staff who have championed the needs of older prisoners at HMP Shotts.

Scottish Prison Service (SPS) Martin Hunter – Industries Officer Bernard Bell – Support and Wellbeing Officer Wendy Stewart – Support and Wellbeing FLM Brogan Currie – Comms (Headquarters)

NHS Scotland Robyn Foster – Health Improvement Officer

Age Scotland Doug Anthoney – Health and Wellbeing Manager Rebekah Ballantyne – Health and Wellbeing Officer Janice Skakel – Healthy Active Ageing Trainer Ann Yourston – Community Development Officer (initial contact)

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