title: Probation as a setting for building well-being through integrated service provision: evaluating an Offender Health Trainer service.
abstract: BACKGROUND
  The NHS Health Trainer Programme was launched in England and Wales in 2005 with the aim of tackling health inequalities. While initially focusing on geographical communities, the initiative has extended its reach to particular population groups, such as offenders and their families, who experience high levels of physical and mental health needs and wider social exclusion. This paper reports on the evaluation of the Offender Health Trainer service delivered in probation settings in Bury, Rochdale and Oldham (Greater Manchester). This service has sought to improve the health of offenders, improve their access to mainstream services, and help reduce health inequalities - as well as facilitate rehabilitation and improve job prospects for ex-offenders through employment as health trainers.
  
  
  OBJECTIVE
  This evaluative research study aimed to explore the delivery of the Offender Health Trainer service and examine its impact on service users. The study design and limited time frame meant that the research was focused on the journeys of service users rather than on long-term outcomes.
  
  
  METHODS
  The evaluation used a mixed-methods approach, comprising two key elements: the interrogation and analysis of routinely collected quantitative data extracted from the National Health Trainer Data Collection Recording System (DCRS); and in-depth qualitative research using interviews and focus groups with clients and health trainers.
  
  
  RESULTS
  The evaluation points to the overall success of the service in meeting its aims and impacting positively on the lives of offenders. It reveals promising trends in behaviour change and self-perceived health and well-being, articulating a rich narrative detailing how the service has helped probation clients tackle multiple interwoven problems and build hope and self-belief. Of particular importance was the health trainers' experience of the criminal justice system, which resonated with and inspired clients, developing trust and motivation to change.
  
  
  CONCLUSIONS
  While the research inevitably had limitations, this study suggests that the health trainer model can be effectively implemented within the probation setting, making a valuable contribution to the improvement of offenders' health and well-being by working in ways that acknowledge the connections between personal lifestyle and wider determinants of health. Within the context of forthcoming probation reforms, it will be increasingly important to develop services that highlight these links and to invest in appropriate evaluation that can generate further learning about 'what works and why'.
authors.affiliation: School of Health, University of Central Lancashire, Preston PR1 2HE, UK. mtdooris@uclan.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Dooris
authors.forename: Dervla
authors.initials: D
authors.lastname: McArt
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Hurley
authors.forename: Michelle
authors.initials: M
authors.lastname: Baybutt
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D003150:Community Health Workers / Q000193:education / Q000458:organization & administration*; D057237:Criminals; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D020377:Self Efficacy; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D013222:State Medicine; D006113:United Kingdom; D055815:Young Adult
keywords: DCRS; evaluation; health trainers; inequalities; offenders; social exclusion