Healthcare provision in prisons: an ongoing challenge highlights the significant progress made over recent decades, particularly the move to NHS-led care and the principle of equivalence. A thoughtful piece that brings together past progress with the ongoing challenges ahead. https://lnkd.in/ex7QD-8S Plugge Emma

I recently attended the webinar "Care for Those Dying in ICUs and Prisons: Adapting the 10/40 Model to Meet the Needs of Niche Areas of Healthcare." The session offered valuable insights into how healthcare systems can better support individuals approaching the end of life in settings that are often overlooked within palliative care. I found the presentation by Dr. Naveen Salins particularly thought-provoking. His discussion on integrating palliative care within intensive care settings highlighted that serious illness affects far more than physical health alone. Patients and families often experience emotional distress, uncertainty, role changes, complex decision-making, and concerns about dignity and quality of life alongside the medical challenges they face. As a Medical Social Worker who has worked in a Medical ICU, many of these reflections resonated with my experience. Critical care environments are uniquely positioned to identify patients who may benefit from palliative care involvement. Early recognition and referral can facilitate holistic support, address psychosocial concerns, improve communication, and help ensure that care remains aligned with the values and preferences of patients and families. Family meetings remain a key intervention within intensive care settings. They create opportunities for patients, families, and clinicians to engage in meaningful dialogue, participate in shared decision-making, and navigate difficult choices together. Such conversations help preserve autonomy, strengthen trust, and support individuals during periods of vulnerability. The growing evidence supporting palliative care integration within ICUs reinforces the importance of multidisciplinary collaboration. Physicians, nurses, social workers, psychologists, spiritual care providers, and other professionals each contribute unique perspectives that help address the diverse needs of individuals living with serious illness. I was also particularly interested in the session delivered by Dr Tamsin Bryan on palliative and end-of-life care within a maximum-security prison. The presentation highlighted the importance of ensuring that compassionate, dignified, and person-centred care remains accessible to all individuals, regardless of circumstance. Access to pain management, emotional support, and end-of-life care should be viewed as fundamental aspects of humane healthcare. My sincere thanks to the organisers for this insightful webinar, and to Dr. Naveen Salins and Dr Tamsin Bryan for sharing their valuable knowledge and experiences. #PalliativeCare #EndOfLifeCare #ClinicalSocialWork #CriticalCare #ICU #PsychosocialCare #SharedDecisionMaking #PatientAutonomy #MultidisciplinaryCare #SeriousIllnessCare #CompassionateCare #PrisonHealthcare #DubaiHealthcare #UAEHealthcare #CDALicensedSocialWorker #CareCoordination #CaseManagement #OncologyCare #RehabilitationCare #IAHPC #WHPCA

Big news! The Lionheart Foundation has received its 10th grant from the CA Department of Corrections & Rehabilitation, marking a decade-long partnership bringing Houses of Healing to California prisons. This funding will expand access to the HOH Complete eLearning Program on CDCR tablets statewide via the Edovo platform – expanding trauma-informed healing and personal transformation opportunities to nearly 90,000 incarcerated individuals across California. The grant also supports weekly, in-person, 14-session Houses of Healing Circle Programs, augmenting the eLearning Program in two CDCR institutions. We’re deeply grateful to CDCR’s Division of Rehabilitative Programs for its continued investment in this work. Learn more about this milestone and our decade-long partnership here: https://lnkd.in/ea75hiM4 Interested in the impact of Houses of Healing (HOH)? Explore the program here: https://lnkd.in/eUEYD_fM

This is a really important piece of work from the Nuffield Trust. The findings are striking: more than 27,000 A&E attendances from prisons and young offender institutions in one year, with higher-than-expected rates of seizures, overdose, cardiovascular conditions and repeat attendance. This speaks to something much bigger than emergency care activity. It highlights unmet need, health inequality, gaps in continuity of care and the pressure points between health, justice, prison services, mental health, ambulance and emergency departments. A&E is often where system pressure becomes visible but the real opportunity sits much earlier. Prevention, early intervention, trauma-informed support and joined-up pathways are essential if we want safer outcomes for people in contact with the criminal justice system and for the staff supporting them - before injury. #Secure24 #VICTOR

Really pleased to have contributed to the latest Nuffield Trust report exploring A&E attendances by people in prisons in England. The report uses Emergency Care Dataset data for the first time to look in detail at how often and why people in prison attend A&E, analysing more than 27,000 attendances across 117 prisons and young offender institutions during 2023/24. Some of the findings are particularly striking, including significantly higher-than-expected rates of seizures, paracetamol overdose and cardiovascular conditions within prison populations. The report also found high levels of repeat A&E attendance, despite the operational challenges involved in accessing hospital care from prison settings. More broadly, the work highlights what emergency care data can tell us about health inequalities, unmet need, continuity of care and pressures across both health and justice systems. A really important piece of work which reinforces the need for prevention, early intervention, joined-up working and stronger continuity of support for people in contact with the criminal justice system. Thank you to the Nuffield Trust team for involving me in such an important piece of work. #NuffieldHealth #HealthInequalities #PrisonHealthcare #UrgentCare #NHS #PopulationHealth #IntegratedCare #HealthEquity Sophie Julian Miranda Davies https://lnkd.in/ej65bUxH

We have recently published this editorial in Medicine, Science and the Law, titled 'How useful is the concept of trauma-informed practice in prisons?' https://lnkd.in/ePqPTbH8 In the editorial, we argue that there is a pressing need for prison reform, and that it is unclear whether these reforms can be usefully conceptualised as, or differentiated from, ‘trauma-informed practice’, and the extent to which TIP can be effectively implemented without broader prison reform. Currently, there is little evidence that TIP improves outcomes, and emerging evidence that the aims of TIP are not felt by people in prison or staff. Although the concept of TIP is theoretically sound and driven by an imperative to respond to the needs of a highly traumatised population, enthusiasm and policy momentum is outstripping evidence, and there is still a way to go before we can be sure that it is a useful concept within prisons and the wider justice system. Megan Kydd-Coutts Cariss Davies-Bishop Andrew Forrester

New editorial in Medicine, Science and the Law asks a question that deserves more airtime: is trauma-informed practice actually a useful concept in prisons? Crole-Rees, Kydd-Coutts, Davies-Bishop and Forrester make several points that will be interesting for anyone invested in TIP as a framework. First, there is growing evidence that Trayma Informed Practice (TIP) can improve service quality, but limited empirical evidence it improves the lives of people who have survived trauma. Studies exploring lived experience perspectives suggest both staff and prisoners have reservations about whether prisons can be truly trauma-informed at all. Second, the components most commonly implemented under the TIP label are not unique to TIP. Safe physical environments, strengths-based services, inter-agency collaboration. These are features of good practice. Related frameworks like Enabling Environments cover broadly the same ground without the explicit trauma framing. It is currently unclear whether TIP leads to improved outcomes compared to these alternatives. Third, the authors argue that using language already familiar to staff, such as respect, safety and fairness, may offer a better fit between aspirations and reality than importing clinical terminology into operational settings. Research by Auty et al found that the delivery of genuine TIP does not necessarily coincide with adopting the label, and that where the label had been adopted, the benefits were often not experienced by the people living in those prisons. The editorial's conclusion is measured but pointed. Overcrowding, understaffing, poor conditions, exposure to drugs and violence. These are the priorities. TIP may be theoretically sound, but I don't think it can be effectively implemented without broader prison reform. Crole-Rees, C., Kydd-Coutts, M., Davies-Bishop, C. and Forrester, A. (2026) 'How useful is the concept of trauma-informed practice in prisons?' Medicine, Science and the Law. DOI: 10.1177/00258024261441354 https://lnkd.in/exTSdprU

Really excited to share our recent published editorial, working alongside Clare Crole-Rees, Cariss Davies-Bishop, and Andrew Forrester. There has been an increasing focus on the trauma-informed approach within the criminal justice system. We explore how effective this approach can be without broader prison reform. We also examine the conceptual usefulness of trauma-informed practice within prison settings and highlight the need for further research into its effectiveness, how it can be meaningfully distinguished from related approaches, and whether it leads to improved outcomes for people in prison and staff. We highlight the need for future research to centre service users’ experiences and perceptions of trauma-informed practice, as well as the mechanisms through which changes in staff knowledge and attitudes may influence outcomes.

In 2023, California became the first state to get permission to spend federal Medicaid dollars on people coming out of jails or prisons. After incarceration, many people have no access to medical care. The Justice-Involved Reentry Initiative, part of CalAIM's effort to connect Medi-Cal enrollees to social services, is helping these people get the health care, medications, and housing support they need before returning to their communities. The initiative aims to reduce recidivism by providing these basic supports. Today, all of California’s 31 state prisons and more than half of its counties have started their reentry programs. Read more about this innovative partnership between law enforcement and public health in Yuba and Sutter counties: https://lnkd.in/gXzqxa5i

“Yuba and Sutter counties, working together, are in the vanguard of a national project to improve access to health care for people coming out of incarceration.” Read about their efforts below.