The themes, gaps, and evidence of best practice in Catch22’s London Personal Wellbeing contract

Three years in: a case study review

This paper was written by Carla Loponte from Greenwich University, and Jody Audley from Catch22.

Contents

• Abstract
• Why personal wellbeing is important to address in interventions
• How Catch22 promotes wellbeing
• Methods
• Themes
• Gaps
• The bright side: evidence of best practice
• Recommendations
• Conclusion

Abstract

Catch22 Justice is part of a large third-sector organisation, comprising of many contracts. One contract, commissioned by the Ministry of Justice and His Majesty’s Prison and Probation Service, is the Personal Wellbeing (PWB) service: a commissioned rehabilitative service, sitting within a criminal justice system third sector organisation, in which frontline practitioners deliver low-level interventions to adult men on probation around their emotional wellbeing, social inclusion, family and significant other relationships, and lifestyle and associates.

The present research was conducted to evaluate the themes, evidence of best practice, and gaps in Catch22’s current Personal Wellbeing (PWB) intervention offer. It is imperative to evaluate our current intervention delivery to identify the strengths and potential improvements of our current service delivery, so we are providing optimal support.

Evaluating this through case studies written by our wellbeing practitioners is a constructive approach that captures the voice of practitioners and first-hand service user experiences and can also provide qualitative insight into PWB to complement more quantitative methods of impact analysis and effectiveness.

The first part of the case study review process set out to evaluate the challenges experienced by Service Users (SUs) before engaging with the service and investigating the impact the PWB service had on them.

This paper will then report and discuss the results of the review. It will highlight some gaps in the service, and specific need areas that the practitioners have not been able to fully address throughout the existing interventions by comparing need areas mentioned in the case study to Catch22’s intervention offer.

Finally, evidence of best practice will be discussed in relation to how this addresses previously-mentioned gaps in our current intervention offer. The swiftness of the referral processes and the efficiency of programme delivery will also be discussed when presenting the evidence of best practice. The paper will eventually offer potential improvements that can be made to our intervention delivery, and how Catch22 intends to action this.

Why personal wellbeing is important to address in interventions

Mental health and wellbeing are at the core of a good quality life and overall health of an individual. Other than the absence of negative feelings, wellbeing is described as “the state of judging life positively and feeling satisfied with it” (Diener et al., 1997). It is essential to remark that not only is wellbeing associated with health promotion but allows the individual to realise their aspirations and have a “long, productive and fruitful life” (Herrman, Saxena and Moodie, 2005). When looking specifically through the lens of offenders and the CJS, the offending behaviour and the subsequent criminal justice processes may at times affect wellbeing by stripping someone of their identity and values, to replace them with prison regimes or belief systems they are not accustomed to, in order to fit in the community and change the way they engage with it.

In this sense, release after a custodial sentence challenges the individual to create a new and redeemed version of themselves and desist from offending behaviours. However, not everyone finds the journey of desistance easy, as one may struggle to reintegrate and achieve stability and wellness due to the daily challenges they face. The main barriers experienced post-release concern the individual’s ability to meet their basic needs, namely housing, livelihood, family and social connections, and health (Simmons University, 2016). Fulfilling these needs can be complex and burdensome due to the disadvantage of having to readapt to life outside prison, which in the case of those affected by long sentences means adjusting to the changes in society whilst also manoeuvring the trials and tribulations of restarting your life in the community under your licence or probation regulations. If the individual is lacking these needs and not receiving adequate support to abide by their licence, this can render them to return to old, familiar habits, which may be their previous life of crime.

How Catch22 promotes wellbeing

Men on probation aged 18 and over can be referred to Catch22’s PWB service by their probation practitioner for rehabilitative purposes to meet the conditions of their Licence, or they can volunteer for the service themselves.

The HMPPS Refer and Monitor (R&M) platform is used by Probation and Catch22 practitioners to view and update information regarding the Service Users (SUs). An Initial Assessment of the SU’s needs is arranged and conducted by the SU’s Wellbeing Practitioner, before completing and submitting an action plan to R&M for the Probation Practitioner’s approval.

When interventions start, attendance and feedback are updated on R&M, and case notes of any interactions are added. After the completion of the referral sessions the practitioner submits an End of Service report within five working days of the final session with the SU to summarise and reflect on what the SU has learned during their time with Catch22. These stages are mentioned in the Case Studies to highlight how the process looks and evidence good practice.

Catch22’s Personal Wellbeing (PWB) contract is within the Commissioned Rehabilitative Services of our Justice Directorate and was mobilised in 2021. Catch22 also has many established referral and signposting pathways to other organisations that can be utilised when seeking additional support with specific needs that Catch22’s PWB interventions do not yet offer or are out of scope contractually.

Designed to be practical and strengths-based, the interventions currently available offer support for a variety of complex needs that the SU might present, coming under the following strands:

• family and significant others (FSO),
• lifestyle and associates (LA),
• emotional wellbeing (EW), and
• social inclusion (SI).

PWB services currently operate in seven hubs across London and operates in Devon and Cornwall, Thames Valley, West Mercia, Avon and Somerset, Dorset, Hampshire and Isle of Wight, Wiltshire and Gloucestershire.

At Catch22, we help achieve wellbeing by delivering programmes and interventions around promoting and/or restoring personal wellbeing.

As the service is relatively new, case studies depict a clearer picture of how interventions are delivered, evaluate what can be improved within the programme, and keep track of successful progress. Case studies may be useful for service evaluation and could subsequently contribute towards credibility for recommissioning.

In accordance with the commissioning principle of continuous improvement, SU feedback is valued by commissioners to recognise the social impact of the business, renew commissioning, and promote development, change and innovation where necessary. The case studies gathered allow the wellbeing practitioners and the wider team working within PWB to share a sense of motivation and purpose from real positive outcomes attained as a result of engaging with Catch22. Accounts of successful outcomes also spread awareness on how beneficial Catch22 can be for men referred to the service.

To contextualise, case studies outline the SU’s journey from the start of the interventions until the end of the work with Catch22’s PWB services. They give a brief background about the SU’s challenges before engaging with the service and details how the practitioner would plan and deliver the interventions around these challenges. The practitioner would then outline the steps taken to correctly deliver the planned actions according to contractual obligations, as well as adjustments made to best engage and support the SU. The interventions and their aims are then summarised including the impact of them on the SU. Finally, a summary of the outcomes of the intervention is described as well as future steps that the SU plans to take after completing their interventions- these vary greatly due to the vast differences in needs for each service user, addressed through PWB’s person-centred and individualised approach to intervention delivery.

The review of these case studies offers the chance to conduct a holistic analysis of the different stages of the referral and programme delivery along with having tangible proof of Catch22’s PWB service effectiveness.

Methods

The research was conducted by reviewing case studies – also known as “good stories” – of completed interventions from September 2021 to June 2023.

The case studies were recorded and uploaded by practitioners based in Catch22’s London hubs. Some hubs were only opened in 2022 and therefore do not have case studies predating their opening, but their case studies from when they opened to June 2023 are included.

Some hubs also had missing case studies from certain months, whilst some others had two or more files for a single month. All case studies are included, even if there are multiple for one month.

The aim of the Case Studies was to describe the structure of the intervention and activities employed and report their impact and outcomes on SUs. Most practitioners followed a template sheet to fill out answering the following questions: “Describe the service user’s situation when they came to Catch22”; “Describe what you did to help them address their challenges”; “What was the outcome?”; “Future plans”; “Quotes”. Some case studies were more creative and took the form of a poster or presentation but encapsulated the same content. The identity of the SUs was kept anonymous throughout the whole case study by administering pseudonyms.

The case studies were subsequently evaluated to investigate the following:

• Themes – what the SUs were dealing with before engaging with Catch22 and the specific needs the SU wanted to address.
• Gaps – needs/concerns/wants mentioned in the case study that are not addressed by Catch22’s interventions at present.
• Evidence of best practice – evidence that the practitioner has adhered to the PWB contractual obligations.

Information was extracted from the case studies about the themes, gaps and evidence of best practice by dividing the case studies up by time of publication and hub, and compiling relevant information into a table to then be analysed in bar charts (see figure 1 as an example).

The extraction was conducted by Carla Loponte, Volunteer Researcher, and peer reviewed by Jody Audley, Academic Partnerships Lead, and Maria Strong, Interventions Manager.

Themes

The most trending themes of support requested by SUs during the interventions were emotional regulation, reintegration into the community, anxiety, stress, depression, and lack of motivation. Catch22 delivers interventions on emotional management, anxiety, stress, and motivation. Moreover, practitioners were accurate in delivering the appropriate interventions.

Themes were further scrutinised to identify potential trends in different areas of London. This produced the following results:

• Brixton hub had a prominent number of cases report struggling with emotional regulation/management, and SUs who saw avoiding risky situations as the main challenge.
• Canning Town hub saw a trend in SUs wanting to address anxiety, substance misuse, gambling and addiction, emotional management, and guilt.
• Croydon hub recorded a trend of SUs struggling with social isolation and health issues. They also mentioned themes of aggression.
• In Ealing hub, no particular trend in themes was recorded.
• King’s Cross hub had a trend of cases struggling with anxiety, dealing with stress, and depression.
• In Lewisham hub, the trending themes were emotional management, sleep issues, low self-confidence, anxiety, resilience, isolation from community, social anxiety, and unemployment.
• Romford hub recorded a trend of Sus struggling with depression, isolation, anxiety, identity, and grief.
• In Tottenham hub, the trending themes were lack of motivation and emotional management.

As the PWB contract went live in June 2021 – during one of the last waves of the COVID-19 pandemic, another analysis was conducted to explore the theme of social isolation and its recurrence and to test whether there was any association with the country’s lock-down. Contrary to expectations, social isolation was not a recurring theme in 2021, and no particular peak was recorded.

What is certain is that a significant number of those struggling with social isolation relied on substance abuse, in particular alcohol, presenting significantly unhealthy lifestyles. Supporting SU’s rehabilitation is crucial, as research shows that criminal behaviour can be linked to substance abuse disorders (United Nations Office on Drugs and Crime, 2019). This is why referrals to relevant partners were swiftly requested by the practitioners for all the SUs in need of additional support.

Cases presenting negative feelings such as low self-esteem, low confidence and low mood also frequently mentioned unemployment. We may then assume that unemployment was a major cause of distress for some SUs. According to resources from the Ministry of Justice (MoJ) unemployment and difficulties with employability appeared to be a major difficulty experienced when having to re-integrate into the community and is a catalyst for many other difficulties on the journey of desistance (Brunton-Smith and Hopkins, 2014).

A high number of SUs mentioned struggling with emotional management and regulation. Emotional management refers to the ability of an individual to adjust their responses according to the settings they are situated in, and the emotional norms and expectations associated with it (Lively and Weed, 2014). A lack of emotional management coupled with low self-esteem can result in antisocial behaviour. In particular, displays of anger and poor well-being (Estrada-Fernández et al., 2023).

Sleep issues were experienced by a consistent amount of SUs and were often associated with anxiety and stress over financial issues and housing conditions. Research shows that acute stress can have a significant negative impact on sleep-wake

regulation (Staner, 2003). Others suggest that negative rumination when trying to sleep involves excessive worries about an uncertain future (Desjardins et al, 2015). Uncertain futures regarding finances and housing were a common theme mentioned in the case studies, so it is no surprise that this is linked with poor sleep.

The data in the graph on page 9 (Figure 1) was extracted from the case studies fact collation table (a table used to collect and organise findings from each hub’s case study). The X-axis shows all the themes discussed by the SUs attending sessions in Romford, and The Y-axis shows the number of times a theme was mentioned.

The trending themes in Romford hub were depression, anxiety, identity, and grief, with the most trending being anxiety.

The same quantitative approach analysis was conducted to extract the rest of the hubs’ themes. Please see the appendix to view the other data graphs.

Gaps

The review of the case studies allowed us to identify specific needs we can better address, and what gaps in the service need to be filled.

Catch22’s PWB contract specifies offering holistic support on the challenges SUs experience to accommodate for any gaps in our intervention delivery. Therefore, we have built a vast network of partners and referral groups across the organisation itself, and external organisations offering diverse rehabilitation and re-integration pathways. To cite one example, we have recently partnered up with Noela Yoga Wellness and Training, offering SUs one-to-one sessions around mindfulness techniques, and promoting gentle exercise from a lived experience trainer.

Another key gap was that some of the themes frequently mentioned above are not yet covered as specific interventions. Namely, there is no intervention specifically addressing depression, trauma or PTSD. The failure to address depression was a recurring gap in Canning Town, King’s Cross, and Tottenham hubs. It is important to recognise that Catch22 is not a clinical service and therefore is not equipped to provide therapy, as practitioners are not trained to do so. The interventions offered are low level, but nonetheless will inevitably receive referrals for SUs that need more intensive support. There was evidence in the case studies that practitioners were still able to address these needs through the interventions we do offer by lightly touching on wellbeing exercises or supporting with signposting to more professional support. Teasdale (1983) asserts that negative thinking patterns are the major cause of depression. We found that our Emotional Management intervention could apply to depression as some activities are created to help SUs challenge their negative thoughts and help them improve their mental health.

In case studies where the SU suffered depression, they were able to tackle this when resilience, goal setting and motivation were addressed. In addition, our wellbeing practitioners can support service users with self-referrals to the GP or private organisations for talking therapies when help from experts is needed.

More practical needs we are currently not fully equipped for concern migration status, employment challenges and housing issues. Many service users shared concerns around deportation, which Catch22’s PWB contract does not have specific interventions for. Moreover, Catch22 does not have any specific referral routes or pathways to other organisations that provide support around immigration statuses.

Our wellbeing practitioners recognise the difficulties of supporting SUs who have such fundamental matters at risk. It is therefore acknowledged by Catch22 that the timing of the referral to us and where we sit in the rehabilitative journey is important.

A frequently mentioned difficulty by SUs is finding employment and housing. The infamous Maslow’s Hierarchy of Needs (1943), which delineates certain needs that must be achieved in a hierarchical format for survival, places employment and shelter as a very immediate need before other needs can be attended.

Catch22 implements Maslow’s Hierarchy of Needs as the theory underpinning their intervention offer: they recognise that there are more pressing needs that a service user may want to address during their journey of desistance, and it is only once they have achieved these that they are well placed to receive support from Catch22’s Personal Wellbeing services.

Nonetheless, a gap identified is that PWB could benefit from developing some referral pathways to immigration support organisations to support a service user that has more practical needs to meet before they can work with Catch22 productively.

The bright side: evidence of best practice

Despite evidence of gaps mentioned, at Catch22 we successfully support SUs with their needs, drive change and advocate for progress. Another important stage of the review consists of identifying good practices carried out by the practitioners to respond to the context of each case. Best Practices indicate a set of actions enacted by the Practitioners, such as adhering to contractual obligations or implementing a person-centred approach to address needs, while also using their innovation and expertise to support with aforementioned challenges.

Being aware of our SU’s background is at the core of Catch22 values, as we strive to make them feel comfortable to share their stories, opinions and concerns, by building a strong rapport. Practitioners conduct initial assessments in which they get to know the service user, their past, and their stance on their current wellbeing. PWB encourages a strong rapport with SUs by adopting a humanistic and person-centred approach within the interventions and their delivery. Interventions offered within PWB are formatted utilising positive discourse: the language used within the interventions is positive to propagate that there is room for growth. Rich (2001) identified that positive discourse can aid “creativity, self-esteem, and self-actualisation”. Catch22 also widely promotes building rapport with service users through their training on motivational interviewing, coaching skills, positive reinforcement, removing unconscious biases, as well as their general ethos of compassion, collaboration, empowerment and curiosity.

By taking the time to build a rapport with the service user, this enables the frontline practitioner to use a person-centred approach for their intervention delivery by conducting sessions in a format that will best benefit that specific service user- this includes providing support that is external to the interventions currently offered by Catch22. Service users can be referred or signposted to subject matter experts of areas Catch22 does not cover. This includes examples such as St Mungo’s, who support with housing, or Synergy Theatre Company who provide SUs with opportunities to get involved in theatre and performing arts. Whilst we want to offer a comprehensive service, we must utilise other services with more expertise in certain areas as supporting the service user to recognise their potential, desist from crime, and contribute to society meaningfully is the priority.

Inclusion is another form of best practice provided by our practitioners that is separate to the intervention itself. Time is taken to identify protected characteristics and other needs of the service user and how these can be accounted for during the sessions. When protected characteristics are then identified, practitioners follow a process of learning more about that characteristic from the perspective of the SU and working with them to identify ways in which the interventions can be adapted to accommodate this. An example may be spreading one intervention over several sessions for someone with learning differences, or not enforcing group sessions for someone with anxiety. An example of this may be found in a case study from February 2022, in which the allocated practitioner reports the SU’s difficult circumstances and challenges related to social anxiety. This led to the decision of re-adapting the intervention plan and delivering the contents of the group session in the form of one-to-one sessions, to put the SU more at ease during the first meetings. A few sessions later, the SU expressed their wish to start attending group sessions as they noticed improvements in their condition. In a case study from September 2021, a practitioner reports she acknowledged the SU’s undiagnosed learning challenges, so she agreed to write down the SU’s contribution when working together during the sessions. Adopting inclusive practices is of paramount importance when working towards a successful intervention.

Best practice also encapsulates delivering appropriate interventions through one-to-one sessions and/or group programmes when suitable or requested by the SU. To set out an order for the topics of discussion of each session and encourage the SUs to reflect on them more independently, workbooks containing activities and definitions are provided. This practice was found to be very popular among the practitioners and may be classified as evidence of best practice as work sheets were found useful by SUs and staff for tracking the SU’s learning and progress.

Catch22 also offers bespoke training packages and resources to equip practitioners to approach the myriad situations they may encounter and enable them to appropriately handle the needs of their caseloads. Some examples include training in motivational interviewing, to encourage engagement from the service user and implement an environment in which the service user feels safe to share. We also provide training which encompasses positive reinforcement and positive discourse, so SU needs are addressed optimistically and future-focused rather than looking at what they did wrong in the past. Essentially, utilising a robust approach that is humanistic, person-centred and tailored to individual needs enables us to build a good rapport with SUs and therefore support them in many ways.

Recommendations

What can continue to be implemented to improve the PWB contract?

Catch22 offers support through a variety of different contracts and an extensive network of collaborative partners, working together to achieve the same objectives.

Nonetheless, the service provided by the PWB contract can be expanded to address more needs which are pertinent to their journey of desistance. For example, a more holistic pathway that can cover multiple areas of need may be more beneficial as this recognises the interplay of various internal and external factors that influence one’s rehabilitation.

An example of this may be a service that can support with accommodation as well as personal wellbeing. In doing so, Catch22 can grow its influence and scope/breadth within the third sector and the Criminal Justice System.

However, more awareness of the service and interventions we offer should be raised and maintained amongst Community Offender Management (COM) – professionals who manage the risk of people on probation when they are in the community after their conviction, whether they spent time incarcerated or not- to make sure future SUs are directed to the right service from the initial referral and avoid miscommunication between agencies causing delays. Catch22 has acted to address this with the introduction of the Stakeholder, Engagement and Referrals Team (SE&R).

SE&R has been working since January 2023 to spread awareness, drive engagement and increase referrals to Catch22’s CRS contracts. They facilitate open days for professionals to enable probation officers to obtain an overall view of the specialised support we offer, build relationships with new stakeholders, and maintain relationships with our longer-term partners, to improve knowledge and confidence in our services.

Probation in the UK faces a lot of challenges: extreme workloads, consequent limited capacity, and changing from local service providers to a national approach (HM Inspectorate of Probation, 2021). Catch22 therefore acts to complement probation by supporting their service users where appropriate, lightening their workload. However, SE&R specifically ensure probation can make correct referrals so that they do not waste time having to alter referrals, and that the referral is correct for the service. This shows that SE&R permit a more efficient workspace for both probation and Catch22 practitioners.

To offer support with mental health needs, more direct resources should be created for SUs who experience setbacks in order to rely less on referrals to outside organisations. Whilst, as mentioned before, intensive mental health support is outside of PWB’s scope, Catch22 has begun to address this by creating the role of an Inclusion Lead, whose focus is to develop more resources and subject matter experts within the workforce that can support with different specific mental health needs. Catch22 has also developed more interventions in 2023 that can address more specific areas. For example, an intervention on grief. Whilst not a specific mental health intervention, experiencing grief encapsulates many mental health symptoms such as depression, anxiety and aggression.

However, Catch22 has created dedicated interventions based on the gaps mentioned by case studies from different hubs. As we mentioned earlier, Croydon hub had a recurring theme of service users wanting to address aggression. Consequently, PWB created an Anger Management intervention which was rolled out in 2023. Grief interventions were also implemented into our service delivery in 2023 following feedback from practitioners about the needs of service users. This evidences Catch22’s eagerness to utilise the experience of the frontline practitioners to formulate and improve our intervention delivery.

Catch22 also does not yet deliver interventions curated specifically for service users in custody, despite having an entire strand dedicated to service users that are still incarcerated. Catch22 has in-prison services such as their OMU in HMP Thameside and a life skills programme that is designed for those on remand in HMP Wandsworth which adapted and provided material to be adapted to the PWB contract, such as sessions around emotional management and decision making. That being said, the lack of specific interventions for the social inclusion strand is an imperative gap in our delivery, as highlighted by the frequent theme mentioned in case studies that service users often request interventions around re-integrating into society. As a practitioner notes in a case study, SUs can feel “unmotivated” and “struggle to adapt to life outside prison” making them “isolated and vulnerable to reoffending”. Catch22’s intervention team is therefore working to develop an in-custody work pack based propagated from intervention material that can be used by prison leads to specifically support SUs that are still incarcerated by emotionally and practically preparing them for their release.

As evidenced, Catch22 makes improvements by acting on frontline feedback and continuing to gather data from case studies and develop subsequent interventions. Since depression and related issues were found to be the trending challenges experienced, it would be recommended to create more specific interventions to assist SUs with their mental health. As a more immediate response to this current intervention gap it would be beneficial to establish liaisons and partnerships with more mental health support providers.

Conclusion

It is evident that our interventions are effective in supporting our service users and that our frontline wellbeing practitioners deliver them to a high standard with compassion and care for each individual service user.

In terms of interventions, we can improve and expand upon our current strategies to make a more profound impact on the lives of SUs. By integrating a richer array of supplementary resources and structured activities into our existing plans and work packs, we can offer a more holistic approach, and this is evidenced by the development and introduction of interventions such as anger management and grief, as well as resources for protected characteristics.

Despite this, Catch22 could strive to improve with a more in-depth focus on discussions and practical activities, which, in turn, would substantially enhance the learning experience for SUs.

To do this, the PWB contract could be equipped with more support surrounding mental health, housing, and immigration status. Some of these could be introduced into existing interventions. For example, the intervention on grief could focus on additional mental health needs associated with it, such as depression, anxiety and aggression.