Does “Enhanced Support” for Offenders Effectively Reduce Custodial Violence and Disruption? An Evaluation of the Enhanced Support Service Pilot

• DOI: 10.1177/0306624X17752254
• Published date: 01 September 2018
• Author: Kerry Joy,Jake Camp,Mark Freestone
• Date: 01 September 2018
• Subject Matter: Articles

752254IJOXXX10.1177/0306624X17752254International Journal of Offender Therapy and Comparative CriminologyCamp et al.
research-article2018
Article
International Journal of
Offender Therapy and
Does “Enhanced Support”
Comparative Criminology
2018, Vol. 62(12) 3928 –3946
for Offenders Effectively
© The Author(s) 2018
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Reduce Custodial Violence
https://doi.org/10.1177/0306624X17752254
DOI: 10.1177/0306624X17752254
journals.sagepub.com/home/ijo
and Disruption? An Evaluation
of the Enhanced Support
Service Pilot
Jake Camp1 , Kerry Joy1, and Mark Freestone2
Abstract
This study aimed to examine the effectiveness of The Enhanced Support Service
(ESS) pilot in reducing custodial violence and disruption, and the associated costs,
by observing the behavioural change of the 35 service users who participated in
ESS intervention within its first 22 months of operation. Frequencies of recorded
incidents of aggressive behaviours, self-harming behaviours, noncompliance, and
positive behaviours were counted from routine administrative systems using a
coding structure developed in previous studies. The count data were analysed using
nonparametric tests and Poisson regression models to derive an Incident Rate Ratio
(IRR). Findings suggest the ESS is associated with a reduction in aggressive behaviours
and noncompliance, with medium to large effect sizes (r = .31-.53); however, it
was not associated with a reduction in deliberate self-harm or increased positive
behaviours. The Poisson models revealed that levels of pre-intervention behaviour,
intervention length, intervention completion, and service location had varying effects
on postintervention behaviour, with those who completed intervention demonstrating
more favourable outcomes. The ESS service model was associated with a reduction
in behaviour that challenges, which has implications for the reduction in associated
social, economic, and political costs—as well as the commissioning of interventions
and future research in this area.
1Oxleas NHS Foundation Trust, Kent, UK
2Queen Mary University of London, UK
Corresponding Author:
Jake Camp, Oxleas NHS Foundation Trust, Forensic Psychological Therapies, The Bracton Centre,
Bracton Lane, Dartford, Kent, DA2 7AF, United Kingdom.
Email: jakecamp@nhs.net

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Camp et al.
3929
Keywords
violence, disruption, custodial, intervention, poisson regression, prison
Introduction
Custodial Violence and Disruption
Custodial violence and disruption leads to serious human, economic, and political con-
sequences. These consequences include the following: staff sickness, burnout, dissatis-
faction, disability, and reduced morale (Daffern, Mayer, & Martin, 2003, Gadon,
Johnstone, & Cooke, 2006; Gallagher & Sheldon, 2010; National Offender Management
Service [NOMS] & Department of Health, 2011; Nhiwatiwa, 2003) as well as environ-
mental damage, expensive regimes (Gadon et al., 2006), diversion of care and resources
(Allen, 2008), management issues (Coid et al., 2006), increased future recidivism
(Bonta, Blais, & Wilson, 2014), reduced safety and security (Liebling & Arnold, 2012),
physical injury (Bennett & Moss, 2013), and emotional trauma (Daffern et al., 2003;
Gallagher & Sheldon, 2010) affecting both staff and prisoners. Consequently, violence
and disruption has significant financial implications worldwide (Brand & Price, 2000;
Waters, Hyder, Rajkotia, Basu, & Butchart, 2005).
Violence and disruption in custodial settings frequently manifests itself through the
following categories (Bridgland, Camp, & Leitner, 2016; Dixon, 2012):
•• Aggressive behaviours encompass physical and verbal aggression. Acts of phys-
ical aggression/violence include spitting, hitting, throwing, smashing, flooding,
burning, and slamming actions toward people and objects as well as when these
events lead to physical restraint (Tew, Dixon, Harkins, & Bennett, 2012). Acts of
verbal aggression include shouting, swearing, arguing, threatening, ranting, ver-
bal bullying, agitation, and angrily challenging (Tew et al., 2012).
•• Self-harming behaviours include intentional acts toward one’s self, such as scratch-
ing, cutting, banging, ingesting, inserting, suffocating, and mutilating (Bennett &
Moss, 2013; Lohner & Konrad, 2006). Deliberate self-harm (DSH) is typically
separated from suicidal behaviours due to differences in intention and motivation
(Lohner & Konrad, 2006). However, to reduce subjective bias when collecting
data, and maintain generalisability across criminal justice systems, these con-
structs are viewed as one utilising the U.K. Ministry of Justice’s (MoJ; 2014) defi-
nition: deliberate self-injury, irrespective of method, intent, or severity.
•• Indicators of “Noncompliance,” such as custodial punishment and reward sys-
tems, are typically used as a proxy for other violent and disruptive behaviours
(Taylor, 2003; Tew et al., 2012). This is disputable, as these systems are used as
indicators for progression through criminal justice systems, and therefore have
important implications. Relevant to the U.K. criminal justice system is the
“adjudication” (NOMS, 2011b) and the “Incentive and Earned Privilege (IEP)
system” (NOMS, 2011a). Adjudications are disciplinary charges given to

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International Journal of Offender Therapy and Comparative Criminology 62(12)
prisoners who complete behaviours which threaten the control, order, safety,
and discipline of the prison (NOMS, 2011b). IEP progression is granted if a
prisoner reaches and maintains a desired standard of behaviour which results in
gaining “privileges.” In the presences of undesirable conduct and/or behaviour,
an IEP warning is issued and earned “privileges” are removed (NOMS, 2011a).
Adjudications and IEP warnings are given out in response to a wide variety of
disruptive behaviours (NOMS, 2011a, 2011b).
•• Positive behaviours include pro-sociality, maximising support and relation-
ships, accessing activities, and fulfilling duties (Bridgland et al., 2016). These
could include going to work on time, accessing education, seeking support,
cleaning their environment voluntarily, apologising to others, and others notic-
ing good conduct. Positive behaviours have been shown to improve negative
behaviour and the perceived safety of custodial environments (Ireland & Quinn,
2007; Loucks, 1996; Polascheck & Ross, 2010; Ward & Bailey, 2013).
Aforementioned violent and disruptive behaviours are attributed to a range of per-
sonal, interpersonal, and situational factors (Gadon et al., 2006; McGuire, 2008;
Schenk & Fremouw, 2012; Sorensen & Cunningham, 2010; Way, Miraglia, Sawyer,
Richard, & Eddy, 2005; Welsh, Bader, & Evans, 2013) including the following: age,
sentence length/type, ethnicity, mental health, personality difficulties, environment,
and staff management. Custodial environments can also result in feelings of frustra-
tion, deprivation, and powerlessness in an offender, leading to increased aggression
and agitation (Wortley, 2002). Importantly, a disproportionately small number of the
prison population is responsible for disproportionately large frequencies of the above
behaviours (Coid et al., 2006; McGuire, 2008; NOMS & National Health Service
[NHS], 2014). These behaviours are rising (MoJ, 2017) and can be significantly higher
in prison populations compared with the general population (Welsh et al., 2013;
Young, Justice, & Erdberg, 2006). This highlights the need for evidence-based inter-
ventions to reduce violence and disruption.
Custodial Interventions
Attempts to mitigate the costs of custodial violence and disruption have been made via
the development of specialist interventions. Punitive strategies to change behaviour
within custodial environments have been shown to engender resentment, anger, and
fear in the recipient, likely perpetuating the issue (Sanson, Montgomery, Gault, Gridley,
& Thomson, 1996). However, previous research has highlighted areas of success in
reducing violence and disruption (French & Gendreau, 2006; McGuire, 2008): risk
assessment (Belfrage, Fransson, & Strand, 2004), offending behaviour programmes
(French & Gendreau, 2006; Walrath, 2001), psychological interventions (Duggan,
Huband, Smailagic, Ferriter, & Adams, 2007; Lowencamp, Latessa, & Holsinger,
2006), staff training (Rice, Harris, Varney, & Quinsey, 1989), interpersonal skill build-
ing (Bell, 1993; Polascheck & Ross, 2010), employment/education (McCorkle, Miethe,
& Drass, 1995), and increasing out of cell activities (Loucks, 1996).

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Camp et al.
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Despite some success, meta-analyses evaluating these interventions only
demonstrate small to medium effect sizes (French & Gendreau, 2006; McGuire, 2008),
suggesting a continued need for more effective strategies. Moreover, many of the
above interventions require motivation and capacity to engage, which may not be
present in the most violent and disruptive populations (NOMS & NHS, 2014).
Increasingly successful interventions for more severe violence and disruption are
contingent on multidisciplinary, tailored, and flexible multimodal methods of delivery
(Bridgland et al., 2016; Humber, Hayes, Senior, Fahy, & Shaw, 2011; McGuire, 2008).
Examples of custodial interventions aimed at hard-to-engage populations who
present with severe behaviour that challenges include the CHROMIS programme (an
accredited programme within the Dangerous and Severe Personality Disorder [DSPD]
service at Her Majesty’s Prison [HMP]...