218

218 provides an integrated, holistic and woman centred residential and day support programme for adult female offenders. The project aims to help women break the cycle of their offending behaviour.

What are the aims and objectives?

The overall aim of the 218 service is set out in the project’s mission statement:

“The 218 service is committed to finding ways of working effectively with women who are marginalised by society. We aim to engage women with complex needs who are involved in the criminal justice system in accessing relevant, individualised services, by means of well trained staff teams who are skilled and confident to deliver a range of exciting and dynamic programmes. Through the experience of being part of this service we aim to empower women to make a more positive contribution to their lives, their families, communities and society.”

Specifically the service wishes to:

• reduce the number of women from the Glasgow area being remanded into custody and/or receiving a custodial sentence;
• reduce the number of women being prosecuted for offences where a diversion would be an appropriate option;
• interrupt the pattern of offending behaviour displayed by the identified client group;
• identify on an individual basis the issues and needs relating to offending behaviour and create an appropriate individual care plan;
• provide immediate health assessment and intervention;
• provide service users with the opportunity to participate in positive life planning;
• encourage service users to establish a healthy lifestyle through dietary and nutritional plans;
• provide comprehensive assessments;
• ensure a high quality service that allows for women to develop skills and strategies to redefine their lifestyles away from offending behaviour and associated patterns.

218 is a key mechanism through which the city of Glasgow is delivering on national criminal justice objectives and improving the provision and outcomes for women offenders.

Why was the project set up?

Over the last 15 years there has been a steady rise in the number of women offenders and women in prison, alongside a growing awareness that the causes of female offending and the needs of women offenders are different to those of their male counterparts.

Following a high number of suicides by women offenders in the late 1990s, a review of service provision for women offenders was carried out. The need for a ‘time out’ centre was identified in response to growing concerns about the requirements and treatment of women offenders in the criminal justice system.  It was believed that such a service would be of particular benefit in Glasgow by offering the courts a specialist facility for women who are subject to the criminal justice process and who may or may not have co-existing addiction problems. It would offer safety and certain limits, in a community setting, whilst keeping the focus on the treatment of problems.

The 218 centre was opened in Glasgow in December 2003. The Scottish Executive provided funding for the service which was originally a partnership between NHS Greater Glasgow and Clyde and Turning Point Scotland (TPS). In 2006 the Glasgow Addiction Service (GAS) began providing health related interventions at 218.

Who are the participants and the partners?

To access the service, 218 participants must be:

1. women offenders who are at least 18 years old with involvement in the criminal justice system (current or within last 12 months);
2. assessed as particularly vulnerable to custody or re-offending.

Many of the women engaged with the project are also involved in substance misuse.

Located in the city centre of Glasgow, the service provides both a residential and a day support programme which can be combined or used separately as required. The maximum period of engagement permitted is six months for the residential service and 12 months for the day service although the project has some flexibility built in. The majority of referrals to the service are made by the courts or Criminal Justice Social Work. The service works with over 600 women per year, predominately aged between 25 and 39 years.

“It’s not about labelling people but we can only provide the best support when you know what’s going on in someone’s life.”

Project participants are usually subject to statutory supervision and have complex needs including substance misuse, mental and/or physical health problems, experiences of domestic abuse, problems with housing/accommodation, trauma issues, or a pattern of repeat offending behaviour. The project is not equipped to work with women with acute mental health problems, those who require hospitalisation due to physical illness or those who require constant observation due to their behaviour.

Priority is given to the referral of women offenders within Glasgow City, although women from other areas will not be refused if their vulnerability would be likely to cause further harm should their referral be denied. From 2007 to 2009, 97% of participants were from a Glasgow postcode.

The service is delivered through a partnership between Turning Point Scotland (TPS) and Glasgow Addiction Service (GAS), and is managed and overseen by three multi-agency, multi-disciplinary groups.

What does the project do?

The 218 service is an initiative that takes a person centred approach to dealing with the issues that women offenders face. The programme of work at 218 is designed to address issues with substance use, physical and mental health and other social needs including housing and childcare.

A nurse led medical clinic provides substitute prescribing, and a wide range of physical and mental health and therapeutic interventions are delivered by nursing and other specialist staff. As a result of this approach an extensive range of interventions and provision is available for women at the service including one-to-one key work, counselling, psychology and psychiatry, physical health advice and intervention, occupational therapy, chiropody, dentistry, dietary and nutritional advice, acupuncture, group exercises, weekend outings and outward bound courses. All that is available is offered in an individually focussed, flexible programme of support which responds to each woman’s needs. Key work is delivered in a woman centred, collaborative manner with both the project worker and the service user negotiating and discussing key elements of the care plan together. 

“218 is person centred which is powerful.”

The residential service provides supported accommodation for up to 12 women offenders from between four weeks and six months. The initial four weeks involves a comprehensive assessment of each woman’s needs culminating in the creation of a tailored care plan. Following assessment, each woman remains in the residential unit or returns to the community and continues their involvement with the 218 day service. After three months of supported accommodation a full review and assessment is carried out. If initial goals have been met, women then work towards community re-integration.

The day service works with up to 50 women offenders who remain in the community. Women attend one compulsory group and up to three further contacts a week and can also voluntarily attend the range of creative or practical groups offered at the service. The programme involves a combination of one-to-one support, group work and a wide range of other activities and interventions. Each woman who engages with the service is fully assessed and contributes to their own individually tailored care plan. The period of engagement with the day service ranges from three to twelve months.

The programme delivered at 218 is structured around four key stages aligned with the four phases of the stages of change model and has been redesigned following consultation with staff and service users.

• Phase 1: motivation to start to address key issues.
• Phase 2: gaining a clearer understanding of key issues and how to overcome them.
• Phase 3: changing behaviour, stabilising.
• Phase 4: looking to the future, maintaining stability and introduction to services in the community.

Has the approach changed over time?

The 218 service has continued to provide fundamentally the same service for women offenders as originally designed. Changes have been made to the structure and organisation of the programmes delivered, the management of the service, the roles and responsibilities of staff, the duration of engagement permitted, and the gathering and use of data held by the service in response to evaluation findings.

In what way is the approach ‘asset based’? 

Working in partnership with the women who engage with the service, doing ‘with’ them rather than ‘to’ them, 218 provides a flexible response to the needs and interests of each participant and strives to address the issues and find diversionary activities that suit each person in a supportive and inclusive way. By providing opportunities for shared experiences and learning, the service helps to build positive relationships between the women. 218 supports positive dialogue and nurtures the development of trust, understanding and awareness of the issues facing female offenders.

“Making services fit people.”

Improvements in mental health, physical health and social health are reported by the majority of women who engage with the service, alongside improved confidence and self esteem, hope for the future and belief in their own abilities and achievements. 218 also assists women to make sense of their environments, take increased control over their own life circumstances and construct independent lives within their families and communities, enhancing their resources and capabilities as they progress. Individuals are supported to identify and overcome barriers to their social and economic inclusion in society and to realise their full potential, thereby improving life chances and circumstances.

“I want to grab this opportunity. I’m focused on recovery and getting the life I deserve.”

The service recognises that, for many, 218 may be one of several interventions and support mechanisms women engage with in heading for an improved quality of life. The service is the start of a much longer journey that often takes years but by helping the women who engage with them to identify and focus on the assets and strengths within themselves, they may use these resources to make sustainable improvements in their lives.

How has success been measured?

Two full scale external evaluations of the work of 218 have been carried out in 2006⁵ and 2010⁴. These evaluations have used a range of data sources, including Strathclyde Police re-offending data, and qualitative data about changes in softer outcomes as identified following one-to-one interviews with participants.

An examination of the cost benefit of the 218 service has also been undertaken and has shown that for each £1 invested in the service there is the potential to save £2.50 across health care, criminal justice, social care, the economy, and in costs to wider society. Research also suggests that this saving may be considerably higher if longer term benefits such as ceasing reliance on benefits and improvements to the circumstances of the children of women offenders are taken into consideration. 

What are the strengths and challenges? 

The 218 services provides a person centred, individually focused approach to support adult women offenders to break the cycle of offending and to make sustainable improvements in their lives. The holistic and integrated approach ensures that an individual care plan is in place for each woman and that women are empowered to make choices and are engaged in decision making about their own care.

“I’ve found out a lot about myself. The old me is coming back.”  

The project adopts a flexibl and adaptive response to the needs of each woman and provides a wide range of health related and therapeutic interventions and activities. The service further provides structure to the day and women are intensively supported to rediscover areas of interest and develop new skills.

Key findings from the evaluation indicate that project participants have reduced their levels of offending by 31% following contact with the service and have also experienced large reductions in sexual/injecting risk behaviour (a 61% reduction) and criminal involvement (a 46% reduction). During the period from 2007 to 2009 a significant reduction in the number of women sentenced to periods of imprisonment in Glasgow (202 to 153) was recorded compared to a large increase seen in Scotland overall (614 to 1,169). There was also a significant reduction in the rate of women offenders imprisoned from Glasgow as a proportion of the Scottish total (33% to 13%).

Many participants reported significant reductions in substance misuse and violent behaviour alongside positive improvements to their mental and physical health, physical appearance and weight particularly after years of self neglect and drug use. Improvements in the women’s relationships with their families and children have also been reported.

A further strength of the service is the unique combination of GAS and TPS approaches within the same building, meaning that the service can effectively work with women who are substance misusers and who also suffer from mental health issues. Help and support is always available including over the phone to women who are feeling vulnerable after they have formally left the service.

The project recognises a number of challenges for the ongoing delivery of an integrated and ‘woman centred’ service. Supporting women who come to the service with undiagnosed mental health issues and individuals who attend many times before they engage fully were highlighted as key challenges. It was also identified that some women start their journey with 218 unwillingly but often engage fully after criminal justice system restrictions have been lifted. Furthermore, some participants struggle initially with the structure of the service but over time come to value the routine and sense of purpose that the service offers.

“I’ve got a glimpse of hope for the future.”

On a personal basis, staff expressed energy and passion for the work that they do and gain tremendous personal benefits from being involved with the service. Staff also reflected on the scale of the challenges that many women face in life and feel that service is making a real difference to many.

Participants expressed high levels of gratitude and appreciation for 218 and for the help and support they had received. They felt that the service had given them hope for the future, the time and space to rediscover who they are and the opportunity to learn new talents and skills. Participants also articulated their pleasure in being able to share experiences with other women in a similar position and to support each other.

Relevant links to other parts of the Understanding Glasgow site:  community safety, lifestyle, social capital, mindset, health, children’s wellbeing