The second part of our blog series, Working in a Prison Setting with Incarcerated Clients, will look into a variety of elements involved in undertaking assessments in a prison setting. This includes:

• Understanding incarcerated individuals, particularly NDIS participants
• Understanding of expectations for OT intervention in community-based settings for participants/clients who have been previously incarcerated, and
• Refining report-writing skills to support incarcerated (past or current) individuals to achieve positive outcomes.

Culturally Safe Practice

Currently, there is an overrepresentation of Indigenous participants in correctional facilities, with:

• 33% of all prisoners are Aboriginal or Torres Strait Islander people (approx. 14,000)
• The incarceration rate has increased by 7% (5% accounting for population growth)
• 91% male, 9% female
• A median age of 33.2 years (approx. 3 years younger than overall median age)
• A prior imprisonment rate of 78% compared to 61% across the general prisoner population.

There are also a variety of supports in place to assist in this, such as:

• An Aboriginal Liaison Officer
  • Who contribute to the implementation of recommendations from The Royal Commission into Aboriginal Deaths in Custody
  • Is a point of contact for families and prisoners
  • They are active in staff training.
• A Social Worker

To partake in culturally safe practice, it is crucial to establish trust and rapport with clients. This can be demonstrated through establishing our role and differentiating ourselves from others. It is also important to be aware of background knowledge, trauma and triggers and also the impact of institutionalisation on participants.

Transition to Community Settings

There are a variety of important things to bear in mind when considering a participants transition to community settings, these include:

• Anxiety, discharge plans (or lack of)
• Homelessness and accommodation
  • Crisis accommodation
  • Temporary Housing
  • Specialised facilities.
• Organising finances, NDIS supports, accommodation upon release
  • All of these will require ID
  • Likelihood of having this organised prior to release.

Client Presentation

While each participant is going to have a unique presentation, therapists can expect the following as common circumstances when working in a prison setting:

• The most common diagnoses such as:
  • Intellectual Disability, Schizophrenia, Anti-social Personality Disorder
• Change from structured to an unstructured environment
• Exacerbation of stress, anxiety and depression
  • Coping mechanisms (substances, aggressive behaviours)
• The cycle of reincarceration
  • Institutionalisation (from time spent incarcerated) and isolation can often lead to reincarceration.
• A prompt/unexpected release, which can have an impact on the ability to provide support through NDIS
• Parole conditions and the restriction on movement
  • Impact on socioemotional functioning and wellbeing
  • Impact on the leisure activities one is able to engage in à poor choices and reoffending!

Areas for Intervention

There are four key areas for intervention when working with incarcerated clients:

• Financial Management
  • Visual cues and simple explanations
  • Needs vs Wants
  • Emphasising funds left over for personal use rather than necessities
• Finding meaningful activities and occupations
  • Minimising the impact of institutionalisation
  • Breaking down daily routines and simultaneously offering structure
• Emotional Regulation
  • Collaborating with Positive Behaviour Support (PBS)
  • Simple breathing exercises
  • Mindfulness and grounding exercises
• Community ADLs
  • Shopping (social and occupational demands)
  • Controlling exposure to uncomfortable situations.

FCAs in Community-Based Settings

Now, the NDIS is adjusting their stance on the validity of evidence from corrections-based Functional Capacity Assessment’s (FCAs). It is now more likely to assess a person twice:

• This would be once in prison and once when released
• This will provide the ability to have findings corroborated by their support provider and other stakeholders.

As a result of this, referrals for FCAs in correctional facilities are now decreasing. This is a direct impact on having supports readily available upon release.

Progress vs Regression Case Study

The below case study has been identified regarding Tony, 40M, Intellectual Disability, Anxiety, and demonstrates progress vs regression:

• Tony was seen whilst incarcerated for an FCA where independent living was recommended due to difficulty with social interaction and was vulnerable to being exploited/manipulated by others
• Tony was released into shared housing with high drug use and then reincarcerated
• Tony was released again with independent housing, however he was not appropriately supported by his provider
• He suffered high anxiety and PTSD from prison which impacted all areas of daily life, he was getting minimal sleep and emotional dysregulation
• Tony was given a new support provider with limited hours, but they were extremely supportive & structured
• His parole conditions have since ended, he has reconnected with his family, and he has found work.

Final Considerations

From this discussion, there are four key takeaways that one should remember when working in a prison setting with incarcerated clients, including:

• Institutionalisation in a vicious cycle of reincarceration
• Knowing when to put therapy on hold or closing off altogether
• Recognising warning signs – such as signs that someone is experiencing a period of heightened difficulty, anxiety and isolation i.e. recognise these and work with your team to prevent reincarceration and promote positive outcomes
• Ensuring you feeling safe.

At Ability Partners, we strive to ensure that assessments undertaken in a prison setting are conducted in a professional and safe manner. We have an excellent team of therapists experienced at working with incarcerated clients and working alongside them to achieve goals that really matter.