Title: Healthy Dads Healthy Kids in prisons: a feasibility study and pilot for an intervention to improve father – child relationships
Funder: Chief Scientist Office, Scotland

Abstract: Prisoners are among the most excluded members of society, often having poor physical and mental health. Many imprisoned men are fathers, and their children experience poor outcomes. The importance of fathers keeping in contact with their children while in prison is increasingly recognized by the World Health Organization and the Scottish Prison Service. Strengthening family relationships during imprisonment reduces the chance of re-offending, and can lead to lasting improvements in the mental health and wellbeing of men and their children. _x000D_ _x000D_ The aim of the study is to make final adaptations to a program called Healthy Dads, Healthy Kids in Prisons (HDHK-P, based on the Healthy Dads Healthy Kids (HDHK) program developed in Australia), and test it in two prisons. We want to find out whether HDHK-P appeals to fathers in custody and their families, and if it appears to improve the mental health, wellbeing and self-esteem of fathers and children, and strengthen father-child relationships. _x000D_ _x000D_ HDHK is a 9-week, healthy lifestyle program, including fun joint activities for fathers and their children, with father-child relationships at its core. Weekly sessions led by trained prison staff facilitators aim to improve father-child relationships through positive interactions focused on physical activity and healthy eating._x000D_ _x000D_ HDHK has been delivered over many years in community settings. It has never been delivered in prisons before. We have existing collaborations with the Scottish Prison Service and the Australian HDHK team (who have previously visited a number of Scottish prisons and met some of the staff involved in the current study). Following these visits, we have made a number of changes to the HDHK materials for delivery in Scottish prisons, and during the initial stages of the study will work with the Scottish Prison Service to make any further changes needed because of COVID-19._x000D_ _x000D_ We will then try out HDHK-P in two prisons, and make any improvements needed, before piloting it in both prisons to see if and how it works. In the pilot, we will look at the potential of HDHK-P to: improve mental health, wellbeing and self-esteem in fathers; improve wellbeing and self-esteem in their children; and strengthen father-child relationships. We will also look at how HDHK-P was delivered and what men and prison staff think of it, by observing sessions and talking to prison staff, fathers and their children. We will also talk to the carers (e.g. mothers) who bring the children to the prison for HDHK-P sessions, other staff involved in the practical arrangements to allow the program to happen, and to people who work to support families with a family member in prison._x000D_ _x000D_ The study is not big enough to tell us if HDHK-P works, but will help us decide whether a larger study is needed to do this. If the results are promising, we will seek funds for a full-scale study that can be carried out in the prison setting. _x000D_ _x000D_ The current study will be run by a team of researchers who have worked together before on prison-based health promotion studies. They have strong existing relationships with Scottish Prison Service and prison staff. Researchers and prison staff will present the findings to local and national prison service representatives, and write up the results for academic, policy and public audiences. _x000D_ _x000D_ Our study steering group will include people from Families Outside, Barnardo's Scotland, the Scottish Government Children and Families team, senior Scottish Prison Service staff and people who have previously been in custody or who have had experience of a relative being in prison.

Lay abstract: People who have been imprisoned (95% of whom are men) are at high risk of increased mortality and poor health. Children of imprisoned parents have poorer health, education and offending outcomes compared to other children. Around half of people in custody lose contact with their families while imprisoned. Delivering effective relationship-promoting interventions to fathers in custody can improve the mental health, wellbeing and self-esteem of fathers and their children, break possible inter-generational cycles of disadvantage, and reduce recidivism and inequalities._x000D_ _x000D_ A program known as Healthy Dads, Healthy Kids (HDHK) has shown significantly improved health outcomes and behaviors in fathers and children when delivered in community settings. For the first time internationally, we have adapted the program for delivery in prisons (HDHK-P). HDHK-P is designed to facilitate children’s contact with their fathers and uses enjoyable joint physical activity and healthy eating sessions to improve their physical and mental health, and father-child relationships. Completed development work means a first version of HDHK-P is available, which requires some further adaptation following changes in prison regimes during COVID-19. Physical Education Instructors (PEIs) in two prisons will then be trained to deliver the program._x000D_ _x000D_ Work package 1 (WP1) will adapt the current version of HDHK-P to reflect the ‘COVID prison context', before testing the feasibility of delivering the program to groups of fathers and their children in two prisons. It will then further refine the program content and delivery process for the WP2 pilot. Meetings with key stakeholders in the two prisons and with those supporting men’s families within the community will inform COVID-related adaptations, identify any recruitment and implementation issues for wider delivery, and will allow us to explore the acceptability and feasibility of the proposed research methods. _x000D_ _x000D_ WP2 will pilot the optimized HDHK-P over two deliveries (A and B) in the same two prisons (four deliveries in total) and will assess the research procedures for a future full-scale evaluation. We will conduct: observations of program sessions; in-depth interviews with the prison Physical Education Instructors facilitating program delivery, the participating fathers and the adults accompanying the children to participate in the sessions; and focus groups with the participating children. Baseline and follow-up measures (at 9 weeks and 6 months for both A and B deliveries, and 9 months for A deliveries only) will collect data on fathers' mental health or wellbeing (likely future full-scale evaluation primary outcome), and a selection of the following (to be finalized in WP1): father and child self-esteem, father discretionary food and drink canteen purchases, father and child self-reported dietary intake, father and child physical activity, father and child weight, child screen time, quality of father-child relationship from both perspectives, and child socio-emotional health and self-worth (potential future full-scale evaluation secondary outcomes). We will also conduct a wider prison consultation with regard to a future full-scale evaluation and/or roll-out (WP3). _x000D_ _x000D_ An optimized HDHK-P program will be a key output of the study. Progression to a full-scale evaluation will make use of a red-green-amber system designed to assess positivity about the program among stakeholders, and aspects of delivery and sustainability that are pertinent to such an evaluation being possible. If there is considerable support for HDHK-P, but a future full-scale evaluation looks to be unfeasible, the possibility of embedding the program in the Scottish’s Prison Service’s Family Strategy will be explored.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE