Title: Understanding the Impacts of Care Farms on Health and Well-being: A Pilot study to inform the design of a follow-on study to assess the cost-effectiveness of care farms in improving health and wellbeing and reducing re-offending
Funder: Department of Health (England)

Abstract: This pilot study uses quantitative and qualitative methods to understand how best develop a follow-on study to assess the cost-effectiveness of Care Farms (CFs) for offenders serving community orders (COs). In addition to gathering the information required to design the follow-on study this pilot will also build knowledge of CFs and the mechanism through which they may improve the health and well being of offenders.Participants: Adult (18 and over) offenders serving COs. Sample: 150 offenders serving their CO in a CF and 150 offenders in other CO settings.Inclusion criteria: Any adult 18 years and over serving a CO in a CF or comparator location.Exclusion criteria: None. Offenders who have committed serious offences or have severe mental health issues are not sentenced to COs. Translation will be provided for those who are not comfortable being interviewed in English.The Intervention: Care farming has been defined as the therapeutic use of farming practices. CFs provide health social or educational care services for vulnerable groups through supervised structured programmes of farming-related activities (1). Qualitative and survey evidence points to the positive impacts for CFs on mental health self-esteem social interaction and physical health. However no studies have been conducted to determine the effectiveness and cost-effectiveness of CFs. Despite the lack of robust evidence commissioners are increasingly placing disadvantaged clients such as offenders young people excluded from school people with substance misuse issues to be supported and ‘treated’ on CFs. Care farming is a growing movement with over 2000 CFs across Europe using nature for health social and/or educational benefits (2). A survey of CFs in the UK (2007) identified 76 CFs seeing on average over 5800 clients per week (3; 40). Of the CFs surveyed 19 took clients from probation Trusts. Recent figures suggest there are now 189 CFs in the UK (personal communication Care Farming UK). Clients are predominantly from disadvantaged backgrounds and include those with poor mental health substance misuse issues social excluded young people and offenders.Offenders serving their COs on CFs are supervised to undertake a range of unpaid work. COs can be up to 300 hours spread over time as appropriate for the offender. On average they run for 6 months. Depending on the nature of the farm the activities undertaken include horticulture livestock care aquaculture building environmental and conservation work. Three CFs in England will participate in this pilot study: one in Yorkshire and one in Shropshire are already confirmed and a third is being finalised. The CFs all provide some form of farming activity as therapy to a range of clients including offenders serving COs. Their work with offenders is commissioned by local Probation Trusts. In general the NHS is not involved in funding CFs for their work with offenders however where NHS funded health trainers are available at the CF these may be used by offenders. The three CFs are selected for this study as they illustrate the wide range of activities and ways of working that can be found in CFs across the UK. This will help in understanding the variation in CFs and the subsequent intra-cluster correlation coefficient which will be needed when calculating the most appropriate sample size for the larger follow-on study. Secondly CFs are selected who have long-standing relationships and funding from their local Probation Trusts.Comparator sites: Adult offenders serving COs in settings other than a CF in West Yorkshire Shropshire and one to be assigned. The activities carried out whilst serving COs in these comparator areas include: building work food handling painting/decorating recycling and cleaning. The Probation Trusts in each region take the decision on where to allocate offenders. Initial discussions with Probation Trusts indicate that these decisions are based on:•a risk assessment•their physical ability and mobility•limiting offenders travel time to the location•supervision requirementsThese factors will be measured and taken into consideration as potential confounders. Outcomes:Primary: Quality of life and well-being derived from the Clinical Outcome in Routine Evaluation–Outcome Measure (CORE-OM). CORE-OM has been validated among offender populations (27; 28) and can be used to derive QALYs (31). The 34 items cover four dimensions: subjective well-being; problems/symptoms; life functioning; and risk/harm (29).Secondary: Re-offending rates over a max 18 month period Mental health derived from Warwick-Edinburgh Mental Well-being Scale (WEMWBS) (32). Measures of smoking alcohol drug use diet and physical activity adapted from General Lifestyle Survey/ Health Survey of England. Exploratory estimates of health utility as derived from CORE-OM (29; 30). Exploratory estimates of the cost per re-offending event avoided due to CF. Potential Impact: While this study is a pilot study it has the potential to contribute to the knowledge base on the processes within a CF that facilitate improvements in health and well-being. Furthermore this more detailed understanding of CFs as an intervention for offenders will provide insights for commissioners in Probation Trusts and potentially on Health and Wellbeing Boards on which clients may benefit from CFs and in what ways.The proposed follow-on study currently envisaged as a natural experiment will provide more definitive answers for commissioners on the cost-effectiveness of CFs as an intervention to improve the quality of life health and well-being of offenders and ultimately reduce re-offending. Such evidence-led commissioning would have the potential to reduce costs due to reduced use of the NHS and social care and reductions in reoffending reducing costs to the criminal justice system and wider society.


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