Embedding change in prison settings: the implementation and impact of the CBHFA programme in Ireland
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Date
2025
Authors
White, Jennie
Journal Title
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Volume Title
Publisher
University College Cork
Published Version
Abstract
This thesis explores the Community-Based Health and First-Aid (CBHFA) programme as it operates within the Irish Prison Service (IPS). It includes two complementary studies. The first examines how CBHFA was implemented and sustained across different prison settings. The second explores the psychological impact of volunteering on those who took part.
CBHFA was developed by the International Federation of the Red Cross and Red Crescent Societies (IFRC). It follows a peer-to-peer model that supports people in identifying health needs and leading their own local initiatives. Ireland was the first country to bring CBHFA into the prison system in 2009. It is now active in all Irish prisons, delivered through a partnership between the Irish Red Cross, the IPS, and Education and Training Boards. Prisoner Volunteers (PVs) work with staff to promote health and wellbeing, build safer prison communities, and support their peers.
The first study examines how CBHFA was implemented and sustained across different prison settings. It used qualitative data from 17 semi-structured interviews with key stakeholders and applied a hybrid inductive–deductive thematic analysis. Deductive analysis, guided by implementation science frameworks, identified enablers and barriers across four key areas: Programme Design, Funding and Resources, People and Attitudes, and Evidence and Evaluation. Inductive analysis identified three overarching themes: Altruism as a Vehicle for Change, The Power of Insiders, and Commitment to Adaptation. CBHFA was sustained through shared values, insider legitimacy, and flexible delivery that could adapt to local contexts.
The second study investigates the psychological and social impact of participating in CBHFA. This was a secondary data analysis. It used a mixed-methods pre–post design. Quantitatively, 43 Prisoner Volunteers (PVs) were assessed on standardised measures of self-esteem, locus of control, and wellbeing. While no changes were seen in self-esteem or locus of control, wellbeing scores showed a statistically significant improvement (η² = .09). Qualitative data from 17 interviews were analysed using Reflexive Thematic Analysis. Two themes were identified: “Realities of Prison”, which described the experience of isolation, stigma, and boredom, and “Journey of Enhancing Own Social Role”. This captured how volunteering helped PVs reframe their identity and take on more valued roles in prison, with family, and in the wider community.
Together, the studies show how CBHFA worked both as a structured programme and as a space for personal change. The findings highlight the importance of creating and supporting valued social roles for marginalised individuals. This research is in line with clinical psychology’s commitment to empowerment, trauma-informed care, and working with excluded groups. Finally, the findings point to a wider role for psychologists in shaping systems that support desistance, connection, and identity growth. CBHFA offers one example of how peer-led, values-driven work can support meaningful change, within and beyond the prison walls.
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Keywords
Community-Based Health and First Aid (CBHFA) , Irish Prison Service (IPS) , Implementation science , Peer-to-peer interventions , Prison health , Desistance , Social role valorisation
Citation
White, J. 2025. Embedding change in prison settings: the implementation and impact of the CBHFA programme in Ireland. DClinPsych Thesis, University College Cork.