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Table 1 Elements of the intervention

From: Development of an intervention to increase health service utilisation in ex-prisoners

Although essentially a post-release intervention, the Passports intervention begins when the participant receives their intervention materials, which are placed with their other personal belongings to be collected at the point of release. Although it may have been beneficial to provide the Passport prior to the point of release, we suspected that this would introduce an unacceptable degree of contamination. Following extensive consultation with stakeholders and consumers, the content and format of the intervention were finalised, and comprised the following:
1. Kitbag A practical issue identified by consumers and some community stakeholders was that many prisoners leaving custody were provided with only a plastic garbage bag for their personal belongings, which was perceived as both impractical and stigmatising. For less than AU$10 per participant we purchased mid-sized, unmarked backpacks in which participants could place their belongings on release. Our intervention materials were placed in the bag, reducing the risk of them being discarded or lost. The kitbag had high face validity and was very well received by participants.
2. Cover letter The kitbag contained a cover letter addressed to the participant and written in plain language, explaining the contents of the kit and the nature and extent of support available from the Passports team. The cover letter also identified dates for follow-up contact in the community and encouraged the participant to call the research team on a freecall 1800 number to keep their contact details up to date. Forms and reply paid envelopes were also provided for this purpose.
3. The Passport The core of the intervention was the ‘Passport’ – a personalised booklet consisting of (a) a step-by-step checklist for the participant to work through post-release (e.g., getting identity documents and a bank account, finding housing and a GP), generated and refined in consultation with consumers; (b) a visually-based, user-friendly summary of the participant’s health status (e.g., hepatitis C infection, medications), including a removable health summary that could be provided to a health professional; and (c) a personalised list of services (e.g., doctor, sexual health, counselling, housing, employment, needle exchange) in the community, tailored to age, gender, Indigenous status, alcohol and other drug use history and other personal and life circumstances. The list of services was extensively tailored to the individual, including to their location anywhere in the state of Queensland (an area of 1.7 million square kilometres) and in some cases interstate. The booklets were passport-sized so that they fit easily in a pocket and bound in a vinyl cover so that they were robust. Although the participant’s first name appeared in a number of places, the Passport did not contain sufficient information to permit identification of the individual, should it be misplaced or stolen. Participants were routinely reminded that a replacement Passport could be sent to them at any time, at no cost, and a number of participants requested and received replacement Passports during the trial.
4. Common Threads Development of the intervention was informed by qualitative interviews with 24 ex-prisoners. In collaboration with the research team, these 24 individuals reduced transcripts of their interviews to brief, de-identified stories of change, presented in a visually appealing way and in plain language, and highlighting key challenges and how they were overcome. These stories were bound together in a book published for the project and entitled Common Threads.
5. Telephone support Following release, intervention participants received telephone calls from trained staff once a week for the first four weeks. Wherever possible, each call was made by the same staff member, to facilitate the development of rapport and trust. Although these calls were primarily for the purposes of providing support, and incorporated some key principles from motivational interviewing (Miller and Rollnick 2002), during each phone call data were collected across the six domains listed above. Intervention participants also had access to a freecall 1800 number they could call to seek advice, support and referral. All incoming calls to this number were logged and information about the nature and outcome of the call was recorded.
In addition to usual care, the control group received a brief letter (a) thanking them for participating, (b) providing a very brief summary of their health, identifying whether their assessment results were below average, average or above average in each domain, (c) reminding them that they would be contacted again one, three and six months post-release (and specifying dates for this), and (d) providing a phone number to contact the researchers if they wished to update their contact details.