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TRANSFORMATIVE REHABILITATION:
EXPLORING PRISONERS’ EXPERIENCES OF THE COMMUNITY BASED HEALTH AND
FIRST AID PROGRAMME IN IRELAND
Róisín O’Sullivan, Wayne Hart and Deirdre Healy
University College Dublin
Róisín O’Sullivan
c/o UCD Institute of Criminology and Criminal Justice
Sutherland School of Law
University College Dublin
Belfield
Dublin 4
Ireland
Email: roisin.o-sullivan.3@ucdconnect.ie
Wayne Hart
c/o UCD Institute of Criminology and Criminal Justice
Sutherland School of Law
University College Dublin
Belfield
Dublin 4
Ireland
Email: wayne.hart@ucdconnect.ie
Deirdre Healy (*corresponding author)
Lecturer
UCD Institute of Criminology and Criminal Justice
Sutherland School of Law
University College Dublin
Belfield
Dublin 4
Ireland
Tel: +353 1 716 4125
Email: deirdre.healy@ucd.ie
*** Forthcoming in the European Journal on Criminal Policy and Research***
Citation:
O’Sullivan, R., Hart, W. & Healy, D. (2018) Transformative Rehabilitation: Exploring
Prisoners’ Experiences of the Community Based Health and First Aid Programme in Ireland,
European Journal on Criminal Policy and Research. https://doi.org/10.1007/s10610-018-
9396-z
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ABSTRACT
Using an assisted desistance framework, this paper explores the lived experiences of eleven
volunteers on the Community Based Health and First Aid programme, which operates in 14
prisons across Ireland and aims to enhance community health, hygiene awareness and first aid
knowledge among prisoners through peer-to-peer education. The findings suggest that
participation fostered a sense of agency among volunteers and facilitated the development of a
new non-criminal self, centred on the ‘wounded healer’ identity. Additionally, participation
appeared to deepen volunteers’ pro-social bonds with other prisoners, staff and families. The
contribution of these findings to knowledge about desistance and desistance-focused practice
is considered.
KEYWORDS
Assisted desistance, transformative rehabilitation, prisoners, Community Based Health and
First Aid Programme, Ireland
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Global estimates suggest that between a quarter and two-thirds of prisoners are reconvicted
within two years of release (Fazel and Wolf, 2015), highlighting the need to develop innovative
and evidence-based programmes that enhance prisoners’ prospects of desistance. The purpose
of this article is to explore volunteers’ subjective experiences of a novel prison-based
programme, the Community Based Health and First Aid (CBHFA) programme, which aims to
enhance community health, hygiene awareness and first aid knowledge among prisoners
through peer-to-peer education delivered by special status Irish Red Cross volunteers. Though
the study was conducted in Ireland, the findings also contribute to international knowledge and
practice. For instance, the aims of the CBHFA programme are consistent with European Prison
Rules (2006) which pay special attention to hygiene, nutrition, mental and physical healthcare,
and safety within prisons. Maculan et al. (2013), who monitored the implementation of
European Prison Rules in eight European countries, found that most prisons had poor records
in terms of healthcare, hygiene, food quality and rehabilitation opportunities. The current study
thus constitutes a useful resource for individuals who want to learn more about an innovative
programme, developed in an Irish prison setting, which can help to improve prison standards,
health and welfare.
There is general consensus that evidence-based approaches to offender rehabilitation can
enhance client outcomes (Welsh and Farrington, 2011). Yet, disagreement still exists as to what
exactly is meant by ‘evidence.’ Historically, researchers adopted a relatively narrow and
uncritical approach to the study of programme effectiveness but were criticised for relying on
recidivism as the sole measure of success and for assuming that treatment effects could be
isolated from the surrounding socio-political context. The emerging literature on assisted
desistance offers an alternative way to conceptualise and study programme effectiveness by
exploring the impact of criminal justice interventions through the lens of desistance theory and
research (Farrall, 2016; King, 2013; McNeill, 2012a; McNeill, Farrall, Lightowler and Maruna,
2012).
Desistance scholars regard recidivism as an important outcome measure but recognise that
abstinence from offending behaviour does not necessarily equate to desistance. Rather,
desistance is best understood as the first step in a journey towards social inclusion. As McNeill
(2012b: 96) observed,
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“Desistance is, perhaps, best understood as part of the individual’s ongoing journey
towards successful integration within society – towards living better lives as better
citizens.”
Researchers should therefore focus on measuring change (and change mechanisms) across a
range of domains, including offending behaviour, agency, generativity, identity and social
inclusion (Nugent and Schinkel, 2016; McNeill et al., 2012).
It is also important to remember that rehabilitation programmes operate as part of a wider
change process that ultimately belongs to the offender (McNeill, 2012a). Though rehabilitation
programmes can play a crucial supporting role, outcomes are always influenced by the
personal, social, political, legal and economic contexts within which the programme operates.
For example, studies show that programme effectiveness can be reduced when participant
motivation is low (Farrall, 2016) or when participants encounter significant structural barriers
such as poverty or social stigma (Miller, 2014). Researchers should thus strive to understand
programme processes and outcomes within these wider contexts. This necessitates a shift in
focus away from examining whether a programme ‘works’ to an exploration of how and why
a programme might help people to desist from crime. In other words, the aim is not to evaluate
the effectiveness of a programme but to understand and explain the change processes that the
programme seeks to initiate or reinforce (McNeill et al., 2012). With this in mind, the next
section reviews the theoretical and empirical background to the study, focusing in particular on
the change mechanisms that are relevant to the CBHFA programme.
Theoretical Background
Though scholars differ in terms of the relative weight they assign to each dimension, there is
widespread agreement that desistance occurs at the intersection between subjective and social/
structural processes (Bersani and Doherty, 2018). At the structural end of the spectrum, Laub
and Sampson (2001) proposed an age-graded theory of informal social control which contends
that major life events such as marriage or employment create attachments to society that
enhance the likelihood of desistance. Pro-social bonds help offenders to ‘knife off’ their
criminal pasts by monitoring behaviour, creating a daily routine that detaches them from
criminal environments, and providing emotional and social support. Laub and Sampson (2001:
51) argued that agency was another important feature of the change process but concluded that
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desistance occurs largely “by default.” While there is ample evidence to support Laub and
Sampson’s (2001) contention that desistance is linked to strong social bonds with romantic
partners (e.g. Salvatore and Markowitz, 2017), evidence regarding the link between
employment and desistance is mixed (e.g. Skardhamar and Savolainen, 2014). This is perhaps
due to the limited employment opportunities available to ex-offenders in the economically
insecure and risk-averse world of late modernity (see further Giordano et al., 2002).
At the opposite end of the spectrum, Maruna’s (2001) identity-based theory proposed that
desisters formulate a redemption script to explain their transition from a ‘criminal’ to a
‘desisting’ self. This script allows ex-offenders to positively reframe their criminal histories
as a prelude to the adoption of a pro-social identity. Typically, desisters begin by describing
how they rediscovered their ‘true self’ through desistance. They preserve a positive self-image
by blaming the criminal past on circumstances beyond their control, but also present
themselves as highly agentic beings who take full responsibility for achieving a crime-free life.
Many ex-offenders also attempt to ‘make good’ by engaging in generative activities, such as
volunteer work. This perspective is among the most influential of all desistance theories and
has been widely investigated, albeit with mixed results. For example, Liem and Richardson
(2014) found that both desisters and persisters adopted elements of the redemption script, the
only difference being that desisters’ narratives were more agentic. The mixed results may be
due to the fact that most desistance research focuses on the early stages of change, when the
fully-fledged redemptive self is still at a distance (Healy, 2012; Giordano et al., 2002). It is
also likely that opportunities to achieve the types of redemption described by Maruna (2001)
are relatively scarce. In this regard, Halsey (2016) noted that ex-prisoners receive little
guidance to help them negotiate the criminal justice system or deal with the challenges they
face on the journey towards desistance.
Developing a new identity is not an easy process in a prison setting where systems and policies
often prioritise punishment over rehabilitation. In such environments, the achievement of
desistance requires significant determination and cognitive change on the part of the prisoner.
One of the ways that imprisonment has a profoundly negative impact on those imprisoned is
its effect on individuals' concept of self. People become defined by their new social role of
prisoner (Hattery and Smith, 2010) in ways that change “the entire set of beliefs, evaluations,
perceptions, and thoughts that people have about themselves” (Swann and Bosson, 2010: 69).
This reflects what is seen more broadly in labelling theory which posits that, once society
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becomes aware of an individual's perceived deviance, the individual is segregated from society
and comes to internalise the deviant label (Stevens, 2012).
To facilitate desistance in criminal justice settings, desistance scholars have recently turned
their attention to developing and researching practice models, often termed ‘desistance-
focused’ (McNeill, 2012a) or ‘strengths-based’ (Maruna and LeBel, 2015) approaches.
McNeill et al. (2012) argued that practitioners should: recognise desistance as a long-term
process that may involve relapse episodes; tailor interventions to individual experiences and
needs; foster hope and agency; build strong working relationships with clients; help clients to
discover hidden strengths; provide opportunities to enact social capital; and avoid stigmatising
language. In particular, the evidence suggests that organised generative activities, such as
volunteering, peer mentoring and rehabilitation work, can support individual efforts at
desistance. LeBel, Richie and Maruna (2014) found that ex-offenders who were employed as
rehabilitation workers experienced a range of benefits, including a sense of belonging, agency
and life satisfaction, as well as a stronger commitment to desistance. Similar findings have
emerged from studies of sponsors within the Narcotics Anonymous community who provide
peer support and mentoring to others on a voluntary basis. Sponsors claim that these activities
help to maintain desistance, increase feelings of empowerment and reduce stigmatisation
(Marsh, 2011). Such activities enable desisters to embrace the identity of the ‘wounded healer’;
that is, an individual who has suffered adversity and uses their experiences to mentor and help
others in a similar situation (Esping, 2014; Maruna, 2001). Generative activities also provide
opportunities to gain external validation for desistance efforts, which can reinforce positive
changes in identity through a phenomenon known as the Pygmalion effect (Maruna et al.,
2004). The Community Based Health and First Aid programme is another example of this type
of programme.
The Community Based Health and First Aid (CBHFA) programme
The CBHFA programme is a global International Federation of the Red Cross and Red Crescent
Societies approach used in over one hundred countries to empower communities to improve
their health. Ireland was the first country in the world to implement such a programme in the
prison community context and has inspired other jurisdictions, including Northern Ireland and
Wales, to introduce similar initiatives within their prison systems (Betts-Symonds, 2015). The
Irish programme is operated on a partnership basis between the Irish Red Cross, Irish Prison
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Service, Education and Training Boards and the Probation Service and is currently being
delivered in all 14 prisons across Ireland. The remit of the programme was recently extended
to include volunteers released into the community but this dimension is not the focus of the
current article.
The CBHFA programme is delivered through peer-to-peer education by special status Irish Red
Cross volunteers. Volunteers are selected by teaching staff, prison management and healthcare
staff on the basis of their commitment to Irish Red Cross principles and their “length of
sentence, credibility in their prison community, representation in different sections of the
prison and approval of discipline staff/governor” (Irish Red Cross, 2017: 8). All Red Cross
volunteers endorse seven fundamental principles: humanity (show kindness, understanding and
respect to everyone), impartiality (avoid discrimination according to nationality, culture or
crime), neutrality, independence (from the Irish Prison Service but follow their rules),
voluntary service, unity, and universality (recognise that all volunteers are equal and share
responsibilities). Over a 4-6 month period, volunteers take part in weekly training sessions and
design healthcare projects to benefit their particular prison community. By way of illustration,
CBHFA volunteers in one prison developed a Weapons Amnesty Project and met with gang
leaders to gain support for the initiative (Betts-Symonds, 2012). Afterwards, prisoners reported
a greater sense of safety and a willingness to dispose of their own weapons. Furthermore,
official statistics revealed a 90% reduction in ‘cutting’ incidents after the project was
introduced. This illustrates the programme’s transformative effect on the prison community,
as it was not only CBHFA volunteers who benefitted from the project but also other prisoners
and prison staff. Other recent projects include HIV rapid testing, health awareness programmes
and Overdose Prevention classes; the latter in partnership with Merchant’s Quay Ireland (Irish
Red Cross, 2017). By July 2017, a total of 950 prisoners had participated in the programme,
with approximately half successfully completing the training. Non-completions occur for a
range of reasons, including volunteers being transferred to another prison, being released from
prison, missing too many sessions or leaving for personal reasons.
A recent evaluation of the CBHFA programme indicated that the programme may improve
health awareness, feelings of empowerment and sense of community among volunteers
(Abiodun and Betts-Symonds, 2016). Due to the strict selection criteria (described above),
most volunteers have already embarked on the journey towards desistance. Thus, it is likely
that the programme helps to reinforce, rather than motivate, change. The evaluation also
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acknowledged the need for additional outcome-based research, a gap that this article aims to
address. The study uses an assisted desistance framework to explore the subjective experiences
of volunteers on the CBHFA programme, focusing in particular on its perceived impact in key
areas such as identity, agency, generativity and social bonds. These themes were chosen
because they are regarded as core mechanisms in the desistance process and are pertinent to
the CBHFA programme theory. The paper argues that the programme constitutes an example
of what we term ‘transformative rehabilitation’ as it provides opportunities to engage in
generative and pro-social activities, which have a transformative effect not only on the lives of
individual volunteers but also on the prison community as a whole.
METHODOLOGY
The study used a qualitative approach to examine the subjective experiences of volunteers who
took part in the CBHFA programme. Qualitative research seeks to produce a data-rich account
of respondents' subjective experiences and elicit in-depth reflections on these experiences,
adding depth and authenticity to the study findings (Banister et al., 2011). Such methods are
ideally suited to research with small samples or study populations and also allow for the
emergence of themes in the data collection process not initially considered by the researcher
(Mills and Birks, 2014). A qualitative approach was thus deemed appropriate for this study,
which aimed to produce an in-depth account of CBHFA volunteers’ lived realities and explore
whether participation in the programme activated or maintained core desistance mechanisms.
The method of data collection used was semi-structured interviews, which are less restrictive
than structured interviews but still allow for comparisons between interviews (May, 2004).
Semi-structured interviews have also been widely utilised in prison-based research in the past
to great effect (see e.g. Beyens et al., 2015). The interview schedules were largely inspired by
the theme of generativity, looking mostly to the Generative Behaviour Checklist (McAdams
and de St. Aubin, 1992) and other themes that emerged from a review of the desistance
literature, such as identity, agency and social bonds. Questions were worded simply in plain
language and examined themes such as relationships, self-image and volunteer's experiences
of the programme itself. While questions posed by the researchers in their interview schedules
were similar overall, small differences did emerge, with one researcher questioning volunteers
on the importance of peer-to-peer education within the programme. The researchers sought to
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avoid leading and overly complex questions, and also included prompts within questions in
case informative answers were not immediately forthcoming.
Procedures
The researchers used convenience sampling to ensure that all volunteers had first-hand
knowledge and experience of the CBHFA programme. The volunteers in this study are thus
not representative of desisters (or prisoners) as a whole; rather the study explores the lived
experiences of a small group of prisoners that engaged in the CBHFA programme. The
experiences of these prisoners are undoubtedly different to the experiences of volunteers in
other prisons, which raises a question with regard to the generalisability of the data collected.
It is contended that the use of a qualitative approach greatly reduced any limitations caused by
the small sample size due to the depth and richness of the information collected.
The recruitment and interviewing of volunteers was facilitated by the Irish Prison Service, the
Irish Red Cross and teaching staff at the prisons. The researchers initially visited the prison
sites in April 2017 to introduce themselves to the volunteers, discuss the research that they
would be conducting and gauge the level of interest in the study. At this stage, the volunteers
who took part in these sessions indicated an interest in taking part, and interviews were
arranged with the assistance of teaching staff in the prisons and the Irish Prison Service’s
CBHFA programme director. Volunteers were recruited from three prisons, including two
medium-security prisons and one low-security, open prison. Two volunteers were post-release
and interviewed in the community. In all, two volunteers were serving sentences in an open
prison, two were post-release and seven were incarcerated in a medium-security prison. The
two volunteers who were post-release were employed but did not mention the exact nature of
their employment.
Data collection took place between May and July 2017. In total, the researchers gathered data
from eleven volunteers using in-person interviews, telephone interviews and written
questionnaires. One of the researchers conducted six face-to-face interviews in a closed
custodial setting. Interviews normally took place in a classroom within the prison school so as
to ensure privacy. Interviews on average took 50 minutes. The second researcher used a
different data collection approach as he was denied access to prison settings due to his insider
status (discussed further below). He used telephone interviews and a written questionnaire to
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collect data from five volunteers who were recruited by the Irish Prison Service’s CBHFA
programme director. Four of the volunteers were interviewed by phone, with interviews lasting
approximately thirty minutes, and the fifth was interviewed using a written questionnaire.
It was clear that conducting research in the prison setting was a unique experience and came
with challenges that would not be encountered in other research settings. One of the most
challenging aspects of conducting research in a prison setting was the highly controlled
environment and the way in which the prison regime often disrupted data collection (Sutton,
2011). This research was not an "institutional priority" (Sutton, 2011: 58) within the prison
environment and it was not uncommon for interviews to be interrupted by prison staff, or for
interviews to end abruptly. This raised obvious challenges in the collection of data and in some
instances meant that the full interview schedule could not be completed.
Data Analysis
All interviews (with the exception of the written questionnaire) were digitally recorded and
later transcribed verbatim by the researchers without censorship to allow for a full
understanding of the data and to ensure that the authentic voice of the volunteers was recorded.
The interviews were transcribed soon after interviews took place so as to keep an accurate
record of what was said. Accuracy in the transcribing process was seen to be of paramount
importance in terms of supporting the validity of the data and subsequent findings (Robson,
2011). Though identifying information has been removed to preserve volunteers’
confidentiality, the researchers chose not to censor the interviews in any other way when
presenting the findings to ensure that the authentic voice of the volunteers was presented.
Thematic analysis was the chosen method of analysis, as this method allowed the greatest
flexibility for the researcher and would assist the researcher in uncovering a rich collection of
data (Braun and Clarke, 2006). Throughout the transcription process, the researchers sought to
familiarise themselves with their data and keep note of the broad themes that were emerging,
including quotations that summed up themes particularly well. Once transcription was
complete, one researcher then coded and analysed the data with the assistance of the computer
programme MAXQDA. The second researcher conducted manual data analysis, also using
thematic analysis, by taking note of themes as they arose. The researchers then met to discuss
the themes in detail and identify points of convergence and divergence across the two datasets.
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Ethics
The researchers gained approval from the UCD Taught Masters Research Ethics Committee –
School of Law and the Irish Prison Service Research Office and the research was conducted in
compliance with the ethical guidelines set out by the UCD Code of Good Practice in Research.
All volunteers gave informed consent and permission to record interviews. To maintain
anonymity, the researchers created pseudonyms for the volunteers, with each being assigned a
new and different name from the top 100 babies' names registered in 2014 (CSO, 2015).
A note on “insider status”
Insider research is a term used to describe studies where researchers have a direct attachment
to, or experience with, the research setting, giving them a level of ready-made knowledge and
insight into the topic that an outsider may only acquire after extensive study, if at all (Robson,
2011). For example, a researcher may be a member of the community under investigation, such
as the recovery community, or, as is the case with one of the researchers on this study, a
desisting ex-offender. Insider status can have a profound impact on openness, trust and validity,
as can be seen from the following extract from one volunteer.
Noah: Well if you’re going to transcribe it, you will be transcribing word for word I
presume, not an interpretation?
Researcher: No, No, No, it would be word for word. Yeah.
At this point, the researcher, from personal experience, had a good idea where the conversation
was going. The decision was made to reveal some of the researcher’s past to try to alleviate
the volunteer’s fears and/or trust issues.
Researcher: I get the feeling you have a question you’d like me to answer?
Noah: [Nervous Laughter] Yeah. Were you ever in Prison? I’m assuming you saw that
coming?
Researcher: Like a forty-ton truck [Laughter]. And yes, I was, so I know where you’re
coming from pal. Everything will be above board, that’s why I gave you all the ethical,
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consent and information forms. By the way, they wouldn’t let me into the prison to do
this because of my record from Garda vetting.
Noah: We’re on the same page so. Not to generalise, but I had the feeling you were in
prison alright. I’m glad you have that experience. I’m not surprised they didn’t let you
back in. That’s what they do, put up barriers instead of helping people, and want us to
trust them [laughter]…I’m relaxed now [laughter]...
Negotiating barriers and developing rapport can be a delicate process in criminological
research (Noaks and Wincup, 2004). As seen in the above extract, insider access can help to
build rapport (Hodkinson, 2005), foster a sense of equality and legitimacy (Chavez, 2008) and
encourage participants to engage with researchers (Hodkinson, 2005). While two volunteers
felt particularly reassured by the insider status of one researcher, both researchers felt that a
rich set of data emerged from their chosen methods of data collection. Indeed, the nature and
quality of the data was consistently high across the two datasets.
DESISTANCE IN PRACTICE
This section explores the subjective experiences of volunteers on the CBHFA programme,
focusing in particular on its perceived impact on core desistance mechanisms such as identity,
agency, generativity and social bonds. The findings are discussed under the thematic headings
of agency, generativity and the new self with a particular focus on the wounded healer identity;
social bonds, with a particular focus on social recognition; and future plans. Data is drawn from
all volunteers and quotes from nine of the volunteers are used to illustrate and contextualise the
findings. As will be shown, acceptance and enactment of CBHFA principles seemed to
encourage volunteers to develop pro-social identities, adopt a self-reflective attitude and
strengthen relationships with prisoners, staff and families.
AGENCY, GENERATIVITY AND THE NEW SELF
Volunteers believed that the nature and ethos of the wider prison system are fundamental for
the preservation of long-term desistance but may sometimes impede the change process (see
further, Swann and Bosson, 2010). Within this context, the adoption and enactment of the Red
Cross principles provided a powerful alternative template for volunteers, facilitating the
emergence of a pro-social identity. The impact of this alternative identity template can be seen
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in the following extract which describes a volunteer’s motivation for taking part in the
programme.
Noah: ...it was something new to the prison system…it was an opportunity to do
something outside of the mundane there, which would drive you demented with
bureaucracy … They say they're doing things to rehabilitate, but they're not actually.
…Oh, yes. It's very punitive, is it not? ...how are lads to stop offending if there is no
rehabilitation…box-ticking organisation which is… covers its ass at every corner by
ticking boxes. The reality isn't shown and is because the prisons and ex-offenders are
never asked. The programme gave me a new perspective of myself and what I could
change, as in my thinking.
Participation in the CBHFA programme allowed volunteers to positively revise their self-
narratives and impose order in their lives. As the following quote shows, the opportunity to
assume a leadership role acted as a key turning point for some volunteers.
Harry: I took a lot of pride, and it mightn't sound an awful lot, being the chair of the
group ... I was also very respected in a lot of ways by staff, that shit doesn’t happen
unless you have changed. Which was a result of me taking ownership of my past and
moving forward positively, you could say it was a major turning point in my life.
Maruna (2001) posits that a successful mechanism of desistance is the ‘redemption script’.
Here, there is an acceptance that the person is naturally of good nature, and that the past is a
direct result of social exclusion and social disadvantage. Likewise, volunteers in the current
study viewed themselves as victims of social circumstances who became caught up in a cycle
of crime and deviance. The programme provided opportunities to perform a redemptive script,
which helped volunteers to transition from a negative to a positive self-image. This rejection
of the "past self" is highlighted in the following quotation from Jack, who was on remand and
had previously been imprisoned.
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Jack: Yeah, I was a little cunt before so I was, yeah? Before I started this, yeah? So I
was a horrible, horrible little cunt, yeah? Over 50 something P19s
1
... and I have 51 P19s
for fighting and stabbing people and phones and drugs and everything.
Through participation in different voluntary activities, such as collecting food for charity,
teaching overdose prevention to other prisoners and facilitating smoking cessation courses,
volunteers were enabled to discover a positive sense of self, which they described as their "true
self" (cf. Maruna, 2001). Indeed, the discovery of the "true self" emerged as a key theme within
a number of the volunteers’ narratives, as can be seen in the following extract.
Researcher: Yeah. Eh, just leading on from that - you've answered this tenfold, but do
you think that you've gained anything from your involvement? What is the thing that
you think [pause] wow that was such a change for me? This thing that I've gained.
Adam: I found me true self.
Researcher: True self?
Adam: Yeah.
Researcher: Yeah. And who is your true self?
Adam: I'm not a bad man if you get to know me. That's the whole thing like. People
take me up the wrong way, by reading the papers, by reading things about me, but um-
I kind of hated meself for years about it, I just had so much [pause] it helped me an
awful lot. Helped and all that. And thinking-wise.
In total, nine of the volunteers described a positive shift in their self-image arising from their
involvement with the programme. However, two volunteers did not perceive any shift in their
self-identities. One of these had no prior experience of custody and therefore had only limited
exposure to the label of "prisoner," at least compared to other volunteers. Conor, who had no
previous experience of imprisonment, saw himself as different to other prisoners, stating: "I
wouldn't be an everyday prisoner, kind of." The second volunteer who perceived no change
was part of a social group that rejects the label of prisoner. This suggests that labelling and
stigmatisation is not experienced to the same extent by volunteers with little experience of
imprisonment, reducing the scope for identity change. Nevertheless, the opportunity to develop
1
A P19 is a disciplinary report prepared by a prison officer for the prison governor when a prisoner is
alleged to have breached the prison rules.
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and enact a new, non-criminal self can enhance motivation to change and feelings of self-
efficacy among volunteers, as Luke’s quote illustrates.
Luke: I found something that I'm passionate about, and that's what I've found ya
know…Like I said, it's part of my rehabilitation. It's part of my change in life and that
ya know. This is playing a massive part for me in my new behaviours and not having
that desire to reoffending…this has given me a different perspective of myself and my
past man.
The CBHFA programme also provided volunteers with opportunities to enhance their sense of
personal agency. As part of the programme, volunteers develop projects that identify and
address the needs of their particular prison community. The volunteers were particularly
enthusiastic when discussing the projects that they were involved in. One factor that enhanced
their enjoyment of these programmes was the fact that volunteers "had a say" in the
programmes that they would run in the prison and were encouraged to come up with their own
suggestions for projects. For many, the experience of volunteering was something they took
considerable pride in, as described by Sean.
Sean: It felt great, going on doing something productive on the [prison] landing, rather
than going on the landing chasing drugs, or trying to find out who has drugs, and when
the next package is coming in.
Maruna (2001) regards the idea that reformed criminals should accept blame and feel ashamed
for all of their crimes as a stretch too far. Instead, it is common for offenders to attribute their
offending to circumstances outside their control, laying the blame at society’s door (Maruna,
2001). Yet, volunteers in the current study who accepted guilt for their criminal actions also
associated themselves with successful desistance. At the same time, their admissions were
often coupled with excuses and justifications, as can be seen in Luke’s quote.
Luke: I knew no better growing up. I know I’ve done wrong but I come from the street
you know yourself man. So ya know I have the experience to help people today,
addiction robbed me of humanity, no one wanted to know or help me. I lived like an
animal man for years. I’m a good person today, kind, compassionate and caring, fuck
even saying that sound nuts man. Thank God for the principles of the programme man
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and I have a job now. I’m a productive member of society these days. I take
responsibility for my actions today and no one can take that from me ya know man.
Overall though, participation in the CBHFA programme appeared to prompt volunteers to take
full responsibility for their behaviour and feel confident in their ability to lead a crime-free
existence. This is evident in the following quote:
Dylan: I have learned through the programme to give people the benefit of the doubt,
give people a chance the way I have been as a result of the programme. As it has had
an impact in my life relationship-wise, I've become an awful lot more in touch even
with me kids, with me wife…Whereas what the programme has taught me big time is
having compassion and empathy for people come with taking responsibility for my past
and Jaysus my future too…I find myself being that bit more empathetic, responsible
and compassionate and stuff like that.
These findings are consistent with the work of desistance scholars, such as Maruna (2001) who
contends that cognitive change and an evolving sense of self is essential to the desistance
process. The findings also suggest that agency plays an important role in the process of
reconfiguring the self, which is again consistent with the wider desistance literature. For
instance, Giordano et al. (2002) argue that desisters draw selectively on components within
their environment to create meaningful life changes.
The 'Wounded Healer' Identity
Amongst the volunteers who perceived a shift in self-identity, the identity of the "wounded
healer" was the most common. The volunteers in this study indicated their adoption of the
wounded healer role in a number of ways. Firstly volunteers viewed their offending history as
an asset in their work on the CBHFA programme, expressly stating that their history of
offending gave them an authenticity, empathy and relatability in their work that they would not
otherwise have had. Secondly, the CBHFA programme is strengths-based, focusing on the
personal development of volunteers as opposed to their risks and deficits, and presupposes that
volunteers are actively looking to improve and develop their skills. This allowed volunteers to
earn their redemption and reconcile their criminal past with their desired future selves, making
17
their criminal history meritorious rather than stigmatising. This re-purposing of the past is
evident in the following quotes.
Harry: It's not me today, but I wouldn’t change my past as I am where I am today
because of it….
Adam: …because you can go into a prison and turn around and say I've come from
Wheatfield prison, and I've been a governor for twelve years and all that. Yeah, yeah,
yeah. I come in, or somebody else will come in [...] [clicks fingers] have their attention.
Straight away you have them. And that's when you go in. But you can relate to them.
The voluntary work they carried out meant that the volunteers were able to take on the identity
of "wounded healers" who viewed their previous offending behaviour as an asset in their efforts
to help others (see further LeBel, Richie and Maruna, 2014). This in turn gave volunteers a
sense of purpose and meaning, enabling them to re-design their self-narratives along the lines
of the redemption script.
Luke: …it has given me focus and drive man. You feel really, really good about
yourself knowing you're helping others in your community. I mean I always seen
myself as a useless lowlife. And for me, this is my new high to realise I’m not …
Re-scripting their past with a redemptive narrative, some volunteers stated that their past lives
had led them to their present mindset and positions in life, as illustrated by the following quote.
Luke: On the streets you know how it is, plus you walked the landings man, you can’t
show weakness. I mean always seen lads as targets if they showed compassion or guilt
[laughter]… Now I’ve been shown a new way to live, I’m kind and understanding now.
I guess it’s because I was never shown that shit but know it’s the right thing to do, its
human man. You’ve been there, you’re wise to what I’m saying man…It’s about giving
back as we took so much.
Interestingly, the theme of generativity emerged strongly among all volunteers, regardless of
perceived shifts in identity. This is presumably due to the range of volunteering activities on
18
offer in the CBHFA programme, and their visible and positive impact on prison life and the
prison community.
Through engaging in the generative work offered by the CBHFA programme, volunteers were
able to achieve what Maruna (2001) calls "making good," namely expressing the desire to help
the next generation avoid making the same mistakes. These changes ultimately made
reoffending less likely and created a very positive attitude for their futures. It was clear from
the interviews that volunteers were in the process of desistance and were beginning to realise
their positive qualities and goals through generative work. The following extracts describe
some of the positive changes cited by volunteers.
Noah: Yes…learning to take full responsibility for my previous actions. It does give
you purpose to believe in your future and mentally helps you to focus on goals…
Dylan: …And so numerous times, I had people come to me and sit in my cell and tell
me things that they couldn't tell anybody else. So, it gave me this degree of trust between
people, which is a huge thing to have in prison or outside, especially for our criminals.
I have used these skills in the return to community scheme
2
while delivering the
programme…Who knows maybe this was my true path in life.
SOCIAL BONDS
As noted above, the chances of an ex-offender staying crime-free very much depends upon the
development of new identities, values and beliefs that are incompatible with offending
(Giordano et al., 2002). This is known as the process of knifing off from the past (Laub and
Sampson, 2001). The CBHFA programme involves a type of voluntary knifing off since all
volunteers made the decision to disassociate themselves from people, places and things with
whom they had been criminally involved. One of the advantages identified by CBHFA
volunteers was that the programme provided new community and pro-social networks as
acquaintances were replaced with deeper friendships, particularly with other CBHFA
volunteers. This nurturing of a different life through new associations, activities and behaviours
2
The Community Return Scheme is a joint initiative of the Irish Prison Service and the Irish Probation
Service. Under this scheme, prisoners complete unpaid work in the community as a condition of early
release.
19
was particularly important to volunteers who had been released from prison and was cited as a
major factor in maintaining their crime-free lifestyle. Therefore, it is worth considering in detail
how the CBHFA programme facilitated the development of new bonds and routines.
The analysis made it clear that the mechanisms outlined above were provided by the
programme. The programme provided a new start, a knifing off of the past and the possibility
of a new community bound by a common thread. Volunteers made new friends, established a
support structure and became responsible to each other and their new social bonds both inside
and outside the prison. These elements were regularly highlighted by volunteers in the CBHFA
programme, as can be seen in the following quote.
Luke: Like I said already I didn’t care about anyone before I did this programme ya
know. So, the impact on my relationships is massive man. I wasn’t shown all this stuff
growing up... As for education, you got that on the streets. My hero was the General
3
for fuck sake man. I had no goals in life other than criminality and me da encouraged
that shit ya know the way it is man, you’re from the same side of the street…
Luke’s comments are reminiscent of differential association theory (Sutherland, 1939),
particularly the suggestion that he learned the values and methods associated with criminal
behaviour through exposure to deviant associates and their deviant value system. He went on
to explain that his engagement with pro-social others through the CBHFA programme helped
him to re-evaluate this perspective. Dylan described a similar shift in his mind-set, evident in
his belief that he will be able to lead a crime-free life once given a chance to become a
responsible and productive member of society. Again, his statement emphasises the role of pro-
social mechanisms, values and commitment in the desistance process.
Dylan: …I feel I have changed a lot and I have better relationships with my family and
friends…my family tell me I have a very positive attitude…I know I will face
challenges getting a job, but I have confidence that I will be given a chance by an
employer and I won’t let him down.
3
A reference to Martin Cahill, a famous Irish criminal nicknamed ‘the General’
20
Moreover, Sean’s quote highlights how the programme enabled volunteers to provide loved
ones with evidence that positive changes were occurring in their lives.
Sean: Yeah, your family comes up, they go through all the programmes that we've been
doing, all the stuff we've been doing while we were in here, and you get to see your
family and you get to see that achievement, and you’re getting a cert off the governors
and stuff like that. So, it looks… I know myself like I'm not in here doing anything. I'm
doing good in here.
The suggestion here is that volunteers view pro-social values and institutions as the way
forward and believe that these pro-social bonds will ultimately control future temptation. This
is consistent with Laub and Sampson’s (2001) theory which suggests that social bonds aid
desistance by enhancing emotional attachments, altering daily routines and encouraging people
to strive towards non-criminal identities (see also Hirschi, 1969). When individuals value and
are committed to social relationships, the costs of crime increase because individuals risk losing
these relationships if they commit further criminal or deviant acts (Laub and Sampson, 2001;
Hirschi, 1969). As Dylan stated “I’ve learned to identify the right type of people I need to be
around.” This quote suggests that Dylan places high value on these social bonds and that ‘the
right type of people’ will be a major factor in sustaining his belief that a crime free lifestyle is
possible.
Hirschi (1969) further submits that pro-social attitudes by themselves do not motivate people
to avoid crime, but can constrain people from committing crimes if strong social bonds are in
place. The link between attitude and behaviour was very evident in the exchange between a
member of the prison staff and one of the volunteers on the CBHFA programme, described by
the following volunteer.
Harry: …He goes, "I'm grateful what you're doing, what you're doing". It's mad
because his belief in us kept me out of trouble in prison…the difference that made to
me knowing that he appreciated what I'd done and a bit of manners and a bit of respect
goes an awful long way…
Social recognition
21
By engaging in generative activities, volunteers in this study felt that their volunteering
activities had changed how others in their lives viewed them, particularly prison staff and their
own families. Volunteers often described how their voluntary activities with the CBHFA
programme was a source of comfort for their families, providing reassurance that they were
"doing good" (Conor) in prison and not engaging in unsafe or illegal behaviour. Involvement
in the programme was also a source of pride for volunteers' families, who regularly
communicated this sense of pride to the volunteers. In the following quote, Conor discusses
how his family took comfort from his involvement with the programme.
Conor: Yeah it'd be- with my family it'd be fairly happy that I was doing something
like that like. I think they would have been a bit- I don't know, people outside would
probably fear what prison is like. Or what it can be like, you know what I mean.
Additionally, volunteers reported how their involvement with the CBHFA programme had
improved relations with prison staff, assuring staff that they were individuals who could be
trusted and given responsibility. It is submitted that staff acted as "certifiers" for volunteers,
supporting the belief that they had positively changed through their involvement with the
CBHFA programme. Additionally, volunteers discussed how their experience of volunteering
helped them to view themselves in a more positive light and allowed them to feel that they
became more than just a "number" (Sean) in the prison system.
Sean: That's…that's the big thing that it goes back to. I'm not just a prison number
anymore, I'm a volunteer, you know.
As Adam explains, the self-respect developed and displayed by CBHFA volunteers encouraged
others to do the same, ultimately transforming relationships across the prison community as a
whole.
Adam: It did, ‘cause I always thought they were just animals locking us up. Well, not
animals that's the wrong word, but just [pause] they call us pigs, we call them pigs, just
locking us up, throw away the key. But we didn't realise you can meet them in everyday
life as well. But there is good officers here, and chiefs, and it broke down many things
for us. And with that breaking down [pause] we came together, and worked together.
It's very hard to work on a programme if youse are against each other.
22
FUTURE PLANS
When questioned about their plans following release, volunteers expressed an aspiration to
continue their involvement in voluntary work. This suggests that the identity changes elicited
by participation in the CBHFA programme were genuine and had become embedded in their
sense of self, as indicated by Adam:
Adam: But now, I've something to give back to the community. That I can save people
when I go out there. I'd love to be- I would love to be a volunteer when I get out.
When discussing their desire to continue volunteering after release, several volunteers
expressly stated their desire to reach young people and to prevent them from following a similar
path. As noted above, volunteers felt that their history of offending made them more likely to
be respected and listened to by young people. James, for example, discussed his desire to help
young people at risk of becoming involved in crime in Dublin's inner city.
James: Some of the programmes would be perfect out there in the inner city. You know
what I mean, especially with this, the feud that's going on at the minute, it might kind
of divert young fellas away from that.
The remaining volunteers were aware that their criminal histories and the ascription of a
criminal label would be a major barrier for them in engaging in voluntary activity following
release.
Researcher: Just on that- do you want to keep volunteering once you're out of prison?
Conor: That's what I was saying, I'd love to be able to still go and volunteer, you know.
I was looking, there's another thing they do as well. Red Cross were doing it at the times
of the floods and all in Ireland, I seen they were doing that.
[...]
Researcher: But also you can kind of… you're a bit sceptical, or unsure about whether
you'd actually be able to get involved because of your record?
Conor: Yeah. Yeah. Basically yeah. So that's… it's going to be a lot of them kind of
challenges when you get out from prison like, you know? Unfortunately.
23
Moreover, volunteers believed that their capacity to engage in generative activities even within
the prison community was significantly curtailed. In particular, volunteers felt that the
volunteering activities of the CBHFA programme were regarded by the prison staff as
secondary to the smooth running of the prison regime. This meant that activities could often be
cancelled at late notice.
Adam: Any issues that we really had is through the prison service, through just bad
communication between…. Everything is an operation like, and I mean like the
simplest thing. Yeah, it's all political stuff and yeah. It can end up a bit of an operation
for us, you know.
Together, these findings corroborate previous research on the CBHFA programme which found
that involvement in the programme helped volunteers to develop a positive self-view, as well
as improved confidence and self-esteem (Bett-Symonds, 2012). They are also consistent with
the results of other studies which show that voluntary work helps ex-offenders to engage in
self-reflection, build hope, formulate meaningful social bonds, construct a positive self-
identity, gain trust and social recognition from others, and circumvent negative labels and
environments (Marsh, 2011; Perrin et al., 2017)
CONCLUSION
This article explored the subjective experiences of eleven volunteers on the Community Based
Health and First Aid programme, which is currently being delivered in fourteen prisons across
Ireland. The findings suggest that the programme provided volunteers with opportunities to
develop a new identity, engage in generative activities, enhance pro-social bonds and gain
confidence in their ability to resolve obstacles in their paths. Moreover, volunteers perceived
their engagement with the CBHFA programme as a key step on the journey towards successful
desistance. In addition to its impact on health, the CBHFA programme may thus help to
promote key desistance mechanisms through its emphasis on empowerment, volunteering and
community-building.
The findings have a number of important lessons for international policy and practice. As the
first country to introduce the CBHFA programme in a prison setting, the experiences of
volunteers in Ireland will be of particular interest to international scholars and criminal justice
24
professionals who may be thinking about establishing similar programmes. Additionally, the
findings provide important insights into programme mechanisms that promote desistance, and
are in accord with international evidence. Theoretically speaking, participation in the CBHFA
programme appeared to provide volunteers with a template for a desistance script. Volunteer
narratives were reminiscent of the redemption script which offers a vision of the desister’s true
self, creating a perception of agency coupled with the desire to become a productive,
responsible member of society (Maruna, 2001). Maruna and Matravers (2007) describe this
self-narrative as a version of the truth that is often quite different from historical facts, but
provides desisters with a sense of purpose and meaning. Furthermore, the CBHFA programme
enabled volunteers to formulate, or deepen, pro-social bonds with other prisoners, prison staff,
and families (cf. Laub and Sampson, 2001). Their experiences in this regard call to mind
Maruna et al.’s (2004: 279) analysis of the "Pygmalion effect", whereby offenders negotiate a
new and reformed identity through the pro-social labelling of others. Maruna et al. (2004)
suggest that positive changes in an individual's self-concept are reinforced when accompanied
by a heightened sense of expectation from others, particularly people in positions of authority
who can both recognise and reinforce participants’ changing sense of self (see also Perrin et al
2017). Engaging in the generative activities of the CBHFA programme thus allowed volunteers
to signal their new pro-social identities to others, manage stigma and ultimately achieve
redemption.
Finally, the CBHFA programme appears to adopt many of the principles of desistance-focused
practice and provides a useful real-world example of a desistance-focused prison programme.
For instance, the training and volunteer activities enabled the discovery and display of personal
strengths; volunteers’ role in the design of interventions encouraged feelings of hope and
agency; and the description of participants as ‘volunteers’ rather than ‘prisoners’ reduced
stigmatisation. Additionally, opportunities to enact a pro-social self through volunteer work
had a transformative effect, changing the nature of volunteers’ interactions with others and
building social capital. As noted above, volunteers are carefully selected for the programme,
which means that participation probably helps to maintain, rather than motivate, change.
Nevertheless, research suggests that the programme is also having a transformative effect on
the prison population as a whole. For instance, volunteer campaigns have reduced misuse of
over-the-counter painkillers by 30% and the demand for dental care by 40% (Betts-Symonds
and O’Halloran, 2013). Because of this, the programme could be described as an example of
transformative rehabilitation practice, a concept originally introduced in disability studies (see
25
e.g. McPherson et al., 2015). Practitioners of transformative rehabilitation aim to transform
the structural conditions that create and reinforce social exclusion. They operate at the
intersection between the person and the social world to reconfigure the relationships between
social actors. Their work is person-centred but not solely concerned with individual change,
in recognition that skills acquisition is of limited value in the absence of social opportunity.
Instead of teaching people how to fit into existing structures, transformative rehabilitation
practice focuses on changing the social, economic, legal and political contexts that can
undermine personal change efforts.
While the CBHFA programme can be described as transformative, its effects may be limited
to the prison environment. Volunteers in the current study were well aware that legal barriers
could undermine their ability to continue this work after release. Ireland was one of the last
European countries to introduce provisions to expunge adult criminal records. However, the
provisions introduced under the Criminal Justice (Spent Convictions and Certain Disclosures)
Act 2016 allow convictions to be expunged only in limited circumstances, which may not apply
in the case of many CBHFA volunteers. Ex-offenders who wish to engage in volunteering
activities also face significant legal barriers since the introduction of the National Vetting
Bureau (Children and Vulnerable Persons) Act 2012, which requires people working with
children or vulnerable adults to undergo mandatory police vetting. Nonetheless, the findings
of this study suggest that participation in the CBHFA programme has a profound impact on the
lives of volunteers despite a challenging external environment.
26
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ACKNOWLEDGEMENTS
We would like to acknowledge the support of Graham Betts-Symonds who acted as a student
mentor for researchers on the project, Carrie McGowan who provided additional support and
Lydia O’Halloran who was instrumental in establishing the research project, and the Irish
Prison Service Research Office for facilitating the research. We would also like to extend our
sincere thanks to the CBHFA volunteers who were willing to share their experiences of the
programme with the researchers.
BIOGRAPHIES
Róisín O’Sullivan, BCL, LLM, is a recent graduate of the LLM Criminology & Criminal
Justice UCD. She is currently working as a Legal Assistant in Berkeley Solicitors while
studying for the FE1 exams. Róisín has also conducted research on the applicability of
Enforced Disappearance to Irish institutional settings of the twentieth century for the Adoption
Rights Alliance in their submission to the Committee against Torture in July 2017. Her research
interests include prisoners’ rights, immigration and asylum law and human rights abuses in
Irish institutional settings of the twentieth century."
Wayne Hart, BSocSc, MSc, holds a Diploma in Community Drugs and Alcohol Work, a
Bachelor of Social Sciences degree in Social Science and Sociology, and an MSc in
Criminology and Criminal Justice. He formerly worked as a drugs support worker in a number
of services including Prisoners Aid through Community Effort (PACE). His research interests
include desistance, the links between drugs and crime, social exclusion and probation.
Dr. Deirdre Healy, BA, PhD, is a lecturer in Criminology at the UCD Sutherland School of
Law and Director of the UCD Institute of Criminology and Criminal Justice. Her teaching and
research interests include desistance from crime, rehabilitation, probation supervision,
criminological theory, and victimization.
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