Drug Abuse

TRAINING SEMINARS

Training seminars for both prison staff and inmates are an important means of transferring relevant information about risk reduction. However, training seminars as part of a risk reduction strategy in prisons are - in most countries - a relatively new phenomenon. This is especially true for seminars in which both prison staff and inmates participate. Training seminars on risk reduction - particularly the ones aimed at inmates - are often perceived as threatening to the traditional abstinence-oriented drug policy in prisons.
Therefore risk reduction seminars must be prepared very carefully with clear arrangements between prison administration and other parties involved. Obtaining permission from criminal justice authorities and the prison governor is the primary prerequisite. The same goes for taking into account the specific conditions of the prison involved. Due to differences in policy, in inmate population, in health problems, in communication and co-operation with community drug and health services and in available human and financial resources, careful preparation is needed to successfully target the specific needs of both prison staff and inmates. If risk reduction activities are planned by prison staff, all relevant units should be informed or integrated. The medical health care unit should be asked for professional support, along with community health services and organisations (e.g. AIDS self-help groups).
The venue of training seminars for staff members seems to be of great importance for the atmosphere and the readiness to talk. It is vital to find a place where people feel at ease. It can make a big difference whether a seminar for prison staff is carried out within the prison walls or outside the prison in training centres. Both options are possible. Carrying out seminars for the staff within the prison has the advantage that the number of participants will be higher, because the threshold for participation is low. Choosing a venue outside prison, on the other hand, has the advantage that it might be easier for the participants to address controversial topics more frankly.
Bearing in mind what has been said above about general organisational matters, the following steps have to be taken:
u Needs assessment
u    Setting priorities and aims
u    Defining the target group or groups
u    Planning and designing a seminar program
u    Evaluation
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In the following section, we will discuss the basics of how to prepare and conduct training seminars.
7.1 Needs assessment
Most of the things mentioned under section 3.1 also apply to a needs assessment for preparing training seminars. Training needs can be identified through directly asking prison staff and inmates what they need to know and what issues might be of special interest. This can be achieved through a group discussion, formally, through a group interview or focus group, or informally via an additional question. Besides this, an individual interview using a questionnaire should also be considered as this not only provides valuable information but is also an effective means to make contact with inmates (see 5 and 10.2).
The focus of this needs assessment should include knowledge about safer behaviour, skills, attitudinal aspects, social norms and self-efficacy. So, when interviewing drug-using inmates, you could include questions like:
u “What does ‘safer use’ mean to you?”
u    “How do you manage to maintain your hygienic require-
ments?”
u    “What is most important to you in your current situation?”
u    “What have you found most interesting about this topic?”
When having these discussions or interviews with staff and inmates, one should pay attention to information you get from ‘reading between the lines’. Answers to questions about factual knowledge might also tell you something about people’s attitude and their social and cultural norms.
Furthermore, information about factual risk behaviour can tell something about actual needs. Valuable information can be obtained here from the prison medical service and from community health services. For example, abscesses are an indication that people do not inject safely.
7.2 Setting priorities and aims
Based on the needs assessment, the priorities and aims of the training activities can be defined. Important issues here include:
u    Which steps have to be taken to realize the training
seminars? In which order should these steps been taken? u    Which target group is the main priority? In general, staff
training will be required prior to the training of inmates.
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One has to make sure that the prison staff is aware of the health risks and acknowledges the need for risk reduction activities.
u    What content do you prioritize? Should the focus be on
awareness, knowledge, skills, attitude, social norms or some specific combination of these things?
u    Are the aims ‘smart’ (see 3.2)?
7.3 Defining the target groups
Although there are issues that are of interest to both inmates and prison staff (e.g. the effects and risks of drugs (see in chapter 2.2) and the transmission of viruses, bacteria and parasites (see in chapter 2.3) there are issues that are only of interest to either the inmates (‘What damage is caused by which drug?’ or ‘How can I avoid damage while continuing drug consumption?’) or to staff (‘How can I avoid a needle stick injury when searching cells?’).
Possible target groups are
u    Prison staff, i.e. guards, health workers and/or manage-
ment.
u    Inmates. One can work with individual drug users, for exam-
ple, to train them as peer tutors (group meetings could be
seen as threatening for the system) or with a group. Depending on the issues to be dealt with in a seminar one can consider whether to differentiate the target group by gender, age or ethnic background. When dealing with sexual behaviour and safer sex, for example, women might feel safer discussing these issues when there are no men present (see below chapter 7.4).
If training seminars for inmates are not possible, one can consider organising seminars on life and health risks in prison for drug users in the community, since many of them either have been in prison in the past or will end up there at some point in the future. Training drug users in the community can be a means of facilitating peer support in prison, as the trained drug users can then pass on the information gathered through training in the community to other inmates when in prison.
u    Community health service staff. These can be an important
target group as some of them work with drug users in prison. Moreover, since many drug users in the community have experienced or will experience imprisonment, the work of community drug and health service workers outside prison can be of importance. Finally, community drug and health
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services can play a supportive role to prison staff in developing risk reduction activities in prisons.
u A mix of these target groups. Combining target groups can be quite powerful with regard to an exchange of information, change in attitude etc. It can facilitate mutual under standing. Possible target groups are prison staff, drug users and drug service or health service workers.
7.4 Planning and designing a seminar program
As stated earlier, training seminars should not only focus on transfer of knowledge about risk reduction but also on transferring skills, influencing attitude and social norms, and enhancing self-efficacy. To ensure that more than only factual knowledge is transmitted the interactive character of the training session is important. Participants should not be taught but stimulated or even provoked to take part in the discussions. Therefore, it is important to limit lectures to what is strictly necessary to transfer relevant information and include as many interactive work forms as possible. One should also keep in mind that a transfer of knowledge also can be achieved through structured discussions on relevant issues, such as how to inject safely. The role of the trainer is then to guide the discussion and to make sure that no inaccurate information is provided and nothing is missed. The exercises included below (see chapter 8) are meant to facilitate this active learning.
It is clear that inmates in different prisons in diverse countries will attend risk reduction seminars with different motivations and different interests. The motivation and interest of the participants should be reflected in the design and contents of seminars. It is also worthwhile checking if risk reduction is an appropriate issue to get people involved. In some cases embedding risk reduction in the broader framework of health promotion has proven beneficial, as it is less linked to taboos than a narrower focus on sexual behaviour and drug use.
When preparing a seminar program, pay attention to the following things:
u    Define the size and composition of the group, keeping in
mind the subject of the seminar, specific target groups, etc.
u Select the trainers. Trainers have to be experts, but they also have to have a positive attitude towards the target groups, and they have to be flexible, i.e. being able to change the program if needed, etc.
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u    Define the course regulations, e.g. one person speaking
at a time, giving respect to different opinions, letting people finish what they have to say, no aggression or violence, etc. u Choose teaching methods (see chapter 7.4)
u Choose assessment and evaluation methods (see 7.1)
u    Design a detailed seminar program and timetable
u    Prepare visual aids (sheets, slides, flipchart, etc.)
u    Prepare handouts and photocopies for exercises
u Choose and book the venue
u    Plan and organise logistics (devices like overhead
projectors, technical assistance, lunches and refreshments, etc.)
General considerations when organising  a risk reduction seminar
u    Invite potential participants well in advance. People,
especially drug users, might have to get used to the idea of being invited to a training seminar. The background of the seminar should be talked over and explained. An official letter might underline that the presence of those invited is appreciated.
u    In the meantime, it can be a good thing to keep people
informed about the development of the training seminar and the planned risk reduction activities.
u    Do not stop motivating people to attend the training
course until they actually have arrived.
u    One could consider inviting more people than one actu-
ally wants to train. Due to the taboo on sex and drugs
in prison, some people might not show up despite their promises to participate.
u    The number of people to be trained at any one time
should not exceed 20 people.
u    It might be better to organise a training course con-
sisting of three afternoons rather than one that runs for an entire day.
u    It is important to use methods of delivery that take
the skills and experience of the participants as a starting point.
u    Consider giving a small present to the participants after
finishing the seminar as an appraisal for their presence.
u    Consider giving people a diploma after the seminar.
u    Always end a training course with an oral or written
evaluation. What have you learned, what was lacking, suggestions for improvement, etc (for examples, see annex).
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*4
Elements of this chapter have been adapted from Brian Murtagh: Peer education (book 2). Health Promotion Unit of the National Youth Federation Ireland
u    Choose a room for the course close to where people
feel comfortable. The room will thus have a greater psychological accessibility.
u    Organising a training course for drug users can be
valuable, but it can become even more valuable if some kind of follow-up activity is organised.
The opening session
A well-prepared beginning to a training seminar is crucial for its success. The opening session of the seminar should include the following:
u    A general welcome to everybody, e.g. thanking people
for showing interest.
u    An introduction of the trainers (name, organisation, pro-
fession, experience, etc.).
u    An explanation of the reasons for and aims of the semi-
nar.
u    A presentation of the program.
u    A round in which the participants introduce themselves
(name, what is their main interest, what do they want to learn, etc.)
u    Working with ‘icebreakers’ at the beginning (refer to a
recent newspaper headline on a relevant issue, connect the training topic to well-known persons, make a joke, etc.)
Methods to be used
Depending on the groups’ experience in the prison, interests and needs, some of the following approaches may be useful elements in a training seminar *4 :
Group work:
Start in small groups where all inmates feel more confident to speak and then to move to larger or plenary discussions. The size of the group may influence the level of discussion and self-disclosure which takes place during exercises.
Consider how a group could be divided up, e.g. participants could be invited to decide to choose who they want to work with or may be directed to work with a person they have not worked with before.
Feel free to use and adapt the suggested outlines of exercises below (see chapter 8), according to your knowledge of your particular group, the prison circumstances and resources.
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Brainstorming
This is a way of recording immediate thoughts on a subject. Everybody’s contribution is written down as it is given. Only when everybody has finished contributing does discussion and analysis of the contributions begin.
Drawing:
Drawing and collage are a useful way to approach issues which are intimate or personal and are useful in stimulating discussion.
Quiz or questionnaires:
These are useful for establishing the information levels of a group but care must be taken not to create a sense of competition (see quizzes in chapter 2).
Attitude continuum:
This involves placing cards with the word agree-disagree, acceptable-unacceptable, at opposite ends of a room and inviting participants to express their views or values. It is a very useful way for enabling structured discussion of participants’ different opinions.
Video:
Videos can be a useful catalyst for discussion or for giving information. TV programs popular amongst inmates can provide relevant material for discussing relationships, sex, personal development etc.
Newspapers and magazines:
Literature, articles, drug users’ magazines, photographs, prison magazines/newsletter, and case studies can be used as the basis for an exercise, too.
Drama, role play:
Drama and role play can be used most effectively. Providing a case study and role playing it can help participants see a variety of angles on an issue. ‘Freeze framing’, where the action is ‘frozen’ and the participants are asked to suggest what has happened or what is about to happen is also a good technique.
It is important to use a variety of presentations and interactive methods to help concentration and make learning as interesting as possible. Finally one should not forget to include regular breaks in the program.
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Taking into account specific target groups / specific issues
From experience we know that generally there are good arguments for having safer-sex seminars for male inmates be conducted by male trainers and a female trainer for female inmates. This is due to the gender specific experiences, habits and risk exposure of both groups (e.g. prostitution, abuse etc.) and gender specific attitudes. Women frequently do not feel safe to discuss issues of sexual behaviour in the presence of men. Men might feel the obligation to play the ‘macho’, boosting their sexual achievements.
The ethnic, cultural and religious differences of inmates should also be considered, perhaps through running different training seminars with different approaches. In a predominantly Islamic culture it is not acceptable to talk as bluntly about sex as in Western countries. This point is important, as in most European prisons the percentage of foreigners is relatively high. This raises specific problems of culture and religion. Communication might also be hampered through language barriers. Having staff available who speak the language, or even better who come from the same country, culture or religious background can be very helpful.
7.5 Training seminars for inmates
Many inmates have not been reached successfully by health services before entering prison. So the time of imprisonment can be used effectively to inform them about risk reduction and other health issues. Here, one can contribute to making sure that the period of imprisonment is not simply ‘lost time’.
Two types of training seminars for inmates can be distinguished:
u    Training small groups of drug-using inmates in prison about
risk reduction, possibly resulting in a snowball effect and
u Training drug-using inmates about risk reduction and as ‘peer supporters’ involved in further risk reduction activities.
Both kind of training seminars have their own perspective. The first type is meant for drug users who do not have any advance intention of becoming active in peer support activities. Nevertheless, our training seminar experiences showed an impact on both the participant and his/her peers. It is not hard to imagine that the training seminar will be discussed with friends and peers. This is
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where the ‘snowball’ starts to roll. This type of training seminar can be organised and conducted by both prison staff and community health or drug workers.
The second type of training seminar only makes sense in a broader peer support framework. It can be conducted as starting point for peer support activities in prison. In such a case it can be valuable for professionals to participate and bring along their knowledge and competence (e.g. nurses from the medical department). For example, when drug users are interested in contributing to a risk reduction strategy through a peer support initiative this kind of seminar can be fruitful. It is obvious that in these seminars attention is paid to organisational aspects and to the message, but also to how to get the message across.
When organising risk reduction seminars for inmates important things to keep in mind include:
u The need to clarify in advance that inmates who want to participate in the seminars will get the opportunity to do so (getting time off from work, schooling etc.). This should be discussed with the prison governor.
u    Inmates should only participate on a voluntary basis to
make sure that they are motivated to do so and to facilitate peer support, i.e. passing on the information to their peers.
u Drug using inmates, especially peer leaders prove to have a lot of valuable information and can contribute in many ways to training seminars.
Working with groups or individual inmates
Training drug users should preferably be done as a group event. This is, of course, more efficient (less work, less money involved) than training on an individual basis. Moreover, it stimulates group discussion, facilitating group influences on attitude and social norms, making use of resources available among inmates.
However, some prisons do not permit group work because it is regarded as a security risk. In that case it might be an option to train individual drug-using inmates to work as peer tutors. Working with individuals allows a very intensive and thus effective transfer of information.
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7.6 Training seminars for prison / drug service staff
“What creates health? It is the interaction of environment and people in the course of everyday life that creates a pattern of health in the individual, the family, the community and the globe.” (Ilona Kickbusch, 1997)
Especially important issues for training seminars for prison staff include:
u    Seminars that help prison staff to identify themselves with
and support the objective of preventing infections
u    Seminars in which prison staff acquire basic knowledge
about drugs, drug use, infectious diseases and other drug use related health risks
u    Seminars in which individual and collective needs for
safety are discussed and agreed upon
Again the focus of these seminars cannot only be on knowledge but should also focus on:
u    Skills, e.g. in the field of counselling;
u    Raising awareness about the staff’s attitude towards drug
use, sexual behaviour, etc.
The training seminars should focus on adequate behaviour patterns as part of measures initiated to prevent the spread of infections in prison. A single training on behaviour change, however, will not be efficient without accompanying structural changes in the prison setting. According to interviews with prison staff, the three aforementioned goals need to be met.
Identification with the goal of preventing infections
Prison staff and management can only personally identify with the objective of preventing infections if they accept that infections are a threat for everybody, both in and even outside prisons and therefore should be fought. They need to understand that they have a vital role in doing so successfully.
Using print media as leaflets is not enough. These are only suited to complementing other preventive measures such as personal counselling and other services (see chapter 9) but they cannot replace such measures. Implementation of preventive measures is frequently jeopardized by individual attitudes and prejudice of prison staff (“Inmates know exactly what they are doing; they are grown-ups and they are responsible for themselves”). Moreover, prison staff often consider drug consumption a weak-
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ness of character (“Addiction can be overcome if the will is strong enough. Quitting is the only solution!”) or religious reasons are given for why earthly means are hardly suitable for combating risks of infection (“AIDS is the well-deserved punishment imposed by a higher power!”). Such attitudes and beliefs are deeply rooted in people. They cannot be changed easily. Hence training offered to prison staff should aim at familiarizing them cautiously with new attitudes and at sensitising staff towards the situation of drug-using inmates and of course, allaying the fears of colleagues.
Acquiring basic medical knowledge
The use of illegal drugs and the use of medical services and medication are often related to each other. However, frequently, drug-using inmates are reluctant to seek help concerning their use of illegal drugs directly from medical services. The situation is getting more complicated by the taboo under which drug use (in prison) operates.
Therefore it is crucial that prison staff learn basics of medical knowledge in order to:
u    Avoid infections, especially viral infections often associ-
ated with drug use,
u    Allow prevention and early treatment of health damage
related to drug use.
Accepting and meeting individual and collective needs for safety
This is an important issue when training prison staff, as it has been shown that fear, insecurity and the wish to separate oneself from others have a negative effect on the atmosphere and on interactions and relations between staff and inmates. Although separation from others can be considered a method of protecting oneself against supposed or real threats, it should be overcome in order to establish a closer relationship between prison staff and inmates. This is a prerequisite for successful risk reduction activities, such as discussing safer behaviour.
A closer relationship can only be established if the prison staff´s need for safety is accepted and met. Seminars should focus on supporting prison staff, helping them to feel more secure in handling drug-related problems. Besides extending their knowledge on drug and drug use related issues (see chapter 2), seminars should also answer questions related to the risk to prison staff of getting infected, and inform participants on things like PostExposure-Prophylaxis (PEP) after a needle stick injury, first aid
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in drug-related emergencies, adequate treatment of wounds and the availability of vaccinations. Often guidelines and protocols for avoiding risk exposure and adequate safety behaviour (such as wearing gloves when searching cells etc.) do already exist. These can be used, as basic material and problems in applying these recommendations then can be discussed.
Besides taking up the staff’s needs and fears as an initial point of departure for training, one can use major parts of this manual (the whole of chapter 2 and also elements from this chapter, e.g. chapter 7 on ‘Methods and material to conduct risk reduction work’ which contains lots of ideas for training seminars) for designing training seminars for prison staff.
7.7 Training seminars for mixed groups
Combining the target groups of prison staff and inmates can be quite powerful with regard to the exchange of information, changes of attitude, etc. Exercises from the European Peer Support Manual have proved to be useful in this respect (Trautmann / Barendregt 1994). Here, again, a needs assessment might be a good thing to start with.
From our experiences working with peer support in prisons (Stöver/ Trautmann 1998) we know that peer support can be an issue to deal with in seminars for mixed groups. Peer support and peer education can be useful approaches to contribute to risk reduction in prisons (see chapter 10.6). To work out a plan for peer support one could organise a mixed seminar to present and discuss options of peer support as part of a risk reduction strategy. How and what can drug users contribute, how can they be supported by prison staff, etc. could be issues of discussion. Using exercises on safer use (such as how to inject safely, etc.) can show prison staff that drug users do have valuable information and know-how.
However, peer support in general should be first introduced to prison staff as part of an introduction of risk reduction strategies in prisons, for example, by seminars on drug use in general. It does not make sense to focus in a seminar or training seminar on peer support without having discussed first the basics of risk reduction. Our experience has also taught us that peer support initiatives are most successful when supported by professional or voluntary organisations (Trautman n/Barend regt 1994). In the closed setting of a prison, a risk reduction strategy would be impossible without the support of prison staff.