Case Synopsis

The Irish Red Cross (IRC) Community Based Health and First Aid (CBHFA) Prison Program was piloted at Wheatfield Prison in 2009 and, following several successful evaluations, was implemented across all of Ireland’s 14 prisons in 2014. The CBHFA Prison Program trains inmates as special status IRC volunteers through weekly CBHFA training sessions, which take place over six months. After completing the community assessment module within the CBHFA program, volunteers, with the support of prison staff, implement projects and engage in peer-topeer health education in an effort to promote the health of the prison community. In addition to having a positive impact on prison health, many volunteers have internalized a more constructive and positive identity and have developed greater self-esteem, self-respect, and confidence. Unfortunately, as a result of policies surrounding the IRC volunteering process, many inmates only keep their volunteer status whilst in prison and therefore their skills and knowledge are not harnessed upon their release.

With high rates of recidivism and a reentry process filled with challenges, the CBHFA management team wanted to develop the program to allow for its continuation in the community. A continuation of the program could help released offenders maintain their association with the IRC and thus their associated positive identity, as well as help address various health challenges associated with transitioning from prison to community. The CBHFA team debated whether to use the “wounded healer” approach for the program design, which involves ex-offenders taking on helper roles in programming surrounding the rehabilitation and reintegration of other offenders. After determining the general design of the program, the CBHFA team would need to develop recommendations regarding the program’s content and its method of implementation and delivery.

Case Objectives

  1. Identify the social determinants of health, relevant to offenders and ex-offenders, and determine what societal conditions are thought to be conductive of successful reintegration using a social determinants of health lens.
  2. Identify the interactions that exist between various social determinants of health and the potential impact such interactions have on individuals and communities.
  3. Use a social determinants of health model to assess the protective and risk factors that exist for given public health interventions and propose ways to mitigate risks and harness strengths.
  4. Formulate relationships between public health interventions and the social determinants of health in terms of the three levels of interaction: micro, meso, and macro.
  5. Assess programs using a health-equity lens and generate implementation recommendations as well as predict potential challenges.

Case Study Questions

  1. How do social and cultural factors shape patterns of recidivism and the reentry process?
  2. What societal conditions are thought to be conducive of successful reintegration?
  3. How should the program move forward in its implementation in order to address the outlined issues – consider partners, program design, etc.? What are the benefits and risks?
  4. Which CBHFA modules (as well as non-CBHFA, module-based content) would be relevant for use in the prison-to-community program in terms of addressing identified challenges?


social determinants of health, strength-based programming, peer-to-peer education, health promotion

Additional Author Information

Alison Green, BSc (Hons), MPH

Graham Betts-Symonds, BA (Hons), DA (Hons), Pg.Dip, RGN, RCNT, Programme Director, Community-Based Health & First Aid in Prisons

Amardeep Thind, MD, PhD, Professor



Recommended Citation

Green, A., Betts-Symonds, G., Thind, A. (2017). Transitioning From Prison to Community. in: John-Baptiste, A. & McKinley, G. [eds] Western Public Health Casebook 2017. London, ON: Public Health Casebook Publishing.