- Start date: 1 January 2013
- End date: 30 June 2015
- Value: £476,997
- Primary investigator: Helen Elsey
- Co-investigators: Darren Shickle Cathy Brennan Janet Cade Sandy Tubeuf Tracey Farragher Tom Fleming Judy Wright
Funded by NIHR
Background: Care farms (CF), where all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed feasibility of determining cost-effectiveness of CFs in improving quality of life compared to comparator sites among probationers undertaking community orders (CO).
1) Systematic review of CF impacts and mechanisms in improving health and logic model development.
2) Inform future studies by estimating differences in quality of life and other outcomes, identifying factors driving CO allocation; ways to maximise recruitment, follow up.
3) Assess feasibility of cost-effectiveness analysis.
Review: mixed methods synthesis following Campbell Collaboration guidelines.
Pilot study: Three probation service regions in England each with CF and comparator CO site. Participants were adult offenders (18 years +) serving COs.
Primary outcome: quality of life (CORE-OM). Other outcomes: health behaviours, mental well-being, connectedness to nature and reconvictions.
Review: Our search identified 1659 articles: 14 qualitative, 12 quantitative and one mixed methods study. Small sample-sizes and poor design meant all had high risk of bias. Components of CFs that potentially improve health: being in a group; role of the farmer; meaningful work and interaction with animals. There was a lack of quantitative evidence indicating CFs improve quality of life; weak evidence of improved mental health, self-efficacy, self-esteem, affect and mood.
Pilot study: We recruited 134 respondents, only 21 declined; 37% were allocated to 3 CFs and the remainder to comparators. This was below our target of 300. Recruitment proved challenging due to changes in probation (Trusts disbanded 2014) and closure of one farm. We found significant differences between CF and comparator users: those at CFs were more likely to be male, smokers, substance users, at higher risk of reoffending (a confounder), have more missing CORE-OM questions. Despite these differences, the use of propensity analysis facilitated comparison.
Participants consented to, and we were able to link probation and police reconviction data for 90% of respondents. We gained follow-up questionnaire data from 52% of respondents, including health and social-care use cost data. We transformed CORE-OM into CORE-6D, allowing derivation of QALYs. As a pilot, our study was not powered to identify significant differences in outcomes. Qualitatively, we observed that within CO’s, CFs can be formally recognised as rehabilitative but in practice, seen as punitive.
Limitations: Changes in probation presented many challenges limiting recruitment and collection of cost data.
Recruitment is likely to be feasible in a more stable probation environment. Retention among probationers is challenging but assessing reconvictions from existing data is feasible. We found worse health and risk of reoffending among offenders at CFs, reflecting use of CFs by probation to manage challenging offenders.
A sufficiently powered natural experiment is feasible and of value. Using reconvictions (from police data) as primary outcome is one solution to challenges with retention. Propensity analysis provides a viable method for comparison despite differences in participants at CFs and comparator sites. However, future work is depedent on stability and support for CFs within probation services.
While further research is needed to determine the cost-effectiveness of care farms in reducing recidivism, our review and qualitative study highlights the potential of care farms to provide innovative rehabilitation interventions to benefit the well-being of probation-users, and ultimately to reduce recidivism. In light of this, we recommend that probation services, both CRCs and NPS build an understanding of the care farms within their catchment areas, identifying their potential to support the rehabilitation of probation service-users. Our study highlights that not all care farms are the same, an understanding of the ethos and aims of the farm is therefore, important before considering allocating service-users. Care farms which can clearly demonstrate that they offer therapeutic benefits through farming activities should therefore be used as a rehabilitative requirement.
Publications and outputs
Elsey, H., Bragg, R., Elings, M., Cade, J. E., Brennan, C., Farragher, T., ... & Richardson, Z. (2014). Understanding the impacts of care farms on health and well-being of disadvantaged populations: a protocol of the Evaluating Community Orders (ECO) pilot study. BMJ open, 4(10), e006536. https://bmjopen.bmj.com/content/4/10/e006536?int_source=trendmd&int_medium=cpc&int_campaign=usage-042019
Elsey, H., Farragher, T., Tubeuf, S., Bragg, R., Elings, M., Brennan, C., ... & Cade, J. (2018). Assessing the impact of care farms on quality of life and offending: a pilot study among probation service users in England. BMJ open, 8(3), e019296.
Wickramasekera, N., Wright, J., Elsey, H., Murray, J., & Tubeuf, S. (2015). Cost of crime: A systematic review. Journal of Criminal Justice, 43(3), 218-228.