A Health needs assessment for young women in young offender institutions Essay Sample

Health Needs Assessment (HNA) for the Young Women in Young Offender Institutions (YOIs)

The overview and purpose

The aim of the Health Needs Assessment (HNA) was to examine the health needs of young women held in custody to determine effective methods for healthcare provisions. Some of the objectives include determining the health status of women aged 17 years through the use of a questionnaire and focus groups. Besides, the second objective was to determine the most appropriate healthcare provision for the young women while collecting evidence from literature on the models of service provisions and consulting with healthcare staff and experts in the field.

Theories used to assess the needs

Public health professionals understand that ‘need’ is a key concept which is used to plan and manage health services such as improvement, allocation of resources, and ensuring that there is equity in provision of health services. Bradshaw (1972) identified four types of social needs such as normative need, felt need, expressed need, and comparative need. Normative needs are identified by experts but may also vary based on standards set by different experts. Within the HNA report, normative needs have been reported by the researchers by stating that young people in the secure state are at a risk of substance misuse, poor sexual health, mental health problems, and sexual violence. For instance, a study in the United States found out that 13.8% of young women had been forced to have sex while another study in Australia revealed that 7.5% of young women had been involved in sex work (Douglas & Plugge, 2006). Therefore, the HNA uses the Bradshaw (1972) social needs, specifically the normative needs to identify the needs of young women in a secure state. The decision that young women need healthcare services is based on past studies which indicated that young women are affected by sexual health.

Felt needs refer to those perceived by an individual. Bradshaw (1972) noted that felt needs are based on the perception of individuals and knowledge of services available. Therefore, the HNA also identifies the felt needs as perceived by the young women in a secure state. Qualitative findings revealed the young women’s perceptions and reported experiences which reveal the felt needs. For instance, self-harm is part of the felt needs since young women in YOI noted that would cut themselves, the young women also felt that persons out of YOI were less likely to drink alcohol (Douglas & Plugge, 2006). For instance, expressed need relate to the need for proper nutrition while avoiding diet that is relies on exercise consumption of carbohydrates. Other expressed needs by the young women include the need for emotional support and counseling services to deal with mental health challenges and drug misuse.

Bradshaw (1972) also identified comparative needs whereby needs are identified through comparison of services received by one group of individuals with those received by another comparable group. The HNA managed to identify comparative needs. For instance, Young women in secure state were compared against adult women in secure state. Findings revealed that levels of smoking, harmful drinking, illegal drug use and registration with GP were similar (Douglas & Plugge, 2006).  When compared against women not in secure estate, it is evident that young women in the society receive quality mental health and other health services which are not accessed by women in secure estate (Douglas & Plugge, 2006). These inequalities should be avoided.

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Approaches used

Epidemiological: the epidemiological focus was achieved by determining the incidence and prevalence rates of key diseases and health conditions (George et al, 2018).  Through a review of literature, Douglas and Plugge (2006) provided key epidemiological findings such as 55% of male and female juveniles in USA drank over more than 20 day in their lifetime with a further 42% using cocaine. Other findings revealed that 38% of women in South Wales had injected drug in last month. Concerning sexual health, 29.8% of female had chlamydia while 11.9% had Gonorrhoea. Quantitative findings also revealed that 81% of the girls had reported that they smoked and the average age for smoking was at 12 years. Besides, 86% drank alcohol before arriving in prison.

Comparative: a comparative focus is achieved in the report by contrasting the services received by one population against those in another setting (King et al, 2017).  The HNA report develops a comparison with adult female offenders on key variables. For instance, the proposition of smoking stood at 81% among young women in YOIs and 85% adult women in secure state. Drinking above recommended level stood at 53% among young women and 50% among adult women (Douglas & Plugge, 2006).  Furthermore, proportion of the use of illegal drugs in the last months stood at 775 among young women and 75% among adult women in secure estate (Douglas & Plugge, 2006).  Equity in healthcare provision should be achieved without any form of discrimination. Young women in secure estate should receive similar health services received by young women not in secure estate.

Corporate approach:  a corporate focus is achieved by evaluating the demands, wishes and alternative perspectives of interested groups such as professionals and patients 9George et al, 2018).  A service provision survey was undertaken within the HNA report.  Nurses as health professionals provided two to 8.5 hours per ten juveniles per week. This is not sufficient since they should provide 60 to 504 hours per week (Douglas & Plugge, 2006).  Besides, nurses were introduced to specialist training such as sexual health, substance misuse, and smoking cessation. Access to community psychiatric nurse was also guaranteed. For instance, all establishments had access to community psychiatric nurses except STC. However,  access to dentists and dental nurses was low. Besides, access to mental health professionals was restricted.

 Strength and weakness of theoretical approaches used

The major strength of the HNA report relates to exhaustive examination of health needs for the young women in secure estate. Normative needs are revealed through risk of substance misuse, poor sexual health, mental health problems, and sexual violence. Felt needs relates to research findings that women in secure estate experience high levels of substance abuse, sexual violence, as well as poor nutrition and health. Therefore, the young women in secure estate have expressed need relating to access to nutrition, exercise, emotional support, psychiatrists, nurses, and other health services (Douglas & Plugge, 2006).  However, a major weakness sis that it is difficult to identify the comparative group which was used. For instance, there is no data on young women not in secure estate.

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 Epidemiological approach has a key strength of identifying the prevalence of health issues. Besides, epidemiological approach managed to identify the key areas of intervention while focusing on the population of interest (young women in YOI). Furthermore, the research method is well designed and controlled. However, major weaknesses relates to the reliability of data. For example, a sample of 73 respondents should not be used to generalize on the whole population of young women in secure estate in England, wales, and Scotland (Douglas & Plugge, 2006). More respondents should be recruited. The second weakness is that there is no causality statistics. For instance, it is not clear whether being in a prison is what leads to alcohol and substance abuse.

Concerning Comparative approach, the major strength is that it compared the need s of different groups such as older women and younger women. However, there are no comparisons with other women not in secure estate such as those living in the community. Comparative approach also identified the need for equity in health services. However, most studies were from the United States which limited the effectiveness of comparisons.

Corporate approaches outlined the importance of engaging nurses, community psychiatrist nurses, and other health professionals. Second, clinical evidence and studies focused on the level in which nurses and community psychiatrist nurses are involved. A major weakness sis that the there were insufficient sample size for women relating female needs. A sample of 73 young women compared to the massive population of female offenders does not reveal the true nature of the needs.


Normative need relates to those defined by experts that young women in prison are at a risk of of substance misuse, poor sexual health, mental health problems, and sexual violence. Part of the felt needs was revealed through quantitative and qualitative research which revealed that women in prison have health needs which should be met. Thus, expressed needs relates to the need for improved nutrition, exercise, emotional support, and psychiatric services. Comparative need was achieved while focusing on older women in prison as well as health services achieved by young women in the society.  Epidemiological approach used quantitative data to revel the incidence and prevalence of disease and health conditions. Further, corporate approach examines the need to ensure that young women in secure estate have access to nurses, psychiatric nurses in community, and other health professionals. However, major weakness with the epidemiological approach is that a sample size of 73 women is not sufficient to achieve generalization to the whole population of YOIs in the UK.





Bradshaw J. (1972) “A taxonomy of social need.” in McLachlan G (ed.) Problems and progress in medical care. Seventh series NPHT/Open University Press.

Douglas, N., & Plugge, E. (2006). A Health Needs Assessment for Young Women in Young Offender Institutions. Youth Justice Board (YJB), Oxford University.

George, I. A., Spec, A., Powderly, W. G., & Santos, C. A. (2018). Comparative epidemiology and outcomes of human immunodeficiency virus (HIV), non-HIV non-transplant, and solid organ transplant associated cryptococcosis: a population-based study. Clinical infectious diseases66(4), 608-611.

King, A., Mullish, B. H., Williams, H. R., & Aylin, P. (2017). Comparative epidemiology of Clostridium difficile infection: England and the USA. International Journal for Quality in Health Care29(6), 785-791.

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