Developmental trauma in a forensic intellectual disability population

2019 ◽  
Vol 11 (1) ◽  
pp. 35-48
Author(s):  
Deborah J. Morris ◽  
Shubhinder Shergill ◽  
Elizabeth Beber
Keyword(s):  
Intellectual Disability ◽  
Prolonged Exposure ◽  
Social Systems ◽  
Treatment Needs ◽  
Care Needs ◽  
Content Type ◽  
Developmental Trauma ◽  
Adverse Childhood Events ◽  
Adverse Childhood ◽  
Forensic Service

Purpose People with an intellectual disability (ID) are more at risk of experiencing adverse childhood events. Moreover, prolonged exposure to ACEs results in enduring changes and impairments in neurological, physiological and psycho-social systems and functioning. In response, van der Kolk et al. (2009) have put forward the concept of developmental trauma disorder (DTD) to reflect the “constellation of enduring symptoms” and complex care needs of this population. The purpose of this paper is to ascertain the level of exposure to adverse childhood events and the prevalence of DTD in an inpatient forensic ID population. Design/methodology/approach A retrospective file review and consensus approach to diagnosis were used in a sample of adults with an ID detained in a secure forensic service. Findings Results revealed that 89 admissions (N=123) had been exposed to at least one significant ACE, with 81 being exposed to prolonged ACEs. A total of 58 admissions (47 per cent) met criteria for PTSD and 80 (65 per cent) met the criteria for DTD. Significant gender differences were noted in MHA status, primary psychiatric diagnoses, exposure to ACEs and DTD. Research limitations/implications The discussion explores the implications for working with forensic ID populations who report high incidents of childhood trauma and the utility, strengths and weaknesses of the proposed DTD, its relationship to ID diagnoses is explored. Originality/value The study outlines the prevalence of DTD and PTSD in ID forensic populations and suggests additional key assessment and treatment needs for this population.

Self-reported experiences of intimate partner violence in a female forensic intellectual disability population

2019 ◽  
Vol 14 (1) ◽  
pp. 1-13
Author(s):  
Deborah Morris ◽  
Claudia Camden-Smith ◽  
Robert Batten
Keyword(s):  
Intimate Partner Violence ◽  
Intellectual Disability ◽  
Partner Violence ◽  
Negative Relationship ◽  
Intimate Partner ◽  
Treatment Needs ◽  
Care Needs ◽  
Content Type ◽  
Significant Difference ◽  
Forensic Care

Purpose Intimate partner violence (IPV) is a complex public health and social issue. Women with an intellectual disability (ID) are at greater risk of experiencing IPV. However, little is known about the IPV experiences of women with an ID and forensic care needs. The purpose of this paper is to explore the history of experienced and perpetrated IPV in women detained to secure specialist ID forensic service. Design/methodology/approach Participants completed the Conflict Tactics Scale-2 (CTS-2, Straus et al., 1996). The CTS-2 measures experienced and perpetrated relationship tactics of common forms of IPV. Findings Participants reported high levels of experiencing and perpetrating IPV across all relationship tactics measured by the CTS-2. Participants reported they engaged in similar levels of experiencing and perpetrating positive and negative relationship tactics. The only significant difference was “minor sexual coercive behavior” where participants were significantly more likely to experience than perpetrate this behaviour. Research limitations/implications Further research exploring the risk factors that contribute to IPV is needed. Shortcomings in the current study are acknowledged. Practical implications Women with an ID and forensic profiles may present with treatment needs as victims and perpetrators of IPV. Clinical activities of women in Forensic ID services should include possible IPV care needs. The importance of developing national guidance and interventions to prevent and manage IPV are discussed. Originality/value This is the first paper, to the authors’ knowledge, to explore experiences of IPV in women with an ID and forensic care needs.

Real Work Opportunities: establishing an accessible vocational rehabilitation programme within a forensic intellectual disability service

2014 ◽  
Vol 5 (4) ◽  
pp. 160-166 ◽  
Author(s):  
Alyssa Cox ◽  
Hayley Simmons ◽  
Ginny Painter ◽  
Pippa Philipson ◽  
Rachel Hill ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Vocational Rehabilitation ◽  
Time Management ◽  
Rehabilitation Programme ◽  
Content Type ◽  
The Real ◽  
Disability Service ◽  
Job Roles ◽  
Real Work ◽  
Forensic Service

Purpose – Patients treated within secure/forensic settings experience numerous barriers to meaningful vocation, including restrictions under the Mental Health Act, which limit community access. The purpose of this paper is to describe the development of Real Work Opportunities, an inclusive and accessible vocational rehabilitation programme within a forensic intellectual disability service. The programme involved setting up employment and interview workshops, interviews, and interview feedback, and job roles within the secure service, to simulate the real work process. Design/methodology/approach – A reflective account of the development and implementation of the Real Work Opportunity programme with a forensic intellectual disability population. Findings – The programme was well received by the patients involved and a high attendance rate was maintained over time despite the demands that were expected. Roles have been advertised for two employment periods and have had two sets of successful candidates. Patients demonstrated skills development throughout the employment process, including general work-based skills, punctuality and time management, managing duties, responsibility, specific role-related skills, interpersonal skills and personal presentation. Research limitations/implications – Despite limited experience of work prior to admission, many patients were enthusiastic and motivated to work. The initial trial of the programme has been well received by both patients and staff. Future developments will include widening the number and types of opportunity offered by the programme. Originality/value – This paper describes a vocational rehabilitation programme for a particularly marginalised population, people with intellectual disabilities within a forensic service. The programme proved highly popular with patients, and enabled them to develop transferable employment skills.

scholarly journals Working together: making the case for integrated forensic services for people with intellectual disabilities

2015 ◽  
Vol 6 (3/4) ◽  
pp. 204-210 ◽  
Author(s):  
Kenneth MacMahon ◽  
Ricky McClements
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Integrated Model ◽  
Content Type ◽  
Fully Integrated ◽  
Forensic Service ◽  
Working Together ◽  
People With Intellectual Disabilities ◽  
Integrated Service

Purpose – There is a general consensus that healthcare for people with intellectual disabilities should be provided by multi-disciplinary teams. Within a forensic setting, recommendations are often made for separate or “parallel” forensic teams, operating independently of generic mental health or intellectual disability teams. An alternative to this model is an “integrated” service, where specialist forensic clinicians work within the general intellectual disability service, to provide support for clients with forensic needs. For clients with intellectual disabilities and forensic needs, there may be advantages to providing access to a wider multi-disciplinary team, through the application of an integrated model. The purpose of this paper is to illustrate the working of an integrated forensic service within a learning disability team, to identify positive aspects of this model, and how potential shortcomings may be overcome. Design/methodology/approach – Literature review, description of service outline with case example. Findings – Although some studies have compared parallel and integrated forensic models within mental health services, there are no evaluations that compare models of forensic services for individuals with intellectual disabilities. However, specific advantages of an integrated model may include availability of multi-disciplinary clinicians, development of forensic skills across wider groups of clinicians, reduction in stigma and avoidance of delay in transfer of care between services. In addition, in areas with smaller populations, parallel services may not be feasible due to low case numbers. Originality/value – There has been no formal evaluation of parallel vs integrated forensic services within an intellectual disability setting. However, the authors describe a fully integrated service and suggest means by which the potential shortcomings of an integrated model may be overcome.

Increasing knowledge of personality disorders in detained women with an intellectual disability

2015 ◽  
Vol 6 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Deborah Morris ◽  
Nathalie Gray
Keyword(s):  
Intellectual Disability ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Rhode Island ◽  
Behaviour Therapy ◽  
Content Type ◽  
Self Compassion ◽  
Education Group ◽  
Personal Strengths ◽  
Forensic Service

Purpose – The purpose of this paper is to describe the evaluation of the “Living with a Personality Disorder” group (Morris, 2011a). This intervention is a psycho-education group for women with an intellectual disability (ID) and a personality disorder (PD). It draws on psycho-education, biosocial theory (Linehan, 1993) and compassionate mind approaches (Gilbert, 2009). It aims to increase knowledge of personality, PDs, to increase awareness of the “non-disordered” parts of self and to increase knowledge of psychological treatments for PD’s. Design/methodology/approach – The intervention was delivered to women detained in a specialist women’s learning disability forensic service. It was delivered over 12 group and two individual sessions. The Knowledge of Personality Disorders Questionnaire (D’Silva and Duggan, 2002), the Self-Compassion Scale (Neff, 2003), the University of Rhode Island Change Assessment scale (McConnaughy et al., 1983) and a series of Likert scale questions and statements were used to assess the utility of the intervention. The intervention was piloted between 2012 and 2014 in a series of small groups. The lead facilitator for each intervention was a registered psychologist with training in dialectical behaviour therapy. Findings – Completing the intervention resulted in an increase in knowledge of PDs, treatments, increased self-compassion and therapeutic optimism and awareness of the limitations of a PD diagnosis. Originality/value – A new intervention that may increase knowledge of PDs, of personal strengths and increase optimism about change that may be a useful component to the treatment for service users with PDs and an ID.

Emotional problems and intellectual disability: comparing groups with and without forensic involvement

2020 ◽  
Vol 11 (4) ◽  
pp. 239-248
Author(s):  
Rachel Craven ◽  
Lyn Shelton
Keyword(s):  
Intellectual Disability ◽  
Physical Aggression ◽  
Impulse Control ◽  
Design Methodology ◽  
Rating Scale ◽  
Treatment Needs ◽  
Content Type ◽  
Outcome Scores ◽  
Behaviour Rating ◽  
Parametric Testing

Purpose Individuals with intellectual disability (ID) are known to experience increased emotional and behavioural concerns. The study aims to assess whether detained ID patients with a forensic history (IDPF) have increased difficulty managing their impulse control in comparison to detained ID patients without a forensic history (IDP). Using the externalising behaviour problems (EBP) subscale of the EPS, the study aims to compare the differences between the IDFP and IDP groups. Design/methodology/approach A total of 60 patients with ID detained under the Mental Health Act 1983 (Revised 2007) were assessed using the behaviour rating scale of the EPS. The outcome scores of the EBP were used to examine any observed differences between the scores of forensically involved patients [n = 34] and those without a forensic history [n = 26]. It was hypothesised that patients with a forensic history would display higher scoring on externalised behavioural problems (EBP) than patients without such a history. Findings Non-parametric testing revealed that there were no significant differences in EBP scoring between the two sample groups. These findings indicate that, for patients in the present study, no differences were detected in the presentation of these two distinct groups. In fact, with the exception of the verbal aggression subscale of the EBP, the other three subscales (physical aggression, non-compliance and hyperactivity) show that actually the IDP group displayed the higher ranked means in these subscales when compared with the forensically involved group. Originality/value These results indicate possible increased treatment needs within the IDP group and question whether offending history is necessarily a reliable predictor of ongoing hostility and behavioural concerns within similar inpatient services.

scholarly journals The characteristics and treatment needs of fire setters with intellectual disability: descriptive data and comparisons between offence type

2019 ◽  
Vol 10 (4) ◽  
pp. 82-88 ◽  
Author(s):  
Ashlee Curtis ◽  
Keith R. McVilly ◽  
Andrew Day ◽  
William R. Lindsay ◽  
John L. Taylor ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Sex Offenders ◽  
Treatment Programs ◽  
Behaviour Therapy ◽  
Treatment Needs ◽  
Sexual Offences ◽  
Content Type ◽  
Cognitive Behaviour ◽  
Offending Behaviour ◽  
The Uk

Purpose Fire setters who have an intellectual disability (ID) are often identified as posing a particular danger to the community although relatively little is known about their characteristics, treatment and support needs. The paper aims to discuss this issue. Design/methodology/approach This study describes the characteristics of 134 residents of low, medium and high security ID facilities in the UK who have either an index offence of arson, a violent index offence or a sexual index offence. Findings Index arson offenders who had an ID had multiple prior convictions, a history of violent offending and a high likelihood of having a comorbid mental disorder. There were many shared characteristics across the three groups. Practical implications The current study suggests that offenders who have ID who set fires have treatment needs that are similar to those of violent and sex offenders. It follows that fire setters who have an ID may also benefit from participating in more established offending behaviour treatment programs, such as cognitive behaviour therapy programs, developed for other types of offender. Originality/value This study is one of the few which has investigated the characteristics and treatment needs of persons who have an ID who set fires. In particular, it is one of the first to compare the characteristics and treatment needs for persons with ID who set fires, to those who have committed violent and sexual offences.

Adverse childhood events, adult distress, and the role of emotion regulation.

2019 ◽  
Vol 25 (2) ◽  
pp. 124-132 ◽  
Author(s):  
Sasha Rudenstine ◽  
Adriana Espinosa ◽  
Andrew Brockbank McGee ◽  
Emma Routhier
Keyword(s):  
Emotion Regulation ◽  
Adverse Childhood Events ◽  
Adverse Childhood

scholarly journals We Want More Than Life-Sustaining Treatment during End-of-Life Care: Focus-Group Interviews

2021 ◽  
Vol 18 (9) ◽  
pp. 4415
Author(s):  
Mirinae Kim ◽  
Minju Kim
Keyword(s):  
Focus Group ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Treatment Needs ◽  
Focus Group Interviews ◽  
Care Needs ◽  
Basic Care ◽  
Life Sustaining Treatment ◽  
Group Interviews

We qualitatively investigated end-of-life care needs. Data were collected via focus-group interviews with three groups: young adults, middle-aged adults, and older adults. The key question was, “What kind of care would you like to receive at the end of life?” Interview data were transcribed and analyzed using content analysis. End-of-life care needs were classified into six categories: life-sustaining treatment needs, physical care needs, emotional care needs, environmental needs, needs for respect, and needs for preparation for death. Because the Korean culture is family-oriented and talking about death is taboo, Korean patients at the end of their life do not make decisions about life-sustaining treatment or actively prepare for death. Therefore, to provide proper end-of-life care, conversations and shared decision-making among patients and their families are crucial. Further, we must respect patients’ dignity and help them achieve a good death by understanding patients’ basic care preferences. Future research should continue examining end-of-life care needs that reflect the social and cultural context of Korea to inform instrument development.

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