scholarly journals Outcomes of an inner city forensic intellectual disability service

2018 ◽  
Vol 9 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Leah Wooster ◽  
Jane McCarthy ◽  
Eddie Chaplin
Keyword(s):  
Intellectual Disability ◽  
Patient Group ◽  
National Policy ◽  
Community Services ◽  
Retrospective Case ◽  
Community Based ◽  
Content Type ◽  
Discharged Patients ◽  
Male Patients ◽  
Community Based Services

Purpose National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England. Design/methodology/approach This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge. Findings The study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge. Originality/value This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services.

Making a difference? Ten years of managing people with intellectual disability and forensic needs in the community

2015 ◽  
Vol 6 (3/4) ◽  
pp. 165-174 ◽  
Author(s):  
Jana de Villiers ◽  
Michael Doyle
Keyword(s):  
Substance Use ◽  
Intellectual Disability ◽  
Case Management ◽  
Patient Group ◽  
Demographic Data ◽  
Community Services ◽  
Service Development ◽  
Content Type ◽  
Illicit Substance ◽  
Illicit Substance Use

Purpose – Nationally community services for patients with intellectual disability and forensic needs are limited, and research to guide service development for this patient group with highly complex needs is sparse. The purpose of this paper is to provide an overview of referrals to and case management by the multi-agency Fife Forensic Learning Disability Service (FFLDS), including demographic data, treatment, risk assessments and outcomes. Design/methodology/approach – All referrals received between 2004 and 2014 were reviewed to identify key demographic factors and to clarify the outcome of the referrals. Risks levels and presence of factors related to ongoing risk management were identified. For those accepted, final outcomes were noted. Findings – In total, 145 referrals were received by FFLDS between 1 January 2004 and 31 December 2014. Of these 117 were accepted for ongoing case management. In total 106 patients were discharged from FFLDS over the review period, with the vast majority remaining in community settings. Patients were overwhelmingly male, with an age range of 16-79 (mean age of 30). Approximately half of referrals were from criminal justice agencies, and sexual and violent offences predominated. Alcohol and/or illicit substance use was problematic in 49 per cent of patients. Research limitations/implications – FFLDS needs to consider building links with Drug and Alcohol Services, for assistance in developing expertise in managing problematic alcohol and/or illicit substance use. Links with professionals working with female offenders may increase the rate of referral of female patients. Originality/value – Policy and legal frameworks emphasise the need to manage people with learning disabilities and forensic needs in the least restrictive environment possible. This paper provides information on a cohort of forensic patients over a ten-year period, including characteristics and outcomes, to inform the evaluation of these frameworks and the planning of both community and in-patient services for this patient group.

Choice-Making Among Medicaid HCBS and ICF/MR Recipients in Six States

2008 ◽  
Vol 113 (5) ◽  
pp. 325-342 ◽  
Author(s):  
K. Charlie Lakin ◽  
Robert Doljanac ◽  
Soo-Yong Byun ◽  
Roger Stancliffe ◽  
Sarah Taub ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Daily Life ◽  
Care Facility ◽  
Intermediate Care ◽  
Intellectual And Developmental Disabilities ◽  
Care Needs ◽  
Community Based ◽  
Choice Making ◽  
Psychiatric Conditions ◽  
Community Based Services

Abstract Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in nonfamily settings in six states. Everyday choice in daily life and in support-related choice was considerably higher on average for HCBS than for ICF/MR recipients, but after controlling for level of intellectual disability, medical care needs, mobility, behavioral and psychiatric conditions, and self-reporting, we found that choice was more strongly associated with living in a congregate setting than whether that setting was HCBS- or ICF/MR-financed. Marked differences in choice were also evident between states.

Reflections on the use of a specialist acute assessment and treatment unit for adults with intellectual disability

2015 ◽  
Vol 9 (3) ◽  
pp. 132-138 ◽  
Author(s):  
Kiran Purandare ◽  
Anusha Wijeratne
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Care Pathway ◽  
Average Distance ◽  
Community Services ◽  
Discharge Process ◽  
Treatment Unit ◽  
Content Type ◽  
Catchment Areas ◽  
The Impact

Purpose – The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London. Design/methodology/approach – The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013. Findings – There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay. Research limitations/implications – This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit. Practical implications – There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers. Social implications – An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process. Originality/value – This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review.

scholarly journals Remodelling the Third Sector: Advancing Collaboration or Competition in Community-Based Initiatives?

2009 ◽  
Vol 38 (2) ◽  
pp. 277-297 ◽  
Author(s):  
LINDA MILBOURNE
Keyword(s):  
Collaborative Work ◽  
National Policy ◽  
Third Sector ◽  
Local Area ◽  
Community Services ◽  
Early Years ◽  
Community Based ◽  
Deprived Neighbourhoods ◽  
Community Stakeholders ◽  
Perspective Drawing

AbstractIn the last decade, UK public agencies have increasingly been required to collaborate with non-state providers to deliver welfare services. Third sector organisations are now providers of services from early years to old age, taking a growing role in children and young people's services in socially deprived neighbourhoods. National policy has recognised third sector expertise in working with marginal groups of people. However, changing relationships with the state have drawn community organisations into new, often uncomfortable, organisational arrangements, affecting their work and their roles in relation to service users and community stakeholders.This article examines recent changes from a third sector perspective, drawing on data from a study of community-based organisations providing children and young people's services in deprived localities. It considers the changing environment of ‘new localism’ affecting these organisations, focusing on recent plans for local area commissioning of services.The article identifies some progress in supporting community services in deprived areas but illustrates how the continuing emphasis on competitive contracts and centrally driven frameworks undermines collaborative work and community trust. It argues that such mechanisms may serve short-term state interests but devalue the very community-level work, which is increasingly being promoted to address challenging social problems.

Contributing factors to providing an effective community-based forensic service for people with a learning disability: a literature review

2019 ◽  
Vol 10 (3) ◽  
pp. 45-57
Author(s):  
Anna Leonie Wark
Keyword(s):  
Learning Disability ◽  
Service Provision ◽  
Quantitative Methods ◽  
Community Services ◽  
Individual Autonomy ◽  
Service Improvement ◽  
Community Based ◽  
Content Type ◽  
Effective Community ◽  
Published Research

Purpose Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment. On these bases there is a growing emphasis on the requirement for local authorities to develop appropriate services for people who are currently in a hospital setting. The purpose of this paper is to examine the literature addressing factors influencing the provision of effective community-based forensic services. Design/methodology/approach The six articles were analysed separately using the evaluation tool – Currency, Relevance, Authority, Accuracy, Purpose. The six articles used divergent sample groups and employed both qualitative and quantitative methods to collate data. The articles shared a purpose of examining forensic community service provision with an aim to improve services. Findings There were three themes that emerged consistently across the literature these included: balancing risk management vs individual autonomy; multi-disciplinary and multi-agency working; service improvement. There is a growing emphasis on the need to replace long-term hospital placements with specialist, community provision, employing least restrictive methods and positive responses to crisis situations. In this climate, it is crucial that multi-disciplinary agencies from local authority, health and the charitable and private sector continue to work collaboratively on the integration of service provision in order to bring about the development of effective and responsive community services. Research limitations/implications Research limited to peer reviewed and published research papers focusing on the subject of community forensic services with publications specifically made within the time frame of the Transforming Care Agenda. Practical implications This paper looks to examine the practical solutions to providing effective community forensic services for a person with an intellectual disability and makes recommendations for research into improving service specific training for support staff. Social implications Following the Winterbourne View Hospital scandal (BBC One, 2011) instigations were made to make legislative change under the Transforming Care Agenda. Despite a renewed conviction in the rights of people to be a part of their local community without segregation or discrimination, professionals in the field continue to report a failure to reduce numbers of people in long stay hospitals and secure settings. With commissioning under pressure to make these intentions a reality it is a really good time to reflect on practice and evaluate service models to establish the factors that bring about positive outcomes for individuals enabling inclusion within community settings. Originality/value This review will focus on the literature evidencing positive intervention and outcome focussed methods of supporting people with a forensic history in the community. This is an entirely original piece of work analysing peer reviewed and published research.

A multi-level ecological model of psychotropic prescribing to adults with intellectual disability

2013 ◽  
Vol 8 (1) ◽  
pp. 24-31
Author(s):  
Niki Edwards ◽  
Chris Bain ◽  
Allyson Mutch ◽  
Julie Dean ◽  
Nicholas Lennox
Keyword(s):  
Intellectual Disability ◽  
Psychotropic Medication ◽  
Ecological Model ◽  
Patient Characteristics ◽  
Valuable Insight ◽  
Community Based ◽  
Content Type ◽  
Multi Level ◽  
Insight Into

Purpose – Simple linear accounts of prescribing do not adequately address reasons “why” doctors prescribe psychotropic medication to people with intellectual disability (ID). Greater understanding of the complex array of factors that influence decisions to prescribe is needed. Design/methodology/approach – After consideration of a number of conceptual frameworks that have potential to better understand prescribing of psychotropic medication to adults with ID, an ecological model of prescribing was developed. A case study is used to outline how the model can provide greater understanding of prescribing processes. Findings – The model presented aims to consider the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The utility of the model is illustrated through a consideration of the case study. Research limitations/implications – The model presented is conceptual and is as yet untested. Practical implications – The model presented aims to capture the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The model may provide utility for clinicians and researchers as they seek clarification of prescribing decisions. Originality/value – The paper adds valuable insight into factors influencing psychotropic prescribing to adults with ID. The ecological model of prescribing extends traditional analysis that focuses on patient characteristics and introduces multi-level perspectives that may provide utility for clinicians and researchers.

Transformers: a programme for people with an intellectual disability and emotion regulation difficulties

2014 ◽  
Vol 5 (4) ◽  
pp. 178-188 ◽  
Author(s):  
Jenna McWilliams ◽  
Ian de Terte ◽  
Janet Leathem ◽  
Sandra Malcolm ◽  
Jared Watson
Keyword(s):  
Emotion Regulation ◽  
Intellectual Disability ◽  
Inpatient Setting ◽  
Stepping Stones ◽  
Community Based ◽  
Complex Behaviour ◽  
Content Type ◽  
Group Format ◽  
Chain Analysis ◽  
Group Members

Purpose – The Transformers programme is a community-based intervention for people with an intellectual disability (ID) who have emotion regulation difficulties, which can manifest as aggressive and challenging behaviour. The programme was adapted from the Stepping Stones programme (Oxnam and Gardner, 2011) – an emotion regulation programme for offenders with an ID who live in an inpatient setting. The purpose of this paper is to describe the development of the Transformers programme that has been implemented at an ID service, which provides secure and supervised care to people who have been convicted of an imprisonable offence or have high and complex behaviour needs. Design/methodology/approach – The Transformers programme is delivered in weekly sessions over a six-month period in a group format. The focus is on helping group members to develop skills in recognising and understanding negative emotions and learning skills to cope effectively with such emotions. Treatment covers a variety of modules including relaxation, goal setting, chain analysis, emotion recognition, and emotion regulation. Specific strategies used include role-plays, DVDs, and quizzes. Findings – This paper presents the rationale, developmental history, and description of a specific approach to the treatment of emotion regulation difficulties. Originality/value – The paper aims to inform health professionals working in the field of ID.

Pain experience and management in a forensic intellectual disability service

2014 ◽  
Vol 8 (2) ◽  
pp. 120-127
Author(s):  
Verity Chester ◽  
Marie Henriksen
Keyword(s):  
Intellectual Disability ◽  
Pain Management ◽  
Pain Treatment ◽  
Community Services ◽  
Disability Services ◽  
Pain Experience ◽  
Content Type ◽  
Appropriate Treatment ◽  
Number Of Patients ◽  
Health Action

Purpose – Research investigating the experience and management of pain in people with intellectual disabilities has mainly been carried out in community services. The purpose of this baseline audit aims to examine this area in a forensic intellectual disability setting. Design/methodology/approach – A baseline audit of pain management was carried out. Audit standards were derived from recent research, and the performance on each measured. Patients and nurses were interviewed. The audit included 82 patients, of which 64 were interviewed. Twelve nurses were interviewed. Health Action Plans and medication files were accessed for information. Findings – There were interesting differences and similarities in the experience and management of pain between community and forensic intellectual disability patients. Within this sample, most patients were able to communicate their pain, and access appropriate treatment. However, a minority required further support. Nurse decision making about providing pain treatment was affected by fears of manipulation, contributing to addition and disbelieving the patient. Additionally, a number of patients appeared to have insufficient knowledge about how to best manage pain. Practical implications – Results suggested that a standardised approach to pain management, incorporating policy, staff training, and health promotion and psycho-education for patients, would have benefits for both patients and staff within secure intellectual disability services. Originality/value – At present, there is little research focusing on pain experience and management in forensic intellectual disability settings.

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