This guide is designed to help with establishing a framework to support individuals with learning disabilities or autistic spectrum disorders whose behaviour challenges services and presents a risk to themselves or others. It sets out in clear and simple terms a structured and systematic approach to the identification, assessment and management of risks associated with challenging behaviours.
This guide is designed to help with establishing a framework to support individuals with learning disabilities or autistic spectrum disorders whose behaviour challenges services and presents a risk to themselves or others. It sets out in clear and simple terms a structured and systematic approach to the identification, assessment and management of risks associated with challenging behaviours.
Extended abstract:
Author
POWELL Sharon.
Title
Risk in challenging behaviour: a good practice guide for professionals.
Publisher
British Institute of Learning Disabilities, 2005
Summary
This guide is designed to help with establishing a framework to support individuals with learning disabilities or autistic spectrum disorders whose behaviour challenges services and presents a risk to themselves or others. It sets out in clear and simple terms a structured and systematic approach to the identification, assessment and management of risks associated with challenging behaviours.
Context
Risk is an evolving concept; it is changing and rarely stays the same from one day to the next. Individuals are prepared to take calculated risks in their daily lives for a variety of reasons. Professionals are expected to identify and manage risk objectively. Reactive strategies for risk management when behaviour challenges should form part of an overall framework. This should include approaches that support positive behaviour. Physical interventions should be used only as a last resort.
Contents
A foreword explains recent developments and an introduction outlines the problem and the intentions of the guide. The first section, on philosophical and organisational issues, discusses organisational foundations, the nature of risk, taking risks, procedures for working with risk, why risk should be assessed, and the elements of risk. The second, on assessing risk, covers risk scoring, identifying hazards and risks, the risk assessment process, describing the challenging behaviour, articulating risk, managed and unmanaged risk, the assessment process, what might go wrong, and physical interventions in the context of risk assessment. Two sets of checklists are given, on procedures for working with risk, consisting of three lists, for developing risk policies, service user vulnerability, and breaking confidentiality; and on risk assessment process, with four lists, for information gathering, planning and consultation, implementation and monitoring, and evaluation and review. Three pro formas are also given, for behaviour description, articulating risk and assessment of service user vulnerability.
Journal of Intellectual Disabilities and Offending Behaviour, 8(2), 2017,
Publisher:
Emerald
Purpose: The prevalence of individuals with an Autism Spectrum Disorder being associated with terroristic threats, lone wolf terrorism or affiliating with terroristic groups is rare.
Design/methodology/approach: However, several cases are presented, where individuals with autism are involved in making a naïve, empty terroristic threat, or uttering serious serial terroristic threats. Other cases are also presented of individuals being at risk for an abduction or being used by a terrorist group, and finally committing an act of domestic lone wolf terrorism.
Findings: Essential to the analysis was establishing a functional connection between autism-based deficits and the terroristic threats, terrorism, and when to not criminalize naïve, empty terroristic threats or acts.
Originality/value: Currently, tools available to law enforcement and prosecutors exploit the vulnerabilities and liabilities which arise as a result of group interactions, a “preventive” approach to terrorism that is not applicable to the solitary, “lone wolf” terrorist (Barnes, 2012; Zierhoffer, 2014).There has been relatively little research (including case studies) examining individuals with ASD who engage in terrorism. For instance, when dealing with an individual with ASD who is charged with terrorism, it is crucial to consider how the diagnosis of autism may have presented as a contextual vulnerability, and to make sure that justice, rehabilitation and management, are informed by an understanding of the person’s diagnosis of ASD (Al-Attar, 2016).
(Publisher abstract)
Purpose: The prevalence of individuals with an Autism Spectrum Disorder being associated with terroristic threats, lone wolf terrorism or affiliating with terroristic groups is rare.
Design/methodology/approach: However, several cases are presented, where individuals with autism are involved in making a naïve, empty terroristic threat, or uttering serious serial terroristic threats. Other cases are also presented of individuals being at risk for an abduction or being used by a terrorist group, and finally committing an act of domestic lone wolf terrorism.
Findings: Essential to the analysis was establishing a functional connection between autism-based deficits and the terroristic threats, terrorism, and when to not criminalize naïve, empty terroristic threats or acts.
Originality/value: Currently, tools available to law enforcement and prosecutors exploit the vulnerabilities and liabilities which arise as a result of group interactions, a “preventive” approach to terrorism that is not applicable to the solitary, “lone wolf” terrorist (Barnes, 2012; Zierhoffer, 2014).There has been relatively little research (including case studies) examining individuals with ASD who engage in terrorism. For instance, when dealing with an individual with ASD who is charged with terrorism, it is crucial to consider how the diagnosis of autism may have presented as a contextual vulnerability, and to make sure that justice, rehabilitation and management, are informed by an understanding of the person’s diagnosis of ASD (Al-Attar, 2016).
(Publisher abstract)
Journal of Intellectual and Developmental Disability, 44(1), 2019, pp.116-120.
Publisher:
Taylor and Francis
Background: Mechanical restraint refers to the use of materials or devices to restrict the behaviours of a person with a disability, where the restraint is neither for therapeutic purposes or required by law. The inappropriate use of mechanical restraint is recognised in legislation and policy as a violation of people’s human rights, and a risk to their health and wellbeing. Understanding who is at risk of mechanical restraint may assist service providers to better support people with a disability. Method: State-wide data collected between July 2012 to June 2013 were sourced. Odds ratios were used to describe the associations between individual characteristics and whether an individual was subjected to mechanical restraint. Results: Individuals with certain characteristics, such as the presence of a hearing, physical, neurological, communication or visual impairment, and autism spectrum disorder had an increased likelihood of being mechanically restrained. Conclusion: Initiatives to reduce mechanical restraint should pay particular attention to the support needs of those with sensory impairments and complex communication support needs including those with autism spectrum disorder and those with a physical impairment.
(Edited publisher abstract)
Background: Mechanical restraint refers to the use of materials or devices to restrict the behaviours of a person with a disability, where the restraint is neither for therapeutic purposes or required by law. The inappropriate use of mechanical restraint is recognised in legislation and policy as a violation of people’s human rights, and a risk to their health and wellbeing. Understanding who is at risk of mechanical restraint may assist service providers to better support people with a disability. Method: State-wide data collected between July 2012 to June 2013 were sourced. Odds ratios were used to describe the associations between individual characteristics and whether an individual was subjected to mechanical restraint. Results: Individuals with certain characteristics, such as the presence of a hearing, physical, neurological, communication or visual impairment, and autism spectrum disorder had an increased likelihood of being mechanically restrained. Conclusion: Initiatives to reduce mechanical restraint should pay particular attention to the support needs of those with sensory impairments and complex communication support needs including those with autism spectrum disorder and those with a physical impairment.
(Edited publisher abstract)
Journal of Intellectual Disabilities and Offending Behaviour, 5(3), 2014, pp.138-146.
Publisher:
Emerald
Purpose: The purpose of this paper is to present preliminary data on a cohort of patients referred to a specialist forensic medium-secure autism spectrum disorder (ASD) service during its first two years of opening and to identify variables associated with admission to the service.
Design/methodology/approach: Data on all referrals to the service (n=40) was obtained from clinical files on demographics, offending history, psychiatric history and levels of therapeutic engagement. The sample was divided into two groups: referred and admitted (n=23) and referred and not admitted (n=17). Statistical analysis compared the two groups on all variables.
Findings: Totally, 94 per cent of all individuals assessed had a diagnosis of autism, however, structured diagnostic tools for ASD were used in a small minority of cases. About half the sample had a learning disability, almost four-fifths had at least one additional mental disorder and almost three-quarters had a history of prior supervision failure or non-compliance with treatment. The sample had a wide range of previous offences. No significant differences were found between the groups on any of the variables included in the study.
Research limitations/implications: The present study presents a starting point to follow up in terms of response to treatment and characteristics associated with treatment outcome.
Practical implications
– The sample had a wide range of clinical and risk-related needs. Both groups shared many similarities.
Originality/value: This highlights the need for comprehensive assessment looking at risk-related needs so that individuals are referred to an optimal treatment pathway.
(Publisher abstract)
Purpose: The purpose of this paper is to present preliminary data on a cohort of patients referred to a specialist forensic medium-secure autism spectrum disorder (ASD) service during its first two years of opening and to identify variables associated with admission to the service.
Design/methodology/approach: Data on all referrals to the service (n=40) was obtained from clinical files on demographics, offending history, psychiatric history and levels of therapeutic engagement. The sample was divided into two groups: referred and admitted (n=23) and referred and not admitted (n=17). Statistical analysis compared the two groups on all variables.
Findings: Totally, 94 per cent of all individuals assessed had a diagnosis of autism, however, structured diagnostic tools for ASD were used in a small minority of cases. About half the sample had a learning disability, almost four-fifths had at least one additional mental disorder and almost three-quarters had a history of prior supervision failure or non-compliance with treatment. The sample had a wide range of previous offences. No significant differences were found between the groups on any of the variables included in the study.
Research limitations/implications: The present study presents a starting point to follow up in terms of response to treatment and characteristics associated with treatment outcome.
Practical implications
– The sample had a wide range of clinical and risk-related needs. Both groups shared many similarities.
Originality/value: This highlights the need for comprehensive assessment looking at risk-related needs so that individuals are referred to an optimal treatment pathway.
(Publisher abstract)
Subject terms:
referral, patients, autism, risk, challenging behaviour, learning disabilities, autistic spectrum conditions, medium secure units, treatment, admission to care;
Using a combination of social scripts and easy-to-understand activities, this maanual provides accessible information on health, hygiene and personal safety issues for people with autism spectrum conditions or other developmental disabilities. Presented as seven distinct units, this new curriculum covers all aspects of day to day life paying particular attention to areas that may cause confusion or distress, including illness and visits to the doctors. The authors also offer advice on puberty, appropriate sexual behaviour and 'stranger danger', making this a comprehensive manual for children and adolescents from the age of five upwards.
Using a combination of social scripts and easy-to-understand activities, this maanual provides accessible information on health, hygiene and personal safety issues for people with autism spectrum conditions or other developmental disabilities. Presented as seven distinct units, this new curriculum covers all aspects of day to day life paying particular attention to areas that may cause confusion or distress, including illness and visits to the doctors. The authors also offer advice on puberty, appropriate sexual behaviour and 'stranger danger', making this a comprehensive manual for children and adolescents from the age of five upwards.
Subject terms:
learning disabilities, risk, sexuality, access to information, activities of daily living, autism, autistic spectrum conditions, health needs;
Information to help CQC inspectors and their managers to identify and respond to ‘closed cultures’ in health and social care services, where abuse and human rights breaches may be taking place. Closed environments may develop in services where people are situated away from their communities, where people stay for months or years at a time, where there is weak management of these services and where staff often lack the right skills, to support people. The document includes advice on identifying risk factors and warning signs and how to use existing regulatory policy when enforcement action is required. The information will be particularly useful for regulating services for people with a learning disability or autistic people. However, the principles apply to all settings where people may be less able to self-advocate, including adult social care services for people with dementia or mental health conditions.
(Edited publisher abstract)
Information to help CQC inspectors and their managers to identify and respond to ‘closed cultures’ in health and social care services, where abuse and human rights breaches may be taking place. Closed environments may develop in services where people are situated away from their communities, where people stay for months or years at a time, where there is weak management of these services and where staff often lack the right skills, to support people. The document includes advice on identifying risk factors and warning signs and how to use existing regulatory policy when enforcement action is required. The information will be particularly useful for regulating services for people with a learning disability or autistic people. However, the principles apply to all settings where people may be less able to self-advocate, including adult social care services for people with dementia or mental health conditions.
(Edited publisher abstract)