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Restraint of adults with intellectual disabilities: a critical review of the prevalence and characteristics associated with its use
- Authors:
- FITTON Lucy, JONES Dominic Ryan
- Journal article citation:
- Journal of Intellectual Disabilities, 24(2), 2020, pp.268-283.
- Publisher:
- Sage
- Place of publication:
- London
Background: As part of their care, adults with intellectual disabilities are often subject to restrictive interventions including restraint. Method: A review examining the prevalence of restraint use with people with intellectual disabilities and the characteristics associated with its use. Results: The seven papers identified used quantitative methodologies and had cross-sectional designs. Prevalence rates of restraint ranged from 11% to 78%, multiple forms of restraint were common. Most studies focused on characteristics within the person with an intellectual disability, three considered external factors. Challenging behaviour was the most consistent characteristic associated with the use of restraint, but how this was defined varied. Conclusions: The review highlights a need for more consistent means of defining and measuring restraint and its associated characteristics. Future research into this area may also want to focus on the context of restraint such as whether it is the least restrictive option used. (Publisher abstract)
The support needs of learning disability nurse facilitators of sex offender treatment programmes: a discussion
- Author:
- SMITH Keeley
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 7(2), 2016, pp.94-102.
- Publisher:
- Emerald
Purpose: The role of the learning disability (LD) nurse has developed and expanded significantly within recent years, especially their responsibility for delivering a variety of specialist treatment programmes. The purpose of this paper is to discuss the facilitation of Sex Offender Treatment Programmes (SOTP) and the issues this raises in providing support for LD nurses. Design/methodology/approach: This is an opinion paper and the views and opinions expressed are solely those of the author and do not necessarily reflect the views of any organisation or group with which the author is affiliated. The aims of this paper are: first, to explore the support needs of the LD nurse facilitators of SOTPs; second, to consider the practical implications of providing clinical supervision and support for LD nurse facilitators of SOTPs; and third, to highlight the need for further research in this area. Findings: This paper does not contain original research findings but offers a discussion of the support needs of the LD nurse who facilitate SOTP, concentrating on the specific themes of training, clinical supervision and support. Implications for clinical practice are identified and recommendations for further research are made. (Edited publisher abstract)
Importance of locus of control in offenders with intellectual disability
- Authors:
- RAYMOND Matthew, HAYES Susan
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 5(4), 2014, pp.189-198.
- Publisher:
- Emerald
Purpose: Locus of control (LOC) is the manner in which one attributes their ability to make change in life. This could be through others, fate or chance (externalised), or through oneself (internalised). An internalised LOC results in greater self-belief in the ability to change one's behaviour. Non-disabled offenders with an internalised LOC are more likely to benefit from treatment through therapy and in turn have reduced rates of re-offending. The relationship between LOC and response to treatment is only understood in a limited way for offenders with intellectual disability (ID) who participate in treatment programmes. The paper aims to discuss these issues. Design/methodology/approach: To better understand LOC for offenders with ID, this paper investigates its role in community-based therapy outcomes along with its use as a common pre-/post-measure of treatment success in mainstream offender populations. Drawing upon these findings information more specific to people with ID will be discussed. Findings: This paper will then explore the importance of LOC in treating offenders with ID through a review of the current published literature, which generally indicates offenders with ID demonstrate a tendency towards an external LOC in comparison with non-disabled or non-offender groups. Originality/value: Given the negative implications for treatment that external LOC may play, several significant therapeutic strategies that can contribute to development of internalised LOC are discussed, in addition to a consideration of other possible variables separate from ID that may play a role in both developing or perpetuating an external LOC. (Publisher abstract)
The Good Thinking! course — developing a group-based treatment for people with learning disabilities who are at risk of offending
- Authors:
- GOODMAN Wendy, et al
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(3), 2011, pp.114-121.
- Publisher:
- Emerald
Offender treatment programmes are often inaccessible to those with learning disabilities, which may mean those convicted of offences may receive no offender treatment. This paper describes the development of the “Good Thinking!” course, a group-based offender treatment programme designed to help address this need. It aims to inform and encourage clinicians and commissioners working in this field to increase the availability of specialist community-based treatments for offenders who have learning disabilities. The course comprises 23 two-hour sessions run once a week in a community setting. Based on the premise that people who commit offences are often trying to meet ordinary life goals through anti-social means, it aims to help participants identify and understand their goals, develop the social skills necessary, and teaches a problem-solving strategy for more complex problems. A description of the course and a case study are provided. However, to date, insufficient data have been produced to enable a formal evaluation of the effectiveness of the course.
Redesigning and evaluating an adapted sex offender treatment programme for offenders with an intellectual disability in a secure setting: preliminary findings
- Authors:
- LARGE Julia, THOMAS Cathy
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(2), 2011, pp.72-83.
- Publisher:
- Emerald
This study examined the needs of multiple stakeholders in an adapted sex offender treatment programme (ASOTP), and evaluated a pilot programme set up to respond to the identified needs. Stakeholders included purchasers of Partnerships in Care Learning Disability Services, referred clients, internal and external clinicians involved in their care and group facilitators. Data was gathered from questionnaires and semi-structured interviews in order to determine the key issues necessitating change. An ASOTP was designed and piloted to address highlighted needs, including time frames for the commencement and completion of treatment. Feedback was positive, with participants showing an increase in motivation, knowledge, and, unexpectedly, enhanced levels of risk disclosure. Facilitators reported increased satisfaction and decreased stress levels. The programme was tailored to respond to individual treatment needs within a group setting whilst ensuring programme integrity and effective risk management within a forensic learning disability service. Implications for future research in terms of improving treatment effectiveness are discussed.
Group treatment for men with learning disabilities who are at risk of sexually offending: themes arising from the four-stage model to offending
- Authors:
- GOODMAN Wendy, et al
- Journal article citation:
- British Journal of Learning Disabilities, 36(4), December 2008, pp.249-255.
- Publisher:
- Wiley
This paper reports on the process of helping offenders, and those at risk of offending, with mild learning disabilities, understand their steps to offending. The four-stage model of sexual offending provides a framework to enable participants and facilitators to understand the individuals' offending, in particular the steps or stages that lead to it. This is one of the modules in a nationally provided group-based treatment programme. Four men completed the local programme and their progress during this module is reported. A number of themes arising from the work the men did in this module are also discussed.
Intellectual disability and sexual offending
- Authors:
- WILLIAMS Fiona, COCKERHAM Janet
- Journal article citation:
- Prison Service Journal, 178, July 2008, pp.56-61.
- Publisher:
- Her Majesty's Prison Service of England and Wales
This paper addresses issues that need to be understood when dealing with sex offenders with an intellectual disability and describes what is known about effective practice. A research based treatment approach for sexual offenders with intellectual disabilities in the Prison and Probation service - The Adapted Sex Offender Treatment Programme - is described. The Programme used multi-modal communication strategies, for example, symbols, gestures, visual stimulation and the written word. Facilitators were also encouraged to incorporate a range of interactive exercises: role plays, games, collage making into their delivery. Suggestions are also made for the future of the Programme.
The dose-effect relationship in psychodynamic psychotherapy with people with intellectual disabilities
- Authors:
- BEAIL Nigel, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(5), September 2007, pp.448-454.
- Publisher:
- Wiley
Although there is an established body of evidence attesting to the dose–effect relationship in psychotherapy with non-disabled adults, the issue as to whether such a relationship exists for persons with intellectual disabilities has not been previously examined. Dose–effect essentially concerns the amount of psychotherapy required to produce positive results. The current study used a naturalistic design to examine and compare the outcomes of three groups of participants with co-morbid psychological problems undergoing treatments of differing lengths (i.e. ‘doses’) with psychodynamic psychotherapy. Three measures of psychopathology were completed at assessment and at subsequent eight-session intervals until the conclusion of treatment. Each patient received a 3-month follow-up appointment, at which time the measures were again completed. Three treatment duration groups were subsequently constructed and compared via anova: eight sessions (n = 8), 16 sessions (n = 5) and 24 plus sessions (n = 7). Results were supportive of a dose–effect relationship, in that outcomes were generally equivalent regardless of treatment duration. It is concluded that most change appears to occur in the first eight sessions of treatment, with subsequent outcomes trailing off over time. The clinical implications of the study are discussed in the context of the methodological limitations identified.
A comparison of the application of the self-regulation model of the relapse process for mainstream and special needs sexual offenders
- Authors:
- KEELING Jenny A., ROSE John L., BEECH Anthony R.
- Journal article citation:
- Sexual Abuse a Journal of Research and Treatment, 18(4), October 2006, pp.373-382.
- Publisher:
- Sage
The self-regulation model of the relapse process (Ward & Hudson, 2000) has been developed and empirically validated on general sexual offender populations (Bickley & Beech, 2002), but not on specific sexual offender populations. This paper aims to investigate whether special needs offenders, as compared to mainstream sexual offenders, can be categorized into the offence pathways described in the model. In addition, this paper aims to evaluate the application of the self-regulation model in highlighting the treatment needs of the special needs group. Special needs sexual offenders are defined as a treatment population that includes individuals with lower functioning, limited social and communication skills, and literacy deficits. Participants were classified into the self-regulation model using a method developed by Bickley and Beech (2002). Demographic and offence information were collected and comparisons made between the special needs and mainstream groups. The results showed that the sexual offenders with special needs could be reliably classified into the offence pathways of the self-regulation model. The largest group of special needs offenders was in the approach-automatic group, followed by the approach-explicit group. The results indicated no significant differences in representation in the offence pathways between the special needs and mainstream sexual offenders. The results also indicate that the special needs group would benefit from a responsive approach to treatment, which incorporates appropriate treatment targets identified by the self-regulation model.
Changing the face of challenging behaviour services: the Special Projects Team
- Authors:
- ALLEN David, et al
- Journal article citation:
- British Journal of Learning Disabilities, 34(4), December 2006, pp.237-242.
- Publisher:
- Wiley
The background to a unique initiative for people with challenging behaviour in Wales is described. The Special Projects Team (SPT) was established in the context of increasing knowledge of effective treatment responses, but lack of widespread expertise as well as growing crisis within challenging behaviour services. Unlike previous innovative approaches, the SPT is designed to focus on the development of new services and demonstration projects as well enhancing local knowledge through training and research, and encouraging collaborative developments by working with partners across agencies and across all sectors. The vision of the ideal multi-component, comprehensive, tiered system of support services is outlined, as are the project brief and principal objectives. Key activities in the initial years have encompassed resettlement, a major epidemiological and service mapping study, the development of the first of a series of accredited training courses, research reviews, and the establishment of formal links with other organizations, including the formation of the Unit for Development in Intellectual Disabilities. Aims for the next phases of the Team are highlighted.