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A programme for alcohol related violence with offenders with intellectual disability
- Authors:
- LINDSAY William R., et al
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 5(2), 2014, pp.107-119.
- Publisher:
- Emerald
Purpose: Although studies suggest alcohol abuse is not the major problem among offenders and others with intellectual disabilities (ID), it is still a significant problem. There are also suggestions that alcohol may have a more serious effect on those with ID. The purpose of this paper is to describe a treatment for alcohol-related difficulties designed for people with ID. Design/methodology/approach: A programme for alcohol-related problems is described and four case studies are presented to illustrate the sessions and review the way in which people with ID have responded to the methods. The cases have a mixture of alcohol-related problems including anger, anxiety, social withdrawal and depression. The alcohol programme is coordinated with a range of person centred interventions for specific difficulties. Findings: All cases responded to the programme positively. Two cases showed reductions in anger, two reported reductions in anxiety and one reported reductions in depression. All cases increased their alcohol knowledge considerably. Research limitations/implications: The programme seems promising in its approach to alcohol-related difficulties. It is noted that alcohol education alone is likely to improve participants’ wellbeing in the absence of coordinated intervention for other relevant personal difficulties. A controlled treatment trial for effectiveness is clearly required. Originality/value: The paper describes a programme for alcohol-related problems and may be the first such programme that has contained pilot evaluation. (Publisher abstract)
From denial to acceptance of sexually offending behaviour: a psychodynamic approach
- Author:
- BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.293-299.
- Publisher:
- Emerald
Purpose: Offenders who have intellectual disabilities like any one else may deny their offence. This paper reports a case study of a man who admitted his offence and them accepted probation with a condition of treatment. However, when he attended treatment he denied the offence. Thus do those providing treatment send them back into the criminal justice system or work with them try and help them accept what they have done and provide appropriate treatment to help them reduce future risk of offending. Design/methodology/approach: In this case study the assimilation model was used to understand the process of change and monitor change through exploratory psychotherapy. The psychotherapeutic model was psychodymnamic. Findings: The client demonstrated gains through the stages of the model toward acceptance of his problematic behaviour and continued to work on this through further psychotherapy. Originality/value: The assimilation model offers a useful approach to monitor change in psychotherapy; but especially when the client does not accept the problem the rest of the world feels they have. (Publisher abstract)
The adaptation of a Solution Focused Brief Therapy domestic violence perpetrator programme: a case study with a client with a learning disability
- Authors:
- BANTING Rosemary, BUTLER Catherine, SWIFT Charlotte
- Journal article citation:
- Journal of Family Therapy, 40(4), 2018, pp.489-502.
- Publisher:
- Wiley
Re‐offending rates of perpetrators of domestic violence are high (Hester et al., 2006) and there is a need for perpetrator programmes to reduce victimization. There is no clear evidence for the effectiveness of existing programmes (Bowen, Gilchrist and Beech, 2005; Herman, Rotunda, Williamson and Vodanovich, 2016; Smedslund et al., 2011). A new perpetrator programme based on Solution Focused Brief Therapy has been developed (Bowen, 2013), and whilst in its infancy it has received positive feedback from services and clients (International Innovation, 2016). Solution Focused Brief Therapy has been found to be effective in the reduction of aggression and criminal behaviours (Gingerich and Peterson, 2013), and has been effectively used with people with a learning disability (Smith, 2005). This case study will explore the effectiveness of the new perpetrator programme with someone with a learning disability on their attitudes towards domestic violence and abuse as well as self‐esteem. Practitioner points: (a) Solution Focused Therapy for domestic violence has been found to successfully change the behaviour and improve the self‐esteem of a man with a learning disability; (b) Where children are at risk of harm, longer‐term interventions remain the recommended therapy; (3) The mainstream model for treatment was adapted by using visual aids and role play to work with someone with learning disabilities and these were found to be useful by the client. (Edited publisher abstract)
Case study illustrations of a psychological treatment pathway in a secure intellectual disability service
- Authors:
- HICKMAN Gareth, THRIFT Su, TAYLOR Chenelle
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 9(2), 2018, pp.102-114.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe in detail the treatment pathway utilised in a male medium and low secure intellectual disability (ID) service. Over the preceding five years, service users have followed the outlined treatment pathway. The current paper offers case study material to illustrate the care pathway. Design/methodology/approach: The treatment pathway is described and two case examples are provided, illustrating participation in the pathway. Evaluative data are provided on length of hospitalisation, direction of pathway at discharge and risk reduction as assessed by the HCR-20, SVR-20 and HONOS Secure measures. Findings: The case examples provided document the assessment and treatment of two male offenders with ID, outlining their treatment pathways, subsequent reductions in assessed risk and their successful community discharge. Originality/value: A comprehensive treatment pathway is outlined together with the theoretical rationale, with illustrative case examples. (Edited publisher abstract)
The bounds of liberty: lessons learnt from treating a man with alcohol use disorder, autism and learning disability
- Authors:
- DRAKE Alexander C.L., et al
- Journal article citation:
- Tizard Learning Disability Review, 23(1), 2018, pp.27-34.
- Publisher:
- Emerald
Purpose: A man in his 40s with alcohol use disorder, learning disability and autism was referred to the learning disability team due to anxiety and low mood. He had been abstinent from alcohol for ten years prior to a recent relapse. The purpose of this paper is to describe his case. Design/methodology/approach: Treatment was person centred, followed standard practice for clients with alcohol use disorder and targeted harm minimisation. Initially, alcohol consumption reduced; however, at month three, he relapsed. Thereafter, he was repeatedly admitted to inpatient settings, drank excessively and engaged in risky behaviours. Findings: Conventional approaches to treating alcohol dependence may not be entirely appropriate for this client group. The client’s alcohol consumption was only curtailed with the use of restrictions to his liberty agreed by him and incorporated into his tenancy agreement. Originality/value: To the best of the authors’ knowledge, this is the first paper to discuss issues pertaining to people with co-occurring learning disability, autism and alcohol dependence. The authors discuss the use of restrictions, reasonable adjustments and policy issues relevant to treating this complex client group. (Publisher abstract)
Commentary on “The bounds of liberty: lessons learnt from treating a man with alcohol use disorder, autism and learning disability”
- Author:
- BROWN Hilary
- Journal article citation:
- Tizard Learning Disability Review, 23(1), 2018, pp.35-41.
- Publisher:
- Emerald
Purpose: In commenting on the issues raised by Drake et al. the purpose of this paper is to discuss three areas of practice: assessing capacity in the presence of intransigence and/or rigid patterns of thinking and behaviour; understanding addiction in this context; and identifying “reasonable adjustments” in the way addiction and substance misuse services are provided to this client group. Design/methodology/approach: As well as discussing the issues raised by Drake et al. the commentary refers to a serious case review exploring similar issues. Findings: Both the case discussed by Drake et al. and the serious case review draw attention to the importance of identifying “reasonable adjustments” to current practice. Research limitations/implications: While the implications of the cases discussed are very significant, further work quantifying the scope of the problems identified would be very useful. Practical implications: The 1995 Disability Discrimination Act (UK) requires public services to make “reasonable adjustments” in order for people with a range of disabilities to access their services on an equitable basis. This paper identifies what some of those areas of difficulty might be. Originality/value: This is a relatively new area of work and expertise in both mainstream addiction and specialist intellectual disability and mental health services needs to be developed in order for them to provide more coherent and accessible programmes to individuals. (Publisher abstract)
Cognitive behavioural therapy for anxiety in a man with autism spectrum disorder, intellectual disability, and social phobia
- Author:
- WRIGHT Kevin Paul
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.284-292.
- Publisher:
- Emerald
Purpose: This paper evaluates the effectiveness of cognitive-behavioural therapy (CBT) in the treatment of social anxiety with a 19-year-old man with intellectual disabilities (ID) and autistic spectrum disorders. Design/methodology/approach: The intervention was evaluated using an A-B single case design. An idiosyncratic measure was developed to measure anxiety symptoms on a daily basis. The brief symptom inventory (BSI; Derogatis, 1975) measured symptom patterns across nine psychological dimensions and was administered at initial assessment, pre-intervention and post-intervention. Findings: Visual and statistical analysis of the data showed that anxiety severity dramatically reduced throughout the course of therapy, reaching and maintaining zero and this was statistically significant. Data seemed to show that sudden gains in the reduction of anxiety severity occurred during the relaxation and cognitive phases of intervention. This sudden gain coincided with an increase in daily activities, and exposure to more anxiety provoking events which was also statistically significant. Global anxiety scores, as measured by the BSI, showed a notable reduction at post-treatment. Originality/value: This paper demonstrates that CBT can bring about meaningful improvements in the treatment of anxiety in people with ID and autism and suggests that further exploration with the wider population is needed. (Publisher abstract)
Sex offenders with learning disabilities: three responses to the challenge of service provision
- Authors:
- HINGSBURGER Dave, et al
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(1), January 2011, pp.42-54.
- Publisher:
- Emerald
This article sets out to explore three differing approaches from three agencies to supporting and treating people with a learning disability who have sexually offended. The three agencies are: Waymarks in the United Kingdom, York Central Hospital Behaviour Management Services and Vita Community Living Services both in Ontario, Canada. Each agency provides services to a similar population of offenders with disabilities. It can be argued that there was a very limited range of theoretical models available when each organisation developed. Consequently each agency developed their service according to the needs and ‘best fit’ of the people they were supporting with the available resources at that time. As a result, different models of service arose, all of which have had real success with meeting the needs of people with learning disabilities who have sexually offended, while providing support and treatment in differing ways. This article examines: the treatment approaches of the three agencies; how success is measured in those participating in treatment; and the style of leadership in the agencies. Some case study examples are provided which demonstrate the success of these agencies.
The assessment and treatment of a man with mild learning disability, violent behaviour and chronic low self-esteem: a case study
- Authors:
- BISHOP Amanda J., HENRY Jayne C.
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 2(1), March 2008, pp.38-44.
- Publisher:
- Emerald
The following case study describes the assessment, formulation and treatment of a man with mild learning disabilities and a history of violent behaviour. Following several years of offence-related work, identification of chronic low self-esteem provided an alternative approach to addressing the risk of violence by treatment based on the cognitive model of low self-esteem. Global self-esteem and fear of negative evaluation were assessed at baseline, middle and end of treatment and at one-month follow-up. Although scores improved over the course of 23 sessions and were maintained at one-month follow-up, the change was minimal and unlikely to be clinically significant. However, the client reported benefits from therapy and there were observable positive behaviour changes. Discharge was facilitated from secure services to supported living in the community. The results from this case study show that, with adaption, cognitive behavioural therapy for low self-esteem may successfully be applied to people with mild learning disabilities. Therapy to address issues underlying offending behaviour is often required in addition to offending behaviour programmes in order to reduce the risk of re-offending.
Integrative treatment in persons with intellectual disability and mental health problems
- Author:
- DOSEN A.
- Journal article citation:
- Journal of Intellectual Disability Research, 51(1), January 2007, pp.66-74.
- Publisher:
- Wiley
Clinical experience has proven thus far that a monodisciplinary treatment approach to behavioural and psychiatric problems in persons with intellectual disability (ID), such as psychotropic medication or behaviour modification programmes, has yielded limited success. It is clear that the complexity of behavioural and psychiatric problems in this population calls for a treatment approach from different perspectives. This article describes a multidimensional treatment approach to the persons with ID who suffer from behaviour problems and psychiatric disorders. Four dimensions – biological, psychological, social and developmental – are represented as well in an integrative diagnosis as in an integrative treatment, embodied by cooperation of different professionals, such as a psychiatrist, psychologist, pedagogues, social worker, nurse and, where possible, the person's caretakers. The developmental dimension receives a salient attention of assessors. By introducing the developmental dimension in diagnostics and treatment, the bio-psycho-social dimensions are set in a new context, more appropriate for persons with ID. The integrative treatment should not be primarily directed towards the symptoms of the disorder but towards restoring a person's mental well-being. The disorder is combated through treatment of the underlying processes that have led to its onset. Different treatment methods from different perspectives may be applied. Strategy and methodological procedures of an integrative treatment are discussed by way of case presentations.