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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.
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 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)
Community dialectical behaviour therapy for emotionally dysregulated adults with intellectual disabilities
- Authors:
- BAILLIE Aubrey, SLATER Sean
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(3), 2014, pp.165-173.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual disabilities (ID) and describes the practical lessons learned about how to maximise the effectiveness of DBT with this client group. Design/methodology/approach: A brief overview of DBT is provided and reference is made to literature which highlights the potential benefits of providing a DBT service to clients with an ID. This is followed by a discussion of the clinical presentation of the clients receiving DBT in the service that is the focus of this case study. Using a reflexive approach, a detailed discussion follows of the challenges faced in implementing a community DBT service for the clients served. Findings: Solutions to a variety of challenges faced in four years of service delivery are described, key lessons learned are highlighted, together with issues meriting further research. Research limitations/implications: This case study and its implications are limited to community DBT services. Another limitation is that, although outcome data have been collected over the past two years, the dataset is not yet large enough to draw statistical conclusions. Practical implications: The paper describes adaptations to treatment structure and strategy which the authors believe are necessary to improve treatment outcomes in community DBT services for adults with ID. In particular, the practical experience suggests that a didactic approach to teaching DBT skills is not effective and should be replaced by the “community of learners” approach that involves the trainer contingently responding to client input. Pre-set lesson plans inhibit the trainers’ ability to respond contingently. Originality/value: The existing literature on providing a DBT service for people with an ID has principally focused on providing a rationale for providing this type of intervention, and on assessing outcomes. Given that this is still a relatively new type of provision for this client group, a detailed examination of process issues is called for. (Publisher abstract)
Life Skills Group: increasing foundation knowledge and motivation in offenders with a learning disability
- Authors:
- PATTERSON Christy, THOMAS Cathy
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 5(1), 2014, pp.4-13.
- Publisher:
- Emerald
Purpose: Offenders with a learning disability present with greater clinical need than those without a learning disability. However, for this client group, access to and engagement with psychological and criminogenic interventions are often limited. The purpose of this paper is to discuss a potentially useful approach to this issue. Design/methodology/approach: A single case study design was used to evaluate an introductory group programme, delivered over 12 weekly sessions, in a forensic learning disability service. Semi-structured interviews were used alongside psychometric measures, which were completed prior to, and following completion of, the group, in order to assess the individual's experience of the group, their emotional understanding and difficulties, and readiness to change. Findings: Readiness to change and emotional understanding improved following completion of the programme. Self-reported emotional difficulties showed improvement, although not all staff reports corroborated this. Notably, the service user reported a positive experience, with increased confidence and motivation to attend further groups. Research limitations/implications: Generalisation from the results of single case studies is limited. Although results suggest that motivation to engage further has increased, more research is required to assess whether this impacts on actual ability to engage. Practical implications: Offering an introductory programme prior to further, more criminogenically focused intervention may be more effective than offering these interventions as the first stage of treatment. Originality/value: An introductory group programme may be potentially helpful in providing the foundation knowledge, confidence and motivation necessary to attend further intervention focusing on criminogenic need for offenders with a learning disability. (Publisher abstract)
A therapeutic community for personality disorder in a high secure intellectual disability service: inception and early experiences
- Authors:
- TAYLOR Jon, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 6(4), 2012, pp.165-170.
- Publisher:
- Emerald
This article explains the reasons for use of a therapeutic community for personality disorder in a high secure intellectual disability service. While no findings are reported, it describes the rationale for, and early experiences of, a therapeutic community intervention for people with mild intellectual disability and personality disorder in a high secure setting. The article describes the allocation of staff and patients to the services, and details staff support and training that has been provided. The article concludes by noting that the ‘whole day’ treatment approach of a therapeutic community enabled the interpersonal style of the offenders with a personality disorder to be explored in depth. The peer pressure and feedback that is a feature of therapeutic communities is an effective intervention for offenders with mild learning disabilities.
Working with people with a learning disability who break the law
- Author:
- LOFTHOUSE Rachael
- Journal article citation:
- Llais, 101, Winter 2011, pp.7-9.
- Publisher:
- Learning Disability Wales
The author briefly highlights research examining why people with a learning disability offend and how best to work with people to manage offending behaviour. She also describes some of her own PhD research which looked at the reasons why people with learning disabilities sometimes behave violently.
Effectiveness of group cognitive-behavioural treatment for men with intellectual disabilities at risk of sexual offending
- Authors:
- MURPHY Glynis H., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 23(6), November 2010, pp.537-551.
- Publisher:
- Wiley
This paper presents results from a study providing treatment for men with intellectual disabilities who had shown signs of sexually abusive behaviours. It also evaluated the effects of such treatment in terms of the men’s knowledge, attitudes, beliefs and re-offending rates. Forty-six men participated. Results showed that 83% had engaged in more than one incident of sexually abusive behaviour but only 57% of the men who came for treatment were required by law to attend. Ninety two percent of the men who began treatment completed treatment 1 year later, indicating considerable motivation amongst the men to get treatment for their difficulties. The men showed statistically significant increases in sexual knowledge and victim empathy, as well as reductions in cognitive distortions. Few men showed further sexually abusive behaviour during the 1-year period when they were attending treatment or during the 6-month follow-up period. Only the presence of autistic spectrum disorders seemed related to re-offending. This trial provided some evidence of the effectiveness of such treatment for men with intellectual disabilities. However, there remains a need for a randomised controlled trial.
Health service inpatient units for people with intellectual disabilities and challenging behaviour or mental health problems
- Authors:
- MANSELL Jim, RITCHIE Fiona, DYER Ricinda
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 23(6), November 2010, pp.552-559.
- Publisher:
- Wiley
This paper presents findings from a survey was carried out of NHS and independent sector (IH) health settings providing specialist inpatient services for people with intellectual disabilities. Data were collected on setting and patient characteristics, staffing and management and care processes and outcomes. Results revealed that services were very unevenly distributed across England. There were differences between NHS and IH settings. IH assessment and treatment units were bigger, had higher occupancy and lower staff ratio. In all three types of unit, IH units had fewer visits to patients, used more seclusion, physical restraint and had more locked areas. They had more complaints in more services from users and from relatives. In low secure units, they had more adult protection referrals. The authors concluded that the number of people who have finished treatment emphasises the importance of developing housing in the community with sufficiently skilled support. The number of patients in low secure services raises the question whether this type of service is recreating the intellectual disability institutions which government policy intends to close.
National service framework for children, young people and maternity services: continence issues for a child with learning difficulties
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2010
- Pagination:
- 23p.
- Place of publication:
- London
This practice guidance describes a care pathway and the considerations which apply at each stage in supporting a child with continence issues relating to a learning difficulty. A exemplar case of a child called Robert, who has learning disabilities and continence problems is used to describe the journal through NHS treatment. For each stage in the journey the relevant standards from the National Standards Framework theme are identified and additional evidence and/or document links provided. Key messages are also summarised. The material forms one of a series of example patient journeys that have been produced to support the National service framework for children, young people and maternity services. The primary audience is professionals from a broad range of backgrounds, including: education, social services and the voluntary sector. It will also be of interest to parents, children and young people.