Dale, C. (2011), "Editorial", Journal of Learning Disabilities and Offending Behaviour, Vol. 2 No. 4. https://doi.org/10.1108/jldob.2011.55402daa.001
Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Editorial From: Journal of Learning Disabilities and Offending Behaviour, Volume 2, Issue 4
As the changes to healthcare policy become clearer then some of the implications for services emerge. At the beginning of December 2011 the Department of Health announced a map of services for Any Qualified Provider. When a service is opened up to choice of “any qualified provider”, patients can choose from a range of providers who meet NHS standards and price. Patients are expected to choose a provider based on quality and individual preferences and money will follow patients’ choices. Providers only need to be registered with the Care Quality Commission (CQC) where they are carrying out a service that is already regulated. If a provider does not need CQC registration, they will need to meet other assurance requirements. Commissioners will own the service specification and will confirm if the provider can deliver that specification. The commissioner holds the contract with a qualified provider – this means that the commissioner has a key role to play in the qualification of providers.
An online interactive map was published on 7 December 2011 outlining what services are going to be opened up to any qualified provider from April 2012. It will allow patients, commissioners and providers to see the local health services where there will be a choice of provider for patients. As well as a range of physical healthcare contracts psychological therapies are listed frequently as being offered to any qualified provider.
New guidance for commissioners and providers of social care has also been published in December 2011 based on the Health Inequalities and People with Learning Disabilities in the UK: 2011 report. This evidence into practice report sets out the determinants of health inequalities, and asks what they mean for social care including social care commissioners, care managers/social workers, providers and support workers. The social determinants of poorer health are seen as:
Increased risk of health problems associated with specific genetic and biological causes of learning disabilities (LD).
Communication and understanding of health issues.
Personal health risks and behaviours.
Access to and the quality of health care and other services.
Taking these two initiatives together suggests a challenging time for commissioners in a new and changing landscape of services and providers. Both initiatives hold the potential to drive up service quality but in less experienced hands could have a detrimental effect.
This edition of the journal covers research and practice across the full spectrum of secure services including an international insight into a group therapy programme in New Zealand.
Stepping Stones is the title of a group therapy programme for the treatment of emotion regulation difficulties in offenders with an intellectual disability. Paul Oxnam and Emma Gardner (Senior Clinical Psychologists at the Central Region Forensic Mental Health, Rehabilitation & Intellectual Disability Service in Wellington, New Zealand) describe how the idea of establishing an emotion regulation programme at RIDSS was first discussed in 2007. At that time there was significant volatility on the medium-secure unit. Most clients required physical de-escalation during times of distress and only a small number were able to engage in individual psychological therapy.
The clients involved in the programme experienced emotion regulation difficulties that typically manifested as challenging behaviours, such as interpersonal violence, self-harm and property destruction. This article describes the work and outcomes of the project.
Rebecca Fish and Helen Reid describe the accounts of two staff groups working with self-harm. Both groups of staff interviewed in this study worked with people with mild LD who self-harm. The sample was taken from nurses working in both medium security and low security in the UK.
Although some allowances should be made because the two groups worked in different services, there were some interesting variations in the themes of the results. The two groups of staff based their discussions on five central themes: types of self-harm, perceived reasons for self-harm, staff personal responses, client treatment options, and staff support.
John Burns, Charlotte Aspinall and Chris Matthews provide “An evaluation of an alcohol awareness group (AAG) for learning disabled offenders in a secure setting”. The background to this study indicates that individuals with LD, who offend, are more likely to be dependent on alcohol than those who do not. There is strong evidence to suggest that interventions for alcohol problems can be effective.
The pre and post assessment scores from an AAG were collected from 34 service users, with a mental health problem and/or LD. The programme was manual led and included 12 sessions. The data collected were used to evaluate the programme.
The results from this study showed that client’s level of knowledge and self-efficacy increased after programme completion. Post group, those with a lower IQ, had gained a greater level of alcohol related knowledge, compared to those with a higher IQ. Clients with a LD alone scored slightly higher than those with a dual diagnosis.
This study concluded that the AAG has been successful in increasing motivation to change drinking behaviour, knowledge of problems related to alcohol and “Safe drinking” practice. These outcomes were achieved across a wide range of cognitive abilities suggesting that those with an IQ below 60 can also benefit from this type of intervention.
The article “Friend or fake? Make crimes and people with learning disabilities” describes the work of the Safety Net project. This project understands that a number of people with a LD are victims of Mate Crimes – where they are befriended but then exploited. Whilst for many this results in them becoming victims, sometimes it leads to the committing of criminal acts and coming into contact with the criminal justice system (CJS).
The Safety Net project has come across examples where, without the intervention of social care staff or advocacy, the people who were victims of “mate crime” would have found themselves charged and in the justice system.
The article on “Young people within the criminal justice system: making sense of fitness to plead and mental capacity in practice” identifies increasing research evidence highlighting the importance of recognising a person’s LD early in their journey through the CJS. This practice paper seeks to raise awareness of the importance of mental capacity and its alignment (or lack of) with the issue of fitness to plead. The Law Commissions recent consultation has highlighted the disparity of the Pritchard Test and the Mental Capacity Act 2005, and has considered several provisional proposals for consideration. The author describes how they regularly encounter young people on Court Orders who struggle to understand the criminal justice process. To highlight the significance of this a particular young person’s case is discussed.
Joy Duxbury, Frances Aiken and Colin Dale describe a recently completed research project looking at the role of restraint on deaths in custody. The authors describe how the practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The researchers undertook a review of the literature on the medical theories relating to restraint-related deaths and an analysis of deaths in custody in the UK for the time period 1 January 1999 to 1 January 2010. Findings showed that certain groups are particularly vulnerable to risks while being restrained. There are also bio physiological mechanisms which staff need to be aware of when restraining an aggressive or violent individual.
Department of Health (2011a), Map of services for Any Qualified Provider, Department of Health, London, December
Department of Health (2011b), Operational Guidance to the NHS: Extending Patient Choice of Provider, Department of Health, London, December