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The Psychopathy Checklist‐Revised is used in forensic and clinical settings to give an indication of the level of psychopathy an individual presents. The use of the PCL‐R with offenders with a learning disability (LD) is understudied. The current study aims to replicate a study by Morrissey (2003) which focused on the problems arising from assessing an LD service sample from Rampton Hospital. The results may suggest that the PCL‐R may be used reliably with offenders with low intellectual functioning.

Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. The model has successfully been used to address violence and aggression in a forensic setting (Evershed et al, 2003). The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning/intellectual disabilities in 2004, and the programme has been developed over a period of six years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain.

The study explored the relationship between self and informant reports of emotional problems in a forensic intellectual disability sample. The Emotional Problems Scales (EPS) (Prout & Strohmer, 1991), which comprises a Self Report Inventory (EPS‐SRI) and an informant Behaviour Rating Scale (EPS‐BRS), was routinely administered to 30 individuals with intellectual disability in a secure forensic setting, as part of a standard clinical assessment procedure. It was hypothesised that there would be a moderate relationship between corresponding scores on the EPS‐SRI and EPS‐BRS. However, there were no significant relationships between corresponding scales of the EPS‐SRI and EPS‐BRS, apart from the EPS‐SRI and EPS‐BRS scales measuring anxiety (r = .376, p<.05). The results continued to be non‐significant, even when positive impression management was controlled for. The findings suggest little relationship between self and informant ratings in a forensic intellectual disability sample, and therefore support the need to gather information from multiple sources when assessing such individuals.

Literature on trauma and post‐traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those in forensic settings. The National Centre for High Secure Learning Disability Services at Rampton Hospital conducted a service evaluation on aspects of trauma experience and post‐trauma symptoms in the current population. File information and self‐reports indicated that most individuals had experienced a great deal of lifetime trauma, typically multiple types of abuse. A high rate of potentially trauma‐related symptoms was noted in files. However, file records of potentially traumatic events, including abuse, were often lacking in detail. There was limited information about the events themselves, and there was no information to suggest that any trauma‐specific assessments had been used to measure trauma exposure or symptoms. PTSD as a diagnosis was rarely considered, and there was little consideration of trauma‐specific interventions. While some individuals said that their experiences had resulted in a lot of distress, others could not talk about the past at all. This paper discusses the problem of assessing past trauma and response in a forensic intellectual disability population, and future directions for practice in forensic services. The service under study plans to address the needs of patients who have experienced trauma and abuse by conducting routine structured assessments, offering adapted evidence‐based psychological interventions where appropriate, and providing trauma‐specific education for staff to promote a compassionate approach.

The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with intellectual disability (ID), and to describe a specific treatment model.

The paper provides a narrative review of approaches to treatment for offenders with personality disorder and draws on the available research for the treatment of personality disordered offenders without ID as well as the treatment of offenders with ID.

The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is summarized. A treatment model, which integrates adapted cognitive behavioural programmes with a social milieu approach, is then described. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.

Services being developed for people with both intellectual disability and personality disorder should take account of the literature on treatment of mainstream personality disorder when developing treatment models.

There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This descriptive paper will be of interest to clinicians working with such populations.

The “outcomes revolution” in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for this population, and to explore some of the challenges of conducting such research. It further describes some illustrative routine outcome data from the National High Secure Learning Disability Service.

Routinely collected outcome measures (length of stay; violent incidents; Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013.

The median length of stay of those discharged during the study period (n=27) was around 9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual return to high security. There did not appear to be a treatment effect over two to three years using staff-rated global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced significantly over a longer period of four years in treatment.

There are identified challenges to research design and outcome measurement which need to be addressed in any future cross-service studies.

There are relatively few published outcome studies from forensic ID services. None of the studies have used clinical measures of changes or patient-rated outcome measures.

Although the PCL‐R is used widely for assessing forensic populations in general, there has been no published research on the reliability and validity of such assessments with offenders with a learning disability. The problems with applying the PCL‐R with this population are discussed. The results of a pilot study analysing data collected for clinical purposes on a high‐security hospital LD admission ward are described, and recommendations for further development and research are made.

Therapeutic Community (TC) approaches have not been applied to individuals with intellectual disability. This paper aims to present preliminary evaluation of a planned TC service intervention in a secure setting for men with mild intellectual disabilities and personality disorder over a period of 12 months.

The TC intervention group (n=11) was compared on repeated measures of violent incidents, seclusion hours, and informant and self‐report clinical outcome measures collected six months prior to, six and 12 months post the start of the intervention. The TC group was also compared with a pragmatic control group (n=10) receiving treatment as usual (TAU).

Clinical changes in the predicted direction were evident, with the TC group showing comparatively less pathology both over time and in relation to the comparison group. However, change was more likely for clinical scales measuring internalising problems, than for externalising problems. The mean number of violent incidents did not reduce over time. There was nevertheless a strong trend towards reduction in seclusion hours in the TC treatment group over time, with significant differences between groups also being observed at the six and 12 months stage.

The sample size is small. The literature suggests a minimum of 18 months in TC treatment, so this is an interim evaluation. The planned evaluation period is two years, although attrition may affect the numbers of participants in the study after this period.

TC treatment is consistent with the core principles of involvement and choice. The findings of this preliminary service evaluation are promising in terms of the TC approach being a potential mode of treatment suitable for a proportion of patients with learning disability in secure conditions.

TC approaches are innovative in forensic learning disability. No previous evaluations of TC based interventions have been published in this field, and this paper contributes to an evidence base.

The purpose of this paper is to describe the profile of community members admitted to the first high secure Therapeutic Community (TC) for males with learning disability and personality disorder.

This paper presents descriptive data.

The characteristics of the men admitted to a TC in the National High Secure Learning Disability Service are likely to present considerable challenges to the development and delivery of the service.

There is very little literature describing interventions for offenders with learning disability and personality disorder. This paper is one of a series that will describe the effectiveness of a TC for men with such difficulties.

The purpose of this paper is to provide a routine evaluation of clinical effectiveness of an adapted DBT informed skills programme (“I Can Feel Good”; Ingamells and Morrissey, 2014), run on both male and female intellectual disability wards of a medium security psychiatric hospital.

A pre–post evaluation study of routine clinical practice was undertaken utilising staff report scales collected as the primary source of evaluation.

Findings show a positive shift regarding each module for both gender groups. Due to observed baseline differences between gender groups, data were separated and analysed separately. Non-parametric statistical analysis demonstrates statistically significant improvement across three modules for the male sample (managing feelings, coping in crisis and people skills) and two modules for the female sample (managing feelings and people skills).

There appears to be subtle outcome differences regarding this programme for both gender groups across modules. Potential reasons for this are discussed, along with clinical reflections regarding gender differences and adaptations. Reflections upon future revisions including the integration of the new DBT skills (Linehan, 2014) are made in light of these findings.