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Article
Publication date: 3 December 2021

Elanor Lucy Webb, Deborah Morris, Abbey Hamer and Jessica Davies

Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools…

Abstract

Purpose

Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting.

Design/methodology/approach

Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk.

Findings

Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed).

Research limitations/implications

The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship.

Originality/value

To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 13 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 8 January 2021

Deborah J. Morris, Elanor L. Webb, Inga Stewart, Jordan Galsworthy and Paul Wallang

A co-produced clinical practice that aims to improve outcomes through a partnership with service users is becoming increasingly important in intellectual disability (ID) services…

Abstract

Purpose

A co-produced clinical practice that aims to improve outcomes through a partnership with service users is becoming increasingly important in intellectual disability (ID) services, yet these approaches are under-evaluated in forensic settings. This study aims to explore and compare the feasibility of two approaches to co-production in the completion of dynamic risk assessments and management plans in a secure setting.

Design/methodology/approach

A convenience sample of adults admitted to a secure specialist forensic ID service (N = 54) completed the short dynamic risk scale (SDRS) and drafted risk management plans under one of two conditions. In the first condition, participants rated the SDRS and risk management plan first, separately from the multidisciplinary team (MDT). In the second condition, participants and MDTs rated the SDRS and risk management plan together.

Findings

In total, 35 (65%) participants rated their risk assessments and 25 (47%) completed their risk management plans. Participants who rated their risk assessments separately from the MDT were significantly more likely to complete the SDRS (p = 0.025) and draft their risk management plans (p = 0.003). When rated separately, MDT scorers recorded significantly higher total SDRS scores compared to participants (p = 0.009). A series of Mann-Whitney U tests revealed significant differences between MDT and participant ratings on questions that required greater skills in abstraction and social reasoning, as well as sexual behaviour and self-harm.

Originality/value

Detained participants with an ID will engage in their dynamic risk assessment and management plan processes. The study demonstrates the impact of different co-production methodologies on engagement and highlights areas for future research pertaining to co-production.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 12 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 26 April 2024

Elanor Lucy Webb, Deborah J. Morris, Benedetta Lupattelli Gencarelli and Jemima Worsfold

Research has established the prevalence and relevance of moral injury in healthcare workers, though less attention has been paid to the different classes of potentially morally…

Abstract

Purpose

Research has established the prevalence and relevance of moral injury in healthcare workers, though less attention has been paid to the different classes of potentially morally injurious events (PMIEs) experienced by this population and their impact. This exploratory study sought to examine the frequency of self- and other-generated PMIE classes and their associations with demographic characteristics and well-being outcomes among mental healthcare staff.

Design/methodology/approach

Secondary analysis of data drawn from two cross-sectional surveys of 267 frontline and leadership staff from mental healthcare settings in the UK was conducted. Responses on the Moral Injury Events Scale and the Short Professional Quality of Life Scale were extracted for analysis.

Findings

Betrayal by others was most frequently endorsed (61.8%), whilst self-transgressions were least frequently reported (25.5%). After controlling for the number of PMIE classes experienced, betrayal significantly predicted secondary traumatic stress (p = 0.01) and burnout (p = 0.04). Additionally, other transgressions significantly predicted secondary traumatic stress (p = 0.008). The predictive effects of self-transgressions on burnout, secondary traumatic stress and compassion satisfaction were all nonsignificant after controlling for the number of PMIE classes experienced.

Practical implications

Findings highlight differences in the frequency and impact of self and other PMIEs experienced by healthcare professionals. Reducing cumulative exposure to differential PMIE classes appears to be of critical importance to improving occupational well-being in this group.

Originality/value

To our knowledge, this study is the first to explore the associations between PMIE classes and occupational well-being in a mental healthcare population, inclusive of frontline and leadership staff.

Details

International Journal of Workplace Health Management, vol. 17 no. 2
Type: Research Article
ISSN: 1753-8351

Keywords

Article
Publication date: 18 December 2019

Deborah J. Morris, Shubhinder Shergill and Elizabeth Beber

People with an intellectual disability (ID) are more at risk of experiencing adverse childhood events. Moreover, prolonged exposure to ACEs results in enduring changes and…

Abstract

Purpose

People with an intellectual disability (ID) are more at risk of experiencing adverse childhood events. Moreover, prolonged exposure to ACEs results in enduring changes and impairments in neurological, physiological and psycho-social systems and functioning. In response, van der Kolk et al. (2009) have put forward the concept of developmental trauma disorder (DTD) to reflect the “constellation of enduring symptoms” and complex care needs of this population. The purpose of this paper is to ascertain the level of exposure to adverse childhood events and the prevalence of DTD in an inpatient forensic ID population.

Design/methodology/approach

A retrospective file review and consensus approach to diagnosis were used in a sample of adults with an ID detained in a secure forensic service.

Findings

Results revealed that 89 admissions (N=123) had been exposed to at least one significant ACE, with 81 being exposed to prolonged ACEs. A total of 58 admissions (47 per cent) met criteria for PTSD and 80 (65 per cent) met the criteria for DTD. Significant gender differences were noted in MHA status, primary psychiatric diagnoses, exposure to ACEs and DTD.

Research limitations/implications

The discussion explores the implications for working with forensic ID populations who report high incidents of childhood trauma and the utility, strengths and weaknesses of the proposed DTD, its relationship to ID diagnoses is explored.

Originality/value

The study outlines the prevalence of DTD and PTSD in ID forensic populations and suggests additional key assessment and treatment needs for this population.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 11 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 4 August 2021

Deborah J. Morris, Elanor Lucy Webb, Lowri Foster-Davies, Paul M. Wallang, David Gibbs, Peter D. McAllister and Farshad Shaddel

Ethical concerns about the use of the Mental Health Act (MHA) have led to calls for developmental disorders to be removed from the list of mental disorders for which individuals…

Abstract

Purpose

Ethical concerns about the use of the Mental Health Act (MHA) have led to calls for developmental disorders to be removed from the list of mental disorders for which individuals can be detained. In parallel, there are long-standing concerns of ethnic disparity in the application of the MHA. Nonetheless, the impact of the intersections of developmental disorder diagnosis, adolescence and ethnicity on the application of the MHA is unknown. This study aims to explore ethnic differences in MHA sections and the factors accounting for this, in an adolescent inpatient developmental disorder service.

Design/methodology/approach

File reviews were conducted to explore differences in MHA status, as well as demographic, clinical and risk factors that may account for this, between 39 white British and ethnic minority adolescents detained to a specialist inpatient developmental disorder service.

Findings

Consistent with adult literature, adolescents of an ethnic minority were overrepresented in the sample and were significantly more likely to be detained on Part III or “forensic” sections of the MHA than White British counterparts, with five times greater risk. Analyses revealed no significant differences between ethnic minority and white British participants on demographic variables, clinical needs, risk behaviours, risk measures nor application of restrictive practices and safeguarding procedures.

Practical implications

National audits exploring patterns of detention under the MHA across adolescent developmental disorder populations need to include analysis of intersections to ensure that the MHA is used as a means of last resort and in an equitable manner.

Originality/value

To the best of the authors’ knowledge, this paper is the first comprehensive exploration of the impact of ethnicity on detention patterns in ethnic minority and White British populations.

Details

The Journal of Forensic Practice, vol. 23 no. 3
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 28 November 2020

Deborah J. Morris, Elanor Lucy Webb, Emma Parmar, Grace Trundle and Anne McLean

People with developmental disorders are significantly more likely to experience adverse childhood experiences (ACEs), although the impact of ACEs on this population is not well…

Abstract

Purpose

People with developmental disorders are significantly more likely to experience adverse childhood experiences (ACEs), although the impact of ACEs on this population is not well understood. Furthermore, considerably less is known about the exposure to, and impact of, ACEs in detained adolescents with complex developmental disorder needs. This paper aims to explore the exposure to ACEs in an adolescent population detained in a secure specialist developmental disorder service.

Design/methodology/approach

A retrospective file review was used to explore ACEs and placement histories within a specialist developmental disorder inpatient service. Data was collated for a convenience sample of 36 adolescents, 9 of whom were female, aged 13–20 years (M = 17.28 years).

Findings

A total of 33 participants (91.7%) had experienced at least 1 ACE, with 58% experiencing 4 or more ACEs and 36% experiencing 6 or more ACEs. The most common ACEs reported were physical abuse (61.6%), parental separation (58.3%) and emotional abuse (55.6%). The majority of participants had also experienced high levels of disruption prior to admission, with an average of four placement breakdowns (range 1–13, standard deviation = 3.1). ACEs held a significant positive association with the total number of placement breakdowns and total number of mental health diagnoses.

Practical implications

Adolescents detained in specialist developmental disorder secure care had, at the point of admission, experienced high levels of adversities and had been exposed to high levels of experienced and observed abuse. The level of exposure to adversity and ongoing disruptions in care suggests that Child and Adolescent Mental Health Services’ developmental secure services should consider adopting dual treatment frameworks of developmental disorder and trauma-informed care.

Originality/value

This study explored the early-life and placement experiences of a marginalised and understudied population.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 14 no. 6
Type: Research Article
ISSN: 2044-1282

Keywords

Content available
Article
Publication date: 21 September 2021

Deborah Morris

495

Abstract

Details

Advances in Mental Health and Intellectual Disabilities, vol. 15 no. 5
Type: Research Article
ISSN: 2044-1282

Article
Publication date: 24 April 2024

Elanor Webb, Benedetta Lupattelli Gencarelli, Grace Keaveney and Deborah Morris

The prevalence of exposure to adversity is elevated in autistic populations, compared to neurotypical peers. Despite this, the frequency and nature of early adverse experiences…

Abstract

Purpose

The prevalence of exposure to adversity is elevated in autistic populations, compared to neurotypical peers. Despite this, the frequency and nature of early adverse experiences are not well understood in autistic adults, with several underlying methodological limitations in the available literature. The purpose of this study is to systematically synthesise and analyse the prevalence of childhood adversity in this marginalised population, in accordance with the adverse childhood experiences (ACEs) framework.

Design/methodology/approach

Peer-reviewed empirical research articles were systematically searched for from electronic databases and screened against established inclusion criteria. Pooled prevalence rates for individual ACE types were calculated.

Findings

Four papers were included (N = 732), all of which used a predominantly or exclusively female sample. Only sexual abuse was reported in all papers, with a pooled prevalence rate of 38%. Physical abuse and emotional abuse were less frequently explored, with two papers reporting on these ACEs, though obtained comparable and higher pooled prevalence rates (39% and 49%, respectively). Pooled prevalence rates could be calculated for neither neglect nor “household” ACEs because of insufficient data. The limited state of the evidence, in conjunction with high levels of heterogeneity and poor sample representativeness found, positions the ACEs of autistic adults as a critical research priority.

Originality/value

To the best of the authors’ knowledge, this study is the first to systematically synthesise the prevalence of early childhood adversities, as conceptualised in accordance with the ACEs framework, in adults with autistic traits.

Details

Advances in Autism, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 26 November 2019

Deborah Morris, Claudia Camden-Smith and Robert Batten

Intimate partner violence (IPV) is a complex public health and social issue. Women with an intellectual disability (ID) are at greater risk of experiencing IPV. However, little is…

Abstract

Purpose

Intimate partner violence (IPV) is a complex public health and social issue. Women with an intellectual disability (ID) are at greater risk of experiencing IPV. However, little is known about the IPV experiences of women with an ID and forensic care needs. The purpose of this paper is to explore the history of experienced and perpetrated IPV in women detained to secure specialist ID forensic service.

Design/methodology/approach

Participants completed the Conflict Tactics Scale-2 (CTS-2, Straus et al., 1996). The CTS-2 measures experienced and perpetrated relationship tactics of common forms of IPV.

Findings

Participants reported high levels of experiencing and perpetrating IPV across all relationship tactics measured by the CTS-2. Participants reported they engaged in similar levels of experiencing and perpetrating positive and negative relationship tactics. The only significant difference was “minor sexual coercive behavior” where participants were significantly more likely to experience than perpetrate this behaviour.

Research limitations/implications

Further research exploring the risk factors that contribute to IPV is needed. Shortcomings in the current study are acknowledged.

Practical implications

Women with an ID and forensic profiles may present with treatment needs as victims and perpetrators of IPV. Clinical activities of women in Forensic ID services should include possible IPV care needs. The importance of developing national guidance and interventions to prevent and manage IPV are discussed.

Originality/value

This is the first paper, to the authors’ knowledge, to explore experiences of IPV in women with an ID and forensic care needs.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 14 no. 1
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 9 March 2015

Deborah Morris and Nathalie Gray

The purpose of this paper is to describe the evaluation of the “Living with a Personality Disorder” group (Morris, 2011a). This intervention is a psycho-education group for women…

Abstract

Purpose

The purpose of this paper is to describe the evaluation of the “Living with a Personality Disorder” group (Morris, 2011a). This intervention is a psycho-education group for women with an intellectual disability (ID) and a personality disorder (PD). It draws on psycho-education, biosocial theory (Linehan, 1993) and compassionate mind approaches (Gilbert, 2009). It aims to increase knowledge of personality, PDs, to increase awareness of the “non-disordered” parts of self and to increase knowledge of psychological treatments for PD’s.

Design/methodology/approach

The intervention was delivered to women detained in a specialist women’s learning disability forensic service. It was delivered over 12 group and two individual sessions. The Knowledge of Personality Disorders Questionnaire (D’Silva and Duggan, 2002), the Self-Compassion Scale (Neff, 2003), the University of Rhode Island Change Assessment scale (McConnaughy et al., 1983) and a series of Likert scale questions and statements were used to assess the utility of the intervention. The intervention was piloted between 2012 and 2014 in a series of small groups. The lead facilitator for each intervention was a registered psychologist with training in dialectical behaviour therapy.

Findings

Completing the intervention resulted in an increase in knowledge of PDs, treatments, increased self-compassion and therapeutic optimism and awareness of the limitations of a PD diagnosis.

Originality/value

A new intervention that may increase knowledge of PDs, of personal strengths and increase optimism about change that may be a useful component to the treatment for service users with PDs and an ID.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 6 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

1 – 10 of 231