Search results

1 – 10 of 976
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…

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: 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…

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

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: 1 June 2008

Ernest Gralton, Angela Muchatuta, Jaume Morey‐Canellas and Coro Lopez

Recent research including advances in neuro‐imaging indicates a profound effect on brain development as a result of exposure to abuse and neglect in childhood. This new…

Abstract

Recent research including advances in neuro‐imaging indicates a profound effect on brain development as a result of exposure to abuse and neglect in childhood. This new area is called developmental traumatology. Areas of the brain that may particularly be affected are important in arousal control and executive function. Many adolescents presenting to forensic services have histories of neglect and abuse and deficits in key brain developmental functions. The management and treatment options for young people with developmental trauma and forensic needs are explored.

Details

The British Journal of Forensic Practice, vol. 10 no. 2
Type: Research Article
ISSN: 1463-6646

Keywords

Content available
Article
Publication date: 21 September 2021

Deborah Morris

331

Abstract

Details

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

Article
Publication date: 11 December 2020

Beverly Love, Arlene Vetere and Paul Davis

Psychological developmental informed theories imply that addiction is not exclusively due to the addictive properties of the substance but that early psycho-social…

Abstract

Purpose

Psychological developmental informed theories imply that addiction is not exclusively due to the addictive properties of the substance but that early psycho-social experiences are influential on later life. The purpose of this paper is to understand substance dependency, relapse and recovery amongst community-based substance using offenders in relation to their childhoods, relationships and significant life events, from their perspective. A key aim was to help better inform policy and practice.

Design/methodology/approach

A qualitative study (interpretative phenomenological analysis) was used to understand the impact of childhood, relationships and significant life events amongst (N = 17) adult ex/offenders with substance use dependency problems, (who were part of the UK Government rehabilitation programme), to understand their substance use and recovery from their own perspectives.

Findings

Four main superordinate themes were developed illustrating participants extremely adverse childhoods. Substance use was a means to cope with current and past trauma and crises and to help manage the emotions and mental health which could accompany these difficulties. Managing recovery was about learning to manage life itself, including emotions, mental health problems, trauma/responses, relationships and everyday life.

Originality/value

This group is under researched where qualitative methods have been used. The study focussed on early-psycho-social experiences and relationships and the influence of these throughout the life cycle, in relation to their substance use. The study was informed by theories often used in therapeutic settings but rarely in research, (Orford, 2008; Khantzian, 2012; Flores, 2012, Van Der Kolk, 2014).

Details

Drugs and Alcohol Today, vol. 20 no. 4
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 4 February 2020

Jurai Darongkamas, David Dobel-Ober, Beth Moody, Rachel Wakelin and Somia Saddique

Improvement is sorely needed to the National Health Service (NHS) care for people with trauma induced emotional regulation and interpersonal relational difficulties…

Abstract

Purpose

Improvement is sorely needed to the National Health Service (NHS) care for people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI), currently labelled as a variant of personality disorder [PD; borderline personalty disorder/emotionally unstable personality disorder (BPD/EUPD)]. This study aims to improve staff training.

Design/methodology/approach

A mixed-methods evaluation demonstrated the benefits of offering 495 staff three-day trainings with a clinician-designed, unique training package.

Findings

Statistically significant improvements were reported in both staff confidence and optimism when dealing with people with a diagnosis of PD (PWDPD) and scores on the Helping Alliance questionnaire. No statistically significant changes in social attitude resulted. Qualitative data shows negative descriptions generated by staff decreased post-training with an increase in positive and neutral descriptions. The responses generated six different themes: resources, client demand, medical model, emotional, human and positive rewards. Differing proportions were found pre and post-training.

Research limitations/implications

This was a clinical-world evaluation, not a formal research project. Different pairs/combinations of experienced clinicians (predominantly clinical psychologists) acted as trainers. Some minor variation occurred within the training package used and presentation.

Practical implications

Given the expense of staff time and resources, this evaluation shows the resultant positive changes achieved. TIERI staff about the difficulties experienced by PWDPD and how to negotiate the relational dynamic is essential. Training helps improve staff perception of the people involved, improves staff confidence and promotes better therapeutic alliances (key to providing the relational and trauma work needed). Ongoing supervision is likely needed post-training.

Originality/value

Positive changes resulted from a mixed-methods evaluation of three-day trainings by using a specially designed training package.

Details

The Journal of Mental Health Training, Education and Practice, vol. 15 no. 2
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 14 November 2016

Asad Ul Lah and Jacqui Saradjian

Schema therapy has gone through various adaptations, including the identification of various schema modes. The purpose of this paper is to suggest that there may be a…

Abstract

Purpose

Schema therapy has gone through various adaptations, including the identification of various schema modes. The purpose of this paper is to suggest that there may be a further dissociative mode, the “frozen child” mode, which is active for some patients, particularly those that have experienced extreme childhood trauma.

Design/methodology/approach

The paper is participant observer case study which is based on the personal reflections of a forensic patient who completed a treatment programme which includes schema therapy.

Findings

The proposed mode, “frozen child”, is supported by theoretical indicators in the literature. It is proposed that patients develop this mode as a protective strategy and that unless recognised and worked with, can prevent successful completion of therapy.

Research limitations/implications

Based on a single case study, this concept is presented as a hypothesis that requires validation as the use of the case study makes generalisation difficult.

Practical implications

It is suggested that if validated, this may be one of the blocks therapists have previously encountered that has led to the view that people with severe personality disorder are “untreatable”. Suggestions are made as to how patients with this mode, if validated, can be treated with recommendations as to the most appropriate processes to potentiate such therapy.

Originality/value

The suggestion of this potential “new schema mode” is based on service user initiative, arising from a collaborative enterprise between service user and clinician, as recommended in recent government policies.

Article
Publication date: 18 December 2017

Ian Barron and David Mitchell

The purpose of this paper is to assess unit manager perspectives on the introduction of a group-based trauma-specific programme delivered across Scotland’s secure estate…

Abstract

Purpose

The purpose of this paper is to assess unit manager perspectives on the introduction of a group-based trauma-specific programme delivered across Scotland’s secure estate. As this was the first time such an estate-wide initiative had occurred, it was important to identify the benefits/challenges at a strategic level.

Design/methodology/approach

An exploratory qualitative case study was utilised involving semi-structured interviews with five senior unit managers in three secure units to discover their perceptions of the benefits and challenges of implementing Teaching Recovery Techniques (TRT). A quasi-qualitative analysis was used to quantify and give meaning to manager responses. Inter-rater reliability of analysis was assessed.

Findings

Unit managers perceived gains in trauma-informed knowledge for themselves, and knowledge and skills gains for programme workers, care staff and adolescents. Challenges involved: managing a shift in paradigm to include a trauma-specific programme; the limiting context of competitive tendering; short duration placements; and the need for psychoeducation for staff, parents and agencies.

Research limitations/implications

Large sample sizes are likely to identify further issues for unit managers. Manager perceptions need directly compared with staff and adolescent perceptions and included in randomised control trials of trauma-specific programmes.

Practical implications

Managers perceived that TRT needed to be delivered within trauma-informed organisations and identified the need for manager training in traumatisation, trauma recovery and organisational implications to guide strategic planning. Managers emphasised the need for psychoeducation for families, staff and agencies.

Originality/value

The current study is the first in Scotland to explore unit manager experience of introducing a trauma-specific programme across the secure estate.

Details

Journal of Children's Services, vol. 12 no. 4
Type: Research Article
ISSN: 1746-6660

Keywords

Article
Publication date: 16 March 2012

Suzanna Rose, Chris Freeman and Simon Proudlock

Despite evidence that exposure to traumatic events can be an important antecedent to a range of serious and chronic mental health problems – it appears that within the…

951

Abstract

Purpose

Despite evidence that exposure to traumatic events can be an important antecedent to a range of serious and chronic mental health problems – it appears that within the British National Health Service at least, this is still not fully understood nor acted upon. This paper aims to examine this evidence and asks why these findings have not been fully implemented in terms of updating practice.

Design/methodology/approach

A literature search was undertaken alongside relevant British DH policy. This resulted in a subsequent policy analysis.

Findings

Although there have recently been changes in recommendation in clinical practice (e.g. CPA guidance) and policy (No Health without Mental Health) it appears that although some knowledge in this area has been changed into policy, its implementation remains “patchy”.

Practical implications

This short paper outlines some of the evidence, examines current issues and highlights a possible pathway which might be of value in addressing this.

Originality/value

This short paper highlights traumatic exposure as an important antecedent to a range of mental health issues and highlights ways in which this may be assessed and, where relevant, addressed.

Details

Journal of Public Mental Health, vol. 11 no. 1
Type: Research Article
ISSN: 1746-5729

Keywords

1 – 10 of 976