Search results

1 – 5 of 5
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: 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…

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: 16 June 2021

Elanor Lucy Webb, Annette Greenwood, Abbey Hamer and Vicky Sibley

Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services…

Abstract

Purpose

Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The provision of support is key in alleviating distress and improving work functioning. This paper aims to incite clarity on whether staff in DD services are more likely to access trauma support. The prevailing needs and outcomes for this population are also explored.

Design/methodology/approach

Data was extracted retrospectively from a database held by an internal trauma support service (TSS) for staff working in a secure psychiatric hospital. Overall, 278 permanent clinical staff accessed the TSS between 2018 and 2020, 102 (36.7%) of whom worked in an adult DD forensic inpatient service.

Findings

Staff working in DD services were over-represented in referrals to the TSS with a greater number of referrals per bed in DD services than in non-DD services (0.94 vs 0.33). DD staff were comparatively more likely to access support for non-physical, psychologically traumatic experiences. Psychological needs and outcomes following support were comparable between staff across services.

Practical implications

The findings highlight the more frequent need for trauma support of staff in forensic inpatient DD settings. Embedding a culture of safety and openness, and establishing appropriate and responsive models of staff support reflect key priorities for inpatient DD health-care providers, for the universal benefit of the organisation, workforce and service users.

Originality/value

This study offers novel insight into levels of access to support for staff working with people with DDs.

Details

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

Keywords

Article
Publication date: 2 February 2021

Alessandra Girardi, Elanor Lucy Webb and Ashimesh Roychowdhury

Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to…

Abstract

Purpose

Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to rate the likelihood of risk behaviours, including self-harm. As result of the assessment, interventions that are implemented to reduce the risk of self-harm may reduce the strength of the predictive validity of a risk assessment tool. The aim of this study was explore the impact of risk management interventions on the capacity of START to predict self-harm. It was predicted that the interventions would weaken the ability of START to predict self-harm in patients who received the intervention.

Design/methodology/approach

Secondary analysis of routinely collected data in a large sample of women in an inpatient secure care setting. Demographic and clinical information, self-harm episodes, safety management interventions and START assessments were extracted and used to build an anonymous database.

Findings

START significantly predicted self-harm in those with and without the safety management intervention. However, the strength of the predictive validity was smaller in those who received the intervention compared to those without.

Practical implications

The results suggest that the implementation of safety management interventions needs to be taken into account when assessing future risk of self-harm.

Originality/value

To the best of the authors’ knowledge, this is the first study to explore the impact of safety management interventions on the predictive validity of START in a large sample of women.

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

1 – 5 of 5