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This paper reports on the first eight years of a community‐based forensic team for people with learning disabilities. The authors give an overview of current research and government guidance regarding the prevalence, care pathway and treatment of people with learning disabilities who offend. The role and function of the community forensic team is described and an analysis of referrals to the service is given. The authors reflect on the frustrations as well as the achievements associated with providing this service.

This paper reports on the first three years of a community forensic team in Birmingham working with individuals with learning disabilities who have offended or are at risk of doing so. Using an interprofessional model, the team provided assessment, intervention and management, enabling individuals to live in the least restrictive environment. There were 113 referrals, the majority (94%) of whom were males. Only 26 had been convicted. The problems this raised for the team are discussed, along with the cost‐effectiveness, impact on admission rates and benefits of providing such a service. Two case scenarios are presented to highlight some of the issues encountered by the team. The paper supports the development of such services.

Traditionally, services for people with learning disabilities (LD) and forensic needs are underdeveloped. This paper aims to describe the setting up of a tiered model of LD forensic service provision in Leicester, Leicestershire and Rutland, facilitated and driven by a core team of professionals who have the skills and expertise in this area.

With no dedicated funding, this team is virtual in nature and provides support for the community and in‐patient teams in the assessment and management of offenders with LD. A care pathway including a process map is included to represent a visual idea of the referral, assessment, intervention and disposal strategies across the four tiers of service delivery. The service has a unique partnership arrangement with the independent sector that allows for staff training in order to deliver quality outcomes. The virtual team can support patients with learning disabilities and forensic needs in the community and in‐patient settings, both by avoiding unnecessary in‐patient admissions and by improving the treatment outcomes of those discharged from in‐patient settings.

Further research is required to demonstrate the clinical and social outcomes for offenders with LD using the tiered model of care and care‐pathway.

The virtual team and the LD forensic care pathway were developed because of a gap in service that was identified as part of a mapping exercise and stakeholder discussion. In the current economic climate, additional resources to address this gap in service may not be readily available; therefore, an innovative way of addressing this gap in service was by developing a care pathway for use by community LD teams based on lean principles and evidence‐based medicine and the pooling of specialist skills to develop the virtual team to enable and support the implementation of the care pathway.

Peer support workers (PSWs) are individuals with lived experience of mental health difficulties, who apply this to support and inspire others in their recovery. The role of PSWs is relatively new within the forensic health-care service. Although there has been little time for these roles to develop, PSWs have successfully integrated into community teams. Despite perceived benefits of having these workers within a multi-disciplinary team (MDT), the views held by mental health professionals in forensic services have not yet been studied. The purpose of this research is to develop an understanding of the experiences of staff working with PSWs in a community forensic team and the impact this has on them.

Structured, individual interviews were conducted with eight mental health professionals, from a variety of disciplines, used across two community teams within forensic services. The data was examined according to thematic analysis.

The data indicated general positive attitudes held by professionals surrounding the working with PSWs, including the themes “providing alternative perspectives”, “unique relationships” and “hope”. Yet, themes concerned around “role ambiguity”, “boundaries” and “the impact on PSWs” also arose.

This study provides insight into the attitudes held by members of an MDT of working with PSWs. Although seemingly positive, the lack of clarity around the role of the PSW is problematic.

To the best of the authors’ knowledge, this is the first study to explore the employment of PSWs in the context of UK forensic settings, highlighting the benefits and challenges of such from the perspective of staff.

The purpose of this paper is to explore the characteristics of adults with intellectual disabilities supported by a Community Forensic Learning Disability Team (CFT) and interventions delivered. It discusses the clinical implications of these and examines outcomes such as recidivism.

A retrospective case note review of all 70 service users open to the CFT during June 2013 was carried out, using a structured service evaluation tool.

The majority of service users (74.3 per cent) had a mild intellectual disability. Multiple mental health and/or physical health diagnoses were common, and 28 per cent had problematic drug or alcohol abuse. Almost half of service users had been victims of physical or sexual abuse, or neglect. Sexual offences were the most common index offence, followed by assault and fire-setting. A wide range of multi-disciplinary interventions were delivered within the Community Forensic Team. Following CFT involvement there was an increase in service users living in supported living in the community and a decrease in people in secure or out of area placements. Over half of service users engaged in no further offending behaviour since their referral, and those who did offend generally showed a decrease in the severity of offending behaviours. There was a large decrease in the number of convictions received.

The study shows the benefits of a multi-disciplinary Community Forensic Team for offenders with intellectual disabilities in terms of reduced recidivism and range of interventions delivered. It highlights the importance of clinicians within such a team having the skills to work with people with co-morbid diagnoses (e.g. autism) and people with trauma backgrounds and problematic substance use.

This paper demonstrates the complexity of the service users who are supported by the CFT, as well as the integral role played in supporting individuals to move to less restrictive settings, with positive outcomes.

Nationally community services for patients with intellectual disability and forensic needs are limited, and research to guide service development for this patient group with highly complex needs is sparse. The purpose of this paper is to provide an overview of referrals to and case management by the multi-agency Fife Forensic Learning Disability Service (FFLDS), including demographic data, treatment, risk assessments and outcomes.

All referrals received between 2004 and 2014 were reviewed to identify key demographic factors and to clarify the outcome of the referrals. Risks levels and presence of factors related to ongoing risk management were identified. For those accepted, final outcomes were noted.

In total, 145 referrals were received by FFLDS between 1 January 2004 and 31 December 2014. Of these 117 were accepted for ongoing case management. In total 106 patients were discharged from FFLDS over the review period, with the vast majority remaining in community settings. Patients were overwhelmingly male, with an age range of 16-79 (mean age of 30). Approximately half of referrals were from criminal justice agencies, and sexual and violent offences predominated. Alcohol and/or illicit substance use was problematic in 49 per cent of patients.

FFLDS needs to consider building links with Drug and Alcohol Services, for assistance in developing expertise in managing problematic alcohol and/or illicit substance use. Links with professionals working with female offenders may increase the rate of referral of female patients.

Policy and legal frameworks emphasise the need to manage people with learning disabilities and forensic needs in the least restrictive environment possible. This paper provides information on a cohort of forensic patients over a ten-year period, including characteristics and outcomes, to inform the evaluation of these frameworks and the planning of both community and in-patient services for this patient group.

National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England.

This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge.

The study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge.

This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services.

Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment. On these bases there is a growing emphasis on the requirement for local authorities to develop appropriate services for people who are currently in a hospital setting. The purpose of this paper is to examine the literature addressing factors influencing the provision of effective community-based forensic services.

The six articles were analysed separately using the evaluation tool – Currency, Relevance, Authority, Accuracy, Purpose. The six articles used divergent sample groups and employed both qualitative and quantitative methods to collate data. The articles shared a purpose of examining forensic community service provision with an aim to improve services.

There were three themes that emerged consistently across the literature these included: balancing risk management vs individual autonomy; multi-disciplinary and multi-agency working; service improvement. There is a growing emphasis on the need to replace long-term hospital placements with specialist, community provision, employing least restrictive methods and positive responses to crisis situations. In this climate, it is crucial that multi-disciplinary agencies from local authority, health and the charitable and private sector continue to work collaboratively on the integration of service provision in order to bring about the development of effective and responsive community services.

Research limited to peer reviewed and published research papers focusing on the subject of community forensic services with publications specifically made within the time frame of the Transforming Care Agenda.

This paper looks to examine the practical solutions to providing effective community forensic services for a person with an intellectual disability and makes recommendations for research into improving service specific training for support staff.

Following the Winterbourne View Hospital scandal (BBC One, 2011) instigations were made to make legislative change under the Transforming Care Agenda. Despite a renewed conviction in the rights of people to be a part of their local community without segregation or discrimination, professionals in the field continue to report a failure to reduce numbers of people in long stay hospitals and secure settings. With commissioning under pressure to make these intentions a reality it is a really good time to reflect on practice and evaluate service models to establish the factors that bring about positive outcomes for individuals enabling inclusion within community settings.

This review will focus on the literature evidencing positive intervention and outcome focussed methods of supporting people with a forensic history in the community. This is an entirely original piece of work analysing peer reviewed and published research.

Following serious case review, the Transforming Care agenda (DH, 2015) highlights the need for adults with learning disabilities, autism, mental health issues or behaviors that challenge to be supported within communities rather than hospitals. Poor or absent leadership has been identified as contributing to serious cases of abuse in health-care settings [Department of Health (DH), 2012]. This paper aims to focus on identifying the elements required for good leadership and service delivery in community forensic services (CFS).

The perspectives of 12 support workers working in CFS were obtained through semi-structured interviews.

Thematic analysis identified two predominant themes, namely, authentic leadership and effective team practice. A culture of trust and learning occurs when teams are well led. This culture leads to consistent practice which benefits services users and reduces risk of poor practice. Analysis suggests a framework for service delivery which is complimented by aspects of the Total Attachment model.

The data set was collected from the same organisation and views may have been aligned to existing organisational policy. However, the sample was taken across different teams and geographical locations to collate more generalised experiences of team dynamics. The lead researcher works for the organisation and this dual role may have affected the candour with which individuals shared information during interviews.

Using a model to understand the functional dynamics of teams within CFS may support leaders and practitioners to improve service delivery.

Improving service delivery within CFS may increase opportunity to meet the Transforming Care Agenda.

This paper examines staff perspectives and the application of theoretical frameworks to propose a unique service delivery model for supported living within CFS.