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At present, there are significant limitations to the criminal justice system’s (CJS) ability to respond appropriately to detainees or defendant with learning disabilities (LD). The development of Liaison and Diversion Services has provided the opportunity to more easily identify people with LD in the CJS through the use of screening assessments. Therefore, the purpose of this paper is to consider why there is a need for screening assessments and review the literature on existing measures, in order to consider the next steps to develop a more effective pathway from the CJS to LD services.

This paper takes the form of a literature review.

The review found that there is a significant body of research defending the need for LD screening in the CJS across the UK. The aim of a screening process would be to identify individuals who possibly have LD and ensure that the correct measures are in place to assess and manage these individuals, including appropriate diversion to specialist LD services. The learning disability screening questionnaire (LDSQ) is an instrument that could be utilised in these instances and could be carried out by Liaison and Diversion Services.

Neither of the tools reviewed in this paper have been vigorously field tested within forensic settings in the UK. It is recommended that there should be trials of the LDSQ as a screening tool within Liaison and Diversion Services with comparison against outcomes of full diagnostic assessments for LD.

Screening for LD is being discussed across the UK as part of Liaison and Diversion Services. This paper highlights the need for a reliable and valid screening tool and provides support for the use of the LDSQ.

The purpose of this paper is to identify neurodevelopmental disorders and difficulties (NDD) in a male prison. The study used standardised tools to carry out screening and diagnostic assessment of the attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID).

The ADHD self-report scale, 20-item autism quotient and the Learning Disability Screening Questionnaire were used to screen 240 male prisoners. Prisoners who screened positive on one or more of these scales or self-reported a diagnosis of ADHD, ASD or ID were further assessed using the diagnostic interview for ADHD in adults, adapted Autism Diagnostic Observation Schedule and the Quick Test.

Of the 87 prisoners who screened positive for NDD and were further assessed, 70 met the study’s diagnostic criteria for ADHD, ASD or ID. Most of those with NDD (51 per cent) had previously gone unrecognised and a high proportion (51 per cent) were identified through staff- or self-referral to the study.

The study demonstrated that improving awareness and providing access to skilled, standardised assessment within a male prison can result in increased recognition and identification of NDD.

The authors reviewed studies of validated tools to screen for cognitive impairment among prisoners. The purpose of this paper is to assist organisations in identifying cognitive impairment in correctional facilities.

A targeted literature review identified peer-reviewed articles on screening of adults in jails, prisons, police watch-houses, custody suites, rehabilitation facilities and forensic settings or community settings for offenders. Validation of screening tools in secure settings, psychometric properties and cultural discrimination is included in this review.

Eight screening tools are considered suitable for use in correctional settings. Two screening tools are recommended for cognitive impairment, one is recommended for adaptive functioning assessment and one is recommended for screening of brain injury. Two screening tools are noted to be subject to piloting and further development for use with First Nations people, and two screening tools for cognitive impairment are noted for positive consideration.

Recommendations for screening tools are based on review only and evaluation was infeasible.

Short, reliable measures of cognitive ability for use in correctional facilities are needed. Such tools must be appropriate with respect to their purpose, feasible within the clinical capability of staff and sufficiently cheap to administer to allow widespread use.

Screening of prisoners for cognitive impairment allows early detection to facilitate rehabilitation and therapy. This research is at the systems level. Therefore, the authors do not purport to provide guidance for individual clinicians.

The purpose of this paper is to validate the learning screening tool (LST) and the adapted functioning checklist-revised (AFC-R) as screening tools to aid programme allocation, and to investigate whether programme decision makers were using the tools as per the guidance provided by HMPPS Interventions Services.

LST and AFC-R data were gathered for 555 men who had been assessed for programmes between 2015 and 2018 across eight prisons and one probation area. WAIS-IV IQ data were also gathered if completed.

The findings provide support for the use of the LST, and AFC-R in helping to make decisions about programme allocation. The LST and AFC-R correlate well with each other, and a measure of intellectual functioning (WAIS-IV). Those who were allocated to learning disability or challenges (LDC) programmes scored higher on the LST (greater problems) and lower on the AFC-R (lower functioning) compared to those allocated to mainstream programmes. The LST had adequate predictive validity. In the majority of cases, the correct procedures were followed in terms of using the tools for programme allocation.

The sample size for examining the relationships between all three tools was limited. The research was also unable to take into consideration the clinical decision making involved in how the tools were interpreted.

This research contributes to the growing evidence about the effective use of LDC screening tools in forensic settings.

The purpose of this paper is twofold. First to ascertain the efficacy of current police reception screening to detect detainees with intellectual disability (ID). Second to assess the validity of a short targeted screen for ID among police custody detainees.

The study comprised three stages. First, 248 police custody detainees were assessed for a range of health morbidities, including a pragmatic clinical evaluation of ID. For those with suspected ID, the police custody screens were scrutinised for evidence that this had been detected. Second, a new police health screen, incorporating a short screen for ID, was piloted. Totally, 351 detainees were assessed in the same way as in part 1 with the new screens being scrutinised for evidence that ID had been detected where relevant. Third, the new police screen for ID was validated among a sample of 64 inpatients, some with ID and some without, from forensic inpatient services. Parts 1 and 2 were carried out in the Metropolitan Police Service, London. Part 3 took place in one NHS Trust.

In parts 1 and 2, the rate of detainees with suspected ID was 2-3 per cent. The standard police screen detected 25 per cent of these detainees in part 1. When the new screen was introduced in part 2, the sensitivity for ID increased to 83 per cent. However, there was no requisite improvement in the proportion of detainees with ID receiving an Appropriate Adult. In the inpatient study, the new screen showed a good level of sensitivity (91 per cent) and reasonable specificity (63 per cent).

It is possible to improve the detection rate of detainees with suspected ID by introducing a short ID screen into the police custody officers’ reception health screen.

The Health Screening of People in Police Custody (HELP-PC) study is a project evaluating screening for health morbidity among police custody detainees. Other data from this study have been reported elsewhere, but this is the first time the data pertaining to ID screening has been reported in detail.

The purpose of this paper is to report on a three‐year contract to provide learning disability in‐reach to young offenders serving a sentence of Imprisonment for Public Protection (IPP) at HMYOI Aylesbury.

A whole population sample (n=75) was obtained between December 2009 and July 2011, where all had received an assessment of intellectual functioning using either the in‐reach screening protocol, consisting of the Kaufman Brief Intelligence Test – Version 2 (KBIT‐2) and four background questions, the Wechsler Abbreviated Scale of Intelligence (WASI) or the Wechsler Adult Intelligence Scale (WAIS).

It was found that 5.5 per cent of the population had a standard score of less than 70 (significant impairment) and a further 18.6 per cent fell between 70 and 79 (borderline range). The mean standard score of the KBIT‐2 (85.8) was consistent with previous studies of prison populations. The background had a significant but weak association with the KBIT‐2 scores, but lacked sufficient specificity.

Further research is required if these findings are to be generalised to the wider prison population.

Systematic screening for learning disability can be of clinical benefit in identifying the needs of young offenders, which is the first step to addressing these needs.

A number of publications by the Department of Health, the Home Office and third sector organisations have identified the need for services for offenders with a learning disability. In‐reach provision to prisons is still in its infancy and, currently, no gold standard exists for screening tools.

While individuals with an intellectual disability form a significant minority in the worldwide prison population, their healthcare needs require specialist attention. In Ireland, services for prisoners with intellectual disabilities need development. However, there is little substantive data estimating the prevalence of intellectual disabilities within the Irish prison system. The paper aims to discuss these issues.

The authors systematically review published data relating to the prevalence of intellectual disabilities in prisons in the Republic of Ireland. The authors searched four databases, governmental websites and corresponded with experts.

Little published data were elicited from searches except for one nationwide cross-sectional survey which reflected a higher prevalence than reported in international studies. Studies from forensic mental health populations are narrated to contextualise findings.

This study found that there is little data to accurately estimate the prevalence of intellectual disabilities in the Irish prison system and the limited data available suggests that this is likely to be higher than international estimates. The authors highlight the need for further research to accurately estimate prevalence in this jurisdiction, alongside the need to develop screening and care pathways for prisoners with an intellectual disability.

This literature review identifies instruments for diagnostic assessment of cognitive impairment in prison populations. The purpose of this paper is to promote procedures for early screening and identification of cognitive impairment using instruments appropriate to prisons.

A targeted literature review identified studies on screening and diagnostic assessment of adults in jails, prisons, police watch-houses (custody suites), rehabilitation facilities and forensic settings or community settings for offenders. Discriminant validity, suitability, reliability and feasibility of instruments in correctional and forensic settings are presented.

From 135 peer-reviewed articles relating to diagnostic assessment of cognitive impairment, 15 instruments were considered appropriate for use in prison settings.

Selection of instruments for prison use considers suitability of the instrument(s) and clinical workforce capability. Cultural and gender validity of the instrument, its feasibility for use in the prison environment and cost and time to administer are also important. Using appropriate tools as part of a staged and targeted process in the screening and diagnosis of cognitive impairment is demonstrated by two case vignettes presented in this paper. As this was a desk review, the authors did not evaluate the instruments.

Identification of instruments that are suitable for diagnosis of cognitive impairment in forensic populations informs the rehabilitation of offenders with cognitive impairment in prison and upon release to probation and parole.

It is known that about seven per cent of the prison population have a learning disability, but historically very little has been done to support these individuals through the Criminal Justice System. Valuing People Now (DH, 2009) acknowledged that people with a learning disability within the Criminal Justice System should be included within the local implementation of the strategy. This article explores what has been achieved since Valuing People Now and what still needs to be done.

Expert consensus is that people with an intellectual disability are over represented across the criminal justice setting (CJS). Primary research studies have been conducted in police stations and prisons, but little is known about the prevalence of this population in the court setting. The purpose of this paper is to conduct a literature review to find out more about the prevalence of defendants with an intellectual disability in court.

A literature review was conducted using standard systematic review methodology (Julian et al., 2011) and the PRISMA reporting guidelines (Moher et al., 2009).

Two papers met the inclusion criteria and were critically appraised. The papers reported prevalence findings ranging from 10%–20%.

Differences in study design, sampling, recruitment and diagnostic criteria affect the ability to make comparisons or synthesise findings.

It is important that future primary and secondary research studies standardise operational terms to enable true comparison between studies, systematic reviews and evidence syntheses.

Defendants with an intellectual disability need to be identified to enable criminal justice professionals to make reasonable adjustments to proceedings and consider diversion and alternative disposal options. This will likely improve outcomes for this population and reduce recidivism.

This literature review contributes to the growing evidence base about meeting the criminal justice needs of people with a learning disability and recognition of the increased prevalence across the CJS and specifically within the court setting.