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This article sets out to explore three differing approaches from three agencies to supporting and treating people with a learning/intellectual disability who have sexually offended. The three agencies are: Waymarks in the United Kingdom, York Central Hospital Behaviour Management Services and Vita Community Living Services both in Ontario, Canada. Each agency provides services to a similar population of offenders with disabilities. Though each client engaged in vastly different behaviour, all clients have been identified as having sex offending history and as having a high likelihood of offending again in the future. As the organisations evolved, differing approaches to the provision of service developed. For the three agencies, it can be argued that there was a very limited range of theoretical models available when each organisation developed. Consequently each agency developed their service according to the needs and ‘best fit’ of the people they were supporting with the available resources at that time. This meant that services developed as a direct response to the need and were designed to best fit the need with the resources to hand at the time. As a result, three different models of service arose, all of which have had real success with meeting the needs of people with learning/intellectual disabilities who have sexually offended, while providing support and treatment in differing ways. This article will examine some of those differences.

Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. The model has successfully been used to address violence and aggression in a forensic setting (Evershed et al, 2003). The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning/intellectual disabilities in 2004, and the programme has been developed over a period of six years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain.

The purpose of this paper is to offer an introduction to the recently recognised phenomenon of “mate crime” as it affects people with learning disabilities. It looks at how concerns arose, considers what may make people with learning disabilities particularly susceptible, and proposes a provisional definition of “mate crime”.

The paper draws on the author's own project work, and reviews the extant research literature on “disablist” hate crime to examine the extent to which so-called “mate crime” has been both explicitly and implicitly identified and analysed in the literature.

The literature review indicates that “mate crime” has not been explicitly identified in any scholarly research to date, either under that or any other name. Crimes that we might label as “mate crimes” have, however, appeared in more general literature concerning the experiences of people with disabilities in general, and as victims of crime.

Despite a lack of firm data there is sufficient in the literature, combined with increasing anecdotal evidence and case studies, to suggest that people with learning disabilities are particularly susceptible to “mate crime”, and are being targeted by perpetrators. Increasing independence and reduced service provision are likely to increase the risks. The author argues that mate crime differs significantly from other manifestations of hate crime and abuse, and needs to be conceptualised, analysed and handled differently.

Whilst the issue of “mate crime” is gaining increasing professional and media attention it lacks any academic base and a definition. This paper attempts to establish an agreed definition and conceptualisation of “mate crime”.

The purpose of this paper is to discuss the role of education and training in addressing health inequalities in intellectual disabilities, before examining innovative approaches to healthcare education. Preliminary findings of a simulation training course to support healthcare professionals to work with people with intellectual disability are then presented.

This study employed a mixed methods design to assess the impact of the simulation course. Quantitative data were collected using the Healthcare Skills Questionnaire and a self-report confidence measure; qualitative data were collected using post-course survey with free text responses to open questions.

Healthcare skills and confidence showed statistical improvements from pre- to post-course. Qualitative analyses demonstrated that participants perceived improvements to: attitudes, communication skills, reasonable adjustments, interprofessional and multi-disciplinary working, knowledge of key issues in working with people with intellectual disabilities.

Encouraging findings imply that simulation training to address health inequalities in intellectual disabilities is a valuable resource that merits further development. This training should be rolled out more widely, along with ongoing longitudinal evaluation via robust methods to gauge the impact on participants, their workplaces, and people with intellectual disabilities.

The authors believe this paper to be the first to assess an interprofessional, high-fidelity simulation course, using actors as simulated patients to address the mental and physical health needs of people with intellectual disabilities. The rigorous use of co-production and co-delivery, alongside promising findings for this training method, represent a useful contribution to the literature.

The purpose of this paper is to highlight the provision of therapy for witnesses who have a learning disability prior to and following a criminal trial. Authors will reflect on clinical practice whilst stressing that this area of work is in its infancy and both continue to learn through continued reflection and each new experience.

The paper broadly describes the nature of pre-trial therapy followed by reflection by a Counsellor and Supervisor on their clinical practice.

Authors describe some of the common themes that arise whilst providing pre-trial therapy.

The authors hope that the paper will encourage professionals involved in Safeguarding cases to fully consider the emotional needs of victims and to seek timely therapeutic support where the need presents. They also hope that it will encourage practitioners from various professions to consider providing this specialist and delicate type of therapy whilst highlighting the need for good supervision.

There is a paucity of written information about this specific subject area. Although safeguarding of vulnerable adults has grown considerably over the last decade and investigations are now more likely to lead to legal action, the availability of emotional support for victims who have learning disabilities needs to be addressed.

It is increasingly recognised that people with intellectual disabilities have poorer access to health care. One of the recommendations from the independent report, Healthcare for All is compulsory undergraduate medical teaching about people with intellectual disabilities. The purpose of this paper is to investigate the attitudes of medical students towards people with intellectual disabilities. The authors hypothesised that knowledge and attitude will change over the course of a 14‐week Neurosciences block, which included a taught intellectual disabilities module and opportunity to undertake a clinical placement.

The authors conducted a naturalistic prospective study in a London university. Data were collected at the beginning and the end of each of the three 14‐week Neurosciences blocks during the year. Attitude was measured using a self‐report questionnaire, including an amended short form of the Community Living Attitudes Scale (CLAS), administered in hard and e‐copy.

In total 136 medical students (35 per cent response rate) completed the questionnaire at the beginning and 133 (34 per cent response rate) at the end of the block. By the end of the block, students had increased knowledge of the definition of intellectual disability. Medical students showed generally favourable attitudes towards people with intellectual disabilities but there was no significant change in attitude between the start and end of the block.

This study shows that didactic teaching and limited exposure to people with intellectual disabilities, although it increases knowledge, is not enough to affect the kind of changes required to improve attitude. Increased face to face contact with people with intellectual disabilities and other innovative teaching methods are more likely to influence attitude in future medical practitioners. These will require further evaluation.

This paper aims to provide a commentary on the previous paper in this issue on “The development of a sex offender assessment and treatment service within a Community Learning Disability Team (the SHEALD project): part 2”.

The authors consider the nature of traditional service delivery for people with learning/intellectual disabilities and the potential that services have for the physical, emotional and sexual abuse of these vulnerable people.

The authors argue that effective community based treatment/support is best delivered in a way that acknowledges and employs the range of skills offered by practitioners from health and social care backgrounds.

Both SHEALD and HIST are examples of community treatment programmes which show that a person‐centred approach supported by a dedicated and consistent team of practitioners may be an effective way of addressing complex, high‐risk behaviours.

Community‐based treatment programmes serving people with learning/intellectual disabilities face the problem of deciding how and when and under what conditions those in treatment will be able to independently access the community. Given the fact that people with disabilities have difficulties in generalization, knowing that they can practice skills in therapeutic sessions does not mean that they will be able to use these skills in real life situations. A Community Trust programme was first described theoretically in 1996 and this paper aims to present how that programme will work in practice.

From the moment treatment begins, data is collected with an eye to the future wherein individuals will be able to access the community and wherein agencies and therapists will be able to make decisions on that access, based on data not opinion. Two case examples demonstrate the principles of the trust programme.

Community trust for individuals who have engaged in serious, dangerous, or criminal behaviours is a serious issue and therefore must be a well thought out process. It also needs to be data based and decisions must be made not on “opinion” but on objective measures.

The paper demonstrates how community‐based treatment programmes, such as the example considered, give individuals “real life” opportunities to practice skills and thus transfer what is learned in therapeutic sessions to practical application.

The aim of this study was to provide a pilot evaluation of novel, brief formulation development workshops with direct care staff supporting people with intellectual disabilities who display significant psychosocial difficulties. A series of workshops were designed and delivered to a staff team supporting an individual who had been referred to specialist intellectual disabilities health services. The workshops used a psychosocial framework to facilitate development with care staff of a case formulation for the individual they were supporting. Following the workshops, there were decreases in problematic behaviours displayed by the individual and in the staff team's perception of the severity of these behaviours. The staff team felt that the workshops had had a beneficial impact on their practice. The pilot indicated that the workshops were feasible, positively received and associated with changes in the psychosocial difficulties displayed by the individuals staff were supporting.