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Article
Publication date: 23 July 2020

Maria Iakovina Livanou, Rebecca Lane, Sophie D'Souza and Swaran P. Singh

There is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However…

Abstract

Purpose

There is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However, little is known about the care pathways of young people transitioning from forensic services. This retrospective case note review sought to examine the clinical characteristics, transition pathways and psychosocial indicators of transition outcomes amongst young people in forensic medium secure services discharged to adult services.

Design/methodology/approach

The electronic records of 32 young people, who transitioned from six adolescent medium secure units in England to adult services between May 2015 and June 2016, were examined.

Findings

Approximately 65% of young people were between 18 and 19 years at the time of transition and the average waiting time from referral to discharge was six months. A total of 63% young people transitioned to community placements and adult medium secure services. Four pathways describing the journey into and out of adolescent medium secure services were identified in a subsample of 12 young people. A total of 25% young people with neurodevelopmental problems moved to specialist services.

Practical implications

The results suggest that diagnosis, severity of offence and clinical background are associated with transition pathway. Promoting a person-centred approach and gradual independence of the young person may improve current practice.

Originality/value

These results inform existing policy and clinical practice in an effort to reform transition guidelines around young people’s needs during transition times. Further studies in adolescent forensic services are needed to understand complex neurodevelopmental problems and comorbidities.

Details

The Journal of Forensic Practice, vol. 22 no. 3
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 8 May 2017

Marilyn A. Sher, Lucy Warner, Anne McLean, Katharyn Rowe and Ernest Gralton

The purpose of this paper is to explore the validity and reliability of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) to determine if it has…

Abstract

Purpose

The purpose of this paper is to explore the validity and reliability of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) to determine if it has predictive accuracy in relation to physical aggression, severe verbal aggression, property damage and self-harm, in a medium secure setting. In addition, the authors hoped to provide some of the first descriptive data available for the START:AV among a UK adolescent population in a medium secure adolescent unit.

Design/methodology/approach

The sample consisted of 90 female and male adolescents, with and without developmental disabilities. It was important to explore the measure’s predictive accuracy across specific population groups, such as between males and females, as well as those with developmental disabilities, and those without.

Findings

Some significant relationships were found between the START:AV and adverse outcomes. For instance, total strength and vulnerability scores were predictive for verbal and physical aggression. Differences in predictive validity were evident when comparisons were made between males and females, with relationships being evident amongst the male population only. When splitting the male sample into developmental disability and non-developmental disability groups, significant relationships were found between strength and vulnerability scores and verbal and physical aggression.

Practical implications

A number of practical implications are considered, such as the START:AV is relevant for use with adolescents in hospital settings and the significant inverse relationship between strength scores and negative outcomes supports the importance of considering protective/strength factors when working with at risk youths.

Originality/value

There is currently limited validation data for the START:AV in the UK or elsewhere.

Details

Journal of Forensic Practice, vol. 19 no. 2
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 5 August 2014

Marilyn A. Sher and E. Gralton

The purpose of this paper is to establish gaps in training, involve staff in the implementation process by incorporating their views on what is helpful and what can be improved…

Abstract

Purpose

The purpose of this paper is to establish gaps in training, involve staff in the implementation process by incorporating their views on what is helpful and what can be improved, as well as provide information that might be helpful to other sites who are considering implementing the START:AV.

Design/methodology/approach

The current study is the first to examine a START:AV implementation and survey a multi-disciplinary team on their views about implementation in a medium secure service for adolescents in the UK. The survey was adapted from the one used by Collins et al. (2008). Once surveys were received the qualitative information was collated to explore themes, and frequency analysis was undertaken on the quantitative information.

Findings

The staff survey on the implementation of the START:AV highlighted a number of strengths and challenges. There was significant support for the START:AV in relation to it being a dynamic assessment to measure change, that focuses equally on strengths and vulnerabilities, making the process individualised. Users of the START:AV reported that the process of rating the START:AV as a team improved communication, teamwork, generated discussion and improved the detailed understanding of the patient being rated. Staff felt it was generally straightforward to use in terms of strengths and vulnerability ratings, but some difficulties emerged regarding making finer distinctions in ratings as well as completing risk formulations, highlighting further training needs. There was also some confusion about differentiating between certain strengths and vulnerabilities, leading to “double ratings”. Other difficulties highlighted centred on time and increasing workload.

Research limitations/implications

The main limitation of the study relates to the low response rate to the survey (31 per cent).

Practical implications

Recommendations for implementation and evaluation of new risk assessment procedures are made.

Originality/value

The current study is the first to examine a START:AV implementation and survey a multi-disciplinary team on their views about implementation in a medium secure service for adolescents in the UK.

Details

Journal of Forensic Practice, vol. 16 no. 3
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 12 December 2016

Rebecca Brewer, Lucy Pomroy, Michelle Wells and Joanne Ratcliffe

The purpose of this paper is to provide wider research evidence for the use of the Short Dynamic Risk Scale (SDRS) in risk management with individuals who have an Intellectual…

Abstract

Purpose

The purpose of this paper is to provide wider research evidence for the use of the Short Dynamic Risk Scale (SDRS) in risk management with individuals who have an Intellectual Disability (ID) and reside in a secure psychiatric inpatient setting. The outcomes are supportive of previous research, showing that outcomes on the SDRS are related to maladaptive behaviours recorded for individual with ID.

Design/methodology/approach

All participant data taken from the hospital healthcare reporting system were entered into a PASW database. The ratings for each of the SDRS and Short-Term Assessment of Risk and Treatability (START) items were entered and totalled, with a separate total score for the SDRS with the additional three items. In order to capture the behavioural monitoring data, average severities weightings of each of the Overt Aggression Scale-modified for neuro-rehabilitation (OAS-MNR) categories for the three weeks following completion of the individual’s SDRS were calculated and recorded. In addition, average severity weightings reflecting the presence of sexualised behaviour (St Andrew’s Sexual Behaviour Assessment (SASBA) in the subsequent three weeks following SDRS completion was included. Using the most recent START assessment completed allowed for analysis of the predictive ability of the START of the same behavioural data.

Findings

A series of Spearman’s correlations were run to determine the relationship between outcomes on the SDRS and engagement in risk behaviours as rated by the OAS-MNR scales. There was a moderate positive correlation between all 11-items of the SDRS and OAS-MNR recordings. A series of Spearman’s correlations were conducted to determine the relationship between outcomes on the START Vulnerability items and engagement in risk behaviours as rated by the OAS-MNR scales. There was a weak negative correlation between all individual START vulnerability item ratings and OAS-MNR recordings.

Research limitations/implications

The current pilot study provides wider research evidence for the use of the SDRS in risk management with individuals who have an ID and reside in a secure psychiatric inpatient setting.

Originality/value

This paper compares outcomes on the START and SDRS in relation to an individual’s risk recordings to support identification of whether either have practical and clinical utility. To the authors’ knowledge, this has not been completed before.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 7 no. 4
Type: Research Article
ISSN: 2050-8824

Keywords

Content available
Article
Publication date: 5 August 2014

Neil Gredecki and Carol A. Ireland

91

Abstract

Details

Journal of Forensic Practice, vol. 16 no. 3
Type: Research Article
ISSN: 2050-8794

Article
Publication date: 12 September 2016

Danielle Mayes, Sarah Victoria Ramsden, Louise Braham, Zoe Whitaker and Mark Norburn

The purpose of this paper is to explore service users’ experience of community meetings (CMs) within a high secure setting.

Abstract

Purpose

The purpose of this paper is to explore service users’ experience of community meetings (CMs) within a high secure setting.

Design/methodology/approach

A qualitative design was employed in which focus groups were used to capture service users’ experience of CMs. In all, 12 focus groups comprising a total of 27 participants were carried out using a semi-structured interview schedule. Data were analysed using thematic and saliency analysis, identifying themes which were pertinent to the research aims.

Findings

Positive experiences reported by service users included a safe space to explore ward issues and develop skills, with some viewing the meeting as a therapeutic forum in which to facilitate personal growth.

Research limitations/implications

There were a wide range of patient presentations and views. Furthermore, only 20 per cent of the patient population were included within this study.

Practical implications

A number of recommendations have been identified that can have positive implications for patients (quality of life and recovery), staff (resolving conflicts and problem-solving) and the overall therapeutic milieu of the ward.

Originality/value

There are no reviews looking at CMs within the last decade. This paper brings the understanding up to date to allow the development of this potentially positive tool.

Details

Mental Health Review Journal, vol. 21 no. 3
Type: Research Article
ISSN: 1361-9322

Keywords

Article
Publication date: 3 August 2012

Jo Nadkarni, David J. Blakelock, Alok Jha, Paul Tiffin and Faye Sullivan

The first NHS forensic low secure unit for adolescents, the Westwood centre, opened in 2004. This paper seeks to focus on service utilisation and initial outcomes for the young…

176

Abstract

Purpose

The first NHS forensic low secure unit for adolescents, the Westwood centre, opened in 2004. This paper seeks to focus on service utilisation and initial outcomes for the young people admitted in the first 45 months compared with young people accessing a neighbouring open adolescent unit.

Design/methodology/approach

In order to understand service utilisation and initial outcomes, the clinical profiles of young people admitted in the first 45 months were evaluated. This included demographics, locality, admission status, length of stay, medication use, presenting problem, diagnosis, previous and discharge destination. The profiles of young people accessing the low secure unit were then compared with young people accessing a neighbouring open adolescent unit. Clinical profiles were ascertained from available healthcare records and service data. These were inspected and analysed using descriptive statistics.

Findings

Thirty (54 per cent) of the 56 Westwood young people were male, the mean age at admission was 16.3 years and mean length of stay was 202 days. Twenty‐five (44 per cent) young people had a discharge diagnosis related to psychosis, the remainder having primary problems relating to emotional and/or conduct problems. 26 (47 per cent) were discharged to another hospital setting and 20 (35 per cent) returned to their home of origin. Young people accessing the low secure unit were significantly older at admission and there was a trend for a higher proportion of females to be admitted to the open setting. In addition, the low secure unit had a greater proportion of young people with psychotic disorders and longer lengths of stay. Case examples illustrate a pilot of initial outcomes.

Research limitations/implications

There were time differences in comparison of low secure and open unit and retrospective use of health care records.

Practical implications

Clinical profiling is useful as a basis to consider clinical outcomes, pathways, utilization of a service, service/training needs and development. Comparisons between inpatient units provide further evidence to the areas above and help dispel myths that may otherwise guide decisions, e.g. about which diagnoses or gender affecting length of stay. Most young people progress positively from the low secure service onto open or community settings. Improving future outcomes for young people include such as through diversion from custody, length of admission, reduced symptoms/risks and planned progress to suitable community placements or home.

Originality/value

The paper provides a clinical profile of young people accessing a low secure setting in comparison to an open unit. This has relevance to other secure and inpatient adolescent units and is important in considering pathways and outcomes.

Details

The British Journal of Forensic Practice, vol. 14 no. 3
Type: Research Article
ISSN: 1463-6646

Keywords

Article
Publication date: 1 May 2004

Phillip Vaughan

A survey was undertaken to determine the number of young people needing secure psychiatric inpatient care as at 1st January 2001. Twenty‐three individuals were identified who were…

Abstract

A survey was undertaken to determine the number of young people needing secure psychiatric inpatient care as at 1st January 2001. Twenty‐three individuals were identified who were placed in a variety of settings. However, few of the placements could be considered ideal. There was a wide range of diagnoses, and most young people had additional problems of social and education deficits and offending behaviour.Specialist resources need to be made available to local secure and residential facilities to reduce the need for secure placements. However, there may be a case for developing a regional secure service although, given the wide range of needs presented, it is unlikely that a single secure resource could meet them all.

Details

The British Journal of Forensic Practice, vol. 6 no. 2
Type: Research Article
ISSN: 1463-6646

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. As this…

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: 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 well…

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

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