Home visits: a reflection on family contact in a specialist forensic intellectual disability service

Purpose – There is little published literature about the number of home visits provided to patients within forensic intellectual disability units, and there is no published data on variables that affect home visits. There is a need for a baseline audit that can formulate standards for future practice. The paper aims to discuss these issues. Design/methodology/approach – This paper describes the home visit programme within a forensic intellectual disability service, and a baseline audit of the programme. The audit measured the number of home visits, any factors that adversely affect home visits, and the extent of family contact. The authors propose audit standards for evaluation of good practice in this area. Findings – The audit involved 63 patients over a one-year period. In total, 81 per cent of patients had some form of family contact and 54 per cent of patients at least one home visit. However, 19 per cent of patients had no contact with their family due to a variety of reasons. There were no significant differences in the number of home visits between men and women, patients on civil vs criminal sections or those treated “within area” or “out of area”. Patients in rehabilitation wards had significantly more visits than those in low or medium secure. Originality/value – Conventional wisdom is that reduced family contact is the direct result of patients being placed “out of area”. The results of this audit suggest that, at least in this group, the reasons may be much more nuanced and that the current definition of “out of area” has to be improved to incorporate the actual distance between the patient’s current family home and the service. Audit standards have been proposed to monitor family contact and home visits. Future work should focus on the relationship between family contact and treatment outcomes

“Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability

Purpose – The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour being treated in forensic hospitals. Design/methodology/approach – The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions – containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored. Findings – Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. Clinicians work within the framework of mental health law and have to be mindful that pragmatic solutions to hasten discharge into the community may not fall within the law. Originality/value – This paper makes practical suggestions for the future on how to best integrate hospital and community care for people with intellectual disability, mental health and offending behaviours. </jats:sec

The Clinical Utility of Social Information Processing Theory in Assessing and Treating Offenders with Autism Spectrum Disorder

Purpose: Social deficits are central within conceptualisations of autism spectrum disorder (ASD), and seperately linked to offending behaviour. Social problem solving interventions are often used with offenders, but little research has examined the social information processing (SIP) skills of individuals with ASD and a history of criminal offending behaviours. Design/methodology/approach: This conceptual paper will introduce the SIP model, review SIP research as applied to those with ASD and in forensic populations, and further consider the relevance to the assessment and treatment of offenders with ASD. Findings: Difficulties in all areas of the SIP model are noted in ASD and research suggests these difficulties may be directly linked to behaviour. Practical implications: It is possible that identifying SIP abilities and deficits could improve the effectiveness of rehabilitation programmes for this group. Originality/value: This paper reviews the utility of social information models in the offending behaviour of people with ASD

Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs

Background: In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability. Aims: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England. Method: File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported. Results: Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores. Conclusions: In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group

The PAAFID project:exploring the perspectives of autism in adult females among intellectual disability healthcare professionals

Purpose: The purpose of this paper is to explore the perspectives of healthcare professionals on autism in adult females with intellectual disability (ID), including regarding the gender ratio of autism, the clinical manifestation of autism in females, and the recognition, screening and diagnosis of autism. Design/methodology/approach: The questionnaire was developed following a review of the relevant literature and distributed to professionals within three healthcare trusts as well as members of two clinical research groups. The questionnaire was completed by 80 ID healthcare professionals. Data were aggregated and analysed using Microsoft Excel. Findings: ID healthcare professionals had a lack of recognition of the smaller gender ratio of autism in patients with ID as compared to those without ID. Most respondents reported believing that autism manifests differently in females; with women demonstrating a greater ability to mask their symptoms. A considerable proportion of participants reported feeling less confident in recognising, screening and diagnosing autism in female patients, with many endorsing a wish for additional training in this area. Practical implications: These findings suggest that ID healthcare professionals are keen to improve their skills in providing services for women with autism. Training programmes at all levels should incorporate the specific needs of women with ASD, and individual professionals and services should actively seek to address these training needs in order to promote best practice and better outcomes for women with autism. Originality/value: This is the first published questionnaire exploring the perspectives of healthcare professionals regarding autism in adult females with ID

Characters with autism spectrum disorder in fiction : where are the women and girls?

Purpose Fiction has the potential to dispel myths and helps improve public understanding and knowledge of the experiences of under-represented groups. Representing the diversity of the population allows individuals to feel included, connected with and understood by society. Whether women and girls with autism spectrum disorder (ASD) are adequately and accurately represented in fictional media is currently unknown. The paper aims to discuss this issue. Design/methodology/approach Internet and library searches were conducted to identify female characters with ASD in works of fiction. Examples of such works were selected for further discussion based on their accessibility, perceived historical and cultural significance and additional characteristics that made the work particularly meaningful. Findings The search highlighted a number of female characters with ASD across a range of media, including books, television, film, theatre and video games. Many were written by authors who had a diagnosis of the condition themselves, or other personal experience. Pieces largely portrayed characters with traits that are highly recognised within the academic literature. However, some also appeared to endorse outdated myths and stereotypes. Existing works appear to preferentially portray high functioning autistic women, with limited representation of those whom also have intellectual disability. Originality/value This is the first exploration of the depiction of ASD in females within fiction. There is a need for more works of fiction responsibly depicting females with ASD, as this can help reduce stigma, develop public awareness and recognition and increase representation

Adapting measures of social climate for use with individuals with intellectual developmental disability in forensic settings

The social climate of forensic settings is thought to impact on a number of important clinical and organisational outcomes and is, therefore, an important construct in relation to the successful functioning of forensic units. A variety of self-report questionnaires have been developed to objectively measure the social climate of forensic settings (e.g. the Correctional Institutions Environment Scale and the Essen Climate Evaluation Schema), however these questionnaires have not been validated for individuals with intellectual developmental disabilities (IDD). Given the prevalence of IDD in prison and forensic psychiatric settings and the potential impact of such cognitive deficits on the ability to complete a range of self-report questionnaires, it is important to consider the potential reliability and validity of existing social climate measures in IDD populations. This article will, therefore: 1) examine the cognitive, linguistic and response format difficulties that may arise when administering self-report measures of social climate in IDD populations; 2) consider potential adaptations to existing measures of social climate that might make them more suitable for use with IDD populations; and 3) identify important directions for future research in the area

Priority concerns for people with intellectual and developmental disabilities during the COVID-19 pandemic

Background The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers. Aims To provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic. Method Senior representatives of major UK-based professional and service-user representative organisations with a stake in the care of people with intellectual disabilities and/or autism were contacted to provide a list of concerns across three domains: ‘mental health and challenging behaviour’, ‘physical health and epilepsy’ and ‘social circumstances and support’. The feedback was developed into statements on frequently reported priorities. These statements were then rated independently by expert clinicians. A video-conference meeting to reconcile outliers and to generate a consensus statement list was held. Results Thirty-two organisations were contacted, of which 26 (81%) replied. From the respondent's data, 30 draft consensus statements were generated. Following expert clinician review, there was initially strong consensus for seven statements (23%), increasing to 27 statements (90%) following video conferencing. Conclusions These recommendations highlight the expectations of people with intellectual disabilities and/or autism in the current pandemic. This could support policymakers and professionals’ deliver and evidence person-centred care

Heterogeneity within Autism Spectrum Disorder in Forensic Mental Health: The Introduction of Typologies

Purpose: Individuals with diagnoses of Autism Spectrum Disorder (ASD) within criminal justice settings are a highly heterogeneous group. Although studies have examined differences between those with and without ASD in such settings, there has been no examination of differences within the ASD group. Design/methodology/approach: Drawing on the findings of a service evaluation project, this paper introduces a typology of ASD within forensic mental health and learning disability settings. Findings: The eight sub-types that are described draw on clinical variables including psychopathy, psychosis and intensity/ frequency of problem behaviours that co-occur with the ASD. The initial assessment of inter rater reliability on the current version of the typology revealed excellent agreement, multirater Kfree = .90. Practical implications: The proposed typology could improve understanding of the relationship between ASD and forensic risk, identify the most appropriate interventions and provide prognostic information about length of stay. Further research to refine and validate the typology is ongoing. Originality/value: This paper introduces a novel, typology based approach which aims to better serve people with ASD within criminal justice settings