Paraphilias: definition, diagnosis and treatment

There is a great deal of controversy concerning paraphilia, and defining what is normal versus deviant or disordered, given that this is to some degree dependent on cultural views of acceptability. In this article, we outline these issues and describe recent progress in diagnosing and treating paraphilias

Profile of repeat victimisation within multi-agency referrals

To help reduce victimisation, safeguarding practices in England and Wales are becoming more multi-agency, with Multi-Agency Safeguarding Hubs (MASH) being a contemporary example of such an approach. MASH aims to reduce victimisation by identifying and managing vulnerability at the earliest opportunity. This is achieved through the co-location of safeguarding agencies, joint decision making and the co-ordination of interventions. Previous research has indicated that the demand placed upon MASH often outweighs available resources, questioning the extent to which MASH effectively safeguards vulnerable people at the earliest opportunity. Whilst existing literature has focused upon the characteristics of MASH referrals, alongside referral processes, rates of repeat referrals have been overlooked. This paper aims to bridge this gap by exploring the number of repeat referrals made over a two-month period to a MASH location in the north-west of England (n ¼ 2,134). By investigating repeat referrals, reasons why some individuals are susceptible to being victimised on multiple occasions are identified. The paper concludes that whilst MASH has taken a step towards identifying and managing victimisation, practices and processes need to be reviewed if MASH is to proactively prevent repeat victimisation

Influences and vulnerabilities in radicalised lone-actor terrorists UK practitioner perspectives.

The threat to national security from terrorists acting on their own initiative is a challenge for law enforcement and intelligence agencies in the UK and elsewhere. The UK Parliament’s 2014 threat assessment noted ‘a trend towards ‘low signature’ terrorism by small, self-directed groups and lone actors’ [House of Commons Home Affairs Committee (2014) Counter-Terrorism – Seventeenth Report of Session 2013–14]. Lone actors have become a higher priority for counter-terrorism professionals (UK police, Prevent practitioners and security agencies), but there is a paucity of research into the views and awareness of these professionals. This qualitative study examined how Prevent practitioners perceived the radicalisation and motivations of lone-actor terrorists they had encountered. Participants were an opportunity sample of five Prevent practitioners; all had served as police officers with varying employment backgrounds and counter-terrorism experience. A thematic analysis of semi-structured interviews identified perceived general characteristics of lone-actor radicalisation. Three themes clustering around the concept of becoming a terrorist are discussed: mechanisms of radicalisation, vulnerability to radical discourse, and individual motivation. Participants construed radicalisation as a process over time, accelerated in the presence of generalised criminality or extensive Internet use. Vulnerability was seen as inherent, as well as a product of social context. Participants adopted folk-psychological explanations with mental health problems, social isolation and relative deprivation cited as prominent vulnerability factors. Lone actors were seen as motivated by grievances (e.g. deprivation), pressure from external sources (e.g. rational prospectors) or personal reward (e.g. sensation-seeking). Practitioners’ perceptions of the process over time had parallels with a diathesis–stress model, although there was some support for social movement theory

Exploration of the risk factors contained within the UK’s existing domestic abuse risk assessment tool (DASH): do these risk factors have individual predictive validity regarding recidivism?

Purpose The purpose of this paper is to explore risk factors contained in the existing UK domestic abuse (DA) risk assessment tool: domestic abuse, stalking and harassment and honour-based violence (DASH) for individual predictive validity of DA recidivism using data from Devon and Cornwall Constabulary. Design/methodology/approach In total, 1,441 DA perpetrators were monitored over a 12-month period, and 270 (18.7 per cent) went on to commit a further DA offence. The individual risk factors which were associated and predictive of increased risk of recidivism were identified. Findings Only four of the individual risk factors were significantly associated with an increased risk of DA recidivism: “criminal history”, “problems with alcohol”, “separation” and “frightened”. Therefore, 21 of the risk factor items analysed could not discriminate between non-recidivist and recidivist perpetrators. Only two risk factors were able to significantly predict the recidivist group when compared to the non-recidivist group. These were identified as “criminal history” and “separated”. Of those who did commit a further DA offence in the following 12 months, 133 were violent and 137 were non-violent. The risk factors associated with these types of recidivism are identified. Practical implications The implications for UK police practice and the DASH risk assessment tool are discussed. By identifying key individual factors that can prioritise those individuals likely to recidivate and the severity of that recidivism, this could assist police decision making regarding the response and further prevention of DA incidents. The validation of association between individual factors and DA recidivism should improve the accuracy of risk levels. Originality/value This is the first large-scale validation of the individual risk factors contained within the UK’s DA risk assessment tool. It should be noted that the validity of the DASH tool itself was not examined within the current study

The Co-occurrence of Risk Factors for Intra-familial Child Homicides and Suspicious Child Deaths in England and Wales.

This study aimed to examine the co-occurrence of known risk indicators for intra-familial child death, to identify any themes which may exist. Data consisted of 100 child intra-familial deaths recorded by Police forces in England and Wales from 2006-2012. Categorical principal component analysis was used to assess relationships between 10 risk factors for intra-familial child death, resulting in the creation of four risk conditions, representing themes drawn from the literature, ‘abusive and unstable co-parenting’, ‘multiple parent stressors’, ‘parental social issues’ and ‘neglectful parenting’. Implications for police practice and risk management strategies are discussed

Calls for Police Service: Understanding the demand profile and the UK police response

Purpose – The purpose of this research paper is to identify and understand the demand profile of a division of Lancashire Police Constabulary in order to assist Police administrators in the evaluation of demand and understanding of Policing response. Design/methodology/approach – Police data records regarding all offences within the Central Division of Lancashire Police Constabulary over the year of 2013 were examined. Descriptive statistics were used to identify the top ten demand addresses in five categories (residential, statutory bodies, retail, nightlife, and young people’s services), and the incident classifications, time frames and response codes that were most associated with these addresses. Further content analysis was conducted on the top ten residential addresses in order to identify specific characteristics of residential demand. Findings - The majority of Lancashire Constabulary resources are being spent dealing with non-traditional police demand. The most demanding residents were found to have one or more of the following properties; (i) to be of white – Northern European origin, (ii) to be unemployed, (iii) to be associated with mental health issues, domestic violence incidents or substance abuse, and (iv) to have previously had other agency involvement. Practical Implications - These results indicate that the police could potentially reduce the demand for service by enhancing work within two key areas; partnership working and early intervention. Originality/value – In this time of austerity and police budget cuts, it is important to understand the demand on the UK police service in an attempt to reduce it

Investigating the Characteristics of Vulnerable Referrals Made to a Multi-Agency Safeguarding Hub

Multi-Agency Safeguarding Hubs (MASHs) have been a feature of safeguarding processes since 2010, aiming to increase information sharing, joint decision-making, and co-ordinated interventions between safeguarding agencies. However, understanding the mechanisms underpinning MASH, and who they protect, is limited. This article attempts to bridge this gap in knowledge by quantitatively examining referrals made to one MASH location in the North of England between 1 October 2013 and 30 November 2014 (n=51,264). The findings outline general features of a MASH framework while demonstrating that demand placed upon MASH is influenced by a range of static and dynamic risk factors, including gender, age, and ethnicity. The study highlights the complex nature of referrals made to MASH and suggests that while MASH has taken a step towards a multi-agency approach to safeguarding, questions regarding MASHs ability to effectively safeguard vulnerable individuals at the earliest opportunity remain

Internet Facilitated Rape: A Multivariate Model of Offense Behavior

In recent years there has been a significant increase in individuals reporting they have been raped by someone they have met through the internet (IFR). Previous literature has primarily focused on child victims, hence, the overriding aim of this study is to further our understanding of IFR in terms of overt crime scene behaviour. The sample consisted of 144 single IFR cases and two comparative samples of age-matched non-IFR offenders (confidence approach and surprise approach). Thirty-eight crime scene actions were coded as either present or absent for each offence. Findings suggest that the platforms IFR offenders use to meet their victims were not suggestive of the behaviour they were likely to display. In terms of specific offence behaviours, the IFR and confidence approach samples were considerably similar and both samples were comparatively different from the surprise approach cases. A smallest space analysis of the IFR sample revealed three distinct themes of behaviour with 71% of cases being assigned to a dominant behavioural theme. The practical and theoretical implications of the findings will be discussed

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study

Background The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. Methods We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, Rt, for the two incidence estimates. Findings From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6–0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56–0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38–0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the Rt of B.1.1.7 by a factor of 1·35 (95% CI 1·02–1·69) relative to pre-existing variants. However, Rt fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. Interpretation The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. Funding Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society