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.
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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.
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This is an invited short overview from a clinician working in a national secure inpatient setting which aims to focus on inpatient forensic services for adolescents with…
Abstract
Purpose
This is an invited short overview from a clinician working in a national secure inpatient setting which aims to focus on inpatient forensic services for adolescents with developmental disabilities.
Design/methodology/approach
The paper gives a brief overview of the needs of this population and the requirements for inpatient assessment and treatment.
Findings
This is a complex population who are referred relatively late to inpatient services, often after recurrent failings in residential services where mental disorders are commonly unrecognised. Comprehensive multidisciplinary assessment and treatment are required for this group.
Originality/value
This paper will be useful to a range of professionals dealing with adolescents with developmental disabilities who are engaging in offending and other high risk behaviours.
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Deborah J. Morris, Shubhinder Shergill and Elizabeth Beber
People with an intellectual disability (ID) are more at risk of experiencing adverse childhood events. Moreover, prolonged exposure to ACEs results in enduring changes and…
Abstract
Purpose
People with an intellectual disability (ID) are more at risk of experiencing adverse childhood events. Moreover, prolonged exposure to ACEs results in enduring changes and impairments in neurological, physiological and psycho-social systems and functioning. In response, van der Kolk et al. (2009) have put forward the concept of developmental trauma disorder (DTD) to reflect the “constellation of enduring symptoms” and complex care needs of this population. The purpose of this paper is to ascertain the level of exposure to adverse childhood events and the prevalence of DTD in an inpatient forensic ID population.
Design/methodology/approach
A retrospective file review and consensus approach to diagnosis were used in a sample of adults with an ID detained in a secure forensic service.
Findings
Results revealed that 89 admissions (N=123) had been exposed to at least one significant ACE, with 81 being exposed to prolonged ACEs. A total of 58 admissions (47 per cent) met criteria for PTSD and 80 (65 per cent) met the criteria for DTD. Significant gender differences were noted in MHA status, primary psychiatric diagnoses, exposure to ACEs and DTD.
Research limitations/implications
The discussion explores the implications for working with forensic ID populations who report high incidents of childhood trauma and the utility, strengths and weaknesses of the proposed DTD, its relationship to ID diagnoses is explored.
Originality/value
The study outlines the prevalence of DTD and PTSD in ID forensic populations and suggests additional key assessment and treatment needs for this population.
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Verity Chester, Harriet Wells, Mark Lovell, Clare Melvin and Samuel Joseph Tromans
Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this population…
Abstract
Purpose
Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this population, through informing services and interventions which prevent behaviours reaching a forensic threshold. The paper aims to discuss this issue.
Design/methodology/approach
The Historical Clinical Risk Management-20, Version 3 assessments of a cohort of 84 inpatients within a forensic ID service were analysed for this study, with a particular emphasis on items concerned with the age at which antisocial or violence first emerged.
Findings
For most participants, violent or antisocial behaviour was first observed in childhood or adolescence. The study also highlighted a smaller subgroup, whose problems with violence or antisocial behaviour were first observed in adulthood.
Originality/value
The study findings suggest that targeted services in childhood and adolescence may have a role in reducing the offending behaviour and forensic involvement of people with ID. This has implications for the service models provided for children and adolescents with ID with challenging or offending behaviour.
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There needs to be an increased recognition of fetal alcohol spectrum disorder (FASD) in services that deal with young people with disruptive and offending behavior, not just those…
Abstract
Purpose
There needs to be an increased recognition of fetal alcohol spectrum disorder (FASD) in services that deal with young people with disruptive and offending behavior, not just those services that deal with adolescents with a recognized intellectual disability. The paper aims to discuss these issues.
Design/methodology/approach
This is a general review of the current available evidence on FASD and how it is likely to predispose affected young people to have contact with secure mental health services and the criminal justice system.
Findings
FASD is likely to have become a more common cause of intellectual disability and behavioral disturbance but the history of significant alcohol exposure in utero if often missed. There is evidence that the hyperactivity is less responsive to psychotropic medication and may represent a different condition to conventional ADHD. However the majority of those affected are in the low normal IQ range.
Research limitations/implications
There is so far very limited research in what is likely to be a relatively common disorder with significant costs to criminal justice, mental healthcare and social services. Epidemiological information from the UK is lacking and urgently needed.
Practical implications
Professionals who work with mentally disordered young people need to be more aware of FASD and its potential contribution to the problems and disabilities in their population.
Social implications
Social workers, foster carers and adoptive parents need to be more aware of FASD and how it can contribute to the breakdown of social care.
Originality/value
There is currently no other review of FASD and the implications for criminal justice, secure mental health and social care for young people.
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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.
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Zana Khan, Sophie Park and Georgia Black
This article aims to present a systematic review and synthesis of evidence on the experiences, role and use of IPE in IH fields by using a meta-ethnographic approach including key…
Abstract
Purpose
This article aims to present a systematic review and synthesis of evidence on the experiences, role and use of IPE in IH fields by using a meta-ethnographic approach including key concepts, reciprocal and refutational translation and lines of argument. Inclusion health (IH) practice suggests that the needs of excluded groups are more effectively addressed through collaborative working. Interprofessional education (IPE) occurs when two or more professions engage in shared practice and learning, resulting in improved collaboration and quality of care. Studies on IPE to train staff in fields relating to IH exist, but without a settled consensus on the best approaches/activities to foster inclusive practice.
Design/methodology/approach
This synthesis is underpinned by a meta-ethnographic approach. It provides explicit stages of data collection and interpretation, while providing space to engage with emerging themes and concepts iteratively (reflecting on author experiences) and inductively (reasoning and interpretation). This study made use of electronic databases and journals for English language peer reviewed articles between 2000 and 2020. Of the 2217 articles, 19 papers were included. The lead author and reviewer completed the review process and a second reviewer reviewed 10% at each stage. The quality was assessed using a modified CASP checklist. Iterative analysis involved PPI and staff stakeholders.
Findings
A total of 16 concepts embedded in 19 papers provide insight into the nature of IPE in IH (IH) for staff. It was found that IPE in IH covers a broad group of practitioners and is a complex activity involving individual and organisation readiness, practical and pedagogical factors, influenced by setting, method, curriculum, lived experience, reflection and a learner-driven approach. Barriers to design, implementation and translation into practice were also found to exist.
Practical implications
Most studies used a combination of core learning and group work. Educational modes include mentoring or coaching, reflective practice, immersive learning and people lived experience of exclusion involved in or facilitation thematically centred in trauma-informed informed care, cultural competence, communities of practice and service learning. The aim of these methods was to promote collaboration through identifying shared experiences, problems and tensions and critical reflection of services and organisations. Such transformative learning is reported to challenge stigma, discrimination and misinformation and promote collective empowerment to address social injustice through human connection. Effective models of IPE re-instated the therapeutic relationship and alliances between patients and staff.
Social implications
This review also calls for the development of health and care workers’ professionalism in relation to their own reflexivity, establishing anti-racist curricula, challenge stigma and ensuring clinicians are aware of and able to negotiate tension and difference identified within the consultation and between themselves. Apart from developing generalist skills, this analysis suggests that IPE in IH may be able to challenge stigma and discrimination towards IH groups by destabilising existing norms and siloed working with the aim of achieving robust interprofessional practice.
Originality/value
IPE in IH is a complex activity affected by individual and organisation readiness, setting, experiential, practical and pedagogical factors. Models of teaching are focused on re-instating the therapeutic relationship. There are no systematic reviews in this field and previously there was no settled consensus on the best approaches and learning activities to foster inclusive and collaborative practice.
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Pauline Gill, Paul McKenna, Helen O'Neill, Johnny Thompson and David Timmons
The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single…
Abstract
The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single inpatient site to a modern national forensic mental health service. Central to this transformation is the need to move from the traditional security‐focused model of care to a model of recovery. The challenge incumbent within this transformation is to incorporate a sophisticated amalgamation of the patients' needs while recognising the broad range of security requirements in a forensic setting. This paper considered that adopting an integrated care pathway (ICP) approach would provide the service with a vehicle to re‐engineer our principles and systems of care. Likewise we hypothesised that the ICP would enable us to consolidate best practices such as multi‐ disciplinary working, structured professional judgement and the involvement of the patient and their carers. Thus far it has afforded us the opportunity to examine many aspects of the care delivered within the service. It has provided a shared understanding of key standards among clinicians, service users and carers that are necessary to implement a quality care pathway. It has certainly not been a stagnant process, and the initial work often bears no resemblance to the current process. In turn, we expect that it will continue to change as the path travelled is as important as the outcome and the ICP becomes a dynamic part of the organisation.
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This article presents a history of the visual merchandising of American firearms from the mid-19th century until the present day. Although the scholarly literature has…
Abstract
Purpose
This article presents a history of the visual merchandising of American firearms from the mid-19th century until the present day. Although the scholarly literature has investigated visual representations of guns in advertising and popular media, it has paid far less attention to how sellers have displayed these objects at or near the point of purchase.
Design/methodology/approach
Primary sources include frescoes, engravings and photographs, plus papers, advertising and illustrations in popular newspapers and trade magazines. These and other period visual data are supplemented by secondary sources from a variety of fields, especially retailing and firearms history.
Findings
Evidence shows that American firearms were merchandised visually by Samuel Colt at three world expositions in the 1850s, by gunmakers and retailers in the latter 19th century, by Winchester and Remington dealers in the 1920s and 1930s, by high- and low-end retailers in New York in the first half of the 20th century and by gun stores, auctions and shows up to the present day.
Originality/value
The history of visual merchandising generally has focused upon major department stores, their alluring street-front windows and their fancy interior displays. This research explores past and present visual merchandising of firearms by manufacturers and smaller retailers. To the best of the author’s knowledge, it is the first such history of the subject.