View in EDS HTML Full Text PDF Full Text

Responsivity to Criminogenic Need in Forensic Intellectual Disability Services

Saved in:
Bibliographic Details
Title: Responsivity to Criminogenic Need in Forensic Intellectual Disability Services
Language: English
Authors: Lindsay, W. R., Holland, A. J., Carson, D., Taylor, J. L., O'Brien, G., Steptoe, L., Wheeler, J.
Source: Journal of Intellectual Disability Research. Feb 2013 57(2):172-181.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 10
Publication Date: 2013
Document Type: Journal Articles
Reports - Research
Information Analyses
Descriptors: Foreign Countries, Mental Retardation, Recidivism, Crime, Behavior Modification, Cognitive Restructuring, Outcomes of Treatment, Violence, Sexual Abuse, Clinical Diagnosis, Community Services, Tables (Data), Research Assistants
Geographic Terms: United Kingdom
DOI: 10.1111/j.1365-2788.2012.01600.x
ISSN: 0964-2633
Abstract: Background: Research has shown for some time that addressing criminogenic need is one of the crucial aspects of reducing reoffending in all types of offenders. Criminogenic need such as anger or inappropriate sexual interest is considered to be crucial in the commission of the offence. The aim of the present study is to investigate the extent to which forensic services address the needs of those accepted into services. Method: This study reviews the treatment for 197 offenders with intellectual disability accepted into a range of services. Participants' case files were examined to ascertain the extent to which need was addressed through recognised therapies. A standard pro forma was used on which we had established good reliability across four research assistants. Results: The most frequently referred problems were violence and sexual offending. Specialist forensic intellectual disability community services were significantly more likely to provide treatment specifically designed to address index behaviours when compared to generic community services and secure services. Conclusions: Various possible explanations of these findings are explored including staffing levels, diagnosed mental illness, expertise of staff and clarity of purpose in services. (Contains 3 tables.)
Abstractor: As Provided
Number of References: 30
Entry Date: 2014
Accession Number: EJ1012857
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwFxqjVrC3UIaiUHYoFIpJc-AAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDGPvQpbpDFe8dE0AEAIBEICBmlxicWQymbnFwzvzAcXEtgd4cQor69GEjDTxSBOxlUz42AzM1KoQL2ufiBRwHhvbhR4z_uK8O56MGFvDVPNEAvJukDXSDedlhhG-TbSC_W80BMtDnnMFqExQz3oU3XCG5eL765zM8PHLIJbQ5bUzs0_kU5JSIfbbnZQfkb9PHYDkIQvr-qP5AFTH6nuLzhg9UoTYlIZ3e3lc9vk=
Text:
  Availability: 1
  Value: <anid>AN0084622604;eul01feb.13;2018Jul09.14:14;v2.2.500</anid> <title id="AN0084622604-1">Responsivity to criminogenic need in forensic intellectual disability services. </title> <p>Background  Research has shown for some time that addressing criminogenic need is one of the crucial aspects of reducing reoffending in all types of offenders. Criminogenic need such as anger or inappropriate sexual interest is considered to be crucial in the commission of the offence. The aim of the present study is to investigate the extent to which forensic services address the needs of those accepted into services. Method  This study reviews the treatment for 197 offenders with intellectual disability accepted into a range of services. Participants' case files were examined to ascertain the extent to which need was addressed through recognised therapies. A standard pro forma was used on which we had established good reliability across four research assistants. Results  The most frequently referred problems were violence and sexual offending. Specialist forensic intellectual disability community services were significantly more likely to provide treatment specifically designed to address index behaviours when compared to generic community services and secure services. Conclusions  Various possible explanations of these findings are explored including staffing levels, diagnosed mental illness, expertise of staff and clarity of purpose in services.</p> <p>intellectual disability; offenders; service response; sexual offending; violence; criminogenic need</p> <p>For over two decades, we have now understood that the principles of risk and responsivity are important in offender rehabilitation. Andrews et al. (1990a) discussed four principles to guide the effect of assessment and treatment of offenders: risk, need, responsivity and professional override. These principles underlined a number of issues. Firstly, characteristics of the offenders are important when considering rehabilitation programmes. Andrews et al. (1990a) noted that programmes should address the specific needs of high risk offenders. Risk is defined in empirical terms as those individuals who are at greatest risk of reoffending. Risk assessment has been shown to be as predictive with offenders with intellectual disability (ID) as it is with offenders without disability (Gray et al. 2007; Lindsay et al. 2008; Camarillo & Quinsey 2011; Fitzgerald et al. 2012). Treatment should be directed towards criminogenic need such as anger, impulsivity, inappropriate sexual preference and so on. Responsivity is defined by the extent to which the treatment programmes in the service are designed to address these criminogenic needs through appropriate treatment. Andrews et al. (1990b) conducted a meta‐analysis of 80 studies of interventions in mainstream forensic settings. They categorised the programmes for the extent to which they responded to criminogenic need and found that programmes focusing on high‐risk offenders (without disability) were five times more effective in reducing recidivism than those focusing on lower‐risk offenders.</p> <p>Layton Mackenzie (2000) reviewed evidence‐based corrections in mainstream settings using the ‘What Works’ criteria. The evidence suggested that effective programmes were structured, focused on developing skills and were directed towards overt problems. They must be designed to address the characteristics of the offenders that are associated with criminal activities. Cognitive behaviour therapy (CBT) was effective in a number of forms including sex offender treatment provided in a hospital setting. CBT directed towards criminal thinking and impulsiveness and treatment directed towards control of anger were particularly useful. After completing a meta‐analysis of sex offender treatment with mainstream sex offenders, Hanson et al. (2002) concluded that those treatments employing CBT techniques showed significant reductions in reoffending. Beck & Fernandez (1998), again with mainstream offenders studies, completed a meta‐analysis of CBT treatments for anger based on 50 studies and reported that on average, participants in CBT anger programmes improved more than 76% of treated controls. Several reviews (e.g. Wilson et al. 2005) have found that cognitive skills programmes in mainstream offender settings, usually prisons, are associated with significant reductions in offending post release. In this way, treatment programmes targeted at the focus of the offending issue produce reductions in recidivism.</p> <p>A number of authors have reported on the characteristics of offenders with ID referred to and accepted into forensic ID services. The most prevalent index behaviour and the most common problem in the history of offenders is aggression and violence (Lindsay et al. 2010a; Lunsky et al. 2011; Vinkers 2012), followed by sexual offences (Lindsay et al. 2010a) and alcohol/substance misuse (Alexander et al. 2010; Lindsay et al. 2010a; Lunsky et al. 2011). For at least the first two of these difficulties there are clearly developed experimentally validated treatments. Of the cognitive behaviour therapies adapted for people with ID, anger management treatment is the best established. There have been a number of controlled trials that have shown the superiority of anger management treatment over a waiting list control (Taylor et al. 2005; Lindsay et al. 2004; Rose et al. 2005) and in a randomised controlled trial (Willner et al. 2002; Rose et al. 2012). Sex offender treatment for people with ID has been shown to reduce recidivism in studies with large samples of offenders (Lindsay et al. 2006, 2011; SOTSEC‐ID 2010). Although it has not been tested in anything other than case studies, alcohol treatment has been shown to reduce alcohol intake and increase alcohol knowledge in people with ID who have a problem with alcohol (Lindsay et al. 2012).</p> <p>In a study on offenders in a range of forensic ID services, Lindsay et al. (2010b) followed up 197 participants for a 2‐year period noting pathways for those accepted into high secure, medium secure, low secure, local in patient, community forensic, and community generic ID services. The greatest stability in referral pathways across the 2 years was seen in secure services and community generic services. The most diverse pathways were seen in those referred to community forensic ID services and to local patient services. The present paper is a development on this work and investigates the delivery of treatment to individuals in these services across this period of time. We also present information relating treatment responsiveness to criminogenic need in the form of index offence.</p> <p>The study aims to ascertain the extent to which services for offenders with ID address the needs of individuals that may have led them into offending. Classically (Andrews et al. 1990a), those services that address criminogenic need such as anger (for violent offending), sexual deviation (for sexual offending) or alcohol problems (alcohol‐related violence) have had greatest effects on recidivism. By identifying the responsivity of services it might be possible to either reassure clinicians that current efforts are appropriately directed or reveal where changes might be required.</p> <hd id="AN0084622604-2">Method</hd> <hd id="AN0084622604-3">Settings</hd> <p>The locations for this study included several health board regions and two maximum secure hospitals. The study was initiated primarily to investigate pathways into and through forensic ID services. It was felt that the most likely method of securing adequate amounts of reliable information on this topic with correspondingly adequate numbers of referrals was to include services with a history of experience and expertise in dealing with offenders with ID and their level of security.</p> <p>Generic community services, which accepted individuals who had committed offences or exhibited offending behaviour consisted of 15 community teams across two large geographical areas (total population 5 million). Each team consisted of at least, community learning disability nursing staff and a psychiatrist. All had access to ID social work staff, psychologists, speech and language therapy and occupational therapy.</p> <p>Two specialist forensic community ID services were included consisting of a psychiatrist, psychologist and community learning disability nurses. They both had direct liaison with criminal justice social work departments. Five general in patient units were studied. Each was staffed by ID nurses, a psychiatrist and a psychologist, and had access to speech and language therapists, occupational therapists and dieticians. Data from these sources were combined because both were considered to be services that were designed as specialist, geared at least to some extent to their specific area needs. Each would have local relationships with social work agencies, housing agencies, possibly education and police. Therefore there was the possibility of adjusting treatment and management procedures to suit local circumstances.</p> <p>One regional and one small local service were included as low security services. Both were staffed by ID nurses, psychiatrists and psychologists. The large regional service also employed speech and language therapists, occupational therapists and dieticians, while the smaller service had access to these professionals. A large regional medium secure service was included. It was staffed by psychiatrists, psychologists, ID nurses, speech and language therapists, occupational therapists and dieticians.</p> <p>Two high secure forensic ID services were included. Both were staffed by ID nurses, psychiatrists, psychologists, speech and language therapists, social workers and occupational therapists and patients had access to dieticians and physical instructors.</p> <p>These six location classifications (generic community, specialist forensic community, acute in patient, low secure, medium secure, high secure) were retained in order to assess the extent to which treatment services were matched to the index offence and history of problem behaviour. Broadly, referral criteria matched the conventions in the UK. This follows International Classification of Disease 10 criteria for the classification of ID including IQ less than 70 giving consideration to the standard error of the test (in effect this has represented IQ less than 75), deficits in two areas of adaptive behaviour as measured by a standardised assessment, and onset of these difficulties in childhood or adolescence. All generic ID services in the UK have an open referral policy for people with problems meeting the diagnostic classification for ID. Forensic ID services accept those with forensic problems and diagnosable ID. Although one would expect a strong relationship between risk and level of security, reflecting the risk principal that those of higher assessed risk require greater levels of secure service, Lindsay et al. (2010c) found that the relationship between risk and level of security in the present study showed a low to medium effect size (from r = 0.24 to r = 0.33 depending on the measure and sample).</p> <hd id="AN0084622604-4">Participants</hd> <p>Participants comprised 168 males and 29 females (total 197) who were accepted into the forensics services already described. All referrals were made in the year 2002 (because of the low referral rate, 2001 and 2002 were included for high secure services) and referral was related to antisocial or offending behaviour including physical aggression, verbal aggression, sexually inappropriate behaviour, cruelty towards and neglect of children, property damage, fire setting, theft, motor vehicle or traffic‐related behaviours, obtaining goods and money under false pretences and illegal drug‐related behaviours. Participants were followed up for the subsequent 2 years and we will present treatment delivered in relation to the index offences. Taking the sample as a whole, 42% were referred for physical aggression, 26% for verbal aggression, 14% for contact sexual offences, 13% for non‐contact sexual offences, 20% for property damage, 5% for cruelty or neglect to children, 5% for alcohol/substance abuse, 5% for theft and 3% for arson.</p> <hd id="AN0084622604-5">Ethical approval</hd> <p>Ethical approval was sought through the Scottish Medical Research Ethics Committee. After some negotiation, approval was granted for England under Section 60 Exemptions of the Health and Social Care Act 2001 and for Scotland under Caldicott Guardian Approval. On the direction of the ethical committees, a pilot study was conducted gathering informed consent and it was found that such a requirement seriously limited and skewed the sample. Therefore it was agreed to allow the gathering of anonymised data from the case files, without informed consent, on the basis of the Section 60 Exemption and Coldacott Guardian approval.</p> <hd id="AN0084622604-6">Procedure and materials</hd> <p>Four research assistants were allocated, one to each of the study areas and liaised with local clinical teams to gather information from the clinical files. They used a standard form manual to gather all the information (pro formas are available from the senior author). Data were collected on a range of variables including index offence, history of problem behaviour and psychological treatment received by each participant. All research assistants had at least graduate level qualifications and psychology. They all completed a dedicated 1‐week course in order to ensure consistency of data collection across sites. Following a rigorous testing on three complex cases, these assistants responded in the same way at least 84% of the time. For each participant there were 848 data points entered in the dataset. In the final reliability check at the end of the training for the research assistants 715 (84.3%) received the same code from all four research assistants, 796 (93.9%) received the same code from three out of four research assistants. This was a significant level of agreement for raters, because if one was discrepant, this was scored as a disagreement. However, such a criterion (four agreements on each item) was necessary for the purposes of this study.</p> <hd id="AN0084622604-7">Results</hd> <p>Of 75 participants referred with an index problem of non‐sexual violence, a total of 27 participants received anger treatment across the review period. Seven were recorded in 0–12 months and nine in the 13‐ to 24‐month period. Eleven participants were recorded across both years. Table 1 shows the number of individuals who were referred to each level of service and the number of those for whom violence was included in the index offence. Two services responded to criminogenic need with some consistency. Of the eight referred to the community forensic ID services, six (75%) attended anger management sessions in the 2‐year review period. Of the three referred to in patient treatment, two (66%) attended anger management. Interestingly, in the community forensic ID services, a further 13 referrals were incorporated into anger treatment. Although their index incident did not include violence, all of these participants had anger problems as having been identified. For the same reason, a further two were incorporated into anger treatment in the inpatient setting. In the other settings, community generic, low secure, medium secure and high secure, only 11 participants from 64 referrals (17%), all with violence has an index offence, received anger treatment.</p> <p>1 Numbers referred to services with violence as an index offence and the numbers in anger treatment at 12 months and 24 months</p> <p> <ephtml> <table><tr><th>Service</th><th>Total n accepted</th><th>n with index violence</th><th>12 months violent index</th><th>12 months not violent index</th><th>24 months violent index</th><th>24 months not violent index</th></tr><tr><td>Community General</td><td>77</td><td>34</td><td>2</td><td>4</td><td>1</td><td>1</td></tr><tr><td>Community Forensic</td><td>53</td><td>8</td><td>4</td><td>8</td><td>2</td><td>5</td></tr><tr><td>In patient</td><td>16</td><td>3</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td>Low secure</td><td>18</td><td>11</td><td>0</td><td>0</td><td>4</td><td>0</td></tr><tr><td>Medium secure</td><td>17</td><td>11</td><td>2</td><td>1</td><td>2</td><td>1</td></tr><tr><td>High secure</td><td>16</td><td>8</td><td>0</td><td>1</td><td>0</td><td>2</td></tr><tr><td>Totals</td><td>197</td><td>75</td><td>9</td><td>15</td><td>10</td><td>10</td></tr></table> </ephtml> </p> <p>In order to make some statistical calculation on the differences in numbers treated in different services some categories were combined to increase the cell numbers. Community generic services were retained as a discrete group since they provided general support to the full range of difficulties experienced by people with ID including forensic problems. Participants in secure services were combined into a single secure service category. For reasons given in Method section, community forensic and acute in patient services were combined since both provide specialist services to their communities. There is evidence that acute inpatient services do cater for individuals with forensic problems in their catchment area in a specific manner since there have been reports in the literature on ways of assessing and treating these individuals (Alexander et al. 2010; Lunsky et al. 2011). The proportions of referrals with a violent index offence who were receiving anger treatment were compared between groupings. Because of low numbers in cells (despite the groupings), Fisher's Exact was used to ascertain the significance of the differences. Between community forensic/acute inpatient and secure services the difference was significant (P = 0.012) with a greater proportion receiving anger treatment in community forensic and acute inpatient services. Similarly, a greater proportion in community forensic/acute inpatient received treatment compared to community generic (P < 0.001). There was no significant difference between secure and generic community services (P = 0.10).</p> <p>A total of 62 participants were referred for sexual offences (Table 2). Slightly more than half (<reflink idref="bib34" id="ref1">34</reflink>) were accepted into sex offender treatment. Twenty‐two were in treatment across both review periods, six were in treatment during 0 to 12 months and six were in treatment during the 13‐ to 24‐month period. Again, those who received treatment were largely in community forensic ID services or in acute inpatient services. In the community forensic ID services, 27 were accepted into the services and 25 (93%) received sex offender treatment at some point in the study. In the acute in patient services, seven admissions had an index sexual incident and all received sex offender treatment at some point. Of the 27 referred with an index sex offence from community generic, low secure, medium secure and high secure services, six (22%) were in treatment. Fisher's Exact conducted on these results showed a significantly greater proportion in treatment for the community forensic/acute inpatient services when compared to both the secure services (P < 0.001) and the generic community services (P < 0.001). There was no difference between community generic and secure (P = 0.18). In contrast to the information on anger treatment, only a small number of individuals who did not have index sexual offences were included and treatment. All those individuals had previous sexual offences.</p> <p>2 Number accepted into the service with a sex offence as an index offence and the numbers in sex offender treatment at 12 months and 24 months in each type of service</p> <p> <ephtml> <table><tr><th>Service</th><th>Total n accepted</th><th>n with index sex offence</th><th>12 months sex offence index</th><th>12 months not sex offence index</th><th>24 months sex offence index</th><th>24 months not sex offence index</th></tr><tr><td>Community General</td><td>77</td><td>12</td><td>0</td><td>1</td><td>1</td><td>1</td></tr><tr><td>Community Forensic</td><td>53</td><td>27</td><td>17</td><td>2</td><td>13</td><td>2</td></tr><tr><td>In patient</td><td>16</td><td>7</td><td>5</td><td>2</td><td>3</td><td>2</td></tr><tr><td>Low secure</td><td>18</td><td>5</td><td>1</td><td>1</td><td>1</td><td>2</td></tr><tr><td>Medium secure</td><td>17</td><td>3</td><td>1</td><td>0</td><td>0</td><td>0</td></tr><tr><td>High secure</td><td>16</td><td>7</td><td>0</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Totals</td><td>197</td><td>62</td><td>24</td><td>7</td><td>20</td><td>8</td></tr></table> </ephtml> </p> <p>Two other behaviours are either commonly associated with offenders with ID or are common criminogenic needs. Fire setting has been associated with offenders with ID (Walker & McCabe 1973; Prins 1980) although more recent studies have found levels of fire setting in this group to be no different from non‐disabled offenders (Hogue et al. 2006; Lindsay et al. 2010a). There were three cases of fire setting in the group accepted into services in this study, two were in treatment at 12 months and none at 24 months. Both cases in treatment were in the community generic service. For the other main issue, 14 individuals were referred with alcohol abuse as part of their index offence. Two were in alcohol treatment at 12 months and none at 24 months. Both cases in treatment were in the community forensic ID services.</p> <p>Because there is such a low level of provision of treatment in the community generic, low secure, medium secure and high secure services, we felt it necessary to investigate the extent to which treatment might have been contra indicated because of other major variables associated with the referral. The most obvious of these is mental illness. If an individual is acutely mentally ill then it is reasonable to wait until the mental illness is under control before embarking on psychological treatment. In this way, the individual participant may not have been able to engage with treatment because of their mental illness. Table 3 shows that those in forensic ID services had significantly lower levels of diagnosed mental illness than all other groups. These differences are reflected in the numbers receiving psychotropic medication at 12 and 24 months.</p> <p>3 Percentages (numbers in parenthesis) of participants diagnosed with mental illness and the numbers receiving psychotropic medication at 12 months and 24 months</p> <p> <ephtml> <table><tr><th>Service</th><th>Total n accepted</th><th>% (n) with psychiatric disturbance</th><th>Medication at 12 months</th><th>Medication at 24 months</th></tr><tr><td>Community General</td><td>77</td><td>50.6 (39)</td><td>68.8 (53)</td><td>67.5 (52)</td></tr><tr><td>Community Forensic</td><td>53</td><td>18.9 (10)</td><td>30.2 (16)</td><td>22.6 (12)</td></tr><tr><td>In patient</td><td>16</td><td>50.0 (8)</td><td>69.8 (11)</td><td>56.3 (9)</td></tr><tr><td>Low secure</td><td>18</td><td>55.6 (10)</td><td>83.3 (15)</td><td>77.8 (14)</td></tr><tr><td>Medium secure</td><td>17</td><td>94.1 (16)</td><td>94.1 (16)</td><td>88.2 (15)</td></tr><tr><td>High secure</td><td>16</td><td>62.5 (10)</td><td>81.3 (13)</td><td>68.8 (11)</td></tr><tr><td>Chi square</td><td /><td>34.5</td><td>38.4</td><td>39.9</td></tr><tr><td>(df 5) P</td><td /><td>0.01</td><td>0.01</td><td>0.01</td></tr></table> </ephtml> </p> <hd id="AN0084622604-8">Discussion</hd> <p>The results reported in this paper reflect the first investigation into response to criminogenic need in forensic ID services in the UK. The study is a reasonably comprehensive review of those individuals refer to and accepted into such services (Lindsay et al. 2010a,b). It has been noted that the catchment areas for the services in this study represents around 12 million people or one‐fifth of the UK population. It is therefore likely that this study is a reasonable reflection of the way in which services responded to people with ID who have forensic needs in the years of study.</p> <p>Given that the sample is reasonably representative it is gratifying that forensic ID services and acute inpatient services do seem to respond to criminogenic need with some sensitivity. Of 11 referrals to these services with an index offence of violence, eight have received anger treatment. Of 34 referred for sexual offence to the services, 32 have received sex offender treatment. Therefore, of these 45 referrals, 40 (89%) have received appropriate treatment. For the community generic referrals, 34 had index violence of whom three received anger treatment while 12 had an index sexual offence with one receiving sex offender treatment. Therefore, while 46 were referred, four (9%) received appropriate treatment. Because they all recorded lower levels of treatment, we have combined the secure services in this discussion. Together 30 individuals were accepted into secure services with index violence and seven (23%) received treatment while 15 were accepted into services for sexual offences and five (33%) received sex offender treatment. In crude terms, for these two main types of index referral, taking appropriate treatment as a ‘responsivity index’, community generic services have a responsivity index of 9%, specialised community services (community forensic and acute inpatient) have a responsivity index of 89% and secure services have a responsivity index of 27%.</p> <p>It is certainly possible that participants would not be treated because they are considered too mentally ill for psychological treatment to be appropriate. For that reason, we assessed the extent to which no treatment was associated with mental illness and antipsychotic medication. We found a significant relationship between treatment status and either mental illness or antipsychotic medication when comparing groups. There was a lower level of mental illness diagnosis in the community forensic group than in all other categories. Therefore, it may be the case that these individuals in services apart from community forensic ID, were considered too mentally ill to warrant treatment for their offence‐related behaviour. However, one piece of data mitigates against this hypothesis. The acute ID hospital services had a similar level of mental illness but a ‘responsivity index’ of 90% which is the highest of all the services compared. There seems no persuasive reason why offence‐related treatment would be considered more appropriate in acute services than in other in patient (secure) services. Indeed the opposite might be more readily argued with acute services more likely to admit individuals for acute mental illness.</p> <p>The generic community services in the study were chosen because of their familiarity and readiness to accept forensic referrals. While this was certainly true, the evidence presented here would suggest that these services are not well equipped to provide appropriate treatment. One possible reason for the low levels of treatment directed at behaviour involved in the index offence is that genetic community ID services have wide‐ranging and comprehensive responsibilities for assessment and treatment of mental illness, challenging behaviour, family breakdown, difficulties in group community homes and so on. Therefore, the responsibilities of genetic services are such that specific difficulties related to offenders may be lost in the large number of referrals. Many of the referrals related to, for example, family breakdown, maybe of such urgency that they take precedence over of referrals such as forensic difficulties. There is little doubt that staffing was an issue in forensic services examined. Although we did not collect comprehensive information about staffing, it is fairly typical that in the community generic service, each member of the team can hold a caseload of between 30 and 40 cases. This makes it very difficult to extend prolonged treatment, such as sex offender treatment, to individuals where appropriate.</p> <p>Another, perhaps related issue is that outlined by Holland (2011) recently when he presented information suggesting that generic community ID services lack cohesion and unity of purpose because of the disparity of referrals, a lack of agreed direction and persistent low levels of staffing. Given a possible lack of cohesion and lack of agreed direction, it is easy to see why certain groups, such as forensic referrals, may be overlooked because cohesion and direction are determined by urgent referrals requiring immediate attention. This would not be the case for a community forensic ID service which by its very nature has a focus for its client group. Therefore, a degree of cohesion is already demanded by the title of the community service. Whether or not this is translated into an assessment and/or treatment service is another issue. The main issue at this point in the argument is that the service as a focus client group.</p> <p>The same cannot be said for the low, medium or high secure services. These services are designed to accept forensic referrals of precisely the nature of individuals in this study, that is, sexual and violent offenders. Medium and high secure services in particular are generally relatively well staffed with appropriately trained individuals so that they can provide treatment for these particular problems. In our experience, and the small amount of data collected on services for this study, these settings generally had around one member of staff available for assessment and treatment of every five to seven participants. It is of some concern that they have been recorded as providing appropriate treatment for only 27% of cases.</p> <p>One reason why community forensic ID services may provide a higher level of treatment related to criminogenic need is that they have no physical security. In low, medium and high secure services there is always a physical barrier that prevents any clients in the services from perpetrating another offence outside of the unit or hospital. This is never the case in community services where an individual is able to commit another offence at any time since they are likely to live at home, with their family or an open community group home. Experience of individuals working in such services would suggest that concern over reoffending is a major motivation for the establishment and maintenance of treatment. Lindsay (2009) has written that it can be difficult to discharge an individual who has previously committed a sex offence because another service, such as a training or housing association, that has accepted him is wary of continuing if he is no longer coming to treatment. In this way, professionals (including those within the community forensic ID service) view continuing treatment as an insurance against possible future incidents. It is also the case that the court may have included treatment as part of the probation order and in these cases, the provision of treatment is monitored by the Probation Service. Therefore, there are a number of internal and external motivators that promote the establishment and continuation of treatment.</p> <p>It is a possible drawback of this study that services were chosen because of their familiarity with forensic referrals. As mentioned in Method section, services were chosen because their experience with forensic referrals made it more likely that there would be an adequate number of referrals included in the study. The corollary of this inclusion policy is that these services might promote some clustering to the results. In effect, the services show that treatment is being provided because they are familiar with such provision. In other services there may have been different results with lower levels of treatment provision. While this is a theoretical concern, the results would not bear out such a limitation. The secure services are specifically designed to provide treatment services for such cases and in this study, a low level of treatment was provided. If clustering were to be evident then we might expect the opposite with higher levels of provision in these settings. Similarly, although the generic community service was familiar with such referrals, it seems that, possibly for reasons given, the service was unable to deliver intervention targeted at these criminogenic factors. Therefore while clustering of treatment provision in the selected services is a theoretical drawback, it has not been evident in the outcome of the study.</p> <p>The analysis did not distinguish between those taking ante epileptic medication for epilepsy and those who were prescribed medication for challenging behaviour and mood disorders. While those with diagnosed mental illness were prescribed medication more frequently, we did not partial out the relationships between type of medication and diagnosis. This is another limitation given that this emerged as a significant relationship. Future studies might focus attention on these more specific interactions.</p> <p>It has also been hypothesised that socio‐economic status might affect the nature of services to the various localities in this study. It is unlikely to influence the secure services since they take referrals nationally or from large regions. However, by their very local nature, other community and hospital services may have attended to local socio‐economic need with, for example, more emphasis on establishing benefit entitlement or housing. Although there was an attempt to gather information on deprivation, this proved very time consuming and ultimately impossible in so many cases that it was abandoned. It should be said that the community services were located in known areas of relative deprivation in several cases (e.g. East of Scotland) and in no obvious case was the demographic noticeably different from the rest of the UK.</p> <p>One definite drawback is that the data are 9 years old and services may have developed since this study was completed. It is certainly the case that the high secure services have altered their design with building work and the implementation of a therapeutic community in one hospital and a complete rebuild with corresponding reductions in provision in the other. To our knowledge there have been no other major reorganisations of services in the other settings. However, it may be that there have been internal changes aimed at reflecting the treatment needs of individuals such as the participants in this study. Therefore the results should be treated with some caution given the possibilities for change in these settings.</p> <hd id="AN0084622604-9">Funding</hd> <p>This research was funded by UK Department of Health National Forensic Health research and development programme – research grant no MRD/12/45.</p> <ref id="AN0084622604-10"> <title>References</title> <blist> <bibl id="bib1" type="bt">1</bibl> <bibtext>Alexander R. T., Green E. N., O'Mahoney B., Gunaratna I. J., Gangadharan S. & Hoare S. ( 2010 ) Personality disorders in offenders with intellectual disability: a comparison of clinical, forensic and outcome variables and implications for service provision. Journal of Intellectual Disability Research 54, 650 – 8. </bibtext> </blist> <blist> <bibl id="bib2" type="bt">2</bibl> <bibtext>Andrews D. A., Zinger I., Hoge R. D., Bonta J., Gendreau P. & Cullen F. ( 1990a ) Does correctional treatment work? A clinically relevant and psychologically informed meta‐analysis. Criminology 8, 369 – 404. </bibtext> </blist> <blist> <bibl id="bib3" type="bt">3</bibl> <bibtext>Andrews D.A., Bonta J. & Hoge R. ( 1990b ) Classification for effective rehabilitation: rediscovering psychology. Criminal Justice and Behavior 17, 19 – 52. </bibtext> </blist> <blist> <bibl id="bib4" type="bt">4</bibl> <bibtext>Beck R. & Fernandez E. ( 1998 ) Cognitive behavioural therapy in the treatment of anger: a meta‐analysis. Cognitive Therapy and Research 22, 63 – 74. </bibtext> </blist> <blist> <bibl id="bib5" type="bt">5</bibl> <bibtext>Camarillo J. & Quinsey V. ( 2011 ) Appraising the risk of sexual and violent recidivism among intellectual disabled offenders. Psychology, Crime & Law 17, 59 – 74. </bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext>Fitzgerald S., Gray N. S., Alexander R. T., Bagshaw R., Chesterman P., Huckle P. et al. ( 2012 ) Predicting institutional violence in offenders with ntellectual disabilities: the predictive efficacy of the VRAG and the HCR‐20. Journal of Applied Research in Intellectual Disabilities (in press). </bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext>Gray N. S., Fitzgerald S., Taylor J. & Snowden R. J. ( 2007 ) Predicting future reconviction in offenders with intellectual disabilities: the predictive efficacy of VRAG, PCL‐SV and the HCR‐20. Psychological Assessment 19, 474 – 9. </bibtext> </blist> <blist> <bibl id="bib8" type="bt">8</bibl> <bibtext>Hanson R. K., Gordon A., Harris A. J. R., Marques J. K., Murphy W., Quinsey V. L. et al. ( 2002 ) First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders. Sexual Abuse: A Journal of Research and Treatment 14, 169 – 94. </bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext>Hogue T. E., Steptoe L., Taylor J. L., Lindsay W. R., Mooney P., Pinkney L. et al. ( 2006 ) A comparison of offenders with intellectual disability across three levels of security. Criminal Behaviour and Mental Health 16, 13 – 28. </bibtext> </blist> <blist> <bibl id="bib10" type="bt">10</bibl> <bibtext>Holland A. J. ( 2011 ) The organisation of community learning disability services – a systemic analysis. Paper presented to the Seattle Club conference, 2011, Cambridge. </bibtext> </blist> <blist> <bibl id="bib11" type="bt">11</bibl> <bibtext>Layton MacKenzie D. ( 2000 ) Evidence based corrections: identifying what works. Crime and Delinquency 46, 457 – 71. </bibtext> </blist> <blist> <bibl id="bib12" type="bt">12</bibl> <bibtext>Lindsay W. R. ( 2009 ) The Treatment of Sex Offenders with Developmental Disabilities. A Practice Workbook. Wiley‐Blackwell, Chichester. </bibtext> </blist> <blist> <bibl id="bib13" type="bt">13</bibl> <bibtext>Lindsay W. R., Allan R., Parry C., Macleod F., Cottrell J., Overend H. et al. ( 2004 ) Anger and aggression in people with intellectual disabilities: treatment and follow‐up of consecutive referrals and a waiting list comparison. Clinical Psychology & Psychotherapy 11, 255 – 64. </bibtext> </blist> <blist> <bibl id="bib14" type="bt">14</bibl> <bibtext>Lindsay W. R., Steele L., Smith A. H. W., Quinn K. & Allan R. ( 2006 ) A community forensic intellectual disability service: twelve year follow‐up of referrals, analysis of referral patterns and assessment of harm reduction. Legal and Criminological Psychology 11, 113 – 30. </bibtext> </blist> <blist> <bibl id="bib15" type="bt">15</bibl> <bibtext>Lindsay W. R., Hogue T. E., Taylor J. L., Steptoe L., Mooney P., O'Brien G. et al. ( 2008 ) Risk assessment in offenders with intellectual disability. International Journal of Offender Therapy and Comparative Criminology 52, 90 – 111. </bibtext> </blist> <blist> <bibl id="bib16" type="bt">16</bibl> <bibtext>Lindsay W. R., O'Brien G., Carson D. R., Holland A. J., Taylor J. L., Wheeler J. R. et al. ( 2010a ) Pathways into services for offenders with intellectual disabilities: childhood experiences, diagnostic information and offence related variables. Criminal Justice and Behavior 37, 678 – 94. </bibtext> </blist> <blist> <bibl id="bib17" type="bt">17</bibl> <bibtext>Lindsay W. R., Holland A. J., Wheeler J. R., Carson D., O'Brien G., Taylor J. L. et al. ( 2010b ) Pathways through Services for Offenders with Intellectual Disability: a one and two year follow up study. American Journal of Intellectual and developmental Disabilities 115, 250 – 62. </bibtext> </blist> <blist> <bibl id="bib18" type="bt">18</bibl> <bibtext>Lindsay W. R., Carson D. R., O'Brien G., Holland A. J., Johnston S., Taylor J. L. et al. ( 2010c ) The relationship between assessed risk and security level for offenders with intellectual disabilities. Journal of Forensic Psychiatry and Psychology 21, 537 – 40. </bibtext> </blist> <blist> <bibl id="bib19" type="bt">19</bibl> <bibtext>Lindsay W. R., Michie A. M., Steptoe L., Moore F. & Haut F. ( 2011 ) Comparing offenders against women and offenders against children on treatment outcome for offenders with intellectual disability. Journal of Applied Research in Intellectual Disabilities 24, 361 – 9. </bibtext> </blist> <blist> <bibl id="bib20" type="bt">20</bibl> <bibtext>Lindsay W. R., Tinsley S. & Emara M. ( 2012 ) (Chapter 15). The assessment and treatment of alcohol problems in people with intellectual disabilities. In: Alcohol‐Related Violence: Prevention and Treatment (ed. M. McMurran ) Wylie/Blackwell, Chichester (in press). </bibtext> </blist> <blist> <bibl id="bib21" type="bt">21</bibl> <bibtext>Lunsky Y., Gracey C., Koegl C., Bradley E., Durbin J. & Raina P. ( 2011 ) the clinical profile and service needs of psychiatric inpatients with intellectual disabilities and forensic involvement. Psychology, Crime & Law 17, 9 – 25. </bibtext> </blist> <blist> <bibl id="bib22" type="bt">22</bibl> <bibtext>Prins H. ( 1980 ) Offenders, Deviants or Patients? The Study of Socio‐Forensic Problems. Tavistock Publications, London. </bibtext> </blist> <blist> <bibl id="bib23" type="bt">23</bibl> <bibtext>Rose J., Loftus M., Flint B. & Carey L. ( 2005 ) Factors associated with the efficacy of a group intervention for anger in people with intellectual disabilities. British Journal of Clinical Psychology 44, 305 – 17. </bibtext> </blist> <blist> <bibl id="bib24" type="bt">24</bibl> <bibtext>Rose J., Willner P., Shead J., Jahoda J., Gillespie D., Townson J. et al. ( 2012 ) Different factors influence thirds party reports of anger by adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities (in press). </bibtext> </blist> <blist> <bibl id="bib25" type="bt">25</bibl> <bibtext>SOTSEC‐ID ( 2010 ) Effectiveness of group cognitive‐behavioural treatment for men with intellectual disabilities at risk of sexual offending. Journal of Applied Research in Intellectual Disabilities 6, 537 – 51. </bibtext> </blist> <blist> <bibl id="bib26" type="bt">26</bibl> <bibtext>Taylor J. L., Novaco R. W., Gillmer B. T., Robertson A. & Thorne I. ( 2005 ) Individual cognitive behavioural anger treatment for people with mild‐borderline intellectual disabilities and histories of aggression: a controlled trial. British Journal of Clinical Psychology 44, 367 – 82. </bibtext> </blist> <blist> <bibl id="bib27" type="bt">27</bibl> <bibtext>Vinkers D. J. ( 2012 ) Pre trial reported defendants in the Netherlands with intellectual disability, borderline and normal intellectual functioning. Journal of Applied Research in Intellectual Disabilities (in press). </bibtext> </blist> <blist> <bibl id="bib28" type="bt">28</bibl> <bibtext>Walker N. & McCabe S. ( 1973 ) Crime and Insanity in England. University Press, Edinburgh. </bibtext> </blist> <blist> <bibl id="bib29" type="bt">29</bibl> <bibtext>Willner P., Jones J., Tams R. & Green G. ( 2002 ) A randomised controlled trial of the efficacy of a cognitive behavioural anger management group for clients with learning disabilities. Journal of Applied Research in Intellectual Disabilities 15, 224 – 53. </bibtext> </blist> <blist> <bibl id="bib30" type="bt">30</bibl> <bibtext>Wilson D. B., Bouffard L. A. & MacKenzie D. L. ( 2005 ) A quantitative review of structured, group orientated, cognitive behavioural programmes for offenders. Criminal Justice and Behavior 32, 172 – 204. </bibtext> </blist> </ref> <aug> <p>By W. R. Lindsay; A. J. Holland; D. Carson; J. L. Taylor; G. O'Brien; L. Steptoe and J. Wheeler</p> </aug> <nolink nlid="nl1" bibid="bib34" firstref="ref1"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1012857
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Responsivity to Criminogenic Need in Forensic Intellectual Disability Services
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Lindsay%2C+W%2E+R%2E%22">Lindsay, W. R.</searchLink><br /><searchLink fieldCode="AR" term="%22Holland%2C+A%2E+J%2E%22">Holland, A. J.</searchLink><br /><searchLink fieldCode="AR" term="%22Carson%2C+D%2E%22">Carson, D.</searchLink><br /><searchLink fieldCode="AR" term="%22Taylor%2C+J%2E+L%2E%22">Taylor, J. L.</searchLink><br /><searchLink fieldCode="AR" term="%22O'Brien%2C+G%2E%22">O'Brien, G.</searchLink><br /><searchLink fieldCode="AR" term="%22Steptoe%2C+L%2E%22">Steptoe, L.</searchLink><br /><searchLink fieldCode="AR" term="%22Wheeler%2C+J%2E%22">Wheeler, J.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+Disability+Research%22"><i>Journal of Intellectual Disability Research</i></searchLink>. Feb 2013 57(2):172-181.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2013
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Information Analyses
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Recidivism%22">Recidivism</searchLink><br /><searchLink fieldCode="DE" term="%22Crime%22">Crime</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Restructuring%22">Cognitive Restructuring</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Violence%22">Violence</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Abuse%22">Sexual Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+Diagnosis%22">Clinical Diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Community+Services%22">Community Services</searchLink><br /><searchLink fieldCode="DE" term="%22Tables+%28Data%29%22">Tables (Data)</searchLink><br /><searchLink fieldCode="DE" term="%22Research+Assistants%22">Research Assistants</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22United+Kingdom%22">United Kingdom</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/j.1365-2788.2012.01600.x
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0964-2633
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Research has shown for some time that addressing criminogenic need is one of the crucial aspects of reducing reoffending in all types of offenders. Criminogenic need such as anger or inappropriate sexual interest is considered to be crucial in the commission of the offence. The aim of the present study is to investigate the extent to which forensic services address the needs of those accepted into services. Method: This study reviews the treatment for 197 offenders with intellectual disability accepted into a range of services. Participants' case files were examined to ascertain the extent to which need was addressed through recognised therapies. A standard pro forma was used on which we had established good reliability across four research assistants. Results: The most frequently referred problems were violence and sexual offending. Specialist forensic intellectual disability community services were significantly more likely to provide treatment specifically designed to address index behaviours when compared to generic community services and secure services. Conclusions: Various possible explanations of these findings are explored including staffing levels, diagnosed mental illness, expertise of staff and clarity of purpose in services. (Contains 3 tables.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 30
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2014
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1012857
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1012857
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/j.1365-2788.2012.01600.x
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 172
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Mental Retardation
        Type: general
      – SubjectFull: Recidivism
        Type: general
      – SubjectFull: Crime
        Type: general
      – SubjectFull: Behavior Modification
        Type: general
      – SubjectFull: Cognitive Restructuring
        Type: general
      – SubjectFull: Outcomes of Treatment
        Type: general
      – SubjectFull: Violence
        Type: general
      – SubjectFull: Sexual Abuse
        Type: general
      – SubjectFull: Clinical Diagnosis
        Type: general
      – SubjectFull: Community Services
        Type: general
      – SubjectFull: Tables (Data)
        Type: general
      – SubjectFull: Research Assistants
        Type: general
      – SubjectFull: United Kingdom
        Type: general
    Titles:
      – TitleFull: Responsivity to Criminogenic Need in Forensic Intellectual Disability Services
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Lindsay, W. R.
      – PersonEntity:
          Name:
            NameFull: Holland, A. J.
      – PersonEntity:
          Name:
            NameFull: Carson, D.
      – PersonEntity:
          Name:
            NameFull: Taylor, J. L.
      – PersonEntity:
          Name:
            NameFull: O'Brien, G.
      – PersonEntity:
          Name:
            NameFull: Steptoe, L.
      – PersonEntity:
          Name:
            NameFull: Wheeler, J.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 02
              Type: published
              Y: 2013
          Identifiers:
            – Type: issn-print
              Value: 0964-2633
          Numbering:
            – Type: volume
              Value: 57
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of Intellectual Disability Research
              Type: main
ResultId 1