Quality of life and relationships in sex offenders with intellectual disability

The change in occupational participation and quality of life following occupational therapy for people supervised by probation

INTRODUCTION

The probation system is a penal and enforcement system in which the completion of sentences of individuals who are incarcerated and rehabilitation processes are carried out together. This study considered the change in occupational participation and quality of life following occupational therapy for people supervised by probation.

METHODS

The research was planned as a pre-test and post-test study. Fifteen individuals participated in the study voluntarily. The participants completed the Socio-Demographic Information Form, COPM for occupational participation, and the Nottingham Health Profile (NHP) for quality of life. We implemented an intervention program consisting of, on average, 1 h once a week for 12 weeks. Post-intervention evaluations were completed, and the results were compared.

RESULTS

There was a significant difference between the pre-intervention and post-intervention measures of the total quality of life scores (p = 0.003) and the COPM scores for performance (p = 0.001) and satisfaction (p = 0.001).

CONCLUSION

Implementing a client-centred occupational therapy intervention involving personal behaviour, organisational environment, and activity change resulted in an increase in clients' activity performance, satisfaction with their performance, and quality of life.

Dutch forensic patients with and without intellectual disabilities: A comparison of demographic, offence, and diagnostic characteristics

BACKGROUND

Patients with an intellectual disability (ID) and offending histories constitute a challenging clinical group. The present study examined commonalities and differences in demographic, diagnostic and offence characteristics in patients with and without intellectual disabilities who were either convicted for violent or sexual offences and who resided in mandated care in the Netherlands.

METHOD

We compared 165 offenders with an ID to 249 offenders without an ID. We compared both groups by type of offence (i.e., sexual versus violent offence) using Mann-Whitney U-test or independent samples t-tests for continuous variables and Chi-square tests for categorical variables.

RESULTS

In general, forensic patients with an ID were younger at admission (U=357, z = -12.668, p < .001), had more prior convictions for violent offences (χ²(1)= 6.175, p = .013) and more prevalent diagnoses of substance abuse disorders (χ²(1)= 9.266, p = .002) than those without an ID. Similar results were found for patients with IDs with sexual offence histories.

CONCLUSION

A clear understanding of distinct characteristics of forensic patients with intellectual disabilities is crucial in understanding (sexual) violent behavior in this population as it mayassistclinicians in prioritizing interventionstrategies.

The Sense of Quality of Life and Religious Strategies of Coping with Stress in Prison Inmates

The aim of the presented research was to analyze differences in religious strategies of coping with stress in a group of prison inmates characterized by different levels of the sense of quality of life-general, psychophysical, psychosocial, personal, and metaphysical. The participants were 390 males, aged 19-68 years, serving sentences in prisons in Poland. The measures used were the Sense of Quality of Life Questionnaire by M. Straś-Romanowska and K. I. Pargament's RCOPE Questionnaire. As expected, individuals with a high sense of quality of life-both general and pertaining to specific dimensions-more often chose positive religious strategies, whereas participants with a low sense of quality of life more often chose negative strategies. The exception was the metaphysical aspect of the quality of life: individuals with a high intensity of this dimension more often chose some of the positive as well as negative religious strategies.

A Training Course for Psychologists: Learning to Assess (Alleged) Sexual Abuse Among Victims and Perpetrators Who Have Intellectual Disabilities

People with intellectual disabilities (ID) are at greater risk of being a victim of sexual abuse and may also be more predisposed to perpetrating sexual abuse. Although the prevalence of sexual abuse among people with ID is difficult to determine, it is clear that there are serious consequences for both victims and perpetrators, and professional support is needed. Psychologists play an important role in the assessment of sexual abuse in both victims and perpetrators and require specific knowledge and skills to execute the assessments. We therefore developed a training course for psychologists aimed at increasing their (applied) knowledge of sexual abuse and the related assessment process in people with ID. In a five-day training course, sessions focusing on theories about diagnostic models were combined with sessions focusing on the assessment of sexual abuse of victims and perpetrators. The effectiveness of the training course was determined in terms of (applied) knowledge via the administration of a study-specific questionnaire including a hypothetical case vignette before, immediately after, and six months after completion of the course. The results show that the knowledge of the psychologists related to sexual abuse and the assessment process for sexual abuse increased significantly, and remained above pre-test level at six-month follow-up. These results are promising, but more research is needed to see if the increased (applied) knowledge in turn leads to application in practice and better care for both victims and perpetrators.

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Background

Inpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies was therefore undertaken.

Objectives

To synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector.

Design

Three linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.

Results

At stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.

Conclusions

Together, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted.

Future work

This would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.

Study registration

This study is registered as PROSPERO CRD42015016941.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities

BACKGROUND

There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.

AIMS

This study identified and developed the domains that should be used to measure treatment outcomes for this population.

METHOD

A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts.

RESULTS

The final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.

CONCLUSIONS

To index recovery, services need to measure treatment outcomes using this framework.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Men with intellectual disabilities with a history of sexual offending: empathy for victims of sexual and non-sexual crimes

BACKGROUND

The objectives were (a) to compare the general empathy abilities of men with intellectual disabilities (IDs) who had a history of sexual offending to men with IDs who had no known history of illegal behaviour; and (b) to determine whether men with IDs who had a history of sexual offending had different levels of specific victim empathy towards their own victim, in comparison with an unknown victim of sexual crime, and a victim of non-sexual crime, and make comparisons with non-offenders.

METHODS

Men with mild IDs (n=35) were asked to complete a measure of general empathy and a measure of specific victim empathy. All participants completed the victim empathy measure in relation to a hypothetical victim of a sexual offence, and a non-sexual crime, while additionally, men with a history of sexual offending were asked to complete this measure in relation to their own most recent victim.

RESULTS

Men with a history of sexual offending had significantly lower general empathy, and specific victim empathy towards an unknown sexual offence victim, than men with no known history of illegal behaviour. Men with a history of sexual offending had significantly lower victim empathy for their own victim than for an unknown sexual offence victim. Victim empathy towards an unknown victim of a non-sexual crime did not differ significantly between the two groups.

CONCLUSIONS

The findings suggest that it is important include interventions within treatment programmes that attempt to improve empathy and perspective-taking.

Sex offenders with intellectual disabilities and their academic observers: popular methodologies and research interests

BACKGROUND

Over the past two decades, disability activists and scholars have developed research paradigms that aim to place (some of the) control over the research process in the hands of disabled people. This paper discusses the appropriateness of applying such paradigms to sex offenders with intellectual disabilities (ID). It exposes to what extent current research about this population is affected by these developments.

METHODS

A content analysis of a sample of 80 articles across 20 academic journals was carried out. This recorded the data collection methods used, to what extent the views of people with ID were represented, subject affiliations of the authors and the subject matter discussed.

RESULTS

Few studies make sense of the personal accounts of this population. Social scientists have mostly not engaged in this area of research, which results in significant gaps in knowledge.

CONCLUSIONS

We currently know little about the subjectivity of sex offenders with ID. Research that seeks to explore this may enhance our understanding of this population and thus contribute towards the effectiveness of preventative work and risk management.

Why do some people with intellectual disability engage in offending behaviour and what can we do about it? Editorial

BACKGROUND

The field of forensic intellectual disabilities has been developing rapidly over the last 15 years. Much of the work has been built on research in mainstream criminality but more recently studies have emerged that reveal issues specific to offenders with intellectual disability.

METHOD

Research on pathways into offending is reviewed with reference to its relevance to the field of intellectual disability. We also summarize some findings on pathways into and through services for offenders with intellectual disability.

FINDINGS

Studies reveal that developmental adversity is an important risk variable. Previous and recent aggression are potent risk factors. New evidence suggests that immediate, proximal risk factors may be more important in this client group. The studies in this issue add to the knowledge on pathways into offending, important areas for assessment and effective treatments as well as advancing knowledge in the academic literature on general criminality.

The Ward and Hudson pathways model of the sexual offense process applied to offenders with intellectual disability

The offense pathways model of Ward and Hudson has had a significant impact on work with sex offenders. Researchers have hypothesised that offenders with intellectual disability (ID) will show a predominantly avoidant and passive pathway. The present study classifies 62 sex offenders with ID according to the four self-regulation pathways. Allocation to pathways is highly reliable and, against prediction, most participants are allocated to approach pathways. Explicit/active offenders have a higher rate of contact offenses and a lower rate of reoffending. Automatic/passive offenders have a lower average IQ. There are no significant differences between groups on victim choice, previous offenses, or assessment of cognitive distortions. The results suggest that treatment may improve understanding of society's laws, promote self-regulation, and reduce recidivism for explicit/active offenders.

Forensic issues in intellectual disability

PURPOSE OF REVIEW

The present paper reviews some of the most significant findings in the field of forensic issues related to intellectual disability over the last 2 years.

RECENT FINDINGS

Recent publications have explored the prevalence and assessment of intellectual disabilities in the criminal justice system, as well as individual characteristics of intellectual disabled offenders. Service by the criminal justice system and treatment of intellectual disabled offenders have also been explored. New insights into violence and sexual offences have been achieved, however identification and evidence-based treatment of intellectual disabled offenders are not widely explored issues.

SUMMARY

Progress in treatment studies, studies of the function of the criminal justice system and risk assessments have resulted in improvements in these aspects during recent years. The wide range of services involved in successful initiatives has been addressed, but some crucial aspects still receive too little attention. Differences between countries and cultures have not been emphasized, and the progress that has been achieved seems to be confined to countries with a clear policy and organized services for offenders with intellectual disabilities.

Research issues in forensic psychiatry

PURPOSE OF REVIEW

Forensic psychiatry is a multidisciplinary specialty within the context of criminal and civil law. This paper reviews a broad spectrum of research areas within the forensic psychiatric field, covering publications in 2006.

RECENT FINDINGS

New developments can be divided into four subject areas. The first relates to risk assessment, the second to the epidemiology of violence, the third refers to treatment outcome studies, and the fourth relates to topics of interest within different offender groups.

SUMMARY

There seems to be a growing interest in specifying the needs of different offender groups, such as intellectually-disabled patients, adolescents and women. When it comes to effective treatment models for these subgroups, however, it is not always clear if sufficient attention is paid to the presence of comorbid disorders and their consequences, even in research publications.

Trends and challenges in forensic research on offenders with intellectual disability

BACKGROUND

The Journal of Intellectual & Developmental Disability has a well-respected history of establishing the parameters and contributing to developments in the field of offenders with intellectual disability (ID).

METHOD

The field has seen a number of developments over the past 15 years, and this paper identifies several trends that have emerged in the research during this period, including work on prevalence of ID in prison populations, development of risk assessment, consideration of staff issues, developing the psychometrics of offence-specific assessments, evaluating treatment methods, and testing the underlying theoretical frameworks which attempt to account for offending.

RESULTS AND CONCLUSIONS

We refer to a number of studies which have advanced these developments in the field and draw the reader's attention to the way in which papers in this special issue contribute to and further develop each of these research trends.

A preliminary evaluation of the adaptation of four assessments for offenders with special needs

BACKGROUND

Appropriate assessment is an essential part of treating sexual offenders. Few assessments exist that can be used with offenders who have lower levels of intellectual functioning and/or literacy deficits.

METHOD

This study describes the adaptation of four self-report assessments for sexual offenders with special needs: (i) the Social Intimacy Scale (SIS: Miller & Lefcourt, 1982); (ii) the Relationship Scales Questionnaire (RSQ: Griffin & Bartholomew, 1994a); (iii) the Criminal Sentiments Scale (CSS: Gendreau, Grant, Leipciger, & Collins, 1979); and (iv) the Victim Empathy Distortion Scale (QVES: Beckett & Fisher, 1994). Each scale was adapted in an effort to simplify content and language and to improve readability. Preliminary data are presented on the comparability of each adapted measure to the original, as well as the internal consistency, reliability, and concurrent validity of the adapted tests.

RESULTS

The SIS and the QVES were identified as appropriate assessment measures, comparable to the original with good reliability and validity. One subscale of the RSQ had fair reliability and validity, while the remaining subscales had varied psychometric properties. The adapted CSS had poor psychometric qualities and the adaptation of this test appears not to have been successful.

CONCLUSIONS

The relevance of these findings to our understanding of offending by this population is discussed.

A test of counterfeit deviance: a comparison of sexual knowledge in groups of sex offenders with intellectual disability and controls

Several authors have suggested that lack of sexual knowledge is a primary reason for inappropriate sexual behaviour in men with intellectual disabilities. This hypothesis, counterfeit deviance, is tested in the current report with two separate cohorts comparing sex offenders and controls, both with intellectual disability. The Socio-Sexual Knowledge and Attitudes Test was completed on all participants and any significant differences between groups indicated that the sex offender cohort had a higher level of knowledge. The hypothesis has not been supported. In addition, a positive relationship was found between intellectual ability and knowledge for the control cohort but not for the sex offender cohort.