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Ryland H, Cook J, Ferris R, Markham S, Sales C, Fitzpatrick R, Fazel S. Development of the FORUM: a new patient and clinician reported outcome measure for forensic mental health services. PSYCHOLOGY, CRIME & LAW : PC & L 2022; 28:865-882. [PMID: 36157331 PMCID: PMC7613634 DOI: 10.1080/1068316x.2021.1962873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/28/2021] [Indexed: 06/16/2023]
Abstract
Forensic mental health services provide care to people in secure psychiatric hospitals and via specialised community teams. Such services are typically low volume and high cost, often highly restrictive and average duration of inpatient care prior to discharge is long. Measuring outcomes of care is important to safeguard patients and the public, monitor progress, inform treatment plans and assist in service evaluation and planning. We describe the development in England of a new outcome measure for forensic mental health services. Patient interviews and multistakeholder focus groups were held to elicit key concepts. Thematic analysis was used to develop an outcomes framework. Fifteen patients participated in the interviews and 48 stakeholders in the focus groups. Six domains were identified in thematic analysis: 'about me, my quality of life, my health, my safety and risk, my life skills and my progress'. Sixty-two stakeholders participated in the first round of the Delphi process, and 49 completed round two. Eight of the top fifteen outcomes were shared between patients/carers and professionals. Based on these results, a new outcome measure, the FORensic oUtcome Measure (FORUM), was developed including both a patient reported and clinician reported measure. Further assessment of the FORUM's use to track patients' progress over time, and facilitate shared decision-making and care planning, is required.
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Affiliation(s)
- Howard Ryland
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jonathan Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Medicine, University of Oxford, Oxford, UK
| | - Rob Ferris
- James Nash House Forensic Mental Health Service, Adelaide, Australia
| | - Sarah Markham
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christian Sales
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Quinn S, Rhynas S, Gowland S, Cameron L, Braid N, O Connor S. Risk for intellectual disability populations in inpatient forensic settings in the United Kingdom: A literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1267-1280. [PMID: 35995572 PMCID: PMC10087896 DOI: 10.1111/jar.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with an intellectual disability who commit a criminal offence can be detained, by a court, in a forensic inpatient facility. There is limited understanding of how inpatients with an intellectual disability and their nurses navigate risk in U.K. forensic services. METHODS A traditional literature review design was followed to map evidence (2000-2021) around the forensic and health and wellbeing risks faced by inpatients with an intellectual disability, nurses' perceptions of managing risk, and patient experiences of informing risk assessment and management. Papers were analysed thematically. RESULTS Findings suggest that restrictive measures to mitigate forensic risks (e.g., violence) can exacerbate the risk of poor health and wellbeing outcomes. There was some limited evidence of direct patient involvement in risk assessment and management. CONCLUSION Further research is required to explore how forensic inpatients with an intellectual disability can have input in care planning, risk assessment and management.
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Affiliation(s)
- Sam Quinn
- The University of Edinburgh, Edinburgh, Scotland
| | - Sarah Rhynas
- The University of Edinburgh, Edinburgh, Scotland
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McCarthy J, Chaplin E, Hayes S, Søndenaa E, Chester V, Morrissey C, Allely CS, Forrester A. Defendants with intellectual disability and autism spectrum conditions: the perspective of clinicians working across three jurisdictions. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2022; 29:698-717. [PMID: 36148388 PMCID: PMC9487969 DOI: 10.1080/13218719.2021.1976297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The treatment of vulnerable defendants by criminal justice systems or correctional systems varies within and between countries. The purpose of this paper is to examine three legal jurisdictions - New South Wales in Australia; Norway; England and Wales - to understand the extent of variation in practice within the court systems for defendants with intellectual disabilities (ID) and/or autism spectrum conditions (ASC). Two of the jurisdictions had a process for screening in place, either in police custody or at court, but this was not universally implemented across each jurisdiction. All three jurisdictions had a process for supporting vulnerable defendants through the legal system. Across the three jurisdictions, there was variation in disposal options from a mandatory care setting to hospital treatment to a custodial sentence for serious offences. This variation requires further international exploration to ensure the rights of defendants with ID or ASC are understood and safeguarded.
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Affiliation(s)
- Jane McCarthy
- Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eddie Chaplin
- Institute of Health and Social Care, London South Bank University, London, UK
- Correspondence: Eddie Chaplin, Institute of Health and Social Care, London South Bank University, 103 Borough Road, LondonSE1 0AA, UK.
| | - Susan Hayes
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Erik Søndenaa
- Faculty of Medicine, Institute of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Forensic Department, St.Olavs Hospital, Trondheim, Norway
| | - Verity Chester
- Hertfordshire Partnership University NHS Foundation Trust, Little Plumstead Hospital, Hospital Road, Norwich, UK
| | - Catrin Morrissey
- Lincolnshire Partnership NHS Foundation Trust and University of Nottingham, Nottingham, UK
| | - Clare S. Allely
- School of Health and Society, Salford University, Salford, UK and affiliate member of the Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrew Forrester
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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Devapriam J, Fosker H, Chester V, Gangadharan S, Hiremath A, Alexander RT. Characteristics and outcomes of patients with intellectual disability admitted to a specialist inpatient rehabilitation service. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:21-34. [PMID: 29444613 DOI: 10.1177/1744629518756698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting 'step-down' referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service 'bridged the gap' between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.
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Affiliation(s)
- J Devapriam
- Leicestershire Partnership NHS Trust, UK; Care Quality Commission, UK
| | - H Fosker
- Leicestershire Partnership NHS Trust, UK
| | | | | | - A Hiremath
- Leicestershire Partnership NHS Trust, UK
| | - R T Alexander
- St Johns House, UK; Leicestershire Partnership NHS Trust, UK
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Wichaikhum O, Abhicharttibutra K, Nantsupawat A, Kowitlawakul Y, Kunaviktikul W. Developing a strategic model of participation in policy development for nurses. Int Nurs Rev 2019; 67:11-18. [DOI: 10.1111/inr.12571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 10/17/2019] [Accepted: 10/31/2019] [Indexed: 12/01/2022]
Affiliation(s)
- O. Wichaikhum
- Faculty of Nursing Chiang Mai University Chiang Mai Thailand
| | | | - A. Nantsupawat
- Faculty of Nursing Chiang Mai University Chiang Mai Thailand
| | - Y. Kowitlawakul
- Alice Lee Centre for Nursing Study/Yong Loo Lin School of Medicine National University of Singapore Country Singapore Singapore
| | - W. Kunaviktikul
- Faculty of Nursing Chiang Mai University Chiang Mai Thailand
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Delforterie M, Hesper B, Didden R. Psychometric properties of the Dynamic Risk Outcome Scales (DROS) for individuals with mild intellectual disability or borderline intellectual functioning and externalizing behaviour problems. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 33:662-672. [PMID: 30460720 DOI: 10.1111/jar.12546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 07/25/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present study examined the psychometric properties of the Dynamic Risk Outcome Scales (DROS), an instrument developed to measure dynamic risk factors in individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) and externalizing (including offending-like) behaviour problems. METHOD The sample consisted of 606 clients (86% male) from inpatient treatment wards at a facility for individuals with MID-BIF and externalizing behaviour problems. RESULTS The DROS showed an acceptable factor structure, good internal consistency, significant test-retest reliability and fair to excellent inter-rater reliabilities for most subscales and total score. Compared to the Adult Behavior Checklist (ABCL; Achenbach & Rescorla, 2003 Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families), the DROS showed convergent and divergent validity, concurrent and longitudinal validity. CONCLUSIONS The DROS is a reliable and valid instrument to measure dynamic risk factors in clients with MID-BIF. Future research on the DROS will focus on the assessment of recidivism and the inclusion of internalizing problems.
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Affiliation(s)
| | | | - Robert Didden
- Trajectum, Zwolle, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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Chester V, Völlm B, Tromans S, Kapugama C, Alexander RT. Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs. BJPsych Open 2018; 4:226-234. [PMID: 29988967 PMCID: PMC6034466 DOI: 10.1192/bjo.2018.24] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/04/2018] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability. AIMS To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England. METHOD File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported. RESULTS Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores. CONCLUSIONS In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.
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Affiliation(s)
- Verity Chester
- Research & Projects Associate, Priory Group, St John's House, Diss and PhD candidate, University of East Anglia, UK
| | - Birgit Völlm
- Professor in Forensic Psychiatry, Institute of Mental Health, University of Nottingham, UK
| | - Samuel Tromans
- Speciality Registrar, Leicestershire Partnership NHS Trust, Leicester & Academic Clinical Lecturer, Department of Health Sciences, University of Leicester, UK
| | - Chaya Kapugama
- Speciality Registrar, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Regi T. Alexander
- Consultant Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust and Honorary Senior Lecturer, Department of Health Sciences, University of Leicester, UK
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Williams EM, Thrift S, Rose J. The subjective experiences of women with intellectual disabilities and offending behaviour: exploring their experiences of 'home'. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2018; 64:132-143. [PMID: 34141300 PMCID: PMC8115536 DOI: 10.1080/20473869.2017.1413153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Services supporting individuals with intellectual disabilities are changing in the UK with a drive towards community care and reducing inpatient provision. More needs to be known about the experiences and opinions of individuals living in inpatient settings. Women with intellectual disabilities and offending behavior are a particularly complex, under-represented group affected by these organizational changes. This research aims to consult women with intellectual disabilities, living in a secure hospital, to explore their housing experiences and hopes for future home and care environments. METHOD Seven participant's experiences, and the meaning they assign to these experiences, were explored through semi-structured interviews. Their narratives were analyzed utilizing Interpretive Phenomenological Analysis. RESULTS Four superordinate themes emerged from the analysis (i) hospital as helpful (ii) hospital as undesirable (iii) a sense of belonging (iv) 'I want to be as independent as I can.' The subtheme 'importance of people' emerged throughout with illustrations of why people are important relating to each superordinate theme. CONCLUSIONS The women interviewed experienced living in hospital as both helpful and undesirable. They wanted to live as independently as possible in the community. However, they identified several helpful aspects of hospital including receiving specialist support for their complex needs. They desired independence, freedom to choose, personal space, familiarity, and support from individuals who understand their needs. Whilst it is recognized that hospitals cannot be homes for people, they do have a function in providing helpful specialist support to some individuals with intellectual disabilities who have committed serious crimes and/or cannot safely be supported in the community.
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Affiliation(s)
| | - Su Thrift
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - John Rose
- School of Psychology, The University of Birmingham, Birmingham, UK
- Academic Unit, St Andrews Hospital, Nothampton, UK
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