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  • Evaluating neuropsychologically informed rehabilitation training for staff within a high secure intellectual disability service

    Purpose: Neuropsychologically informed rehabilitation (NIR) is one approach to supporting people with intellectual disabilities, cognitive impairment and challenging behaviour. This study aims to evaluate a five-day training course in NIR for staff working with adult male offenders with intellectual disabilities in a high secure hospital. The impacts on both the staff who undertook the training and the patients with challenging behaviour were explored. Design/methodology/approach: Participants were psychology, nursing and day services staff and male patients. The staff completed a post-training questionnaire and three measures at pre-NIR training, post-NIR training and one-year follow-up. Patients completed four questionnaire measures within the same periods. Findings: NIR training was positively evaluated by staff. Staff members’ perceived efficacy in working with challenging behaviour significantly increased post-training which was maintained at follow-up. Thematic analysis showed that the training staff members built their confidence, knowledge and skills. Because of these being high to start with, the study could not evidence statistically significant changes in these. Thematic analysis yielded two main themes, namely, benefits and quality of training, each with their own subthemes. The impacts of the training on patients were difficult to assess related to various factors. Research limitations/implications: The knowledge and confidence measures used were limited in scope with an experienced staff group and required development. Practical implications: NIR training could assist staff in other secure and community settings in working with people with intellectual disabilities and challenging behaviours. Originality/value: This study positively contributes to an area that requires more research.

  • Causal attribution and coping with classmates’ isolation and humiliation in young adults with mild intellectual disability

    Purpose: The purpose of this study is to consider the role of causal attribution of isolation and humiliation from classmates in the coping of young people with mild intellectual disability. Design/methodology/approach: The R-PI test (Kurtek, 2018) was administered to a sample of 151 transition-age students (age 18-22 years) in Poland. It consists of vignettes that describe stressful situations in which classmates might engage in isolating or humiliating behavior directed at the respondents. The respondents’ coping responses were interpreted according to a coding system based on a multi-axis approach by Hobfoll (1998) and Kelley’s attribution theory (1973). Findings: The results have revealed that a majority of attributions are of defensive character. However, it was found that the justifying attributions were significantly associated with prosocial coping and the accusing attributions were related to antisocial coping. Research limitations/implications: Because a vignette study is not based on actual interactions, the results refer to cognitive rather than behavioral performance. Practical implications: The implications for supporting coping skills through attribution training, especially for youth with aggressive and passive behaviors, are discussed. Social implications: Promoting positive and situational attributions to stressful interactions with classmates increases the likelihood of prosocial coping. Originality/value: Applied cognitive approaches emphasize each respondent’s subjective perspective in attempting to explain humiliating and isolating incidents from classmates and the various coping strategies they personally considered effective in these situations. The present study contributes to the relatively small current literature available in this area.

  • Inpatient aggression in forensic psychiatric patients with autism spectrum disorder: the role of risk and protective factors

    Purpose: Patients with autism spectrum disorder (ASD) are overrepresented in forensic samples. However, research on risk assessment in forensic patients with ASD is scarce. The purpose of this paper was to examine the prevalence of short-term inpatient aggression and explore the risk and protective factors for aggression in forensic psychiatric patients with ASD (N = 32). Design/methodology/approach: The association between two commonly used violence risk assessment instruments (HKT-R and SAPROF) and physical aggression during ten weeks of inpatient stay was examined in a Dutch forensic psychiatric hospital. Findings: Results showed no significant association between HKT-R and SAPROF and incidents of physical aggression. This suggests that the commonly used assessment instruments may be of limited use for assessing the risk of short-term inpatient aggression in patients with ASD. Research limitations/implications: Limitations to the current study include the relatively small sample size and the lack of information on index offenses. Further research with a larger, more homogeneous sample and longer follow-up is indicated to confirm the results of this study. Future research should also include the possible association between aggressive behavior of people with ASD and other factors that might be relevant, such as social cognition deficits, cognitive and sensory impairments, deficient empathy and emotion regulation problems. Originality/value: To the authors’ knowledge, this is the first study to directly examine the prevalence of inpatient aggression of forensic psychiatric patients with ASD and its association with risk and protective factors.

  • Autism spectrum disorder, bestiality and zoophilia: a systematic PRISMA review

    Purpose: There remains a lack of knowledge surrounding paraphilic or deviant arousal sexual behaviours in individuals with Autism spectrum disorder (ASD) (Kellaher, 2015). The purpose of this paper is to explore the literature for any empirical study, case study or discussion/review paper surrounding individuals with ASD and zoophilia or bestiality. Design/methodology/approach: A systematic PRISMA review was conducted. Findings: This systematic review highlighted only a small number of papers, which have looked at zoophilia or bestiality in individuals with ASD. Only one article was identified as being relevant in the present review, three further articles included a description of a case involving someone with ASD who engaged in zoophilia or bestiality and another paper, although not the focus of the study, found one person with Asperger’s disorder who had several paraphilias including olfactophilia, podophilia and zoophilia in a sample of 20 institutionalised, male adolescents and young adults with Autistic disorder and borderline/mild mental retardation. All the case studies clearly highlight some of the ASD symptomology that can contribute to engaging in bestiality or zoophilia. Practical implications: It is important that individuals with ASD have access to appropriate and timely sex education and that parents are supported by healthcare professionals to engage with their children with ASD in such interactions across the autism spectrum irrespective of the parent’s expectations. Originality/value: To the author’s knowledge, this is the first review of ASD in relation to bestiality and zoophilia.

  • Collaborative case report: participatory action research into using EQUIP to support community discharge

    Purpose: There is a need to evaluate an adapted Equipping Youth to help One Another (EQUIP) programme for people with intellectual disabilities and forensic needs. The purpose of this paper is to explore a service user’s experience of completing the intervention as part of their transition into the community. Design/methodology/approach: A collaborative case report was used. Following hospital discharge and completion of the adapted EQUIP programme, one service user with mild intellectual disability was supported to share their treatment experiences using participatory action research. Findings: Findings suggest that while the adapted community EQUIP group can support skills acquisition (e.g. problem-solving), discharge processes and community reintegration, professionals need to maintain a person-centred approach mindful of participants’ complex emotional journeys. Research limitations/implications: The design allows for tentative conclusions to be made about the service user’s journey and is not necessarily generalisable. Practical implications: There is a pressing need to develop the evidence base for interventions offered in the community to people with intellectual disabilities and a history of offending. This report provides some evidence that EQUIP can be adapted to support this population. Originality/value: This is the first coproduced publication exploring the experience of a service user with intellectual disability who completed an adapted EQUIP programme.

  • Training needs analysis of nurses caring for individuals an intellectual disability and or autism spectrum disorder in a forensic service

    Purpose: Examining the education and training needs of forensic nurses is paramount as services move from the older institutions to new care settings. The purpose of this study was to identify Irish Forensic nurses perceived deficits in their knowledge and skills to assist them to provide effective seamless care for individuals with an intellectual disability within their forensic mental health service, so that appropriate training could be provided. Design/methodology/approach: Training needs analysis (TNA) procedures are used as a way of establishing the continuing processional development of staff, as they seek to identify the gaps between the knowledge and skills of an individual and the need for further training. A training needs tool developed by Hicks and Hennessy (2011) was used and completed by nurses working in an Irish forensic mental health service. A total of 140 surveys were circulated and 74 were completed (51 per cent response). Findings: The top priority training needs identified were for additional training in research and audit and in the use of technology. Other self-identified training needs included additional training in behavioural management for challenging behaviour, understanding mental health and intellectual disability and dual diagnosis, training in enhancing communication skills and how to work with patients who have an intellectual disability patients specific training on autistic spectrum disorders and a guide and template for advance individual care planning and for caring for the physical health needs and promoting the physical health needs of these patients. Originality/value: Despite there being a vast range of training issues identified, the majority of nurses appear to have a clear idea of their training needs to ensure the provision of seamless care for individuals with an intellectual disability within a forensic mental health setting. This TNA has identified the specific needs of nursing staff working at different positions across the interface of intellectual disability and forensic mental health care.

  • ASD, OCD and violence – a forensic case study

    Purpose: The purpose of this paper is to illustrate the formulation and psychological treatment of a complex case whereby a combination of autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD) has resulted in violent and aggressive behaviour. Design/methodology/approach: This paper provides a brief summary of literature in relation to ASD, OCD and risk-offending behaviour followed by a case study of a man (referred to as “John”) with a diagnosis of ASD and OCD who has an extensive history of institutional violence and aggressive behaviour. Findings: This paper highlights the complexity of a case that may support research suggesting that impaired theory of mind, poor emotional regulation and problems with moral reasoning increase the risk of an individual with ASD engaging in violence, in addition to a comorbidity of ASD and OCD resulting in a more severe and treatment-resistant form of OCD. Originality/value: This paper highlights the challenges faced when working with a patient with Asperger’s syndrome and OCD with entrenched beliefs that lead to the use of violence as a compulsion to temporarily overcome unpleasant thoughts related to low self-esteem.

  • Learning disability training and probation officer knowledge

    Purpose: Knowledge about learning disabilities has found to be limited in both health and social care staff. To improve the treatment of individuals with learning disabilities and mental health problems within the criminal justice system (CJS), Lord Bradley recommends that professionals receive mental health and learning disability awareness training. However, little is known about the impact of training on the knowledge of professionals in the CJS. This study aims to investigate the impact of a 3-h learning disability training session on the knowledge of probation officers. Design/methodology/approach: Using a repeated measures design, the impact of a 3-h learning disability training session on the knowledge of 12 probation officers was analysed. Findings: In support of this study’s hypothesis, a repeated measures t-test revealed a significant difference between participants pre-training and post-training learning disability knowledge questionnaire (LDKQ) scores. Participants scored significantly higher on the LDKQ post-training compared to pre-training. A linear regression revealed that years worked in probation did not significantly predict participant’s difference scores. Research limitations/implications: Limitations of this study and directions for future studies are discussed. Originality/value: This paper demonstrates that learning disability training can significantly improve the knowledge of probation officers.

  • Learning disability and challenges in male prisons: programme screening evaluation

    Purpose: The purpose of this paper is to validate the learning screening tool (LST) and the adapted functioning checklist-revised (AFC-R) as screening tools to aid programme allocation, and to investigate whether programme decision makers were using the tools as per the guidance provided by HMPPS Interventions Services. Design/methodology/approach: LST and AFC-R data were gathered for 555 men who had been assessed for programmes between 2015 and 2018 across eight prisons and one probation area. WAIS-IV IQ data were also gathered if completed. Findings: The findings provide support for the use of the LST, and AFC-R in helping to make decisions about programme allocation. The LST and AFC-R correlate well with each other, and a measure of intellectual functioning (WAIS-IV). Those who were allocated to learning disability or challenges (LDC) programmes scored higher on the LST (greater problems) and lower on the AFC-R (lower functioning) compared to those allocated to mainstream programmes. The LST had adequate predictive validity. In the majority of cases, the correct procedures were followed in terms of using the tools for programme allocation. Research limitations/implications: The sample size for examining the relationships between all three tools was limited. The research was also unable to take into consideration the clinical decision making involved in how the tools were interpreted. Originality/value: This research contributes to the growing evidence about the effective use of LDC screening tools in forensic settings.

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