The Journal of Forensic Practice

Publisher:
Emerald Group Publishing Limited
Publication date:
2021-02-01
ISBN:
2050-8794

Latest documents

  • Using a visually adapted repertory grid technique (VARGT) with people who stalk

    Purpose: This paper aims to provide instructions on how to implement an adapted version of the standard repertory grid technique (VARGT). The purpose of which is to provide practitioners with a tool, which enables active engagement by participants in research and clinical practice. This tool has been used effectively with people convicted of stalking offences. Design/methodology/approach: Repertory grids, developed from Kelly’s Personal Construct Theory (1955), had never been used with those who stalk, either clinically or in a research context. Visual and kinaesthetic adaptations were made to standard RGT procedures (Grice, 2002; Tan and Hunter, 2002), for use in a mixed methods research study (Wheatley, 2019, p. 77) due to expected challenges in engaging with this group. This manuscript presents theoretical underpinnings and step-by-step instructions for practical application. Findings: The VARGT is easy to administer and produces rich data, in both qualitative and quantitative formats. This adapted approach encourages active participation and an interpreted therapeutic collaboration (Wheatley et al., 2020). Practical implications: This novel technique has engaged men convicted of stalking offences collaboratively in research activities and showed potential for its use as a clinical tool. This instructional technical paper allows the technique to be replicated. Originality/value: This novel technique has engaged men convicted of stalking offences collaboratively in research activities and showed potential for its use as a clinical tool. This instructional technical paper allows the technique to be replicated.

  • Researcher-practitioner reflections: the therapeutic utility of the visually adapted repertory grid technique (VARGT) with stalkers

    Purpose: This paper outlines researcher–practitioner reflections on the use of a visually adapted repertory grid technique (VARGT) with men convicted of stalking. It draws on and assimilates participant experiences of the VARGT as a research engagement tool. Further, it extends discussion to propose its value as a generic engagement tool for when personal insights and collaborative case formulations may otherwise be difficult to access. Design/methodology/approach: The repertory grid technique, developed from Kelly’s Personal Construct Theory (1955), was adapted visually for utility in a mixed methods research study with those who commit stalking offences (Wheatley, in preparation). Analytical and reflexivity processes within this original study highlighted rich and recurrent data across the sample pertaining to the positive participant experience of the VARGT, unrelated to its core research question. Findings: This paper presents reflections and psychological discussion for experiences of using the VARGT. Key features clustered around therapeutic alliance and engagement, enlightenment and a motivation for positive change. Practical implications: This paper suggests the VARGT has value in participant–client engagement, particularly where sensitive topics are being investigated and participants have difficulty directly articulating their psychosocial functioning. Originality/value: This novel technique offers potential as an engagement tool for use in research and clinical settings.

  • Care quality commission inspections of high-security hospitals

    Purpose: Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and regulates forensic healthcare provision. The purpose of this study is to identify key concerns highlighted in CQC inspection reports of the three high-secure hospitals in England between 2010 and 2018. Design/methodology/approach: In this qualitative study, 49 CQC inspection reports from three high-secure hospitals were subjected to thematic analysis. Findings: Five central themes emerged: staffing and management; restrictive practice; physical environment and ward atmosphere; patients’ needs and involvement in their care; and legal and statutory matters. There was some variation in the overall quality of care between the hospitals. Positive staff–patient interactions and good practice in assessing and delivering care were consistently observed. However, enduring staff shortages within each hospital were experienced negatively and sometimes co-occurred with concerns over restrictive practices, poor care-plan procedure and inadequate legal documentation. Over time, Rampton and Broadmoor Hospitals appeared to worsen with regard to staffing levels, staff morale and management involvement. While services progressed over time in providing patients with access to advocacy and information concerning their rights, in some recent inspections it remained unclear whether patients were adequately involved in the care-plan process. Practical implications: These findings provide preliminary indicators for areas requiring further attention from policymakers, clinicians and advocates. Originality/value: This study appears to be the first systematic analysis of key concerns expressed in CQC reports of English high-security hospitals.

  • “Swimming against the tide”: conditional discharge from medium secure care

    Purpose: The purpose of this paper is to explore the experiences of mentally disordered offenders (MDOs) conditionally discharged from secure hospitals on a restrictive Section of the Mental Health Act (Section 37/41). Design/methodology/approach: Data were derived from seven semi-structured interviews from three forensic community teams. Findings: Thematic analysis identified seven predominant themes: (1) the uncertainty of the discharge timeframe; (2) fear of jeopardising discharge; (3) progress; (4) engagement with community life; (5) barriers to social engagement; (6) evolving identity and (7) someone to turn to. Findings are discussed in relation to the recovery model and the good lives model. Practical implications: The findings highlight the importance of fostering trust between MDOs and their care teams to encourage help-seeking. They also suggest that resources should be sequenced appropriately throughout the discharge process, to match the “window of engagement” and maximize impact and effectiveness. Originality/value: This research gained rarely obtained first-hand perspectives from MDOs, with the findings contributing to a more effective evaluation of the discharge pathway.

  • Understanding the lived experience of British non-offending paedophiles

    Purpose: Research into paedophilia mainly uses offender samples; thus, little is understood about non-offending paedophiles. The limited body of research has been conducted in North America or Europe whose health and legal systems differ from those in the UK. Using semi-structured interviews, the purpose of this study is to explore the experience of three non-offending British paedophilic males. Design/methodology/approach: The interview discussed their paedophilia, refraining from offending and perspectives on treatment initiatives. Data were analysed using interpretative phenomenological analysis. Findings: Three superordinate themes emerged: “paedophilia as more than a sexuality,” “acceptance leads to management” and “barriers to support.” These encapsulated how paedophilia was understood, how accepting one’s sexual attraction is tantamount to well-being and the various obstacles to providing support were discussed. Research limitations/implications: Acknowledging the sampling considerations (size and recruitment), the results implicate research into paedophilia. The onset of paedophilia was chronologically associated with typical sexual attraction, and not the result of sexual abuse as some theories suggest. Furthermore, the tenets of attraction to children extending beyond sexual desire were highlighted. Practically, the results influence future research into the area and highlight the dearth in our understanding of diverse behavioural management techniques (i.e. computerised images of children or human-like dolls). Originality/value: This paper presents novel insight into the aspects of paedophilia, excluding offensive behaviour and highlights the need for affordable, UK-based services targeted towards people with a paedophilic attraction to manage child sexual abuse preventatively and not reactively.

  • Implementation of a schema therapy awareness group for adult male low secure patients with comorbid personality difficulties: reflections and challenges

    Purpose: The purpose of this study/paper is to describe the implementation of a six-month schema therapy awareness (STA) group. Research supporting individual schema therapy (ST) as an effective intervention for personality disorder is growing steadily within a number of settings including with forensic patients. Alongside individual ST, positive results have been reported for group ST. However, to the best of the authors’ knowledge, no current published research exists with regard to the use of group ST within forensic populations and more specifically within a low secure environment. Design/methodology/approach: This paper describes the implementation of a six-month schema therapy awareness (STA) group with individuals situated within a low secure environment. Findings: For individuals transitioning into the community from a secure setting, the focus of risk management should attempt to move away from external controls towards more of a reliance on internal factors. In ST, this is achieved by understanding the role of schema modes (and underlying schemas) that are linked to an individual’s offences/risk and developing this understanding into a coherent and accessible formulation for the individual to make changes. Research limitations/implications: Further robust research evaluating clinical change is recommended as the next step. Practical implications: The group protocol is described along with the challenges and potential solutions experienced during the implementation. This provides an opportunity for other professionals to replicate this approach in the future. Originality/value: With regard to group ST within forensic populations, the research is sparse at present and this study focusses on practical application of theory and the challenges of operationalising a STA group.

  • The importance of considering trauma in individuals with autism spectrum disorder: considerations and clinical recommendations

    Purpose: The area of trauma in autism spectrum disorders (ASDs) is an important area given the substantial rates of abuse endured by these individuals. However, there are issues with the identification of trauma, understanding how it is perceived, and manifested. The paper aims to discuss this issue. Design/methodology/approach: The limited research regarding trauma in ASD is reviewed and gaps are identified. Findings: The key findings from the relevant literature are discussed. Practical implications: Practical suggestions are outlined for more effective identification of trauma in individuals with ASD. Originality/value: To date, there has been relatively little research on trauma and ASD. This paper emphasises the urgent need for attention in this area.

  • Adolescent inpatient completers of dialectical behaviour therapy

    Purpose: Dialectical behaviour therapy (DBT) aims to reduce emotional dysregulation and engagement in less adaptive behaviours for adults with mixed disorders of conduct and emotions (MDCE). However, there is limited evidence available for the effectiveness of DBT skills training for adolescents with MDCE who are resident within a secure impatient setting. The paper aims to discuss these issues. Design/methodology/approach: A retrospective study investigated changes in aggressive and self-injurious behaviours in 22 adolescents within a secure inpatient mental health setting with MDCE who had completed one cycle of DBT skills training. Changes in symptomatic problems, behavioural and social impairment were also investigated in 17 of the 22 participants who completed the DBT skills training cycle. Findings: There were statistically significant decreases in the frequencies of engagement in total aggressive and deliberate self-harm behaviours after the DBT skills training cycle. There was a significant improvement in symptomatic and behavioural impairment, but not in social impairment. Practical implications: The findings of this study suggest that DBT skills training may be beneficial for behavioural and symptomatic outcomes in adolescent inpatients with MDCE. Originality/value: This study provides preliminary evidence for the effectiveness of DBT skills training for adolescents with MDCE within a secure inpatient setting. Additional studies are required to investigate the clinical benefits of specific aspects of DBT for individual patients.

  • The perceived challenges of working with patients who use new psychoactive substances: a qualitative study in a medium secure unit

    Purpose: New psychoactive substances (NPS) are increasingly being used in secure mental health settings. Within these settings, NPS use presents a range of challenges and staff currently lack adequate training to manage these challenges. The purpose of this paper is to explore nursing staffs’ perception of the challenges of working with patients who use NPS and to explore nursing staffs’ perception of their training needs in relation to NPS. Design/methodology/approach: A cross-sectional qualitative design was employed. Semi-structured interviews were conducted with eight nursing staff from a medium secure unit (MSU). Findings: A thematic analysis identified three overarching themes: “There Will Always Be Something”, “We Are Doing Our Best” and “If We Know More, We Can Do More”. The findings describe how nursing staff manage NPS use at present, and their perceptions of how training could improve their management of NPS use in the future. Practical implications: The findings suggest that MSUs require a local policy for managing NPS use. The research implies that staff training programmes should recognise the existing methods staff use to manage NPS use. The findings also suggest that NPS interventions should target the whole peer group and not just the individual using NPS. Originality/value: This paper contributes to the limited literature on NPS. The findings demonstrate the importance of developing evidence-based mechanisms for managing NPS use. Changes to practice are suggested, with the view of developing ways in which staff currently manage NPS use by complementing this with specific training on NPS.

  • Changing clinicians’ perceptions of the role that risk formulation and the HCR-20v3 play in the assessment and management of violence

    Purpose: The assessment and management of risk towards others is an integral part of clinical practice, particularly in forensic and other psychiatric settings. Version 3 of the HCR-20 is the latest version of a comprehensive set of professional guidelines based on the Structured Professional Judgement model. It is the most widely used and best validated tool available to assess risk of violence; however, clinicians perceive it as an additional task with limited clinical usefulness, which requires undergoing expensive training and takes considerable time to implement. The paper aims to discuss these issues. Design/methodology/approach: Training was delivered to 148 clinicians to improve perceptions with regard to risk formulation and the HCR-20v3 as an effective and clinically useful tool in generating individual and robust care plans to minimise risk of violence. Findings: Results indicated significant score increase post-training, indicating higher regard for the HCR-20 in terms of its usefulness, anticipated impact upon working, anticipated impact upon managing risk, ease of completion and perceived relevance to clinical practice. This was also consistent with qualitative feedback indicating improved risk management and care planning with reference to how learning would support respective roles. Feedback also highlighted the added value of certain aspects of the training provided, which may be useful to consider when designing HCR-20 training packages. Research limitations/implications: This study demonstrates the importance of engaging clinicians in bespoke training on the practicalities of HCR-20 completion and the fundamentals of risk formulation. Practical implications: This study highlights the importance of incorporating a training package for staff of all disciplines in changing perceptions of risk management tools and thus their use in the practical management of violence. The useful aspects of training may assist changing perceptions of the role that risk formulation and the HCR-20v3 play in the assessment and management of violence. Originality/value: This research suggests that if this can be done successfully, it may lead to a change in the perception of the role that the HCR-20v3 can play in assessing risk of violence and generating meaningful management plans to reduce the future likelihood of violence.

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