Case study illustrations of a psychological treatment pathway in a secure intellectual disability service

Pages102-114
Published date11 June 2018
Date11 June 2018
DOIhttps://doi.org/10.1108/JIDOB-02-2018-0002
AuthorGareth Hickman,Su Thrift,Chénelle Taylor
Subject MatterHealth & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders
Case study illustrations of a psychological
treatment pathway in a secure intellectual
disability service
Gareth Hickman, Su Thrift and Chénelle Taylor
Abstract
Purpose The purpose of this paper is to describe in detail the treatment pathway utilised in a male medium
and low secure intellectual disability (ID) service. Over the preceding five years, service users have followed
the outlined treatment pathway. The current paper offers case study material to illustrate the care pathway.
Design/methodology/approach Thetreatment pathwayis described andtwo case examples areprovided,
illustrating participation in the pathway. Evaluative data are provided on length of hospitalisation, direction of
pathwayat discharge and risk reductionas assessed by the HCR-20,SVR-20 and HONOS Secure measures.
Findings The case examples provided document the assessment and treatment of two male offenders
with ID, outlining their treatment pathways, subsequent reductions in assessed risk and their successful
community discharge.
Originality/value A comprehensive treatment pathway is outlined together with the theoretical rationale,
with illustrative case examples.
Keywords Treatment outcome, Case study, Secure services, Intellectual disabilities, Inpatient,
Treatment pathway
Paper type Case study
Introduction
In the UK, secure services provide healthcare treatment aimed at risk management and
reduction in cases where custodial disposals are required, but prison is deemed unsuitable for
the individual, in keeping with the recommendations of the HM Government (2009). This
provision includes secure services for people with intellectual disabilities (ID) whose presentation
requires ongoing detention and cannot be safely managed in the community (Alexander et al.,
2011). Individuals within secure services are predominantly detained under sections of the
Legislation.gov.uk (2018), most commonly the criminal sections of the Mental Health Act, due to
their ongoing risk of offending or risk behaviour.
Given that the primary aim of secure services is to reduce risk of offending, the question of the
effectiveness of treatment approaches at reducing risk is inevitably pertinent. However, with no
commonly agreed outcome measures with which to evaluate service impact and treatment
outcome, this can be challenging. Alexander et al. (2011) highlight a small number of studies that
relate specifically to service-level outcomes at the point of discharge from high, medium and low
secure ID services (Reed et al., 2004; Day, 1988; Halstead et al., 2001; Alexander et al., 2006;
Gray et al., 2007; Butwell et al., 2000; Morrissey et al., 2007). The core outcome measures
utilised in these studies were duration of stay, direction of care pathway, hospital re-admission,
institutional aggression and re-offending behaviour. In summary, this literature highlights a
number of limitations with these evaluation approaches. For example, average duration of stay is
a difficult construct to meaningfully measure (Butwell, 2003), and dependent on what inclusion/
exclusion criteria (e.g. high/medium/low secure patients; males and/or females; remanded
Received 19 February 2018
Revised 19 February 2018
Accepted 19 February 2018
Gareth Hickman is based at the
Secure Services, Coventry and
Warwickshire Partnership NHS
Trust, Birmingham, UK.
Su Thrift is based at the
Brooklands Hospital, Coventry
and Warwick Partnership NHS
Trust, Birmingham, UK.
Chénelle Taylor is based at the
Community Learning Disability,
North East London NHS
Foundation Trust, London, UK.
PAGE102
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
VOL. 9 NO. 2 2018, pp.102-114, © Emerald Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-02-2018-0002

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