Essential elements of treatment and care in high secure forensic inpatient services: an expert consensus study
| Pages | 189-203 |
| DOI | https://doi.org/10.1108/JFP-07-2015-0041 |
| Published date | 08 August 2016 |
| Date | 08 August 2016 |
| Author | James Tapp,Fiona Warren,Chris Fife-Schaw,Derek Perkins,Estelle Moore |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Essential elements of treatment and care
in high secure forensic inpatient services:
an expert consensus study
James Tapp, Fiona Warren, Chris Fife-Schaw, Derek Perkins and Estelle Moore
James Tapp is a Chartered
Psychologist in Clinical and
Research Governance at
Centralised Groupwork
Service, Broadmoor Hospital,
Crowthorne, UK.
Fiona Warren is a Lecturer and
Chris Fife-Schaw is a Professor
of Psychology, both at the
Department of Psychology,
University of Surrey,
Guildford, UK.
Derek Perkins is based at
Department of Psychology,
Broadmoor Hospital,
Crowthorne, UK.
Estelle Moore is a Head of
Psychological Services at the
Department of Psychology,
Broadmoor Hospital,
Crowthorne, UK.
Abstract
Purpose –The evidence base for what works with forensic patients in high-security inpatient settings has
typically focused on outcome research and not included clinical expertise from practice-based experience,
which is an important facet of evidence-based practice. The purpose of this paper is to establish whether
experts with clinical and/or research experience in this setting could reach consensus on elements of
high-security hospital services that would be essential to the rehabilitation of forensic patients.
Design/methodology/approach –A three-roundDelphi survey was conducted to achieve this aim. Experts
were invited to rate agreement with elements of practice and interventions derived from existing research
evidence and patient perspectives on what worked. Experts were also invited to propose elements of hospital
treatment based on their individual knowledge and experience.
Findings –In the first round 54 experts reached consensus on 27 (out of 39) elements that included physical
(e.g. use of CCTV), procedural (e.g. managing restricted items) and relational practices (e.g. promoting
therapeutic alliances), and to a lesser extent-specific medical, psychological and social interventions. In total,
16 additional elements were also proposed by experts. In round 2 experts (n ¼45) were unable to reach a
consensus on how essential each of the described practices were. In round 3 (n ¼35), where group
consensus feedback from round 2 was provided, consensus was still not reached.
Research limitations/implications –Patient case complexity, interventions with overlapping outcomes
and a chequered evidence base history for this population are offered as explanations for this finding
alongside limitations with the Delphi method.
Practical implications –Based on the consensus for essential elements derived from research evidence
and patient experience, high-secure hospital services might consider those practices and interventions that
experts agreed were therapeutic options for reducing risk of offending, improving interpersonal skills and
therapeutic interactions with patients, and mental health restoration.
Originality/value –The study triangulates what works research evidence from this type of forensic setting
and is the first to use a Delphi survey in an attempt to collate this information.
Keywords Evidence-based practice, What works, Forensic mental health, Clinical expertise, Delphi,
High-secure hospitals
Paper type Research paper
Introduction
High-secure forensic inpatient services provide specialist mental health care for adults with
mental disorder, who also present as a significant risk of causing harm to themselves or others.
These services often sit at the end of a pathway of forensic inpatient provision that steps down to
medium and then low-secure services and finally the community, and aim to rehabilitate patients
to live in the most optimal environment (Blackburn, 2004). They are also often expensive to
Received 27 July 2015
Revised 4 September 2015
Accepted 5 September 2015
The authors would like to thank all
the experts that took part in the
Delphi consensus survey and the
International Association of
Forensic Mental Health Services
(IAFMHS) and the Research and
Development services and staff
members across the four UK
high-security hospitals for
reviewing and approving the
survey and cascading invitations to
experts. The study was conducted
as part of a PhD completed by the
first author.
DOI 10.1108/JFP-07-2015-0041 VOL. 18 NO. 3 2016, pp. 189-203, © Emerald Group Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAG E 18 9
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