Management of aggression care plans in a forensic intellectual disability service: a ten-year progress update
| Date | 03 June 2014 |
| Pages | 88-96 |
| Published date | 03 June 2014 |
| DOI | https://doi.org/10.1108/JIDOB-03-2014-0003 |
| Author | David Kitchen,Cathy Thomas,Verity Chester |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour |
Management of aggression care plans in
a forensic intellectual disability service:
a ten-year progress update
David Kitchen, Cathy Thomas and Verity Chester
David Kitchen is a Training and
Development Manager, based
at Department of Nursing,
Partnerships in Care Learning
Disability Services,
Norfolk, UK.
Dr Cathy Thomas is a
Consultant Clinical
Psychologist, based at
Department of Psychology,
Partnerships in Care Learning
Disability Services,
Norfolk, UK.
Verity Chester is a Research
Assistant, Department of
Psychiatry, Partnerships in
Care Learning Disability
Services, Norfolk, UK.
Abstract
Purpose – Standardised approaches to the management of aggression and violence are critical for all
stakeholders of intellectual disability services. The purpose of this paper is to describe the Management of
Aggression Care Plan (MoACP). The care plan aims to reduce levels of restrictive interventions, to ensure
any interventions relative to aggression and violence are the least restrictive possible, and to promote
adaptive behaviours and support life enriching opportunities, in a manner which is personalised to the
unique profiles of every patient.
Design/methodology/approach – The MoACP was first described by Thomas et al. (2005). This paper
describes the rationale, theoretical basis, structure and benefits of the care plan, and provides details of
revisions made to the plan in response to evidence-based practice recommendations.
Findings – The value of implementing a structured approach to the care planning of management of
aggression and violence, in reducing the frequency and impact of restrictive practices, and promoting life
enriching opportunities is described.
Practical implications – The paper describes a number of practical features of the care plan which
most support its continued effectiveness, including patient involvement, individual patient focused training,
and audit.
Originality/value – Although many services undertake localised approaches to the care planning of
management of violence and aggression in forensic intellectual disability services, few have been described
in the published literature.
Keywords Intellectual disability,Violence, Learning disability, Forensic, Aggression, Challenging behaviour,
Positive Behaviour Support, MVA
Paper type Technical paper
Introduction
In recent years, there has been increasing concern about the use of physical intervention in
psychiatric and intellectual disability services, particularly in wake of the events at Winterbourne
View Hospital exposed by the 2011 BBC One (2001), Panorama broadcast “Undercover Care:
the Abuse Exposed”. The programme showed staff mistreating and assaulting adults with
intellectual disabilities and autism, including the “dangerous and illegal uses of restraint” (Flynn
and Citarella, 2013). Since the scandal, there has been much dialogue around the use of, and
need for physical restraint when working with people with intellectual disabilities, with some
headlines claiming that physical restraint should be banned altogether (e.g. Calkin, 2012).
Although that would be the ideal, it is unlikely that the use of physical restraint could ever be
completely eradicated. Aggression and violence remains a problematic feature of all inpatient
settings (Dickens et al., 2013). There are significant numbers of people with intellectual disability
who display high levels of violence with the potential to cause harm to others (Royal College of
Psychiatrists’ Faculty of Psychiatry of Intellectual Disability, 2013). For complex reasons they
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JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
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VOL. 5 NO. 2 2014, pp. 88-96, CEmerald Group Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-03-2014-0003
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