Reflections on introducing a Leavers’ Preparation Group in an intellectual disability secure service
| Date | 11 June 2018 |
| Pages | 81-90 |
| DOI | https://doi.org/10.1108/JIDOB-12-2017-0026 |
| Published date | 11 June 2018 |
| Author | Gareth Hickman,Nicola Booth,Thuy Hoang |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders |
Reflections on introducing a Leavers’
Preparation Group in an intellectual
disability secure service
Gareth Hickman, Nicola Booth and Thuy Hoang
Abstract
Purpose –The purpose of this paper is to report on the introduction of a Leavers’Preparation Group in an
Intellectual Disability (ID) Secure Service. In the context of reductions in ID inpatient beds and reductions in
restrictive practices, discharge and transfers out of hospital settings are increasing. The current group was
established to provide support and preparation for service users as they approach discharge/transfer from
hospital. The current paper provides example outcome data and reflects on the experience and learning
points in delivering such interventions in secure contexts.
Design/methodology/approach –TheLeavers’PreparationGroup is an eight-session preparatory,recovery
focussed group intervention focussing on supporting service users as they approach discharge/transfer to
lower levels of security. The interventionhas a multi-disciplinary approach,focussing on psychosocialaspects
of current and future riskreduction.
Findings –Overwhelmingly service users reported that they experienced the group as positive and
beneficial. Personal reflections of the authors are offered on service user attitudes to discharge/transfer, the
contextual impact of restrictive systems and the benefits of this type of group intervention.
Originality/value –This paper reports on clinical practice, which involves multi-disciplinary intervention,
co-production with service users and relevant stakeholders, and provides a description of the group
intervention. It also offers critical reflection on tensions in this area of service provision, such as control and
choice, freedom and responsibility, limitations and restrictions and power imbalances.
Keywords Secure services, Intellectual disabilities, Hospital, Discharge, Reflective practice,
Group programme
Paper type Case study
Introduction
Secure Services for people with Intellectual Disabilities (ID) were established for patients whose
presentation rendered their management unsafe in the community (Alexander et al., 2011).
Due to current recording practices it is difficult to establish the precise number of Secure Hospital
inpatients with ID, however the most recent available Assuring Transformation data indicates that
1,190 patients with ID were in a Secure ward as of November 2017. What is clear is that post the
Winterbourne enquiry (Department of Health, 2012) and the introduction of the Transforming
Care Agenda, there has been a drive to reduce inpatient beds for people with ID. The position of
Secure Hospitals within this agenda remains debated however documents such as Houlden
(2015) promote the relevance of Transforming Care in this area and outline proposed national
reductions in Secure beds. Despite this, some services have reported experiencing pressure to
provide discharge dates for some forensic patients who continue to present levels of risk that
local service providers and community teams are not adequately resourced to manage with
seemingly limited alternative models of care for this population (Taylor et al., 2017). However,
reducing duration of hospitalisation and seeking to progress service users to lower levels of
restriction, community placements and indeed discharge from Section of the Mental Health Act
is expected to lead to an increase in service users leaving Secure hospitals.
Received 6 December 2017
Revised 8 January 2018
Accepted 10 January 2018
Gareth Hickman, Nicola Booth
and Thuy Hoang are all based
at the Secure Services,
Coventry and Warwickshire
Partnership NHS Trust,
Birmingham, UK.
DOI 10.1108/JIDOB-12-2017-0026 VOL. 9 NO.2 2018, pp. 81-90, © Emerald Publishing Limited, ISSN2050-8824
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
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