SHEALD Sexual Harm Exhibited By Adults With Learning Disabilities

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SHEALD Sexual Harm Exhibited By Adults With
Learning Disabilities

• 6th International Conference on the Care and
  Treatment of Offenders with a Learning Disability
• Preston 3rd April 2007
• Judith McBrien, Liam Newton, Christian Ashford
  Sue Chamberlain

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Content a description of how one Community LD
service approached risk posed by sexual offending
/behaviour

• Programme background the un-assessed risks
• Risk assessment methods results
• Risk assessment repercussions
• The Mens Group

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LD and sexual offending

• Prevalence of offending is as common if not more
  common in LD popn as in mainstream popn
  (Griffiths et al 1985).
• Particularly regarding sex and arson (OBrien DoH
  study suggests not arson).
• Some 6 of LD popn have severe sexual aggression
  (Thompson Brown 1997)
• 41 of pwld engaged in sex related challenging
  behaviour, of whom 17 had police contact and 4
  convictions for sexual offences (McBrien et al
  2002)

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Sexual Offenders with LD

• 55-78 more than one offence category
• 50 same sex
• 50 both children and adults
• Majority of victims under 11 yrs old
• 10 15 of all sexual offence convictions is by
  men with low intellectual functioning.

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Rationale for action1. SOTPs can reduce
re-offending

• Mainstream Craig et al 2003 review 18/19
  studies showed reduced recidivism. Hanson et al
  2002 meta analysis recidivism 9.9 for treated
  (CBT) and 17.4 for non treated.
• LD some evidence from case studies (Lindsey et
  al, Murphy 1997).

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Rationale for action2. Local un-assessed risk

• Our own study found 41 of pwld in a community LD
  service, engage in sex related challenging
  behaviour, of whom 17 have police contact and 4
  convictions for sexual offences (McBrien et al
  2002).
• These were local people on whom we had no detail
  of risk and no treatment was being offered.

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Rationale for action3. Costs human financial

• Of 77 high cost LD placements from Plymouth, 43
  were forensic or risky for offending. Of these
  43
• Only 17 were known to CJS.
• 13 were in a secure unit out of area (4,000 per
  week in some cases, paid for by Plymouth LD NHS
  budget).
• Only 8 of the 13 were receiving tailored
  treatment.
• 30 were in local homes, highly staffed for public
  protection, but not treated (similar costs
  falling to SS).

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Service gaps

• There were no Forensic LD teams in community
  services in Devon (1 million pop) or Cornwall
  (1/2 million pop).
• There is a worryingly low level of Consultant
  Psychiatry provision for LD.
• There are no Medium Secure LD beds in the SW
  Region. But some are planned.

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LD Offenders and NHS/SSKeeping Track

• Some national local providers import adults
  with LD from elsewhere in the country.
• They claim to specialise in high risk behaviour.
• There is no contact with the local LD service
  prior to placement.
• Local Social Services do not monitor them.
• The Health team does not know of them until a
  crisis referral is made.

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Exploring un-assessed risk

• Long list of 62 based on research clinical
  knowledge in 2005.
• List revisited in clinical team at intervals.
• March 2007 34/62 remain a concern ( 4 new).
• 29 names removed following review
• 8 now out of area (6 due to boundary change)
• 8 considered low risk and well managed
• 6 no LD
• 3 sev/profound and well managed
• 2 very high risk, to remain in MSU out of area
• 2 not clear

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Un-assessed risk contd

• 38 remain on list causing concern
• 15 have had full asst discuss later
• 2 assessment underway
• 3 awaiting full assessment
• 1 not for group, receiving 11
• 3 high risk in MSU due to return locally
• 14 currently checking (of whom 5 in 11 24 hour
  support, 9 situation unknown)

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Use of secure services

• We have none for LD
• From the long list of 62
• 13 have been in MSU, of whom
• 3 not returning
• 2 too high risk 1 resettled in new area
• 7 have been returned locally
• 1 low secure. Rest to local independent sector
  homes
• 4 plans underway to return locally

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SHEALD project

• Sexual Harm Exhibited by Adults with Learning
  Disabilities
• Collaboration between Primary Care Trusts in
  Plymouth and Devon, the NSPCC, the Probation
  Service.
• Objective to assess risk provide community
  based Sex Offending Treatment Programme (SOTP) to
  men with LD living locally.

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Steering Group

• Plymouth PCT managers, commissioners and
  psychologists
• NSPCC manager and experienced worker
• Probation senior manager
• Invites to all participating PCTs.

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Staffing for SHEALD now

• Forensic psychologist full time (half for SOTP).
• Higher Level Assistant Psychologist full time
  (half for SOTP).
• NSPCC experienced SOTP facilitator (half time).
• Clinical Psychologists in the dept risk
  assessments and risk management.

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• Over to Liam

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SHEALD Risk assessment

• Full chronology/file review and PNC.
• Cognitive assessment and social functioning
  including suitability for CBT.
• Full social history including talking to key
  informants.
• Actuarial assessment of risk (Static-99 Thornton
  2003, Harris et al 2003).
• Aetiology of sexual offending (Functional
  analysis). Analysis of offending pathways (Ward
  Hudson 1998 Finkelhor 1984)

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SHEALD Risk assessment cont..

• Assessment of dynamic risk factors utilising the
  Dynamic supervision project (Harris 2001
  factors identifed by Boer, Tough, Lindsay
  Haaven (2004) and treatment outcome variables
  including SOTSEC measures (QACSO, SAKs and
  Victim Empathy Scale) Murphy et al 2006.
• P-scan or PCL-SV (Psychopathy)
• Formulation

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SHEALD Risk assessment results N 15 assessed

• IQ means (range) for n 14
• FSIQ 61 (55-70)
• VIQ 62 (55-78)
• PIQ 65 (53-78)
• BPVS mean age equivalent (range) for n 10
• 9 years (8-11) (Recent research require 7ish for
  CBT)
• Chronological age mean (range)
• 33 yrs (20-47)

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STATIC-99 n 14 Psychopathy n 11
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Results N 15 assessed, contd

• Sex offences 3 had convictions, 9 had police
  contact, 3 no CJS contact.
• 2 had had prison sentences for sex offences.
• Non sex offences 5 had convictions, 4 had police
  contact, 6 no CJS contact.
• MHA only 3 ever sectioned.
• Secure units 3 had been in Medium Secure Units
  in the past.

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Victim groups of n 14 assessed
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Nature of harm caused n 15

• Exposure
• Sexual touch of others
• Sexual assault
• Attempted rape
• Rape

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Repercussions of RA complexities of care
management
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Repercussions of RA complexities of care
management, contd
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Risk management/public protection

• Canadian research shows that increased officer
  training in monitoring risk and systematised
  offender supervision reduces the level of
  recidivism.
• If immediate concerns arise from referral or
  during assessment then
• Strategy meeting with relevant professionals
  set up Core Group /or
• Adult Protection strategy meeting /or
• Child Protection strategy meeting /or
• MAPPA (with Probation and Police)

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Treatment decisions n 15

• Suitable for SOTP
• 10 (6 on group now 4 waiting)
• Not suitable
• 3 (2 v low risk 1 v unwilling)
• Suitable but fell through (brighter)
• 1 started but excluded
• 1 breached care plan did not start

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Eligibility for treatment

• All men must have a care manager.
• All men must have stable accommodation.
• Must have a learning disability (IQ under 70
  meeting LD Partnership criteria).
• Must be able to cope with CBT.

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The Mens Group

• Utilises a number of approaches adapted from the
  TV-SOGP, Prison and probation SOTP and A-SOTP.
  Uses a risk-needs approach in combination with a
  Goodlives approach.
• Emphasises responsivity as important to group
  work.
• An attempt to make the group a rolling programme,
  but this is proving difficult.

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Mens group cont

• Group is made up of 5 blocks. Each block has 8
  sessions of therapy. Each session consists of 4
  hours of group work in a day.
• At the end of each block there is a three week
  break to allow reports and group reviews to held
  for each client.
• The group equates to 160 hours of direct group
  work per client.

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Mens group Measurements

• The Acute risk assessment aide memoire is
  completed between blocks and the Stable between
  every other block.
• A number of the SOT-SEC psychometrics have been
  used as pre and post measures including the
  QACSO.

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Experiences of running the group

• Use of symbols (Heart and mind bubble)
• Use of drama/experiential techniques
• Use of art and creative techniques
• High levels of cohesion, trust, safety and fun.
• Unexpected ability for the group to identify and
  utilise emotions in the group.
• Group able to process a variety of exercises and
  make links to their offending behaviour.
• Use of a non-manualised model has facilitated
  responsivity particularly for less able clients.

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Good but

• Boundaries for clients can an issue.
• Professionalism, boundaries, confidentiality and
  attitudes of supporting staff.
• Rolling programmes?
• Individual work?

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Messages

• Head in the sand not visiting un-assessed risk.
• If you do have a look .
• Impact on the men of having risk assessed, even
  without treatment.
• Enormity of risk monitoring and care management
  tasks post assessment.
• Complexities in Community LD Services
• Carers in independent sector their role in
• Risk monitoring and reporting
• Reinforcing messages of Group
• need for awareness training
• Dearth of literature to guide practice.