IABA: It's Applicability to a Learning Disabled Offender Population

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IABA It's Applicability to a Learning Disabled
Offender Population

• A Case Study

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IABA Multi-Element Model (LaVigna Willis)

• Why use this model?
• Well grounded within the ethos of Positive
  Behaviour Support (PBS)
• Provides for both proactive and reactive
  strategies in a non aversive framework
• Person centred
• Enhances a persons quality of life
• Well researched

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What is Positive Behaviour Support?

• Positive Behavioural Support (PBS) is an
  overriding philosophy of the IABA approach that
  blends values about the rights of people with
  disabilities with a practical science about how
  learning and behaviour change occur. (Horner,
  1999).
• The goal of PBS is to enhance the quality of life
  for individuals through their support providers.
• PBS ...brings together values and commitment
  with evidence based methods and skills. In the
  past behavioural approaches have been guilty of
  treating people mechanistically of looking only
  at the behaviour and not the lifestyle of the
  person. PBS aims to avoid this trap and
  recognises that to do so we have to draw on the
  skills and the knowledge of everyone involved and
  to work constructively, creatively and
  responsively together. (Osgood Marks, 2002).

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PBS Continued....

• Model is defined by number of characteristics
• Use of comprehensive functional assessment of
  problem behaviour
• Altering deficient environmental conditions
• Altering deficient behavioural repertoires
• Achieving lifestyle change and improved QoL,
  through multi-component treatment plans while
  decreasing the frequency of CB (Grey McClean,
  2007)

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Why is PBS important?

• Valuing People
• Rights, Choice, Independence and Inclusion
• Encourages service providers to focus on person
  centred approaches and QoL
• Focusing specifically on problematic behaviours
  alone is an extensively narrow focus
• ...the appropriate goal of LD services is to
  support the individual in achieving as good a
  quality of life as possible in spite of their
  problems (Mansell DoH, 2007).
• World Class Commissioning
• Reduction in social exclusion, increased patient
  choice improved quality and access to services
• Better experience of care

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What is the Evidence Base?

• PBS effective in almost 2/3rds of cases (Carr et
  al, 1999)
• McClean et al, 2007
• Reduction in CB in 100 participants
• 66 reduction in psychotropic medication
• QoL improved significantly in 60 participants
• Grey McClean, 2007
• Significant reductions in frequency, management
  difficulty and severity of CB
• No reductions found in control group
• PBS can bring about reductions in CB within
  persons natural environment (Donnellan et al,
  1985)
• Wealth of further research into PBS
• see Clarke Dunlap, 2008 for review

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Case Study
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Reason for Referral

• Mark was engaging in illegal sexual behaviours
  e.g. sexual acts with others in exchange for
  money or goods and sexual acts with minors /
  making vulnerable others available for sex.
• He was suspected as presenting a risk to his
  siblings and some Social Services and Criminal
  Justice Service professionals believed he has the
  potential to offend, although he has no current
  convictions.
• He was at risk of losing his current living
  environment, community integration, community
  presence and independence.
• He has a long history of being extremely
  vulnerable to many forms of abuse and his
  presenting behaviours increased his
  vulnerability.
• The referral requested that a comprehensive
  assessment be carried out to assess areas of risk
  and to provide comprehensive support plans to
  reduce the risk and improve his quality of life.

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Relevant background factors

• Mild Learning Disability
• History of Vulnerability
• Over disclosure e.g. PIN, Possessions, Personal
  Life
• Bullied
• Poor social skills masked by effective
  communication / community survival skills
• Friendly, open disposition
• Family reputation
• Chaotic family lifestyle lack of boundaries and
  direction
• History of Abuse
• Financial -- Parental control (given only a few
  pounds of his benefits and made to fend for
  himself)
• Emotional -- Blame for brothers death, targeted
  / isolated within family
• Sexual -- Very early exposure to pornographic
  media and early references to sexualised
  behaviour, raped in his teens
• Physical -- Assault from father
• Neglect -- Hygiene, food, locked in, injuries
  medical problems
• Fear of reprisal
• Child protection -- Foster care

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Process

• Detailed assessment
• Review of historical records
• Access to other professionals reports /
  assessments
• Interviews
• Assessments
• Direct observations
• Involvement in Multi Disciplinary meetings
• Formulation
• Development of recommended support plan
• In conjunction with others
• Realistic
• Implementation
• Staff training

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Analysis of Meaning / Formulation

• Vulnerability the main issue as opposed to risk
  to others
• Pairing of rape experience (sex) with financial
  gain was instrumental in the development of the
  behaviour
• Survival skills increase vulnerability
  significantly i.e. Money, food
• Being without money had a significant impact on
  the behaviour
• Lack of appropriate sexual relationships /
  knowledge / understanding of legal issues
• Reputation makes change more difficult i.e. Work,
  behaviour
• Poor assertion skills
• Very little treatment / support over time
  consistently failed to learn
• Motivated to change / learn
• He has personal goals i.e. Work
• He is very health conscious i.e. Diet

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Main Communicative messages

• I feel worthless and I want my life to be better
  but I dont know how to do it.
• I want some control of my life.
• I feel overwhelmingly sad, lonely and bored.

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Recommended Support Plan

• Ecological Strategies
• Living environment location, peer group
• Staff support how much, who, skills
• Health / Medical
• Finances
• Activities / routines
• Positive Programming
• General skills Money skills, Cooking, Drama
• Functionally equivalent Assertion
• Functionally related Education in sexual health
  and relationships
• Coping and tolerance Therapy re negative self
  beliefs and emotions
• Focussed Support Strategies DROP schedule
• Reactive Strategies
• Further assessment by psychology re capacity to
  consent

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Implementation

• Social Services became Appointees
• Package agreed by Social Services
• Staff team employed
• Moved to new accommodation away from previous
  location
• Staff Training given (2 day)
• Further development of specific strategies for
  staff working with Mark
• Purchase of own belongings
• New activities developed

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Outcomes

• Improved Quality of life
• Significant reduction in target behaviour
• Pride
• Evaluation feedback to FSS from Mark
• Thank you for working with me and I am grateful
  for the house Im in

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Challenges

• Accurate data (self reported sexual interactions)
• IQ level access to services
• Continued contact with family
• Capacity Vulnerability further allegations of
  rape