Providing community Providing community services for people with services for people with intellectual disabilitiesintellectual disabilities

Shamim Dinani and Wendy GoodmanShamim Dinani and Wendy GoodmanAvon forensic community learning disabilities Avon forensic community learning disabilities

teamteam shamim.dinani@bristol.gov.ukshamim.dinani@bristol.gov.uk

Intellectual disabilities and the Intellectual disabilities and the criminal justice systemcriminal justice system

Policy contextPolicy context Community service in AvonCommunity service in Avon AFCLDT AFCLDT

what is the compositionwhat is the composition what we dowhat we do reflections and discussionreflections and discussion gapsgaps

Next steps for allNext steps for all

What do you think?What do you think?

scenarioscenario

You receive a phone call from your local You receive a phone call from your local police station. They have arrested a man police station. They have arrested a man for stalking and they think he has ID. Can for stalking and they think he has ID. Can you assess to inform if he has ID? Can you assess to inform if he has ID? Can you advise what action should/could be you advise what action should/could be taken? Can you provide support such as taken? Can you provide support such as an Appropriate Adult?an Appropriate Adult?

Policy Context - pastPolicy Context - past

Reed report 1992 Reed report 1992 Quality of care – needs of the individual Quality of care – needs of the individual Community not institutional – divert to health Community not institutional – divert to health

and social care and social care Least restrictive option - No greater security Least restrictive option - No greater security

than is justifiedthan is justified Maximise rehabilitation – range of servicesMaximise rehabilitation – range of services As near to their home As near to their home PWLD differ from other offenders – LD PWLD differ from other offenders – LD

specific servicesspecific services

Policy Context - recentPolicy Context - recent Bradley report 2009Bradley report 2009 No One Knows – Prison Reform Trust 2008No One Knows – Prison Reform Trust 2008 Positive Practice Positive Outcomes 2007Positive Practice Positive Outcomes 2007 Commissioning specialist services in ld – good Commissioning specialist services in ld – good

practice guide 2007practice guide 2007 Mansell report 2007Mansell report 2007 Valuing People Now 2009Valuing People Now 2009 Social inclusion agendaSocial inclusion agenda Legal – Disability Discrimination Act 2005 and Legal – Disability Discrimination Act 2005 and

Human Rights Act 1998Human Rights Act 1998

The Bradley Report The Bradley Report Similar findings to Prison Reform Trust - Similar findings to Prison Reform Trust - highlights highlights

the difficulties people with ld face throughout the CJSthe difficulties people with ld face throughout the CJS Recommendations Recommendations

Early identification – Early identification – learning difficulties, learning disability learning difficulties, learning disability and borderline ldand borderline ld

Training – Training – teachers, family doctors, police, probation, courts, teachers, family doctors, police, probation, courts, prison staff prison staff

Continuity of care – Continuity of care – whole of the offender pathwaywhole of the offender pathway Working in partnership – Working in partnership – criminal justice mental health criminal justice mental health

teamsteams Prevalence – Mottram 2007Prevalence – Mottram 2007

IQ <70 7% and LD 3% using social competence and skillsIQ <70 7% and LD 3% using social competence and skills IQ 70 – 79 IQ 70 – 79 = = 24% 24%

ID offender journey - pathwayID offender journey - pathway

Pre-sentence

Early detection inc schools and GP, training of police, provision of Appropriate Adults,YOT to include health, cautions and

warnings and divert

Sentence

Courts ID aware, defendants to get same facilities as vulnerable witnesses, rapid reports, divert, training of probation officers and

FME

Post sentence

Community orders, probation, admission to hospital, training of prison staff and provision of Ld nurses in prison, in reach, CPA

and resettlement, continuity of care

Offender health service in AvonOffender health service in Avon

AFCLDTAFCLDT CARS CARS Court assessment and referral schemeCourt assessment and referral scheme

Prison in reach teamPrison in reach team Prison HealthcarePrison Healthcare OAT secure inpatient – Quaternary teamOAT secure inpatient – Quaternary team

AFCLDT – background historyAFCLDT – background history

Closure of long stay hospitals Closure of long stay hospitals Community care - cldt but no specialist skills and access Community care - cldt but no specialist skills and access

poor, service fragmented, no strategy, many expensive poor, service fragmented, no strategy, many expensive private placements and needs of LD offender often private placements and needs of LD offender often unidentified and overlookedunidentified and overlooked

Multi agency MDO reference groupMulti agency MDO reference group AFCLDT formed (2000) as first step – highly skilled AFCLDT formed (2000) as first step – highly skilled

forensic psychologist (1wte) and senior forensic nurse forensic psychologist (1wte) and senior forensic nurse (1wte), plus admin and some psychiatry (0.1wte) Now (1wte), plus admin and some psychiatry (0.1wte) Now we also have a nurse practitioner, nurse in CARS team we also have a nurse practitioner, nurse in CARS team and social work championand social work champion

AFLDT - contextAFLDT - context

Avon wide – population 1.1 millionAvon wide – population 1.1 million 4 unitary authorities 4 unitary authorities 8/9 LD community teams 8/9 LD community teams 4 specialist challenging behaviour teams4 specialist challenging behaviour teams Residential careResidential care Other housing with various levels of Other housing with various levels of

supportsupport Education, employmentEducation, employment

AFCLDT – liaison with other AFCLDT – liaison with other agencies and servicesagencies and services

police

Social services

national

A&T beds

probation

prison

courts

OtherForensic

cldt

MSU out of area

LocalCLDTs

AVONFCLDT

AFCLDT – liaison with CJSAFCLDT – liaison with CJS

Courts – diversion Courts – diversion Prison – identify and manage, in-reach Prison – identify and manage, in-reach

help with dischargehelp with discharge ProbationProbation Multi-agency planningMulti-agency planning Police – training Police – training Youth offending teamYouth offending team

AFCLDT – what we did AFCLDT – what we did

Clarify service user group, widerClarify service user group, wider Risk assessment – identify high, medium Risk assessment – identify high, medium

and low risk – prioritise those with urgent and low risk – prioritise those with urgent needneed

Developed clinical programmesDeveloped clinical programmes Developed links with police, probation etcDeveloped links with police, probation etc Policy and proceduresPolicy and procedures Staff training – raise awareness, risk Staff training – raise awareness, risk

assessmentsassessments

AFCLDT – risk typeAFCLDT – risk type

0

20

40

60

80

100

2001 2002 2003 2004 2005 2006 2007

Violence

Sex

Acquisitve

Arson

Driving

AFLDT – referral sourceAFLDT – referral source

0

10

20

30

40

50

60

70

80

90

2001 2002 2003 2004 2005 2006 2007

NHS

Social Services

Probation

Prison

legal

other

AFCLDT – what do we do? AFCLDT – what do we do? Clinical programmesClinical programmes

Specialist consultancy - Risk assessments Specialist consultancy - Risk assessments and advice on managementand advice on management

Group – ‘good thinking’ offender Group – ‘good thinking’ offender programmeprogramme

Mens group – sex offender Mens group – sex offender Individual therapy – mainly CBT Individual therapy – mainly CBT OATs – advise on placement and monitor OATs – advise on placement and monitor

progressprogress

AFCLDT – “GOOD THINKING”AFCLDT – “GOOD THINKING”

Enhanced thinking skills – adapted the Enhanced thinking skills – adapted the programme to suit LDprogramme to suit LD

Not exclusively for convictedNot exclusively for convicted Offending behaviour is an antisocial Offending behaviour is an antisocial

means of attaining an appropriate goalmeans of attaining an appropriate goal Focus on pro-social means to attain goalsFocus on pro-social means to attain goals Teach structured problem solving strategyTeach structured problem solving strategy

AFCLDT – “GOOD THINKING”AFCLDT – “GOOD THINKING”

Accessible informationAccessible information 25 sessions of two hours – now once weekly, 25 sessions of two hours – now once weekly,

lasts about 6 months – 9 monthslasts about 6 months – 9 months Pre and post treatment measures Pre and post treatment measures Currently on our 6Currently on our 6thth course course Anecdotal – positive, life changes, multiple Anecdotal – positive, life changes, multiple

interventions concurrently, impact offending?interventions concurrently, impact offending? Research – multi-centre plannedResearch – multi-centre planned

AFCLDT – individual workAFCLDT – individual work

Those not suitable or not ready for group Those not suitable or not ready for group work, booster sessionswork, booster sessions

About a third of the clientsAbout a third of the clients Eclectic but mainly CBTEclectic but mainly CBT Outcomes - not formally evaluated but Outcomes - not formally evaluated but

tends to be valued tends to be valued Flexible approachFlexible approach

AFCLDT – Out of areaAFCLDT – Out of area

Average of 12 – did not rise until recently Average of 12 – did not rise until recently now 15 – young graduatesnow 15 – young graduates

Advice on placementAdvice on placement Monitor progress, attend meetingsMonitor progress, attend meetings Return to area, step downReturn to area, step down Long distance awayLong distance away New quaternary team will monitor the New quaternary team will monitor the

pathway – gatekeepers – Avon, Glos pathway – gatekeepers – Avon, Glos Somerset and WiltshireSomerset and Wiltshire

FCLDT – Research and academic FCLDT – Research and academic activitiesactivities

Appropriate AdultAppropriate Adult Qualitative study of service users viewsQualitative study of service users views Appropriate adults experience of roleAppropriate adults experience of role Examined custody records – ascertain Examined custody records – ascertain

numbers of PWLDnumbers of PWLD Locus of controlLocus of control Mens groupMens group Predictors of offendingPredictors of offending

FCLDT – audits and service FCLDT – audits and service evaluationsevaluations

Referrer satisfactionReferrer satisfaction OATs consumer views of secure servicesOATs consumer views of secure services Timely response and communicationTimely response and communication Clinical programme evaluations – ongoing as part of the Clinical programme evaluations – ongoing as part of the

treatmenttreatment Female referralsFemale referrals Reason for re-referralsReason for re-referrals Reason for ‘drop out’Reason for ‘drop out’ Needs of vehicle related offendersNeeds of vehicle related offenders Service user perception of usefulness of treatment Service user perception of usefulness of treatment

groupsgroups

AFCLDT – reflections - what AFCLDT – reflections - what works?works?

Based in the community – within CLDTBased in the community – within CLDT Small is beautiful! – efficient, innovative, highly Small is beautiful! – efficient, innovative, highly

skilled and confident, autonomy, creativityskilled and confident, autonomy, creativity No distraction to in-patients workNo distraction to in-patients work We are passionate and enthusiasticWe are passionate and enthusiastic Community teams, social services, probation etc Community teams, social services, probation etc

are receptive and value joint workingare receptive and value joint working National profileNational profile

FCLDT - reflections of challenges FCLDT - reflections of challenges and gapsand gaps

Lack of secure provisionLack of secure provision Manage workload – priority matrix, remind people it is a Manage workload – priority matrix, remind people it is a

tertiary service! Ongoing training and joint work to build tertiary service! Ongoing training and joint work to build confidence and maintain interestconfidence and maintain interest

Services for womenServices for women Advocate for those at the bottom of the pile! Try to make Advocate for those at the bottom of the pile! Try to make

the invisible visible the invisible visible The lost tribe of mild LD – no longer detected and needs The lost tribe of mild LD – no longer detected and needs

not met in childhoodnot met in childhood What of those who do not meet criteria for inclusionWhat of those who do not meet criteria for inclusion

Conclusion – next stepsConclusion – next steps

Mapping exercise into service provision – Mapping exercise into service provision – courts, prisons, probation, courts, prisons, probation,

Plan training and identification of ID Plan training and identification of ID Enhance local provision and expertise in Enhance local provision and expertise in

specialist risk assessment and treatmentspecialist risk assessment and treatment ADVOCATE for this marginalised groupADVOCATE for this marginalised group