Providing community services for people with intellectual disabilities

Providing community services for people with intellectual disabilities Shamim Dinani and Wendy Goodman Avon forensic community learning disabilities team shamim. dinani@bristol. gov. uk

Intellectual disabilities and the criminal justice system Ø Policy context Ø Community service in Avon Ø AFCLDT l l Ø what is the composition what we do reflections and discussion gaps Next steps for all

What do you think?

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

Policy Context - past Ø Reed report l l l 1992 Quality of care – needs of the individual Community not institutional – divert to health and social care Least restrictive option - No greater security than is justified Maximise rehabilitation – range of services As near to their home PWLD differ from other offenders – LD specific services

Policy Context - recent Bradley report 2009 No One Knows – Prison Reform Trust 2008 Positive Practice Positive Outcomes 2007 Commissioning specialist services in ld – good practice guide 2007 Ø Mansell report 2007 Ø Valuing People Now 2009 Ø Social inclusion agenda Ø Legal – Disability Discrimination Act 2005 and Human Rights Act 1998 Ø Ø

The Bradley Report Ø Similar findings to Prison Reform Trust - highlights Ø Recommendations the difficulties people with ld face throughout the CJS l l Ø Early identification – learning difficulties, learning disability and borderline ld Training – teachers, family doctors, police, probation, courts, prison staff Continuity of care – whole of the offender pathway Working in partnership – criminal justice mental health teams Prevalence – Mottram 2007 l l IQ <70 7% and LD 3% using social competence and skills IQ 70 – 79 = 24%

ID 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 Avon Ø AFCLDT Ø CARS Court assessment and referral scheme Ø Prison in reach team Ø Prison Healthcare Ø OAT secure inpatient – Quaternary team

AFCLDT – background history Ø Ø Closure of long stay hospitals Community care - cldt but no specialist skills and access poor, service fragmented, no strategy, many expensive private placements and needs of LD offender often unidentified and overlooked Multi agency MDO reference group AFCLDT formed (2000) as first step – highly skilled forensic psychologist (1 wte) and senior forensic nurse (1 wte), plus admin and some psychiatry (0. 1 wte) Now we also have a nurse practitioner, nurse in CARS team and social work champion

AFLDT - context Ø Avon wide – population 1. 1 million Ø 4 unitary authorities Ø 8/9 LD community teams Ø 4 specialist challenging behaviour teams Ø Residential care Ø Other housing with various levels of support Ø Education, employment

AFCLDT – liaison with other agencies and services Local CLDTs police MSU out of area Other Forensic cldt Social services AVON FCLDT courts national prison A&T beds probation

AFCLDT – liaison with CJS Ø Courts – diversion Ø Prison – identify and manage, in-reach help with discharge Ø Probation Ø Multi-agency planning Ø Police – training Ø Youth offending team

AFCLDT – what we did Ø Clarify service user group, wider Ø Risk assessment – identify high, medium and low risk – prioritise those with urgent need Ø Developed clinical programmes Ø Developed links with police, probation etc Ø Policy and procedures Ø Staff training – raise awareness, risk assessments

AFCLDT – risk type

AFLDT – referral source

AFCLDT – what do we do? Clinical programmes Ø Specialist consultancy - Risk assessments and advice on management Ø Group – ‘good thinking’ offender programme Ø Mens group – sex offender Ø Individual therapy – mainly CBT Ø OATs – advise on placement and monitor progress

AFCLDT – “GOOD THINKING” Ø Enhanced thinking skills – adapted the programme to suit LD Ø Not exclusively for convicted Ø Offending behaviour is an antisocial means of attaining an appropriate goal Ø Focus on pro-social means to attain goals Ø Teach structured problem solving strategy

AFCLDT – “GOOD THINKING” Accessible information Ø 25 sessions of two hours – now once weekly, lasts about 6 months – 9 months Ø Pre and post treatment measures Ø Currently on our 6 th course Ø Anecdotal – positive, life changes, multiple interventions concurrently, impact offending? Ø Research – multi-centre planned Ø

AFCLDT – individual work Ø Those not suitable or not ready for group work, booster sessions Ø About a third of the clients Ø Eclectic but mainly CBT Ø Outcomes - not formally evaluated but tends to be valued Ø Flexible approach

AFCLDT – Out of area Ø Average of 12 – did not rise until recently now 15 – young graduates Ø Advice on placement Ø Monitor progress, attend meetings Ø Return to area, step down Ø Long distance away Ø New quaternary team will monitor the pathway – gatekeepers – Avon, Glos Somerset and Wiltshire

FCLDT – Research and academic activities Ø Appropriate Adult l l l Qualitative study of service users views Appropriate adults experience of role Examined custody records – ascertain numbers of PWLD Ø Locus of control Ø Mens group Ø Predictors of offending

FCLDT – audits and service evaluations Ø Ø Ø Ø Ø Referrer satisfaction OATs consumer views of secure services Timely response and communication Clinical programme evaluations – ongoing as part of the treatment Female referrals Reason for re-referrals Reason for ‘drop out’ Needs of vehicle related offenders Service user perception of usefulness of treatment groups

AFCLDT – reflections - what works? Based in the community – within CLDT Ø Small is beautiful! – efficient, innovative, highly skilled and confident, autonomy, creativity Ø No distraction to in-patients work Ø We are passionate and enthusiastic Ø Community teams, social services, probation etc are receptive and value joint working Ø National profile Ø

FCLDT - reflections of challenges and gaps Ø Ø Ø Lack of secure provision Manage workload – priority matrix, remind people it is a tertiary service! Ongoing training and joint work to build confidence and maintain interest Services for women Advocate for those at the bottom of the pile! Try to make the invisible The lost tribe of mild LD – no longer detected and needs not met in childhood What of those who do not meet criteria for inclusion

Conclusion – next steps Ø Mapping exercise into service provision – courts, prisons, probation, Ø Plan training and identification of ID Ø Enhance local provision and expertise in specialist risk assessment and treatment Ø ADVOCATE for this marginalised group