1. Working with high risk young prisoners with emerging personality disorders
Jake Shaw
Consultant Forensic Psychologist
Dr Owen Forster
Clinical Psychologist
----- Meeting Notes (06/03/15 06:51) -----
Introductions
Talk about AYOI Pathways
Service for HRHH Emerging PD

2. The next 20 minutes
The needs of high risk prisoners with PD at HMYOI Aylesbury
Aylesbury Pathways Service
Core principles
Service model
Future Directions
Discuss needs of client group

3. HMYOI Aylesbury – 1847 to present day
Opened as a county gaol in 1847
Operational Capacity 440
Since 1989 designated long term YOI
Currently holds longest sentenced
young adults (18-21) in English prison
system
Reputation for taking behaviourally challenging young prisoners

4. Inside through the times

5. Renovation

6. The challenges of adolescence
A period of profound change in social and emotional development
Increase in impulsivity, stimulation seeking, risk taking, conflict with authority, peer focused interactions
Internal world an emotional rollercoaster
Fragile and fluctuating self-esteem
Avoidant behavior and impulsive acting out are common
When coupled with problematic attachment experiences, trauma, deprivation and negative peer influences can be a period of particular vulnerability
Spend few moments thinking about the particular needs of hrhh young adult prisoners with emerging personality disorders
Let’s start by thinking about normal adolescent development, Fe

7. Emerging personality disorders in adolescence and young adulthood
Many young people presenting with PD had significant impairments in adulthood when followed up 20 years later (Crawford et al., 2008)
Higher levels of psychosocial adversity associated with
more persistent personality difficulties
more frequent antisocial behaviour
more serious convictions (Vizard et al., 2007)
Young adulthood is therefore a critical point for intervention
The social, relational, occupational and criminal consequences of emerging PD in adolescence can shape later life course trajectories
The social, relational, occupational and criminal consequences of emerging PD can shape later life course trajectories
Early onset PD associated with psychosocial adversity, antisocial behaviour, convictions and 88% of young male sentenced prisoners meet criteria for PD
81% ASPD(ONS, 2000)

8. Needs of high risk young prisoners with emerging PD at HMYOI Aylesbury (McMurran et al, 2013)
High risk, complex cases (N=54, 17%)
54% self-harm
70% childhood behavioural problems
89% early onset offending
37% excessive violence/sadism in offence
98% impulsive
98% reckless/risk taking
43% difficulties coping
But - hard to reach group
Exemplified by recent needs analysis which was completed prior to our service being set up

9. HRHH PD group sig. more likely to have the following offending related needs
Emotional difficulties
(OR 13.5)
Drug misuse (OR 4.0)
Relationships problems
(OR 4.8)
Accommodation (OR 2.5)
Criminal Attitudes (OR 2.3)
Anecdotally we can add that this population are also both frequent perpetrators and victims of assaults
Quite severe trauma histories
High proportion of gang affiliations
Often pend protracted periods in segregation
Presenting with a number of co-morbid conditions Including ADHD/ASD
For the longer term incarcerated youths there is often a serious lack of general life skills
Surface level hostility is often driven by very low levels of confidence in their abilities outside of a delinquent peer group

10. Aylesbury Pathways Service
Direct work with individuals
Case formulation
Enabling environment +
Workforce development
One of two sites for high risk high harm young adult prisoners in the OPD strategy
Delivered by London Pathways Partnership (LPP) in partnership with NOMS
Integrated treatment model
Delivered within an attachment framework AMBIT, MBT + Schema models, self-harm support groups
Service User Involvement central to the service model, design and delivery
Consistent focus on engagement and motivation with young people, the broader prison and also the
Recognising the importance of the broader system
Accommodate frequently co-morbid conditions ADHD/ASD
Diverse staff group, mixed NOMS/NHS staff, employ ex-service users – working with Emergence, with extensive use of 3rd sector agencies.
Diverse range of activities, including formal therapy, creative sessions, music production, Art therapy, life skills workshops.

11. Pathways Service Design
Tier 1
For all staff & prisoners
Prison wide training
Tier 2
Service support
Consultation
Signposting/ liaison
Tier 3
Enabling Environments x 2
Case ID & Assessment
Outreach Clients x 20
Enhanced supervision & training
Tier 4
Intervention Service Clients x 20
Formulation
Evidence based intervention
Social, creative & occupational activities

12. Service Delivery: Tier 1 & Tier 2
To deliver training to all prison staff (including KUF training)
Enhance all prisoners understanding of available support & services
Tier 1 Provision
Supporting existing services in management of prisoners
Provide consultation to the prison on management & progression of problematic prisoners
Signposting & Liaison for prisoners to help them access existing services or for progressive moves onwards.
Tier 2 Provision

13. Tier 3 Provision Working towards awards on F & G wing
10 standards set by the RCPsych
Joint working between Pathways Service, Wing Staff and Prisoners
Enabling Environments
Accept referrals from all sources in the prison including self-referral
Joint assessment by Clinical and Operational staff
If suitable devise initial treatment plan & Initial formulation
Case ID & Assessment
20 prisoners, fortnightly contact from staff
Focus on engagement, motivation & stabilisation
Help to access existing services & programmes or to progress into the Intervention Service
Outreach Clients
Individual & Group supervision offered to all Pathways staff
KUF training
Individual development including CBT, Schema Therapy & AMBIT
Enhanced Training & Supervision

14. Tier 4 Provision 15-20 prisoners, weekly contact from staff
Participation in Individual & Group sessions
Liaison & joint working with other prison services
Intervention Service
Full formulation of offending, risk & difficulties across the lifespan
Narrative understanding for prisoners & staff
Developed in conjunction with psychology staff
Formulation
Individual psychotherapy
Group therapy including Schema, Mentalization Based Therapy & R&R 2
Co-facilitated groups including Self-Harm, Hearing Voices & Managing License
Evidence Based Intervention
A large range of group and individual activities aimed at reducing isolation, promoting self-esteem and building skills
Including Life Skills, Art, Social Skills, Well-being, Mindfulness & Yoga
Social, Creative & Occupational Activity

15. Pathways Staffing Group
Clinical Staff Group
1 x 8c Clinical Lead (0.6 wte)
2 x 8a/Band 8 Clinical Psychologist (2.0 wte)
1 x 7 Occupational Therapist (1.0 wte)
1 x 6 Occupational Therapist (1.0 wte)
Operational Staff Group
1 x Band 4 Supervising Officer - Service Lead(1.0 wte)
1 x Band 4 Supervising Officer – EE Lead (1.0 wte)
4 x Band 3 Prison Officers (4.0 wte)
Additional Staff
1 x Admin Support (1.0 wte)
2 x Service User Consultants (0.4 wte)
1 x Consultant Forensic Psychiatrist (0.2 wte)
Sessional workers including systemic therapist, art therapist, SLT & Yoga teacher.

16. Thanks for listening