1. Dr Carine Lewis, Research Lead, OPD Pathway Programme
The Offender Personality Disorder (OPD) programme Using an evidence-based approach to build better futures for complex and high risk offenders
Dr Carine Lewis, Research Lead, OPD Pathway Programme
Taking research informed approach
Good example of why not only impact research is important

2. Introduction
What is the Offender Personality Disorder (OPD) programme?
Our principles
Our services
Taking an evidence-based approach
What might be the critical ingredients?
Next steps

3. Strategic context: From DSPD to OPD
Response to the offender personality disorder consultation Oct 2011, page 11:
“The Government believes that the £69m currently invested in DSPD services can be used more effectively to improve the management of offenders thereby reducing re-offending, risk of harm to the public, and providing more treatment places and high quality services.”
Public protection
Psychological health improvement
Workforce development
Use resources efficiently

4. Markers for offenders who potentially have PD
Defining ‘personality disorder’
Markers for offenders who potentially have PD
Mild PD
Notable problems BUT
Not associated with harm
Moderate PD
Marked problems. Harm but not endangering life
Severe PD
Severe problems in all areas of life. High levels of harm to self and others. Endangering life
Screen in tool
7 or more checked items on OASys
AND / OR childhood difficulties, mental health problems, history of self harm or suicide, risk of serious harm to staff
What do we mean by severe PD? It’s where the PD severely affects all areas of their life – we often apply the 3Ps test – pervasive, problematic and persistent – and where the PD results in risk of harm to self and others that may endanger life.
Classification, assessment, prevalence, assessment and effect of PD. Tyrer et al . The Lancet. Vol 385, pp

5. Entry criteria for services
Men
Assessed as presenting a high likelihood of violent or sexual offence repetition and high or very high risk of serious harm to others at some point during their current sentence
Managed by NPS
Likely to have a severe personality disorder
A clinically justifiable link between the personality disorder and the risk.
Women
Likely to have a severe form of personality disorder

6. The Offender Personality Disorder pathway
There is shared ownership, joint responsibility and operations, and partnership working
There is a whole system, community-to-community pathway
Offenders are primarily managed through the criminal justice system, with the lead role held by Offender Managers.
Services will be developed inline with the model and using an evidence-based approach, where evaluation continually informs services.
There is meaningful service user involvement, in design, delivery, review, performance management and evaluation of services.
All services adopt a relational approach.
Treatment and management is informed by a bio-psychosocial approach, in which individual’s development is understood.

7. The pathway model An active pathway of intervention
Early identification
An active pathway of intervention
Pathway planning
Psychologically Informed Planned Environments (PIPEs) & enabling environments (EEs)
Workforce development
Treatment
interventions
Involvement
Evaluation
Case identification, consultation, formulation, joint casework, workforce development and support to APs provided (partnership between a health provider and NPS in all probation areas)
Accredited & non-accredited programmes
Community case management

8. Introducing PIPEs ENRICHING EXPERIENCES Socially-Creative Sessions
Clinical Supervision
Socially-Creative Sessions
Training & Workforce Devpt
Structured Sessions (Pathway)
Key Worker Relationship
An Enabling Environment
AN UNDERSTANDING OF
HUMAN DEVELOPMENT
WHOLE-ENVIRONMENT
Experienced Leadership
A Joint Operation
Dedicated Environment Increased Staffing
Institutional Support
ENRICHING EXPERIENCES
SHARED CREATIVITY
SHARED READING
SHARED NARRATIVE

9. Drawing on Rehabilitative Culture
settle
Address
attitudes
and thinking
Address drug & alcohol
problems
Rehabilitative culture;
Rehabilitative
staff prisoner relationships
Safety, Decency and Fairness
Drawing on Rehabilitative Culture
Residents have hope
Staff have hope
Staff and residents feel treated fairly
Mutually respectful staff/resident relationships
Activities that promote learning, wellbeing, desistance
Staff promote future orientation & identity shift
Staff encourage participation in rehabilitation

10. Taking an evidence-based approach
Reduce reoffending
Reduction in number & severity of general & violent misconduct
Reduction in serious reoffending
Longer time between reoffending
Improve psychological health & wellbeing
Improved relational outcomes
Reduction in number & severity of self-destructive behaviour
Workforce: Improved competence, confidence, attitudes
Improved understanding of behaviour & risk factors
Effective risk management
Increased efficiency, cost effectiveness & quality
Improved access & progression
Improve quality of relational environment
Outcomes
Based on evidence & psychological theory
National programme of research
Revised research & evaluation strategy
National & local level evaluations

11. A National perspective
National Evaluation (NEON)
PIPEs longitudinal study
Democratic Therapeutic Communities outcomes study
Mentalisation RCT (MOAM)
Impact – case formulation
Validation of PCQ (Rehab culture)

12. Key gaps & next steps Workforce development Pathway Interventions
Robust methods?
Pathway
Service user journey
What harms?
Formulation
Testing mechanisms of change
Workforce development
Resilience
Impact on wider outcomes
Interventions
Community
TC+
Funding?!

13. What is the most robust method we can use? Considering what harms
High quality research
Underpinning logic model
What are the expected outcomes?
Process evaluations
Demonstrate value of services
Identify how operating – barriers/facilitators
Identifying mechanisms of change
Impact evaluations
Short-medium term outcomes
Long-term outcomes
Triangulation
Mixed methods
What is the most robust method we can use?
Objective approach
Considering what harms

14. The importance of research-informed practice
Ensuring services are doing what they intend to
Reflection
Improving services
Identifying facilitators & barriers
Identifying potential mechanisms of change
Service user experience
Impact on personality functioning
Impact on violence and self harm
Barriers for BAME service users
Local Evaluation Priorities

15. Identifying the critical ingredients
Working with offenders with ‘personality disorder’
Stressful
Relentless
Challenging behaviour
Engagement = difficult & frustrating
The role of workforce development
Resilient workforce
Improved wellbeing
Improved attitudes, competence, confidence
Meaningful interactions
Improved outcomes for service users?
Plus MH problems, PTSD in prison officers
Also a morally challenging job
As a result of working, tend to get negat.ive attitudes
Attitudes encourage and enable rehabilitation

16. OPD pathway & empowering the workforce
Currently, little evidence on:
LT impact of training
Burnout
How might the pathway help?
Role of case formulation
Collaborative case formulation & relationships (Shaw et al., 2017)
Increased competencies, confidence, understanding (Ramsden)
Reflective practice
Supervision
Training
Planning & partnership working
Time to know what they are trying to change (e.g. formulations & planning) – link to rehab cultre
Research has found that staff with higher levels of hope are less likely to experience burnout

17. Relationships as a mechanism of change
Drawing on rehabilitative cultures
Enabling Environments
Hope & relationships - PIPEs
Turley et al. (2013) – Observed better interactions between residents than in other comparable locations
Current PIPEs impact evaluation
Evidence from treatments
Willmot & McMurran (2013)
Emphasises importance of therapeutic relationship in effecting change
Jeffcote (2017)
Relationships “seen as the primary medium of therapeutic change”
Fongay
Role of epistemic trust?

18. Hope, Resilience & Wellbeing
Relationships
Trust
Confidence
Training
Support
Understanding
What does the evidence say?
Role of staff & service users?
Mention continuous role of empowerment here

19. Processes of change Relationships with staff
Shaw & Foster (Under review) - Perspectives about what changes (if any) had occurred following therapy (1 year)
Relationships with staff
Mentalisation of others
Adaptive coping
Self knowledge
Trust

20. Processes of change Coping Attitudes Understanding Relating/ trust
McMurran & Delight (2017) – Service users & staff perspectives of change in OPD treatment unit
Changes
Experiences leading to change
Mechanisms of change
Coping
Attitudes
Understanding
Relating/ trust
Optimism
Direction & skills
Reflection
Help & support
Environment
Key work
Partnership working
Mention time that this research took place
Relationships with staff
Dealing with situations
Value
Understanding

21. Processes of change Coping Attitudes Understanding Relating/ trust
McMurran & Delight (2017) – Service users & staff perspectives of change in OPD treatment unit
Changes
Experiences leading to change
Mechanisms of change
Coping
Attitudes
Understanding
Relating/ trust
Optimism
Direction & skills
“Because the staff are genuine, I’m able to approach them knowing I’ll get a solid answer & they’re not just going to fob me off with any old thing & being able to trust like my key worker…”
Reflection
Help & support
Environment
Key work
Partnership working
Mention time that this research took place
Relationships with staff
Dealing with situations
Value
Understanding

22. Processes of change “future direction” Coping Attitudes Understanding
McMurran & Delight (2017) – Service users & staff perspectives of change in OPD treatment unit
Changes
Experiences leading to change
Mechanisms of change
Coping
Attitudes
Understanding
Relating/ trust
Optimism
Direction & skills
“future direction”
Reflection
Help & support
Environment
Key work
Partnership working
Mention time that this research took place
Environment – positives & negatives
Relationships with staff
Dealing with situations
Value
Understanding

23. Hope, resilience & wellbeing - is it enough?
Findings align with offenders who have been able to move away from life of crime but we need to know more in relation to impact
Overlap with reduction in aggressive incidents
But…
Desistance literature = self identity
Preston (2015) – identity & empowerment
What about wider difficulties?
Service user journey
Wider environment & culture
Lack of services in the community
Links to institutional violence – overlap between elements of RC and those believed to reduce violence, Increased levels of support, respectful contact and opportunities for growth and learning have been found to reduce the number of aggressive incidents in secure units
Impact on mental health – Prison culture has been found to impact directly on mental health and wellbeing of prisoners.
Prisoners have described their improved behaviour, outlook and attitude as being down to a sense of feeling valued and respected by staff. A rehabilitative culture is highly relevant to reducing offending. Having hope and motivation, a sense of agency and self-efficacy, being believed in, and having a place in a social group are all factors that contribute to desistance from offending
People who want to desist from crime are more likely to when significant others believe in their ability to change and communicate that belief to them.

24. Concluding thoughts Ensuring we take an approach of ‘What works’
OPD pathway is one of the few opportunities where we can provide meaningful activity in current UK climate
Mechanisms of change = complex but key to understanding & success
Next steps for the pathway programme

25. Discussion points
In the current UK climate, how far can we really go in improving culture and opportunities in order to achieve these outcomes?
Developing services – understanding need
What about the role of prevention?
How can we encourage a better culture within the wider context of prison & probation?

26. “I think maybe it gives me time to reflect on the past and look at the future. In the past, I haven't always been open with members of staff, but since being on here I have been able to bring my problems up to the staff. The original situation was that I didn't have confidence in the staff and I felt that I would put myself in a negative position, but looking back I realise that the decision I made was the worst decision possible and I've either came to this decision myself or been helped to sort of look at the whole situation and now I'm trying to put it right here. Certainly, progression is the main thing, it's good to hear that lads are moving on, got their C Cats, going to D Cats and are being released. It gives everybody that sort of little bit of hope for the future.”