1. Providing community services for people with intellectual disabilities
Shamim Dinani and Wendy Goodman
Avon forensic community learning disabilities team

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

3. What do you think?

4. scenario
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?

6. Policy Context - past Reed report 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

7. 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
Mansell report 2007
Valuing People Now 2009
Social inclusion agenda
Legal – Disability Discrimination Act 2005 and Human Rights Act 1998

8. The Bradley Report
Similar findings to Prison Reform Trust - highlights the difficulties people with ld face throughout the CJS
Recommendations
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
IQ <70 7% and LD 3% using social competence and skills
IQ 70 – 79 = 24%

10. 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

11. Offender health service in Avon
AFCLDT
CARS Court assessment and referral scheme
Prison in reach team
Prison Healthcare
OAT secure inpatient – Quaternary team

12. AFCLDT – background history
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 (1wte) and senior forensic nurse (1wte), plus admin and some psychiatry (0.1wte) Now we also have a nurse practitioner, nurse in CARS team and social work champion

13. AFLDT - context Avon wide – population 1.1 million
4 unitary authorities
8/9 LD community teams
4 specialist challenging behaviour teams
Residential care
Other housing with various levels of support
Education, employment

14. AFCLDT – liaison with other agencies and services

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

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

17. AFCLDT – risk type

18. AFLDT – referral source

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

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

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

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

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

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

25. FCLDT – audits and service evaluations
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

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

27. FCLDT - reflections of challenges and gaps
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 visible
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

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