The forensic support service: a 12 month follow up

1
The forensic support service a 12 month follow up

• Steve Field (Clinical Psychologist)
• Karen Mellor (FSS Lead)

2
Brief background history

• Commissioned by NWSCT (end of 2006)
• Objectives
• To support local agencies services
• To transfer skills and knowledge
• To reduce admissions to secure services
• To facilitate discharge from secure services
• To identify appropriate carepathways
• To reduce out of area treatments

3
Continued...

• Strategic development, pilot study recruitment
  (2007)
• Aims
• Identify nature and degree of forensic risk using
  gold standard risk assessments (e.g. HCR-2o
  RSVP)
• Advise on risk management (balance positive
  approaches, person centeredness least
  restrictive options)
• Focus on transfer of clinical skills through
  joint working and training programme
• Fully functioning team (April 2008)

4
Team Structure (09/10)
5
Geographical Area
1. South Lakeland Ana-Maria Guzman/Andy Shaw 2.
Barrow Ana-Maria Guzman/Andy Shaw 3. North
Lancashire Vicky Dunn/Andrew Jackson 4.
Blackpool Fiona Whalley/Lizzie Kidd 5. Central
Lancashire Andy Shaw/Julia Anderson 6. East
Lancashire Julia Anderson/Andrew Jackson 7.
Ashton, Leigh and Wigan Andy Shaw/Ana-Maria
Guzman 8. Bolton Ana-Maria Guzman/Andy Taylor 9.
Blackburn with Darwen Fiona Whalley/Andy
Taylor 10. Bury Lizzie Kidd/Fiona Whalley 11.
Rochdale, Heywood and Middleton Vicky Dunn/Steve
Field 12. Salford Julia Anderson/Karen Mellor 13.
Trafford Lizzie Kidd/Karen Mellor 14. Manchester
North Fiona Whalley Manchester South Vicky
Dunn Manchester Central Lizzie Kidd/Vicky
Dunn 15. Oldham Julia Anderson/Steve Field 16.
Tameside and Glossop Steve Field/Andy Taylor 17.
Stockport Steve Field/Andrew Jackson
6
Specialist Leads

• Research
• Womens issues
• 16-18 year olds (transition)
• Psychodynamic approaches
• Sex Offender Treatment Programmes
• Autism/Aspergers
• Police Probation liaison
• Drugs Alcohol
• Mental Health Act/Mental Capacity

7
Developing

• Links with other services agencies
• Mapping the local areas
• Clinical skills and knowledge development locally
• Joint working
• Outcome measures
• Forensic Risk
• Quality of Life
• Mental Health
• Service Service User Satisfaction Questionnaires

8
Referrals received 08/09
9
Referrals received (2)

• RISK AREAS OF CONCERN

10
Experience so far......

• Achievements to date
• Difficulties/Challenges
• Gaps in services
• Feedback to date

11
Achievements

• Client successes (see 5.00pm presentation)
• Acceptance
• Built positive working relationships with
  majority of services/agencies
• Staff skill mix (we work well together!)
• Foundation Trust Status
• Out of 83 referrals this year only 9 people have
  been admitted to secure accommodation (NB In
  these cases this was considered the appropriate
  care pathway at that time)
• Start the ball rolling commissioning
  additional resources / services, promoting
  multiagency working.

12
Difficulties/Challenges experienced

• Understanding of roles (who does what?)
• Expectations regarding case management
• Local services difficulties in identifying
  suitable accommodation
• Accessing information/files
• Finding services willing to support someone with
  borderline LD
• Local variations regarding what constitutes
  access to LD services
• What is forensic behaviour? Fine line between
  challenging and offending
• Health care needs on occasion have been
  superseded by the label of offender.

13
Gaps in Services

• LD vs MH (on going issues re who supports who?)
• Spectrum disorders (who supports full stop!)
• Community LD Psychiatric input (where?)
• Joint working between services for children in
  transition
• LD support for probation services knowledge,
  expertise/confidence, joint working with LD
  services (proposal that will be involved in
  training imitative with GM Offender Mental Health
  team previous training to probation and MH
  services re what is LD and how to work with LD
  offenders)

14
What next?......plans for the future

• Plans for 2009-2010
• Research
• Training Programmes
• Ongoing Promotion
• Development of waiting list !

15
Research

• Development of Community Risk profile screening
  tool (in collaboration with inpatient community
  services)
• Evaluations of PBS training programme (Fylde
  Wyre)
• Applications of IABA within an LD offender
  population
• Continual in house audit of training packages

16
Training
17
Training Cont

• Risk Assessment
• Understanding anger aggression
• Sexually aberrant behaviour (insights and
  understandings)
• What constitutes a learning disability issues
  around offending within a LD pop
• Specific training around individual cases
• In addition the FSS has been involved in the
  development and delivery of training into
• Clinical Psychology Doctoral Training Courses
• Diploma of H.E. in Positive Behaviour Support
  (EdgeHill)
• Northwest Training and Development Team
• Given that we are a regional resource ... Watch
  this space!

18
Ongoing Promotion
19
Feedback

• Feedback from Services
• I feel the assessment carried out was very
  in-depth. The meetings were an essential part of
  the process as it brought all the support
  provided together. It made us all look at things
  differently and the report gave me the tools to
  put the guidance for the staff team together
• CLIENT continues to display behaviours that our
  team are not qualified or skilled enough to
  assess? However I am fully satisfied with the
  support CLIENT receives given our limitations. I
  can only commend my colleagues for their
  continued care and dedication to CLIENT. Thank
  you for your valuable support
• Feedback from Clients
• Thank you for working with me and I am grateful
  for the house I'm in
• I CLIENT got help to avoid vulnerable people
  so that I don't get into trouble
• Indicator of satisfaction repeat business?

20
Final Comments

• I believe that the FSS is making a considerable
  contribution to our declared strategy of treating
  and supporting people locally and within the
  least restrictive environment possible.
• The FSS have already stopped people with learning
  disabilities who have very complex offending type
  behaviours, from having to leave the North West
  to receive their treatment.  Furthermore it has
  already prevented admissions to secure beds and
  continues to help in the discharge of some
  patients from secure beds and services.
• We are very privileged to have a highly trained
  and professional team in the North West.  Not
  only do they provide advice, support and direct
  working, but also pass on their expertise to
  local practitioners.  This skill transfer process
  will result in even more people with learning
  disabilities and complex behaviours, living
  successfully in our community.
• This long awaited service will also reduce the
  number of victims as the skill transfer process
  gathers momentum.  As local services develop
  further their expertise in this area more
  preventative work becomes possible, in addition
  to them being able to manage those with offending
  behaviours more successfully.
• Mr P. Shackell, Regional Secure Commissioner