Psychological approaches to assessing and treating adolescent offenders with developmental disabilit

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Psychological approaches to assessing and
treating adolescent offenders with developmental
disabilities

• Marilyn Sher
• Chartered Forensic Psychologist

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Aims

• About our service
• Our approach to assessment
• Assessment tools, including risk assessment
• Our treatment programmes
• Brief outcomes
• Top tips

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Adolescents!!!

• Late adolescence involves
• Increasing independence
• trying out pushing boundaries
• Continued brain development
• Personality evolving
• Mixing of developmental features and valid issues
  i.e. impulsiveness moody feel being picked on
  blaming others

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The Adolescent Offender

• Adolescence is a period of biological,
  psychological and social change, but additionally
  can be a time of heightened risk and dysfunction
• Disobedience and oppositional behaviour is to a
  degree part of normal adolescent behaviour.
• However, such behaviours can escalate into
  violence and criminal acts

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SAH Adolescent service for developmental
disabilities

• 4 units (10 bed each)
• 2 male units
• Learning Disability
• Autistic Spectrum Disorder
• Trauma
• Mental illness
• Emerging personality disorders
• High rates of co-morbidity

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The literature

• Substantial rates of psychopathology
• Mental illness (i.e. paranoid)
• ADHD (i.e. impulsivity)
• ASD (i.e. interactional style change of routine)
• LD (i.e. suggestibility poor emotional control)
• EPD (i.e. callous unemotional)
• BUT cannot assume all problems attributed to
  above
• Treatment needs to reflect this complexity

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Assessment process

• Life maps/time-lines
• Psychometrics sourcing simple tools as well as
  use existing tools for LD
• Beck Youth Inventories AARS, SSRS
• Some tools specifically for LD
• QACSO
• Simplify existing tools e.g. NAS-PI
• Observational and behaviour monitoring
• GLM and Recovery Star materials

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Assessment

• Use visual likert scales, e.g. NAS-PI

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Assessment

• Full speech and language assess as may appear to
  understand mask well
• Be specific and give examples
• Use visual aids as much as possible
• Fidgets for concentration
• Be clear on expectations
• Are expectations in line with ability???

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RA So what about developmental disabilities???

• No specific risk assessment tools for this client
  group
• However, many tools like HCR-20, SAVRY and START
  make provision for additional items to be added
• Draw these into risk scenarios as well as
  treatment and management planning

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Risks associated with developmental disabilities

• Autism communication deficits, difficulty
  adjusting behaviour to the context, limited
  ability to form friendships, impaired
  empathy/remorse perspective taking difficulties
• Learning disability e.g. impulsivity
  suggestibility poor emotional control
  communication and social skill deficits
  understanding of relationships delays in moral
  development
• Trauma e.g. emotional dysregulation low
  self-esteem hyper vigilance

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Treatment
The most successful interventions target a range
of offence related needs
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What works?? - Approaches

• What Works principles
• Risk (intervention match recidivism risk)
• Need (personal/social factors targeted)
• Responsivity (sensitive to individualised needs
  i.e. culture learning style)
• Multimodal CBT approaches , behv. skill based
• Group environment
• Some say it does not work
• ASD social/cog processes

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Offence Related Programmes

• Adapted Sex Offender Treatment Group (ASOTG)
• Safe Life Group
• Aggression Replacement Training (ART)
• Problem Solving Group
• Arson Treatment Programme (Hot Topics)
• Understanding Group Processes
• Social Skills Group
• Substance Misuse Group
• Mental health Issues group

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Procedures

• Facilitator training impartial approach
  non-leading/open questioning style
• MDT facilitators reinforce skills outside
  session value our work learn about selves and
  gain skills
• Supervision
• Group guidelines
• Confidentiality
• Voluntary

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Creative approaches

• Multiple approaches enhance learning
• Visual
• Interactive
• Fun
• Worksheets
• Activities

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e.g. an adapted schema approach

• Negativity/Pessimism
• You always look at the bad parts of life, and
  ignore the good stuff. You are always expecting
  things to go wrong. You might be really scared of
  making a mistake. Because of this you may
• often worry,
• unsure about things,
• always on the watch
• or complaining lots

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Aggression Replacement Training (ART)

• 3 modules moral reasoning anger control skills
  streaming
• Once per week (45 min sessions)
• Cognitive, behavioural skill acquisition
• Anger control Sequence of skills taught through
  modelling role play
• Moral reasoning scenarios using ve peer
  pressure to shift to prosocial reasoning
• Skill streaming separate group
• Adaptations
• Assessments NAS-PI HIT IRI OAS-MNR

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Aggression Replacement Training

• LD/ASD group more impulsive so greater
  difficulty implementing skills, but still
  improved in right direction
• Harder to learn - need more repetition
• Lack insight
• High incidence of aggression but low reporting

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Outcomes so far ART

• ASD LD lower level of reported use of
  cognitive distortions
• Nature of violence different, being more reactive
• Low IQ so lack understanding i.e. knowledge of
  prosocial behv.
• lacking rather than propensity for violent styles
  of behv.

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Outcomes so far ART (a single case)

• Case X IQ 60 ADHD Conduct Disorder
  Tourettes Bipolar Affective Disorder
• Violence acquisitive offending
• Section 37
• Clinically significant improvements found in
  (reliable change index)
• Self-reported anger (all in functional group),
  which matched behaviour on the ward
• Utilisation of distorted thinking styles (6 out
  of 10)
• Not sufficient to target all distorted thinking
  styles
• Empathy/perspective taking elevations

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Adapted sex offender treatment group (ASOTG)

• Assessments ERASOR SOAP ASOAP QACSO
• Twice weekly (1 ½ hours sessions)
• CBT, skill acquisition
• ASOTP G-MAP Self regulation/good lives recent
  research
• Pilot 7 patients. 5 completed

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ASOTG content

• Block 1 Why are we here? Getting started
• Block 2 Sexual knowledge and the law
• Block 3 Introducing the programme
• Block 4 Offence account excuses
• Block 5 The four steps
• Block 6 Impact to self others
• Block 7 Old life / New life
• Block 8 Attachment

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ASOTG content cont

• Block 9 Feelings communication
• Block 10 Relationships intimacy what is ok
• Block 11 Assertiveness coping with anger
• Block 12 Consolidation and reviewing options
• Complimented by weekly ½ hour individual sessions
• support
• monitor

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ASOTG single case

• Case Y Mild LD Conduct disorder EPD
• Series of indecent sexual assaults
• CPIA 5
• Improvements over psychosocial
  family/environmental treatment domains of
  ERASOR
• Little shift on sexual interest domain
• Whole group positive GES scores
• i.e. cohesion support expressiveness
  independence order self-discovery leader
  control on task

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Reporting

• Simplified CPA reports e.g.
• Since your last report you have completed a few
  more assessments.
• One assessment looks at different parts of your
  personality so it can help us with your future
  treatment.
• From the assessment we can see that sometimes you
  can act without thinking, you may get angry
  quickly, and you can sometimes not think about
  others feelings. You can sometimes want to be
  in-charge and control situations. These things
  can sometimes lead you into trouble.
• Because you are still young some of the things
  noticed in the assessment may change as you get
  older.
• Another assessment looks at how well you do tasks
  in daily life (for example how well you clean
  yourself). Your results show the skills you have
  are about right for your abilities.
• You are very good at communication and self care
  skills.

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Challenges

• An integral part of custodial and therapeutic
  work in secure settings is clinical assessment,
  minimization and management of violence BUT
• Very little research base
• Baseline assessments
• Individualised, so difficult to compare
• So many issues at play

sigh
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Tips to take away
Use lots of colour
Varied tasks and exercises
Fun pictures
Individual support
Flexibility
Comprehensive session planning
Be inventive - don't be scared
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Thank you Contact information01604 614
531email msher_at_standrew.co.uk