Jessica R. Wheeler

Pathways Into Services for Offenders with Intellectual Disabilities Childhood Experiences, Diagnostic Information, and Offense Variables

The patterns and pathways into intellectual disability (ID) offender services were studied through case file review for 477 participants referred in one calendar year to community generic, community forensic, and low, medium, and maximum secure services. Data were gathered on referral source, demographic information, index behavior, prior problem behaviors, diagnostic information, and abuse or deprivation. Community referrers tended to refer to community services and secure service referrers to secure services. Physical and verbal violence were the most frequent index behaviors, whereas contact sexual offenses were more prominent in maximum security. Age at first incident varied with security, with the youngest in maximum secure services. Attention-deficit/hyperactivity disorder or conduct disorder was the most frequently recorded diagnosis, and severe deprivation was the most frequent adverse developmental experience. Fire starting, theft, and road traffic offenses did not feature prominently. Generic community services accepted a number of referrals with forensic-type behavior and had higher proportions of both women and people with moderate or severe ID.

Community services and people with intellectual disabilities who engage in anti-social or offending behaviour: referral rates, characteristics, and care pathways

Provision of health and social support to people who engage in anti-social or offending behaviour and have intellectual disabilities (ID) remains a challenge to services. Numerous population studies have produced contradictory findings with reviews calling for the development of more fruitful approaches and recommending investigation of the care pathways operating within ID services. This study reports on the pathways through services encountered by adults with offending or anti-social behaviour referred to 15 UK community ID services in 2002. Pathways through services were tracked for 24 months post referral. Referral rates, demographic characteristics, and associations with anti-social or offending behaviour were statistically analysed for 237 cases. Most referrals originated from the local community (66%); a high proportion were female (40.5%). Community services appeared encapsulated, serving adults with offending behaviour over the long term, but predominantly (74%) those already known to local ID services. Implications for services and future research strategies are considered.

Referrals into services for offenders with intellectual disabilities: variables predicting community or secure provision.

BACKGROUND There is a need for research to promote an understanding among service developers on why people with intellectual disabilities (ID) are referred to offender services in order for them to receive appropriate assessment and treatment. Previous studies investigating referrals into forensic ID services have concentrated on referral sources and administrative variables such as legal status. AIMS To construct a predictive model for choice of service referral based on a comprehensive range of information about the clientele. METHOD We conducted a case record study of 336 people referred to community services and 141 to secure provision. We gathered information on referral source, demographics, diagnosis, index behaviour, prior problem behaviours and history of abuse. RESULTS Comparisons revealed 19 candidate variables which were then entered into multivariate logistic regression. The resulting model retained six variables: community living at time of referral, physical aggression, being charged, referral from tertiary health care, diverse problem behaviour and IQ < 50, which correctly predicted the referral pathway for 85.7% of cases. CONCLUSIONS An index act of physical aggression and a history of diversity of problem behaviours as predictors against the likelihood of community service referral suggest that professionals have similar concerns about people with ID as they do about their more average offending peers; however, the more severe levels of ID mitigated in favour of community referral, regardless. Offenders with ID tend to be referred within levels of service rather than between them, for example, form tertiary services into generic community services.

Pathways through services for offenders with intellectual disability: a one- and two-year follow-up study.

The pathways through services for offenders with intellectual disability were reviewed. Participants were 197 offenders with intellectual disability accepted into three types of community and three types of secure forensic intellectual disability services. They were first compared with 280 participants referred but not accepted into services and were then followed-up for 2 years to review pathways through services. Those accepted into services had a higher charge rate than did those who were referred (46% and 25%, respectively). The greatest diversity in pathway was seen in participants in community forensic intellectual disability and inpatient services. Individuals in secure settings showed the least diversity over time, and, similarly, a relatively high percentage of those accepted into generic community services remained in these services.

Alcohol and its relationship to offence variables in a cohort of offenders with intellectual disability

Abstract Background Alcohol use and misuse may be lower in people with intellectual disability (ID) than in the general population but may be related to offending. Method Alcohol-related crime and history of alcohol use was recorded in 477 participants with ID referred to forensic ID services and related to offending. Results Level of alcohol-related crime and history of alcohol misuse was lower than in some previous studies at 5.9% and 20.8%, respectively. History of alcohol abuse was associated with alcohol-related offences and theft. Higher rates of alcohol problem history were associated with histories of a number of offences, psychiatric disturbance in adulthood, psychiatric disturbance in childhood, and experiences of childhood adversity. Most effect sizes were weak or moderate. Conclusions The convergence of childhood adversity, psychiatric problems in childhood and adulthood, and alcohol abuse is consistent with studies that have found these as risk markers for offending.

A comparison of sex offenders and other types of offenders referred to intellectual disability forensic services

This study compared 131 sex offenders with ID and 346 other types of offenders with ID using case file records. All the females in the study were non sexual offenders. Significantly more sexual offenders were referred from court and criminal justice services while significantly fewer were referred from secondary healthcare. A higher percentage of sex offenders had some form of legal status at time of referral. Greater proportions of non sexual offenders were referred for aggression, damage to property, substance abuse and fire setting while only the sex offenders had an index sex offence. For previous offending, the non sexual offenders had higher rates of aggression, cruelty and neglect of children, property damage and substance abuse while the sexual offenders had higher rates of previous sexual offending. For psychiatric disturbance and adversity in childhood, only ADHD showed a significant difference between groups with the non sexual offenders recording higher rates.

What can social and environmental factors tell us about the risk of offending by people with intellectual disabilities

A minority of men and women with intellectual disabilities at times engage in, and are suspected, or convicted, of illegal activity. Recent policy developments in England and Wales emphasise the need to respond appropriately to putative offending risk through the provision of safe and effective community management, treatment, and support services. In line with these concerns, research has focused increasingly on testing the utility of an evolving variety of risk assessment procedures. Here, the authors set out to challenge the repertoire of a number of prominent and/or recently developed risk assessment procedures and the scope of an associated research literature, on the basis that contextual risk factors are receiving insufficient attention in relation to offending among people with intellectual disabilities. Drawing on the wider criminological literature, a novel study is reported that compares key contemporary proximal social and environmental circumstances in the lives of offenders and non-offenders with intellectual disabilities. A contextual risk score is derived, providing statistical support for increased consideration of the impact of relevant social and environmental circumstances. Increased emphasis on key contextual risk factors is recommended to strengthen community service responses to offenders with intellectual disabilities.

Diagnostic information and adversity in childhood for offenders with learning disabilities referred to and accepted into forensic services

Several studies have related diagnostic information and adversity in childhood to criminal careers and risk of recidivism. Notably, ADHD and conduct disorder in childhood, schizophrenia, sexual abuse and physical abuse have been associated with offences in adulthood. This study investigates these variables in relation to large cohorts of offenders with learning disabilities. A case note review was undertaken for 126 individuals referred but not accepted into forensic learning disability services and 197 individuals accepted for such services. Results are reported on diagnostic information and experience of adversity in childhood. ADHD/conduct disorder featured prominently in both groups. Autistic spectrum disorders were not particularly over‐represented. For adversity in childhood, general socioeconomic deprivation featured prominently in both groups. This also increased significantly for those accepted into services. Sexual abuse and non‐accidental injury were featured at around 13‐20% for both groups. These results are broadly consistent with the mainstream literature on offending, ADHD/conduct disorder and general deprivation featuring significantly in all groups and rising for those accepted into offender services. It is important to deal with these aspects during assessment and to provide appropriate psychotherapeutic services for these individuals.

Jack of all trades, master of none? Challenges facing junior academic researchers in bioethics

The rise of a ‘new’ empirical bioethics, which aims to ground normative judgments in ‘real-world’ data relating to different ethical problems in the biomedical sciences, has been well-documented in recent years. – 7 Indeed, the journal Clinical Ethics was established as a valuable forum for the dissemination of research that embraced an empirical approach to the exploration of ethical problems in clinical practice. For postgraduates who see themselves as engaging in bioethics research, these developments present both a real opportunity to adopt a broad range of disciplinary perspectives in exploring their chosen topic, and a series of challenges in producing rigorous and respected work that might lead to an established academic career. The breadth of the field called ‘bioethics’ is well-suited to postgraduate research. At this level, researchers have a great degree of freedom to draw on different theoretical and methodological traditions in developing projects that address new problems in different ways. Indeed, one might say that this freedom to explore and experiment with different perspectives is what makes undertaking a PhD so special. However, this process of experimentation is also conducive to producing identity crises. When asked to describe the work that we do, we might respond by saying, for example, that it has a social scientific, a philosophical, a legal and a psychiatric component. When asked how these components integrate, or when called to account on the basis of the quality of our research by supervisors, reviewers or examiners, we have an uneasy sense that everything might unravel around us, our projects amounting to less than the sum of their parts.

A comparison of referrals with and without autism spectrum disorder to forensic intellectual disability services

Although some authors have suggested that there are higher rates of people with Autism Spectrum Disorder (ASD) in forensic and offending groups, systematic studies have not supported the hypothesis. The present study reviewed 477 referrals made to forensic intellectual disability (ID) services in one calendar year. It was found that 10% of referrals had ASD, a figure similar to the general population of people with ID. Those with ASD had similar patterns of offending to those without but they showed a lower prevalence of contact sexual offences and fewer had been previously charged. We concluded that there is no persuasive evidence that ASD is a risk factor for offending or for any particular type of offending.