Nicole Hickey

A Randomized Controlled Trial of Multisystemic Therapy and a Statutory Therapeutic Intervention for Young Offenders.

OBJECTIVE To evaluate whether Multisystemic Therapy (MST) is more effective in reducing youth offending and out-of-home placement in a large, ethnically diverse, urban U.K. sample than an equally comprehensive management protocol; and to determine whether MST leads to broader improvements in youth sociality and in mediators believed to be responsible for change in MST. METHOD 108 families were randomized to either MST (n=56) or the comprehensive and targeted usual services delivered by youth offending teams (YOT, n = 52). RESULTS Although young people receiving both MST and YOT interventions showed improvement in terms of reduced offending, the MST model of service-delivery reduced significantly further the likelihood of nonviolent offending during an 18-month follow-up period. Consistent with offending data, the results of youth-reported delinquency and parental reports of aggressive and delinquent behaviors show significantly greater reductions from pre-treatment to post-treatment levels in the MST group. In this study MST was observed to have some delayed impact on offending, the nature and causes of which will require further study. CONCLUSIONS The superiority of the MST condition in reducing offending and antisocial behavior suggests that MST adds value to current U.K. statutory evidence-based youth services. The provision of MST does not supplant existing services but is best used to facilitate the appropriate and cost-effective organization of statutory services for young persons and their families.

Assessment of Somatic Symptoms in British Secondary School Children Using the Children's Somatization Inventory (CSI)

OBJECTIVE To present normative and psychometric data on somatic symptoms using the Childrens Somatization Inventory (CSI) in a nonclinical sample of British young people, and to assess associations with stress and functional impairment. METHODS A total of 1,173 students (11- to 16-years old) completed the CSI and self-report psychopathology measures. RESULTS The median CSI total score was 12 (5, 23). Headaches, feeling low in energy, sore muscles, faintness, and nausea were most frequent. Girls scored higher than boys, and respondents aged 13-14 years lower than younger children. The CSI showed good internal consistency and exploratory factor analysis yielded three factors: pain/weakness, gastrointestinal, and pseudoneurological. A quarter of respondents reported somatic symptoms were made worse by stress. CSI scores were moderately significantly correlated with impairment and emotional symptoms. CONCLUSIONS The CSI, complemented by information on functional impairment and stress is an appropriate measure of recent somatic symptoms and somatization risk in young people for use in the UK.

Children and adolescents who present with sexually abusive behaviour: A UK descriptive study

Abstract Background: This study describes the largest UK sample of young people presenting with sexually abusive behaviour to a fourth-tier NHS specialist service. Aims: To describe the psychosocial and behavioural characteristics of these children. Method: The case files of 280 referrals to a national assessment and treatment service for young people displaying sexually harmful behaviour were reviewed using a specially designed research protocol. Results: The sample had experienced extremely emotionally deprived and abusive upbringings, with family instability and dysfunction. Early onset of sexual and aggressive behaviour, neuropsychological deficits, and mental health problems were noted. Conclusions: A matrix of developmental risk factors underlies the onset of sexually abusive behaviour in this sample. The need for a developmental model of sexually abusive behaviour in children is stressed.

Comparing the developmental and behavioural characteristics of female and male juveniles who present with sexually abusive behaviour

Abstract Relatively few studies have compared female and male juveniles who sexually abuse. These studies have reported that while female juveniles with sexually abusive behaviour are more likely to have experienced childhood sexual abuse, they display similar patterns of abusive behaviour. However, to date these findings have not been replicated in a UK sample. The current study compared 22 female and 254 male juveniles, referred to a UK specialist community forensic service, in relation to family environment, maltreatment experience, psychiatric diagnoses and perpetrated abusive behaviour. Consistent with previous studies perpetrated behaviour was similar across genders, but females were significantly more likely to have been sexually victimized as children, at a younger age and by a greater number of abusers. In addition, they were more likely to have been exposed to inadequate sexual boundaries at home. These findings suggest that females and males may follow different pathways to sexually abusive behaviour.

Economic Evaluation of Multisystemic Therapy for Young People at Risk for Continuing Criminal Activity in the UK

Objective To evaluate whether multisystemic therapy (MST) is more cost-effective than statutory interventions that are currently available for young offenders in England. Method A cost-offset evaluation of MST based on data from a randomised controlled trial conducted in North London, England, comparing MST with usual services provided by two youth offending teams (YOT). Service costs were compared to cost savings in terms of rates of criminal re-offending. Results 108 adolescents, aged 11–17 years, were randomly allocated to MST+YOT (n = 56) or YOT alone (n = 52). Reductions in offending were evident in both groups, but were higher in the MST+YOT group. At 18-month follow-up, the MST+YOT group cost less in terms of criminal activity (£9,425 versus £11,715, p = 0.456). The MST+YOT group were significantly cheaper in terms of YOT services than the YOT group (£3,402 versus £4,619, p = 0.006), but more expensive including the cost of MST, although not significantly so (£5,687 versus £4,619, p = 0.195). The net benefit per young person for the 18-month follow-up was estimated to be £1,222 (95% CI −£5,838 to £8,283). Conclusions The results reported in this study support the finding that MST+YOT has scope for cost-savings when compared to YOT alone. However, the limitations of the study in terms of method of economic evaluation, outcome measures used and data quality support the need for further research.

Early-onset sexually harmful behaviour in childhood: a marker for life-course persistent antisocial behaviour?

While traditionally adolescent sexually harmful behaviour (SHB) has been considered beyond the domain of general delinquency, many adolescents showing SHB also show a pattern of non-sexual offending. It was hypothesised that an early onset of SHB would probably reflect the presence of developmental risk factors associated with a generic and persistent antisocial trajectory. A retrospective file review of cases referred to a national SHB service was conducted. Cases were categorised as early onset (n = 100), with SHB evident prior to the age of 10, or late onset (n = 137), with SHB first evident after the age of 10. The early onset group were found to have higher rates of maltreatment, poor temperament, aggression, hyperactivity, educational difficulties, and mental health problems. They also displayed greater continuity of non-sexual antisocial behaviour across childhood and adolescent periods, and scored significantly higher on a standard psychopathy measure. We propose that an early onset of SHB may act as a clinical marker for a group of children at risk of a general delinquency trajectory. These children require early and multifaceted interventions beyond those addressing sexual behaviour problems alone.

Psychiatric diagnosis and differential risks of offending following discharge

Psychiatric diagnosis is not considered a risk factor for offending following discharge. However, treatment interventions and aftercare are strongly influenced by clinical primary diagnosis. We compared differential risks of reoffending of patients falling into six primary diagnostic categories following discharge from Medium Secure Units in the UK: schizophrenia/schizoaffective disorder; delusional disorder; mania/hypomania; depressive disorder; organic brain syndrome; personality disorder. We followed up 1344 patients, on average 6.2 years (SD=2.1) at risk, discharged from 7 of 14 Regional Medium Secure services in England and Wales. Outcomes were period prevalence, incidence, and cumulative probability of criminal conviction. Established demographic and criminal history predictors of reoffending were observed across different diagnostic categories. Risks of all offending were increased for personality disorder, violence/acquisitive offending for delusional disorder, sexual offending for mania/hypomania and violence/acquisitive offending for organic brain syndrome. Patterns of risk over time differed markedly between categories of mental disorder. Most patients with personality disorder who offended violently did so within 4 years of discharge. A subgroup with delusional disorder demonstrated increased risk of violent offending 5 years after discharge. Differential risks of reoffending are observed between different diagnostic groups. Clinical diagnosis should be included together with established risk measures in risk management following discharge. Close supervision of patients with personality disorder should begin immediately after discharge when risks of reoffending are greatest. For delusional disorder further investigation is needed into the marked increase in risk of violence after 5 years.

The development of the Medium Security Recidivism Assessment Guide (MSRAG): an actuarial risk prediction instrument

The majority of patients in medium secure services in the UK have a primary diagnosis of major psychosis. Currently available actuarial risk prediction instruments have limited application, having been developed in different jurisdictions on samples with different characteristics. The Medium Security Recidivism Assessment Guide (MSRAG) was developed to assess risk of acquisitive and serious offending in patients with schizophrenia and delusional disorder. It assesses static predictor variables and is designed for use at the pre-discharge stage of rehabilitation. Results indicate the MSRAG has good predictive accuracy, and acquisitive and serious offending scales were cross-validated. Dynamic risk factors occurring post-discharge interact with four levels of ascribed risk, impacting especially on those at high risk. The MSRAG can be easily scored from case file information, does not require extensive training, and can be used to screen patients routinely prior to discharge. Observed interactions with dynamic factors after discharge can guide clinical risk management.