Susan Brown

Circles of Support and Accountability for Sex Offenders A Systematic Review of Outcomes

We conducted a systematic review of studies reporting on the effectiveness of Circles of Support and Accountability (Circles). Circles use volunteers to provide support for sex offenders living in the community. We searched 10 databases up to the end of 2013 and identified 3 relevant outcome studies. An additional 12 papers or reports were identified by searching reference lists, Google, and contacting key authors and Circles providers to obtain unpublished data. These 15 studies comprised one randomized controlled trial, three retrospective cohorts with matched controls, and 11 case series. The majority reported measures of recidivism, particularly reconviction. The 4 studies with controls generally reported that participation in Circles was associated with lower recidivism although there were few statistically significant differences. Few studies examined changes in risk or psychosocial outcomes. A number of methodological issues are discussed. Longer term, prospective follow-up studies with control groups are required to address these issues.

Case formulation in personality disordered offenders: Views from the front line

BACKGROUND Case formulation (CF) is a process that provides a psychological understanding of a persons difficulties and results in an intervention plan to address them. CF may be particularly useful in complex cases; yet the evidence base on its application in forensic settings is limited. Nevertheless, CF is a key part of the UK governments strategy for high-risk personality disordered offenders. As part of this strategy, probation staff are expected to carry out CF in order to inform interventions for these offenders. AIMS/HYPOTHESES This study sought to access the experience of probation staff of working with personality disordered offenders and their views around their role in the strategy and what challenges and benefits might arise. METHODS Three focus groups were carried out, each with 6-7 probation staff. RESULTS Four themes emerged. Firstly, staff reported a lack of personality disorder (PD)-specific training, and the work that they do with PD offenders is hampered by this. Secondly, probation staff experience difficulties when attempting to obtain help for PD offenders, including diagnostic assessments and treatment for those already diagnosed. Thirdly, the work probation staff currently do with offenders covers similar areas as CF but with a different focus. Fourthly, participants welcomed the prospect of PD-specific training but were concerned that they should be appropriately supervised and not left to carry out work for which they feel under-trained. CONCLUSIONS Our findings point towards potential benefits in providing probation staff with PD-specific training in order to implement the PD offender strategy. IMPLICATIONS FOR PRACTICE Issues relating to the lack of provision of appropriate treatment and the need for relevant supervision of probation staff conducting CF need to be addressed in order to enhance the successful operation of the strategy.

The implementation of case formulation by probation officers: service user and carer views

Abstract Background: The recent UK Government strategy on high-risk offenders with personality disorders (PD) proposes improved identification of this group, assessment of their treatment needs through case formulation (CF) and the subsequent provision of treatment pathways. Little is known about service user and carer views on this strategy. Aims/Hypotheses: This study sought to identify the views of personality-disordered (PD) offenders and carers on the proposed role of Probation staff in CF. Methods: Three focus groups were carried out, two with service users and one with carers, with a total of 10 participants overall. Results: Five themes emerged: ‘power’, ‘conflicting roles’, ‘trust’, ‘building a relationship through consistency of care’ and ‘hope and possibility’. Conclusions/Practical implications: Offenders and carers were sceptical regarding the proposed role of Offender Manager (OMs) in CF and this could pose a potential barrier to the successful implementation of the strategy.

The effects of using the PReDicT Test to guide the antidepressant treatment of depressed patients: study protocol for a randomised controlled trial.

BackgroundAntidepressant medication is commonly used to treat depression. However, many patients do not respond to the first medication prescribed and improvements in symptoms are generally only detectable by clinicians 4–6 weeks after the medication has been initiated. As a result, there is often a long delay between the decision to initiate an antidepressant medication and the identification of an effective treatment regimen.Previous work has demonstrated that antidepressant medications alter subtle measures of affective cognition in depressed patients, such as the appraisal of facial expression. Furthermore, these cognitive effects of antidepressants are apparent early in the course of treatment and can also predict later clinical response. This trial will assess whether an electronic test of affective cognition and symptoms (the Predicting Response to Depression Treatment Test; PReDicT Test) can be used to guide antidepressant treatment in depressed patients and, therefore, hasten treatment response compared to a control group of patients treated as usual.Methods/designThe study is a randomised, two-arm, multi-centre, open-label, clinical investigation of a medical device, the PReDicT Test. It will be conducted in five European countries (UK, France, Spain, Germany and the Netherlands) in depressed patients who are commencing antidepressant medication. Patients will be randomised to treatment guided by the PReDicT Test (PReDicT arm) or to Treatment as Usual (TaU arm). Patients in the TaU arm will be treated as per current standard guidelines in their particular country. Patients in the PReDicT arm will complete the PReDicT Test after 1 (and if necessary, 2) weeks of treatment. If the test indicates non-response to the treatment, physicians will be advised to immediately alter the patient’s antidepressant therapy by dose escalation or switching to another compound. The primary outcome of the study is the proportion of patients showing a clinical response (defined as 50% or greater decrease in baseline scores of depression measured using the Quick Inventory of Depressive Symptoms – Self-Rated questionnaire) at week 8. Health economic and acceptability data will also be collected and analysed.DiscussionThis trial will test the clinical efficacy, cost-effectiveness and acceptability of using the novel PReDicT Test to guide antidepressant treatment selection in depressed patients.Trial registrationClinicalTrials.gov, ID: NCT02790970. Registered on 30 March 2016.

Women's sport leadership styles as the result of interaction between feminine and masculine approaches

There is a growing body of research focusing on women in the business sector using a transformational model of leadership that identifies the ways in which they lead yet little is known about the style of leadership women practise in sport. In attempting to redress this oversight in the literature, this article draws on data from a larger study to identify how women practise leadership within a sporting context. It identifies the leadership styles of women working at the community (club and regional) and elite (state and national) sectors of the Australian sport system in the state of Victoria as being feminine but which appropriate aspects of masculine styles. It also suggests that the womens early experiences of growing up played a significant part in shaping their leadership styles.

Protocol investigating the clinical utility of an objective measure of attention, impulsivity and activity (QbTest) for optimising medication management in children and young people with ADHD ‘QbTest Utility for Optimising Treatment in ADHD’ (QUOTA): a feasibility randomised controlled trial

Introduction Attention-deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity and impulsivity. To improve outcomes, the National Institute for Health and Care Excellence ADHD guidelines recommend regular monitoring of symptoms when children commence medication. However, research suggests that routine monitoring rarely happens, and clinicians often rely on subjective information such as reports from parents and teachers to ascertain improvement. These sources can be unreliable and difficult to obtain. The addition of an objective test of attention and activity (QbTest) may improve the objectivity, reliability and speed of clinical decision-making and so reduce the time to identify the optimal medication dose. This study aims to assess the feasibility and acceptability of a QbTest medication management protocol delivered in routine healthcare services for children with ADHD. Method and analysis This multisite feasibility randomised controlled trial (RCT) will recruit 60 young people (aged 6–17 years old), diagnosed with ADHD, and starting stimulant medication who are seen by Child and Adolescent Mental Health Services or Community Paediatric services. Participants will be randomised into one of two arms. In the experimental arm (QbTest protocol), the participant will complete a QbTest at baseline (prior to medication initiation), and two follow-up QbTests on medication (2–4 weeks and 8–10 weeks later). In the control arm, participants will receive treatment as usual, with at least two follow-up consultations. Measures of parent-, teacher- and clinician-rated symptoms and global functioning will be completed at each time point. Health economic measures will be completed. Clinicians will record treatment decision-making. Acceptability and feasibility of the protocol will be assessed alongside outcome measure completion rates. Qualitative interviews will be conducted. Ethics and dissemination The findings will be used to inform the development of a fully powered RCT. The results will be submitted for publication in peer-reviewed journals. The study has ethical approval. Trial registration number NCT03368573; Pre-results.

The Influence of Human Factors on Access and Scheduling of Primary Care Services

This paper explores human and organisational factors (HOFs) related to access and scheduling (A&S) of Healthcare services. Here human factors relate to the ‘processed’ (patients) as well as the ‘processors’ (people working in the operation). A ‘whole system perspective’ is taken to investigate how these influence outcomes. The analysis differentiates acceptable demand on the service from failure demand [1], where failure demand represents unnecessary demand placed on acute care (such as Accident and Emergency in hospitals) as well as primary care services. For eight General Practices in the UK, approaches to practice organisation, including A&S, are analysed to establish HOFs that influence service delivery and performance. Findings highlight HOFs affecting outcomes and ways in which A&S arrangements can be modified to improve them. These should inform the choice and management of effective A&S in a range of Health service scenarios, as well as for General Practices in the UK.

1659 – The development of a case formulation training package for probation staff

Introduction A recent UK Government initiative has sought to address the management of personality disordered (PD) offenders, aiming to improve public protection by reducing reoffending whilst simultaneously improving the psychological health of offenders with PD. Case formulation (CF) is given primacy here as it enhances offender management through a psychologically informed approach and informs pathway planning through Criminal Justice System or NHS services. Probation services are given an important role in formulating cases as part of the new strategy. Objectives Develop a consensus amongst professionals as to what makes a good Case Formulation (CF). Investigate whether probation services can be taught CF skills, and to enhance these skills. Aims Develop a case formulation training package for probation staff and evaluate the training. Method The training package was informed by the results of a Delphi survey amongst professionals, and focus groups with probation staff, offenders and carers of individuals with PD. Results There was consensus that CF allows for collaboration between client and therapist, helps with complexity through organisation of case notes and has utility in treatment planning. Themes highlighted for effective CF included background, trauma, offending, risk and current lifestyle. The theoretical model gaining most support was a CBT model. The assessment of formulations was identified as challenging. The CF training package is currently being evaluated and findings will be presented at the conference, alongside outcomes of all phases of the research. Conclusions CF has the potential to enhance treatment planning. Its suitability for probation staff will be discussed.