Tammi Walker

Caseload management in community learning disability teams Influences on decision-making

This report is the result of quantitative and qualitative inquiry into the workings of community learning disability teams with particular reference to the handling of caseloads and specifically discharge procedures. The study focused on four teams in the West Yorkshire area. Quantitative data to represent professionals within the teams, their caseload sizes and waiting lists were analysed. Qualitative information with respect to caseload management strategies was gathered via semi-structured interviews and the findings were validated by a focus group. The professionals identified the decision-making processes they employed regarding maintaining service users or discharging service users from their caseload. The management and structures within each of the teams were found to be complex and varied. The implications of these findings and recommendations for further investigations into the nature of caseload management practices in community learning disability services are discussed.

‘Seeing beyond the battled body’ – An insight into selfhood and identity from women's accounts who self-harm with a diagnosis of borderline personality disorder

Abstract Background: Self-harm (self poisoning and self-injury) is broadly characterised as any act intended to harm ones own body, without a conscious intent to die. Research indicates that when practitioners encounter self-harm they often remain anxious, fearful, frustrated, and challenged about such individuals, principally because they are constrained to understand and respond to self-harm almost exclusively within a problematised discourse (Walker, 2006). That is, a problem that must be diagnosed and contained. Women who self-harm with a diagnosis of BPD are often portrayed as being risky, chaotic and their identity can be unstable. The aim of this study was to examine and explore the subjective experiences of women who self-harm with a diagnosis of BPD. Participants: Four women who had a history of self-harming behaviour with the diagnosis of BPD volunteered for the study. Method: Face-to-face, in-depth narrative interviews were undertaken and were analysed within a framework which drew upon aspect...

Voices from the Group: Violent Women's Experiences of Intervention.

This study discusses the experiences of women who participated in a program for partner-violent women by understanding their views of the treatment process, outcomes and the meanings they attached to it. This study followed a Husserlian descriptive phenomenology. Interviews were conducted with seven English women who used physical intimate partner violence in heterosexual relationships. The data were analyzed using by the method developed by Colaizzi (1978). The qualitative findings suggest the women experienced the treatment as positive and meaningful and experienced personal transformations. Deeper analysis of the data, showed that there were two key areas of benefit to the women, one involving the connections and bonds formed with other women in the group and the facilitators, and the second including the skills and strategies the women learned for managing anger and negative emotions.

The use of time base lag sequential analysis to look at the relationship between environmental events and challenging behaviour in people with learning disabilities

Although low frequency challenging behaviour (that which occurs less than once a day) is common, very little research has been done into its analysis or treatment. It is suggested that the methods of analysing high frequency challenging behaviour, such as experimental functional analysis, will not be applicable with low frequency challenging behaviour. The use of correctional analysis of case records is considered as a method for generating hypotheses as to why a client is showing low frequency challenging behaviour. It is noted that using simple correlations is a method that can provide only limited information as to the relationship between a challenging behaviour and other events. A method that can reveal more about the temporal relationship between environmental events and challenging behaviour is time base lag sequential analysis. Three case studies are presented in which time base lag sequential analysis was used to analyse the relationship between challenging behaviour and possible causal factors.

Supporting imprisoned women who self-harm: exploring prison staff strategies

Purpose The purpose of this paper is to explore the experiences of prison staff working with imprisoned women who self-harm in English prisons. In this small-scale study, 14 prison staff in three English prisons were interviewed to examine the strategies currently used by them to support imprisoned women who self-harm. Design/methodology/approach Thematic analysis (Braun and Clarke, 2006) was used to identify three key themes: “developing a relationship”, “self-help strategies” and “relational interventions”. Findings Many staff expressed some dissatisfaction in the techniques available to support the women, and felt their utility can be restricted by the prison regime. Research limitations/implications This study suggests that there is currently a deficit in the provision of training and support for prison staff, who are expected to fulfil a dual role as both custodian and carer of imprisoned women. Further research into prison staff’s perception of the training currently available could highlight gaps between current theory and practice in the management of self-harm and thus indicate content for future training programmes. Research exploring the impact of working with imprisoned women who self-harm is suggested to identify strategies for supporting staff. It must be acknowledged that this is a small-scale qualitative study and the findings are from only three prisons and may not apply to staff in other settings. Originality/value Currently few studies have focussed on the perspective of prison staff. This study is one of very few studies which focusses on the techniques and resources available to support the women, from the perspective of the prison staff.

Health and social care services for women offenders: current provision and a future model of care

Secure provision for women in both the Criminal Justice System and the Health Service has evolved in the last decade, in line with emerging gender-specific policy. Notable gains have been the approach to self-harm in prison and a reduction in the inappropriately high levels of secure hospital care. Although treatment pilots in UK settings are in progress, much practice remains poorly described and insufficiently evaluated. Recent strategic initiatives by both the Ministry of Justice and the Department of Health, as well as the commissioning changes that have followed the Health and Social Care Act 2012, provide a basis for reconsideration and a further paradigm shift. Suggestions for a reinvigorated model of gender-sensitive provision are made, relying on principles of resilience and autonomy.

The WORSHIP II study: a pilot of psychodynamic interpersonal therapy with women offenders who self-harm

Abstract The Women Offenders Self Harm Intervention Pilot II (WORSHIP II) study was conducted in three female prisons in England and piloted a treatment intervention for self-harm. WORSHIP II specifically aimed to reduce thoughts and actions of self-harm and suicide risk, through an evidence-based intervention Psychodynamic Interpersonal Therapy (PIT), which is also known as the conversational model. This paper provides an outline of this pilot evaluation of using the PIT approach in prison settings. Therapeutic obstacles associated with implementing WORSHIP II in a correctional environment are discussed, together with successful strategies to overcome these difficulties. Finally, examination of some of the quantitative outcomes suggests that WORSHIP II is a promising approach for this difficult area.

A Qualitative Study of Good-Bye Letters in Prison Therapy.

Background: Self-harm rates among imprisoned women in the UK are extremely high and there are limited psychological therapies available to support them in prison. This paper presents womens subjective accounts of receiving good-bye letters at the end of brief psychodynamic interpersonal therapy (PIT) and how these letters positively impacted on their incidents of self-harm. Aims: This study presents the accounts of 13 imprisoned women who self-harmed and received letters following completion of a minimum of four sessions of brief PIT in prison. Method: A semi-structured interview covered several aspects of their experience, which included details of self-harm since completing brief therapy as well as usage of a good-bye letter and its impact. The interviews were analyzed using thematic analysis. Results: Three themes emerged from the analysis: connecting with the therapist: receiving the letter; connecting to self: understanding and awareness; and connecting to others: sharing the good-bye letter. Conclusion: Findings show the positive impact the letters had for the women following therapy. The preliminary impressions suggest that letters may be a helpful tool enhancing the benefits of brief PIT therapy with imprisoned women who self-harm.

Women in secure care

Welcome to this special edition of The Journal of Forensic Psychiatry & Psychology. We are delighted that researchers and practitioners from the fields of forensic and clinical psychology, psychiatry, and criminology have agreed to share their research and observations with the readers of this special issue. The following pages contain eight outstanding articles that shed light on contemporary research and understanding relating to current practice with women in secure care. We are honoured to present these papers from authorities in this field as they provide fresh insights from which such an important area of work can continue to develop. The first paper, by Walker and colleagues, describes a study conducted in three female prisons in England, which piloted a brief psychological intervention aimed at reducing thoughts and actions linked to self-harm and suicide risk in women in prison with a history of self-harm. Therapeutic obstacles associated with implementing the study are discussed. The authors conclude that the pilot is innovative and promising for vulnerable imprisoned women but that further research is required into brief, specialised psychological programmes in correctional environments. The second paper, by Bainbridge, evaluates the development of the therapeutic environment of a Psychologically Informed Planned Environments (PIPE) unit for women in custody in HMP Low Newton near Durham in the north-east of England. Drawing on accounts from focus groups with imprisoned women, she suggests why, for many women, the environment plays a significant part in their recovery and progression in prison. Next, following the prison theme, Allen and colleagues use a case study to examine the integrated service model utilised in HMP/YOI Holloway, a large women’s prison in London, which has recently been closed. This novel paper illustrates the development and application of case formulations and recommendations derived from several perspectives. The authors describe the benefits of such an integrated approach and highlight its potential for nurturing change and recovery when working in the challenging environment of women’s prisons. The fourth paper in this special issue focuses on secure care pathways for women and describes an evaluation by Edge and colleagues of Women’s Enhanced Medium Secure Services (WEMSS) as a model of care compared to standard medium secure forensic psychiatric services. The authors describe a study comparing the clinical and risk outcomes of women in both mainstream medium secure and WEMSS services and examined their pathways of care. The findings are clear: WEMSS services showed no additional clinical benefit and the authors suggest that the women in

Secure pathways for women in the UK: lessons from the women’s enhanced medium secure services (WEMSS) pilots

Abstract Women’s enhanced medium secure services (WEMSS) is a model of care aimed at providing a more appropriate level of security for women and, in so doing, reducing the number of women in high secure psychiatric services. In 2007, three Department of Health commissioned WEMSS pilots became operational. This study compared the clinical outcomes of women in WEMSS with control women in six standard medium secure services and one high secure service matched on key clinical and risk characteristics, in order to examine their pathways of care. Our findings confirm that the WEMSS pilots were successful in transitioning women from high secure services who had previously been thought unsuitable for medium secure services. However, WEMSS showed no additional clinical benefit, suggesting that these women could be cared for equally well within standard medium secure services. We make recommendations about WEMSS and the future shape of women’s secure care in England.