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ABSTRACTBackgroundThe link between a therapist's motivational interviewing skills and the subsequent response of individuals with mild intellectual disabilities to borderline intellectual functioning (MID‐BIF) is unknown. This study examines this sequential relationship and describes change talk (CT) in individuals with MID‐BIF during substance use disorder (SUD) treatment.MethodIn this study, 35 treatment sessions were sequentially coded using the Motivational Interviewing Sequential Code for Observing Process Exchanges. Observed and expected frequencies of transitions, transitional probabilities, odds ratios and 95% confidence intervals were calculated in Generalized Sequential Querier software. Furthermore, frequencies of CT in IBM SPSS statistics were calculated.ResultsQuestions and reflections of CT and two‐sided questions were followed by CT. Questions and reflections of counter change talk (CCT) and two‐sided questions were followed by CCT. Individuals expressed all kinds of CT utterances.ConclusionsQuestions and reflections of CT are powerful skills in evoking CT in individuals with MID‐BIF during SUD treatment.

ABSTRACT Background: A qualitative process evaluation was carried out to investigate implementation of Active Support in services for people with mild and moderate intellectual disability in the Netherlands, and to identify contextual factors that may contribute to variation in implementation, perceived effectiveness, and pathways to successful outcomes. Method: Qualitative semi-structured interviews were conducted with stakeholders who were involved with the Active Support implementation. Interviews with practice leaders (n = 6), Active Support trainers (n = 4), direct support staff (n = 8), and residents with mild intellectual disabilities (n = 7) were analysed through a thematic analysis. Results: Organisational and managerial preparation appeared to lead to positive Active Support training experiences, in turn leading to behavioural changes in staff, resulting in resident wellbeing. Practice leaders’ coaching, staff collaboration, and additional staffing resources through volunteers and students facilitated implementation of Active Support. Conclusions: Identification of these factors enhances our understanding of the dynamic process of Active Support implementation in a Dutch context.

This study investigated the reliability and validity of the dynamic risk outcome scales-short version (DROS-SV). This instrument is developed to monitor treatment progress using dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning and behavioural and/or mental health problems. Data were collected from 264 clients who received Flexible Assertive Community Treatment (FACT), a form of intensive outpatient treatment. A principal component analysis showed that there were six components explaining 73.9% of the variance. Furthermore, the DROS-SV showed good internal consistency of its subscales and total score (α > 0.78). Correlating the DROS-SV with the Historical and Clinical subscales of the Historical, Clinical and Future-30 indicated convergent and divergent validity. The DROS-SV has good psychometric properties for measuring dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning in FACT teams.

Forensic vigilance is a hypothesized specialty of forensic mental health professionals which seems to play a role in maintaining safety in forensic hospitals. It is unclear exactly how forensic vigilance relates to preventing incidents. We used standardized reports of severe incidents that occurred in forensic hospitals to investigate how forensic vigilance plays a role in the occurrence of incidents. Eight forensic psychiatric hospitals in the Netherlands contributed 69 anonymized incident reports, which were investigated by means of thematic analysis and interpretative phenomenological analysis. Analysis revealed five important themes. Four core skills needed by professionals, namely observation, integration, communication and action, which each need a number of prerequisites (e.g., knowledge). The fifth theme specifies that the professional needs to "connect the dots" meaningfully. This is a highly cyclical process in which the core four skills are steps. The process is unique to the forensic context in terms of how the "dots" are connected and weighed, and which risks need to be considered. We present a model of this process and prerequisites needed in professionals. This model can inform policy makers, aid assessment of and communication between forensic professionals and can form the basis of a training for forensic mental health professionals.

Terrorists in detention. An overview of the development and debate regarding terrorism detention centers in the Netherlands, 2004-2022 There has been a lot of discussion around the terrorist wings in the Netherlands. This article highlights the development and discussion of the terrorist wings in the Netherlands and can be read as background information to our article on judicial decision-making in relation to the detention on the terrorist wing in terrorism cases. This article discusses the question how and why the terrorist wings were created, why they have been the focus of criticism and to what changes and developments the criticism has lead.

BackgroundVictimization is highly prevalent in individuals with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and is an important risk factor for mental health problems and violent behavior. Not much is known, however, about victimization history in women with MID-BIF admitted to forensic mental health care. AimsThe aim of this multicenter study is to gain insight into victimization histories and mental health problems of female forensic psychiatric patients with MID-BIF. MethodsFile data were analyzed of 126 women with MID-BIF who have been admitted to one of five Dutch forensic psychiatric hospitals between 1990 and 2014 and compared to data of 76 female patients with average or above intellectual functioning and to a matched sample of 31 male patients with MID-BIF. ResultsAll forensic patients had high rates of victimization, but women with MID-BIF showed an even higher prevalence of victimization during both childhood and adulthood and more complex psychopathology compared to female patients without MID-BIF. Compared to male forensic patients with MID-BIF, women with MID-BIF were more often victim of sexual abuse during childhood. During adulthood, the victimization rate in these women was more than three times higher than in men. ConclusionsVictimization is a salient factor in female forensic patients with MID-BIF and more gender-responsive trauma-focused treatment is needed.

BackgroundSetting up and conducting a randomised controlled trial (RCT) has many challenges—particularly trials that include vulnerable individuals with behavioural problems or who reside in facilities that focus on care as opposed to research. These populations are underrepresented in RCTs.ApproachIn our paper, we describe the challenges and practical lessons learned from two RCTs in two care settings involving long‐stay psychiatric inpatients and people with intellectual disabilities. We describe five main difficulties and how these were overcome: (1) multisite setting, (2) inclusion of vulnerable participants, (3) nutritional supplements and placebos, (4) assessment of behavioural outcomes, and (5) collecting bio samples.ConclusionsBy sharing these practical experiences, we hope to inform other researchers how to optimally design their trials, while avoiding and minimising the difficulties that we encountered, and to facilitate the implementation of a trial. Both trials were registered in the Clinical Trials Register (RCT A: NCT02498106; RCT B: NCT03212092).

BackgroundMeasuring eudaimonic well-being is important to gain a complete picture of the well-being of individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF), but there is no measurement instrument available for this population coding for multiple dimensions of eudaimonic well-being. AimsThe current study developed and piloted a new instrument coding for eudaimonic well-being in individuals with MID-BIF. Methods and proceduresThe instrument (SPWB-ID) was adapted from Ryff’s scales of psychological well-being, including subscales addressing purpose in life, environmental mastery, positive relationships, self-acceptance, personal growth, and autonomy. Adaptations were based on the literature and interviews with people with MID-BIF and experts in the field. The SPWB-ID was piloted among 103 adults with MID-BIF. Outcomes and resultsThe trimmed version of the SPWB-ID showed sufficient to good internal consistency and test-retest reliability. Hypothesis testing for construct validity suggested the subscales of the SPWB-ID measured well-being, showing moderate to high correlations with quality of life, and differences in eudaimonic well-being between participants with and without clinically relevant depression scores. Conclusions and implicationsThe SPWB-ID reliably measures eudaimonic well-being in individuals with MID-BIF. This enables support providers to collect information on eudaimonic well-being, providing input for person-centred care and support for individuals with MID-BIF.

Objectives Previous studies on the interrelationship between sleep and agitation relied on group-aggregates and so results may not be applicable to individuals. This proof-of-concept study presents the single-subject study design with time series analysis as a method to evaluate the association between sleep and agitation in individual nursing home residents using actigraphy. Method To record activity, three women and two men (aged 78–89 years) wore the MotionWatch 8© (MW8) for 9 consecutive weeks. Total sleep time and agitation were derived from the MW8 data. We performed time series analysis for each individual separately. To gain insight into the experiences with the actigraphy measurements, care staff filled out an investigator-developed questionnaire on their and participants’ MW8 experiences. Results A statistically significant temporal association between sleep and agitation was present in three out of five participants. More agitation was followed by more sleep for participant 1, and by less sleep for participant 4. As for participants 3 and 4, more sleep was followed by more agitation. Two-thirds of the care staff members (16/24) were positive about the use of the MW8. Acceptability of the MW8 was mixed: two residents refused to wear the MW8 thus did not participate, one participant initially experienced the MW8 as somewhat unpleasant, while four participants seemed to experience no substantial problems. Conclusion A single-subject approach with time series analysis can be a valuable tool to gain insight into the temporal relationship between sleep and agitation in individual nursing home residents with dementia experiencing sleep disturbance and agitation.

Purpose The purpose of this study is to provide an in-depth account of how individuelas with a mild intellectual disabilitiy or borderline intellectual functioning (MID-BIF; IQ 50–85) perceive their group climate in a secure forensic setting. Giving voice to these service users may provide relevant insights for secure forensic settings. Design/methodology/approach The interpretative phenomenological analysis was used to explore what individuals with MID-BIF experience with regard to their group climate. Findings In the interviews about the four domains of group climate (i.e. repression, support, growth and atmosphere), five overarching dimensions appeared, namely, autonomy, uniformity, recognition, competence and dignity. Depending on the person and the (treatment) context in which he/she resides, these five dimensions relate to all four factors of the group climate instrument. Originality/value From the perspective of individuals with MID-BIF, this study contributes by providing a framework to “fine-tune” group climate on five dimensions. Training socio-therapists to be sensitive to interpret ambiguous signals on these dimensions can contribute to optimizing group climate in secure forensic settings.