Northgate Hospital

PurposePeople with intellectual disabilities who set fires are a heterogeneous and clinically complex group who present significant challenges to the wider community and to forensic practitioners working in forensic mental health and correctional settings. There is little available in the literature to support professionals when considering assessment and formulation for clients exhibiting these perturbing behaviours. The paper aims to discuss this issue.Design/methodology/approachIn this paper the materials available to assist forensic practitioners in considering assessment and formulation of people with intellectual disabilities who set fires are described and outlined.FindingsAn assessment scheme is proposed for organising information from a variety of sources to assist professionals in understanding the nature of risks and clinical needs of firesetters with intellectual disabilities. A newly revised risk assessment measure designed for this population is provided.Practical implicationsForensic practitioners are provided with a framework and tools to assist with their assessment and formulation of firesetters with intellectual disabilities.Originality/valueThis is the first time a newly revised risk assessment for firesetting behaviour by people with intellectual disabilities has been presented.

Background: A development of a needs-led mental health classification system based on the Health of the National Outcome Scales (HoNOS) has previously been developed.Aims: To extend the needs-based mental health (MH) clusters to accommodate the additional needs of people accessing UK intellectual disabilities health services.Method: Hierarchical cluster analysis was performed on assessment data from 18 National Health Service (NHS) provider organisations. The statistical results were clinically shaped through multi-disciplinary workshops. The resulting clusters were combined with six independently rated measures for a second data collection exercise. Based on these data, refinements were made before performing internal and external validity checks.Results: Eight additional clusters for people with health needs associated with their intellectual disabilities were produced. Three described primarily physical health (PH) needs, four described needs arising from behaviours which challenged (with/without autism) whilst one described people with generally low needs. Together, these covered 83.4% of cases with only a 10% overlap. The clusters were replicable and had clinical utility and validity.Conclusions: It was possible to extend the needs-led mental health classification system to capture the additional needs of people accessing UK intellectual disability services.

Family interventions appear to be effective at treating young people's substance misuse. However, implementation of family approaches in UK services is low. This study aimed to demonstrate the feasibility of recruiting young people to an intervention based on an adaptation of adult social behaviour and network therapy. It also sought to involve young people with experience of using substance misuse services in the research process. To demonstrate the feasibility of recruiting young people to family and social network therapy and to explore ways in which young people with experience of using substance misuse services could be involved in a study of this nature. A pragmatic, two-armed, randomised controlled open feasibility trial. Two UK-based treatment services for young people with substance use problems, with recruitment taking place from May to November 2014. Young people aged 12-18 years, newly referred and accepted for structured interventions for drug and/or alcohol problems. A remote, web-based computer randomisation system allocated young people to adapted youth social behaviour and network therapy (Y-SBNT) or treatment as usual (TAU). Y-SBNT participants were intended to receive up to six 50-minute sessions over a maximum of 12 weeks. TAU participants continued to receive usual care delivered by their service. Feasibility was measured by recruitment rates, retention in treatment and follow-up completion rates. The main clinical outcome was the proportion of days on which the main problem substance was used in the preceding 90-day period as captured by the Timeline Follow-Back interview at 3 and 12 months. In total, 53 young people were randomised (Y-SBNT, n = 26; TAU, n = 27) against a target of 60 (88.3%). Forty-two young people attended at least one treatment session [Y-SBNT 22/26 (84.6%); TAU 20/27 (74.1%)]; follow-up rates were 77.4% at month 3 and 73.6% at month 12. Data for nine young people were missing at both months 3 and 12, so the main clinical outcome analysis was based on 24 young people (92.3%) in the Y-SBNT group and 20 young people (74.1%) in the TAU group. At month 12, the average proportion of days that the main problem substance was used in the preceding 90 days was higher in the Y-SBNT group than in the TAU group (0.54 vs. 0.41; adjusted mean difference 0.13, 95% confidence interval -0.12 to 0.39; p = 0.30). No adverse events were reported. Seventeen young people with experience of substance misuse services were actively involved throughout the study. They informed key elements of the intervention and research process, ensuring that the intervention was acceptable and relevant to our target groups; contributing to the design of key trial documents, ideas for a new model of public involvement and this report. Two parents were also involved. The adapted intervention could be delivered in young people's services, and qualitative interviews found that Y-SBNT was acceptable to young people, family members and staff. Engagement of family and network members proved difficult within the intervention and research aspects. The study proved the feasibility of this work in routine services but outcome measurement based on narrow substance use variables may be limited and may fail to capture other important changes in wider areas of functioning for young people. Validation of the EuroQol-5 Dimensions for young people aged 12-18 years should be considered and flexible models for involvement of young people in research are required to achieve inclusive representation throughout all aspects of the research process. Although recommendation of a full trial of the Y-SBNT intervention compared with TAU is not supported, this study can inform future intervention development and UK research within routine addiction services. Current Controlled Trials ISRCTN93446265. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 15. See the NIHR Journals Library website for further project information.

This study examines Weiner's recent cognitive emotional model which makes a distinction between judgements of control and responsibility and emphasizes the moderation of control by 'mitigating' factors. In response to four vignettes describing two conditions of control (high or low) and mitigating factors (present or absent), questionnaires rating judgements of responsibility and emotional responses (anger and sympathy) were completed by 52 care staff. Analysis of the data for sympathy demonstrated that attributions of control were moderated by communication ability and that the effect of control upon sympathy was mediated by the judgement of responsibility. The data offer tentative support Weiner's account of the mitigation of control attributions in making responsibility judgements and their subsequent effects on emotional responses. Implications for research and clinical work are discussed.

This paper reviews the evidence for changes in carers' attributions regarding the behaviour of people with intellectual disabilities as a consequence of carer training in challenging and complex behaviour. Papers were included in the review if they reported outcomes for carer training on the behaviour of people with intellectual disabilities and used a measure of carer attribution of the behaviour of people with intellectual disabilities. The characteristics of the scales used and the content and length of training are considered as possible factors affecting changes in attribution. Eleven papers were reviewed, most studies using behavioural curricula for their training, and none explicitly set out to change attributions. Eight of the 11 papers reviewed reported changes in attribution although core characteristics of training did not distinguish those papers that reported such changes and those that did not. Changes in beliefs and attributions occur even though these are not identified as a focus within the training provided. The present authors suggest that the formulation processes involved in behavioural training may play a key part in changing attributions as a consequence of this training. The present authors discuss the potential for more focussed intervention designed to change attributions and for better alignment of measures to specific attribution change expected as a result of specific training approaches.

PurposeThe purpose of this paper is to investigate how human resources (HR) can create value for an organization through the use of technology.Design/methodology approachThe paper looks at areas in which HR can create value through the use of technology. It introduces the e‐HRM Value Model based on a range of themes that emerged form research interviews and an systematic review of a wide range of literature.FindingsThe e‐HRM Value Model argues that value can be created in one of three ways: HR operational cost reduction; people management/productivity; and strategic capability. It is also revealed that barriers to e‐HRM technology development are not primarily technical, but are strongly connected to dimensions of value creation.Originality/valueThe paper provides useful information on the creation of HR value through technology.

The End of Life Care Strategy takes as inclusive an approach as possible, but can it make a difference for people with learning disabilities who are dying? Therefore we must ask ourselves 'Does one size fit all?'

CBT for psychosis conducted in clinical settings was more strongly characterized by assessment of symptoms and work on coping strategies and less so by relapse prevention and schema-level work. Relapse prevention interventions and schema work could be considered more challenging for therapists to undertake. The findings suggest that therapists working in routine clinical settings are able to establish good therapeutic relationships with people with psychosis and to work on assessing and coping with their psychotic symptoms. However, some therapeutic approaches may be more challenging in this context.

Meaningful communication with people with profound communication difficulties depends on the ability of carers to recognize and translate many different verbal cues. Carers appear to be intuitively skilled at identifying distress cues, but have little confidence in their observations. To help in this process, a number of pain tools have been developed, but this sits uncomfortably with the lack of evidence that pain has any specific signs or behaviours. A palliative care team working with people with intellectual disabilities developed the Disability Distress Assessment Tool (DisDAT) to document a wide range of signs and behaviours of distress and when an individual is content. The tool was piloted with 16 carers and 8 patients. It was then assessed using quantitative and qualitative methods, employing 56 carers in routine clinical situations with 25 patients, most with severe communication difficulties. Carers of 10 patients participated in semi-structured interviews exploring the signs and behaviours demonstrated by patients when distressed and when content. These same 10 patients were observed for distress cues during different activities. It became clear that distress did not have a common meaning among carers, but there was a clear understanding that distress did not just cover physical pain. The range of distress cues was wide, with no evidence that any cues were specific to particular causes. Although some distress cues were common between patients, each patient had a distinct pattern of distress cues. In addition, different carers identified a different range of distress cues, while the length of the relationship did not influence the number of cues identified. Most distress cues were a change from the norm, but some patients demonstrated distress as an absence of content cues. Carers found the DisDAT simple to use and useful, and several felt that DisDAT would have helped advocate for the patients in previous conflicts with clinical teams. There was no evidence that pain has any specific signs or behaviours. The preliminary and assessment phases showed that distress was a useful clinical construct in providing care. The DisDAT reflected patients' distress communication identified by a range of carers, and provided carers with evidence for their intuitive observations of distress.