Providing community
services for people with
intellectual disabilities
Shamim Dinani and Wendy Goodman
Avon forensic community learning disabilities
team
shamim.dinani@bristol.gov.uk
Intellectual disabilities and the
criminal justice system
 Policy
context
 Community service in Avon
 AFCLDT
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what is the composition
what we do
reflections and discussion
gaps
Next steps for all
What do you think?
scenario
 You
receive a phone call from your local
police station. They have arrested a man
for stalking and they think he has ID. Can
you assess to inform if he has ID? Can
you advise what action should/could be
taken? Can you provide support such as
an Appropriate Adult?
Policy Context - past
 Reed
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report 1992
Quality of care – needs of the individual
Community not institutional – divert to health
and social care
Least restrictive option - No greater security
than is justified
Maximise rehabilitation – range of services
As near to their home
PWLD differ from other offenders – LD
specific services
Policy Context - recent
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Bradley report 2009
No One Knows – Prison Reform Trust 2008
Positive Practice Positive Outcomes 2007
Commissioning specialist services in ld – good
practice guide 2007
Mansell report 2007
Valuing People Now 2009
Social inclusion agenda
Legal – Disability Discrimination Act 2005 and
Human Rights Act 1998
The Bradley Report
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Similar findings to Prison Reform Trust - highlights
the difficulties people with ld face throughout the CJS
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Recommendations
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Early identification – learning difficulties, learning disability
and borderline ld
Training – teachers, family doctors, police, probation, courts,
prison staff
Continuity of care – whole of the offender pathway
Working in partnership – criminal justice mental health
teams
Prevalence – Mottram 2007
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IQ <70 7% and LD 3% using social competence and skills
IQ 70 – 79 = 24%
ID offender journey - pathway
Pre-sentence
Early detection inc schools and GP, training of police, provision
of Appropriate Adults,YOT to include health, cautions and
warnings and divert
Sentence
Courts ID aware, defendants to get same facilities as vulnerable
witnesses, rapid reports, divert, training of probation officers and
FME
Post sentence
Community orders, probation, admission to hospital, training of
prison staff and provision of Ld nurses in prison, in reach, CPA
and resettlement, continuity of care
Offender health service in Avon
 AFCLDT
 CARS Court assessment and referral scheme
 Prison
in reach team
 Prison Healthcare
 OAT secure inpatient – Quaternary team
AFCLDT – background history
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Closure of long stay hospitals
Community care - cldt but no specialist skills and access
poor, service fragmented, no strategy, many expensive
private placements and needs of LD offender often
unidentified and overlooked
Multi agency MDO reference group
AFCLDT formed (2000) as first step – highly skilled
forensic psychologist (1wte) and senior forensic nurse
(1wte), plus admin and some psychiatry (0.1wte) Now
we also have a nurse practitioner, nurse in CARS team
and social work champion
AFLDT - context
wide – population 1.1 million
 4 unitary authorities
 8/9 LD community teams
 4 specialist challenging behaviour teams
 Residential care
 Other housing with various levels of
support
 Education, employment
 Avon
AFCLDT – liaison with other
agencies and services
Local
CLDTs
police
MSU
out of area
Other
Forensic
cldt
Social
services
AVON
FCLDT
courts
national
prison
A&T beds
probation
AFCLDT – liaison with CJS
– diversion
 Prison – identify and manage, in-reach
help with discharge
 Probation
 Multi-agency planning
 Police – training
 Youth offending team
 Courts
AFCLDT – what we did
 Clarify
service user group, wider
 Risk assessment – identify high, medium
and low risk – prioritise those with urgent
need
 Developed clinical programmes
 Developed links with police, probation etc
 Policy and procedures
 Staff training – raise awareness, risk
assessments
AFCLDT – risk type
100
80
Violence
60
Sex
40
Acquisitve
20
Arson
0
Driving
2001 2002 2003 2004 2005 2006 2007
AFLDT – referral source
90
80
70
60
50
40
30
20
10
0
NHS
Social Services
Probation
Prison
legal
other
2001 2002 2003 2004 2005 2006 2007
AFCLDT – what do we do?
Clinical programmes
 Specialist
consultancy - Risk assessments
and advice on management
 Group – ‘good thinking’ offender
programme
 Mens group – sex offender
 Individual therapy – mainly CBT
 OATs – advise on placement and monitor
progress
AFCLDT – “GOOD THINKING”
thinking skills – adapted the
programme to suit LD
 Not exclusively for convicted
 Offending behaviour is an antisocial
means of attaining an appropriate goal
 Focus on pro-social means to attain goals
 Teach structured problem solving strategy
 Enhanced
AFCLDT – “GOOD THINKING”
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Accessible information
25 sessions of two hours – now once weekly,
lasts about 6 months – 9 months
Pre and post treatment measures
Currently on our 6th course
Anecdotal – positive, life changes, multiple
interventions concurrently, impact offending?
Research – multi-centre planned
AFCLDT – individual work
 Those
not suitable or not ready for group
work, booster sessions
 About a third of the clients
 Eclectic but mainly CBT
 Outcomes - not formally evaluated but
tends to be valued
 Flexible approach
AFCLDT – Out of area
of 12 – did not rise until recently
now 15 – young graduates
 Advice on placement
 Monitor progress, attend meetings
 Return to area, step down
 Long distance away
 New quaternary team will monitor the
pathway – gatekeepers – Avon, Glos
Somerset and Wiltshire
 Average
FCLDT – Research and academic
activities
 Appropriate
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Adult
Qualitative study of service users views
Appropriate adults experience of role
Examined custody records – ascertain
numbers of PWLD
 Locus
of control
 Mens group
 Predictors of offending
FCLDT – audits and service
evaluations
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Referrer satisfaction
OATs consumer views of secure services
Timely response and communication
Clinical programme evaluations – ongoing as part of the
treatment
Female referrals
Reason for re-referrals
Reason for ‘drop out’
Needs of vehicle related offenders
Service user perception of usefulness of treatment
groups
AFCLDT – reflections - what
works?
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Based in the community – within CLDT
Small is beautiful! – efficient, innovative, highly
skilled and confident, autonomy, creativity
No distraction to in-patients work
We are passionate and enthusiastic
Community teams, social services, probation etc
are receptive and value joint working
National profile
FCLDT - reflections of challenges
and gaps
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Lack of secure provision
Manage workload – priority matrix, remind people it is a
tertiary service! Ongoing training and joint work to build
confidence and maintain interest
Services for women
Advocate for those at the bottom of the pile! Try to make
the invisible visible
The lost tribe of mild LD – no longer detected and needs
not met in childhood
What of those who do not meet criteria for inclusion
Conclusion – next steps
exercise into service provision –
courts, prisons, probation,
 Plan training and identification of ID
 Enhance local provision and expertise in
specialist risk assessment and treatment
 ADVOCATE for this marginalised group
 Mapping