"Let's Do More Than Talk About Sex: Promoting Good Lives In Practice" • Dr F Douds, Consultant LD Psychiatrist, The State Hospital • Dr M Doyle, Forensic Psychologist, NHS Fife Process for use when considering facilitating a sexual relationship between community clients with forensic needs and other adults Matter raised at forensic team meeting Multi-agency discussion re community forensic client. Key question: •Level of risk posed by client to partner? (given forensic history and/or previous relationship history) Multi-agency re partner. Key questions: •Is partner unable to give informed consent to sexual relationship? •Is partner a vulnerable adult? Yes to one or both questions No to both questions Convene vulnerable adults case conference to consider appropriate course of action Convene multi-agency case conference to develop action plan and necessary protocols (action plan likely to include socio-sexual education for one/both parties – some of which may be done jointly) Take protocol to multi-agency risk management group Relationship appropriate? Attempt to facilitate relationship No Yes Document reasons Convene multi-agency case conference (see above) NB: Disclosure of previous sexual offending. At which point of pathway, if any, will this take place What makes your life a ‘Good Life’? • Choose three things in you life that are important to you. (count partners as one thing & children as a different one ) • Nothing too sensitive! • Write each one on a separate post-it. • What do they contribute to your life? Why are they important? • Which would you give up first? Second? Third? $$ SURVEY OF US LOTTERY WINNERS $$ • WHAT DO YOU VALUE MOST? • NUMBER ONE ANSWER? • CAN MONEY BUY IT? ‘All meaningful human action reflects attempts to achieve primary human goods’ Ward & Mann (2005) Good Lives Autonomy Relationships & Community Inner Peace Achievement Purpose The Good Lives Model (GLM) Key Argument Human behaviour is directed towards goal of achieving fundamental needs or ‘primary human goods’. Difficulties in achieving primary goods in socially appropriate ways will possibly lead to anti-social or offending behaviour. Strengthening the ability of offenders to achieve primary human goods in socially appropriate ways will reduce their offending behaviour Achieving Primary Goods through Secondary Goods Family Intimate Partners Secure Social skills Consist -ency Relatednes s Money, work Friends Staff The Good Lives Model (GLM) • Central role of construct of personal identity and self-narrative. ‘…not enough to simply equip individuals with skills to control or manage risk factors, it is imperative they are also given the opportunity to fashion a more adaptive personal identity..’ Gannon (2006) Ward & Not ‘New me’ but perhaps ‘Better me’. The Good Lives Model (GLM) • ‘Twin focus’ ‘managing the delicate balance between the …. promoting offender goods and ..reducing risk. Erring on the side of either goal can have disastrous social and personal consequences…’ Ward, Mann & Gannon, (2007) • Human action is context-dependent. Ability of an individual to implement coping strategies is dependent on the social and physical environments they inhabit. The Good Lives Model (GLM) • Treatment plan needs to address all of human goods needed for psychological well-being and should be explicitly constructed in form of a ‘good lives formulation’. Goal of treatment is to recognise individual agency and build capacity and opportunity to meet primary goods in socially appropriate ways. • Requires a strong ‘therapeutic alliance’ non-confrontational, motivational and collaborative approach. • Implies creating ‘bespoke’ personcentred holistic interventions to address individual need. SAPROF (Structured Assessment of Protective Factors) Internal factors 1. Intelligence ❑ 2. Secure attachment in childhood 3. Empathy ❑ ❑ 4. Coping ❑ ❑ 5. Self-control ❑ ❑ Motivational factors 6. Work ❑ ❑ 7. Leisure activities ❑ ❑ 8. Financial management ❑ ❑ 9. Motivation for treatment ❑ ❑ 10. Attitudes towards authority 11. Life goals ❑ ❑ 12. Medication ❑ n/a ❑ ❑ External factors 13. Social network ❑ ❑ 14. Intimate relationship ❑ ❑ 15. Professional care ❑ ❑ 16. Living circumstances ❑ ❑ 17. External control ❑ ❑ Good Lives Assessment & Formulation ‘Jim’ • 29 years old; ‘mild’ learning disability • History of serious offences from ages 9 years to 16 years against female children. • Convicted age 17. (1998) • Lynebank Hospital (via HMP Edinburgh) 1998 – 2003 • Community-based CTO 2003 - 2008 24/7 ‘Core & Cluster’ Support Package • 2008 – 2009 Community Outreach Support Good Lives Assessment & Formulation ‘Jim’ • ‘Hopeless’ – ‘never get out’ • Clear set of future goals obscured by ‘anger balloon’ Marriage Work Family Hom e Motorbik e Jim’s Good Lives Assessment & Formulation Proble mSolvin g Sexual Knowle dge Knowle ` dge Empat hy Insigh t Jim’s Good Lives Assessment & Formulation Motorbi ke Relationship s with female peers Autonom ` y Stepped reduction in support Tenanc y Jim’s Intervention History Sex Offences Group 1999 - 2002 1:1 Emotiona l Regulatio n 2003 - 2005 Social ProblemSol ving 2006 -2007 Engaged to Girlfriend Motorbik e Work Placemen ts The Good Lives Model (GLM) ‘Jim’ and SRAG/MAPPA • Jim and Anne. • Jim and Claire • Motorbike • Stepped reduction in support Process for use when considering facilitating a sexual relationship between community clients with forensic needs and other adults Matter raised at forensic team meeting Multi-agency discussion re community forensic client. Key question: •Level of risk posed by client to partner? (given forensic history and/or previous relationship history) Multi-agency re partner. Key questions: •Is partner unable to give informed consent to sexual relationship? •Is partner a vulnerable adult? Yes to one or both questions No to both questions Convene vulnerable adults case conference to consider appropriate course of action Convene multi-agency case conference to develop action plan and necessary protocols (action plan likely to include socio-sexual education for one/both parties – some of which may be done jointly) Take protocol to multi-agency risk management group Relationship appropriate? Attempt to facilitate relationship No Yes Document reasons Convene multi-agency case conference (see above) NB: Disclosure of previous sexual offending. At which point of pathway, if any, will this take place