Cultural affordance, social relationships, and narratives of independence: Understanding the meaning of social care for adults with intellectual disabilities from minority ethnic groups in the UK.

Objectives: To explore the perspective of adults with intellectual disabilities from minority ethnic groups, on their relationship with social care services. Methods: Thirty-two adults took part in semi-structured interviews. Transcripts were analyzed within a Pluralist framework, adopting the structure of Template Analysis and then drawing on phenomenological, narrative, and discursive approaches. Results: Our participants were generally positive about the services which they received, which they evaluated primarily in terms of their continuing good relationship(s) with specific workers. Our respondents were sophisticated users of cultural resources and identities; the concept of 'cultural affordance' may be useful alternative to 'cultural competence'. We discuss three distinctive narratives about independence (Stability; Progress; Resistance). Each highlights the importance of maintaining connectedness to others, and the crucial role played by ownership of decision-making. Conclusions: We have developed a set of resources which service providers (and researchers) can use with people with intellectual disabilities, in order to support mutual understanding, service planning and delivery.

Assessing anger in people with intellectual disability.

BACKGROUND: There is a growing interest in the use of cognitive approaches for the treatment of psychological difficulties with people who have intellectual disability. The aim of the present study was to investigate the properties of an anger inventory, the relationship between self-reported and staff-reported levels of anger, and the relationship between different staff measures. METHOD: Two studies are described that use self-report and staff-report measures. The first study employs a cross sectional design and the second, a longitudinal design. RESULTS: No relationship was found between self-reported and staff-reported levels of anger on the first measurement occasion, but on the second measurement occasion after some intervention a significant relationship was found. If staff had accompanied individuals during an intervention a larger correlation was found. CONCLUSION: These results suggest that staff may require specific training or exposure to a therapeutic environment before they can predict the response of people with intellectual disability on the anger inventory. This suggests that involvement of care staff in interventions may be useful therapeutically.

The development of a questionnaire to assess the perceptions of care staff towards people with intellectual disabilities who display challenging behaviour.

The perceptions of staff about challenging behaviour may be a key factor in designing successful behavioural interventions. There is a lack of robust psychometric instruments designed to assess staff attributions towards incidents of challenging behaviour. The aim of this research was to develop a scale based upon the self-regulation theory of illness behaviour. Two staff focus groups identified and clarified relevant constructs to be included in the Challenging Behaviour Perception Questionnaire (CBPQ), which was then completed by 51 staff. Some correlations between the CBPQ and the Attributional Style Questionnaire were found. A significant amount of the variance in the perception of challenging behaviour was explained by the subscales of the new questionnaire. In particular, episodic timeline would seem to be a promising area for further investigation.

A preliminary evaluation of the adaptation of four assessments for offenders with special needs.

BACKGROUND: Appropriate assessment is an essential part of treating sexual offenders. Few assessments exist that can be used with offenders who have lower levels of intellectual functioning and/or literacy deficits. METHOD: This study describes the adaptation of four self-report assessments for sexual offenders with special needs: (i) the Social Intimacy Scale (SIS: Miller & Lefcourt, 1982); (ii) the Relationship Scales Questionnaire (RSQ: Griffin & Bartholomew, 1994a); (iii) the Criminal Sentiments Scale (CSS: Gendreau, Grant, Leipciger, & Collins, 1979); and (iv) the Victim Empathy Distortion Scale (QVES: Beckett & Fisher, 1994). Each scale was adapted in an effort to simplify content and language and to improve readability. Preliminary data are presented on the comparability of each adapted measure to the original, as well as the internal consistency, reliability, and concurrent validity of the adapted tests. RESULTS: The SIS and the QVES were identified as appropriate assessment measures, comparable to the original with good reliability and validity. One subscale of the RSQ had fair reliability and validity, while the remaining subscales had varied psychometric properties. The adapted CSS had poor psychometric qualities and the adaptation of this test appears not to have been successful. CONCLUSIONS: The relevance of these findings to our understanding of offending by this population is discussed.

Comparing sexual offender treatment efficacy: mainstream sexual offenders and sexual offenders with special needs.

BACKGROUND: This paper investigates the efficacy of a treatment program for sexual offenders with special needs in comparison to treatment outcomes for mainstream sexual offenders. Follow-up data is also presented for the group of offenders with special needs. METHOD: Participants from the two groups were matched on four variables (risk category, sex of victim, type of offence and age). All participants completed an assessment battery pre- and post-treatment and the scores on these tests were analysed for each group. Change on these measures was also compared between the two groups. Follow-up data for the special needs cohort were collected from an offender database. RESULTS: Overall, both groups made few significant changes on the tests post-treatment, however individual results demonstrated that some offenders in both groups had achieved reliable change. In comparing treatment results between the two groups, the sexual offenders with special needs differed only on progress relating to "avoidant" relationship styles. The results also indicated that social desirability bias played a significant role in self-report assessment for both groups. Follow-up data for the group with special needs identified that none of the offenders had committed further sexual offences, after an average release time of 16 months. CONCLUSIONS: There are a number of limitations to this study, particularly as a result of the experimental design and the small number of participants, and these should be considered as a major limitation on the conclusions drawn from the results. However, it is suggested that the program had some positive effects for some offenders, with little difference in progress detected between the two groups. Possible explanations for the varied outcomes are discussed.

Care staff perceptions of challenging behaviour and fear of assault.

BACKGROUND: Past research has determined that fear of violence is often "irrational" in relation to the actual level of risk presented. This has been found to exacerbate the negative effects of exposure to work-related violence. AIMS: This study investigates fear of assault in relation to exposure to challenging behaviour. The extent to which a social psychological model of fear of assault can be generalised to care staff working with individuals with intellectual disability (ID) was tested and the validity of the instruments used was assessed. METHOD: A total of 87 care staff took part in a questionnaire-based study carried out in two separate and distinct organisations providing residential services to individuals with ID. In one service, staff exposure to challenging behaviour was high, with many clients having a forensic history, and in the other, staff exposure to challenging behaviour was low. RESULTS: According to one measure, care staff exposed to high levels of challenging behaviour were more fearful about work-related violence. However, no difference was found between the groups on the second measure. Regression analyses indicated some support for the generalisability of dimensions of the model of fear of assault in explaining feelings of unsafety. CONCLUSIONS: This study suggests that fear of assault may be an important factor when trying to understand care staff responses to challenging behaviour. However, the equivocal nature of the results raises questions about the validity of existing methods of assessing this fear.

A comparison of the application of the self-regulation model of the relapse process for mainstream and special needs sexual offenders.

The self-regulation model of the relapse process (Ward & Hudson, 2000) has been developed and empirically validated on general sexual offender populations (Bickley & Beech, 2002), but not on specific sexual offender populations. This paper aims to investigate whether special needs offenders, as compared to mainstream sexual offenders, can be categorized into the offense pathways described in the model. In addition, this paper aims to evaluate the application of the self-regulation model in highlighting the treatment needs of the special needs group. Special needs sexual offenders are defined as a treatment population that includes individuals with lower functioning, limited social and communication skills, and literacy deficits. Participants were classified into the self-regulation model using a method developed by Bickley and Beech (2002). Demographic and offense information were collected and comparisons made between the special needs and mainstream groups. The results showed that the sexual offenders with special needs could be reliably classified into the offense pathways of the self-regulation model. The largest group of special needs offenders was in the approach-automatic group, followed by the approach-explicit group. The results indicated no significant differences in representation in the offense pathways between the special needs and mainstream sexual offenders. The results also indicate that the special needs group would benefit from a responsive approach to treatment, which incorporates appropriate treatment targets identified by the self-regulation model.

Relapse prevention with intellectually disabled sexual offenders.

The adaptation of relapse prevention theory to sexual offending (W. D. Pithers, J. K. Marques, C. C. Gibat, & G. A. Marlatt, 1983) has represented an important movement in cognitive-behavioural treatment for sexual offenders. However, this model of relapse prevention has been criticised for its limited view and oversimplification of the relapse prevention process (R. K. Hanson, 2000; T. Ward & S. M. Hudson, 1996). As a result, T. Ward and S. M. Hudson (2000a) have developed a multiple pathway model of the relapse prevention process based on self-regulation theory. Although this model continues to be empirically validated on sexual offenders (J. A. Bickley & A. R. Beech, 2002; T. Ward, S. M. Hudson, & J. C. McCormick, 1999), there has been no empirical research regarding the application of this theory to intellectually disabled sexual offenders. This paper discusses whether the characteristics of offenders in each of the relapse offence pathways, as described by T. Ward and S. M. Hudson (2000a), may be similar to the characteristics of intellectually disabled sexual offenders. From a review of the literature, it appears that the intellectually disabled sexual offender may be most likely to offend via the approach-automatic pathway or the avoidant-passive pathway. The potential treatment implications of the self-regulation model for intellectually disabled sexual offenders is discussed, as well as the need for empirical evaluation with regards to the application of this model to the intellectually disabled sexual offender population.