speech and language therapy in criminal justice: a pilot study

Speech and Language Therapy in Criminal Justice: A Pilot StudyRachel Iredale, Harriet Pierpoint & Beth Parow

Speech and Language DisordersSpeech disorders: • Articulation disorders, e.g. difficulties in producing

sounds in syllables or saying words incorrectly to the point at which other people cannot understand what is being said

• Fluency disorders, e.g. stuttering• Voice disorders, e.g. problems with the pitch, volume

or quality of a person’s voice that distract listeners from what is being said

Language disorders:• Difficulties in understanding or processing language• Difficulty in putting words together• An inability to use language in a socially appropriate

way

Background• Communication disorders are positively associated with:

• low attainment • behavioural problems • mental health issues • poor employment prospects • criminal behaviour.

• To date, research studies have focussed on basic skills needs and conditions such as dyslexia and attention deficit/hyperactivity disorder

• The majority of available research has utilised quantitative methodologies, focussing on convicted offenders

Aims of Study

• To pilot methods and assessments that could be used in a larger study in a community setting

• To identify offenders who may have speech and language difficulties

• To identify what specific problems are experienced by offenders with speech and language difficulties moving through the criminal justice system

Original Intentions • Explore possible impact of S&L difficulties by interviewing

offenders to find examples of times when they had difficulty understanding the language used, or had difficulty expressing themselves

• Bring together Magistrates Courts, Youth Offending Teams and the Probation Service

• Begin data collection in Magistrates’ Courts

• Assess 80 offenders to identify 20 with communication difficulties

• Follow up assessments with face-to-face interviews

• Hold a focus group to discuss communication difficulties in the criminal justice system and what can be done to address these issues

Getting Started …..

• 18 months ago very few people discussing this issue

• No SLT at Glamorgan. Secondment from NHS necessary

• Difficulties in attracting funding for community-based research

• Six months to apply for necessary approvals• Approval was granted by the Faculty Ethics

Committee at UoG and NOMS• Local permissions were obtained from

Pontypridd Probation Service

Study Design

• Secondment to UoG from NHS (Beth Parow)

• Focus only on Probation Service (Pontypridd)

• Project explained to managers and staff at the Lifelong Learning Centre

• Information sheet emailed to all probation workers

• Accessible information sheet/consent form written for offenders

• Assessment and interview would take place at the same time

Recruitment

• On the recommendation of staff • Opportunistically • Observation by the SLT of their interaction

with staff or peers

• 10 participants • 7 males and 3 females• Aged 21-49, average age 31

What We Learnt about Recruitment?

• Time and effort required

• Effect on researcher

• Area that is new to SLTs (limited knowledge; reliance on staff that offenders trust)

• Participants unlikely to attend pre-arranged appointments

• Vouchers help

Choosing the Assessments

• Mount Wilga assessment• Pool table narrative assessment• MCLA vocabulary assessment• Observation of communication skills

(Broadmoor)

• The language assessments took 30-45 minutes to complete

Aspects of the Assessments: 1. Vocabulary naming skills: naming pictures, e.g. aerial.

2. Re-telling a sequence of events “Tell me how to set up an pool table for a game of pool and tell me how you win”.

3. Explaining the meanings of idioms, e.g. ‘turn over a new leaf’, ‘butterflies in your stomach’.

4. Listening to, and answering questions about a story.

5. Making sense of complex sentences, e.g. ‘I had breakfast after I spoke to Kate. What did I do first?’

6. Make a sentence with given words, e.g. left, became, work.

7. Social communication skills (assessed by observation).

8. Speech clarity (assessed through observation).

Interview Questions Can you remember a time when you couldn’t

understand what people were saying at court/ probation?

Can you remember a time when you couldn’t explain what you wanted to say at court/ probation?

Who and what would have made it easier for you to understand/ explain what you wanted to say in court/probation?

Data Analysis Assessments • Were analysed using scoring guidelines• Scores were classified as ‘within normal limits’ or

‘moderately low/severely low’• Offenders were identified as having difficulties with

expressive language and comprehension

Interviews • Were analysed for emerging themes • Themes included:

• Type of communication difficulty• Communication partners/ location• The impact of communication difficulties• Suggestions for addressing these difficulties

Preliminary Results: Assessments

• All participants scored below average on three or more of six subtests

• 5 scored below average on four or more subtests

• 7 had difficulties with comprehension subtests

• 4 had difficulties with all expressive language subtests

• 3 had difficulties with both comprehension and expressive language

Preliminary Results: Assessments

Non verbal skills, conversational skills and speech

• 5 had at least one low score for their non-verbal communication skills (gesture, eye-contact)

• 5 had at least one low score for their conversational skills (topic maintenance, relevance)

• 2 had speech sound difficulties (intelligibility, volume)

• 1 had a stutter (mild)

• Only 3 had skills that would be expected in the general public

Interview Findings

Expressive language difficulties (n=4)• ‘I get muddled on my words terrible. I do. I'm

like… like yesterday, I had to say things and I mean it different. It comes out wrong, so wrong’

• ‘I just can’t get … you know, I can’t use the words and get the words out what I want to use, you know it is hard, awful hard’

• ‘But when I’ve had to explain something and I can’t remember it, because I’ve been drunk half the time like …’

Interview FindingsComprehension difficulties (n=8)• ‘Sometimes it’s easier to switch off’

• ‘The judge was speaking to me in their language, which I couldn’t understand …. I couldn’t understand what he was saying’

• ‘I can remember he went on and on for about half an hour on his summing up and I didn’t have a clue what he was on about’

• ‘There were times I wasn’t sure if I was going to jail; or not when they said suspended sentence’

Interview findingsWhat would help?• ‘Be a lot more patient with different people.

Explain the different ways instead of using big massive words, so people can understand them’

• ‘You feel stupid sometimes but I mean that is what you have got to do if you don’t understand, you have got to ask haven’t you’.

• ‘And ask the person “Are you sure you understand me?” “Do you want me to explain it in a different word way?”’

Interview findings

Being understood

• ‘I did have a barrister at the time, and he was right on the ball like. He turned around and said ‘Yeah, she is a bit slow and different things, but she does understand people if you talk to her properly’, innit’

• ‘And my probation officer, I feel like I can talk to her…… so it makes a big, big difference’

Interview findings

The impact of communication difficulties (n=6)

• ‘If I’m too quick with my words, or I get… if I can’t get something out I’ll get nastyish and then…’

• ‘Do you know what I mean, and you just get agitated then do you know what I mean? That’s when you find yourself in trouble then like’

• ‘And then you think ‘Oh God, I had better turn around and say can you explain it in a different way’’

• ‘I shout .. Oh yeah …I don’t mean to .. But I say ‘Fuck this’ … and made it worse for me, haven’t I by doing that like …’

Vocabulary Assessment• Words Tested: Bail, Adjourn, Concurrent, Alleged,

Breach, Comply, Suspended, Licence ……..

• Reparation: Only 1 person attempted to define this word

• Compensation: 70% thought it was money they should receive. Only 30% viewed it in terms of compensating victims of crimes

• Remorse: 30% did not understand this word

• Revocation: 30% understood what it means to have an order revoked

• Custodial: 40% did not understand this word, despite one having been in prison

Tentative Conclusions

• Existing evidence suggests many offenders have communication disorders

• Crudest measures reveal problems with comprehension and expression

• Consequences for all criminal justice agencies

• Sentences in the community often predicated on understanding, explaining and discussion

• SLTs may have a role to play in future service delivery, e.g. helping offenders complete their orders

• Low levels of awareness in criminal justice agencies about speech and language disorders sentences and reducing re-offending

Project Limitations

Methodology• Length of time to get approvals• Small number of participants• Range of recruitment methods

Assessments• Lack of assessments available for this age group• Some incomplete assessments • Brief assessments. More detailed assessments

needed to give diagnoses

What next? • Sharing findings with others

• SLT community• Magistrates’ Courts (all users)• Trainers (JPs and legal advisors) • Probation services (relationship between S&L

disorders and completion of orders)

• Future projects• Bigger sample sizes• Different assessments• Comparisons

Contact Details

Dr Rachel Iredale riredale@glam.ac.uk

Dr Harriet Pierpoint hlpierpo@glam.ac.uk

Ms Beth Parowbeth.parow@cardiffandvale.wales.nhs.uk