the lincolnshire personality disorder pathway dr kerry beckley (consultant clinical forensic...
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The Lincolnshire Personality Disorder Pathway
Dr Kerry Beckley (Consultant Clinical Forensic Psychologist)
Dr Felicity Nichols (Clinical Psychologist)
Helena Wilks (Probation Officer)
Marina Simeou (Assistant Psychologist)
BIGSPD March 2015
The Personality Disorder Pathway: Developing a Schema Informed
Workforce
Dr Kerry BeckleyConsultant Clinical Forensic Psychologist
Lincolnshire Personality Disorder Probation Pathway
What is schema informed practice?
Behavioural strategies (including offending)
understood as mechanism for meeting
unmet needs from childhood
Uses the relationship as primary vehicle for
change
Emphasis on impact of childhood
experience
Project Tasks
Early Identification
Workforce Development
Sentence/Pathway Planning
Specialist Focus
• 100% of caseload screened• Mechanism for ongoing
screening
• KUF Awareness Training• Schema Informed Practice
• HMP North Sea Camp• Eastern European Offenders• Mentalization Based Therapy
• Schema Informed Consultation and Formulation
Staff Development
• 100% of senior managers, offender managers, PSO’s 2 day training in schema formulation and consultation (inc. CRC service)
• Same training offered to allied organisations (CFS, Police, Housing)
• 31 Offender Managers completed KUF• 146 staff trained in Schema Informed PracticeAIM: To have a shared multiagency framework for case management
Schema Informed TrainingOverview of Personality Disorder• Function of Personality• Developmental origins• Diagnostic Categories
Overview of Schema Theory• Application of Model to self• Schema Chemistry in the OM relationship• Schema informed relational strategies
Sentence/Pathway Planning• Schema Formulation of case studies 5 P’s/Schema Formulation• Consultation Methods
Evaluation of Training1. Before attending the two-day training, what was your knowledge of...
1. Personality Disorder? (1-10)2. Schema model? (1-10)3. Formulation? (1-10)
2. Following the two-day training, what is your level of knowledge of...1. Personality Disorder? (1-10)2. Schema model? (1-10)3. Formulation? (1-10)
3. Following the two-day training, how confident do you feel about..4. Applying what you have learnt independently when managing your
caseload? (1-10)5. Formulating a schema-informed pathway with an offender you manage,
with support from the project team? (1-10)
Evaluation of training cont.5. Is there any part of the two-day training which you felt you would have liked more of?
6. Is there any part of the two-day training which you felt you would have liked less of?
7. Which aspects of the training do you feel will be the most useful in practice when managing your caseload?
8. Which aspects of the training do you feel will be the least useful in practice when managing your caseload?
Table 1. Pre-training and post-training comparisons of rated knowledge of Personality Disorder for each training group.
Month N Pre-training Post-training t(df), p, rAugust 16 M=5.2
SD=2.2M=7.8SD=1.3
t(15)=7.4, p<0.001, r=0.58
September 14 M=4.3SD=1.9
M=7.5SD=1.2
t(13)=6.8, p<0.001, r=0.71
October 21 M=4.2SD=1.5
M=7.4SD=1.1
t(20)=10.2, p<0.001, r=0.77
November 18 M=4.4SD=1.8
M=7.0SD=1.3
t(17)=9.9, p<0.001, r=0.64
December January February March July September
10 13 23 12 10 11
M=4.6SD=1.4M=4.5SD=2.3M=5.0SD=2.0M=4.7SD=2.3M=3.6SD=2.0M=3.5SD=1.8
M=7.9SD=0.3M=7.5SD=1.2M=7.7SD=1.0M=6.9SD=2.2M=7.2SD=1.4M=6.2SD=1.6
t(9)=18.3, p<0.001, r=0.70 t(12)=6.6, p<0.001, r=0.78 t(22)=7.7, p<0.001, r=0.73 t(11)=4.2, p<0.005,r=0.61 t(9)=6.4,p<0.001,r=0.81 t(10)=4.5,p<0.001,r=0.67
Table 2. Pre-training and post-training comparisons of rated knowledge of the Schema model
Month N Pre-training Post-training t(df), p, rAugust 16 M=3.8
SD=2.4M=7.3SD=1.7
t(15)=7.0, p<0.001, r=0.64
September 14 M=3.7SD=2.6
M=7.2SD=1.5
t(13)=6.1, p<0.001, r=0.74
October 21 M=3.3SD=1.7
M=7.0SD=1.0
t(20)=9.7, p<0.001, r=0.82
November 18 M=3.3SD=2.2
M=6.8SD=1.3
t(17)=7.6, p<0.001, r=0.70
December January February March July September
10 13 23 12 10 11
M=2.6SD=1.4M=3.3SD=2.5M=3.8SD=2.3M=3.4SD=2.5M=1.9SD=1.5M=1.3SD=0.6
M=7.2SD=1.5M=6.8SD=1.8M=7.7SD=1.3M=6.6SD=2.5M=6.8SD=1.4M=5.5SD=1.8
t(9)=7.4, p<0.001, r=0.85 t(12)=6.4,p<0.001,r=0.70 t(22)=7.2, p<0.001,r=0.70 t(11)=4.1,p<0.005,r=0.60 t(9)=9.7,p<0.001,r=0.91 t(10)=7.7,p<0.001,r=0.86
Table 3. Pre-training and post-training comparisons of rated knowledge of Formulation by training event
Month N Pre-training Post-training t(df), p, rAugust 16 M=2.4
SD=1.2M=7.0SD=1.3
t(15)=10.4, p<0.001, r=0.85
September 14 M=2.6SD=2.1
M=6.6SD=1.6
t(13)=7.2, p<0.001, r=0.73
October 21 M=2.0SD=1.2
M=6.7SD=1.5
t(20)=12.0, p<0.001, r=0.87
November 18 M=2.3SD=1.5
M=6.7SD=1.3
t(17)=10.4, p<0.001, r=0.84
December January February March July September
10 13 23 12 10 11
M=2.5SD=1.6M=2.8SD=2.2M=2.7SD=2.1M=3.6SD=2.8M=2.0SD=1.5M=1.4SD=0.9
M=7.2SD=1.8M=6.7SD=1.7M=7.3SD=1.3M=6.3SD=2.5M=7.1SD=1.8M=5.5SD=1.9
t(9)=6.7, p<0.001, r=0.81 t(12)=9.8, p<0.001, r=0.89 t(22)=11.4, p<0.001, r=0.86 t(11)=3.5, p<0.005, r=0.53 t(9)=10.6, p<0.001, r=0.93 t(10)=6.4, p<0.001, r=0.80
Table 4. Retained knowledge at 3 month follow-up
N Pre-training Post-training 3mth follow up
PD Knowledge 146(45)
M=4.47SD=1.92
M=7.36SD=1.35
M=6.8SD=1.47
Schema Knowledge
146(45)
M=3.18SD=2.19
M=7.00SD=1.60
M=6.33SD=1.45
FormulationKnowledge
146(45)
M=2.42SD=1.80
M=6.74SD=1.65
M=5.89SD=1.60
Table 5. Confidence levels for implementing knowledge immediately after training
Confidence independently applying training
Confidence applying with support from the PD Pathway team
August (N=16) M=6.9, SD=1.3 M=7.2, SD=1.5
September (N=14) M=6.8, SD=1.4 M=7.0, SD=1.5
October (N=21) M=6.4, SD=1.4 M=7.8, SD=1.3
November (N=18) M=6.4, SD=1.4 M=6.4, SD=1.5
December (N=10)
January (N=13)
February (N=23)
March (N=12)
July (N=10)
September (N=11)
M=7.4, SD=1.8
M=6.8, SD=1.8
M=7.3, SD=1.4
M=6.4, SD=2.4
M=7.3, SD=1.8
M=5.5, SD=2.3
M=7.8, SD=1.2
M=6.6, SD=1.7
M=7.5, SD=1.2
M=5.9, SD=2.4
M=6.6, SD=2.4
M=5.6, SD=2.0
Table 6.Retained Confidence
N Post training
N 3mth follow up
Independently 133
M=6.73SD=1.70
36 M=6.56SD=1.60
Support from team
126
M=6.92SD=1.73
33
M=6.63SD=1.90
Table 7. Retained confidence in independently using formulation and using formulation with team support
N Post trainingVs 3mth follow up
t(df), p, r
Independently
34
M=0.33SD=2.17
POST VS 3MTH = t(33)=0.87, p=0.39. NON SIG
Support fromteam
30
M=0.20SD=2.57
POST VS 3MTH=t(29)=0.43, p=0.67. NON SIG
Results Summary
• Statistically significant effect sizes for all 3 components of acquired knowledge from training.
• No sig. differences between the training cohorts suggests the training provided a consistent effect regardless of job role or the cohort in which they were placed.
• Improvements in confidence not significant but…• Low return rates at 3 month follow-up precluded
meaningful comparisons to initial knowledge gained….but returns suggest knowledge is retained post training but figures too small.
Qualitative Feedback – helpful..
• Useful techniques to use with offenders – to ask why?• Clearer understanding of team remit• Better understanding of the link between offending and child
trauma• Understanding own schemas• Considering impact of self on offender management
relationship• Don’t take things so personally• Need more 1:1 time with some people• Considering need for nurturing v’s strong approach – I can be
‘fluffy!’
Qualitative Feedback – not so helpful
• Case formulation too lengthy….need to get to the why’s more quickly.
• Formulation template too complicated• Overwhelmed….can’t think about individual's
in such depth • Not enough solutions –too much discussion• Generates more questions than answers
Want more of….
• More Schema Theory• Better clinical supervision – impact of job on
self• Managerial understanding of time constraints• Reflective space and personal development• Support and training in practical management
Summary
Training improves immediate knowledge of targeted areas.Confidence building is more complex…possibly dependent on job roleFurther training to address practical aspects of offender management The challenge of meeting the unmet needs for reflective space, supervision and organisational care………
Questions?
On the Path Out of ProbationRobert’s Story
Dr Felicity Nichols Clinical Psychologist
Helena WilksProbation Officer
Outline
• The Schema Model• Overview of the Pathway• Using a case example:
– Screening– Consultation– Pathway Plan– Progress– Formulation– Tools along the way– Update
• Questions
The Schema Model
Integrative Model
Developed by Dr Jeffrey YoungDraws upon CBT, Gestalt, Psychodynamic, Interpersonal, Attachment Increasing evidence base
Early Maladaptive Schemas
Define thoughts and behavioursDevelop throughout childhoodSignificantly dysfunctionalEnduring Personality Traits
Schema Modes
Dominate an individuals presentation in the momentIndividuals ‘flip’ between modesMaladaptive way to protect self
ALL NPS Cases and CRC Females
START
CONTACT USE-MAIL: PD PATHWAY MAILBOX /LINCOLNSHIRE/ NPS
TELEPHONE: 01522 528520
Useful Contacts:Community Forensic
ServiceTel: 01522 577363
Community Forensic Psychology ServiceTel: 01522 573243
Nicky GibsonTel: 01427 611092
ALL NPS AND CRC FEMALE CASES TO BE SCREENED. Offender Managers need to complete the screening tool based on the most recent OASys Assessment. The completed form should be sent to the PD Team email address.
Offender fits into the PD Pathway
criteria
Offender doesn’t fit the PD
Pathway criteria
LEVEL 1All offenders who enter the Pathway will
have a Level 1 Formulation as a minimum. A Level 1 Formulation is where the offender is progressing according to
the sentence plan.
INITIAL CONSULTATION
Appointment arranged between PD Team and OM to discuss the case.
Factors to be explored:• Offending• Childhood • History• Behaviour• Sentence• Risk Assessment • Mental health• Any other relevant
information.
Based on this information a Joint decision will be made as to what level of Formulation is required for the Offender.
Cases which score below 3 and are not PD will be signposted to Mental Health Services if required.
The PD Team will email you to
confirm whether the Offender
Screens Out or warrants an
Initial Consultation
OM to record all contact on NDelius and any pathway plans are embedded
and documented in OASys.
LEVEL 2The level 2 formulation is a Mode
Formulation which can be completed in a number of ways, please see the OM
guidance December 2014 v2.0
LEVEL 3This is a full Formulation Report which
includes a face to face assessment with the offender. The report is completed by
a Clinical Psychologist from the PD Team who will meet with the offender and liaise with staff who have contact
with the offender.
Screening
• Scored 4 of 5 possible factors
• Identified as possible OM Strand case
• Simultaneous MH referral submitted
Time
May 2013Offence
Sept 2013PSR
Oct 2013
Initial Consultation• Overview of case history
• Offending• Childhood
• Current presentation• Behaviour• Mental Health• Risk Assessment • Any other relevant information
• Pathway Plan
Time
May 2013Offence
Sept 2013PSR
Oct 2013Screening
Oct 2013
Case History - Offending
• 16 convictions: 2005-2013– Acquisitive– ABH – Common Assault – Drunk and Disorderly– Arson – Possession of an Offensive
Weapon
• Disclosed offending behaviour– Burglary– Criminal Damage– Kidnapping– Drug related offences– Driving Offences– Domestic Abuse– Racially Aggravated Incidents– Football Violence– Gang links– Links to extremist groups– Accomplice to violence
Case History - Personal
• Dad well known to Criminal Justice Agencies– MAPPA 3– Violence– Mental Health– Far Right Groups link– Trained children in bare
knuckle fighting• Abuse and Violence from
young age• Difficult schooling history
• Voice in head• Drug use from aged 12• Parents split up aged 6• Difficult relationship with
step-mum• Provided for materially• Short term relationships• Children
– 2 Confirmed– 3 Awaiting DNA– Unsure number of others
Current Presentation
• Voice in head• Arriving late• Re-offending• Non- attendance• Rude to reception staff• Disparities in presentation• Concerns about far-right links
• Recognise need to do something different• “I need help” vs. bravado and family culture
Pathway Plan
• Referral to MAPPA• Referral to CHANEL• Co-working with a view
to moving into the team• Psychology assessment
with a view to offering therapy
Time
May 2013Offence
Sept 2013PSR
Oct 2013Screening
Oct 2013Consultation
Oct 2013
Progress…
• Schema informed practice• Close joint working• Weekly Appointments
– Probation Supervision– Schema Therapy
• Monthly joint appointments planned around PREVENT intervention
• “Every day is a winding road…But I get a little bit closer”
Jan 2014Transfer
Time
May 2013Offence
Sept 2013PSR
Oct 2013Screening
Oct 2013Consultation
Oct 2013Assessment
Nov 2013
Sept 2014
Mar 2014Review
Apr 2014Moved
Jun 2014Anxiety
Little RobFeel scared
Feel vulnerableFeel ignored
Feel scared of what other people might think about meFeel like there is something wrong with me
Angry Child Do things to see if anyone cares
Get into troubleTest where the boundaries are
Offending – smash car windows, steal bikes…Think I can get away with it
Joker Rob(Happy Child)
Likes to have a laughPlayful
Healthy Adult RobI know I need help
I want to be respected in a good wayI am trying to understand myself
I need to find suitable accommodationNot being a ‘sheep’
I don’t mind working for things – at least I know it’s mine then
Honest and open about what I do
Punitive Parent If you make a
mistake you deserve to be punished
Likely SchemasAbandonment / Rejection
Mistrust / AbuseDefectiveness / Shame
Dependence / IncompetenceInsufficient self-control
WHAT TO DO:Leave me alone to calm down
See if I want wot go somewhere else to cool off
WHAT TO DO:Cuddles, love and attention
Someone to help and keep me safeSomeone to be there and to understand
WHAT TO DO:• Set realistic boundaries• Remind me about how
this males me feel when I beat myself up
Angry ProtectorDon’t trust people
Keep people away – make them scaredGet cross
Detached Protector RobNo thinking or remembering
‘Cut off’Play games to escape and become invincible
Take drugs to feel goodListen to loud music
Bully-Attack RobAttack before I’m attacked
Offending – holding knife to throatVoice takes over
Compliant SurendererBe a sheep
Feel used and abused
WHAT TO DO:Help me to stop / know when to stop
Notice me more for the good things – pay attention
Notice how hard I am tryingTell me to stop it
Put in the boundaries and explain why without just giving orders out
WHAT TO DO:Try to encourage me to do more stuff
Chat more – about anythingKeep trying with me
Notice that I am changing the topic and think about why
WHAT TO DO:Let me deal with it
Don’t get in my way
WHAT TO DO:Encourage me to do what I want / need
Need someone to “throw me a leash and show me the light”
THE PLANWork with Helena to complete my order
Work with Felicity to think about my childhood
Work with Dave
Tool Kit
The long and winding road….
• Completed FIRST probation supervision period
• Risk of Serious harm– High Medium
• Continued engagement with PREVENT• Request to re-engage voluntarily• 6 Months offending free• No emotional needs Acknowledgement
Jan 2014Transfer
Time
May 2013Offence
Sept 2013PSR
Oct 2013Screening
Oct 2013Consultation
Oct 2013Assessment
Nov 2013Co-work
Sept2014
Mar 2014Review
Apr 2014Moved
Jun 2014Anxiety
Mar2015
Dec 2014Contact
Feb 2015Loss
BUT…“From his initial presentation to yourself until now there has
been a significant change in his beliefs and behaviours. I remember a few months ago he was saying how proud you and Felicity would be of him. He had seen a phone on the front seat of an unlocked car and just walked on as he did not want to get
in trouble again. When we first met him he was relatively unconcerned about the potential to get in further trouble and
his stance has changed substantially. He is in a considerably improved place with his stress levels and this affects his general demeanour and any potential for violence. I am of the opinion
that he now appears to know himself better and is more comfortable with himself”
Jan 2014Transfer
Time
May 2013Offence
Sept 2013PSR
Oct 2013Screening
Oct 2013Consultation
Oct 2013Assessment
Nov 2013Co-work
Sept 2014Completed
Mar 2014Review
Apr 2014Moved
Jun 2014Anxiety
Mar 2015Dec 2014
ContactFeb 2015
Loss
Questions?
Evaluating the Effectiveness of the Pathway: Staff and Offender’s Feedback
Dr Felicity NicholsClinical Psychologist
Project Tasks
Early Identification
Workforce Development
KUF Awareness Training2 Day Schema Informed Practice1 Day Skills Training
Sentence/Pathway Planning
3 Tiered Formulation SystemOngoing case consultation
Offender Management
Approved Premise
• Formulation work
• Case consultation
Training
“Many thanks for getting us a slot on the training. I found it useful and informative and the fact that Kerry was delivering made it even more
informative based on her knowledge levels and experience.”
PREVENT Engagement Officer
On Mode Formulations
“Thank you Marina, this is awesome and couldn't have come at a better time.”
Probation Support Officer
“Marina, this is excellent and so detailed which is really useful. Thank you so much.”
Approved Premises Support Worker
“Many thanks - this is really helpful - even with relatively limited knowledge it gives a clear picture of the different ways in which GS is operating which will be particularly useful in the imminent SPRB!
Very timely!!”Probation Officer
Touring the Country
“Felicity seems to have got a lot more out of him in face to face interview”
Probation Officer and Offender Supervisor
“Thanks for seeing him - it sounds like it was quite productive - any insight re the best way forward
with him will be much appreciated.”Probation Officer
The Approach
“He hasn`t volunteered any feedback re this - made absolutely no comment about it or reference to it of his own volition. I
wrote to him with feedback re your comments about how well he engaged and he replied that he was pleased with this. I
presume he didn`t ask for a video link to discuss the content - but as far as I`m aware - he also hasn`t made any complaint
about either the interview or the report..........................not that I`m suggesting anything was warranted!....................but given he
can spend months complaining about the use of a single word this seems ot suggest he felt `heard` at least at the time.”
Probation Officer
Empathic Confrontation
“Ah its nice to hear that as I have just seen him and spent 15 minutes using those sorts of statements and got so much
information out of him and actually had a conversation. Using statements such as ‘It must be so tough for you to...’ ‘I
understand that you....’ ‘you have said that.....’It works!
Thank you for the information”
PSO Programmes Tutor
Consultations
“All of us involved in the management of X, thought it was brilliant and has really assisted us.
When I went through my DRR Review which was obviously informed by our discussions, X was really happy with it and he would like to meet with you for
formulation - there was no selling necessary”Probation Officer
A chance to think
“Your comments really helped in seeing more clearly beyond the
multiple complaints which seem to exercise so much of his time; energy, thinking & emotion. I was guessing
before but stepping back and seeing the complaints in their own right as
a barrier to self revelation/emotion - rather more concrete than the usual
smoke and mirrors perhaps! really helps to try to see beyond.”
Probation Officer and Offender Supervisor
On Full Formulation Reports
“I wanted to say again how much I appreciated this - I`m not a psychologist but I found it accessible and felt it gave a much better
insight into how X operates/functions … It particularly felt both immediate and connected to the person rather than an almost detached set of observations which although they relate to the
person can almost seem like the fridge on their back they`re hitch hiking with without any realistic suggestions or means to ditch the
burden”
Facilitating Recommendations
“This is to be honest, an excellent piece of work and I would like to thank you for all the time and effort that
you have put into producing this. It is clear in respect of language, easy to use, well
laid out and concise.”
Probation Officer Treatment Manager
Multi-Agency Working“It was very noticeable when we first met with X that there was a trust within him of
your process and this made our engagement so much easier. He warmed to our provider very quickly as a result of your relationship and the provenance that had
been givenSharing of information between ourselves was key so that there were no conflicting
messages and we were all working from the same knowledge.”Prevent Engagement Officer
Many thanks for your positive and swift reply. Your response re wider circulation was much appreciated - particularly as the e-mail seemed to take on a life of it`s own ...
Probation Officer
Multi-Agency Working“The majority of the credit for the reduction in risk is purely down to the positive work done, by the PD
Pathways team. This sentiment was agreed at the last Channel meeting
by all partners present. The excellent relationship they formed with the individual, the professionalism shown when
working with Channel, bearing in mind the staff had no previous
knowledge or experience of Channel practices, has provided this end
result and for that I would like to thank the team on behalf of
Lincolnshire Channel.”
Prevent Engagement Officer – Lincolnshire
Police
The Team
“Everyone was really positive about the changes and really positive about the working relationship that we have with you guys.
It has become clear to me how open to our queries and concerns the PD team are. Historically we may have felt that we were unable to speak out or
raise concerns when we had conflict between the probation and psychological approach however it was clear from this meeting that this was
encouraged.”
Approved Premise Supervisor
Missing the Mark?
“There was a problem with the letter from PD Pathway which he commented ‘ I wish people in Probation would learn to speak plain English ... what exactly is this saying Oh I don’t
understand a word’ he described it as ‘Psycho babble’”Court Service Officer reporting on Judge’s Comments
“Perhaps the formulation report could have a bit of formatting to make it a little more OAsys compatible to aid cutting and pasting thus
formulation report wording cut and pasted in (as I have tried to do) with a score put in reflecting
the report narrative.....if that makes sense.”Probation Middle Manager
Some way to go…“It was decided that better
communication was needed between the two teams in relation to
enforcement. I explained how important it was to get feedback on challenging
incidents and to understand the reasons why certain decisions are being made. I am confident that X will help us to find
the middle ground between the probation and the psychological
approach. If we are unhappy we can bring this up in our supervision or book
a consultation to discuss this directly with the PD team.”
Approved Premise Supervisor
The Person behind the Offender“When we first met him he was relatively unconcerned about the
potential to get in further trouble and his stance has changed substantially.
He is in a considerably improved place with his stress levels and this affects his general demeanour and any potential for violence. I am of the opinion that he now appears to know himself better and is more
comfortable with himself.I am amazed at his transformation which I put at your door. When we were first briefed I would never have guessed that he would end up in
the place he is at now.”Police Officer
From the Horses Mouth…
“If I had another Probation Officer I would have been recalled as they don't understand me. I have not got on with Probation in the past and I have never complied for as long as I have this time. I enjoy coming to see Helena and Kerry and feel I can have a laugh and this keeps me engaged. I
appreciate the level of support for the AP Staff and PD Team and Kerry and this has helped me. I am happy with continuing to engage voluntary. I feel
happy that I would have completed my first period on Probation but also feel pleased that the Police
are wondering what I am up to as I have never been this quiet!”
On the Service
“I am again really grateful we have this intervention available - plus the
consultation etc in general. It`s a real asset at all levels and probably one of the best
innovations we`ve ever had.Thanks again - and then some!”
Probation Officer
“Glad to help. It's an important project and we need to ensure it gets embedded into mainstream practice.”
Middle Manager
Questions?
Does Gender Matter? A Thematic Analysis of Level 3
Formulations in the Lincolnshire OPD Pathway
Marina Simeou(Assistant Psychologist)
Rationale • Commissioned to look into women and womens’ needs• Previous research
– Nature of Personality Disorder– Levels of Self-Harm (Nehls, 1999)
– Substance Use (Trull et al., 2000)
– History of abuse (Herman et al., 1989)
– Increased risk of prostitution– Family implications (Caddle & Crisp, 1997)
– Contact with Services– Impact of Prison Environment (Wolff & Shi, 2009)
Formulation Report
Method
• Qualitative – thematic analysis• 14 scripts (7 Male, 7 Female)• Childhood, School/Employment, Relationship
History, Mental Health, Drug and Alcohol, Offending History, Schemas, Modes, Recommendations
• Key themes
Results
• Childhood differences:
• Similarities: Physical abuse, Financial difficulties, Parent alcohol misuse, Parent MH problems, Children’s Services, Child behavioural problems, Prostitution
Domestic Abuse
Emotional Abuse
Infidelity Single Parent
Sexual Abuse
Homeless-ness
Child Pregnancy/Termination
Female 43% 71% 43% 43% 56% 0% 14%
Male 14% 43% 0% 80% 29% 29% 0%
Results
• School/ Employment differences:
• Similarities: Multiple schools, Left school >16yrs old, No formal qualifications on leaving school, Current employment status
Expulsion ADHD/ additional learning needs
Truanting Bullied Challenging behaviour
GCSEs
Female 14% 14% 71% 29% 43% 29%
Male 57% 57% 43% 57% 71% 0%
Results
• Relationship history differences:
• Similarities: Physical abuse, Infidelity, Big age gap, Significant relationship, Under-age sexual relationship, Partner MH problems
Emotional Abuse
Compliant/ dependent relationship
Partner - Probation
Partner – Substance Misuse
Child/ children
Female 29% 57% 29% 43% 43%
Male 0% 14% 0% 0% 29%
Results
• Mental Health differences:
• Similarities: MH diagnoses, Medication, Other MH services
Borderline PD Other PD i.e. Antisocial/ Avoidant/ PD traits
Self-harm Suicidal Ideation/ Attempt
Crisis Team
Female 57% 0% 86% 86% 71%
Male 29% 43% 57% 29% 0%
Results
• Drug and Alcohol differences:
• Similarities: Underage drug and alcohol misuse, Drug misuse
Alcohol Misuse
Cannabis Misuse
Amphetamines Substance Misuse Services
Currently substance-free
Female 86% 43% 29% 57% 29%
Male 57% 100% 57% 14% 0%
Results
• Offending History differences:Convictions >18yrs old
Sexual Offences
Drug Offences
Burglary Fraud & Forgery
Motoring Offences
Female 29% 0% 14% 29% 0% 43%
Male 71% 43% 0% 0% 14% 14%
Results
• Offending History differences (cont.):
• Similarities: No prior convictions, Violence Against the Person, Theft & Handling Offences, Criminal Damage, Retaliation
Use of Weapon
Under the influence
MH Acquisitive Offences
Custody Community Sentence
Female 0% 71% 0% 43% 43% 57%
Male 57% 43% 29% 0% 86% 14%
Results
• Schema differences:
• Similarities: Average number, Disconnection & Rejection, Impaired Limits
Impaired Autonomy & Performance
Other Directedness Over-vigilance/ Inhibition
Female 43% 71% 57%
Male 14% 29% 43%
Results
• Mode differences:
• Similarities: Average number, Parent Voice
Child Mode Avoidance Surrender Over-Compensatory
Female 43% 100% 100% 71%
Male 71% 71% 57% 100%
Results
• Recommendation differences:
• Similarities: MH Services, Supported Accommodation, Planned ending of supervision, Specific psychological intervention i.e. trauma work
Substance Misuse Services
PD Services Voluntary Probation Engagement
Education
Female 43% 0% 29% 29%
Male 14% 29% 0% 0%
Conclusion & Discussion
• Mixed bag…
• Very exploratory!• Small sample - not proportionate
• Inter-rater reliability - multi-disciplinary
• Further research
Questions?
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