THE STATE HOSPITALS BOARD FOR SCOTLAND

ANNUAL REPORT

Research Committee and Research Funding Committee

Reference Number Issue: v1.0

Lead Author Jamie Pitcairn, Research and Development Manager

Contributing Authors

Approval Group Clinical Governance Committee

Effective Date 13th May 2020

Review Date 13th May 2021

Responsible Officer (eg SMT lead)

Medical Director

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Table of Contents

Contents Page Number

Table of Contents 2

1 Introduction and Highlights 3

2 Governance arrangements 3

2.1. Committee membership 3

2.2. Role of the committee 4

2.3. Aims and objectives 4

2.4. Meeting frequency and dates met 4

2.5. Strategy and Work plan 5

3 Key pieces of work undertaken during the year 6

3.1. Annual Research and Clinical Effectiveness Conf. 2019 6

3.2. Forensic Network Research Conference 2019 7

4 Key performance indicators 8

4.1. Priority Research Theme Activity 8

5 The Patient’s Voice 9

6 Comparison with last annual report 10

7 Areas of good practice 10

7.1. Research Study Implementation 10

7.2. Research by Professional Group 11

7.3. Support for Quality Improvement approach 13

8 Identified issues and potential solutions 13

8.1 Factors Affecting use of Research Budget 13

8.2 Research Participation 13

9 Future areas of work and potential service developments 13

10 Implications 14

10.1. Finance 14

11 Next review date 14

App 1 Research Activity 15

1. Completed Studies 15

2. Journal Articles 16

3. Presentations 17

4. Ongoing Studies 19

5. Studies in development to commence in 2020/21 21

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1 Introduction and Highlights Within the NHS, it has been shown that research not only furthers knowledge but improves staff morale, recruitment and retention, and patient care. Research is therefore core to the business of The State Hospital and to our pursuit of evidence based practice. The skills obtained by those engaged in research are directly transferable to other areas of health care such as service planning, teaching and management. The State Hospital has shown a considerable commitment to research and has a proven track record. 2019/20 has seen a continued focus on the implementation and dissemination of the wide range of excellent research and evaluation conducted by staff at the State Hospital. Highlights include both our annual State Hospital Research, Clinical Effectiveness and Quality Improvement Conference (3.1), and the national Forensic Network Research conference (3.2) which includes considerable contribution from State Hospital staff. The focus of research and research implementation in supporting Quality Improvement activity is highlighted in 7.3, and examples of how our research studies have been used to influence practice are provided in 7.1.

2 Governance arrangements 2.1. Committee membership Research Committee Membership: Professor Lindsay Thomson Chair, Medical Director and Professor of Forensic Psychiatry, University of Edinburgh Mrs Patricia Cawthorne Consultant Nurse Mrs Patricia Coia Senior Charge Nurse Mrs Hannah Connor Lead Occupational Therapist Ms Rebecca Hart Librarian, The State Hospital Dr Sheila Howitt Consultant Forensic Psychiatrist (To October 2019) Dr Joe Judge Clinical Psychologist Dr Suzanne O’Rourke Consultant Forensic Clinical Neuropsychologist, Lecturer in Forensic Clinical Psychology, University of Edinburgh Mr Jamie Pitcairn Research and Development Manager Dr Kerry Jo Smith Forensic Clinical Psychologist Mrs Catherine Totten Lead AHP Ms Lindsay Tulloch Clinical Research Nurse, Nursing Team Leader Dr Helen Walker Consultant Nurse, Forensic Network; Senior Lecturer, University of

the West of Scotland (UWS) Ms Jacqueline McDade Committee Secretary Research Funding Committee Membership: Dr Duncan Alcock Associate Medical Director Mr Robin McNaught Finance and Performance Management Director Mr Mark Richards Nursing Director

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2.2. Role of the committee Research Committee The role of the Research Committee is to support, encourage and promote research, and to ensure the quality and dissemination of research projects associated with the State Hospital. It seeks to ensure that the Board can have confidence in the quality of research with high scientific and ethical standards, with transparent decision making, and clear monitoring arrangements. The committee also plays a key role in the statutory Research Governance responsibilities of The State Hospitals Board for Scotland, and conducts this role in line with the Research Governance framework of the Chief Scientist Office. The members of this committee also provide a resource for staff undertaking research by providing support, advice and education on research matters. Additionally the committee can assist the hospital through the appraisal and development of evidence or research findings generated through research external to TSH, and promote the practise of evidence based medicine. Research Funding Committee The Research Funding Committee (RFC) is the committee that takes decisions on research funding requests, informed by a full review of the scientific merit and ethical standards of a proposed project by the Research Committee. Project proposals that require financial support must detail this clearly in the format as for a funding body, e.g., Chief Scientist Office. The funding application is then reviewed by the Research committee and a decision made on the appropriateness and value of the application prior to the review being passed to the RFC to assist in their approval decision. 2.3. Aims and objectives The aims and objectives of the Research Committee, as outlined below mirror those within The State Hospital Research Strategy 2016-2020. The aims and progress made against them will be reviewed as part of developing the new updated Research Strategy.

1. Support the use of data and research evidence as part of an evidence based culture aimed at improving both patient care and the patient experience of care, though a focus on continuously improving practice.

2. Place the research conducted in TSH within the context of the national strategic approach to research in health and the governance required as part of this process.

3. Identify research needs and priorities; and to commission research accordingly. 4. Improve research infrastructure, capacity and management systems. 5. Support evidence based culture through focus on training, developing staff competencies in

transferable research skills and increasing research capacity. 2.4. Meeting frequency and dates met The research committee meets monthly on the first Thursday of every month (except January). It considers new research proposals, timetabled project reviews, final report reviews and any other research related issues. A series of forms have been developed for the initial research proposal, full research proposal and proposal and final report reviews. All ongoing research projects are reviewed six-monthly and a standardised progress report form is completed. The Research Funding Committee convenes on an ad hoc basis as and when required to review a research related funding request that has been supported by the Research Committee.

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2.5. Research Committee Strategy and Work plan The current State Hospital Research Strategy covers the period 2016-2020. Work will commence this year (2020) to develop a new updated Research Strategy for the hospital. This work will include a full review of the work plan attached to the 2016-2020 strategy and this work will used to both assess work conducted during the current strategy, and help to inform the development of the new version. The research committee work plan provides a month by month outline of the priority items of work throughout the year, and shows how actions related to these are structured to meet the deadlines associated with each. The work plan is included below. Month Activity

January

No committee meeting

February

Research Committee

March

Research Committee

April

Research Committee

Completion of RC Annual Report

May

Research Committee

Presentation of Research Committee (Incl. Research Funding Committee) Annual report to the Clinical Governance Committee.

Research and Clinical Effectiveness Conference

June

Research Committee

July Research Committee

August

Research Committee

September

Research Committee

Specific focus on the prioritisation of the uncommitted funds remaining within the Research budget for following financial period.

October

Research Committee

November

Research Committee

Early planning period for following years R&CE conference.

Forensic Network Research Conference

December

Research Committee

Final Planning period for R&CE conference.

Specific focus on the end of financial year budgetary management.

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3. Key Pieces of work undertaken during the year 3.1. Annual Research and Clinical Effectiveness Conference 2019. On the afternoon of Thursday 9th of May 2019, the nineteenth annual Research and Clinical Effectiveness Conference was held in the Islay Staff Development and Conference Centre. The conference was attended by both State Hospital staff and many external delegates attending from across the Forensic Network. The event was chaired by Gary Jenkins, Chief Executive, and the following presentations were made: Developing a New Scale to Measure Clinicians' Awareness and Understanding about Staff-Patient Dynamics: The Relational Aspects of CarE (TRACE) Scale. Dr Adam Polnay, Consultant Psychiatrist in Psychotherapy, The State Hospital

The use of Health and Wellbeing Plans in managing Physical Health care in a high secure setting Frances Waddell, Lead Dietician; Dr Khuram Khan, Consultant Forensic Psychiatrist, The State Hospital

Delivering MAP of Behaviour Change Training in TSH. Alison Burrell, Trainee Health Psychologist; Claire Borthwick, Trainee Health Psychologist, The State Hospital

PANSS People: Investigating and Improving the use of the PANSS in Clinical Practice Dr Sheila Howitt, Consultant Forensic Psychiatrist, The State Hospital

TSH30:30 Rapid Poster Presentation. Monica Merson, Head of Corporate Planning and Business Support, The State Hospital

Panel Q&A: TSH30:30 Quality Improvement Initiative

Rapid Poster Presentations: Exploring Patients’ Experiences of Familial Support: An Interpretative Phenomenological Analysis Martha Gillespie, Trainee Clinical Psychologist, The State Hospital TSH30:30 Events Committee Project. Sarah Innes, Specialist Occupational Therapist, The State Hospital Greatix: Learning from Excellence. Caroline Kelly, Assistant Psychologist, The State Hospital Predicting and Understanding the Uptake of the Seasonal Influenza Vaccination among Inpatients in a High-Secure Forensic Mental Health Hospital. Claire Borthwick, Assistant Psychologist, The State Hospital Evaluation of a Healthy Lifestyle Group Intervention for Patients with Intellectual Disability at The State Hospital. Alison Burrell, Trainee Health Psychologist, The State Hospital Posters: Introducing a Full Chain of Custody Dual Sampling Oral Fluid Testing for Restricted Patients in a Regional Forensic Service. Dr Callum Maccall, Consultant Forensic Psychiatrist, The State Hospital Quality Improvement Project - Validation of Progress Notes. Dr Duncan Alcock, Associate Medical Director; Carol Ann Finlayson, Quality Improvement Officer; Jill Kerr, Clinical Effectiveness Co-ordinator, The State Hospital; Sheila Smith, Clinical Effectiveness Team Leader, The State Hospital AHP Team Development Journey, The State Hospital. Sarah Innes, Occupational Therapist, The State Hospital; Triona O'Sullivan, Occupational Therapist, The State Hospital

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Healthy Working Lives Group. Jean Byrne, Organisational Development Manager; Gayle Scott, OD & Learning Advisor; Fraser Breed, Dietician; Josie Clark, Practice Development Facilitator; Co-Authors, Healthy Working Lives Group Members, The State Hospital Clinical Supervision for Ward Based Nurses in a High Secure Hospital. Mhairi Ward, Senior Nurse, Nursing Practice Development; Carol Anderson, Senior Charge Nurse; Marlene Irvine, Practice Education Facilitator; Michelle McKinlay, Staff Nurse, Carolin Walker, Professional Nurse Advisor, The State Hospital The Lewis Open All Hours TSH30:30 Project. Catherine Totten, AHP Lead; Triona O’Sullivan, Specialist Occupational Therapist; Sandra MacAllister, Lead Nurse; John Fern, Senior Charge Nurse; Nicola Porter Occupational Therapist; Jackie Smith, Technical Instructor; Ian Hanson, Charge Nurse; Ian Dickson, Charge Nurse, The State Hospital 3.2 Forensic Network Research Special Interest Group Conference 2018 The Forensic Network Research Special Interest group (FNRSIG) held their sixth national Forensic Network Research Conference on the 7th of November 2019 at the Scottish Prison Service College in Polmont. The day was chaired by Dr Daniel Bennett, current chair of the FNRSIG, and featured key note speeches from eminent speakers, Professor Thanos Karatzias whose talk was titled ‘Trauma in Forensic Settings and CPTSD as a new condition in ICD-11’ and Dr Helen Walker who spoke on ‘Connecting Learning, Teaching, and Research’. This national conference included significant contribution from State Hospital staff showcasing work conducted within the hospital including: An exploration of recovery among patients experiencing high secure care: A 20+ year follow up. Cheryl Rees Forensic experiences of recovery from mental illness: Analysis of the Questionnaire on the Process of Recovery in Scottish forensic patients. Lindsey Gilling McIntosh & Cheryl Rees Exploring high secure forensic patients’ experiences of familial support: An Interpretative Phenomenological Analysis. Martha Gillespie A Systematic review comparing Dialectical Behaviour Therapy and Mentalisation for Adolescents with Borderline Personality traits, suicide and self-harming behaviour. Dr John J Marshall Lost in implementation? (Results of a process evaluation to determine barriers and facilitators to implementation of a cognitive behavioural therapy for psychosis (CBTp) treatment programme in a high secure setting). Patricia Cawthorne Night-time Confinement and the Practice of Realistic Medicine. Professor Lindsay Thomson Examining the Perceived Facilitators and Barriers to Patients’ Uptake of Physical Activity in a High-Secure, Inpatient Mental Health Hospital. Alison Burrell The Development and Implementation of the Forensic Network Service User Database: Supporting clinical care, service planning and research initiatives across the Scottish forensic estate. Owen Smith Neuropsychological Characteristics of Forensic Inpatients in Scotland. Sarah Janes Identifying Distress or Imminent Violence Using a Wristband Device. Dr Suzanne O’Rourke

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Poster presentations: Introducing Oral Fluid Testing for a panel of 50 drugs, including New Psychoactive Substances, in High Security, Low Security & Community Forensic services. Dr Callum A. MacCall Exploring patient experiences of evening routines within a high secure hospital. Josie Clark Psychiatric Police Cells Assessments: Who, Why, What Happened? Dr Rachael Sibbett, Dr Leah Jones The conference received excellent feedback from delegates and the 2020 FNRSIG Research Conference is scheduled to take place on the 5th of November, 2020 at the SPS College, Polmont. The 2020 conference will be dependent on the status of the Covid-19 crisis and the possibility of holding large gatherings of people. A decision on whether the conference can take place will be made as soon as is possible. 4. Key Performance Indicators Number of study proposal reviews: 18 Number of study progress reports: 10 Number of study final reports: 5 Number of studies approved: 10 Number of peer reviewed publications: 12 Number of ongoing studies: 27 The figures given above comprise the key performance indicators as required within the Clinical Governance annual report. They give an indication of the level of research activity monitored by the Research Committee. Appendix 1 provides further details on the range of studies completed and the way in which the TSH research activity has been disseminated on a local, national and international basis. 4.1 Priority Research Themes On review of the State Hospital Research Strategy 2016-2020 the hospitals Clinical Governance Committee requested that some of the items contained within the strategy were also included within the Research Annual report to provide an opportunity to check progress annually throughout the life of the strategy. Subsequently this section addresses the activity undertaken in relation to already identified priority areas for research. The priority areas of research will be reviewed as part of the process to develop the new updated research strategy. Table 4.1: Priority Research Themes HEAT Target Priority Research Theme Activity

Health Improvement Physical Health

Obesity, Weight Management and Physical Activity

Metabolic Syndrome and Diabetes

Smoking Cessation Outcomes based approach to Healthcare

Monitoring Clinical Outcomes

Identifying interventions associated with positive outcomes

Recovery model and long term follow up

Health Informatics and long term data trending

Evaluation of Diabetes self management group and Study of the uptake of seasonal Flu vaccination completed. Study of barriers to patients physical activity, and Evaluation of ID patient Healthy Living group completed. 20 Yr Follow Up recovery study completed August 2019. Health Informatics systems development ongoing with Tableau BI system in place.

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Treatment Appropriate to Individuals

Person centred care and the needs of users and carers.

Co-Production Specific Diagnostic areas

Schizophrenia

Neuropsychological Functioning

Personality Disorder

Learning Disability, Autistic Spectrum Disorder and ADHD.

Substance Misuse and Co morbidity

Recovery Research in Action study in place. CBT for Psychosis study completed and being used to inform practice. Major trial of ADHD medication ongoing and nearing completion.

Efficiency and Governance Access to Services

Patient Safety

Risk assessment and management

Seclusion and other de-escalation techniques

Service Evaluation, continuous improvement and evidence based practice.

Evaluating the Forensic Psychiatric Matrix and wider PTS service

Recovery Model and Long term follow up

Clinical Outcomes monitoring

Pharmacological Interventions

Evaluating the impact of the Clinical Model and Forensic Managed Care Network

Evaluating the efficacy of Staff Training and Development Initiatives

Staff Health and Wellbeing

Study to investigate use of seclusions and other de-escalating techniques across FN High and Medium security underway with study research assistant in place. TSH30:30 project conducted to evaluate the use of live DASA IV data on wards. Wide range of service evaluations in place: See ongoing study list App1, Section 4.. Outcomes monitoring and data utilisation ongoing. Major study into Adverse Drug Reactions in conjunction with University of Liverpool approved. KAMQ, TRACe and MAP studies in place. Study of staff wellbeing and link to level of direct patient contact completed.

Please see Section 7.1 of this report, which highlights the way in which a range of research studies, including those within the priority areas as noted above, have directly influenced practice both within the State Hospital and across the wider Forensic Managed Care Network. 5. The Patients’ Voice The Research Committee is committed to the development and delivery of studies focused on the patient perspective of the programmes and initiatives that they are asked to participate in. The feedback that is received from patients is extremely valuable in informing the ongoing development of treatment programmes and other initiatives designed to support patients. Involving Forensic in-patients in all aspects of research has traditionally been seen as a difficult thing to do. However the importance and value of including patients at every possible stage, and taking an inclusive co-productive approach is now well documented, and this approach is entirely supported by the Research Committee.

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6. Comparison with last annual report The key performance indicators outlined within the table below have largely remained consistent with the performance of the committee over recent years.

KPI 2018/19 2019/20

Number of study proposal reviews 18 18

Number of study progress reports 20 10

Number of studies approved 12 10

Number of peer reviewed publications (Total number of publications)

12 (19) 12 (15)

7. Areas of good practice 7.1 Research Study Implementation. A number of studies have made varying contributions to the ongoing development and improvement of practice.

Example: Recovery Research into Action study: Professor Lindsay Thomson, Medical Director, The State Hospital, Professor of Forensic Psychiatry, University of Edinburgh, Cheryl Rees, Research Assistant, University of Edinburgh. Through the ‘Recovery Model for Patients within High Secure Care; 20 year Follow up study’, the experience of patients of their own recovery process has been studied in depth. The findings of this study have provided considerable insight into specific aspects of recovery including both the barriers to recovery and also factors that have been instrumental in supporting patients in their recovery journey. The study findings have now been used to develop a subsequent action research study which aims to use a participatory action research methodology in involving current patients within the State Hospital in a peer led early intervention to promote a recovery focused approach. The study research assistant has commenced work with the hospitals patient partnership group to create a peer to peer early intervention, and start developing introductory materials based on new qualitative interview data. The aim of the study is to include patients within specific project roles to ensure an inclusive participatory approach to both aspects of the intervention and the wider study itself.

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The research committee have also undertaken to establish better direct links with the Clinical Governance Group. This will be with the aim of ensuring that Research Evidence developed through the research supported by the Research Committee will subsequently be directed to the most appropriate multidisciplinary group in the hospital to support the implementation of appropriately peer reviewed research findings into the practice of the Hospital. 7.2 Support for Quality Improvement approach The hospital is committed towards a continuous Quality Improvement approach within all aspects of activity. One of the key aims of the hospitals Quality Strategy 2017-2020 is:

Examples: Recovery Research into Action study. Professor Lindsay Thomson, Cheryl Rees The Recovery Model for Patients within High Secure Care; 20 year Follow up study was a major piece of work conducted by the hospital in conjunction with the University of Edinburgh. The study generated a wide range of information on the process of recovery for patients who had been detained within the State Hospital. The Recovery Research into Actions study is based on the findings of the initial study, and aims to utilise these findings in assessing the recovery status of the current patient cohort, and investigate whether patients taking part in Participatory Action Research directly linked to a patient led peer to peer early intervention supports patient recovery. Clinicians' awareness of staff-patient dynamics and processing emotional impact: determining reliability and validity of The Relational Aspect of CarE scale (TRACE) Dr Adam Polnay, Dr Helen Walker Examining the effectiveness of Reflective Practice Groups using The Relational Aspect of CarE scale (TRACE). Dr Adam Polnay, Dr Helen Walker, Patricia Coia and DR Jon Patrick The TRACE scale has helped in the evaluation of a new workshop at the State Hospital - 'Essential Relational Aspects of Care'. The availability of a valid and reliable scale has been important in ensuring accurate evaluation of the impact of some of the relational aspects of care. The relational aspects of care scale (TRACE) will be used to evaluate the impact of reflective practice groups across the Forensic Network, commencing 2020. The Reflective Practice work on Iona 2 has helped increase interest and participation in Reflective Practice Groups in the hospital, encouraging wider adoption of these groups at the ward level. The initial pilot model on Iona 2 was later adopted within Mull 1. Cognitive Behavioural Therapy (CBT) for psychosis and personality disorder in a high secure forensic setting. Pat Cawthorne Findings from this study have had implications for the provision of CBT for psychosis within the Psychological Therapies Service. Preliminary discussions about these findings will be utilised to provide positive change have taken place between Ms Cawthorne, the PTS leads and the Head of the Psychology Service. Clinical Outcomes Monitoring report. Professor Lindsay Thomson, Jamie Pitcairn The data monitoring supported by the Clinical Outcomes monitoring report has been used to identify and support further work. The incident data was instrumental in instigating work on the hospitals Safety Report, a key step in initial review of the hospitals clinical model. The data on patients physical health was used as evidence to support further investigation and the subsequent development of the Supporting Health Choices taskforce led by Dr Khuram Khan.

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Achieve demonstrable improvements in outcomes including the patient experience This is directly aligned to the aims and objectives of the Research Committee (2.3) as laid out within the hospitals Research Strategy 2016-2020. This aim informs priority areas of research or evaluation, by supporting clinical teams in answering one of the fundamental questions of The Model for Improvement; How will we know that a change is an Improvement? The hospitals Quality Improvement Forum has been instrumental in developing and running a specific QI initiative called TSH30:30. TSH30:30 was run within the Hospital for the second time in November 2019 and a summary of its success is provided below.

TSH30:30 2019 Description Launched in October the 2019 TSH30:30 initiative brought applications in from 38 teams, 28 teams went onto complete the 4 week challenge and submit final posters. Over 20 QI methods were used by the teams, including process mapping, patient feedback and run charts.. The majority of teams were multi-disciplinary. The majority of teams were multi-disciplinary and many had patients as members, some teams involved staff and patients on a ward to work together on Quality Improvement. Overall 146 staff and 64 patients were engaged. The focus of projects included increasing patient engagement and activity, staff health and wellbeing, improving processes in the hospital and raising awareness of services and activities. Methodology Staff were invited to form teams and spend 30 minutes a day for 30 days over November on QI projects. The approach was consistent with the principles of patient safety and realistic medicine. The self-selected TSH3030 teams were invited to come forward with their ideas; the slogan used was ‘TSH3030 make your ideas matter’. The importance of supporting teams was recognised and each team had a QI mentor and deputy mentor, who supported their team with QI methods. Quality Improvement Training was held over 2 days in October and many teams benefited from team members taking part in this. The QI Zone was available on the intranet for all teams to access resources to support their projects. The teams provided weekly updates of their work which were viewed by the CEO and Directors. ‘Team of the Week’ awards were given over the four week period to the team who had progressed most over the week. The teams were recognised for their contributions in an award ceremony marking the end of the initiative in December 2019. The awards ceremony was conducted both centrally in the Skye centre, but was also taken out to each of the Hubs to recognise the important contribution made by the patients. Aims and Objectives To engage staff across the Hospital in QI and equip them with the knowledge and experience of understanding the process of developing, delivering and embedding quality improvement initiatives using a 30 day QI approach. Results and Outcomes TSH3030 was delivered across a whole system with a significant increase in the number of both staff and patients across the hospital engaged thus building capacity and capability for use of QI methods. It has helped QI methods and approaches to be accessible to all and further enabled staff to consider issues of quality and how they can collaborate to improve quality of care and outcomes for patients in health and care environments. The benefits of providing both QI training and the QI Zone intranet resource was clear throughout the initiative and these QI support structures remain an important part of the work of the QI Forum in encouraging and enabling QI activity across the hospital.

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7.3 Research by Professional group 2019/20*.

Profession Completed studies Ongoing Studies Planned studies Total

Psychiatry 4 9 5 18

Psychology 7 12 4 23

Nursing 6 8 4 18

SW 0 0 0 0

AHP 2 1 0 3

Other 1 5 3 8

*Figures are affected by the Multi-disciplinary nature of some study teams. 8. Identified issues and potential solutions 8.1 Factors affecting use of research budget As noted in the research finance statement (Section 10.1) the annual research budget has again not been fully utilised. While Forensic service staff have undoubtedly found it increasingly difficult to conduct research alongside the mounting demands of both clinical and non clinical roles, it will be the role of the hospitals research committee to identify innovative ways on which the dedicated research budget can be used to support the information and evidence needs of the organisation. Initial discussions have taken place to investigate the possibilities of utilising the budget to support PhD studentships, although further discussions are required. 8.2 Current Research suspension Due to the impact of the Coronavirus crisis, social distancing and the current lockdown, all research field activity has been suspended. This will have a considerable knock on effect on timescales for a number of studies, and will subsequently impact on the financial management of studies with approved funding in place. The research committee will be required to find solutions to support these studies and to ensure that once the conditions allow fieldwork to resume, that study leads and assistants receive the support they need to complete their research. 9. Future areas of work One main area of work for 2020/21 will be the completion of an updated State Hospital Research Strategy. This work will include a full review of the existing Research Strategy 2016-2020 work plan, a review of the priority Research areas as identified in section 4, and a systematic approach to align research with the wider strategic aims of the hospital. Work will be required to evaluate the impact and efficacy of the new clinical model, which will be supported by the large range of existing data collection undertaken within the hospital. Some focus will also be required on the impact of the current Coronavirus crisis, its impact on patients and staff, patient and staff perceptions of the impact of measures taken, and an evaluation of the wide range of measures being introduced across the hospital in response to Covid-19 at this time. For a list of research studies in the planning and development stage see Appendix 1, Section 5.

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10. Implications 10.1. Finance

Allocation per Financial plan 2019/20

Recurring Funding 100,000

Taken to savings 10,000

Funds Available 90,000

Research Grants Committed 2019/20

Recovery Model for Pxts within a High Secure Setting (incl. Carry Forward from 18/19)

26,524.62

Referral and Transfer Pathways 3,664.21

Management of Violence and Aggression study 6209.00

Recovery Research into Action 6899.81

TSH30:30 500.00

TOTAL 43,297.64

Funds remaining to be allocated 46,702.36

Research Grants Spent - to date 2019/20

Major

Recovery Model for Pxts within a High Secure Setting 3,708.09

I-DUW Wristband study 5,953.13

Recovery Research into Action 7,829.81

19/20 accrual 32,408.97

Minor

TSH Research Conference costs 450.00

TSH Conference sponsorship -350.00

TOTAL 50,000.00

Funds available less spend: Under / (over spend) 40,000.00

11. Next review date: 13th May 2021

Appendix 1: Research Activity

1. Completed Studies A process evaluation to determine the barriers and facilitators to implementation of a cognitive behavioural therapy for psychosis treatment programme in a high secure setting. Patricia Cawthorne No more walking on eggshells! How a clinical team in a high-secure service put new and emerging evidence into practice to support the recovery of a man with primary Dissocial Personality Disorder. Patricia Cawthorne Reducing waiting times between group-based psychological interventions at the State Hospital: A quality improvement project. Joe Judge, Martin O’Hanlon, Natalie Bordon, Lindsey McIntosh, Mari McLay, Kellie Gourlay. TSH 3030 QI project offering mindfulness practice to Arran hub staff. Joe Judge, Rachael Sibbett.

Predicting and Understanding the Uptake of the Seasonal Influenza Vaccination Amongst Inpatients in a High Secure Forensic Mental Health Hospital. Louise Kennedy, Claire Borthwick, Carol Ann Topping. Exploring the value that high secure forensic patients place on familial support: an Interpretative Phenomenological Analysis. Martha Gillespie, Joe Judge Forensic experiences of recovery from mental illness: Analysis of the Questionnaire on the Process of Recovery in Scottish forensic patients. Lindsay Thomson, Lindsey McIntosh, Cheryl Rees. The effectiveness and acceptability of The Healthy Lifestyle Group Intervention for patients with intellectual disabilities at The State Hospital. Alison Burrell, Louise Kennedy and Frances Waddell. Is Staff Well-being in a High Security Hospital Related to the Level of Patient Contact, Job Experience, Resilience, Distress Tolerance and Coping Strategies. Vilius Andrulionis, Kerry Jo Smith Staff perceptions on their experience of implementing the Dynamic Appraisal of Situational Aggression (DASA-IV) risk assessment tool within a high secure environment. Kevin Duffy, Dr Helen Walker Assessment of joint working group involving dietetics and art psychotherapist Fraser Breed, Sharon Jeffrey The Recovery Model for Patients within a High Secure Setting. Prof. Lindsay Thomson, Cheryl Rees Clinicians' awareness of staff-patient dynamics and processing emotional impact: determining reliability and validity of The Relational Aspect of CarE scale (TRACE). Dr Adam Polnay, Dr Helen Walker

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2. Journal Articles

Smith, K. J., O’Rourke, S., & Macpherson, G. (2020). The Predictive Validity of the HCR20v3 within Scottish Forensic Inpatient Facilities: A Closer Look at Key Dynamic Variables. International Journal of Forensic Mental Health, 19(1), 1-17. doi: 10.1080/14999013.2019.1618999 Smith, K. J., Macpherson, G., O’Rourke, S., & Kelly, C. (2020). The relationship between insight and violence in psychosis: a systematic literature review. The Journal of Forensic Psychiatry & Psychology, 31(2), 183-221. doi: 1080/14789949.2019.1706760 Macpherson, G. (2019). The Historical Clinical Risk 20 (HCR-20): 15 Years of violence prediction amongst mentally disordered offenders. European Congress of Psychology Book of Abstracts, 1369. Macpherson, G. (2019). Domestic Abuse Redefined. Journal of the Law Society of Scotland February, 21. Herbert, C., Macpherson, G et al (2019). What makes a good capacity assessment? A guide for Psychologists. The British Psychological Society. ISBN: 978-1-85433-772-6 Neil, C., O’Rourke, S., Ferreira, N., & Flynn, L. (2020). Protective factors in violence risk assessments: Predictive validity of the SAPROV and HCR-20 V3. International Journal of Forensic Mental Health, 19(1), 84-102. doi: 10.1080/14999013.2019.1643811 McAleese, N., Guzman, A., O’Rourke, S. & Gillespie, D. (ePub ahead of print) Post-stroke Emotionalism: A qualitative investigation. Disability and Rehabilitation. 10.1080/09638288.2019.1620876 McKay, P., Martin, C., Walker, H., Fleming, M and Martin, C. (2019) Chronic Fatigue Syndrome (CFS)/ Myalgic Encephalomyelitis (ME) and Fibromyalgia (FM): The foundation of a relationship. British Journal of Pain https://doi.org/10.1177/2049463719875164 Walker, H., Tulloch, L., Boa, K., Ritchie, G., Thompson, J. (2019) A multi-site survey of forensic nursing assessment. Journal of Forensic Psychiatry, 21:2, 124-138. Walker, H., and Tulloch, L. (In press: accepted with minor amendments at 31st March 2020) ‘A necessary evil’; staff perspectives of Soft Restraint Kit use in a high secure hospital. Frontiers Psychiatry. Karatzias T, Shevlin M, Pitcairn J, Thomson L, Mahoney A and Hyland P (2019) Childhood Adversity and Psychosis in Detained Inpatients from Medium to High Secured Units: Results from the Scottish Census Survey. Child Abuse Negl. 2019 Oct;96:104094. doi: 10.1016/j.chiabu.2019.104094. Epub 2019 Jul 22. Asherson P, Johannson L, Holland R, Faihey T, Forester A, Howitt S, Lawrie S, Strang J, Young S, Landau S. and Thomson, L (2019) Randomised Control Trial of the short-term effects of OROS – methylphenidate - on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit / hyperactivity disorder (CIAO-II) - Trials open access 20:663 https://doi.org/10.1186/s13063-019-3705-9 McIntosh LG, McMurran M, Taylor PJ, Thomson LDG. (2019) Gaps in measures of adverse outcomes relating to psychological interventions. Crim Behav Ment Health. 2019;1–6. https://doi.org/10.1002/cbm.2100 Thomson, L.D.G. (In press) Community Forensic Psychiatry, Forensic Liaison to General Adult Services and Liaison to Public Protection Agencies. Book chapter. In Seminars in Forensic Psychiatry, Ed. Kennedy, H. and Davoren, M.

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Polnay, A; Richards, H; Wilkinson; P. Balint-style Reflective Practice Groups in a Year 4 Undergraduate General Practice Attachment: Experience of the first two years. Scottish Medical Journal; https://doi.org/10.1177/0036933020918056

3. Presentations April, 2019. Walker, H. Validity and Reliability of the Relational Aspects of Care Scale (TRACE). (Invited speaker )Faculty of Forensic Psychiatry, Vienna. May 2019. Polnay A. Clinicians' awareness of staff-patient dynamics and processing emotional impact: determining reliability and validity of The Relational Aspect of CarE scale (TRACE). Oral presentation at TSH research and clinical effectiveness conference. May 2019. Burrell, A. & Borthwick, C. Delivery and evaluation of MAP of Behaviour Change- training for health care professionals in effective behaviour change conversations and use of behaviour change techniques. Oral presentation: the State Hospital Research and Clinical Effectiveness Conference. Carstairs, UK. May 2019. Burrell, A., Kennedy, L., & Waddell, F. Effectiveness and Acceptability of a Healthy Lifestyle Group Intervention for Patients with Intellectual Disabilities in the State Hospital. Poster presentation: the State Hospital Research and Clinical Effectiveness Conference. Carstairs, UK. June 2019 Cawthorne, P. A process evaluation to determine the barriers and facilitators to successful implementation of a CBT for psychosis treatment in a high secure setting. Symposium presentation: International Association of Forensic Mental Health Services Conference. Montreal, Canada. June 2019. Gilling McIntosh, L., O’Rourke, S., & Thomson, L. The challenge to evaluate the Forensic Matrix: Results from a feasibility randomized controlled trial of the On the Road to Recovery low intensity psychological therapy. Symposium presentation: International Association of Forensic Mental Health Services Conference. Montreal, Canada. June 2019. Gilling McIntosh, L., Rees, C., & Thomson, L. Forensic experiences of recovery from mental illness: Analysis of the Questionnaire on the Process of Recovery in Scottish forensic patients. Oral presentation: International Association of Forensic Mental Health Services Conference. Montreal, Canada. June 2019. Walker H. Validity and reliability of the Relational Aspects of Care Scale (TRACE). Oral presentation: International Association of Forensic Mental Health Services Conference. Montreal, Canada. June 2019. Pitcairn, J. The Forensic Network Census: Monitoring Scotland's Forensic Inpatient Population 2013 – 2018. Oral presentation: International Association of Forensic Mental Health Services Conference. Montreal, Canada. June 2019. Thomson, L. Models of care symposium: pathways and mazes. Female forensic pathways through the Scottish Forensic Mental Health Estate, International Association of Forensic Mental Health Services Conference. Montreal, Canada. June 2019. Thomson, L Symposium on restrictive practices: Night time confinement and the practice of realistic medicine, International Association of Forensic Mental Health Services Conference. Montreal, Canada.

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June 2019. Thomson, L. Symposium: Approaches to recovery across forensic services.25 year outcomes study of special security patients in Scotland. International Association of Forensic Mental Health Services Conference. Montreal, Canada. July 2019. Burrell, A., Kennedy, L., & Waddell, F. Effectiveness and Acceptability of a Healthy Lifestyle Group Intervention for Patients with Intellectual Disabilities in The State Hospital. Poster presentation: British Psychological Society Health Psychology Annual Conference. Manchester, UK. September 2019. Walker H. Development of the Scottish Forensic Network. (Invited speaker) Northern Ireland September 2019. Thomson, L. Hoist with his own petard: the effects of violence on mentally disordered offenders. UGASP, Stobhill Hospital, Glasgow October 2019. Thomson, L. Schizophrenia and offending. Offender Management Unit National Conference. October, 2019. Walker H. Chair of the 5th Lead Forensic Nurses Conference. Polmont. Oct 2019 November 2019. Cawthorne, P. Lost in implementation? Results of a process evaluation to determine barriers and facilitators to implementation of a cognitive behavioural therapy for psychosis (CBTp) treatment programme in a high secure setting. Oral presentation: The Forensic Network Research Special Interest Group Annual Research Conference. Polmont, UK. November 2019. Burrell, A., Kennedy, L., & Swanson, V. Examining the perceived barriers and facilitators to patients' physical activity in a high-secure inpatient mental health hospital. Oral presentation: Forensic Network Research Special Interest Group Annual Research Conference. Polmont, UK. November 2019. Burrell, A., Kennedy, L., & Waddell, F. Evaluating the effectiveness and acceptability of a healthy lifestyle group intervention for patients with intellectual disabilities at The State Hospital. Oral presentation: RCGP’s 7th Health and Justice Summit. Bristol, UK. November 2019. Gillespie, M., Judge, J. Exploring high secure forensic patients’ experiences of familial support: An Interpretative Phenomenological Analysis. Oral presentation: The Forensic Network Research Special Interest Group Annual Research Conference. Polmont, UK. November 2019. Gilling McIntosh, L., Rees, C., & Thomson, L. Forensic experiences of recovery from mental illness: Analysis of the Questionnaire on the Process of Recovery in Scottish forensic patients. Oral presentation: The Forensic Network Research Special Interest Group Annual Research Conference. Polmont, UK. November 2019. Janes, S., O’Rourke, S. Neuropsychological Characteristics of Forensic Inpatients in Scotland. Oral presentation: The Forensic Network Research Special Interest Group Annual Research Conference. Polmont, UK. November 2019. Marshall, J.J. & McIntosh, L. A Systematic review comparing Dialectical Behaviour Therapy and Mentalisation for Adolescents with Borderline Personality traits, suicide and self-harming behaviour. Oral presentation: The Forensic Network Research Special Interest Group Annual Research Conference. Polmont, UK. November 2019. O’Rourke, S. Identifying Distress or Imminent Violence Using a Wristband Device. Oral presentation: The Forensic Network Research Special Interest Group Annual Research Conference. Polmont, UK.

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November 2019. O’Rourke, S.Edinburgh VOW Project: a successful collaboration between police officers and mentors with lived experience. The Fifth International Conference of Law Enforcement and Public Health, Edinburgh, UK. November 2019. Walker H. Connecting Learning, Teaching and Research. Keynote address, Forensic Network Research Conference. Polmont, UK. November 2019. Walker H. Coping With Mental Illness Psycho-education for psychosis. Keynote address, SHSCT IDD Conference, Northern Ireland. November 2019. Thomson, L. Pakistan educational initiative. Global Citizenship Conference. November 2019. Thomson, L. Night time confinement and practice of realistic medicine. Forensic Network Research Special Interest Group Conference. Polmont, UK. November 2019. Walker G, Polnay A, de Villiers K, Kennedy L, Docherty W. Poster: Introduction of a pilot multi-disciplinary Reflective Practice Group for Iona 2 Ward. RCPsych in Scotland, Psychotherapy Conference, Edinburgh.

4. Ongoing Research Studies Appeals against detention in conditions of excessive security. Dr Daniel Bennett, Professor Lindsay Thomson Examining the perceived facilitators and barriers to patients uptake of physical activity in a high secure, inpatient mental health hospital. Alison Burrell Measuring ward atmosphere in a high secure setting. Chris Gallacher / Helen Walker Cognitive Contributors to Risk of Harm to Others: A Feasibility Study. Sarah Janes, Suzanne O’Rourke Supplementary Analysis: Cognitive contributors to short-term risk of inpatient violence and variance of daily risk ratings using the Dynamic Appraisal of Situational Aggression, Inpatient Version (DASA-IV). Approved study being entitled, ‘Cognitive Contributors to the Risk of Harm to Others: A Feasibility Study’ (CCRHO). Sarah Janes Opening the gates to enable curiosity and exploration of occupation in a high secure forensic environment. Pamela Johnston / Jo Offerdal / Jackie Smith / Catherine Totten A feasibility randomised controlled trial (fRCT) of the On the Road to Recovery program. Lindsey McIntosh, Morag Slesser, Suzanne O’Rourke, Lindsay Thomson. Systematic review and meta-analysis of structured psychological interventions for forensic psychiatric inpatients. Lindsey McIntosh, Suzanne O’Rourke, Morag Slesser, Lindsay Thomson. Evaluating the effectiveness of the Forensic Matrix – the delivery of evidence based psychological interventions. PhD 2015-2018. Lindsey McIntosh, Dr Suzanne O’Rourke, Morag Slesser, Professor Lindsay Thomson Pathways into and out of high-security: Systematic analysis of referrals to the State Hospital and transfer referrals out of the State Hospital over one-year period. Lindsey McIntosh, Dr Duncan Alcock, Prof. Lindsay Thomson Can physiological monitoring identify imminent violence in mentally ill offenders . Suzanne O’Rourke

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Co-production in secure settings: researching the skills required to deliver co-production in low secure settings and the potential enablers / barriers there and in high secure. Frank Reilly Unusually Persistent Complaints against the Police in Scotland: developing management, education and clinical solutions. Validation of developed tool by SPSO. Dr Gordon Skilling, Professor Lindsay Thomson Measuring the Effect of Introducing Formulation into Nursing Care Plans through use of Repertory Grid. Alan Steel, Linda Steven, Helen Walker. Molecular Genetics of Adverse Drug Reactions (MOLGEN): Clozapine arm. Morag Wright, Lindsay Tulloch, Chris Gallacher. Randomised controlled trial of the short term effects of OROS methylphenidate on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit/hyperactivity disorder. MRC / EME Reference: 14/23/17 1/9/16-31/8/19. Professor Lindsay Thomson, Dr Sheila Howitt, Caroline Kelly, Claire McCafferty Understanding Needs, Securing Public Safety: The Forensic Network Census. Professor Lindsay Thomson, Jamie Pitcairn An exploration of the management of significant violence and aggression in high and medium secure forensic psychiatric hospitals in Scotland. Lindsay Tulloch, Sandra MacAlister, Dr Helen Walker Measurement of clinicians’ awareness of staff-patient dynamics and processing emotional impact; determining validity and reliability of The Relational Aspects of CarE (TRACE) scale. Dr Helen Walker & Dr Adam Polnay Evaluation of New to Forensic Essentials of Psychological Care (2017-2020). Dr Helen Walker, Jamie Pitcairn, Nicol Shadbolt. Examining the Validity of the CORE-OM as a Measure of Distress in a Forensic Population with Severe and Enduring Mental Illness. Maxine MacDonald, Lindsey Gilling McIntosh, John Marshall, Suzanne O’Rourke, Clara Calia. The Relationship between Adverse Childhood Experiences, Violence, Empathy and Psychosis within Forensic Settings. Leanne Banks. Exploring patient’s experiences of the ‘Life minus Violence – enhanced’ (LMV-E), programme. Martin O’Hanlon Patient directed aggression or violence in a forensic mental health setting: The nature of patient directed incidents and variables associated with being subjected to aggression or violence. Alice Fawdrey, Joe Judge, Suzanne O’Rourke Recovery Research into Action. Cheryl Rees, Lindsey Gilling McIntosh, Lindsay Thomson To Explore the Therapeutic Relationship Between Keyworker and Patient, from the Patients Perspective. Rebecca Carr

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5. Studies in development to commence in 2020/21

Service evaluation of impact of staff wellbeing interventions in TSH during the Coronavirus pandemic. Patricia Cawthorne Assessing the level of cPTSD in the State Hospital patient population. Dr Suzanne O’Rourke, Jamie Pitcairn. Measuring the validity and reliability of the International Trauma Questionnaire (ITQ) within a high secure forensic population, and addressing the need for an adjusted ITQ-Forensic version. Dr Suzanne O’Rourke, Jamie Pitcairn, Prof. Thanos Karatsias. Examining the effectiveness of Reflective Practice Groups using The Relational Aspect of CarE scale (TRACE), 2nd Stage. Dr Helen Walker, Patricia Coia, Dr Adam Polnay ,Dr Jon Patrick A service evaluation to examine whether a structured screening tool is required for the identification of a history of traumatic brain injury in the State Hospital. Dr Suzanne O'Rourke A multi-level modelling examination of the process of change during therapeutic interventions in the Forensic Network. Dr Suzanne O'Rourke Protocol for new research on improving risk assessment in prisoners: Ox Rec. Prof Seena Fazel, University of Oxford, Professor Lindsay Thomson Establishing the prevalence and understanding the experience of dementia among prisoners in Scotland. Full application to CSO March 2018 with University of West of Scotland. Professor Lindsay Thomson, Dr Helen Walker Bridging the gap between research and nursing practice. Lindsay Tulloch Novel Psychoactive Substances in a High Secure Mental Health Setting: an examination of the problem and clinical impact. Dr Callum MacCall, Dr Craig Marsh, Dr Hollie Walker. Introduction of electronic monitoring for mentally disordered offenders. Funding secured from Forensic Network. Dr Helen Walker, Nicol Shadbolt, Prof Lindsay Thomson.