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

Screening

So What…?

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?