Violent incidents in a secure service for individuals with learning disabilities: Incident types, circumstances and staff responses

Risk for intellectual disability populations in inpatient forensic settings in the United Kingdom: A literature review

BACKGROUND

People with an intellectual disability who commit a criminal offence can be detained, by a court, in a forensic inpatient facility. There is limited understanding of how inpatients with an intellectual disability and their nurses navigate risk in U.K. forensic services.

METHODS

A traditional literature review design was followed to map evidence (2000-2021) around the forensic and health and wellbeing risks faced by inpatients with an intellectual disability, nurses' perceptions of managing risk, and patient experiences of informing risk assessment and management. Papers were analysed thematically.

RESULTS

Findings suggest that restrictive measures to mitigate forensic risks (e.g., violence) can exacerbate the risk of poor health and wellbeing outcomes. There was some limited evidence of direct patient involvement in risk assessment and management.

CONCLUSION

Further research is required to explore how forensic inpatients with an intellectual disability can have input in care planning, risk assessment and management.

Flip the Triangle: using quality improvement methods to embed a positive behaviour support approach on a medium secure forensic ward for men with intellectual disabilities

Incidents of violence and aggression are serious concerns on a secure ward for people with intellectual disabilities and are often met with increases in physical and restrictive interventions. However, these interventions are usually high risk for both patients and staff and are ineffectual in promoting long-term behaviour change. This study aimed to promote positive culture change and embed the evidence-based practice of positive behaviour support by shifting focus and efforts from the use of physical and restrictive interventions to manage crises to intervening positively and proactively to prevent crises from occurring. The key drivers for change involved increasing access to positive engagement opportunities, expanding the staff team’s repertoire of proactive interventions through training and skill development and supporting staff well-being and resilience. Change ideas occurred alongside a shift in culture that promoted the development of a learning culture, psychological safety and consideration of contextual fit. Quality improvement methods helped the project increase the rate of positive and proactive interventions from 70.65% in December 2018 to 97.18% in January 2020. Increases in staff’s knowledge, confidence and safety were also reported. Lessons and limitations of the project are discussed.

Impact of the initial response to COVID-19 on long-term care for people with intellectual disability: an interrupted time series analysis of incident reports

BACKGROUND

The lockdown-measures in response to COVID-19 taken by long-term care organisations might have impacted problem behaviour and behavioural functioning of people with intellectual disability. This study tested changes in reported incidents, in particular regarding aggression, unexplained absence and, for contrast, medication errors.

METHODS

Metadata on weekly incident and near-incident reports from 2016 to June 2020 involving over 14 000 clients with mild to serious intellectual disability of 's Heeren Loo, a long-term care organisation for people with intellectual disability, were subjected to interrupted time series analysis, comparing the COVID-19 with the pre-COVID-19 period.

RESULTS

The imposition of lockdown-measures coincided with a significant drop in incidents (total, P < .001; aggression, P = .008; unexplained absences, P = .008; and medication errors, P < .001). Incidents in total (P = .001) and with aggression (P < .001) then climbed from this initial low level, while medication errors remained stably low (P = .94).

CONCLUSION

The rise in incidents involving aggression, against the background of generally lowered reporting, underlines the need for pandemic control measures that are suitable for people with intellectual disability in long-term care.