Download Shaw J Working with high risk young prisoners with

Working with high risk young
prisoners with emerging
personality disorders
Jake Shaw
Consultant Forensic Psychologist
Dr Owen Forster
Clinical Psychologist
The next 20 minutes
The needs of high risk prisoners with PD at
HMYOI Aylesbury
Aylesbury Pathways Service
 Core principles
 Service model
 Future Directions
HMYOI Aylesbury –
1847 to present day
Inside through the times
Renovation
The challenges of adolescence
 A period of profound change in social and emotional
development
 Increase in impulsivity, stimulation seeking, risk taking, conflict with
authority, peer focused interactions
 Internal world an emotional rollercoaster
 Fragile and fluctuating self-esteem
 Avoidant behavior and impulsive acting out are common
 When coupled with problematic attachment experiences, trauma,
deprivation and negative peer influences can be a period of
particular vulnerability
Emerging personality disorders in
adolescence and young adulthood
 Many young people presenting with PD had significant
impairments in adulthood when followed up 20 years later
(Crawford et al., 2008)
 Higher levels of psychosocial adversity associated with
more persistent personality difficulties
more frequent antisocial behaviour
more serious convictions (Vizard et al., 2007)
 Young adulthood is therefore a critical point for intervention
Needs of high risk young prisoners with emerging
PD at HMYOI Aylesbury (McMurran et al, 2013)
37% excessive
violence/sadism
in offence
89% early onset
offending
98% impulsive
70% childhood
behavioural
problems
54% self-harm
98% reckless/risk
taking
High risk,
complex
cases
(N=54, 17%)
43% difficulties
coping
HRHH PD group sig. more likely to have the
following offending related needs
Relationships problems
Drug misuse (OR 4.0)
(OR 4.8)
Emotional
difficulties
(OR 13.5)
Accommodation (OR 2.5)
Criminal Attitudes (OR 2.3)
Aylesbury Pathways Service
• One of two sites for high risk high harm
young adult prisoners in the OPD strategy
• Delivered by London Pathways Partnership
(LPP) in partnership with NOMS
Direct work with
individuals
Case formulation
Enabling environment
+
Workforce
development
Pathways Service Design
Tier 1
Tier 2
Tier 3
Tier 4
•For all staff &
prisoners
•Prison wide training
•Service support
•Consultation
•Signposting/ liaison
•Enabling
Environments x 2
•Case ID &
Assessment
•Outreach Clients x
20
•Enhanced
supervision &
training
•Intervention Service
Clients x 20
•Formulation
•Evidence based
intervention
•Social, creative &
occupational
activities
Service Delivery: Tier 1 & Tier 2
Tier 1 Provision
• To deliver training to all prison staff (including KUF training)
• Enhance all prisoners understanding of available support &
services
Tier 2 Provision
• Supporting existing services in management of prisoners
• Provide consultation to the prison on management &
progression of problematic prisoners
• Signposting & Liaison for prisoners to help them access
existing services or for progressive moves onwards.
Tier 3 Provision
Enabling Environments
•Working towards awards on F & G wing
•10 standards set by the RCPsych
•Joint working between Pathways Service, Wing Staff and Prisoners
Case ID & Assessment
•Accept referrals from all sources in the prison including self-referral
•Joint assessment by Clinical and Operational staff
•If suitable devise initial treatment plan & Initial formulation
Outreach Clients
•20 prisoners, fortnightly contact from staff
•Focus on engagement, motivation & stabilisation
•Help to access existing services & programmes or to progress into the Intervention Service
Enhanced Training & Supervision
•Individual & Group supervision offered to all Pathways staff
•KUF training
•Individual development including CBT, Schema Therapy & AMBIT
Tier 4 Provision
Intervention Service
•15-20 prisoners, weekly contact from staff
•Participation in Individual & Group sessions
•Liaison & joint working with other prison services
Formulation
•Full formulation of offending, risk & difficulties across the lifespan
•Narrative understanding for prisoners & staff
•Developed in conjunction with psychology staff
Evidence Based Intervention
•Individual psychotherapy
•Group therapy including Schema, Mentalization Based Therapy & R&R 2
•Co-facilitated groups including Self-Harm, Hearing Voices & Managing License
Social, Creative & Occupational Activity
•A large range of group and individual activities aimed at reducing isolation, promoting selfesteem and building skills
•Including Life Skills, Art, Social Skills, Well-being, Mindfulness & Yoga
Pathways Staffing Group
Clinical Staff Group
• 1 x 8c Clinical Lead (0.6 wte)
• 2 x 8a/Band 8 Clinical Psychologist (2.0 wte)
• 1 x 7 Occupational Therapist (1.0 wte)
• 1 x 6 Occupational Therapist (1.0 wte)
Operational Staff Group
• 1 x Band 4 Supervising Officer - Service Lead(1.0 wte)
• 1 x Band 4 Supervising Officer – EE Lead (1.0 wte)
• 4 x Band 3 Prison Officers (4.0 wte)
Additional Staff
• 1 x Admin Support (1.0 wte)
• 2 x Service User Consultants (0.4 wte)
• 1 x Consultant Forensic Psychiatrist (0.2 wte)
• Sessional workers including systemic therapist, art therapist, SLT & Yoga teacher.
Thanks for listening