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Adapting Psychological Therapies for Individuals with ID and ASD. Pam Mount, Clinical Nurse Specialist Dr Lorraine Potts, Clinical Psychologist. Introduction…. Calderstones Partnership NHS Foundation Trust is a specialist learning disability service.
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Pam Mount, Clinical Nurse Specialist
Dr Lorraine Potts, Clinical Psychologist
Calderstones Partnership NHS Foundation Trust is a specialist learning disability service.
The Trust is based in the Ribble Valley near the village of Whalley in Lancashire. We provide a specialist service to men and women with a learning disability and/or other developmental disorders, mental health problems, challenging behaviours and offending behaviour including in-patient assessment and treatment and community based services across the North West.
Reason for Admission
Breakdown of placement: 3
Breakdown of placement: 17
Sexual Offending: 7
Fire setting/arson: 3
Crimes of acquisition: 1
Imprisonment of others: 1
We identified a group of service users to help us reflect on our practice. Our criteria were as follows:
Best Practice Learning
Family and Community - Supportive
KEEPING PEOPLE SAFE
FUNCTION AND SOCIAL PARTICIPATION
Resources / Policies / Environment
Whilst we reflected on the aspects of our practice that were different as a result of the individuals ASD, we also felt it was important to allow our service users to speak for themselves.
3 of our service users kindly offered to contribute to today's presentation and we have therefore included audio clips and some drawn material as we work our way through these slides.
Responses to therapy and the adaptations that we make are very different according to each service users individual needs.
Each service user had strengths we could draw upon and differences or weaknesses which needed to be addressed.
The development of a ‘safe enough’ therapeutic relationship is key.
This can take + + time.
Some of the engagement styles we have come across:
Answers all questions openly and honestly – over inclusive
Too much detail?
Socially acceptable response
The ‘Perfect patient’
Inflexible, unable to shift / evaluate / reflect
Then it dawned on me he chose everyone with blonde hair
Specific issues which require consideration when using assessment tools:
For example: (QACSO – Questionnaire on Attitudes Consistent with Sex Offences)
Formulation is the process of making sense of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them.
It is a bit like a personal story or narrative that a psychologist or other professional draws up with an individual and, in some cases, their family and carers.
Offending behaviour: Indecent Assault
Offence: Touching a stranger in a sexual manner
Power / dominance
Poor social skills
Inability to start a conversation
Fascination with ‘blonde hair’
Fear / threat
Treatment decisions are made on the basis of the assessment and formulation:
He’s like a sponge in the environment he soaks up bits of everyone
Victim Empathy: defined as the capacity to express compassion for victims
Victim Awareness: motivators for change are not about the victim/family and friends but about the perpetrators family and friends
It can be very difficult to hear the offence accounts of individuals who have an ASD.
He told me about his offence like he was reading his shopping list
It’s all about what happens to him
He’s just ‘weirding’ me out
How do I find a legal ‘sparkly ‘
Example 1: This individual says he doesn’t feel much. His only ‘sparkly’s’ arise when he’s drunk, when he sees violence and when he is sexually offending. The mere presence of something sensory flips him into a sexual place.
Example 3: 4 out of the 10 individuals we looked at for this presentation had sexualised behaviours which were associated with urine and faeces.
Example 2: A primary component of this individuals offence was smelling his hand after having made contact with females.
Keep the individual in mind.
Bring the best knowledge from ASD practice and the best knowledge from sexual offending practice.
It’s a process of working it out with the client and with the team. Reviewing and refining.
Pam Mount is a Clinical Nurse Specialist (Learning Disabilities) and CAT Practitioner who takes a lead on the Calderstones Adapted Sex Offender Treatment Programme. Pam promotes a person centred, formulation based approach to understanding offending behaviour in order to develop risk plans supportive of the ‘Good Lives’ model.
Dr Lorraine Potts is a Clinical Psychologist who has a specialist interest in working with individuals on the autism spectrum. Within this role, Lorraine undertakes ASD diagnostic and functional assessment and works closely with multi-disciplinary teams to develop clinical formulations to guide intervention. Lorraine also undertakes individual psychological therapy with individuals who have autism and who have offended.