Comparing co-production approaches to dynamic risk assessments in a forensic intellectual disability population: outcomes of a clinical pilot

Abstract

Purpose A co-produced clinical practice that aims to improve outcomes through a partnership with service users is becoming increasingly important in intellectual disability (ICD) services, yet these approaches are under-evaluated in forensic settings. This study aims to explore and compare the feasibility of two approaches to co-production in the completion of dynamic risk assessments and management plans in a secure setting. Design/methodology/approach A convenience sample of adults admitted to a secure specialist forensic ICD service (N = 54) completed the short dynamic risk scale (SDRS) and drafted risk management plans under one of two conditions. In the first condition, participants rated the SDRS and risk management plan first, separately from the multidisciplinary team (MDT). In the second condition, participants and MDTs rated the SDRS and risk management plan together. Findings In total, 35 (65%) participants rated their risk assessments and 25 (47%) completed their risk management plans. Participants who rated their risk assessments separately from the MDT were significantly more likely to complete the SDRS (p = 0.025) and draft their risk management plans (p = 0.003). When rated separately, MDT scorers recorded significantly higher total SDRS scores compared to participants (p = 0.009). A series of Mann-Whitney U tests revealed significant differences between MDT and participant ratings on questions that required greater skills in abstraction and social reasoning, as well as sexual behaviour and self-harm. Originality/value Detained participants with an intellectual disabilities will engage in their dynamic risk assessment and management plan processes. The study demonstrates the impact of different co-production methodologies on engagement and highlights areas for future research pertaining to co-production.

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

“…Finally, Morris et al ( 2021 ) compared the feasibility of two approaches to co‐production (MDT assisted and non‐assisted) in the completion of risk assessments and management plans in a medium secure setting ( n = 54 patients). Patients were invited to review their risk assessments and risk management plans.…”

“…There as one paper on the topic of using coproduction to enable patient input on issues of risk, and whether this is effective in improving the management of risk and care provided for people with intellectual disabilities in UK forensic settings (Morris et al, 2021 ). When given the opportunity, the majority of patients with an intellectual disability actively engaged in risk assessments and the drafting of risk management plans, indicating a willingness among patients to discuss risk and the potential value of coproduction in facilitating this.…”

“…Twenty-two peer-reviewed articles around issues of risk in U.K. inpatient forensic settings for people with an intellectual disability were deemed suitable for inclusion. Of these, seven were quantitative/experimental designs (Campbell & McCue, 2013;Chester et al, 2017Chester et al, , 2018Fitzgerald et al, 2013;Hogue et al, 2007;Morris et al, 2021;Novaco & Taylor, 2015), five were qualitative (Duperouzel & Fish, 2010;Lovell et al, 2014;Malda-Castillo et al, 2018;Wright et al, 2014;Wood et al, 2008), four cohort studies (Russell et al, 2018;Lindsay, Carson, et al, 2013;Lindsay et al, 2012), There were two service evaluations/ audits (Alexander et al, 2015;Plant et al, 2011), two survey designs (Fish et al, 2012;Mason et al, 2011), one case study (Ashworth et al, 2020) and one study utilising the Delphi approach (Morrissey et al, 2017). Setting: forensic psychiatric hospital units The intellectual disability and non-ID groups were strikingly similar on many sociodemographic, clinical and forensic variables.…”

“…The authors argue that hoping for the cessation of harm in patients who self-injure repetitively might be an unrealistic aim because self-injuring is often a way of coping or surviving distress. 85% of staff in the survey (n = 71) supported the introduction of a harm minimisation policy that taught patients about wound care, and 72% supported involving patients in care planning and risk management.Finally,Morris et al (2021) compared the feasibility of two approaches to co-production (MDT assisted and non-assisted) in the completion of risk assessments and management plans in a medium secure setting (n = 54 patients). Patients were invited to review their risk assessments and risk management plans.…”

The value and contribution of intellectual disability nurses/nurses caring for people with intellectual disability in intellectual disability settings: A scoping review

“…The clinical leadership and governance domain (10%) clearly highlighted the work of the nurse in the development of practice guidelines and policies and their integration into practice (O'Reilly et al, 2018) along with service plans/planning (Bertelli et al, 2021). Promotion of safety (5%) articulated the work of the nurse in risk assessment and management in the prevention of aggression and violence and protecting clients, self and others (Morris et al, 2021). Management of the environment (3%), while scoring low, was a valuable activity where the nurse supported inclusion and participation of people with intellectual disability in their communities through developing skills, creating connections and preventing isolation (Hodges & Northway, 2019).…”