Group climate, aggressive incidents and coercion in a secure forensic setting for individuals with mild intellectual disability or borderline intellectual functioning: A multilevel study

Abstract

A high number of aggressive incidents in secure forensic care are considered a serious problem, not only for clients but also for sociotherapists 1 as well (Robinson et al., 2018;Ros et al., 2013).According to the results of a study presented by one of the Dutch labour unions (CNV, Zorg & Welzijn, 2018) addressing aggressive incidents in Dutch health care for people with intellectual disabilities, more than 50% of the 640 caregivers experienced physical (70%) or verbal (79%) aggressive incidents in their work.About half (53%) reported an increase in aggressive incidents during the past year. These results are worrying given the range of negative consequences for victims, the aggressor and the organization in which aggressive incidents occur. Negative consequences for the victim can include psychological effects (e.g. anxiety, sleep disturbance, fear, anger and resentment) and physical injury (Knotter, 2019). Sociotherapists and clients may feel less safe in living groups where there are a high number of aggressive 1 Throughout this paper, the term 'sociotherapist' is used to describe the role of a professional caregiver.

Relationships between dynamic risk factors for externalising problem behaviour and group climate in adults with mild intellectual disability in forensic treatment

“…Repression by staff is related to aggressive behaviour in clients with MID‐BIF and represents a major impediment to successful forensic residential treatment (De Valk, 2019; Neimeijer et al, 2021). Therefore, it is necessary to reduce coercive measures such as physical restraint, seclusion and chemical restraint and use less restrictive means to minimise aggressive behaviour and maximise treatment efficacy.…”

“…Although both group climate quality and dynamic risk factors appear to affect the occurrence of inpatient aggression in clients with MID‐BIF (see e.g. Drieschner et al, 2013; Neimeijer et al, 2021), there is a gap in our understanding of the relations between dynamic risk factors for externalising problem behaviour and group climate quality in this target group.…”

“…Environmental factors are influences from the physical environment and the people around the individual. For example, several studies have found negative associations between the quality of the group climate and aggression within institutional settings (De Decker et al, 2018; Neimeijer et al, 2021; Robinson et al, 2018). The group climate refers to the perceived quality of the physical conditions of a ward and the social relationships between its members (Van der Helm, 2019).…”

“Back off means stay with me”. Perceptions of individuals with mild intellectual disability or borderline intellectual functioning about the group climate in a secure forensic setting

“…support, growth, atmosphere and repression) were used to operationalize group climate within this study. Given that group climate is measured by the GCI within this setting (Neimeijer et al, 2019(Neimeijer et al, , 2020, we believe that this is an appropriate choice. Another topic list with regard to group climate might have led to other dimensions.…”

Measurement invariance of the group climate inventory across adults with and without mild intellectual disability in secure residential facilities

“…Several studies have shown associations between an open group climate and favourable clinical outcomes in clients without intellectual disabilities, such as greater personal development (Van der Helm, Stams, Van Genabeek, & Van der Laan, 2012), increased empathy (Heynen et al, 2017;Van der Helm, Stams, Van der Stel, et al, 2012), fewer mental problems (Beijersbergen et al, 2014), greater internal locus of control (Van der Helm et al, 2009), adaptive coping skills, higher level of treatment motivation (Van der Helm et al, 2014), less aversive responses to social problem situations such as hostile and aggressive behaviour (Eltink et al, 2015), and less aggressive behaviour (Robinson et al, 2018;Van den Tillaart et al, 2018). An association between an open group climate and less aggressive behaviour has also been found in clients with mild intellectual disabilities (Neimeijer et al, 2021).…”