Prison Services and Offenders with Intellectual Disability The Current State of Knowledge and Future

1
Prison Services and Offenders with Intellectual
Disability The Current State of Knowledge and
Future Directions

• Susan Hayes, AO FIASSID
• Associate Professor and Head, Centre for
  Behavioural Sciences
• Department of Medicine, D06, University of
  Sydney, NSW 2006
• Tel [phone] Fax [phone]
• Email s_hayes_at_bsim.usyd.edu.au
• 4th International Conference
• Care and Treatment of Offenders with a Learning
  Disability
• 6-8 April 2005
• University of Central Lancashire, Preston, UK

2

• When Oscar Wilde was being taken to prison, he
  was forced to wait in the rain for the prison
  truck. He commented famously

If this is the way Queen Victoria treats her
prisoners, she doesn't deserve to have any.
3

• Every area of investigation concerning the person
  with ID in the criminal justice system needs
  further research
• Reviews outlining research in this area, and the
  gaps in knowledge
• Simpson Hogg 2001
• Lindsay 2002
• Holland et al 2002

4
Identifying the prisoner with ID

• In Vermont USA, the term HLD Horrible Life
  Disorder has been coined, i.e. people with ID
  plus other life challenges
• psychiatric disorder
• substance abuse
• homelessness
• history of physical or sexual abuse
• (Kinsler et al 2004)

5
Difficult to identify ID in prisons because

• The mean IQ of prisoners is lower than the
  average IQ in the community
• In NSW prisons, mean IQ 85 on IQ tests, 81 on
  adaptive behaviour (Hayes 2000)
• Therefore fine differentiations between low
  average functioning and ID have to be made

6
Other social and health issues that can make
identification more difficult in prisons -

• Half left school by age 14
• 1 in 20 - hearing impairment (higher for
  Australian indigenous populations)
• 1 in 5 - visually impaired
• 1 in 12 - speech impaired

7
Screening instruments

• The Vermont project questionnaire for use by
  public defenders
• Has the client been in a special education class
  at school?
• Did they have an Individual Education Plan at
  school?
• Have they received substance abuse or mental
  health services?
• Have they taken medication for ADD or ADHD?

8

• Plus the question You may have to come back to
  court in 12 weeks. When would that be?
• Public defender can then ask for an evaluation,
  and obtain school records
• No published validation of this questionnaire.

9
Learning disabilities in the Probation Service
(LIPS) (Mason and Murphy 2002)

• A verbal test
  A non-verbal test
  Questions
  relating to daily living skills
  Other background information
• BUT
• Small study sample for validating the instrument
  
• Few women and no juveniles in the sample
• Reliance on info from a third party who knows the
  offender well
  
• Poor validity for one of the tests used

10
Hayes Ability Screening Index (HASI) (Hayes 2000)

• The HASI takes 5-10 minutes to administer, and
  has a number of sub-tests
• several self-report questions
• reverse spelling
• a join the dots puzzle
• a clock drawing sub-test

11

• Presently used in a wide variety of service
  settings -
• juvenile
• adult offender services
• mental health
• community services
• police stations

12
HASI -

• Validated on 567 participants, including
• males and females
• juveniles and adults
• indigenous and non-indigenous offenders
• in both community and custodial settings
• High rate of correct diagnosis of ID
• Effectively excludes non-disabled individuals

13
HASI -

• Not a diagnostic instrument
• Designed as a screening test
• Deliberately slightly over-inclusive e.g.
  offenders who have little English, or significant
  psychiatric symptoms
• Already being widely used in various services in
  the UK
• About to be used in a project at HMP Liverpool

14

• The prisoner with probable ID has been identified
  and referred for diagnostic assessment
• ID is confirmed
• Then what?

15
Needs of offenders with ID -

• Complex, multi-faceted
• In a UK high security hospital, average of 10
  needs (possible max. 25)
• One-third of needs unmet
• Accommodation in less secure placement
• Psychiatric care suicide prevention
• Daily living, interpersonal skills needs

16
Needs are not simple

• Require inter-service cooperation
• Long-term commitment

17
Do prison based programmes have any effect?

• Some prisons have special units for prisoners
  with ID
• Are special units a return to the old segregated
  institutions?
• Or are there advantages?

18
Advantages of special units

• Dedicated staff
• Individual programmes
• Clear sanctions for unacceptable behaviour
• Positive reinforcers
• Might be safer for prisoners
• Opportunity to work, learn skills

19
And the disadvantages?

• Could just be protection/segregation by a
  different name
• Little out-of-cell time
• Few education, therapy opportunities
• Other inmates violent and dangerous
• No opportunity for learning daily living skills
• Little opportunity model on non-disabled people

20
Lets look at outcomes of prison programmes.

• Dearth of information, evaluation
• Yet community and courts place trust in the
  programmes
• And lots of money is spent
• Need to evaluate and PUBLISH
• Then we can all learn from others examples

21
Offending and Criminal Justice Group on What
Works, in the Home Office (Falshaw et al 2004)

• Evaluated the effectiveness of prison-based
  cognitive skills programmes in England and Wales
• Looked at re-conviction rates for adult male
  offenders
• No significant differences in re-conviction rates
  between participants and non-participants

22

• BUT the programmes were expanding rapidly at the
  time perhaps this affected the quality of
  programme delivery
• Therefore, quality of programme delivery affects
  the outcomes

23
Other programmes address

• Aggressive behaviour
• Sex offender characteristics, attitudes
• (e.g. HM Prison Service study, Williams,
  1999)
• Intensive behaviour therapy directed at personal,
  daily living skills decrease in disciplinary
  reports (Daniel et al 2003)

24
Limitations of many studies

• Small samples
• Evaluations in hospital/community, not prison
• Changes noted, but no info about re-offending
  rates
• Lack of follow-up of maintenance of change
• Inclusion of different levels of ability
• Definition/assessment of ID variations

25
Staff training

• Evaluate this too!
• Everyone recommends it, no-one knows much about
  the outcome
• Taylor et als research (2003) increased
  knowledge, even for experienced staff
• More confidence

26
Is recidivism a good outcome measure?

• Its difficult to measure short-term nature of
  research
• Recidivism is high for this group, as for other
  offender groups
• Success of programmes might also reflect quality
  of life life skills humanitarian
  considerations public safety the ability to
  benefit (Barron et al 2002)

27
Can we make them participate?

• Do clients resist mandatory programmes?
• Does it undermine the therapeutic process?
• Well, apparently NOT!
• Outcomes for coerced programmes are better than
  for voluntary ones
• And even better if there is informal coercion,
  e.g. family pressure (Linhorst et al
  2003)

28
Recommendations not mine but I agree
(Linhorst et al 2002)

• Needs assessment
• Continued funding ditch the pilot project
• Cooperation between criminal justice and social
  services
• Underlying philosophy clear and agreed
• Identify what services will be offered, and where
  to get the other ones

29
More recommendations

• Decide on voluntariness or coercion/conditions of
  sentence
• Staff experienced in both areas
• IDENTIFICATION of ID part of intake
• Staff liaise with referring agencies
• Evaluation of programmes measure outcomes,
  improve performance

30
Do we need more research?

• If so, in what areas?

31
Prevalence
32
The prevalence issue?

• Does it really matter?
• Well ,possibly for service planning
• BUT were never going to arrive at a definitive
  figure too many regional, institutional
  differences
• Even 1 or 2 individuals deserve the best
  services, study, cooperation

33
Programme evaluation

• This is important
• Liaison
• Meta-analyses

34
Research-practitioners

• Answer a question
• Dont be intimidated by the academic aura
• More practical information is needed

35
Look and put research

• Lets move beyond description
• Pathways
• Prevention
• Multivariate analyses
• So BACK we go to more cooperation

36

• Susan Hayes, AO FIASSID
• Associate Professor and Head
• Centre for Behavioural Sciences
• Department of Medicine, D06
• University of Sydney, NSW 2006
• Australia
• Tel [phone] Fax [phone]
• Email s_hayes_at_bsim.usyd.edu.au