Identifying Learning Disability Need Within Adolescents Who Have Come in Contact With the Criminal J

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Identifying Learning Disability Need Within
Adolescents Who Have Come in Contact With the
Criminal Justice Service One Year On!

• Nicola Silvester
• Senior Assistant Psychologist
• Northumberland, Tyne Wear NHS Trust

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Presentation Plan

• Describe how the project came about by looking at
  what research was already out there and what our
  aims of the project were.
• Discuss some of our findings now that we are two
  years into the screening process.
• Share some of the knowledge we have acquired
  including the benefits and the limitations of the
  project.
• Talk about where we go from here including new
  projects that are emerging.

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Nicola Silvester

• Was Senior Assistant Psychologist for the CYP LD
  Psychology Service at Prudhoe Hospital for 2
  years.
• Background in Special Educational Needs
  (Decade!).
• Interested in gaining experience in a forensic
  setting.
• Utilised CPD time to facilitate this.
• Opportunity arose for joint project between NTW
  and Aycliffe.
• Supervised by Dr Ruth Andrews, Consultant
  Clinical Psychologist for the Northern Forensic
  Mental Health Service.
• Now Senior Assistant Psychologist for Lennox
  Ward, Roycroft Unit First NHS commissioned
  Medium Secure Unit for adolescents with a
  Learning Disability.

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What Research Did We Have?

• Casey and Keilitz (1990) from a meta-analysis of
  American studies estimated that prevalence within
  the incarcerated juvenile population in America
  was 12.6 .
• Hall (2000) summarised several studies of IQ in
  young offenders and found that between 5 and 13
  show an IQ within the LD range.
• Kroll et al. (2002) found a 27 prevalence in
  boys in secure care using just a full scale
  assessment.
• Harrington and Bailey (2005) using just the
  Wechsler Abbreviated Scale of Intelligence (WASI)
  to examine the mental health needs of young
  offenders in both community and custodial
  services of Youth Justice in England and Wales
  reported that 23 of adolescents had an IQ of
  lt70, and a further 36 had an IQ in Borderline LD
  range (70-79).

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Limitations to the Research

• There is a range of figures as to the prevalence
  of LD in the adolescent offender population
  Why?
• McBrien (2002) lack of consistency in
  methodologies and definitions.
• Fail to adhere to the clinical criteria for LD
  which includes both cognitive and adaptive
  functioning.
• Use short form cognitive assessments like the
  WASI.
• Tend to focus on those detained in custody or on
  remand.
• Therefore as a consequence, there is no
  definitive estimate of the level of LD need among
  adolescent offenders in the UK.
• Ford, Andrews, Booth, Dibdin, Hardingham Kelly
  (2008)

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Where Did That Leave Us?

• Given
• this reported prevalence of LD within the
  adolescent offender population and
• that engaging in education, training and
  employment plays an important role in preventing
  recidivism (Ball and Connolly, 2000)
• An agreement was made between staff at a secure
  childrens home and the Children and Young
  Peoples Learning Disability Psychology Service
  at Prudhoe Hospital, Northumberland, Tyne and
  Wear NHS Trust to jointly work on a project
  looking at identifying learning disability need
  within adolescents who had come in contact with
  the criminal justice service.

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Project Aims

• Look at the assessment / screening process that
  was already in place.
• Introduce a screening process to roughly identify
  the prevalence of adolescents with a learning
  disability.
• Develop an efficient screening process for
  identifying young people with a need for
  assessment by specialist learning disabilities
  services within this environment.
• Try to forge links between this service and
  specialist learning disabilities services in and
  around the county.

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Aycliffe Secure Services

• 38 bed Local Authority Secure Unit situated in
  County Durham.
• Separated into four residential houses - each
  accommodate between eight and ten young people
  from all over the country.
• All aged between 12 and 17 years.
• Three of the houses are mixed, and one is for
  boys only.
• Young people are
• On remand.
• Serving the detention element of a Detention and
  Training Order (DTO).
• Serving a longer (Section 91) sentence for more
  serious offences.
• With them on grounds of welfare.
• Considered too vulnerable to be placed in other
  custodial accommodation.

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Updated Findings Gender

• The diagram below shows the breakdown of gender
  from the total population of new admissions that
  have been screened via the K-BIT over the last
  two years (N107)

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Updated Findings Age

• The diagram below shows the breakdown of age from
  the total population of new admissions that have
  been screened via the K-BIT over the last two
  years (N107)

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Updated Findings K-BIT Composite

• The diagram below shows the breakdown of the
  composite scores from the total population of new
  admissions that have been screened via the K-BIT
  over the last two years (N107, Range60
  (50-110), Mean80, SD12)

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Updated Findings Discrepancies

• The diagram below shows the breakdown of
  significant discrepancies between Verbal and
  Non-Verbal scores from the total population of
  new admissions that have been screened via the
  K-BIT over the last two years (N107)

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Our Own Limitations

• We were unable to gather consistent complete
  background information on all the young people
  being assessed.
• We struggled to collate potentially supportive
  data that would have been provided via the
  Vineland.
• This was due to staff time constraints on both
  our parts and that of the staff at Aycliffe.
• Therefore, we did not have comparable data to
  produce a succinct report on anyone's level of
  LD.
• Thus unable to maintain the process for
  identifying LD need within an adolescent offender
  population.
• HOWEVER!

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Conclusion

• Our data continues to support the Harrington
  Bailey (2005) data in that approximately 25 of
  the YJS population already fall within the realms
  of LD and approximately a further 25 warrant
  further investigation.
• Both clinically and within the education setting
  the K-BIT has proved to be a useful tool BUT we
  were unable to gather data to evaluate its
  specificity and sensitivity to LD.
• However it did show
• a need for input regarding LD needs within the
  YJS.
• a need to pin down an appropriate screening
  process.
• and the need for this to include background
  information.

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So Where Do We Go From Here?

• The Holy Grail - We need to develop a
  screening process that
• Screens for both evidence of cognitive impairment
  and for adaptive functioning.
• Is specific and sensitive enough to LD.
• Is compatible with the YJS environment.
• Is quick and easy to complete so as to reduce the
  limitation of staff time constraints.

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Hayes Ability Screening Index (HASI)

• Ford, G., Andrews, A., Booth, A., Dibdin, J.,
  Hardingham, S Kelly, T (2008) Screening for
  Learning Disability in an Adolescent Forensic
  Population. Journal of Forensic Psychiatry
  Psychology. 19(3) Pg 371 381.
• A sample of 71 young people within the YJS in
  the north-east of England completed the Hayes
  Ability Screening Index, together with standard
  measures of cognitive functioning (Wechsler
  intelligence scale WISC-IV and WAIS-III) and
  adaptive behaviour (Vineland Adaptive Behaviour
  Scales). HASI results were compared to the
  results of these diagnostic measures to assess
  the utility of the HASI in identifying those who
  warrant more detailed assessment for LD. Analysis
  revealed that in this UK population the HASI did
  not have adequate specificity to be helpful in
  identifying which young people should be referred
  for further assessment by specialist LD services.

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Kaufman Brief Intelligence Test (KBIT)

• Murphy, M., Harrold, M., Carey, S., Mulrooney,
  M (2000) A Survey of the Level of Learning
  Disability among the Prison Population in
  Ireland. Completed for the Department of Justice,
  Equality and Law Reform.
• In each of the fourteen prisons ten percent of
  inmates (264) were randomly selected for
  inclusion in the study. Assessments included the
  Kaufman Brief Intelligence Test (KBIT), the Wide
  Range Achievement Test (WRAT), the Vocabulary sub
  test from the Weschler Adult Intelligence
  Scale-Revised (WAIS-R), and the National Adult
  Prisoner Survey (NAPS). Results showed that 28.8
  of the sample population scored below 70 on the
  KBIT, which is suggestive of a significant degree
  of intellectual disability/mental handicap.
  Results from other tests were consistent with
  those of the KBIT.

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Learning Disability Screening Questionnaire (LDSQ)

• Currently a project is being proposed by
• Mark Freeman, Primary and Social Care Policy
  Lead, Offender Health
• Jenny Talbot, Programme Manger, The Prison Reform
  Trust
• Glynis Murphy, joint Chair of Clinical Psychology
  and Learning Disability at the Tizard Centre,
  University of Kent /Oxleas NHS Trust.
• This project aims to look at the validity of the
  LDSQ as a screening tool for LD by sampling it
  within three prisons across England against the
  WAIS III, HASI and sections of the LIPS (some
  adaptive functioning questions).

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HELP!
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Copies of this presentation or further
information can be requested from myself at

• Nicola.Silvester_at_ntw.nhs.uk