In recent years, there has been an increase in the number of people with Learning Disabilities who present a risk of sexual offending, requiring input from the Community Team for People with Learning Disabilities (CTPLD). There has also been an increased requirement for the CTPLD to engage with this population, as a consequence of Transforming Care. Clinicians were feeling overwhelmed by the challenge of managing the risks in the community, particularly given the frequent absence of a legal framework.
Furthermore, service pressures meant that clinicians were often working on an individual basis. In recognition of this challenge, a group of clinicians, from varied professional backgrounds, came together in order to establish a care pathway relating to sexual offending. After attending SOTSEC-ID training and reviewing the relevant evidence, we developed the SOTSEC-ID materials to set up a therapeutic group. We also developed a protocol pack, to ensure that the processes enabled maximum safety and most positive, lasting outcomes. In terms of outcomes for the first group, there was overwhelming evidence of positive attitudinal change within 5 of the 6 attendees and significant changes to safety for all men.
The CONTEXT was one of an increase in presentation of need around sexual offending with pressured resources.
CHALLENGES included busy clinicians trying to set up a new initiative which involved risk and required a lot of time and effort to establish safely, limited experience of direct care providers, and our service embracing new ways of working.
- FINANCIAL: in the long-term, the level of resource required from the CTPLD should be reduced, and the Local Authority/CHC should obtain more value for money from direct care providers.
- PATIENT OUTCOME: the primary aim was to increase safety and reduce risks presented to the public. This was measured through attitudinal questionnaires related to offending and structured risk assessments. Another aim was to progress towards more freedom and healthy relationships.
- PATIENT EXPERIENCE: to provide the intervention recommended by the evidence base (group-based adapted CBT) and to feel less isolated with these difficulties.
In 5 out of 6 cases, there were significant positive changes in relation to attitudes towards sexual offending. In the sixth case, whilst the service user’s attitudes did not shift, the therapeutic process of the group resulted in a disclosure, which precipitated the service-user’s removal from the family home, thereby ensuring the safety of other family members.
In three of the six cases, significant changes were made to the care package, which resulted in a reduction in the risks presented to other people. Significant changes were accordingly noted in relation to the self-care of those three gentlemen. Awareness of this pathway has grown throughout the service, so that there has been an increase in the number of men referred for screening. In several scenarios, appropriate use of the screening steps within the pathway have resulted in changes to care packages, which promote safety.
We have placed increased emphasis (particularly from the first run of the group, to the second – due to start next week) on working with the direct care provider, so as to ensure that the knowledge and skills regarding adapted SOTP are shared with those supporting the individual on a daily basis, and are spreading throughout direct care providers in the county.
We have linked with the community forensic team in our trust, who are aware of this pathway and support our work. We have also shared the outcomes with the service as a whole, so that clinicians do not continue to work with offenders on an individual basis but rather redirect them towards the evidence-recommended treatment of the group.
We have shared the outcomes of the group with the Low Secure Network, who reported that we were one of only a few community services to launch this treatment programme. With regards to benefits experienced by others, previously clinicians were involved with these cases for many years, without offence-specific work taking place. Now, work is explicitly focused on offending and risk management, with the aim of handing over support to direct care providers.
Value has been created through an increase in the quality of interventions being provided to people who sexually offend - the intervention is now much more consistent with the evidence base than previously. Furthermore, the creation of an intervention package and associated process protocol ensures that we are able a) to apply the intervention more consistently and b) to continue to review the intervention against the evidence base.
We have closed some cases which were open to the team for many years and those cases now return intermittently for short “top-ups” rather than unhelpfully and inefficiently repeating previous interventions. This means that a) professional time is used more effectively and b) time is not wasted unnecessarily repeating an intervention, but rather focusing in on why things have become stuck/need reviewing.
Our main stakeholders were managers and staff within the LD service - we needed their support in order to ensure that we had the time and money to train staff in the approach, and time to develop and provide the treatment group itself, and analyse the impact.
Having managerial support for this approach has been essential to allowing the group to become established and training enough staff within the service to deliver the approach. We recently had contact with one of our previous group members who was happy to be quoted as saying “the group has changed [my] life. I know what to do now to have a healthy relationship and be safe.” His carer concurred with his synopsis.