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

1. 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

2. 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.

3. 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.

4. 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 <70, and a further 36% had an IQ in Borderline LD range (70-79).

5. 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)

6. 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 children�s home and the Children and Young People�s 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.

7. 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.

8. 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.

9. 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 (N=107):

10. 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 (N=107):

11. 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 (N=107, Range=60 (50-110), Mean=80, SD=12):

12. 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 (N=107):

13. 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!

14. 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.

15. 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.

16. 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�.

17. 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�.

18. 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).

19. HELP!

20. Copies of this presentation or further information can be requested from myself at: Nicola.Silvester@ntw.nhs.uk