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

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: 61 2 9351 2776 Fax: 61 2 9351 5319 Email: s_hayes@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

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. Let’s 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 al’s research (2003) – increased knowledge, even for experienced staff More confidence

26. Is recidivism a good outcome measure? It’s 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 we’re 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 Don’t be intimidated by the “academic” aura More practical information is needed

35. “Look and put” research – Let’s 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: 61 2 9351 2776 Fax: 61 2 9351 5319 Email: s_hayes@bsim.usyd.edu.au