Community based services for children and adults with learning disabilities

Transcription

1 Community based services for children and adults with learning disabilities

2 Circle of support and Accountability: A trauma-based approach which addresses harmful sexual behaviour Lorenzo Picco Respond COSA Coordinator

3 Discuss in groups: Which are the main issues that your client group brings with them that you feel it is hard for professionals to address? Which are your main thoughts on sexually harmful behaviour/sex offenders (origin of it? effective ways to deal with it?) Which are your thoughts on volunteers supporting a client with harmful sexual behaviour?

4 Respond Mission Statement To lessen the effect of trauma and abuse on people with learning disabilities, their families and friends

5 What do we mean by learning disability? Definition from the Department of Health, 'Valuing People' White Paper (2001) A significantly reduced ability to understand complex information or learn new skills (impaired intelligence), A reduced ability to cope independently (impaired social functioning), A condition which started before adulthood (18 years of age), and has a lasting effect At Respond we offer a service to people who have been identified by the referrer as having a learning disability People with a learning disability are people first

6 Respond Community Based Services Psychotherapy for children and adults with learning disabilities who have been affected by abuse or trauma Forensic Service (risk analysis, parenting assessments and therapeutic treatment) Family support services providing advice, support and counselling to families in crisis COSA Survivors Services including ISVA/Women s Group Forced Marriage project Training/consultancy/clinical supervision

7 The Respond Model

8 Respond s model Psychotherapy at the heart of our work The importance of relating and relationships always held in mind empowering people with LD to have better, healthier relationships Therapy work not done in a vacuum, also work with the client s network Awareness of the bigger picture, the wider environment and social policy and actively seek to influence and change in order to improve conditions for people with learning disabilities

9 What the Respond client brings Every client brings at least two of these issues

10 Theories and Approachesd Approaches Attachment Object Relations Psychodynamic Psychotherapy Systems Theory/ Organisational Dynamics Creative and Play-based Approaches Loss and Bereavement Theory Trauma Theory Forensic Psychotherapy

11 Attachment Theory Originated in the 1950s through the work of John Bowlby Early relationships are central to our later relationships Attachment styles are not set in stone they can change throughout the life span

12 Object Relationss Object relations describes the nature of the relationship between an infant and his/her primary carer/attachment figure (the object ) As with attachment theory, object relations theory suggests that a child s experience of early care will help to create a template for their future relating

13 Psychodynamic Psychotherapy Unconscious processes influence feelings, relationships and behaviour The way clients make us feel will provide insight into how they are feeling. In relationships both brains at work are affected and are capable of change

14 Creativity, art and play Art, play and creativity are avenues to the unconscious Creativity is essential to healthy psychological development Imagination, storytelling, and metaphor act as containers for feelings which learning disability or other defences may prevent from being expressed directly

15 Grief and BereavementTrauma Repeated experiences of trauma (including neglect), over time, have the capacity to affect the whole of the child s development and functioning. Repeated dysregulation in response to trauma affects the whole functioning of the person.

16 Forensic Psychotherapyychotherapy Respond works with people whose behavior sometimes puts others at risk Our therapy model works with the view that the capacity to be hurt and to hurt others co-exist in all of us Harmful behavior whether enacted against the self or others is very often a response to traumatic experience

17 History of Circles Circles of Support and Accountability (CoSA) were initiated by Mennonite Church in Canada in response to the release of a high profile offender At the point of his release from prison, Charlie had been assessed as being 100% guaranteed to re-offend. Eleven or so years later, Charlie died from complications of diabetes. He had lived outside prison walls for eleven years without harming another person, and he had forged true friendships with a group of people who never thought they d find themselves in a relationship with a sex offender. The volunteers themselves were irrevocably changed by the experience of getting to know a pedophile as a person first and a person with many parts to him Charlie the sex offender was also Charlie the son and Charlie the friend and Charlie the employee and Charlie the member of the Mennonite church. available at:

18 Background Due to the CoSA's success in Canada the Quakers in the UK began to investigate and promote its use in UK In 2002 a pilot scheme was established in the Thames Valley area and was staffed by a Quaker faith group In 2008 Circles UK took over the management of the CoSA model 17 project areas and 250 circles by January 2014 and in 2014 Circles UK were awarded funding from the Government to provide 74 more circles mil Big Lottery funding to potentially support 200 offenders over 4 years

19 How does a Circle work? Used with adult high to medium risk sex offenders on release from prison The core member (perpetrator) volunteers for the programme 4-6 members of the community join the core member to form the inner circle. The volunteers support and hold the core member accountable Regular meetings. Formal/group then social/ one to one.

20 The Three Key Principles Theoretical Framework Support Monitor Maintain Reduce Isolation and Emotional Loneliness Model Appropriate Relationships Demonstrate Humanity and Care Public Protection Support Statutory Authorities- Police, Probation, MAPPA Safer Communities Hold Offender Accountable Relationship of Trust Maintain Treatment Objectives Reduce Reoffending Saunders & Wilson 2002

21 Who monitors Circles to ensure they are safe? In 2007 Circles UK (which is funded by MOJ) established: An Umbrella organisation for local Circle projects with 6 key objectives Development Quality assurance Learning, evaluation and research Public awareness and media relations Influence Sustainability Circles UK Mission Statement: To substantially reduce the risk of future sexual abuse by assisting and supporting offenders who are committed to not reoffending. To assist them in the task of integrating with the community and leading responsible, productive and accountable lives.

22 Do they work? And if so, how? Wilson 2007 The CoSA initiative has had a profound effect on all stakeholders: offenders, community volunteers, affiliated professionals, and the community at large. Being involved in a CoSA appears to have greatly assisted many high-risk offenders released to the community I remaining crime-free, with many reporting that they likely would have returned to offending without help from CoSA They work because the core member feels included and is part of a community and the safety of the community is enhanced because his circle volunteers were there for him.

23 How did Respond come to apply to develop a new CoSA project? We had been working with adults and young people who exhibited Sexually Harmful Behaviour for a long time We realised that lots of our service users were: 1: Isolated 2: Had a trauma history including domestic violence, sexual abuse and bereavement 3: Had poor social skills 4: Confused and poor sexual knowledge 5: Chaotic family history We also saw time and again damaging impact of sexual abuse on people in our victims service and thought that intervening early would make a huge positive impact on individuals and society

24 Inner and Outer Circles

25 Lifecycle of Circle Circle Reviews (quarterly) Volunteer Social Event Planning/Disclo sure Meeting Phase 1 Risk Reviews (3 times a year) Professiona l Reports End of Circle Report Initial Circle Meeting Weekly Circle Meetings Monthly/Fortnightly Circle Meetings Phase 2 Small group contact Social Circle Events

26 Respond CoSA adapting circles to work with people with learning disabilities exhibiting SHB Similarities A network of interested and concerned adults Relationship based Acknowledges the impact of trauma and past experience Lots of core members have trauma history Differences Respond is a therapy based organisation (unlike other providers with CJS background) Informed by attachment, loss & bereavement and trauma theories and best practice in learning disabilities. Recognises the importance of art, creativity and play as a way of working. For core members who are young people as well as adults. For core members who have not been through the criminal justice system as well as offenders. Works alongside the core member s support network.

27 Meetings To provide a supportive and non-judgemental space which offers companionship and emotional support. To work with the Core Member to explore his behaviours and attitudes that may be associated with his offending cycle. To develop constructive and pro-social strategies to address every day problems. To offer a sense of equal participation, stability and consistency. To advocate for the Core Member where necessary.

28 The role of the COSA Coordinator Overseeing the process of the Circle from week to week in accordance with agreed objectives underpinned by forensic clinical supervision. Supervising and supporting volunteers (this also includes recruitment and training) Liaison between inner and outer circles Monitoring and Evaluation Building a post-circle provision for each Core Member

29 Referrals Process Informal conversation with coordinator if needed Referrer completes referral form Discussion or meeting with coordinator - Supporting Paperwork Agency cooperation agreement signed Planning meeting with referrer First Circle meeting

30 Who are the Core Members? Aged Level of learning disability: mild, moderate and severe Some core members are on the autistic spectrum Most have additional mental health issues All have complex family backgrounds 50% from ethnic minority groups.

31 Outcomes Absence of recidivism Improvements in overall psychological wellbeing Increase in self-confidence and self-worth Decrease in emotional loneliness and greater socialisation Improved communication skills Greater sense of personal responsibility Improved sexual knowledge Experience of positive care and relationships that endure.

32 Case Study G 17 year old young man with diagnosis of global developmental delay, autism & ADHD Experienced acute neglect & emotional abuse from early age Taken into foster care aged 2 and adopted aged 6 Referred to Respond for risk assessment by his school as a result of his harmful sexual behaviour towards young children. Recommendation of risk assessment included COSA and therapy

33 Process - G Volunteers were made aware of G s history and childhood difficulties and that it was a priority to ensure he did not put others at risk. The outer circle consisted of G s head teacher, social worker, psychiatrist and support worker who met regularly with the volunteers to review goals and manage risk. Volunteers showed great ingenuity in inventing creative modes of communicating including games and role play.

34 Outcomes for G Improved sense of positive wellbeing, and reduced levels of anxiety Better communication skills and ability to interact Greater ability to express his feelings and talk about his sexually harmful behaviour Experience of being value and participating as a member of a group which modelled positive relationships Greater ability to empathise Improved sexual knowledge Toolkit of alternative strategies for managing his thoughts and emotions Access to psychotherapy

35 Lorenzo Picco COSA Coordinator Stephenson Way London NW1 2HD