Changes in staff confidence and attributions for challenging behaviour after training in positive behavioural support,within a forensic mental health setting: a replication study with follow-up

Positive behavioural support (PBS) is a proactive approach to managing challenging behaviour. Staff in a forensic mental health service were provided training in PBS. The study aimed to assess the effectiveness of training by measuring changes to staff confidence and attributions for challenging behaviour before training, post training and at six-month follow-up. Qualified and unqualified staff were compared, as were male and female staff. Confidence was measured using an adapted version of the Confidence in Coping with Patient Aggression Instrument. The Challenging Behaviour Attributions Scale and the Causal Dimension Scale II assessed staff attributions. Staff confidence levels in working with challenging behaviour increased following PBS training, and this increase was maintained at six-month follow-up, for unqualified, qualified, male and female staff. Changes in attributions for challenging behaviour were observed post training; however changes were not maintained at follow-up. Limitations and clinical implications were outlined.     

Training multi-disciplinary teams to work with sex offenders: Effects on staff attitudes

Abstract

A recent British Prison Service initiative has focused on providing sex offender programmes facilitated by multi-disciplinary teams of staff. A three week long training programme was designed to provide staff with the necessary knowledge, skills and experience to facilitate these structured treatment groups. Following the training, staff indicated they were more confident in their ability to provide treatment and showed a greater belief that treatment could be successful. In addition, they showed significantly more positive attitudes towards sexual offenders and to offenders in general. However, participants did not indicate undue concern about working in a sensitive treatment area. This pattern continued at six month follow-up, indicating that the training changed attitudes as expected, and that the training was seen by participants as adequately preparing them to undertake provision of a structured sex offender treatment programme in a secure setting.     

Professional attitudes regarding treatment and punishment of incest: Comparing police,child welfare,and community mental health

Brief case histories involving incest were presented to police officers, child welfare workers, and community mental health practitioners in a rural area in Canada. Intervention priorities involving “treatment versus punishment” were assessed across the three professional groups for each specific case vignette. Attitudes were assessed on three factors: perpetrator mentally ill rather than criminal, view regarding treatment of victims and mothers, and support for court mandated treatment. Police and community mental health practitioners had significantly different attitudes as to whether perpetrators of child sexual abuse should be viewed more as criminals or as mentally disturbed. Both mental health and child welfare staff differed significantly from police with a less punitive view towards victims and their mothers. All three profressional groups showed no difference in their modest endorsement of the use of mandated treatment by the courts. Gender was not found to influence response to case vignettes.     

Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system

We investigate the impact of the transition towards managed competition in the Dutch health care system on health insurers' contracting behaviour. Specifically, we examine whether insurers have been able to take up their role as prudent buyers of care and examine consumers' attitudes towards insurers' new role. Health insurers' contracting behaviour is investigated by an extensive analysis of available information on purchasing practices by health insurers and by interviews with directors of health care purchasing of the four major health insurers, accounting for 90% of the market. Consumer attitudes towards insurers' new role are investigated by surveys among a representative sample of enrollees over the period 2005-2009. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use 'soft' positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumer attitudes towards channelling vary considerably by type of provider but generally became more negative in the first two years after the reform. Insurers' reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care. The credible-commitment problem seems to be particularly relevant to the Netherlands, since Dutch enrollees are not used to restrictions on provider choice. Since consumers are quite sensitive to differences in provider quality, more reliable information about provider quality is required to reduce the credible-commitment problem.     

Changes in staff confidence and attributions for challenging behaviour after training in positive behavioural support within a forensic medium secure service

Positive behavioural support (PBS) is a non-aversive approach to preventing and managing challenging behaviours. Seventy-nine qualified and unqualified nursing, psychology and occupational therapy staff were trained in using PBS. To measure the effectiveness of the training, confidence in managing challenging behaviour and attributions for causality, control and stability were measured before and after the training. To measure confidence, an adapted version of the Confidence in Coping with Patient Aggression Instrument was used. Attributions were measured using the Challenging Behaviour Attributions Scale and the Causal Dimension Scale II. There was a significant increase in confidence after training. In addition, there were significant changes in attributions relating to causality and stability of challenging behaviour, particularly for qualified staff. The results suggest that confidence and attributions are affected positively by training in PBS within a medium secure forensic mental health setting.     

We've had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting

The present study assesses barriers to identification and referral of domestic violence (DV) victims by staff at a health care institution following a 3-hr DV training program in which 752 health care providers participated. Focus groups are conducted with staff in hospital departments that serve a high volume of women. Responses to focus group questions identify system-wide and individual hospital department barriers. These barriers have implications for health care organizations trying to implement DV screening protocols through training alone to change staff behavior in diverse clinical settings. Limitations of this study and future research recommendations are also discussed.     

Rating the prison boss: Examining supervision among prison health care staff

Health care staff are instrumental in prisons given their roles in aiding security and the growing demand for medical services among prisoners. Unfortunately, little attention has been paid to this prison staff subpopulation. This study examined perceptions of supervision among 424 prison health care staff in the Federal Bureau of Prisons. Participants felt that prison supervisors were most effective in clarifying expectations and least effective in giving feedback for performance, involving staff in planning, and extending job autonomy. Using hierarchical linear models (HLM), some unique findings emerged. Efficacy in dealing with inmates was the strongest predictor variable: health care staff who felt more positive and effective with inmates had more favorable feelings toward supervision. Staff working in high- and medium-security prisons had more positive feelings toward supervision than those in minimum security, and younger staff had more favorable attitudes toward supervisors than older staff. The implications of these findings and directions for future research are discussed.     

Attitudes of police recruits towards domestic disturbances: An evaluation of family crisis intervention training

Police student officers' attitudes towards domestic disputes following family-crisis-intervention training are analyzed. A total of 359 student officers from fourteen training classes participated in the study. The most dramatic improvement in attitudes was observed in officers' perceptions of disputants and in their perceptions of domestic disturbance calls. The study also investigated the attitudes of student officers toward organizational policy, training, and community relations. Student officers' attitudes significantly improved in thirty-one of fifty-one items (p < .05). In general, the changes in attitudes demonstrated that the family-crisis-intervention program did affect the attitudes of student officers in the predicted direction of change. Following training, student officers were more likely to view domestic disputes as legitimate police business and more likely to believe that their actions could influence families in crisis and that people in crisis both want, and will benefit from, assistance. It is concluded that crisis-intervention training appears to be responsible for the change in officer attitudes and that family-crisis training should be included in the curriculums of police training academies.     

The dynamics of health care opinion, 2008-2010: partisanship, self-interest, and racial resentment

Recent debate over the Patient Protection and Affordable Care Act highlights the extent of party polarization in Washington. While the partisan divide on this issue is stark among political elites, it is less clear how the mass electorate has responded to this divisive conflict. In this article we examine individual-level dynamics in health care attitudes between 2008 and 2010. We find partisan attachments and self-interests strongly predict change in health care attitudes, with Republicans growing more opposed to universal health insurance between 2008 and 2010, and those personally worried about medical expenses less likely to abandon support. We find, however, that the effect of partisanship is moderated by self-interest, with strong Republicans significantly less likely to switch to opposition if they were personally worried about medical expenses. Finally, we find that health care policy preferences, already tinged with racial attitudes in 2008, became increasingly so by 2010.     

Attitudes among stakeholders towards compulsory mental health care in Norway

Objectives

The Norwegian Mental Health Care Act allows use of coercion under certain conditions. Even though the current practice has been criticized, little empirical data exist about the attitudes towards compulsory mental health care.

Method

This study used Q-methodology to identify prototypical attitudes and to test possible differences of attitudes between groups of stakeholders towards the use of coercion in mental health care. Sixty-two respondents who represented six groups with different roles in mental health care participated: former patients, relatives of psychiatric patients, members of supervisory commissions, psychiatrists, other physicians, and lawyers.The participants were asked to assess the degree to which they agreed on 30 statements concerning use of coercion for the mentally ill.

Results

Three factors that in a meaningful way express different attitudes towards the question were found. The most widely shared attitude stated that a trusting relationship between patient and therapist is more important than the right to have an attorney. This attitude gives partial support to the present Mental Health Care Act. However, the second most common attitude argues that involuntary hospitalization, if necessary, should be decided in a court and not by the hospital doctor.

Conclusions

Differences in attitude could partly be explained by the respondents' role in mental health care. Both psychiatrists and “somatic” physicians expressed more agreement with the present legislation than the other stakeholders. The findings may have implications for the legal protection of mental health care patients.     

Evaluation of Effectiveness of Health Services Training Given with Different Methods in Combating of Intimate Partner Violence against Women: A Pilot Study

The study was conducted to evaluate the effectiveness of health services training provided with different methods in combating of intimate partner violence (IPV) against women. The intervention group of the study consisted of 132 healthcare workers (HCW) and 249 HCWs in the control group. According to the result of study, training given to the intervention group was more effective in increasing the knowledge level, compared to the control group. Furthermore, comparison of the HCWs in the intervention group with the control group revealed that the attitudes towards emotional, psychological and sexual violence and justifying myths changed positively. In this scope, it can be said that intervention training was effective in terms of improving knowledge and attitude on IPV. However, it is determined that the training given to both groups was inefficient in terms of turning into behaviour.     

Evaluation of a Health Care Provider Training Program to Identify and Help Partner Violence Victims

This study tested four hypotheses about the impact of a 3-h domestic violence training program with 752 health care providers on attitudes and values related to screening and helping partner violence victims. Hypotheses 1, 2, and 3 were that training would be related to: 1) increased self-efficacy to identify and help partner violence victims, 2) increased endorsement of the role of health care providers and settings for helping partner violence victims, and 3) increased comfort making appropriate community referrals to help partner violence victims. Hypothesis 4 was that training effects would be moderated by prior training and by prior experience with helping a victim. Following training, health care providers reported increased self-efficacy, increased comfort making appropriate community referrals, and increased valuation of health care providers and the health care system as having an important role in stopping domestic violence. Hypothesis 4 was also supported. Prior training and/or experience with an abuse victim predicted smaller changes in the dependent variables. These gains held at a 6-month follow-up. Implications for training curriculum design are discussed, in addition to institutional policy implications for determining the benefits versus costs of universal training, including staff who demonstrate prior training or experience with battered victims. Study limitations and future research directions, including the need to measure performance and policy compliance will also be outlined.     

Assessment of public attitudes towards sex offenders in an Australian population

Public attitudes towards sex offenders are believed to play a key role in the development of legislation and public policy designed to manage the risks posed by known sex offenders who live in the community. There have, however, been few previous attempts to validate methods by which public attitudes can be measured. The current study aims to address this issue by establishing the factor structure of the Community Attitudes Towards Sex Offenders (CATSO) scale with an Australian community sample and examine the extent to which demographic variables and support for sex offender management policies influence these attitudes. A sample of 552 participants recruited through online social media sites completed the CATSO as well as a number of items developed by the researchers designed to assess individuals' support for specific sex offender policies. Results of an exploratory factor analysis suggested the presence of four distinct factors which were labelled ‘social tendencies’, ‘treatment and punishment’, ‘crime characteristics’ and ‘sexual behaviour’. Individuals with higher levels of educational attainment rated sex offenders less negatively than those with lower educational attainment, while those who reported being supportive of community notification reported more negative attitudes towards sex offenders.     

Attitudes towards personality disorders: Comparison between prison officers and psychiatric nurses

Objectives. This study investigates the effects of working with dangerous and severely personality disordered (DSPD) prisoners and patients on the attitudes, perceptions and beliefs of staff, which may be important therapeutic variables in the management and treatment of prisoners and patients. Method. The attitudes of prison officers working in a DSPD prison unit and psychiatric nurses working in high‐security psychiatric hospitals were compared using the Attitude to Personality Disorder Questionnaire (APDQ) and the Staff Attitude to Personality Disorder Interview (SAPDI). Results. Prison officers and nurses differed in their attitudes. Prison officers' attitudes were more positive than those of psychiatric nurses in all aspects of the APDQ. Prison officers indicated that they felt more liking for and interest in contact with personality disordered prisoners, less fear and helplessness, less anger, were more optimistic regarding treatment, and less frustrated. The SAPDI revealed that nurses expressed more concern about caring for and managing personality disordered patients, and felt more vulnerable and less accepting towards them. Prison officers conveyed more confidence in their own abilities and felt less vulnerable. Conclusion. Differences found in attitudes towards personality disordered prisoners/patients are discussed in terms of personal, environmental and experiential influences, and implications for DSPD services. Attitudes towards personality disordered prisoners/patients between nurses and officers differed. They are likely to be influenced by a combination of experience with personality disorder, organisational culture and personal characteristics.     

Dating violence education: What do student learn?

The purpose of this study is to understand how a social change approach to dating violence education affects the ways in which students think about physical abuse in dating relationships. The program was designed to simulate a typical two-hour workshop format, using small group discussion and short lecture. a total of 331 participants, recruited from introductory psychology classes, attended one of 22 small group sessions; 14 received the Program condition (n=219), 8 the Comparison condition (n=119). Both quantitative and qualitative data were collected. The results revealed significant differences between the Program and Comparison groups which remained stable over a three-week period, as well as specific gender differences. Women were more likely to view violence in relationships from a structural perspective, were more knowledgeable about dating violence and responding to survivors, and were less likely to blame the victim. In addition, discriminant analyses showed that attitudes towards survivors and response towards survivors emerged as the most important content separating Program and Comparison group males, while attitudes toward survivors, a structural explanation for dating violence, and general knowledge about dating violence were the best discriminators for females. Finally, implications for educating students about physical abuse in dating relationships were examined, including the need to address power and control issues.     

A systematic review of effective therapeutic interventions and management strategies for challenging behaviour in women in forensic mental health settings

Women in secure forensic mental health care require therapy and care that is responsive to their specific needs. Despite the policy recognition that women require a distinct service, evidence based practice is not available for this population. This review was undertaken in response to a clinical need within a medium secure unit in Glasgow that was experiencing high levels of challenging behaviour, in a female ward. The review aimed to identify effective strategies or interventions for the management of challenging behaviour in women in secure services and, therefore, improve practice and patient care. A synthesis of the findings from the 11 identified studies revealed variability in the approaches used to support women in forensic services, including: behavioural programmes; organisational change with a focus on staff training and support; medication; ECT and mechanical restraint. The challenging behaviours assessed included self-harm; physical and verbal aggression; suicide attempts and arson/fire setting. The majority of articles suggested some improvement in aspects of challenging behaviour, however this was limited by the lack of control groups and small sample sizes. Further investigation is required to find out whether interventions identified in this review can sustain a reduction in challenging behaviours in the long-term.     

AIDS and murder

This study examined whether mental health professionals would differentiate, in terms of confidentiality and a duty to protect, persons with AIDS (PWAs) who refused to inform their partners from persons with homicidal intent. Six hundred professionals were randomly assigned one of four hypothetical therapy vignettes. In each vignette, the client had either AIDS or homicidal intent. The relationship of the client to the third party was either heterosexual or homosexual. PWAs were rated as being significantly more dangerous than persons with homicidal intent. Persons with homicidal intent were significantly more likely to receive increased intervention and their partners were significantly more likely to be warned. PWAs were rated significantly more negatively on most adjective rating scales.This research was completed while the first author was a doctoral candidate at the University of Virginia. This study does not reflect, in any way, the opinions or endorsement of the Alaska Area Native Health service, the Indian Health Service, or DHHS. The authors gratefully acknowledge the contributions of Steve Nock, Joe Allen, Eric Turkheimer, Cathy Crosby, Michael Arthur, and the Philadelphia Child Guidance Clinic in this endeavor.     

Court outcomes for clients referred to a community mental health court liaison service

Court liaison and diversion services come in a variety of forms, but the similarities and differences between these services are not well characterized. Findings from a six-year audit of the Newcastle (Australia) Mental Health Court Liaison (MHCL) service are reported, including client characteristics, offence and service contact profiles, court outcomes, and interrelationships among these variables. During the audit period, there were 2383 service episodes by 1858 clients (1478 males, 380 females). Drug and alcohol disorders (40.9%) and psychotic disorders (17.0%) were the most prevalent mental health problems, while assault (23.1%), theft (23.1%), offences against justice procedures (15.4%), driving offences (13.4%) and malicious damage to property (8.3%) were the most frequently recorded charges. Among service episodes with a finalized court outcome, 70.0% involved a punishment (bond: 49.5%; jail term: 29.7%). Females were less likely to be punished, but more likely to have their case dismissed under sections of the relevant Act that required further assessment and monitoring. Being married, or having an adjustment or drug and alcohol disorder, were also associated with an increased likelihood of punishment, while clients with a psychotic or bipolar disorder were less likely to be punished. Among clients who were punished, those referred from inpatient mental health services were more likely to receive a non-jail punishment, while unemployed clients were more likely to be jailed. A substantial proportion of clients had court outcomes that required an ongoing involvement with local mental health services. By being part of community mental health services, our MHCL service is able to work efficiently and effectively with the criminal justice system, while facilitating ready access to existing mental health services and continuation of care.