[Show abstract][Hide abstract] ABSTRACT: Background: Arson and fire-setting are highly prevalent among patients in secure psychiatric settings but there is an absence of valid and reliable assessment instruments and no evidence of a significant approach to intervention. Aims: To develop a semi-structured interview assessment specifically for fire-setting to augment structured assessments of risk and need. Method: The extant literature was used to frame interview questions relating to the antecedents, behaviour and consequences necessary to formulate a functional analysis. Questions also covered readiness to change, fire-setting self-efficacy, the probability of future fire-setting, barriers to change, and understanding of fire-setting behaviour. The assessment concludes with indications for assessment and a treatment action plan. The inventory was piloted with a sample of women in secure care and was assessed for comprehensibility, reliability and validity. Results: Staff rated the St Andrews Fire and Risk Instrument (SAFARI) as acceptable to patients and easy to administer. SAFARI was found to be comprehensible by over 95% of the general population, to have good acceptance, high internal reliability, substantial test-retest reliability and validity. Conclusions: SAFARI helps to provide a clear explanation of fire-setting in terms of the complex interplay of antecedents and consequences and facilitates the design of an individually tailored treatment programme in sympathy with a cognitive-behavioural approach. Further studies are needed to verify the reliability and validity of SAFARI with male populations and across settings.
Behavioural and Cognitive Psychotherapy 07/2013; · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Interpersonal effectiveness and social competence are central issues in treatment engagement and recovery for women with a diagnosis of personality disorder or schizophrenia in secure psychiatric settings.Aims To assess the effectiveness of a manualized group cognitive behavioural treatment for women admitted to a secure inpatient unit.Method Thirty four patients were divided into treatment completers and non completers on the basis of rates of attendance. Pre-post measures covered interpersonal problems, self efficacy, company, relationships and risk behaviours.Results Completers show significant pre-post changes on all measures, in contrast to non completers. Completers were younger and more likely to have experienced psychotherapy in the past.Conclusions Results provide confirmatory evidence for the value of training in interpersonal and communication skills training for women in secure care. The failure of one third of patients to complete treatment raises issues about the timing and applicability of treatment for some patients.
Journal of Psychiatric Intensive Care 04/2013; 9(01).
[Show abstract][Hide abstract] ABSTRACT: Problem-solving interventions are a feature of overall medium secure treatment programmes. However, despite the relevance of such treatment to personality disorder there are few descriptions of such interventions for women. Beneficial effects for women who completed social problem-solving group treatment were evident on a number of psychometric assessments. A treatment non-completion rate of one-third raises questions of both acceptability and timing of cognitive behavioural interventions.
Medicine, science, and the law 10/2011; 51(4):215-9. · 0.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Women in secure psychiatric settings have gender specific treatment needs. The current study examined the feasibility of a Dealing with Feelings Skills Group training for dual diagnosis women admitted to a medium secure setting.
A pre-test--post-test design was used to evaluate a group programme adapted from dialectical behaviour therapy skills training.
Most patients had a primary diagnosis of personality disorder. Treatment completers (n = 29) were compared with non-completers (n = 15). Clinically significant changes in treatment completers were apparent on coping response measures of positive reappraisal, problem solving and alternative rewards; on measures of anxiety and suicidality; on self-reported ability to engage in activities to reduce negative mood and to recognize mood changes. Self-harming and aggressive behaviours also reduced in the 3 months following group treatment.
An adapted coping skills component of DBT benefit many dual diagnosis patients: issues related to treatment drop-out and failure to benefit are discussed.
Behavioural and Cognitive Psychotherapy 03/2011; 39(2):243-7. · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The treatment of substance abuse in secure settings needs to be informed by gender specific considerations.Aim: To assess the effectiveness of a manualised CBT substance abuse treatment programme designed for women in medium security.Method: Assessment of pre–post changes following treatment using substance-specific and other outcome indicators.Results: Positive outcomes were identified for treatment completers (n = 23) in terms of improved substance-related self-efficacy, lower perceived costs and greater benefits of change. These differences, which were not evident in the non-completer group (n = 11), were paralleled by positive clinical changes on subscale of the BPRS, CANFOR needs and increased general self-efficacy.Conclusions: Treatment was successful in engaging two-thirds of patients to complete treatment in readiness for conditions of lower security and potential exposure to alcohol and other drugs. Differences between completers and non-completers raise issues about the timing and intensiveness of treatment at stages in treatment paths for women in secure settings.
Mental Health and Substance Use dual diagnosis 10/2010; 3(3):227-237.
[Show abstract][Hide abstract] ABSTRACT: The inadequacy of inpatient facilities for women with severe psychiatric and co-morbid difficulties has been repeatedly documented. The establishment of effective therapeutic programmes for women in medium psychiatric facilities is also in their infancy, and little research has been undertaken. This article describes the development of a 'best practice' psychological treatment programme for women with a dual diagnosis. Emphasis is placed on the need to develop further intensive gender-specific services using an established model for effective therapeutic service development. In addition to a detailed description of the group therapy programme, staff training initiatives, methods for ensuring treatment integrity and a methodology for service evaluation is given.