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Inclusion for DSPD: Evaluation Assessment and treatment

Research Team
Tom Burns, Jenny Yiend, Tom Fahy, Seena Fazel, Ray Fitzpatrick, Julia Sinclair and Robert Rogers.

Site Teams

Broadmoor Site:  Cara Jones and Jacinta Prendergast
Frankland Site:  Leah Teschner and Alison Foster
Rampton Site:  Martin Clarke and Zoe Elkington
Whitemoor Site:  Helen Mckinnon and Lucy Willmott

Project Description

Background
Dangerous and Severe Personality Disorder (DSPD) is a controversial working definition for a small group of people assessed as posing a significant risk of very serious harm to others as a consequence of their disorder.  Personality Disorders are thought to be life-long and relatively stable and consequently have often met with therapeutic pessimism and exclusion. The Home Office and Department of Health have established four specialist units within existing high secure prison and health service facilities to pilot a dedicated programme aimed to reduce the risk of those assessed to be DSPD. http://www.dspdprogramme.gov.uk

Current research
The IDEA project evaluates the programmes offered by the four units by embedding two researchers on each of the units over a three year period. Given the accepted time scale of change in DSPD and the time limits imposed by our funders we are evaluating improvement associated with care rather than outcome in the more usual ‘final’ sense.  Our primary outcome measure is changes in risk profile. A second focus of interest is the match between patient/ prisoner needs, indicated by risk profile, and actual treatment received. The ‘pathways’ research characterises the types of patients/ prisoners who are referred to each unit and are accepted or rejected by them at each stage of the process. This, along with a treatment description, permits an assessment of the implementation fidelity of the units against the criteria guidance issued by the Home Office and Department of Health.   A qualitative strand of the research is to acquire an in-depth understanding of the ‘lived experience’ of patient/ prisoners at each stage of the service delivery across the four sites. 

Despite an over-arching treatment model, the units vary in their approach. We use clinical consensus to identify both common and unique care components across the sites. Using both case records and detailed interviews with patients/ prisoners we identify which interventions they engage with, which they prefer, impact on behaviour, well being, relating and emotional processing. Annual, interviews will include neuropsychological tests to explore cognitive predictors of improvement, a battery of psychometric tests to measure change in clinical, behavioural and social profiles and a semi-structured interview to assess dynamic risk profiles.

Staff on each unit and forensic service users have significantly shaped our project and will continue to feed into it via regular meetings.

The project has the following aims:

Develop an overall description of services, and their component parts, in a common, accepted language
Measure patient/ prisoner exposure to and engagement with these individual service components
Characterise referred, assessed and treated patients/ prisoners with comparisons of those excluded at each stage and explore the basis for these decisions.
Acquire an in-depth understanding of patient/ prisoner experiences at each stage of service delivery
Measure change in patients/ prisoners’ risk, clinical, behavioural and social profiles, and test these for their association with treatment experiences and baseline predictors.

Measure therapeutic alliance for both patients/ prisoners and staff, and test both for their association with treatment experiences and baseline predictors