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Description of an Adolescent At-risk and/or Offending Client Group
Dr Troy Tranah Adolescent At-risk & Forensic Service Division of Forensic Psychology Conference 2015
Young people who are… • often looked after, subject to child protection plans,
parental mental illness, not attending school, substance misuse problems and may belong to a gang
• with mental health problems - conduct disorder, attention deficit hyperactivity disorder, emerging borderline personality disorder, self-harm, post-traumatic stress disorder, substance misuse, learning difficulties, developmental disorders.
• have or are at risk of committing serious violence, sexually inappropriate behaviour and/or present an emerging antisocial or borderline personality disorder.
Young Offender Mental Health
• MH difficulties 33%
– 20% depression – 10% history self-
harm within last month
– 10% anxiety – 10% PTSD – 15% hyperactivity – 5% Psychosis
• 23% IQ <70
• Wider difficulties: 50% interpersonal 33% educational
• History of social care placements, family breakdown & school exclusion
Service development
• Treatment-focused team aimed at 160-372 high risk young offenders with complex mental health problems in London (Kathryn Pugh, 2010)
• Pulled together expertise in risk assessment, neurodevelopmental disorders, MST, CBT and DBT
• Assertive outreach
• Highly individualised care
Populations of interest
• Female young offenders:
High levels of abuse
3x more likely to have poor mental health
71%-86% in YOIs ‘some level’ of psychiatric disturbance
• Neurodevelopmental disorders:
23-32% with LD
11-18.5% ADHD
15% ASD
60% Communication Disorders
Who do we see for treatment?
• 35% female
• 50% one or more neurodevelopmental disorders
• 32% emerging BPD
• Average age of 16 years
Treatment
• Conducted in line with NICE quality standard 59 (April 2014), which states:
“Children &Adolescents aged 11-17 years with Conduct Disorder are offered… multimodal interventions, with the involvement of their parents or carers”
Treatment Pathways
29%
45%
26%
Sexually harmful behaviour
Harm to self/sexualexploitation
Violence and aggression
Service Outcomes
(52)
(5)
(9)
(31)
(55)
(28)
(15)
(58)
(0)
(44)
55
54
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10 11 12
Paired SDQ scores (%age change)
Initial
discharge
30
72
69
31
19 20
0
17
43
25
-2
0
34
42
33
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Paired CGAS scores (%age change)
Initial
Discharge
Mean = 27% improvement Mean = 29% reduction
Risk before/after treatment
SAVRY
0
1
2
3
4
5
6
7
Before After
High
Moderate
Low
ERASOR
0
1
2
3
4
Before After
High
Moderate
Low
The Cost of Antisocial Behaviour
• Sexual offence = £36,000
• Serious wounding = £21,000
• YOI placement = £50,000
• STC placement = £164,750
• School exclusion = £20,000
Health Economic Indicators
0
2
4
6
8
10
12
14
16
No FurtherConvictions
In Education Stable Placement TreatmentRetention Rate
Economic Indicators at Discharge
YES
NO
Health Economic Indicator AAFS MST in UK
No Further Convictions 83% 82%
In Education 78% 75%
Stable Placement 78% 90%
Treatment Retention Rate 78% unavailable
Adolescent At-risk & Forensic Service
Dr Troy Tranah Adolescent At-risk & Forensic Service Maudsley Hospital London [email protected]
