Applying the Principles of Applied Behavioural Analysis to an Incentive Scheme for Learning Disabled Offenders

1. Applying the Principles of Applied Behavioural Analysis to an Incentive Scheme for Learning Disabled Offenders Ian Thorpe / Ian Thorne Forensic Services Northgate Hospital Northumberland Tyne & Wear NHS Trust

2. Historical Perspective Ken Day described an incentive scheme based on token economy strategies. (British Jnl of Psychiatry, 1988) Main features: 5 grades linked to - weekly earnings, - access to social activities - home / community leave subject to weekly multi-disciplinary review

3. Grading on the basis of: standards of self-care cooperation with domestic chores (ward) observation of ward / hospital rules behaviour / attitude towards peers / staff application to work / work output behaviour outside of hospital (where applicable)

4. Post 1998 service development significant service development / expansion (? forensic low secure, medium secure, female services) scheme �generalised� for use across a range of inpatient settings multi-disciplinary attendance at review meetings became impractical ? scheme became nurse managed.

5. Evolution of the Incentive Scheme incentive scheme remained an integral part of the culture / language perceived by patients as punitive � a means of losing, rather than gaining privileges (i.e. not a learning experience). Reflected in the use of language (e.g. �I�ve been booked / dropped�) used primarily by staff as a risk management tool (removal / addition of social leave) absence of individualised incentives increasing support / momentum for review (prompted in part by Advocacy services)

6. November 2004 � IABA Training 8 members of staff from a range of disciplines attended IABA training original motive had been with a view to service provision for patients presenting with challenging behaviours thru� a process of informal discussion � the utility of IABA principles were realised in relation to the Incentive Scheme

7. IABA Principles positive, non-aversive approaches ethical likely to generalise patient-centred empowering � enhancing patient authority / choice proactive before-the-fact after-the-fact strategies

8. Process Incentive Scheme due for review at senior clinician level services of IABA trainees offered to facilitate this review meeting between clinicians implementing existing scheme, advocacy and senior clinicians Outcome: identified issues of concern and mechanism for review � IABA Steering Group with Advocacy representation

9. Guiding Principles Recognition of need for a flexible incentive scheme to cover a range of clinical areas. Separating the existing Incentive Scheme into 3 constituent parts: 1. Incentive Scheme 2. Expectations of social behaviour 3. Grading of risk

10. Incentive Scheme Reconceptualised as a behavioural intervention, consistent with IABA principles � by consent, targeting specific agreed behaviours, with personally meaningful and feasible rewards once achievement criteria have been met

11. Expectations of Social Behaviour To include - social behaviour - �house rules� - behaviour in the work place Likely to vary considerably across the division (low secure � medium secure etc) Primarily relates to financial incentive

12. Grading of risk Distinct from any incentive scheme Based on clinical (multi-disciplinary) judgement of risk and decision-making

13. Overview

14. Case ExampleLow secure resident � S37/41 Restriction Order