Presentation on theme: "Nichola Tyler, Theresa A. Gannon, & Lona Lockerbie"— Presentation transcript:
1Nichola Tyler, Theresa A. Gannon, & Lona Lockerbie The Evaluation of the Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO)Nichola Tyler, Theresa A. Gannon, & Lona LockerbieToday I am going to be talking about a research project which is a collaboration between the University of Kent and KMPT, evaluating a standardised treatment programme for mentally disordered firesetters.
2OverviewHigh prevalence rate of firesetting in mentally disordered offendersLack of existing treatment programmesPromising initial resultsToday I will firstly give a little bit of background information on firesetting and its prevalence in mentally disordered offenders, then talk a bit about the rehabilitation and treatment methods that have previously/currently used with firesetters.I will then give you a brief overview of the FIP-MO programme and the current research, before presenting some preliminary data on the effectiveness of FIP-MO based on those who have currently completed treatment.Finally I will discuss future directions for the FIP-MO and it’s evaluation and highlight the implications of this research for professionals working with firesetters in forensic mental health settings.Future directions
3Firesetting in Mentally Disordered Offenders Firesetting = Acts of setting fire that may or may not have been legally recorded as arson, or legally recorded at allHigh prevalence rates amongst psychiatric populations (Coid et al., 2001; Geller & Bertsch, 1985)Mental illness is consistently reported in the literature as a risk factor for repeat firesetting (Tyler & Gannon, 2012)Research into firesetting is very scant, however …Mental health problems have long been associated with firesetting in the literature and firesetting is suggested to be highly prevalent amongst mentally disordered offenders .Prevalence rates of firesetting in non-offending psychiatric populations have been reported to be approximately 26% (Geller & Bertsch, 1985) and it is estimated that approximately 10% of patients in forensic mental health services have some history of firesetting (be that convicted or unconvicted).The presence of a mental illness has also consistently been reported in the literature as a risk factor for repeat firesetting (Barnett, Richter, Sigmund & Spitzer, 1997; Dickens, Sugarman, Edgar, Hofberg, Tewari, & Ahmad, 2009; Lindberg et al., 2005; O’Sullivan & Kelleher, 1987).These figures highlight the apparent propensity this population have towards firesetting and emphasises the need for further research in this area.
4What Treatment Programmes Exist for Firesetters? No standardised treatment available (either in prison or hospitals; Palmer, Caulfield, & Hollin, 2007)Some treatment in psychiatric settings (e.g., Rampton, Broadmoor, Ashworth)Very little treatment or evaluation is publishedCurrently no standardized treatments for firesetters in the UK, US or Australasia although a programme is currently under development by colleagues in Australia.What few programmes that do exist have been developed in house in psychiatric services and very little information detailing the content or effectiveness of these programmes is published, making it difficult for us to establish “what works” with this population.
5Why Such Little Work With Firesetters Generally? Lack of knowledge regarding risk factors (Palmer, Hollin, Hatcher, & Ayres, 2010)We assume needs are met by general programmes (e.g., social skills, problem solving)Lack of understanding of the role mental health plays in the offence process for firesetting (Hollin, 2012)At present, there is no standardized best practice with firesetters. It is unlikely that we would ever dare inform a sexual offender that his needs would be adequately met via myriad general offending behavior programs. Thus, we urge professionals to think about the careful construction of research programs and offending behavior programs to address the significant gaps in the firesetting arena that we have highlighted. We find it curious that professionals have not deemed the issue of firesetting unique enough to warrant separate intervention and recidivist study. Certainly, base rates of reoffenses for firesetting are low (approximately 16%, Rice & Harris, 1996), but these are not exceptionally different to the base rates of sexual offending (cf. 16.8%; Hanson et al., 2002). Sexual offenders also hold generalist offense histories (Gannon et al., 2008), and yet many specialist standardized programs are available for sexual offenders. We are certainly not suggesting that firesetting programs focus only on offenses related to fire. Instead, it may be beneficial for firesetters to construct offense chains, not only for their firesetting behaviors, but also for other offending behaviors so that they can make sense of the patterns of behaviors underlying their offending behavior. Such interventions would enable firesetters to develop strong and unified relapse prevention plans that target both their firesetting behavior and also their other offending.Also personal identity not met by general obp’s (Haines et al., 2006)Untreated firesetters re-offend at rate of 16% (Rice & Harris, 1996)
6Why Do We Need to Treat Firesetters? Firesetters found to request treatment to focus more directly on their firesetting behaviour (Haines et al., 2006)Recidivism rates for sexual offending similar (16.8%)Research suggests mental health plays an important role in the offence process for firesetters (Tyler et al., 2013)Firesetters appear to feel that their personal identity is not being met by general offending behavior programmes (Haines et al., 2006)We find it curious that professionals have not deemed the issue of firesetting unique enough to warrant separate intervention and recidivist study. Certainly, base rates of reoffenses for firesetting are low (approximately 16%, Rice & Harris, 1996), but these are not exceptionally different to the base rates of sexual offending (cf. 16.8%; Hanson et al., 2002). I do no think anyone would suggest that we inform a sexual offender that his needs would be adequately met via general offending behavior programs.Estimated that deliberate firesetting costs the UK economy £53.8 million per week (Arson prevention Forum, 2013)
7The Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO) Developed at the Trevor Gibbens UnitPositive patient feedbackWanted to develop further and roll programme out multi-site to evaluate it’s effectivenessCognitive behavioural in orientation as this approach is considered to be most effective with a variety of offending populations.Psychotherapeutic elements in the programme to encourage self-reflection, healthy emotional and social expression, and the development of a strong therapeutic relationship.
8The Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO) Cognitive behavioural with psychotherapeutic elementsDual focus:Increase patients’ understanding of the factors associated with their firesettingIncrease patients’ skills to manage risk/lead a rewarding lifeCognitive behavioural in orientation as this approach is considered to be most effective with a variety of offending populations.Psychotherapeutic elements in the programme to encourage self-reflection, healthy emotional and social expression, and the development of a strong therapeutic relationship.
9FIP-MO Structure 28 week programme (approx 85-95 treatment hours Weekly group sessions (approx 2 hours in length)Weekly individual sessions (approx 1 hour in length)Patients do not need to:Admit their firesetting or,Have actually set a fire (threats to set a fire, interest in explosives can be includedMedium intensity group. Semi-structured – earlier sessions more structured and get less structured as go on.Individual sessions support the group sessions and allows patients to work on other issues alongside group and work on things that they are not comfortable discussing in a group session.Examples of activities covered in group sessions group discussions, brainstorming activities, presentations.Examples of activities covered in individual session – helping patients prepare for group presentations, helping clarify any points not understood in group, if patient self harming or has another problem with relationships for example during the group may work on this in the individual sessions along side group.
11Treatment Targets Offence Supportive Attitudes (Mills & Kroner, 1999) Attitudes that support violenceAttitudes that support antisocial behaviourSense of entitlement in relation to offendingCriminal associates
12Treatment Targets Self Management/Coping Anger (Spielberger, 1999) Locus of control (Nowicki, 1976)
14Treatment TargetsFire Interest/Identification (Ó Ciardha et al., 2013)Every day fire interest – “Having a box of matches in your pocket”Serious fire interest – “Watching a person with his clothes on fire”Fire Safety Awareness – “I know a lot about how to prevent fires”Identification with fire – “Fire is part of my personality”Normalisation of fire – “Most people have set a few small fires just for fun”
15Multi-Site Research Project Research being conducted across 22 sites (NHS and Non-NHS in the UK).NHSNewton LodgeArnold LodgeTrevor Gibbens UnitAllington CentreRavenswood HouseBrockfield HouseGeorge McKenzie HouseEdenfield CentreBroadmoor HospitalHellingly CentreRoseberry Park HospitalArdenleighGuild LodgeReaside CentreIndependent SectorAlpha Hospital BurySt Andrews HealthcareAlpha Hospital SheffieldWaterloo Manor (Inmind)The Dene (PiC)Cygnet Hospital DerbyCygnet Hospital Stevenage
16Multi-Site Research Project Research being conducted across 21 sites (NHS and Non-NHS in the UK).NHSNewton LodgeArnold LodgeTrevor Gibbens UnitAllington CentreRavenswood HouseBrockfield HouseGeorge McKenzie HouseEdenfield CentreBroadmoor HospitalHellingly CentreRoseberry Park HospitalArdenleighGuild LodgeReaside CentreIndependent SectorAlpha Hospital BurySt Andrews HealthcareAlpha Hospital SheffieldWaterloo Manor (Inmind)The Dene (PiC)Cygnet Hospital DerbyCygnet Hospital Stevenage
17Current Research Research Questions Do firesetters who have attended the firesetting treatment make pre-post treatment improvements on the treatment areas of interest?(2) How do these improvements or shifts compare with control firesetters who have not attended the programme?
1912 FIP-MO groups (5 female and 7 male) Current Research12 FIP-MO groups (5 female and 7 male)Data collected for 35 treatment participants to date.Preliminary results for those who have completed treatment.22 participating sites – some running treatment only, some collecting controls only some both.Comparisons to be made pre-post treatment for treatment group and then scores compared to those of control group to establish treatment effectiveness.Highlight at this point that we are still data collecting and that preliminary results will be presented for those participants who have completed only at this stage.
20Participants: Treatment Group 19 male and 16 female firesettersAged 22 – 57 (M = 38.08, SD = 10.44)Majority White British/Irish (85.7%)All have a current psychiatric diagnosis
21Results: Offence Supportive Attitudes Treatment NeedTime 1MTime 2tdfpViolence4.203.701.1132.27Entitlement6.686.93-.64.52Antisocial3.6184.108.40.206Associates5.435.40.09.92Violence = 45.4% of sample showed a reductionEntitlement = 39.3% of sample showed a reductionAntisocial = 42.4% of sample showed a reductionAssociates = 45.4% of sample showed a reductionPositive shifts were seen for attitudes that support violence, general antisocial attitudes, and attitudes towards criminal associates, however, none of these results were statistically significant.
22Results: Self Management/Coping Treatment NeedTime 1MTime 2tdfpExperience of Intense Angry Feelings17.6017.06.6232.53Anger Expression37.6034.571.96.05Locus of Control21.1021.05.0731.94Experience of Intense Angry Feelings = 21.8% of sample showed a reductionAnger Expression = 63.6% of sample showed a reductionLocus of Control = 50% of sample showed a shift towards a more internal locus of controlAnger index – person with high scores experience intense angry feelings which may be suppressed or expressed in aggressive behaviour, or both. May relate to the improvements in their anger expression (in). Elevated AX-I, AX-O and AX-Index relate to difficult interpersonal relationships.
23Results: Communication/Relationships Treatment NeedTime 1MTime 2tdfpSelf Esteem14.9716.49-1.4332.16Assertiveness63.0662.90.04.96Emotional Loneliness50.7544.541.06.29Self Esteem = 51.5% of sample showed an increaseAssertiveness = 37.5% of sample showed an increaseEmotional Loneliness = 30.3% of sample showed a reductionIncrease in all domains of self esteem, however, a significant increase in participants personal self esteem (e.g., more positive view of themselves)A reduction was also seen in self reported emotional loneliness, however, this did not reach statistical significance.
24Results: Fire Interest/Identification Treatment NeedTime 1MTime 2tdfpIdentification with Fire43.6937.352.3732.02Serious fire Interest34.1828.762.0531.04Fire Safety Awareness21.7117.072.14Everyday Fire Interest45.6645.191.86.07Normalisation of Fire41.0642.19-.42.67Positive shifts in the majority of areas, however, significant/marginally significant results found for identification with fire, serious fire interest, fire safety awareness, and everyday fire interest.Fire normalisation appeared to slightly increase, although this was not significant. This may be explained by the fact that participants have spent 7 months discussing fire on a weekly basis so this generally feels more normal for them.
25Results: Fire Interest/Identification Identification with fire = 54.5% of sample showed reductionSerious Fire Interest = 48.4 % of sample showed reductionFire Safety Awareness = 72.7 % of sample showed increaseEveryday Fire Interest = 54.5% of sample showed reductionPositive shifts in the majority of areas, however, significant/marginally significant results found for identification with fire, serious fire interest, fire safety awareness, and everyday fire interest.Fire normalisation appeared to slightly increase, although this was not significant. This may be explained by the fact that participants have spent 7 months discussing fire on a weekly basis so this generally feels more normal for them.Normalisation of Fire = 45.4% of sample showed reduction
26Patient Feedback“The worst thing about the group was waiting for it to start.”“The worst thing about the group was having to get up an hour earlier than usual.”Patient’s also completed feedback on their perceptions of the group. Comments that patients“The group could have been better if it was shorter.”
27“The group helped me a lot.” Patient Feedback“I thought that the group was good, interesting, and will help me in the future.”“The group helped me a lot.”“[The individual sessions] help you understand things you might not know about yourself.”Overall patients have given positive feedback about the FIP-MO and how they felt it had helped them.“I got a better understanding about myself than I did before and also it made me think twice about fires and made me realise they were more dangerous than what I thought.”
28DiscussionPreliminary findings suggest that FIP-MO is successful in addressing some of mentally disordered firesetters key deficitsPatients report positive experience of FIP-MOParticular reductions seen for:Fire interest,Identification with fire,Increase in personal self esteemReduction in anger expressionStarting point for an evidence based intervention for patient benefit
29A New Structured Treatment Programme for the NHS? Complete the full evaluation of FIP-MO (i.e., compare pre-post treatment shifts to those of control group)Examine any differences in treatment outcomes across genderRevise programme manual based on outcome of evaluationComplete evaluation – compare to controls and explore if shifts are clinically meaningful (i.e., do problematic scores reduce post treatment to the range of responding for the non-firesetter)