Objectives: The aim of the current study was to investigate whether forensic nursing staff who worked with different patient groups (i.e. learning disability, mental illness, or personality disorder): made different causal attributions for an episode of aggressive challenging behaviour; drew on different causal models to explain the behaviour; reported different levels of optimism regarding the efficacy of therapeutic intervention for the behaviour; and reported different beliefs about the future risk of the behaviour.;Design and Method: A between-subjects design was employed. Eighty-eight nursing staff working within one of three Directorates in a high security hospital, read a vignette depicting an episode of aggressive challenging behaviour and completed a self-report questionnaire. Participants were required to make causal attributions along Weiner's (1980) dimensions of controllability, locus and stability and to provide causal explanations in accordance with five models of challenging behaviour (Hastings, 1997b). Participants also rated their therapeutic optimism and beliefs about future risk of the challenging behaviour occurring. Data were analysed using non-parametric tests of difference (Kruskal-Wallis test) and association (Spearman's Rank Order Correlation).;Results: Overall, the three participant groups did not make significantly different causal attributions, report different levels of therapeutic optimism, or different beliefs about future risk. Participants who worked with patients with a personality disorder were significantly more likely than participants who worked with patients with learning disabilities to consider an emotional causal model when seeking to explain the behaviour. All three participant groups held concurrent explanations for the behaviour. Participants cited psychological interventions as being useful in reducing the behaviour, but mainly referred to reactive physical strategies with commenting on their training.;Conclusions: Clinical implications of the current study are explored and suggestions made concerning the role of forensic nursing staff and clinical psychologists in addressing aggressive challenging behaviour. Directions for future research are suggested.

Individuals who are prone to yield to leading questions and/or change answers under pressure are considered vulnerable to interrogative suggestibility (IS). This vulnerability can lead to false confession or inaccurate statements to the police or court. The first paper critically. reviewed 23 studies investigating IS with people with intellectual disability (ID), mental health problems and forensic participants using the Gudjonsson Suggestibility Scales (GSS) or modified versions of these. The findings show that modifying the initial stimulus on the GSS (auditory) to a dual modality improves recall, reduces yield to leading questions and the tendency to change answers. Patients with mental health disorders (i.e., attention deficit hyperactivity disorder, autism spectrum disorder and conversion disorder) performed differently to the general population on the unmodified GSS. In forensic participant, confession retraction was associated with higher yield to leading questions and changing answers on the unmodified GSS where there was an ID. In conclusion, modification to the GSS initial stimulus to include a dual modality for people with ID improves recall and reduces IS when compared to the unmodified GSS. Modifications may also benefit forensic participants. Evidence is emerging that mental health problems may impact on components of IS. Overall the findings are compromised by methodological flaws. I The empirical paper investigated the association between IS and anxiety, fear of negative evaluation and fear of engulfment in 24 offenders with schizophrenia Anxiety uniquely predicted IS and was associated with bow people yield to leading questions rather than how they cope with interrogative pressure. Fear of engulfment uniquely predicted IS and was associated with how people change their original answers following negative feedback. Fear of negative evaluation did not predict IS . These findings suggest that offenders with schizophrenia are vulnerable to IS which may in some cases have resulted in erroneous testimony.

Research indicates that Multisystemic Therapy (MST) is an effective intervention for young people presenting with antisocial and offending behaviour (Henggeler & Sheidow, 2011). A model has been developed to explain the process of change in MST, however, little is known about which aspects of the intervention contribute to these change processes and how this ultimately links with outcomes. Research has explored the processes of change in more detail with young people and their families up to two months post MST (Tighe, Pistrang, Casdagli, Baruch, & Butler, 2012). As such, there is limited knowledge regarding factors contributing to sustained positive outcomes at long-term follow-up. The study employed a qualitative design, using grounded theory methodology (Charmaz, 2006; Glaser & Strauss, 1967) to explore young people's experiences of MST and what they perceived as helpful in sustaining positive outcomes over the long-term. The aim was to develop a detailed theoretical model of sustained change for young people following participation in MST, and to explore whether the existing model of the process of change in MST adequately explains this process for young people. Eight young people who had achieved positive outcomes upon completion of MST were interviewed between five to 21 months following MST. Data analysis led to the development of a model of sustained change in MST, incorporating theoretical codes including: the therapeutic alliance, increases in systemic awareness, recognising responsibility, positive peer relationships, acknowledging and celebrating success, the continued use of strategies and the identification and creation of a preferred future. 3 ~ •... -------------------------- This research provides detailed information on the process of change and how c is sustained from young people's perspectives, highlighting relevant developmental, individual and systemic factors in relation to this. This will be discussed in relation to clinical implications and developments needed to the general model of change in MST.

High secure forensic inpatient hospitals provide a wide range of interventions in a restricted environment. Patients referred to high security will have both a serious and enduring mental disorder and have committed an offence of interpersonal violence with significant impact. The task of these services is to restore mental health well-being and reduce risk to prevent further harm to others. Evidence to demonstrate whether this task is achieved is limited, which has a number of implications for those who deliver care, those who receive it and the wider public. To develop a clearer understanding of the effectiveness of high secure hospital treatment three different approaches were taken to investigate the evidence base for this setting. A systematic review of existing outcome research from high secure hospitals was undertaken to establish its scope and rigour. Patients who were preparing to move on from high security were interviewed to explore perceived values of care that contributed to reaching this stage. A consultation of professional experts was conducted to determine what essential elements of high secure care were required to improve patient outcomes. Clinical evidence from the best available outcome research demonstrates that a range of interventions can improve the clinical and social functioning of patients. Pharmacological practices can help symptom reduction in patients with enduring schizophrenia and reduce aggression where violence is associated with symptoms. Psycho education can improve insight in patients with schizophrenia and cognitive behavioural therapies enhance coping skills for managing intense emotions, lowering risk of violence and preventing re-offending. Patient and professional perspectives on the values of treatment aligned with some of these benefits and also identified additional key processes for rehabilitation. Developing safe relationships with peers and therapeutic alliances with professionals was seen as essential in gaining insight into personal difficulties and promoting change. The use of clinical evidence, practitioner's experiences and patient's values demonstrates the contribution each source of information can make to uncovering and understanding a system of care. To establish how the sum of the high secure treatment parts impact on rehabilitation, and identify which package of treatment is best for whom, ideographic investigations that closely and longitudinally monitor change are recommended.

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Clinicians working with women in forensic secure environments will be acutely aware of the diverse risks, complex treatment needs and unique responsivity issues found in this multifaceted marginal group. Women make up 5% of the prison population and approx 20% of the secure forensic psychiatric population (approx 4,500 and 1,085 women respectively). What animates the studies of women is not so much numbers of offenders but the particular circumstances of the women and girls “behind” the numbers. There is a common perception that women make up such a small number of the criminal justice service (CJS) population that devising gender sensitive environments and interventions is unnecessary. However studies of patients detained in high and medium security have identified significant gender differences. Women are more likely to commit minor offenses, be diagnosed with a personality disorder, present with self injurious behavior and have suffered childhood victimization. Thus, women and girls who are caught up in the justice system enter it as a result of circumstances distinctly different from those of men. Up until recently the needs of women were inadequately met in services centered on the needs of men and it is only relatively recently that the need to address these glaring differences has been thrashed out in the public arena. Following a number of high profile reviews and reports mixed sex wards have been become a exceptional, strip searches of women in prison have been abolished and large numbers of women have been reviewed and stepped down to lower levels of security. A less well researched area of women’s secure care centers on the profound impact of adjusting to a new environment which involves coping with severance of social support networks.

The polygraph, and other methods of lie detection, measure the physiological arousal thought to accompany attempts to deceive. Traditional methods of lie detection, however, have failed to acquire the accuracy and consistency necessary to be relied upon in important applications. The reason for this is that there is not a sufficient understanding of why people exhibit physiological arousal when they are deceptive, and how they come to have these responses. The current thesis explores how classical conditioning can be used to explain the physiological arousal a person has to their own deception, and how this might come about in the normal social conditioning of the individual. Chapters 1 discusses the background of lie detection to this point, current methods in use, and the current understanding of why people exhibit physiological arousal when they are deceptive. Chapter 2 covers some of the technical aspects of the experiments presented in this thesis, such as the experiment programs and environment used. Chapter 3 of the current thesis examined the punishment of verbal behaviors in a person’s past conditioning can cause them to exhibit increased physiological arousal when engaging in that behavior. Chapters 4 and 5 explored the classical conditioning of eyeblink and skin conductance responses to deception and truth-value in a laboratory setting. Chapter 6 further explored the classical conditioning of a skin conductance response to instances of deception regarding an internally consistent context, and the generalization of these conditioned responses to instances of deception that only the subject knew about. In conclusion, the current thesis argued that the responses relied upon by traditional methods of lie detection can be explained using a behavioral explanation based on classical conditioning and past punishment. Classical conditioning, it is argued, can provide a more direct explanation of the responses exhibited, and potentially a powerful tool for improving the responses we rely upon to detect deception.