Evaluation of a therapeutic community intervention for men with intellectual disability and personality disorder

Abstract

PurposeTherapeutic Community (TC) approaches have not been applied to individuals with intellectual disability. This paper aims to present preliminary evaluation of a planned TC service intervention in a secure setting for men with mild intellectual disabilities and personality disorder over a period of 12 months.Design/methodology/approachThe TC intervention group (n=11) was compared on repeated measures of violent incidents, seclusion hours, and informant and self‐report clinical outcome measures collected six months prior to, six and 12 months post the start of the intervention. The TC group was also compared with a pragmatic control group (n=10) receiving treatment as usual (TAU).FindingsClinical changes in the predicted direction were evident, with the TC group showing comparatively less pathology both over time and in relation to the comparison group. However, change was more likely for clinical scales measuring internalising problems, than for externalising problems. The mean number of violent incidents did not reduce over time. There was nevertheless a strong trend towards reduction in seclusion hours in the TC treatment group over time, with significant differences between groups also being observed at the six and 12 months stage.Research limitations/implicationsThe sample size is small. The literature suggests a minimum of 18 months in TC treatment, so this is an interim evaluation. The planned evaluation period is two years, although attrition may affect the numbers of participants in the study after this period.Practical implicationsTC treatment is consistent with the core principles of involvement and choice. The findings of this preliminary service evaluation are promising in terms of the TC approach being a potential mode of treatment suitable for a proportion of patients with learning disability in secure conditions.Originality/valueTC approaches are innovative in forensic learning disability. No previous evaluations of TC based interventions have been published in this field, and this paper contributes to an evidence base.