Adolescent Forensic Unit Research Articles

Violent girls in adolescent forensic care are more often psychotic and traumatized than boys in the same level of care

Background: Most research on violent perpetrators is based on male samples. Aims: To compare girls and boys admitted to an adolescent forensic unit due to physically violent and/or sexually coercive behavior. Methods: On an adolescent forensic ward, demographics, family, treatment, crime and victimization histories, diagnose, psychiatric symptoms and violent behaviors during care of all adolescents are collected in a cumulative database. These were compared between girls and boys admitted due to violent behaviors. Results: Girls were more often diagnosed with schizophrenia group psychoses. The symptom profiles and violence risk ratings did not differ by sex. The girls were less antisocial in general. They were more suicidal and displayed more promiscuous behaviors, and they had more commonly been victims of sexual abuse. During inpatient care they displayed much more often violent and uncontrollable behaviors than the boys. Conclusion: Treatment approaches that respond to the special needs of aggressive girls are required.

Provision of Interventions in Adolescent Forensic Units – A European Perspective

This study aimed to describe treatment settings and interventions provided by adolescent forensic inpatient units in four Northern European countries. Data were collected with the Monitoring Area and Phase System (MAPS). Data were analyzed using descriptive statistics and qualitative methods. Results showed that there were differences in intake criteria and in theoretical orientation between the units studied. In addition, there were differences in treatment focus. The results can be used in service planning and provision of care in adolescent forensic setting. Exchange of information cross-nationally facilitates the advancement of knowledge and sets parameters for education in the clinical forensic setting.

Staff's perception of adolescent aggressive behaviour in four European forensic units: A qualitative interview study

Background: Aggressive behaviour among patients is extremely common in forensic adolescent psychiatry compromising the safety of the treatment milieu and posing a treatment challenge to the staff. The staff's perception of aggression is likely to contribute to the aggression management practices among disturbed adolescents. Aims: To examine staff's perceptions of adolescent aggressive behaviour and factors contributing it. Methods: Qualitative interviews were conducted in four adolescent forensic units in four European countries. Data was analysed using qualitative content analysis. Findings: Aggressive behaviour was perceived to be verbal and physical in nature with various levels of severity. Several factors were perceived to contribute to aggressive acts, including adolescents’ early life experiences. Participants mainly shared perceptions of adolescent aggressive behaviour in the four units studied. Conclusions: The study provides new international knowledge about how staff perceive adolescent aggressive behaviour in the forensic setting. The shared understanding of adolescents’ aggressive behaviour enables the implementation of safe, ethically sound and more consistent aggression management in clinical forensic practice. Reduced occurrence of aggression may improve the therapeutic milieu of the unit and may strengthen the staff's occupational health.

Management of aggressive behaviour among adolescents in forensic units: a four-country perspective

Management of aggressive behaviour is a challenge in adolescent forensic units. Aggressive behaviour endangers the safety of the treatment milieu for patients and nursing and multidisciplinary staff. However, there is a paucity of literature about how the staff manage aggressive behaviour among patients in adolescent forensic settings, and whether the nursing practices are similar across countries. The purpose of this study was to explore nursing practices used to manage adolescent aggressive behaviour in adolescent forensic units in four European countries. An exploratory, descriptive research approach was adopted for the study. A convenience sampling was used by selecting the staff members working in adolescent forensic units (Belgium n= 15, Finland n= 18, the Netherlands n= 16, the UK n= 9). Personal thematic interviews were used to collect the data; and for data analysis, qualitative content analysis was applied. Staff members preferred using verbal and less restrictive interventions when intervening in escalated situations and perceived the use of coercive measures as the last option. Differences between countries were found in the use of restrictive methods. The principles of aggression management were fairly similar across Europe, even if differences were reported in practical solutions.

Aggression Management in an Adolescent Forensic Unit

The present study aimed at describing and evaluating the effectiveness of a comprehensive aggression management program in an adolescent forensic unit. Six-month trends in figures for aggressive behaviors against staff, and rates and characteristics of physical interventions to control aggression were studied over 2 years using irregularity reports from the study unit, and structured forms filled in by the nursing staff immediately after each event. Events of verbal and physical aggression decreased as the implementation of the aggression management program stabilised. Physical interventions became shorter over time. Injuries to the staff became less frequent. A systematic and comprehensive aggression management program allows improvement of aggression management without increasing use of coercion. As the use of coercion decreases, the staff injuries decrease.

Violent incidents in a forensic adolescent unit: A functional analysis

This paper reports on a survey which identified categorised and measured the relative frequency of specific antecedents before, and the consequences following, violent incidents in an adolescent forensic unit during a two-year period. Retrospective analysis of 219 violent incidents involved the examination of incident forms, nursing-process records and accident reports. Antecedents and precipitating factors were also recorded. The results demonstrated that the vast majority of incidents were precipitated by several observable antecedents or precipitating factors (186, 85%). Only a small proportion of the violent incidents were preceded by a single risk indicator (21, 9.5%) and a minority were reported to have occurred in the absence of observable antecedents (12, 5.5%). The severity of violent incidents was rated on a four-point scale but no significant correlation was found between category or frequency of antecedent and the violent act itself. The consequences for the young person following acts of violence were also documented, and the results show that the large majority of incidents were followed by increased staff observation (197, 90.5%). Coercive interventions such as physical restraint (177, 80.8%) or idiosyncratic sanctions (88,40.2%) were commonly recorded. A significant proportion of violent incidents did not appear to be followed by staff intervention, sanction or punishment (80, 36.5%). Finally, results are considered against research and best practice evidence, and suggestions for further studies are presented. Organisational interventions, strategies for the management of aggression and violence, and a staff training needs analysis are also indicated.

Violent incidents in a forensic adolescent unit: A retrospective analysis

A correlational survey of violent incidents using a descriptive, retrospective design and quantitative data analysis showed that the large majority of violent incidents in an adolescent forensic unit were generated by young people with no prior offending history. The most violent young people were characteristically psychotic and conduct-disordered, and presented with high risk and challenging behaviour. By contrast, a small minority of violent incidents were generated by mentally disordered young offenders with a history of seriously violent behaviour including murder, attempted murder and manslaughter. A training needs analysis is presented which will inform a strategy for the management of aggression and violence in young people.

The psychosocial characteristics of juvenile sexual offenders referred to an adolescent forensic service in the UK.

Criminal statistics indicate that a high percentage of sexual offences are committed by perpetrators under the age of 18 years. Descriptive data based on a retrospective case note study of 121 juvenile sexual offender referrals to an adolescent forensic unit are presented. The results suggest that adolescents commit an array of offences and present with generalized adjustment difficulties. Conduct disorder was the most common diagnosis, while rates of mental illness were lower than in earlier studies. Abused as opposed to non-abused offenders experienced more dysfunctional upbringings and demonstrated higher rates of personal disturbance. Theoretical and treatment implications are discussed in relation to the available literature on adolescent sexual offending.

Violent Incidents in an Adolescent Forensic Unit

Violent incidents in psychiatric institutions have been the focus of much study over the past few decades. But there has been little work looking at similar incidents in child and adolescent units. The authors set out to examine whether some of the patterns observed in adult populations are true of adolescent groups. The Gardener Unit was considered appropriate in light of reports of a higher frequency of assaultative behaviour among younger clients and because of the nature of problems presented by clients needing a secure environment. All violent incidents are automatically recorded. The violent incident register was examined between 1 June 1991 and 1 June 1992 and the information cross-checked with case notes and nursing reports. Demographic details, etc. were obtained from case notes. The results indicated a slightly higher daily incident rate than adult studies. At least half of the population were involved in some form of violent episode over the 12-month period. The majority of incidents were minor in nature. Nursing staff were the most frequent targets, although females showed an excess of inwardly directed aggression (self harm). A prior history of violent behaviour did not serve as a realistic predictor of frequency of violent incidents in this study. With increasing concern regarding the care of this disturbed group of young people, it was felt important to look closely at the nature of and handling of violent incidents on this unit. A second paper will consider in detail how these incidents were dealt with.