The care we provide is directly informed by the research we do – and the research we do is directly informed by the care we deliver. That’s our research in a nutshell.
At MHC, we believe that the high-quality care we provide should be supported by insightful research. That’s the key to delivering positive outcomes at every opportunity.
It is important to understand that at MHC, research doesn’t just happen in an office. The concept of research informing care and care informing research permeates through every level of the organisation.
Constantly striving to challenge conventional thinking, we are regular publishers of research that influences the way we work and the way we achieve quality outcomes. Our research committee also meets periodically to review research and establish the steps we can take to more forward.
As regular publishers of research, we lead the way in the quality of research we produce and the way in which it is used to achieve positive outcomes.
Our staff regularly present professional and academic work at conferences and events across the UK and Europe – explore our upcoming events.
Our research in practice
June 2017
Aggression and risk factors for adults with learning disabilites and autism
This research analyses the reasons for aggressions and ways to reduce incidents. As part of this, we have developed an innovative online compatibility test for living well together.
The Living Well Together Tool
Transforming Care for People with Learning Disabilities – Next Steps (2015) set the Government strategy for transforming care for people with learning disabilities and/or autism.
Among this some of the key objectives centred around empowering people and families and getting the right care in the right place. The emphasis being on ‘personalised care and support planning’ and that the views and wishes of people and their families should be made more central to decision-making (Care Act (2014).
The National Service Model – principle 5 – ‘where I live and who I live with’ reflects this ensuring that people should have a choice about where and with whom they live.
In response to this MHC have developed the ‘Living Well Together Tool’. The tool is based on research conducted with people with autism and intellectual disabilities about living preferences. It asks simple questions about a range of things that might be important when living together and considers in what ways people may be
compatible.
The tool can highlight how people might not get along and prompts for suggestions about how people could be supported with these differences. The purpose of the tool is to provide people with a voice to express their likes and dislikes and to enable service users and providers to consider the compatibility of ‘who I live with’.
The tool is available in a number of formats:
Tablet – An online app which individuals can access via a tablet and complete by tapping their answers.
Picture Cards – A version with cards and symbols for individuals that may prefer to use pictures to communicate their preferences.
Paper Form – A printed version which can be filled in by hand.
Psychologically Informed Environment
At MHC we are proud to announce the services based at Llangwyfan as the first autism and/or learning disability psychologically informed environments.
What is a Psychologically Informed Environment (PIE)?
A Psychologically Informed Environment, or PIE, is a consciously adapted environment in which organisational decisions, behaviour, and culture can be informed and planned on the basis of psychological thinking in order to address the psychological and emotional needs of individuals. ‘The environment’ includes all the external conditions, covering both individual and social relations that facilitate learning and growth, rather than reinforcing behaviours of concern.
Psychologically Informed Environments have been used successfully for clients with a range of difficulties because they provide:
- consistent and reliable relationships
- support for individuals to develop practical and psychosocial skills
- reflective interactions between staff and individuals where staff are ‘mindful’ of every interaction (both verbal and non-verbal) they have and how this could impact on the individual
- staff who adopt psychological thought when planning the environment and how they will behave in each environment to optimise individuals’ success
- living arrangements and activities that are supportive of individual wellbeing and pro-social living to develop skills, independence and choice
- an approach to and expectations of individuals which are personal to them and non-institutional
- an environment where individuals feel heard and understood
- a systemic approach to supporting residents whereby psychologically informed decisions are made at every level within the organisation from executive managers, to front line and ancilliary staff.
How do we implement PIE at our Llangwyfan services?
- Developing a Psychological framework – We have an understanding of Positive Psychology and recognize that all people have fundamental human needs. The role of our staff is to use Positive Behaviour Support (PBS) and functional analyses to understand the person they are supporting and support them to meet their needs in pro social ways, which do not cause harm to themselves or others.
- Physical environments and social spaces –Environmental assessments, The ‘Living Well Together©’ (compatibility) tool and sensory assessments are used to identify how the environment can best meet the person’s needs and preferences. The people we support have direct influence over the social and recreational opportunities we provide including ‘Highfield Hub’ our Active Support Centre and the ‘Woodlands’ (launching end of July 17) an outdoor classroom and sensory space.
- Staff training and support –Staff receive a comprehensive training programme as part of their induction, and continuous professional development which includes PBS, Active Support, Autism,Person Centered Planning, Pathological Demand Avoidance and more. Staff also engage in regular Reflective Practice with the PBS Team where they are supported to reflect on their practice, and are encouraged to write PBS plans for the people they support. This ensures plans are developed systemically and to support staff to think in a psychologically informed way.
- Managing relationships –Each resident has a proactive PBS plan focusing on improving quality of life, understanding the function of challenging behaviour and with the aim of achieving the human need in more pro-social ways. We are have recently undertaken a research project looking at the most important intrinsic qualities needed in a member of staff to successfully support an individual with ASD. This research is being utilised to develop a recruitment tool to assist in the recruitment of staff.
- Evaluation of outcomes – Residents have regular PCP reviews explore their PBS plans, Quality of Life measures and goal, which is the basis for setting Active Support goals for the next 6 months. We have established links with Universities across the UK, with whom we are currently undertaking various research projects which is continuously informing the growth of our services.
Our published research
Recent publications include:
Worthington, R (2016). What are the key skills that staff require to support adults on the autism spectrum effectively? Forensic Update, Issue 123, 15-23.
Abstract:
The paper begins by defining autism and the associated presentations of clients with this diagnosis. It then explores what skills have been found to be helpful for staff working with this client group. The paper identifies that whilst there is some guidance on what skills may be helpful when selecting staff to work with this client group, however, much of this is based on opinion rather than research. What is evident is that some of the skills discussed are those which can be learned or taught and these will be discussed. The paper makes suggestions for the ways in which future research could be developed.
Worthington, R (2016). Applying the concept of reciprocal roles to relapse prevention with offenders: a cognitive analytic therapy informed approach. Journal of Criminological Research, Policy and Practice, 2 (1), 67-79.
Abstract:
Purpose – Adopting a person-environment (P-E) fit approach, the purpose of this paper is to examine the role of emotional labour, segmentation/integration and social support in the development of work-home conflict.
Design/methodology/approach – Mental health professionals (n=118) completed the work-home conflict and home-work conflict scales (Netemeyer et al., 1996), the segmentation preferences and supplies scales (Kreiner, 2006) and the Mann Emotion Requirements Inventory (Mann, 1999). A social support checklist was also developed to assess the perceived value of work and non-work sources of support.
Findings – Contrary to expectation, emotional labour was associated with lower levels of work-home conflict. There was no evidence found for the relevance of a P-E fit approach, rather the results indicated that the perception that the organisation supports the separation of work and home is sufficient in ameliorating work-home conflict. In addition, work-based support was found to reduce work-home conflict.
Research limitations / implications – The importance of support within the work environment as a way of reducing work-home conflict has been highlighted. That is, providing a safe environment to discuss anxieties and concerns is a fundamental factor when developing organisational support structure. The importance of providing professionals with choice regarding their preference to segment or integrate work and home has also been highlighted. Based on the contradictory findings with regards to emotional labour and work-home conflict, future research should aim to further examine this relationship within a forensic psychiatric setting.
Originality / value – This is the first research paper to explore the role of emotional labour, segmentation/integration and social support in the development of work-home conflict.
Johnson, H., Worthington, R., Gredecki, N., & Wilks-Riley, F. R. (2016). The impact of forensic work on home life: the role of emotional labour, segmentation / integration and social support. Journal of Forensic Practice, 18 (1), 52-63.
Abstract:
Purpose – Adopting a person-environment (P-E) fit approach, the purpose of this paper is to examine the role of emotional labour, segmentation/integration and social support in the development of work-home conflict.
Design / methodology / approach – Mental health professionals (n=118) completed the work-home conflict and home-work conflict scales (Netemeyer et al., 1996), the segmentation preferences and supplies scales (Kreiner, 2006) and the Mann Emotion Requirements Inventory (Mann, 1999). A social support checklist was also developed to assess the perceived value of work and non-work sources of support.
Findings – Contrary to expectation, emotional labour was associated with lower levels of work-home conflict. There was no evidence found for the relevance of a P-E fit approach, rather the results indicated that the perception that the organisation supports the separation of work and home is sufficient in ameliorating work-home conflict. In addition, work-based support was found to reduce work-home conflict.
Research limitations/implications – The importance of support within the work environment as a way of reducing work-home conflict has been highlighted. That is, providing a safe environment to discuss anxieties and concerns is a fundamental factor when developing organisational support structure. The importance of providing professionals with choice regarding their preference to segment or integrate work and home has also been highlighted. Based on the contradictory findings with regards to emotional labour and work-home conflict, future research should aim to further examine this relationship within a forensic psychiatric setting.
Originality / value – This is the first research paper to explore the role of emotional labour, segmentation/integration and social support in the development of work-home conflict.
Johnson, H., Worthington, R., Gredecki, N., & Wilks-Riley, F. R. (2016). The relationship between trust in work colleagues, impact of boundary violations and burnout among staff within a forensic psychiatric service. Journal of Forensic Practice, 18 (1), 64-75.
Abstract:
Purpose – The purpose of this paper is to examine the relationship between trust and burnout among mental health professionals working within a forensic psychiatric setting. The association between these factors and boundary violations was also examined.
Design / methodology / approach – Mental health professionals (n=117) completed the Maslach Burnout Inventory and a measure of their trust in co-workers. A series of 12 vignettes was also designed to assess the frequency and impact of boundary violations by clients.
Findings – Propensity to trust was found to be predictive of personal accomplishment. A higher propensity to trust others was associated with lower levels of emotional exhaustion and depersonalisation. It was also associated with greater cooperative behaviour. Higher frequency of boundary violations reported by professionals was associated with lower levels of perceived trust and cooperative behaviours among colleagues, and increased depersonalisation. In addition, professionals reporting more of a perceived impact of boundary violations, reported higher emotional exhaustion and depersonalisation. The results also indicate that younger professionals reported higher levels of emotional exhaustion and depersonalisation, whereas older professionals were more positive regarding their competence and sense of accomplishment.
Research limitations / implications – The results are discussed in terms of the development of trust within teams as an effective strategy to reduce the development of burnout. Implications are made for the importance of reflective practice and clinical supervision in developing positive working relationships with clients, and providing a safe environment to discuss professional conflict. The importance of supporting younger professionals has also been highlighted.
Originality/value – This is the first research paper to explore the relationship between trust within teams and the development of burnout within forensic psychiatric services.
Dr Rachel Worthington, Psychopathy and Sexual Offending. Addressing Personality Disordered Schema, Therapy Interfering Behaviours and Risk through a Human Needs Based Treatment - NOTA Conference, 2014.
Abstract:
This presentation will explore the aetiology of psychopathy and sexual offending to explain the rationale for a new group treatment intervention designed to target risk of sexual offending amongst high risk males with complex personality disorder. It will argue that as a result of early childhood and adolescent experiences this client group may develop schemata that presents in treatment as therapy interfering and that this should be targeted within the group prior to exploring offending behaviour. The rationale for the intervention is based on current research in relation to criminogenic risk factors, human needs and schema therapy as an approach for managing therapy interfering behaviours associated with psychopathy and personality disorder. It describes each sequential aspect of the group and recommends that exploration of sexual offending should be undertaken within the context of exploring the functions of offending based on human needs and that attendance to therapy interfering behaviours and forensic over-compensatory schemas should be addressed from the outset.
Worthington, R. (2015). Trauma Informed Additional - Programme. Journal of Criminological Research, Policy and Practice, 1 (1), 37-50.
Abstract:
Purpose – The purpose of this paper is to explore the ways in which trauma may manifest both in terms of internalising and externalising symptoms.
Design / methodology / approach – The paper will argue that the effects of trauma can contribute to victims engaging in problematic behaviours (such as aggression) both towards themselves and others which may require them to attend treatment programmes to target these problem behaviours. However, standard interventions designed to target these problem behaviours do not sufficiently take into account the effects of trauma in terms of attending to the therapy interfering behaviours which are brought to treatment. The paper will argue that these trauma related therapy interfering behaviours should be attended to prior to the client engaging in specific groups to target other problem behaviours (e.g. aggression).
Findings – Clients who are referred for standard group based interventions to target problem behaviours such as aggression towards themselves or others should be offered a trauma intervention first in order to improve concentration, reduce drop-out rates and enhance feelings of safety to engage effectively in the group. Group based Eye Movement Desensitisation and Reprocessing (EMDR) should be used as a method of targeting therapy interfering behaviours associated with the effects of trauma and this should also incorporate meditation and neurobiologically informed approaches. Standard target problem behaviour groups should be adapted and modified to account for the role of trauma in information processing.
Originality / value – The paper will introduce Trauma Informed Additional – Programme (TIA-P) which is a newly designed group designed to assist clients to tolerate and modify therapy interfering behaviours which are present as a result of trauma in order that they can then go on to attend standardised interventions. The TIA-P attends to the latest research in relation to the treatment of trauma utilising EMDR within the group to enhance safety and reduce therapy interfering behaviours.
Worthington, R. (2016). Prison organisational climate: exploring the impact of climate on emotional wellbeing. The British Journal of Forensic Practice, 14 (3), 192-203.
Abstract:
Purpose – This paper aims to describe research which was undertaken exploring organisational climate within a prison setting and the potential directional affects of work and home. The purpose of the research was to develop a conceptual framework of the impact of climate on social and emotional functioning.
Design / methodology / approach – Using the competing values framework 149 prison staff completed a questionnaire designed to explore the interactional effects of boundary theory, organisational climate and wellbeing.
Findings – It was found that all staff placed emphasis on the control quadrant of the organisational climate. In addition, the data revealed a moderately curvilinear relationship between length of service and climate engagement on each of the quadrants. These results parallel other research in relation to attitude change. The desire for higher integration was associated with an increased impact on work/home life and a desire for, and achievement of, segmentation does not directly impact on subjective wellbeing. The research concluded that viewing integration and segmentation along a continuum in relation to the prison service role is too simplistic. Rather, these should be viewed in a more complex way and a model for this is proposed. The findings also indicate that employees with high identity consistency (integration) also had a more engaged experience of the prison climate whereas employees with lower identity consistency (segmentation) were less engaged.
Research limitations / implications – There are several implications of the research. Firstly, further research is required to explore the potential impact of attempting to change a prison climate in terms of understanding why certain climate quadrants may be preferred by staff in different roles. The findings indicate that where certain quadrant preferences occur these may be functional to prison safety and alteration of these should be considered carefully. The research also indicated that current theories of boundary management may have some applicability but that within a prison setting these are complex and influenced by both internal organizational factors and those within the wider community. Further research into the concept of “dirty work” and the impact this may have on climate would be of benefit.
Originality / value – This is the first research to explore the role of organizational climate within a prison setting and to consider factors which are specific to a prison environment which may influence the organizational climate. This paper is of value to those who are interested in prison settings and how the environment can influence employee experiences of working in a prison and how identity consistence can influence experiences of work.
Worthington, R. & Cormack, E. (2011). ‘Different Strokes for Different Folks’: The development and evaluation of a staff training package for working with prisoners. Forensic Update, 103, 12-15.
Abstract:
The purpose of this paper is to describe the development of a staff training to improve the working experiences of staff within a prison. The paper will begin by describing the process of designing training and the context in which the training was commissioned. The development of the training was based on the four principles from Eitington’s model of training. The winning trainer (2002)’.Within this circular model, training may be identified under four labels known as the four Ds and are described as follows:
Determine Need. This is Stage 1 – Diagnose or determine need which involves exploring for difficulties (problems), deficiencies, or new developments that indicate that a training effort is in order.
Design Training. This is Stage 2 – Design or develop the programme based on the needs identified in stage 1. Plan and design a course or training to meet those needs.
Deliver Training. This is Stage 3 – Deliver or present the training in the most effective way possible. This stage focuses on the methods of training.
Discern Differences (Evaluation). This is Stage 4 – Discern differences which require the measurement of results of the training. With a specific focus on whether the training has made a difference in knowledge, skill (behaviour/performance) and attitudes.
This model upholds the process suggested within the handbook for the Diploma in Forensic Psychology. Therefore, the paper will conclude that by utilising this model and psychological principles it is possible to design a package of training. In this instance the training assisted participants to understand the different types of roles and relationships that they may develop with clients in a prison setting. Participants also demonstrated an increased knowledge of the importance of these varied roles. In addition, independent evaluation of the quality of staff prisoner relationships also improved.