Analytical Summary 2018 The development of a screen to identify individuals who may need support with their learning Helen C Wakeling The identification of individuals serving prison and community sentences who may have a mild learning disability (LD) or may find learning and day to day activities challenging, and therefore require particular help and support in their everyday living, is critical to ensure they are able to get the most out of their sentence. Her Majesty’s Prison and Probation Service (HMPPS) are committed to supporting people with challenges to learning as much as for those without. On a population level, identifying the number of people in prison and serving community sentences who may struggle and need support would be helpful to improve the targeting of resources and to ensure the commissioning of appropriate services. On an individual level, referring those who may be more likely to have learning disabilities and difficulties coping with prison life for further assessment of their difficulties, or flagging them for additional support, has the potential to be helpful to those individuals and to the staff responsible for their care. This study reports on the development of a screen using the Offender Assessment System (OASys; Home Office, 2006). For the purpose of this research, we are aiming to identify individuals who may struggle with prison or community sentences because of learning disabilities or learning challenges, and thus may need additional support. Some of these will likely have a mild LD (as defined by the World Health Organisation) with an intelligence quotient (IQ) of less than 70, whereas others will have an IQ of between 70 and 80, and therefore would not meet the diagnostic criteria for a mild LD, but who nonetheless may still have challenges with learning and managing day to day. Key findings • A sample of 2,232 adult males who had been convicted of a sexual offence and who were serving a custodial sentence was used. All had IQ information available using the Wechsler Adult Intelligence Scale (WAIS IV). In the present study we suggest that WAIS IQ data can be used as a marker for the identification of those who may require support with learning and everyday living while serving their sentence. • Twenty-nine OASys items, which were found to be associated with IQ, were entered into a logistic regression with IQ (higher >=80 / lower <=79) as the outcome variable. Eight variables significantly predicted lower IQ (<= 79): no fixed abode, (lack of) work skills, problems with reading, writing and numeracy, reading problems, numeracy problems, learning difficulties, (no) qualifications, and easily influenced. • A stepwise logistic regression was performed entering in these 8 variables. The final model contained 7 of the 8 variables (easily influenced did not add to the model): (no) qualifications, learning difficulties, problems with reading, writing and numeracy, reading problems, numeracy problems, no fixed abode, and (lack of) work skills. • A seven-item tool was developed, which had good predictive validity. • Possible uses of the tool are discussed. These include using the tool as a means of approximating the proportion of those in our care who may require support with learning and everyday living while serving their sentences. The tool could also be used as a way of helping to refer individuals for further assessment of their needs. The views expressed in this Analytical Summary are those of the author, not necessarily those of the Ministry of Justice (nor do they reflect government policy). Context The aim of the current research was to develop a screening tool to: 1) help identify the approximate extent The World Health Organisation (WHO, 1992) defines an of individuals with an IQ of less than 80, including those intellectual or learning disability (LD) as a significant who may have an LD, who may struggle to cope in the reduced ability to understand new or complex information prison population; and 2) facilitate the identification of and to learn and apply new skills, which results in a individuals within prison or serving community reduced ability to cope independently (impaired social sentences, who require further assessment of their functioning), and begins before adulthood. IQ levels are difficulties, as well as further support. used as a guide and the range of 50-69 is usually indicative of mild learning disability (although IQ levels Method alone are not sufficient to diagnose LD). The DSM-V (American Psychiatric Association, 2013) definition of Sample ‘Intellectual Disability’ refers to limited functioning in 3 A sample of 2,232 adult males who had been convicted areas: social skills (e.g. communicating with others), of a sexual offence and who were serving a custodial conceptual skills (e.g. reading and writing ability) and sentence was used. All had taken part in a cognitive practical ability (e.g. clothing/bathing one’s self). LD is behavioural treatment programme, collectively known as distinct to ‘specific learning disabilities’ or ‘learning the Sex Offender Treatment Programmes (SOTPs; Mann difficulties’ which refer to a variety of disorders that affect & Fernandez, 2006) targeted at individuals who had the acquisition, retention, understanding, organisation or committed a sexual crime between 2006 and 2011. This use of verbal and/or non-verbal information, such as sample was used as all had IQ information available from dyslexia and dyscalculia (Davey, 2008). Although there is the Wechsler Adult Intelligence Scale (WAIS IV; discrepancy on the prevalence of individuals with LD Lichtenberger & Kaufman, 2009). At the time, WAIS IV within the Criminal Justice System (CJS) due to the lack was routinely used on all individuals participating in these of established tools, it is estimated that between 20% programmes. The average age of the sample was 38.8 and 30% of the prison population have some form of LD and their average IQ was 94.2. Four hundred and fifty- or difficulties that interfere with their ability to cope with two individuals (20%) had an IQ score of 79 or less, and the CJS (Loucks, 2007). It is estimated that around 7% of 1,780 (80%) had an IQ score of 80 or more. One prisoners have an IQ of less than 70, whereas a further hundred and fifty-nine individuals had an IQ score of 69 25% have an IQ of between 70 and 79 (Mottram, 2007). or less (7.2%) and 2,218 had an IQ score of 70 or more It is also estimated that individuals with LD are (92.8%). overrepresented in the CJS (e.g. Holland, 2004), which includes both those in prison and on probation. Measures However, estimations of the extent of the problem are WAIS IV difficult without established and validated means of The WAIS IV (Lichtenberger & Kaufman, 2009) was measurement. The HM Inspectorate of Prisons completed on all individuals prior to their participation highlighted the failure within the CJS to identify in an SOTP. Assessments were conducted at the individuals with LD (HMIP, 2015). Without a means of establishment at which the individuals started a identifying individuals it is likely that an individual with LD programme. or difficulties coping with the CJS will not be identified IQ classification is primarily used by health professionals and, in turn, that their support needs will not be met to assess the presence of LD and/or difficulties coping. (Talbot, 2009). This may cause problems for the However, the use of IQ as a marker of difficulties is not individual and for the staff who work with them, who are without its issues; impairments of social functioning and not able to appropriately identify the individuals who communication skills should be present in addition to a need further support. If not identified and supported in low IQ for a diagnosis of a LD. The World Health their specific needs, people may experience difficulty in a Organisation diagnoses LD according to 3 elements: IQ, prison context. Prisoners with LD have, for example, social functioning and age at onset before adulthood been found to be more likely than other prisoners to have (WHO, 1992). It is therefore acknowledged that IQ is just broken a prison rule, been subject to control and restraint one aspect of LD and difficulties coping. However, it was procedures, and to have spent time in segregation the best marker available on a large sample from which (Talbot, 2008). If people with LD and people with milder to test the validity of a screening tool. difficulties that interfere with their ability to cope are better identified and understood, these individuals may The IQ cut-off selected for this research was below 80. have a better chance of rehabilitative success. Mild disability is often identified as being below 70. 2 However, it is acknowledged that individuals with an IQ was then calculated to determine the predictive validity of of between 70 and 80 may indeed have difficulty with the tool. Sensitivity and specificity of the final tool were aspects of life in general (Vankatesen, 2017), and with also examined. prison life, that would benefit from support. In fact, it is widely recognised that individuals with IQs of 80 or below Results may experience problems if they encounter the CJS Initial Exploration of OASys Items (Talbot, 2008). As such, we decided to proceed with development of a tool to identify individuals with an IQ of OASys items were scrutinised and 29 items were less than 80. The current research therefore aims to selected as being potentially relevant. Table 1 lists these identify individuals who may struggle with prison or items, as well as the results of a logistic regression community sentences, and thus may need additional analysis. The sample was divided into two according to support.