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In this study, we compared three groups of women admitted to a public forensic inpatient facility over the course of a two-year period. Detailed and systematic examination of social and psychiatric histories revealed that the group with the most persistent levels of aggression differed from the other two groups with respect to frequency of self-harming behavior, intellectual impairment, hypothyroidism, a childhood diagnosis of attention deficithyperactivity disorder (ADHD), and age of onset of psychiatric and behavioral symptoms. The high-aggression group also had the highest rate of childhood physical and sexual abuse, but the difference between that group and the two lower aggression groups did not achieve statistical significance. From the standpoint of childhood adversity, 94 percent of those in the high-aggression group had been placed outside of the original home by age 11. Eighty-nine percent were intellectually impaired. At admission, physical examinations revealed that 50 percent had a history of hypothyroidism and two-thirds were obese. Before admission, most had manifested severe aggression and emotional dysregulation, as evinced by high levels of self-harm, suicide attempts, and aggressive behavior in previous institutional settings that was both frequent and intense. Patients who share these characteristics are currently placed on a ward at the hospital with a milieu and individual therapy programs that are based on a dialectical behavior therapy approach that targets key symptoms of emotional and behavioral dysregulation. [ABSTRACT FROM AUTHOR]

With steadily growing populations of individuals with severe mental illnesses in forensic hospitals and correctional institutions, there is a need for effective rehabilitation services in these facilities. Individuals in such facilities have many of the same rehabilitation needs as people with severe mental illnesses in other settings. This paper describes the use of a comprehensive social-learning approach to rehabilitation that has been implemented in forensic facilities with documented success. The effectiveness of the social-learning approach has been well established for individuals with the most severe mental illnesses in public psychiatric hospitals. The application of this approach within the Forensic Services of the Missouri Department of Mental Health is outlined, and some of the challenges associated with implementing psychosocial rehabilitation technologies within highly secure facilities are discussed.

Many persons with schizophrenia are characterized by cognitive impairments that interfere with their ability to benefit from traditional rehabilitation interventions, including some forms of cognitive rehabilitation. To date, shaping procedures, a form of social-learning based intervention, have demonstrated effectiveness in several reports in improving the attention spans and lengths of continuous work performance among people severely impaired by schizophrenia. Despite this encouraging data, shaping as a form of cognitive rehabilitation remains underutilized. In this paper, we review the conceptual foundations for shaping, the rationale for the use of shaping as a form of cognitive rehabilitation, and future tasks necessary to refine this intervention.

Functional assessment of persons with psychiatric disabilities requires reliable and valid instruments that can be used by clinicians for planning psychosocial rehabilitation services. Two such instruments, the Independent Living Skills Inventory and the Independent Living Skills Survey are operationalized and behaviorally specific tools that can be administered as questionnaires or interviews. Both instruments have well-documented reliability and validity and are 'user-friendly."