The main objective of the study is to investigate the effect of inclusion in the LLA on E33 notifications. Secondary objectives include investigating the effect of inclusion in the LLA on criminal behaviour (arrests, recidivism and risk of…
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Brief title
Condition
- Other condition
Synonym
Health condition
Psychische problematiek en delict gedrag
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
To investigate the influence of the LLA on nuisance behaviour, E33
registrations will be used as the primary outcome measure. These are
registrations made by police in the event of 'public nuisance caused by an
individual with confused/misunderstood behaviour'. Events leading to an E33
registration are diverse, ranging from panhandling to physical aggression and
vandalism. In 2023, a total of 141.724 E33 registrations were made in the
Netherlands. A large portion of these E33 registrations are caused by the same,
relatively small group of individuals (Verward/Onbegrepen Gedrag en Veiligheid.
Eindrapport Parlementaire Verkenning, 2024). It is currently unknown how many
of these registrations are caused by LLA clients. However, given their
psychiatric problems, persistent problematic behaviour, and fragmented support
systems, it is likely that many E33 registrations are associated with those
included in the LLA. These registrations do not always indicate dangerous
and/or criminal behaviour and do not always lead to arrest, they do require
police resources and can have broader societal implications.
The current study will investigate changes in the annual frequency and
prevalence of E33 registrations over a period of four years before inclusion,
during inclusion and (maximum) four years after inclusion in the LLA. Changes
in frequency and prevalence of E33 registrations will be investigated at the
individual level, between care and safety regions, for different groups,
different demographics and for the entire study population.
Secondary outcome
The secondary outcomes consist of several variables measuring different levels
of criminal behaviour, namely arrests, recidivism and risk of recidivism. By
investigating the influence of the LLA on multiple measures of criminal
behaviour, in addition to E33 registrations, a comprehensive view of the
criminal behaviour displayed by LLA clients and the different levels of impact
this may have on society is gained. This study will investigate changes in the
annual frequency, prevalence and severity of arrests and recidivism over a
period of four years before inclusion, during inclusion and (maximum) four
years after inclusion. In addition, shifts in risk of recidivism, assessed
through validated risk assessment instruments, will be investigated, along with
objective quality of life metrics to gauge clients' objective well-being and
satisfaction with life. Using objective indicators for quality of life
alongside risk factors provides a fuller picture of well-being and behaviour,
with higher life satisfaction often linked to lower arrests and recidivism
risks. This enables the LLA to offer more targeted support for lasting
reintegration. Differences across these measures will be investigated on an
individual level, between Care and Safety regions, for various groups,
different demographics, and across the overall study population.
Background summary
The Levensloopaanpak (LLA) is a relatively new person-centred, collaborative
network approach aimed at providing continuous care and support to individuals
with a mental disorder and/or addiction and/or intellectual disability, as well
as a high safety risk. By fostering collaboration across judicial, (mental)
health care, and social organisations within regional networks, the LLA aims to
address clients* needs in a holistic, life-encompassing manner, providing
stability and minimizing disruptions due to fragmented care. Since 2019, 29 of
the 31 Care and Safety regions in the Netherlands have implemented the approach
and now over 600 clients have been included, with the expectation that this
number will grow to 1,500 clients nationally in the coming years. If effective,
the LLA could yield great benefits, not only enhancing client outcomes, but
also strengthening their social networks and providing a positive impact on
society by reducing incidents and increasing public safety. However, so far
neither large-scale (national) nor in-depth (analytical) research has been
conducted on the (cost)effectivity of the LLA.
Study objective
The main objective of the study is to investigate the effect of inclusion in
the LLA on E33 notifications. Secondary objectives include investigating the
effect of inclusion in the LLA on criminal behaviour (arrests, recidivism and
risk of recidivism), as well as its effect on objective quality of life.
Tertiary objectives include investigating the perspectives of the LLA's network
partners on the collaboration within the LLA-approach and evaluating the
development and application of personalised life course plans. In addition, the
study will investigate the cost-effectiveness of the LLA, explore client
characteristics and possible client profiles. Finally, case reports will be
made to capture clients' satisfaction, both in terms of (subjective) quality of
life and their experience and satisfaction with inclusion in the LLA.
Study design
The study will employ a longitudinal, observational design to investigate the
LLA on a national scale. A substantial portion of data regards information
related to clients' progress in the LLA, which is systematically registered by
practitioners involved in the approach. This data will be complemented by
outcome measures sourced from partners of the LLA. For each client, data will
be collected covering four years prior to inclusion, monitored during
inclusion, and followed for up to a maximum of four years post-inclusion.
Study burden and risks
By definition, this study involves a vulnerable group, well-supported from a
care perspective by professionals who form a support network around each
client. Active participation from clients is limited to optional involvement in
case reports, keeping participant burden very low. These case reports involve
one to two appointments, during which clients are invited to participate in an
interview investigating their subjective life satisfaction, (risky) behaviour,
and experiences with the LLA. Interviews are held at accessible locations for
clients and length kept to a minimum. Eligibility for participation is assessed
by the client*s case manager, ensuring that clients deemed too vulnerable are
excluded from participation. Therefore, risks for the client associated with
participation are minimal. Risks associated with the current study are mainly
related to data management and protection of privacy.
Warandelaan 2
Tilburg 5037 AB
NL
Warandelaan 2
Tilburg 5037 AB
NL
Listed location countries
Age
Inclusion criteria
The inclusion criteria for the current study are those outlined by the
Levensloopaanpak, as all clients included in the Levensloopaanpak from 1-1-2019
up to and including 31-12-2024 will be included in the study. The criteria
outlined by the Levensloopaanpak are as follows: 1) Individuals (min. 18 years
old) who (are at risk of) exhibiting aggressive and/or dangerous behaviour as a
result of a mental disorder and/or a mild intellectual disability and/or
non-congenital brain injury; 2) The individual shows dangerous behaviour
towards others/society or evidence of (high) risk of this behaviour is present;
3) There are long-term, recurring (co-existing) conditions that are difficult
to manage and cannot be adequately managed within existing support, care and
guidance systems; 4) In part due to dominant behavioural problems, there is a
need for structured treatment and guidance, preferably in an outpatient
setting; 5) There is, or was, a treatment order mandated by the courts as a
result of the dangerous behaviour towards others/society; 6) There is a risk
that without a comprehensive offer of outpatient intensive care and support,
appropriate help or housing, there is a greater chance of recurrence of the
dangerous behaviour that is inextricably linked to the mental disorder, the
mild intellectual disability and/or non-congenital brain injury.
Exclusion criteria
Exclusion criteria are only applicable to (voluntary) interviews investigating
opinions and experiences of clients of the Levensloopaanpak, as all individuals
included in the approach from 1-1-2019 up to and including 31-12-2024 will be
included in the study.
Clients will be excluded from eligibility for participation in interviews if
the responsible case manager (Levensloopcoördinator) deems participation
unsafe, potentially detrimental to the therapeutic relationship between them or
between the client and any other party involved, or a threat to their
psychiatric or psychological state of mind. Further, clients with an acute
(within the last 3 months) and invalidating episode of a psychiatric illness
(i.e., major depression, manic episode, psychotic episode), as determined by
the case manager, will be excluded from the study.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL88941.028.25 |