De-escalation is recommended as the first response to potential aggression within forensic psychiatry. To imbed de-escalating techniques in daily clinical practice, education and training of the staff is essential. Various de-escalation training programmes have been developed, but research on the effectiveness of these training programmes in the forensic psychiatry is scarce. Previous research rarely focused on the impact of the training on the prevalence of aggressive behaviour and the use of coercive measures within forensic psychiatric clinics.
Therefore, the aim of the current study is to measure the effect of a de-escalation training programme on aggressive incidents and the use of seclusion. A pre-post measurement design with paired data was set up within a Flemish high-security forensic psychiatric unit, that provides treatment for female forensic psychiatric patients.
No significant differences were found in the number of aggressive incidents between the pre- and post-measurement period, not even when the type of aggression was taken into account. However, there was a decrease in the severity of verbal aggression. Although, no significant differences were found in the number of seclusions with and without restraint between the pre- and post-measurement period, the mean number of seclusion hours did decrease significantly.
The findings of the current study were not consistent with those of previous research. Possible explanations for these differences are variation in the implementation process of the de-escalation training, in the contextual factors and in the methodology used. Decreasing the prevalence of aggressive incidents and the use of seclusion by using de-escalating techniques is a long-term goal and asks a lot of reflection and further practice. Future research should focus on the factors that facilitate or complicate the impact of a de-escalation training. In this way, the possible added value of de-escalation in clinical practice can be further scientifically supported.

Background. Androgen deprivation therapy (ADT) is frequently used in the treatment of men with a paraphilic disorder. Due to ethical reluctance, there is a lack of randomized controlled trials in this target group to make evidence-based statements about somatic and psychiatric follow-up of ADT in Flanders and the Netherlands.
Aim. Creating recommendations on the follow-up of ADT in men with a paraphilic disorder based on the experience of medical experts.
Method. Using a modified Delphi method, 22 experts were questioned in three rounds about different aspects of the somatic and psychiatric follow-up of ADT.
Results. Based on the degree of consensus between the experts recommendations were made concerning the somatic and psychiatric follow-up of ADT. The follow-up of ADT must be carried out by a multidisciplinary team, led by a forensic psychiatrist. High doses of cyproterone acetate (CPA) should be avoided, as a switch to a gonadotropin releasing hormone-agonist (GnRH agonist) is preferred. The expert opinion is very much in line with the influential WFSBP guideline, beyond some identified differences that rely on conflicting findings in existing research.
Conclusion. The essence of the formulated recommendations is the necessity for a systematic assessment of the somatic and psychiatric condition of each patient with a paraphilic disorder undergoing ADT, in which cooperation between all multidisciplinary partners is important. The recommendations have the potential to reduce heterogeneity in clinical practice in Flanders and the Netherlands. Nevertheless, further research is required to clarify existing uncertainties and contradictions regarding certain follow-up parameters of ADT.

People who have possessed child abuse material (CSAM) constitute a specific group of sex offenders, who can be distinguished from both those who have committed child abuse and the ‘mixed’ group, who are known to have committed both crimes. This specific group is in itself a heterogeneous group. Much research on this group relates to people who have already come into contact with the justice system and little is known about people who come forward voluntarily. The current study does include the latter group and investigates possible differences in sexual problems between those who were arrested for looking at CSAM (the judicial group) and those who sought help themselves without judicial intervention (the self-reporting group). Pedophilic or hebephilic interests, other paraphilic interests, sexual preoccupation and sexual coping were compared between the two groups by means of the VSP and HBI019 self-report questionnaires. The results showed that the self-reporting group experienced more problems on all measured dimensions than the judicial group. The results are relevant to the treatment of these groups.

This contribution examines the practice of contact with victims within forensic psychiatric treatment from the perspective of the forensic social worker who supervises the network of an inpatient. Both the direct contact between inpatient and victim and the indirect contact between network supervisor and victim are included. This professional contribution examines the specific role of a forensic network supervisor and describes what is possible in contact with victims and how this is achieved on the basis of three themes, namely 1) the work and vision that network supervisors have on their role, 2) the chain partners and the cooperation therewith, and 3) the various procedures that exist and how they are handled. For each theme, the substantive relevance in relation to contact with victims is discussed, as well as the opportunities and possible difficulties. This study shows that network supervisors experience a tension between the interests of inpatients and victims, whereby the importance of good chain cooperation is clearly endorsed. Furthermore, not all network supervisors act the same in equal cases, which can create inequality for victims. A more uniform job description and task interpretation could overcome this. Finally, this study shows that network supervisors consider it to be important that victims have a voice and are involved in important moments during forensic treatment.

Within forensic populations, exposure to traumatic experiences is high. These experiences are associated with multiple mental and physical health problems later in life. Besides this, trauma may be a risk factor for the development of delinquent behavior and reduce responsiveness to forensic treatment. Treating trauma more specifically and intensively could potentially contribute to increasing the effect of forensic treatment and thus reducing the risk of recidivism. The expected symptom relief creates more room for the patient to participate in other treatment components within his or her program. Short-term, intensive trauma treatment appears to be more effective than long-term trauma treatment. This study describes the implementation, and first experiences with intensive trauma treatment within a forensic hospital. This treatment is a short-term trauma treatment consisting of eight days filled with Eye Movement Desensitization and Reprocessing (EMDR), Imaginary Exposure (IE), an activating sports and exercise program and psychoeducation. According to the experience of several patients and staff members, intensive trauma treatment appears to have a short-term effect on the trauma-related symptoms of patients who participate in this treatment. It is however still unclear whether these results are long-lasting. Implementing intensive trauma treatment takes time and requires extra efforts and investment from many different staff members. For a successful implementation it is important that this time is made available organization wide. The aftercare of patients after the intensive trauma treatment is crucial, and attention must be paid to the transition back to the regular program.