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Models of care in secure services for people with intellectual and developmental disability: Implementing the Walkway to Wellness

Lookup NU author(s): Dr Iain McKinnonORCiD, Arman Iranpour, Dr Simon Hackett



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: Changes to policy around inpatient services for people with Intellectual and Developmental Disability (IDD) who offend, have led to a need for services to reconsider their models of care. Resultant changes in the profile of patients in these services means that there has been a call for more individualised, patient centred models, with less emphasis on programmatic treatment programmes. In response, the Walkway to Wellness (W2W) was developed at one NHS Trust providing secure services to people with IDD, with the intention of delivering a more collaborative, co-produced and goal-oriented care model that was better understood by staff and patient stakeholders. Aims: To evaluate the implementation of the W2W using Normalization Process Theory (NPT), an evidence based theoretical approach used across a number of health settings. Methods: Staff were invited to complete a short questionnaire, using the NPT informed NoMAD questionnaire, at two time points along the implementation process. Patients were invited to complete a simplified questionnaire. Both groups were asked for their views on the W2W and the process of its implementation. Results: Although the W2W was more familiar to staff at the second time point, scores on the four NPT constructs showed a trend for less normalization, with significant results concerning the appraisal of the new model. Patient views were mixed; some saw the benefit of more goal-oriented processes, but others considered it an additional chore hindering their own perceived goals. Conclusions: Whilst the W2W is more patient centred and goal oriented, resource limitations and the impact of delays due to the COVID-19 pandemic have had an impact on implementation.

Publication metadata

Author(s): McKinnon I, Iranpour A, Charlton A, Green E, Groom F, Watts O, McKenna D, Hackett S

Publication type: Article

Publication status: Published

Journal: Criminal Behaviour and Mental Health

Year: 2024

Pages: epub ahead of print

Online publication date: 27/01/2024

Acceptance date: 04/01/2024

Date deposited: 29/01/2024

ISSN (print): 0957-9664

ISSN (electronic): 1471-2857

Publisher: John Wiley & Sons Ltd.


DOI: 10.1002/cbm.2328


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Funder referenceFunder name
Academic Health Sciences Network North-East and North Cumbria
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust