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Domestic Violence Knowledge Sharing Forum

Domestic Violence Knowledge Sharing Forum. Lethbridge, AB March 24, 2011. Who Do We Serve?. Target population is adults and adolescents who are: 12 years of age or older In conflict with the law Thought to have mental problems

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Domestic Violence Knowledge Sharing Forum

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  1. Domestic Violence Knowledge Sharing Forum Lethbridge, AB March 24, 2011

  2. Who Do We Serve? Target population is adults and adolescents who are: • 12 years of age or older • In conflict with the law • Thought to have mental problems • Legally mandated for assessment or treatment for mental health or behavioural problems

  3. What Do We Do? • Assessment for the courts • Fitness To Stand Trial • Not Criminally Responsible due to Mental Disorder (NCRMD) • Risk Assessment • Treatment

  4. What is a Risk/Threat? • the potential that a chosen action or activity (including the choice of inaction) will lead to an undesirable outcome • Complex – incorporates notions of nature, severity, frequency, imminence, and likelihood • Contextual – depends on circumstances!

  5. What is Violence? • The actual, attempted, or threatened physical harm to another person • Diverse – includes many acts • Intentional – deliberate or reckless • Non-consensual – unwanted by the victim

  6. What is Assessment • In the mental health profession, assessment is the process of gathering information for the use in making decisions. • Include: interviews, psychological testing, review of records, collateral informants

  7. Risk Assessment • Is the process of gathering information about people to make decisions regarding their risk of perpetrating/offending. • The primary decision to be made is preventative, that is, a determination of what steps should be taken to minimize any risks posed by the individual.

  8. Risk Assessment cont… • Mental health professionals use two basic approaches • Actuarial decision making • Professional judgement

  9. Actuarial Risk Assessment • Are designed not to measure anything but solely to predict the future. • Typically, they are highly optimized to predict a specific outcome in a specific population over a specific period of time. • The items used in such tools are usually selected empirically (on the basis of their association with the outcome in past research). • The items are weighted and combined according to some algorithm to yield a decision.

  10. Professional Judgement • Has evolved over the years into what is now called structured professional judgement or guided clinical judgement. • Decision-making is assisted by guidelines that have been developed to reflect the “state of the discipline” with respect to empirical knowledge and professional practice.

  11. SPJ Cont… • The guidelines attempt to define the risk being considered, discuss necessary qualifications for conducting the assessment, recommend what information should be considered as part of the evaluation and how it should be gathered, and indentify a set of core risk factors that according to the scientific and professional literature should be considered as part of any reasonably comprehensive assessment.

  12. SPJ Cont.. • Such guidelines help to improve the consistency and usefulness of decisions. • The core assumption behind structured professional judgement assessments is that good prevention is based on planning, not on prediction. • Planning reflects practical wisdom rather than abstract knowledge of technical skills • The advantage is that planning doesn’t assume a single “possible future”

  13. General Procedures • Gather information (purpose, history, behaviours) • Consider relevance of risk factors (motivators, disinhibitors, destabilizers) • Consider scenarios of violence • Develop case management strategies (monitoring, supervision, tx, risk management) • Document summary judgements

  14. What is a Static Factor? • Something that that can not be changed • Natural hair colour • Eye colour • History • Sex • Criminal record

  15. What is a Dynamic Factor? • Something that can change over time and as result change a person’s risk • Relationships • Employment • Substance use • Suicidal/homicidal ideation • Mental health

  16. Factors Predictive of Future Violence • Actuarial instruments as well as clinical assessments consider a number of factors in their assessment of risk potential magnitude, imminence and frequency. Research has indicated that the following factors have predictive value:

  17. Base Rates • refers to the frequency of violence in a given population • one of the most highly predictive actuarial factors • does not relate specifically to mental disorder • can "over-predict" (e.g.,. can incorrectly identify some offenders as potential killers)

  18. Demographic Factors • men more highly represented in criminal and violent populations (though not necessarily in psychiatric areas) • age: crime (especially violent) tends to occur more in younger than in older men • unemployment: low socioeconomic status, low educational achievement correlate with violence • race and ethnicity: although these can be factors, they tend to dissipate when the other factors taken into account statistically

  19. Past History of Violence • violent history: one of most powerful indicators of future violence potential • nature of the violence: always important to consider (e.g.,. types of victims, environmental and contextual issues, etc)

  20. Substance Abuse • drugs and alcohol are major contributors to violence amongst both mentally disordered and non-mentally disordered offenders • prevalence of substance abuse in mentally disordered offender tends to be higher than in general (non-incarcerated) population • substance abuse is important risk factor in psychotic individuals • doubles the lifetime risk of violence among the severely mentally disordered, particularly if substance abuse had early onset

  21. Psychiatric Diagnosis • earlier research linked violence with schizophrenic patients in particular but later studies have been more equivocal about this • much more relevant to look at psychiatric symptoms as opposed to diagnosis:

  22. Antisocial Personality Disorders • characterized by persistent disregard for and violation of the rights of others • begins in childhood • higher prevalence of it in severely mentally ill population and in prison population (50-70%) • strong association with substance abuse • strong predictor of criminal recidivism, particularly violent recidivism, and especially in women

  23. Psychopathy • often overlaps with Antisocial Personality Disorder (APD) • characterized by combination of traits from APD and Narcissistic Personality Disorder: self-centredness, egocentricity, lack of empathy, etc. • degree of psychopathy measured effectively by Hare's Psychopathy Checklist-Revised (PCL-R) • high scores on PCL-R consistently correlate with violence in incarcerated offenders and forensic patients

  24. Organic Disorders and Learning Disorders (influence of) • presence increases the risk of violence • elderly neurologically impaired responsible for disproportionately high number of violent incidents in health care facilities • Attention Deficit/Hyperactivity Disorder ( ADHD):- persistent pattern of inattention or hyperactivity-impulsivity- in childhood, is more frequent and severe than comparable behaviour of other children at similar stages of development

  25. Attachment, Mental Disorder and Criminality • children learn about relationships through complex interruption with their caregivers • early disruption of this attachment can lead to later psychopathology, mental disorders and criminality in some individuals • fertile ground for research into relationship between abuse/neglect and later violence: • it may well be that prison environments tend to replicate or reflect lack of care that some offenders may have experienced as children

  26. Who can use the assessments? • Professionals in a variety of disciplines • Expertise in conducting assessments • Expertise in the area of violence, spousal assault, sexual violence. • Expertise in mental disorders • Proper training in the risk assessment tool • Refer to the User Qualifications in the risk assessment manual

  27. Actuarial Risk Assessment Tools

  28. Violent Risk Appraisal Guide (VRAG)Quinsey, Harris, Rice, Cormier (1998) • This instrument contains a 12-item actuarial scale which has been widely used to predict risk of violence within a specific time frame following release in violent, mentally disordered offenders. Developed at Penetanguishene Mental Health Centre, the tool uses the clinical record, particularly the psycho-social history component, as a basis for scoring as opposed to interview or questionnaires. The Hare PCL-R (Psychopathy Checklist -Revised) score is incorporated into the VRAG calculations of risk. • -24 to -8 = low risk, -7 to 13 = medium risk, 14 to 32 = high risk

  29. Psychopathy Checklist - Revised (PCL-R)Hare, 1991 & 2002 • Even though it was not originally designed as a risk assessment device, the Hare PCL-R has gradually come to be used to assess likely future recidivism and violent offending. It is a 20-item rating scale, scored on the basis of both semi-structured interview and collateral information. It has been validated for use in adult male correctional and forensic psychiatric samples. Over recent years, research has shown that it is a relatively good predictor of violence across diverse populations. Hare PCL-R scores are incorporated into a number of subsequently developed risk assessment tools and guides.

  30. Level of Service Inventory – Revised (LSI-R)Andrews & Bonta, 1995 • This is a 54-item rating scale used to assess the likelihood of general recidivism among adult offenders. It is designed to measure attributes of offenders and their situations in relation to level of supervision and treatment decisions. It has been validated for use with adult male and female correctional offenders.

  31. Static-99/Static-2002Hanson & Thornton, 1999 and 2002 • Developed subsequently to the RRASOR, the original 10-item STATIC-99 was designed to assess the long-term potential for sexual recidivism among adult male sex offenders. It incorporates RRASOR factors. A revised version, STATIC-2002, has so far been used predominately within the correctional system.

  32. Number Risk Factor Codes Score • 1 Young Aged 25 or older 0 • Aged 18 – 24.99 1 • 2 Ever lived with lover for at least two years? Yes 0 No 1 • 3 Index non-sexual violence - Any Convictions? No 0 Yes 1 • 4 Prior non-sexual violence - Any Convictions? No 0 Yes 1 • 5 Prior Sex Offences Charges Convictions None None 0 1-2 1 1 3-5 2-3 2 6 + 4+ 3 • 6 Prior sentencing dates (excluding index) 3 or less 0 4 or more 1 • 7 Any convictions for non-contact sex offences No 0 Yes 1 • 8 Any Unrelated Victims No 0 Yes 1 • 9 Any Stranger Victims No 0 Yes 1 • 10 Any Male Victims No 0 Yes 1 • Add up scores from individual risk factors for Total Score • 0-1 = low risk, 2-3 = moderate-low, 4-5 = moderate-high, 6+ = high

  33. Structural Clinical Guides

  34. Sexual Violence Risk-20 (SVR-20)Boer, Hart, Kropp, & Webster, 1997 • This is a 20 item guide for assessing violence risk in sex offenders. Eleven items deal with Psychosocial Adjustment, 7 with Sexual Offences and 2 with Future Plans. Scoring is based on a N (definitely not present), ? (perhaps present), or Y (definitely present) scale with allowance for changes over time. Little is currently known about its effectiveness as a predictive device. Its main current usefulness lies in its ability to help structure clinical assessments.

  35. Structured Assessment of Violence Risk in Youth (SAVRY)Bartel, Borum, & Forth, 1999 • This is a violence risk assessment scheme designed to assess risk for violence in adolescents. It consists of 10 historical variables, 8 social/contextual variables, 7 individual/clinical variables and 6 protective variables.

  36. HCR-20Webster, Douglas, Eaves, & Hart, 1997 • Consists of 20 items. There are 10 historical variables, 5 clinical variables, and 5 risk management factors.  Each item is scored as 0 (not present), 1 (possibly present) or 2 (definitely present) to yield a score out of 40.

  37. HCR-20 Cont… • It includes variables that capture relevant past, present, and future considerations. It can be regarded as an important first step in the risk assessment process. The manual provides information about how and when to conduct violence risk assessments, reviews the research on which the risk factors are based, and suggests key questions which should be addressed when making judgments about risk.

  38. Spousal Assault Risk Assessment Guide (SARA)Kropp, Hart, Webster, & Eaves, 1995 • This is a a 20 item set of risk factors for use in the assessment of spousal assault. It can be used to help gauge risk of future violence in men arrested for spousal assault.

  39. Gather information by interviewing offender, victim, reviewing documents, etc • Score items either as being present (yes), possibly or partially present (?), or absent (no). • Speculate about the kinds of intimate partner violence the person might commit and plausible scenarios

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