Search results

The assessment and management of risk towards others is an integral part of clinical practice, particularly in forensic and other psychiatric settings. Version 3 of the HCR-20 is the latest version of a comprehensive set of professional guidelines based on the Structured Professional Judgement model. It is the most widely used and best validated tool available to assess risk of violence; however, clinicians perceive it as an additional task with limited clinical usefulness, which requires undergoing expensive training and takes considerable time to implement. The paper aims to discuss these issues.

Training was delivered to 148 clinicians to improve perceptions with regard to risk formulation and the HCR-20v3 as an effective and clinically useful tool in generating individual and robust care plans to minimise risk of violence.

Results indicated significant score increase post-training, indicating higher regard for the HCR-20 in terms of its usefulness, anticipated impact upon working, anticipated impact upon managing risk, ease of completion and perceived relevance to clinical practice. This was also consistent with qualitative feedback indicating improved risk management and care planning with reference to how learning would support respective roles. Feedback also highlighted the added value of certain aspects of the training provided, which may be useful to consider when designing HCR-20 training packages.

This study demonstrates the importance of engaging clinicians in bespoke training on the practicalities of HCR-20 completion and the fundamentals of risk formulation.

This study highlights the importance of incorporating a training package for staff of all disciplines in changing perceptions of risk management tools and thus their use in the practical management of violence. The useful aspects of training may assist changing perceptions of the role that risk formulation and the HCR-20v3 play in the assessment and management of violence.

This research suggests that if this can be done successfully, it may lead to a change in the perception of the role that the HCR-20v3 can play in assessing risk of violence and generating meaningful management plans to reduce the future likelihood of violence.

There are substantive gaps in the literature in relation to older women in prison This chapter will utilise the risk, need and responsivity framework to develop a more comprehensive understanding of the characteristics attributable to this small but significant group. To date most research into the experiences of older women in prison consist of relatively small-scale qualitative research. Wahidin (2004) argues that this group may have been overlooked and broadly neglected because of a latent form of ageism which has served to permit organisational oversight (p. 10). While others reflect on the difficulties posed by such small numbers and subsequent lack of statistical power resulting in a dearth of research (Omolade, 2014).

Britton and Jensen (2003, p. 2) emphasised a well-documented dichotomy when they stated that a ‘women’s violence stands in stark contradiction to prevailing norms around (white) femininity’. For older women, a crude lack of intersectionality and denial of reality is combined with the systemic male bias of the criminal justice system (Kerr & Shackel, 2018), limited acknowledgement of variability (Chrisler & Palatino, 2016) and how these factors are considered in terms of risk, need and responsivity (Wilson-Smith & Carr, 2017).

This chapter will utilise these considerations as a foundation together with theoretical underpinnings of development, socialisation and incarceration, in order to further develop knowledge while emphasising the hidden challenges of older women in prison and identifying areas requiring urgent development.

This paper aims to illustrate by means of a case study how HKT-R Spider reference profiles of recidivists and non-recidivists may be supportive in leave decisions.

The authors describe what is known for recidivists and non-recidivists about changes in risk factors during treatment. The HKT-R Spider is introduced. By comparing a case study to group profiles, the authors illustrate how discussions about leave may be rationalised. From a study among 278 patients to explore the profiles, the authors report the inter agreement, and differences between recidivists and non-recidivists of the clinical HKT-R factors. Intra correlation coefficients, Wilcoxon signed ranks test and independent and paired t-tests are applied. To explore which combination of factors are discriminating between both groups, the authors also performed logistic regression analyses at six treatment stages.

The inter agreement reliability and internal consistency of the clinical HKT-R scale were acceptable to good in all six stages studied. The HKT-R Spider and profiles can be used to assist in evidence-informed decision-making about leave.

Globally recidivists had somewhat higher levels of clinical risk factors at all six decision moments, but the interpretation of HKT-R Spiders profiles should always be adapted to the individual’s context.

Applying the HKT-R Spider reference profiles on individual cases may structure and rationalize discussions lead to decisions based on clinical facts.

The purpose of this paper is to conduct a preliminary evaluation of a Violent Offender Treatment Program (VOTP) adapted for use in a medium secure unit (MSU). The patient population is adult male mentally disordered offenders.

Patient outcomes are explored using the Reliable Change Index and Clinical Significance Criterion. Outcomes are assessed using VOTP facilitators violence risk assessment (VRS), multi-disciplinary team violence risk assessment (HCR-20 and GAS-V), and patient self-report using two measures (FAVT and STAXI-2).

There was evidence of improved outcomes for some participants in some areas related to risk of violence.

Consideration is given to using varied risk assessments to evaluate outcomes of an adapted VOTP for a MSU.

There is limited development and evaluation of psychological treatment programmes that aim to reduce risk of violence for male offenders within MSUs. Outcomes of this evaluation could influence treatment delivery and evaluation in other services.

The purpose of this paper is to describe family intervention (FI) with four families in which the service user is under the care of forensic mental health services. There is a focus on identifying how systemic practice is used or adapted in working with families who have a family member who has presented risk and caused harm.

Four case studies are used to provide a basis for the exploration of commonalities in practice between the cases and the utility of FI within forensic services, which have the dual purpose of promoting mental health recovery and reducing offending/risk behaviour.

Family work can be a key healing tool in the recovery journey of forensic service users and their families. An integrated systemic and psycho-educational FI approach was found to be appropriate in the cases described. Issues particular to forensic services are identified; these include the role of safety planning; the function of talking about the history of trauma in the family including the impact of offending behaviour; mediating difficult relationships between family members and professionals; and overcoming barriers to having difficult and emotive conversations.

The absence of outcome assessments limits the findings to observational data and self-reported experiences from the authors.

FI can be safely and effectively used within forensic settings, facilitated by practitioners competent in working with trauma and complexity, as an integrated component of the therapeutic treatment.

There are recognised barriers to the provision of FI within forensic settings, with limited research regarding the application of such therapies with forensic patients and their families. This paper adds to the small pool of knowledge regarding useful applications of FI in such settings.

The purpose of this paper is to understand the constructions of female-perpetrated intimate partner violence (IPV) among postgraduate (PG) students studying and preparing for a career in forensic psychology. A social constructionist methodological framework was adopted in order to explore students’ dominant discourses surrounding gender and IPV. Of particular interest was how female perpetrators of IPV within heterosexual relationships were constructed and subsequently positioned by students in terms of social and gender identity. Implications regarding future practice for graduates in relation to risk assessment and treatment interventions are discussed.

Six female PG forensic students took part in a qualitative focus group and discussed their understanding of IPV and views regarding perpetration. Focus group members were also asked to discuss details of a vignette depicting a violent relationship where gender identity was purposefully removed. The focus group interview data were analysed using Foucauldian discourse analysis.

The students constructed IPV as a behaviour that was predominantly perpetrated by men towards women. Students acknowledged that female-perpetrated IPV occurred; however, such behaviour was constructed as non-threatening, and subsequently, less serious than male-perpetrated IPV. Moreover, the analysis revealed that the overall discourses drawn on by the students projected a feminine representation of female IPV that positioned women as emotionally unstable, vulnerable and acting in self-defence.

Students’ constructions of female-perpetrated IPV appeared to minimise aggression. It is argued that the positioning of women in terms of vulnerability serves to undermine any responsibility for perpetrating violence among this group of students. In terms of implications for practice, oversimplified assumptions in relation to gendered constructions have the potential to inhibit female IPV from being recognised as a serious form of aggression, and it is argued that this could potentially bias assessments of risk leading to an under-estimation of threat. Female perpetrators of IPV may subsequently receive inadequate supervision and intervention and inadequate levels of victim safety planning may occur. These gendered constructions may also inhibit male victims from seeking help and help being offered.

This paper highlights the importance of understanding constructions of IPV among students who are preparing for careers as a forensic psychology practitioner. Female IPV is clearly challenging. With respect to the social construction of IPV, the students in this study made many assumptions about female identity by linking this to feminine and essentialist ideas that constrain women as emotionally and biologically vulnerable. Such findings raise questions about whether future training and study programmes are equipped to critically challenge the dominant discourses and subsequent constructions of gender and IPV. Thus, this study has highlighted the need for further research around constructions of IPV in this field of work in order to fully examine potential knowledge gaps in training and teaching of future forensic practitioners.

The purpose of this paper is to outline the development, structure and implementation of the Choices, Actions, Relationships and Emotions (CARE) programme.

This paper will present some of the background to the programme, its aims, structure and delivery methods and the nature of the treatment population to date. It will also reflect on some of the lessons learnt through the development and implementation of the programme and the challenges faced in evaluating its impact. Plans for its future evaluation and development are discussed.

Female offenders represent a distinct group with particular treatment and responsivity needs. These have traditionally been accommodated in programmes developed for male offenders, adapted slightly to meet their needs. CARE represents a distinct approach, designed specifically for the needs of female offenders with a history of violence and complex presentations.

CARE is a relatively new programme and this is the first paper to outline its structure and content.

The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups.

A cross-sectional survey design of n=45 mental health clinicians (psychiatrists, psychologists, and others) working in a secure hospital responded to an online survey about their risk assessment practice.

HCR-20 Historical and Clinical subscales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women, respectively.

This was an exploratory survey and results should be verified using larger samples.

Clinicians judge recent violence and Clinical items most important in inpatient violence risk assessment but may overvalue historical factors. They believe that recent violent behaviour is important in risk formulation; however, while recent violence is an important predictor of future violence, the role it should play in SPJ schemes is poorly codified.

It is important that risk assessment is accurate in order to both protect the public and to protect patients from overly lengthy and restrictive detention.

Despite the vast number of studies examining the predictive validity of tools like HCR-20 very little research has examined the actual processes and decision-making behind formulation in clinical practice.

Despite the rising number of females in forensic psychiatry, research about their characteristics remains limited and is currently lacking in Belgium. Optimizing knowledge about the characteristics of these women will lead to a better understanding of this specific group. Therefore, the aim of the study was to gain insight into the characteristics of female forensic psychiatric patients in Flanders, Belgium.

A case file study was carried out in the forensic psychiatric hospital Sint-Jan-Baptist in Zelzate, Belgium. The files of female patients admitted in the period 2006–2017 were analysed (N = 82) based on a checklist including sociodemographic, mental health care and offence-related characteristics as well as historical risk factors.

The study revealed that female patients have been confronted with a large number of adverse experiences during both childhood and adulthood, were frequently diagnosed with borderline personality disorder and usually had an extensive mental health treatment history with many drop-outs. The majority of the female patients had committed violent offences towards relatives.

These findings are similar to those of other jurisdictions and highlight the importance of a gender-responsive treatment. This kind of treatment should include trauma-informed care, gender-sensitive risk-assessment and adapted versions of dialectical behavioural therapy and schema-focussed therapy. Additionally, treatment should focus on breaking the intergenerational transmission of violence and mental health problems by targeting parenting skills.

To the best of the authors’ knowledge, this is the first study that scientifically scrutinized the detailed characteristics of female forensic psychiatric patients in Flanders, Belgium. Recommendations for gender-responsive treatment and directions for future research are discussed.

Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this population, through informing services and interventions which prevent behaviours reaching a forensic threshold. The paper aims to discuss this issue.

The Historical Clinical Risk Management-20, Version 3 assessments of a cohort of 84 inpatients within a forensic ID service were analysed for this study, with a particular emphasis on items concerned with the age at which antisocial or violence first emerged.

For most participants, violent or antisocial behaviour was first observed in childhood or adolescence. The study also highlighted a smaller subgroup, whose problems with violence or antisocial behaviour were first observed in adulthood.

The study findings suggest that targeted services in childhood and adolescence may have a role in reducing the offending behaviour and forensic involvement of people with ID. This has implications for the service models provided for children and adolescents with ID with challenging or offending behaviour.