Mental Health Professionals Risk Assessment Health And Social Care Essay

Mental Health maestros Risk perspicaciousness Health And Social C ar EssayThis sagacity item requires students to comp be and differentiate traditional jeopardy sound judgement move upes that offer still prophecys of hazard versus essay judgement accesses that offer dynamic holistic predictions of happen. Students atomic number 18 expected to research hypothetic and empirical literature. This assignment emphasizes academic writing skills.Since the 1980s there has been increased push on mental wellness professionals to modify their ability to predict and punter manage the level of hazard associated with forensic mental health patients, and offenders be dealt with in the justice system (Holloway, 2004). This increased pressure has also increased interest within a wider spectrum of researchers and forensic clinicians working within the justice system to improve the accuracy and reliability of their compendium of whether recidivism is a high possibility. The overa ll survey of this research is that it enable the improvement in the assessment, supervision, planning and attention of offenders, in conjunction with a more reliable viewpoint line for follow up military ratings (Beech et al., 2003). nevertheless there continues to be an increasing interest and expectation on professionals from the mankind and the culpable justice system in regards to the authority danger comprise by serious offenders being released back into the community and the need for the offenders to be better managed, in order to adequately protect the public from dangerous individuals (Doyle et el, 2002). As the assessment of risk of infection is made at various stages in the management process of the violent offender it is highly important that mental health professionals crap a structure and consistent approach to risk assessment and evaluation of frenzy. (Doyle et el, 2002).This paper pull up s seize ons examine three gravels of risk assessment that are u tilize currently in an attempt to reduce potential danger to others when integrating violent offenders back into the community. These three approaches are uncrystallized clinical judgement, structured clinical judgement and actuarial assessment.It is non intended in this paper to explore the various instruments employ in the assessment process for the respective actuarial and structured clinical approaches.Unstructured Clinical sound judgementUnstructured clinical judgement is a process involving no specific guidelines but relies on the individual clinicians evaluation having regard to the clinicians experience and qualifications (Douglas et al, 2002). Doyle et el(2002, p650) refers to clinical judgement as first generation, and sees clinical judgement as allowing the clinician complete discretion in sex act to what selective information the clinician will or will not take notice of in their final determination of risk level. The unstructured clinical interview has been widel y criticised because it is seen as incompatible and inherently lacks structure and a same approach that does not allow for test, retest reliability over time and between clinicians (Lamont et al, 2009). It has been argued that this inconsistency in assessment corporation lead to incorrect assessment of offenders, as either high or low risk due to the subjective opinion inherent in the unstructured clinical assessment approach (Prentky et al, 2000). crimson with these limitations discussed above the unstructured clinical interview is still likely to be the most widely used approach in relation to the offenders violence risk assessment (Kropp, 2008).Kropp (2008) postulates that the continued use of the unstructured clinical interview is that it allows for idiographic synopsis of the offenders behaviour (Kropp, 2008, p205). Doyle et al (2002) postulates, that ancient clinical studies wear shown that clinicians using the risk analysis method of unstructured interview, is not as i naccurate as generally believed. Perhaps this is due more often than not to the level of experience and clinical qualifications of those conducting the assessment. The unstructured clinical assessment method relies heavily on verbal and non verbal cues and this has the potential of influencing individual clinicians assessment of risk, and thence in turn has a high probability of over reliance in the assessment on the exhibited cues (Lamont et al, 2009). A major flaw with the unstructured clinical interview is the apparent lack of structured govern methodology being used to enable a test retest reliability measure previously mentioned. still the lack of consistency in the assessment approach is a major injustice in the use of the unstructured clinical interview. The need for a more structured process allowing for predictable test retest reliability would appear to be a necessary component of any risk assessment in relation to violence.actuarial AssessmentActuarial assessment was developed as a way to assess various risk factors that would improve on the probability of an offenders recidivism. However Douglas et al (2002, p 625) precautions that the Actuarial approach is not conducive to violence prevention. The Actuarial approach relies heavily on standardized instruments to assist the clinician in predicting violence, and the bulk of these instruments take over been developed to predict future probability of violence amongst offenders who have a past history of mental illness and or criminal offend behaviours. (Grant et al, 2004)The use of actuarial assessment has increased in recent years as risk assessment due to the fact that more non clinicians are tasked with the function of management of violent offenders such as community corrections, correctional officers and probation officers. Actuarial risk assessment methods enable provide that do not have the experience, footing or necessary clinical qualifications to conduct a standardised clinical ass essment of offender risk. This actuarial assessment method has been found to be extremely helpful when having to risk assess offenders with mental health, substance abuse and violent offenders. (Byrne et al, 2006). However Actuarial assessments have limitations in the inability of the instruments to provide any information in relation to the management of the offender, and strategies to prevent violence (Lamont et al, 2009). Whilst such instruments may provide transferable test retest reliability there is a need for caution when the instruments are used within differing samples of the test population that were used as the validation sample in exploitation the test (Lamont et al, 2009). Inexperienced and untrained staff may not be aware of the limitations of the test instruments they are using. The majority of actuarial tools were validated in North America (Maden, 2003). This has significant implications when actuarial instruments are used in the Australian context, especially whe n indigenous cultural complexities are not taken into account. Doyle et al (2002) postulates that the actuarial approach is focused on prediction and that risk assessment in mental health has a much broader function and has to be link closely with management and prevention (Doyle et al, 2002, p 652). Actuarial instruments desire on measures of static risk factors e.g. history of violence, gender, psychopathy and recorded social variables. Therefore static risk factors are taken as rest constant. Hanson et al (2000) argues that where the results of unstructured clinical opinion are open to questions, the empirically based risk assessment method can significantly predict the risk of re offending.To assert totally on static factors that are measured in Actuarial instruments and not incorporate dynamic risk factors has lead to what Doyle et al (2002) has referred to as Third Generation, or as more commonly ac friendshipd as structured professional judgement.Structured Professional Ju dgmentProgression toward a structured professional model would appear to have followed a process of evolution since the 1990s. This progression has developed through acceptance of the complexity of what risk assessment entails, and the pressures of the courts and public in developing an expectation of increased predictive accuracy (Borum, 1996). Structured professional judgement therefore brings together empirically validated risk factors, professional experience and contemporary intimacy of the patient (Lamont et al, 2009, p27). Structured professional judgement approach requires a broad assessment criteria covering both static and dynamic factors and attempts to bridge the gap between the other approaches of unstructured clinical judgement and actuarial approach (Kropp, 2008). The incorporation of dynamic risk factors that is to say fetching account of variable factors such as current emotional level (anger, depression, stress), social supports or lack of and willingness to part icipate in the treatment rehabilitation process. The structured professional approach incorporates dynamic factors which have been found to be also significant in analysing risk of violence (Mandeville-Nordon, 2006). Campbell et al (2009) postulates that instruments that examine dynamic risk factors are more sensitive to recent changes that may influence an increase or decrease in risk potential. Kropp (2008) reports that research has found that Structured Professional Judgement measures also correlate substantially with actuarial measures.ConclusionKroop (2008) postulates that either a structured professional judgement approach or an actuarial approach presents the most viable options for risk assessment of violence. The unstructured clinical approach has been widely criticised by researchers for lacking reliability, validity and accountability (Douglas et al, 2002). Kroop (2008) also cautions that risk assessment requires the assessor to have an appropriate level of specialized kn owledge and experience. This experience should be not only of offenders but also with victims. There would appear to be a valid argument that unless there is consistency in training of those conducting risk assessments the validity and reliability of any measure either actuarial or structured professional judgement will fail to contact the level of predictability of violence that is sought. Risk analysis of violence will always be loaded down by the limitation which lies in the fact that exact analyses are not possible, and risk will never be completely eradicated (Lamont et al, 2009, p 31.). Doyle et al (2002) postulates that a combination of structured clinical and actuarial approaches is warranted to assist in risk assessment of violence. Further research appears to be warranted to improve the methodology of risk management and increase the effectiveness of risk management.ReferencesBeech, A.R., Fisher D., Thornton D, 2003. Risk Assessment of sex offender. Professional Psycholo gy, Research and Practice 34 339-352.Borum, R. (1996). Improving the clinical practice of violence risk assessment. American Psychologist, Vol 51, No 9, 945-956.Byrne, J.M., Pattaviana, A. 2006. Assessing the role of Clinical and Actuarial Risk Assessment in an Evidence-Based Community Corrections System Issues to Consider. Journal of Federal Probation, Vol 70, No 2 p64-66.Douglas, K.S., Kropp, P.R., 2002, A prevention-based paradigm for violence risk assessment Clinical and Research Applications. Criminal Justice and Behaviour, Vol. 29, 5, 617-658.Doyle, M., Dolan, M. 2002. craze risk assessment combining actuarial and clinical information to structure clinical judgements for the formulating and management of risk. Journal of Psychiatric and Mental Health Nursing. 9 649-657.Grant, T.H., Rice, M.E., Camilleri, J.A., 2004. Applying a Forensic Actuarial Assessment (the Violence Risk Appraisal Guide) to Nonforensic Patients. Journal of Interpersonal Violence, Vol 19, p 1063-1064.Hanso n, R. Karl, Thornton, David, 2000. Improving Risk Assessments for Sex Offenders A Comparison of Three Actuarial Scales. Law and Human Behaviour, Vol 24, No 1.Holloway, F. 2004. Risk More questions than answers. Invited comment on Psychodynamic methods in risk assessment and management. Advances in Psychiatric Treatment, 10 273-274.Kropp, P.R., 2008, Intimate Partner Violence Risk Assessment and Management. Violence and Victims, Vol 23, No 2.Lamont, S., Brunero, S.,2009. Risk analysis An integrated approach to the assessment management of aggression violence in mental health. Journal of Psychiatric intense Care, Vol.5, 25-32.Maden, A., 2003. Standardised risk assessment Why all the fuss? Psychiatric Bulletin, Vol 27 201-204.Mandeville-Norden, R., 2006. Risk Assessment of Sex Offenders The Current Position in the UK. small fry Abuse Review, Vol 15, 257-272.Prentky, R.A., Burgess, A.W., 2000. Forensic Management of Sexual Offenders. Kluwer Academic/Plenum Press London.IntroductionSin ce the 1980s therehas been increasedpressure on mental health professionals to improve their ability topredictand better manage the level of risk associated with forensic mental health patients, and offendersbeing dealtwith in the justice system (Holloway, 2004).This increasedpressurehas also increased interest within a wider range of researchers and forensic clinicians,working in the justice system to improve the accuracy and reliability of their analysis of whether recidivism is a strong possibility.The overall value of this research is that it allows the improvement in the assessment, supervision, planning and management of offenders, in conjunction with a more reliable base line for follow up evaluations (Beech et al., 2003).However, there continues to be an increasinginterestandexpectationon professionals from the public and the criminal justice system in regards to the potentialdangerposed byseriousoffendersbeing releasedback into the community and the need for the offenders t o be better managed, in orderto adequately protectthe public from dangerous individuals (Doyle et el, 2002). As the assessment of riskis madeat various stages in the management process of the violent offender,it isextremelycrucial that mental health professionals have a structured and consistent approach to risk assessment and evaluation of violence. (Doyle et el, 2002).This paper will examine three models of risk assessment thatare usedcurrentlytoreducepotential danger to others when integrating violent offenders back into the community.These three approaches are unstructured clinical judgement, structured clinicaljudgementand actuarialassessment.It is not intended, in this paper, to explore the various instruments used in the assessment process for therespectiveactuarial and structured clinical approaches.Unstructured Clinical JudgementUnstructured clinical judgement is a process involving no specific guidelines,but relies on the individual cliniciansevaluationhaving regard to the clinicians experience and qualifications (Douglas et al, 2002).Doyle et el(2002, p650) refers toclinicaljudgement as first generation, and sees clinical judgement as allowing the cliniciancompletediscretion in relation to what information the clinician will or will not take notice of in their final determination of risk level. The unstructured clinicalinterviewhas been widely criticised because itis seenas inconsistent and inherently lacks structure and auniformapproachthat does not allow fortest, retest reliability over time and between clinicians (Lamont et al, 2009). Ithas been arguedthat this inconsistency inassessmentcan lead toincorrectassessment of offenders, as either high or low risk due to the subjective opinion inherent in the unstructured clinical assessmentapproach(Prentky et al, 2000). Even with these limitations discussed above the unstructured clinicalinterviewis still likely to be the most widely usedapproachin relation to the offenders violence risk assessment (Kr opp, 2008).Kropp (2008), postulates that the continued use of the unstructured clinicalinterviewallows for idiographic analysis of the offendersbehaviour (Kropp, 2008, p205).Doyle et al (2002) postulates, thatclinical studies have shown,that clinicians using the risk analysismethodof unstructured interview, is not asinaccurateasgenerallybelieved.Perhaps this is due, largely to the level of experience andclinicalqualifications of those conducting the assessment. The unstructured clinicalassessmentmethodrelies heavily on verbal and non verbal cues and this has the potential of influencing individual clinicians assessment of risk, and thus in turn has a high probability of over reliance in the assessment on the exhibited cues (Lamont et al, 2009).A major flaw with the unstructured clinicalinterview,is the apparent lack of structured standardized methodologybeing usedtoenableatestretest reliabilitymeasurepreviously mentioned.However, the lack of consistency in the assessment approach is asubstantialdisadvantage in the use of the unstructured clinical interview. The need for a more structuredprocessallowing forpredictabletest retest reliability wouldappearto be anecessarycomponent of any risk assessment in relation to violence.Actuarial AssessmentActuarialassessmentwas developedtoassessvarious risk factors that would improve on the probability of an offenders recidivism. However, Douglas et al (2002, p 625) cautions that the Actuarialapproachis not conducive to violence prevention. The Actuarial approach relies heavily on standardized instruments to assist the clinician in predicting violence, and the majority of these instrumentshasbeen developedto predict futureprobabilityof violence amongst offenders who have a history of mental illness and or criminal offending behaviours. (Grant et al, 2004)The use of actuarialassessmenthas increased in recent years as risk assessment due to the fact that more non cliniciansare taskedwith the responsibility of management of vi olent offenders such as community corrections, correctional officers and probation officers.Actuarial risk assessment methods enable staff that do not have the experience,backgroundor necessaryclinicalqualifications toconducta standardised clinicalassessmentof offender risk. This actuarialassessmentmethodhas been foundto be extremelyhelpfulwhen having risk assessing offenders with mental health, substance abuse and violent offenders. (Byrne et al, 2006). However, Actuarial assessments have limitations in the inability of the instruments to provide any information in relation to the management of the offender, and strategies to prevent violence (Lamont et al, 2009).Whilst such instruments may provide transferabletestretest reliability, there is a need for caution when the instrumentsare usedwithin differing samples of thetestpopulation thatwere usedas the validationsamplein developing thetest(Lamont et al, 2009).Inexperienced anduntrainedstaffmay not be aware of the limitations of th etestinstruments they are using. The majority of actuarial toolswere validatedin North America (Maden, 2003). This hassignificantimplications when actuarial instrumentsare usedin the Australian context, especially when indigenous cultural complexities are not taken into account. Doyle et al (2002) postulates that the actuarialapproacharefocusedon prediction and that risk assessment in mental health has a much broaderfunctionand has to belinkclosely with management and prevention (Doyle et al, 2002, p 652). Actuarial instruments rely on measures of static risk factors e.g. history of violence, gender, psychopathy and recorded social variables.Therefore, static risk factorsare takenas remaining constant.Hanson et al (2000) argues that where the results of unstructuredclinicalopinionareopento questions, the empirically based risk assessmentmethodcan significantly predict the risk of re offending.To relytotallyonstaticfactors thatare measuredin Actuarial instruments,and not incorporate dynamic risk factors hasleadto what Doyle et al (2002) has referred to as, Third Generation, or as more commonly acknowledged as structured professional judgement.Structured Professional JudgmentProgression toward a structured professionalmodelwouldappearto have followed a process of evolution since the 1990s.Thisprogressionhas developed throughacceptanceof the complexity of what risk assessment entails, and the pressures of the courts andpublicin developing an expectation of increased predictive accuracy (Borum, 1996).Structured professional judgementbrings together empirically validated risk factors, professional experience and contemporary knowledge of the patient (Lamont et al, 2009, p27).Structured professional judgement approach requires abroadassessmentcriteria covering both static and dynamic factors, and attempts to bridge the gap between the other approaches of unstructured clinical judgement and actuarialapproach(Kropp, 2008).The incorporation of dynamic risk factors that aretaking account of variable factors such as current emotionallevel(anger, depression, stress), social supports or lack of and willingness to participate in the treatment rehabilitation process.The structured professional approach incorporatesdynamicfactors, whichhave been found, to be also crucial in analysingriskof violence (Mandeville-Nordon, 2006).Campbell et al (2009) postulates that instruments thatexaminedynamic risk factors are moresensitivetorecentchanges that mayinfluencean increase or decrease in risk potential. Kropp (2008) reports that research has found that Structured Professional Judgement measures alsocorrelatesubstantiallywith actuarial measures.ConclusionKroop (2008) postulates that either a structured professional judgement approach, or an actuarial approach presents the most viable options for risk assessment of violence.The unstructuredclinicalapproachhas been widely criticised by researchers for lacking reliability, validity and accountability (Douglas et al , 2002). Kroop (2008) also cautions that risk assessment requires the assessor to have an appropriate level of specialized knowledge and experience. This experience should be not only of offenders but also with victims.There wouldappearto be a valid argument that unless there is consistency intrainingof those conducting risk assessments the validity and reliability of anymeasureeither actuarial or structured professional judgement will fail togivethelevelof predictability of violence thatis sought.Risk analysis of violence will always be burdened by thelimitationwhich lies in the fact thatexactanalyses are notpossible, andriskwill never be totally eradicated (Lamont et al, 2009, p 31.). Doyle et al (2002) postulates that a combination of structured clinical and actuarial approachesis warrantedto assist in risk assessment of violence. Further research appears to be warranted to improve the methodology of risk management and increase the effectiveness of risk management.