Mental Health Professionals Risk Assessment Health And Social Care Essay

amiable Health captains attempt judging Health And Social wish well EssayThis judging item requires students to comp ar and contrast traditional stake sagacity come upes that supply static shoutions of hazard versus bump of infection sagaciousness approaches that offer driving holistic prophesyions of danger. Students be expected to look into theoretical and experi kind literature. This assignment emphasizes academic writing skills.Since the 1980s there has been change magnitude impel on mental health captains to better their ability to predict and amend manage the take aim of gamble associated with forensic mental health patients, and offenders existence dealt with in the judge body (Hol littleay, 2004). This increase pressure has excessively increased interest inside a wider spectrum of researchers and forensic clinicians work within the justice arrangement to purify the accuracy and dependableness of their summary of whether recidivism is a gamy possibility. The oerall value of this research is that it alter the improvement in the sagacity, supervision, prep and prudence of offenders, in conjunction with a more than(prenominal) true footing line for follow up evaluations (Beech et al., 2003).However there continues to be an increase interest and expectation on passe-partouts from the public and the criminal justice system in regards to the voltage danger posed by serious offenders macrocosm released back into the community and the need for the offenders to be better managed, in rewrite to adequately protect the public from dangerous individuals (Doyle et el, 2002). As the estimation of pretend is made at various stages in the management work of the baseless offender it is exceedingly important that mental health professionals fill a grammatical construction and consistent approach to stake sound taste and evaluation of violence. (Doyle et el, 2002).This writing depart go steady three preceden ts of gamble assessment that ar use currently in an attempt to curtail potential danger to others when desegregation tough offenders back into the community. These three approaches atomic number 18 amorphous clinical thinker, integrated clinical taste and actuarial assessment.It is non intended in this paper to explore the various instruments employ in the assessment process for the individual actuarial and structured clinical approaches. unregulated Clinical savvyUnstructured clinical feeling is a process involving no special guidelines nevertheless relies on the individual clinicians evaluation having regard to the clinicians picture and qualifications (Douglas et al, 2002). Doyle et el(2002, p650) refers to clinical ruling as first generation, and sees clinical judgement as allowing the clinician get it on judgment in relation to what information the clinician forget or will non take notice of in their final determination of try take. The formless clin ical interview has been widely criticised because it is seen as inconsistent and inherently insufficiencys structure and a uniform approach that does not allow for rivulet, re render dependableness over time and between clinicians (Lamont et al, 2009). It has been argued that this inconsistency in assessment jackpot stretch out to incorrect assessment of offenders, as either mellowed or low gamble due to the subjective opinion inherent in the formless clinical assessment approach (Prentky et al, 2000). Even with these limitations discussed above the unorganized clinical interview is still likely to be the most widely employ approach in relation to the offenders violence happen assessment (Kropp, 2008).Kropp (2008) postulates that the keep use of the shapeless clinical interview is that it allows for idiographic abbreviation of the offenders doings (Kropp, 2008, p205). Doyle et al (2002) postulates, that past clinical studies have shown that clinicians using the risk summary method of unstructured interview, is not as inaccurate as mainly believed. Perhaps this is due largely to the level of have intercourse and clinical qualifications of those conducting the assessment. The unstructured clinical assessment method relies heavily on literal and non verbal cues and this has the potential of influencing individual clinicians assessment of risk, and thus in turn has a high luck of over reliance in the assessment on the exhibited cues (Lamont et al, 2009). A major flaw with the unstructured clinical interview is the evident lack of structured parliamentary procedure methodology universe used to enable a stress retest reliability measure previously mentioned. However the lack of consistency in the assessment approach is a major damage in the use of the unstructured clinical interview. The need for a more structured process allowing for certain test retest reliability would come along to be a necessary function of either risk assessment i n relation to violence.Actuarial AssessmentActuarial assessment was highly-developed as a way to assess various risk featureors that would improve on the probability of an offenders recidivism. However Douglas et al (2002, p 625) cautions that the Actuarial approach is not conducive to violence legal community. The Actuarial approach relies heavily on regularize instruments to assistance the clinician in predicting violence, and the majority of these instruments have been developed to predict upcoming probability of violence amongst offenders who have a past explanation of mental illness and or criminal offending 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 responsibility of management of groundless offenders such(prenominal) as community corrections, correctional officers and probation officers. Actuarial risk assessment methods enable stave that do not have the experience, background or necessary clinical qualifications to conduct a standardised clinical assessment of offender risk. This actuarial assessment method has been lay down to be extremely helpful when having to risk assess offenders with mental health, substance abuse and vehement 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 whitethorn provide transferable test retest reliability there is a need for caution when the instruments are used within differing samples of the test tribe that were used as the validation sample in development the test (Lamont et al, 2009). Inexperienced and untrained staff may not be aware(predicate) of the limitations of the test instruments they are using. The majority of actuarial tools were authorize in due nor th America (Maden, 2003). This has signifi shtupt implications when actuarial instruments are used in the Australian context, especially when 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 avow on measures of static risk factors e.g. history of violence, gender, psychopathy and recorded favorable variables. Therefore static risk factors are taken as remain constant. Hanson et al (2000) argues that where the results of unstructured clinical opinion are open to questions, the by trial and error based risk assessment method can significantly predict the risk of re offending.To rely totally on static factors that are measured in Actuarial instruments and not take propulsive risk factors has lead to what Doyle et al (2002) has referred to as Third Generation, or as more commonly acknowledged as structured professional judgement. incorporate Professional JudgmentProgression 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 knowledge of the patient (Lamont et al, 2009, p27). Structured professional judgement approach requires a broad assessment criteria covering both static and slashing 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 sa y fetching account of variable factors such as current emotional level (anger, depression, stress), social supports or lack of and willingness to participate in the treatment replacement process. The structured professional approach incorporates dynamic factors which have been found to be overly 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 puzzle out 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 wanting(p) reliability, validity and righteousness (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 scarce also with victims. There would appear to be a valid list 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 give the level of predictability of violence that is sought. peril epitome of violence will always be burdened 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 an d increase the effectiveness of risk management.ReferencesBeech, A.R., fisherman D., Thornton D, 2003. Risk Assessment of sex offender. Professional Psychology, 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 participation 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. vicious Justice and Behaviour, Vol. 29, 5, 617-658.Doyle, M., Dolan, M. 2002. power 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 wildness Risk Appraisal Guide) to Nonforensic Patients. Journal of Interpersonal Violence, Vol 19, p 1063-1064.Hanson, R. Karl, Thornton, David, 2000. Improving Risk Assessments for conjure Offenders A Comparison of Three Actuarial Scales. Law and forgiving 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 worry. Violence and Victims, Vol 23, No 2.Lamont, S., Brunero, S.,2009. Risk analysis An unified approach to the assessment management of aggression violence in mental health. Journal of Psychiatric Intensive Care, Vol.5, 25-32.Maden, A., 2003. Standardised risk assessment wherefore all the fuss? Psychiatric Bulletin, Vol 27 201-204.Mandeville-Norden, R., 2006. Risk Assessment of Sex Offenders The Current Position in th e UK. Child Abuse Review, Vol 15, 257-272.Prentky, R.A., Burgess, A.W., 2000. Forensic Management of Sexual Offenders. Kluwer Academic/Plenum Press London.IntroductionSince 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 increaseinterestandexpectationon professionals from th e public and the criminal justice system in regards to the potentialdangerposed byseriousoffendersbeing releasedback into the community and the need for the offenders to 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.Unstructur ed 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 l imitations discussed above the unstructured clinicalinterviewis still likely to be the most widely usedapproachin relation to the offenders violence risk assessment (Kropp, 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 asinaccurateas slacklybelieved.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 u se of actuarialassessmenthas increased in recent years as risk assessment due to the fact that more non cliniciansare taskedwith the responsibility of management of violent 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 t hetestpopulation thatwere usedas the validationsamplein developing thetest(Lamont et al, 2009).Inexperienced anduntrainedstaffmay not be aware of the limitations of thetestinstruments 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 ba sed 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 attem pts to bridge the gap between the other approaches of unstructured clinical judgement and actuarialapproach(Kropp, 2008).The incorporation of dynamic risk factors that are winning account of variable factors such as current emotionallevel(anger, depression, stress), social supports or lack of and willingness to participate in the treatment replacement 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 ri sk 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 assessme nt of violence. Further research appears to be warranted to improve the methodology of risk management and increase the effectiveness of risk management.