The Dynamic Risk Assessment and Management System: An Assessment of Immediate Risk of Violence for Individuals with Offending and Challenging Behaviour

Predicting aggression in adults with intellectual disability: A pilot study of the predictive efficacy of the Current Risk of Violence and the Short Dynamic Risk Scale

BACKGROUND

Structured assessments have been shown to assist professionals to evaluate the risk of aggression in secure services for general offender populations and more recently among adults with intellectual disabilities. There is a need to develop intellectual disability sensitive measures for predicting risk of aggression in community samples, especially tools with a focus on dynamic variables.

METHODS

The study prospectively followed 28 participants for up to 2 months to test whether the Current Risk of Violence (CuRV) and Short Dynamic Risk Scale (SDRS) were able to predict verbal and physical aggression in a community sample of adults with intellectual disability.

RESULTS

CuRV and SDRS ratings significantly predicted verbal and physical aggression over a 2-month period.

CONCLUSIONS

The current study supports the use of the CuRV with adults with intellectual disability living in community settings. The CuRV and SDRS are worthy of future development and evaluation in independent investigations.

Psychometric properties of the Dynamic Risk Outcome Scales (DROS) for individuals with mild intellectual disability or borderline intellectual functioning and externalizing behaviour problems

BACKGROUND

The present study examined the psychometric properties of the Dynamic Risk Outcome Scales (DROS), an instrument developed to measure dynamic risk factors in individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) and externalizing (including offending-like) behaviour problems.

METHOD

The sample consisted of 606 clients (86% male) from inpatient treatment wards at a facility for individuals with MID-BIF and externalizing behaviour problems.

RESULTS

The DROS showed an acceptable factor structure, good internal consistency, significant test-retest reliability and fair to excellent inter-rater reliabilities for most subscales and total score. Compared to the Adult Behavior Checklist (ABCL; Achenbach & Rescorla, 2003 Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families), the DROS showed convergent and divergent validity, concurrent and longitudinal validity.

CONCLUSIONS

The DROS is a reliable and valid instrument to measure dynamic risk factors in clients with MID-BIF. Future research on the DROS will focus on the assessment of recidivism and the inclusion of internalizing problems.

The protective scale of the Armidilo-S: The importance of forensic and clinical outcomes

BACKGROUND

The Armidilo has two scales-the risk scale and the protective scale. Research has been confined to the risk scale which appears to predict future incidents with medium to large effect sizes. There have been no publications on the use of the protective scale.

METHODS

The Armidilo was completed on four individuals with IDD who were either moving on from their placement or whose placement was in jeopardy because of new information or altered policies in the organization. The Armidilo was completed in the usual fashion.

RESULTS

Risk and protective results show that for each individual, recommendations could be made that ensured the best outcome. For two participants, restrictive placements were avoided because of the data on protective factors.

CONCLSIONS

The protective scale can be a powerful support for the clinician's case in offenders with IDD. The protective scale should be completed routinely for clinical evaluation.

The Structured Assessment of Violence Risk in Adults with Intellectual Disability: A Systematic Review

BACKGROUND

While structured professional judgement approaches to assessing and managing the risk of violence have been extensively examined in mental health/forensic settings, the application of the findings to people with an intellectual disability is less extensively researched and reviewed. This review aimed to assess whether risk assessment tools have adequate predictive validity for violence in adults with an intellectual disability.

METHODS

Standard systematic review methodology was used to identify and synthesize appropriate studies.

RESULTS

A total of 14 studies were identified as meeting the inclusion criteria. These studies assessed the predictive validity of 18 different risk assessment tools, mainly in forensic settings. All studies concluded that the tools assessed were successful in predicting violence. Studies were generally of a high quality.

CONCLUSIONS

There is good quality evidence that risk assessment tools are valid for people with intellectual disability who offend but further research is required to validate tools for use with people with intellectual disability who offend.

Markers for aggression in inpatient treatment facilities for adults with mild to borderline intellectual disability

In high care settings for persons with intellectual disability (ID) aggressive incidents often occur. Still little is known about factors that are associated with an increased risk for aggressive behavior in clients who are admitted to an inpatient treatment facility. In four inpatient facilities, 108 adults with mild and borderline ID and behavior problems were categorised into three aggressive incidents groups (no, mild, severe) according to their actual aggressive behavior observed for six months. The three groups were compared with regard to background and admission characteristics, psychiatric co-morbidity and emotional and behavioral problems. Results show that antisocial behaviors, behaviors indicative of a lack of impulse control, psychotic behaviors, mood related behaviors, and auto-aggressive behavior increased the likelihood of severe aggression. The three groups did not differ with regard to client and admission characteristics or psychiatric co-morbidity. Behaviors that are predictive of severe inpatient aggression in settings for adults with mild to borderline ID and behavior problems closely resemble those that are distinguished in risk assessment instruments for forensic non-disabled individuals.

Persons with intellectual disabilities in the criminal justice system: review of issues

Although the vast majority of individuals with intellectual disabilities (ID) are law-abiding citizens, there is a small percentage with offending behaviour that is considered antisocial, socially inappropriate, or defined as illegal. It has long been recognised that individuals with ID or mental-health needs who break the law should be dealt with differently from the general population. There have been an increasing number of empirical studies in this area; however, these have been plagued by various definitional and methodological issues. Prevalence estimates of offenders with ID are complicated by diagnostic variations and inconsistencies in the criminal justice process. International studies have shown a large range, from 2% to 40%, depending on methodological approaches. The following review will highlight the salient issues including prevalence of offending, characteristics of offenders, vulnerabilities within the legal system, assessment, and a brief overview of intervention and treatment approaches.

Forensic aspects in people with intellectual disabilities

PURPOSE OF REVIEW

The past few years have seen a growth in research of forensic issues relating to people with intellectual disabilities. This review examines a broad spectrum covering 2005 and 2006, for which articles are already available. Given the diversity of publications, reference will also be made to some of the main articles of 2004 to provide a context.

RECENT FINDINGS

We are now at the stage where people are questioning the existing forensic psychiatry evidence base for people with intellectual disabilities. This review examines the assessment and treatment of three different groups, that is, fire setters, sexual offenders and those with problems of anger and aggression along with service outcome research, the criminal justice system, and a round up of other related research.

SUMMARY

The growth of research in this area has aided the development of assessment and treatment instruments and treatment models for people with intellectual disabilities. This has helped to highlight the specialist and complex nature of this group. The review also looks at services from the point of delivery and the difficulty in research methodology and quantifying outcomes that take into account a changing society and current health inequalities.

Assessment in intellectual disability

PURPOSE OF REVIEW

This review examines an eclectic selection of publications from the past 12 months under the broad heading of 'assessment in intellectual disability'. Being unable to cover all possible publications the authors have concentrated on the assessment of pain (in those with severe intellectual disability), psychopathology, risk assessment and offending, autism, preference and choice, and dementia.

RECENT FINDINGS

Research into assessment has generally taken the form of developing new instruments, or adapting existing ones, or comparing the performance of a range of scales in a certain area. Researchers are using increasingly sophisticated psychometric analyses and refining the nature and purpose of tools for a range of clinical purposes.

SUMMARY

The result of recent effort in this area is better instruments, often developed by experienced researchers who have been working in their chosen area of speciality for some years. It has been a very worthwhile period of extension and consolidation.

The management of aggression care plans: implementation and efficacy in a forensic learning disability service

This article describes the design and implementation of the management of aggression care plans (MOACAP) in a secure service for people with learning disability and severe challenging behaviour. The MOACAP is a five‐part document, which has sections for descriptions of challenging behaviour, escalation patterns of the behaviour, non‐physical interventions, physical interventions and post‐incident briefing.Preliminary evaluations suggest that use of MOACAP leads to a reduction in aggressive incidents in the service. The approach should also be relevant to other forensic, mental health and challenging behaviour services and brain injury units. The MOACAP may also be relevant to services that will be affected by the National Institute for Clinical Excellence (NICE) and the National Institute for Mental Health in England (NIMHE) guidelines on the short‐term management of disturbed (violent) behaviour.