The Scottish High Risk Mental HealthYouth Project (IVY)– Key Findings

andMessages for Practice

Leanne Gregory, Principal Clinical Psychologist, IVYHeather Irving, Social Worker CYCJ/IVY

Nota Scotland Conference29th April 2014

The Challenges

The rest of IVY

Stuart Allardyce Dr Lorraine Johnstone

Our Aims

IVY

The Model

Framework for Risk Assessment Management and Evaluation (FRAME)

http://www.rmascotland.gov.uk/standardsandguidelines/

Structured Professional Judgement

Risk Formulation

Formulation is the summation and integration of the knowledge that is acquired by the assessment process (which may involve a number of different procedures). This will draw on psychological theory and data to provide a framework for describing a problem, how it developed and is being maintained”

Division of Clinical Psychology 2001; cited Johnstone & Dallos (2006)

Risk Formulation

Formulation is not a new or novel concept in general terms; it is used in each of the main models of psychotherapy – behavioural, cognitive-behavioural, psychodynamic, systemic and integrative approaches - these are theoretically guided or model specific forms of formulation.

Risk Formulation

No single theory or model of violence exists

therefore

A pragmatically guided formulation has more utility in risk assessment

4 P’s Approach

• predisposing (i.e., factors in the individual’s past that may increase his proclivity or vulnerability to violence)

• precipitating (i.e., events or circumstances that may trigger the behaviour or disinhibit usual behavioural controls); (motivators, disinhibitors)

• perpetuating (i.e., factors that cause the risk to remain) (impeders, unresolved vulnerabilities)

• protective factors (i.e., aspects of the offender’s functioning or circumstances that moderate the risk)

Who is referring?

25 referrals

1 police

5 health 19 social work

4

11

22

2

1

15

2

13

LOCALITY/BOARD Number

East Dumbartonshire 1

East Lothian 1

Dumfries and Galloway 4

Falkirk 2

Fife 2

Glasgow 2

Highlands 1

Inverclyde 1

Lanarkshire 5

Moray 2

North Ayrshire 1

Renfrewshire 3

Map of Scotland provided courtesy of FreeVectorMaps.com

Demographics – Age & Sex

N= 25Mean age = 15.5Mode = 16Range 12-17Male = 19Female = 6

Accommodation

Domestic Violence

Other Maltreatment

Diagnosed or Suspected Difficulty Number

Anger 7

Anxiety 1

Autism Spectrum Disorder 6

Attachment Disorder 5

Attention Deficit Hyperactivity Disorder 6

Communication Disorder 1

Complex Post Traumatic Stress 6

Deliberate Self-Harm 7

Dissociation 2

Eating Difficulties 2

Emotional Dysregulation 6

Learning Disability 2

Low Mood 2

Oppositional Defiant/Conduct Disorder 2

Psychosis 2

Sleep Difficulties 2

Substance Misuse Difficulties (Alcohol/Drugs) 7

Suicidal Ideation/Action 6

Unusual perceptual experiences 3

MEAN = 4.4

PRIMARY RISK

N = 17Nature of Risk n =

Primary Risk

Fire-setting 1

Interpersonal Violence

10

Self-harm/Suicidality 3

Sexual offences (contact)

5

Sexual offences (non-contact)

1

Victimisation 1

Violent Extremism 1

Interpersonal Violence

Suicide /DSH

Firesetting

Sexual offences

non-contact

Violent Extremism

Victimisation

Sexual offence - contact

Nature of Risk n = Secondary

Risk

Fire-setting 1Interpersonal Violence

3

Self-harm/Suicidality

3

Sexual offences (contact)

0

Sexual offences (non-contact)

1

Victimisation 5Violent Extremism

0

SECONDARY RISK

Victimisation

Suicide /DSH

Firesetting

Sexual offences

non-contact

Interpersonal violence

Comorbid Risks

64%

Level 2

10 offered 9 accepted

Risk Assessment Learning Disability

Personality

Mental Health Diagnostic Review

Emerging Themes

Reflections and Discussion