ASSESSING AND MANAGING RISK OF VIOLENCE IN SECURE SETTINGS:

The use of case formulation, functional analysis and behaviour management

Danielle Matsuo | State-wide Manager Programs

Corrective Services NSW

Session overview

• Brief overview of violence risk assessment

• Formulation & Functional analysis

• Evaluating change

• Behaviour management plans

Where do we start?

• Broadly:

– Who is the person in front of you?

– How have you conceptualised the reasons why they are behaving the way they are?

– How can you affect behaviour change?

Violence risk assessment tools

• So which violence risk assessment tool should I use?

– Level of Service Inventory – Revised (LSI-R)

– Historical Clinical Risk scale (HCR-20)

– Violence Risk Scale (VRS)

– Hare Psychopathy Checklist Revised/Screening Version (PCL-R/PCL-SV)

– Violence Risk Appraisal Guide (VRAG)

Violence risk assessment tools – meta-analyses

• Campbell, French & Gendreau (2009) used 88 studies from 1980-2006

– Instruments comprised mainly of dynamic risk factors generated strongest effect sizes; third generation better prediction than second

– No one tool stood out – the LSI-R was equivalent to the PCL-R in predictive validity and to a lesser degree with the HCR-20 and SIR

Violence risk assessment tools – meta-analyses

• Yang, Wong & Coid (2010)

– Extracted from 28 studies from 1999-2008 using 9 different assessment tools

– Overall results demonstrated all 9 tools predicted at above-chance levels and no one tool predicted violence better than another (effect sizes = .51-.79; AUC = .65-.71)

– PCL factor 1 scores were significantly worse compared to total scores – implications for treatment

Violence risk assessment

• Yang, Wong & Coid (2010) conclude the selection of a tool should be based on what other functions it can perform rather than its predictive efficacy per se (e.g. identify treatment targets; risk management plan)

– Could be concluded that “after five decades of the development of risk prediction tools the evidence increasingly suggests the ceiling of predictive efficacy has been reached with the available technology”

• Risk assessment research has identified many potential causes of violence however understanding causal relationships and risk predictors (and protective factors) requires more work

What is ‘Case Formulation’ and how is it relevant?

Why has person A engaged in behaviour X at this time?

• Formulation is the combination of the individuals distal (background’ or ‘predisposing ) and proximal (short term’ or ‘situational) factors into a provisional, hypothesis testing framework.

• The formulation must be brief with the aim of helping the assessor provide treatment and management guidelines/recommendations

Functional Analysis = A:B:C

1. Describes the precise triggers of a client’s behaviour, with special emphasis on those that may be modified as part of a treatment program.

2. The key to identifying the precise determinants/triggers is to remember each behaviour serves a function in a particular context.

3. It is based on the belief that problems are the result of biological make-up, a person’s learning history and current situational influences:

Important principles1. Examine triggers that maintain the problem behaviour

and what maintains the non-occurrence of more adaptive behaviours.

2. Problem behaviours can be viewed as

a failure to learn adaptive behaviours, or

learning maladaptive behaviours to satisfy this function.

The task of treatment becomes either (a) reduce the functional value of the maladaptive behaviour or (b) facilitate more adaptive means of achieving the same purpose.

TARGET BEHAVIOURS to decrease1. Reduction in use of knock up system

Covering of cell cameras

TARGET BEHAVIOURS to increase1. Stress management and coping strategies

whilst in cell

Identifying the ‘target behaviour/s’:

Identifying the ‘target behaviour/s’:

• The first step is to gather information about the presenting behaviour so as to describe its:

– Nature/severity

– Target(s)

– Temporal characteristics (duration, frequency, when commenced and terminated)

– Contextual characteristics (time(s) of day, location, whether group or solo activity, etc.)

Key steps in functional analysis• Identify ‘risk’/facilitating factors and

‘protective’/inhibiting factors’.

• Also examine risk and protective factors in framework of distal factors, and proximal factors.

• Risk/protective factors can occur at the level of the individual and the social/environmental context.

Important to note that presence of risk factors does not guarantee behaviour will occur, just as the presence of

protective factors does not guarantee behaviour will not occur.

Multi Sequential Functional Analysis (MFSA)Gresswell & Hollin (1992)

A : B : C

A : B : C

A : B : C

MFSA Structure for each Target Behaviour

Antecedents: what is contributing to the behaviouroccurring?–What are the relevant ‘risk’ (facilitating) factors? –What are the relevant ‘protective’ (inhibiting) factors?

Behaviour: what is the target behaviour?

Consequences: what is contributing to the behaviourbeing maintained? –What are the relevant ‘risk’ (facilitating) factors? –What are the relevant ‘protective’ (inhibiting) factors?

MFSA should also facilitate the identification of offence paralleling behaviours

Assessment & Classification of Function (ACF)Daffern, Howells & Ogloff (2006; 2008)

• Aggressive behaviour may serve several functions

• ACF eliminates the need to distinguish external (environmental) from internal causes of behaviour - aggression is most often a consequence of the individual’s perception of environmental events

Assessment & Classification of Function (ACF)

1. Demand avoidance2. To force compliance3. To express anger4. To reduce frustration5. To enhance status6. Compliance with instruction7. To obtain tangibles8. To reduce social distance9. To observe suffering

Table 1: Percentage of aggressive behaviours towards staff and patients in which each purpose was evident

Purpose % aggressive behaviours towards staff

% aggressive behaviours towards patients

Demand avoidance 43.9 6

Force compliance 46.9 12

Express anger 72.8 86.5

Reduce frustration 64.4 36.1

Enhance status 25.1 54.1

Compliance with instruction

2.3 6.8

Obtain tangibles 12.2 15.8

Reduce social distance 9.9 5.3

Observe suffering 3.6 5.3

Evaluating Change

• Evaluating change requires a broad focus:

I. Offence Paralleling Behaviour (OPB/OAB)

II. Pro-social Adaptive Behaviour (PAB/ORB)

III. Detection Evasion Skills (DES)

IV. Unique Custodial Reactions (UCR)

V. Offence Paralleling Behaviour versus general criminal tendencies

Offence paralleling behaviour

OPB (or OAB’s) may occur before or after an offence of relevance

‘a behavioural sequence incorporating overt behaviours (that may be muted by environmental factors), appraisals, expectations, beliefs, affects, goals and behavioural scripts that is functionally similar to behavioural sequences involved in previous criminal acts’

Daffern et al. (2007). Refining the definition of offence paralleling behaviour. Criminal Behaviour and Mental Health, 17, 265-273.

Are the current behaviour/s relevant to offending behaviours?

Not all topographically similar behaviours observed in custody are offence paralleling or offence analogue

• Problem behaviours may arise in the context of unique environmental factors and transient psychological factors.

Some problematic and criminal behaviour may only be tenuously related to previous offending.

• These may reflect general criminal propensities indicating risk for criminal behaviour without being offence paralleling.

• The OPB or OAB frameworks promote comparison of two or more sequences of behaviour to determine similarity/relationship to offending behaviour:

– Similarity is determined by comparing functional analyses-this is the starting point.

– As such, an adequate functional analysis is a prerequisite for OPB assessment.

How do I know if there is sufficient similarity in behaviours to be offence paralleling?

• What aspects of the sequence are important?

1. Only with continuity in “psychologically active” features will behaviour be maintained across environments (Mischel, 2004); Mann, Hanson & Thornton (2008) also talk about this as “psychological meaningful” risk factors

How do I know if there is sufficient similarity in behaviours to be offence paralleling?

2. Understand which social cognitive variables are causal - the General Aggression Model (Anderson & Bushman, 2002) provides guidance for this task:

Activated schemas Aggressive scripts Hostility Functional rather than topographical

similarity

Challenges…

• OPB framework may only be useful for those with entrenched, consistent and idiosyncratic patterns of offending???

• Planned or offence/goal driven acts (e.g., sexually sadistic or instrumental), may show greater consistency than reactive acts- as such OPB framework may be better for these types of offences and offenders.

Evaluating Change

• Regular

• Collect data

• Important to evaluate in light of aims i.e. the behaviour(s), not global personality transformation

• Some questions in evaluating change:

– Duration of problems relative to positive change

– Relative frequency

– Exposure to triggers, contexts etc.

– Generalised across contexts

– Others..

Basic functions of Behaviour Management Plans

• Describe or identify problematic behaviour

• Provide consistent responses from staff / system

• Provide clear guidelines for expected behaviour for the offender

• Identify the roles of those involved

• Outline appropriate consequences for both appropriate and inappropriate behaviour

• Offer an opportunity for reviewing progress / regress

Factors to be considered in developing the plan

• Overall goal of the plan

• What is the offenders case plan?

• What is operationally feasible?

• How much detail, is too much detail?

• Language…..

• When will the plan be reviewed?

Behaviour Management Plan

• Used where there are acute problematic behaviours

• Seeks to reduce inconsistent staff responses

• Provides clear links between specific behavioural problems and responses from staff

• Regular reviews to identify changes in behaviour

Expectations of Behaviour Management Plans

• Plans need to be realistic for the individual• Reductions in:

– Frequency of behaviour– Severity of behaviour– Duration of behaviour

• Increase in:– Periods of appropriate behaviour– Engagement in ‘normal’ activities

QUESTIONS

Danielle.Matsuo@dcs.nsw.gov.au