Hi Anne: I have been working in Forensic Psychiatry in Toronto (Canada) for more than two years now. Conducting risk assessments is an integral part of my role as a Case Manager in the Forensic Psychiatry program (now getting better known as the "Law and Mental Health Program (LAMHP"). More specifically I work with outpatients after they have cascaded down from higher security levels, and are considered safe to live in the community. As a case manager I wear at least two hats, the first as a clinician for whom community/public safety is paramount; and a second hat focusing on psychosocial rehab issues. I work within a program management model and am the OT for the LAMHPs outpatient service. In my OT role I focus on functional assessments, vocational assessments, group work, and work that is generally done by OTs in most psychiatric settings. The uniqueness of the OT role in the Forensic Psychiatric system flows from the fact that risk management is given precedence over rehabilitation issues. This and the fact that clients are involuntary poses unique clinical dilemmas for the OT.
Risk assessment/management is not delivered through OT interventions, though my perspective of the client is informed by an OT model of practice like the Canadian Model of Occupational Performance. In fact OT interventions are delivered through a risk management framework. For this reason risk assessments are common to all clinicians regardless of the discipline they come from, whether it is a Social Worker, an RN, an OT etc. The risk assessments that I routinely use are the following two: 1. HCR-20 The H stands for Health, C stands for Clinical, and the R stands for Risk. I don't have the manual on hand with me right now, so I can't give you the names of the authors. 2. Level of Service Inventory (Revised), better known as the LSI-R; again I don't have the manual on hand, so I can't give you the names of the authors right now. There is one other assessment that undergirds the risk management of clients termed "mentally disordered offenders". This assessment is known as the Violence Risk Appraisal Guide (VRAG), which incorporates within it the Psychopathic Checklist - Revised (PCL-R). This assessment score provides an idea in percentage terms of the chances of a mentally disordered offender recidivating (reoffending) over a period of 10 years. However, I am not trained to administer the VRAG, so it is administered typically by Psychometrists under the supervision of a Psychologist. My description of the VRAG given here is a relatively oversimplified one. These are pretty much the Forensic Risk Assessments I am aware of. It is possible that OTs working in Forensic Psychiatry settings in the U.S. may be using a different battery of assessments. If you can wait till next Monday, I could give you the names of other OTs working in Forensic Psychiatry in other countries, including possibly the U.S. For the time being you might find SOME of the references given below of some use. The first reference based on a study by Dr. Farnworth is a relatively recent one, possibly published in an AJOT issue during the year 2000. She had been extremely helpful to me when I was researching Forensic Psychiatry from an OT perspective, in preparation for my job interview. Feel free to contact me off-list for any further information. Good luck with your project, Best wishes, Biraj Khosla OT - Reg. (Ontario) Given below is the list of references: Time Use and Leisure Occupations of Young Offenders, AJOT; by Louise Farnworth (my apologies I don't have the proper reference information on this article. But I would look for this article first.) Abrams, K.M., & Robinson, G.E. (1998). Stalking Part I: An Overview of the Problem. Canadian Journal of Psychiatry, (43), 473-476. Abrams, K.M., & Robinson, G.E. (1998). Stalking Part II: Victims� Problems With the Legal System and Therapeutic Considerations. Canadian Journal of Psychiatry, (43), 477-481. Best, D. (1996). The Developing Role of Occupational Therapy in Psychiatric Intensive Care. British Journal of Occupational Therapy, (59), 161-164. Craik, C. (1998). Occupational Therapy in Mental Health: A Review of the Literature. British Journal of Occupational Therapy, (61), 186-192. Duncan, J.C. & Rogers, R. (1998). Medication Compliance in Patients with Chronic Schizophrenia: Implications for the Community Management of Mentally Disordered Offenders. Journal of Forensic Sciences, (43), 1133-1137. Garner, R., Butler, G., & Hutchings, D. (1996). A Study of the Relationship between the Patterns of Planned Activity and Incidents of Deliberate Self-Harm within a Regional Secure Unit. British Journal of Occupational Therapy, (59), 156-160. Garner, R. (1995). Prevocational Training within a Secure Environment: A Programme designed to Enable the Forensic Patient to Prepare for Mainstream Opportunities. British Journal of Occupational Therapy, (58), 2-6. Lamb, R.H., Weinberger, L.E., & Gross, B.H. (1999). Community Treatment of Severely Mentally Ill Offenders Under the Jurisdiction of the Criminal Justice System: A Review. Psychiatric Services, (50), 907-913. Lloyd, C. (1995). Trends in Forensic Psychiatry. British Journal of Occupational Therapy, (58), 209-213. Lloyd, C. & Guerra, F. (1988). A Vocational Rehabilitation Programme in Forensic Psychiatry. British Journal of Occupational Therapy, (51), 123-126. Mason, T. (1998). Tarasoff Liability: Its Impact for Working with Patients who Threaten Others. International Journal of Nursing Studies, (35), 109-114. Strong, S. (1998). Sentenced to Care. Nursing Times, (94)2 , 26-29. Yates, M. & Craddock, E. (1998). Culturally Sensitive Care in a Forensic Setting. Nursing Times, (94)26, 68-69 ANNE COLCLOUGH wrote: > I am a 2nd year student and my project proposal is to be on the > subject of Risk Assessment in Forensic Psychiatry relating to OT. I > have been searching through Journals but articles seem to be thin on > the ground as far as OT in relation to risk assessment. Is there > anyone who has tackled this subject as a research project and if so > could they get in touchThanksAnne > *********��*********** Unsubscribe? Send a message to [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist ** List messages are archived at: http://www.mail-archive.com/[email protected] *********��***********
