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Background: Violence in inpatient settings is recognised as a worldwide issue, with inpatient intellectual disability services having higher rates than other mental health settings. Violence results in injury and illness, lack of confidence in the organisation and staff burnout. These combined effects have a negative impact on the ability of services to provide therapeutic environments. Attempts to manage violence tend to focus on the individual. This is only one part of the solution. Situational risk factors for violence within secure settings can be identified and modified to reduce violence rates. The role of situational risk factors in rates of institutional violence requires consideration in addition to individual patient risk assessment and management. Aims: To discuss an illustrative case study of a ward experiencing high levels of violence, resulting in staff burnout and low morale. To describe how assessing and addressing the relevant situational risk factors led to demonstrable reductions in violence and improvements in the service provided. Methods: This case study demonstrates the practical application of assessing and managing situational risk factors for violence in a locked intellectual disability ward in order to effectively reduce levels of violent incidents. A description of the violence and critical issues faced by the ward is provided, noting key elements of the timeline of events and the application of the Promoting Risk Intervention by Situational Management (PRISM) process to address these. Results: The PRISM protocol enabled a comprehensive assessment and understanding of situational factors relevant to the violence rates in the ward. The recommendations following the analysis enabled the management team to identify areas for immediate and long‐term action. Practical steps to address issues such as improving soundproofing were implemented quickly whilst other issues required changes over the longer term. Significantly, reduced levels of violence were observed within a 2‐month period of immediate steps being taken, with further gains achieved over the longer term. Conclusion: This paper provides the only example of the use of the PRISM protocol in an intellectual disability inpatient setting. The reduction in violence seen in this unit provides 'real world' evidence that addressing situational factors for institutional violence can be effective in intellectual disability inpatient settings, with beneficial outcomes for patients and staff. Whilst individual patient risk assessment and risk management are key components of forensic mental health care, situational risk factors for violence are highly relevant to rates of violence within secure care settings. Structured assessment of situational risk factors should be considered when inpatient settings experience persistent high levels of violence. Further research on the impact of assessing situational risk factors in forensic mental health settings (including intellectual disability services) would help to develop the existing evidence base. [ABSTRACT FROM AUTHOR]

The authors elucidate Johnstone's ABC Formulation Framework and 6D model for understanding and intervening with young people who display distressed behaviour. This approach equips care professionals with a theoretically informed method of identifying unmet needs that drive harmful behaviours. By simplifying complex psychological theories, the approach empowers practitioners to apply best practices effectively. The authors describe the implementation of this framework in the secure care context at Rossie Young People's Trust, providing a clear account of its transformative impact on both staff and young people. [ABSTRACT FROM AUTHOR]

The RSVP is a set of structured professional judgment guidelines for assessing risk of sexual violence. We investigated the interrater reliability (IRR) of judgments made using the RSVP in a multidisciplinary forensic-clinical context. Raters were 28 forensic mental health and intellectual disability professionals with diverse training and experience. They used the RSVP to evaluate six case vignettes that varied with respect to offense characteristics, clinical complexity, and level of risk. The IRR of ratings for individual risk factors was generally fair. There was a good level of interrater reliability on Summary Judgments and Supervision Recommendations. Interrater reliability was highest when used by professionals who were highly trained in forensic risk assessment. On average, professionals with lower levels of specialist training agreed less with their colleagues and experts, and provided higher estimations of sexual violence risk. Lower levels of agreement were found in cases with moderate levels of complexity and risk. The RSVP can be used to make judgments of risk with adequate levels of interrater reliability. However, this is dependent on the training and expertise of professionals who use the tool. Methodological strengths and limitations are considered, followed by a discussion of implications for training, practice, and future research. [ABSTRACT FROM AUTHOR]

The extant research demonstrates that the combination of personality disorder and violence implies severe dysfunction, poor responsivity to treatment, more serious and persistent violence, and higher recidivism rates. Thus, it comes as no surprise that personality disorder is included in many of the available guidelines for assessing and managing violence. Unsurprisingly, the combination of personality pathology and violence frequently presents the greatest challenge to services, even those in whom violence risk assessment and management practice is established and routine. Conceptual and methodological limitations pervade the literature and a full explanation of the nature of the association between personality pathology and violence is still awaited. Furthermore, current approaches to risk assessment fail to provide a systematic framework for assessors to use to make sense of the heterogeneous presentations typically found in individuals with personality disorder and violence. In this paper, formulation is proposed as the critical process linking risk assessment and risk management. It is argued that assessors must move beyond a simple listing of risk factors and should instead produce detailed, comprehensive, individualized explanations of risk potential and risk management needs. Personality disorder is used in this paper to illustrate the important contribution of formulation to the risk assessment process, and in doing so, the link between personality pathology and violence is explored. [ABSTRACT FROM AUTHOR]

Tackling violence in prisons and forensic institutions is a key role for mental health professionals. Major strides have been made in the last twenty years in the evaluation and management of individual risk factors. However, the understanding of situational-or institutional-risk factors is less well developed. This special section considers PRISM. PRISM is a set of structured professional guidelines for assessing and managing the risk of violence in institutions. In contrast to better known forms of structured judgment approaches the focus of concern is the functioning of the institution, not the individual patient or prisoner. In this introductory paper we describe the development of PRISM, its conceptual and empirical base, and demonstrate and propose a range of applications for the approach. We argue that PRISM can have value in a range of important practical tasks, but also, PRISM can be used to enhance our theoretical understanding of the risk processes that underpin institutional violence. [ABSTRACT FROM AUTHOR]

PRISM: Promoting Risk Intervention by Situational Management (Johnstone & Cooke, 2008) provides a systematic process for evaluating a range of situational risk factors known to influence institutional violence in prisons and secure hospital settings. This paper reports on findings from the first multiple case-study evaluation using this protocol. We applied PRISM in the Scottish Prison Service (SPS). The SPS is a modern prison system. It respects prisoners' human rights, maintains order and control via humane and dignified means, and works towards the rehabilitation of prisoners and reducing reoffending rates overall. The SPS comprises a national headquarters where relevant policies and protocols are derived but governors and senior management teams are based within the local prisons to ensure the effective running of the organisation. While the SPS can boast decreasing rates of serious violence, there are significant variations across sites. We used PRISM to explore the relevance of situational risk factors to understanding these variations. Results suggested that the protocol was a promising paradigm for assessing risk factors unique to each site as well as showing utility for exposing problems related to the national policies and practices. The risk assessment led to a range of risk management interventions being proposed. The implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Violence among prisoners and that between prisoners and staff is a perennial concern for all prison systems. That violent prisoners are only violent in certain circumstances suggests a need to develop ways to understand not only the origins of violence in prison but also the situational contexts in which violence occurs. The technology of risk assessment has evolved dramatically in the last decade; however, the focus on individual risk factors has been at the expense of a de-emphasizing of the role of situational factors. In this article, evidence for the importance of situational factors in relation to prison violence is considered. The authors describe the development of a new risk assessment procedure—promoting risk intervention by situational management (PRISM). Within the context of the Scottish Prison Service, they conclude that systematic attention to situational risk factors can help reduce prison violence. [ABSTRACT FROM AUTHOR]

Can psychopathy be identified in pre-adolescent children? This question has both theoretical and practical implications. So far, attempts to answer this question have been made by making downward extensions of symptoms of the disorder as found in adults. We argue that for the construct of psychopathy to be viable as a construct in childhood it is necessary to demonstrate that a coherent syndrome of symptoms can be identified during childhood. To achieve this it is necessary first to use a strong measurement model, and second to use developmentally informed conceptualizations of key constructs. In order to progress from the measurement perspective, it is necessary to demonstrate (i) configural invariance of symptoms across key ages, (ii) similar performance of age cognate symptoms across key ages, and (iii) stability of relative standing on the latent trait across age. Novel techniques including item response methods and structural equation modelling techniques are required. In this paper, we review the relevant literature and evaluate the strength, or otherwise, of the evidence that key traits of psychopathy can be observed in childhood. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives. To examine whether individuals instructed to fake intellectual impairment on the WAIS-R employed common faking tactics and to assess the accuracy of detection of faking tactics employed. Method. Two groups of participants were instructed to fake 'mental handicap' on the WAIS-R. The first group included incarcerated young offenders and the second group included postgraduate students and research fellows from a university psychology department. Results. Both groups produced faked mean IQ scores within the 'mental retardation' range. There were, however, unusual features in the answers of both groups, including unusual error types. The faking tactics employed were readily detected. Conclusions. The results suggest that an individual's WAIS-R performance should be interpreted with due consideration given to both the quantitative and the qualitative aspects of their presentation. [ABSTRACT FROM AUTHOR]