“The Struggle is Real”: Punitive assessment in community services

2021 ◽  
pp. 146247452199043
Author(s):  
Marianne Quirouette

Assessment tools are pivotal for the work of frontline community services providers, shaping client relationships, access to supports and producing evidence for agencies that need to allocate resources, demonstrate outcomes and secure funding. These tools are combined and used cumulatively, as marginalized individuals are cared for – but also controlled and punished - within these systems (e.g. in shelters, street outreach, mental health or re entry supports). Punishment literature has clarified that risk tools are impactful but also contested and resisted. Still, we know little about how the process is experienced and negotiated by frontline by practitioners working with people pushed through the ‘revolving doors'. Drawing from two years of ethnographic fieldwork and 105 interviews with community practitioners, I examine tools and practices used to ‘assess’ criminalized and marginalized individuals. I show that practitioners are producing evidence about problems occurring outside legal institutions while relying on criminal justice logics and engaging with criminal justice spaces and paces. I highlight the challenges service providers face and negotiate, focusing on three themes: the composition of tools, the process of using them, and the service context in which they are used. I argue that despite discretionary efforts and adaptations, community practitioners remain frustrated by assessment tools and practices, and particularly by their inability to meet the needs they are assessing.

CNS Spectrums ◽  
2019 ◽  
Vol 25 (5) ◽  
pp. 593-603
Author(s):  
Sarah L. Desmarais ◽  
Evan M. Lowder

Eligibility criteria for participation in mental health jail diversion programs often specify that, to be diverted, a candidate must not pose a level of threat to public safety that cannot be managed in the community. Risk assessment tools were developed to increase consistency and accuracy in estimates of threat to public safety. Consequently, risk assessment tools are being used in many jurisdictions to inform decisions regarding an individual’s appropriateness and eligibility for mental health jail diversion and the strategies that may be successful in mitigating risk in this context. However, their use is not without controversy. Questions have been raised regarding the validity and equity of their estimates, as well as the impact of their use on criminal justice outcomes. The purpose of this review is to provide an overview of the science and practice of risk assessment to inform decisions and case planning in the context of mental health jail diversion programs. Our specific aims include: (1) to describe the process and components of risk assessment, including differentiating between different approaches to risk assessment, and (2) to consider the use of risk assessment tools in mental health jail diversion programs. We anchor this review in relevant theory and extant research, noting current controversies or debates and areas for future research. Overall, there is strong theoretical justification and empirical evidence from other criminal justice contexts; however, the body of research on the use of risk assessment tools in mental health jail diversion programs, although promising, is relatively nascent.


2020 ◽  
Vol 26 (4) ◽  
pp. 332
Author(s):  
Kate Silburn ◽  
Virginia Lewis

Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.


2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e49-e49
Author(s):  
Sarah Gander ◽  
Sarah Campbell ◽  
Kate Flood ◽  
Bryn Robinson

Abstract Background It is well-documented that children facing social disparities, trauma and toxic stress will experience a disproportionate number of negative physical and mental health outcomes across their lifespan. A common manifestation of this is the increasing prevalence of behaviour-related diagnoses in school-aged children. Regardless of whether a child suffers from a true behaviour disorder, or if they are displaying symptoms that relate to complex and challenging social conditions, they require a thoughtful, collaborative and inclusive approach to their care. Community Social Pediatrics adopts such an approach. Objectives The objective of the current study is to examine and understand the experiences of children and their families during the referral and treatment process for pediatric behavioural referrals in our local region. We will also explore the perspective of service providers on the challenges and strengths of the current system. Design/Methods A focus group (n=8) using semi-structured group interviews was conducted with caregivers whose children were in various stages of care/treatment regarding behavorial issues in the region surrounding Saint John, NB. Questions focused on: experiences in the system; efficacy of services; the child’s experience; wait times; and system cohesion. Qualitative thematic analysis was used to analyze the data. Through a strategic planning exercise (n=26), we were able to engage service providers and experts in this area to delineate the challenges and strengths that they perceive in the current system, and to provide insights they have into working with families. Results The major themes identified by families were defined by positive interactions, negative interactions, barriers, their own behavioural responses to the system and the impact on the child. Families’ positive experiences were associated with respectful and effective communication, integrated wrap-around services, assistance with navigation, and a child-centred approach. Negative experiences were rooted in feeling stigmatized by service providers, lack of communication between service providers, and inadequate mental health services for children. A number of system and personal barriers were identified. The service providers echoed these issues: provide equitable and efficient access to services; understand the needs of the family; strengthen relationships with partners and clients; and create a supportive working environment. Conclusion Consultation with families and service providers identified a number of issues in how children access and engage with community services. Community Social Pediatrics seeks to impact health at the community level and addresses the needs of children in a way that reflects the social context of their lives, community and society. Assessment and care procedures that are delivered through this model aim to remove barriers, reduce fragmentation and increase collaboration and communication across the entire care team.


2016 ◽  
Vol 24 (6) ◽  
pp. 592-597 ◽  
Author(s):  
Dennis Liu ◽  
Charlotte de Crespigny ◽  
Nicholas Procter ◽  
Janet Kelly ◽  
Hepsibah Francis ◽  
...  

Objective: This study identified barriers to and facilitators of mental health (MH) and alcohol and drug (AOD) comorbidity services, in order to drive service improvement. Method: Participatory action research enabled strong engagement with community services, including Aboriginal and refugee groups. Surveys, interviews and consultations were undertaken with clinicians and managers of MH, AOD and support services, consumers, families, community advocates and key service providers. Community participation occurred through consultation, advisory and working party meetings, focus groups and workshops. Results: Barriers included inadequate staff training and poor community and workforce knowledge about where to find help. Services for Aboriginal people, refugees, the elderly and youth were inadequate. Service fragmentation (‘siloes’) occurred through competitive short-term funding and frequent re-structuring. Reliance on the local hospital emergency department was concerning. Consumer trust, an important element in engagement, was often lacking. Conclusions: Comorbidity should be core business of both MH and AOD services by providing consistent ‘no wrong door’ care. Non-governmental organisations (NGOs) need longer funding cycles to promote stability and retain skilled workers. Comorbidity workforce training for government and NGO staff is required. Culturally appropriate comorbidity services are urgently needed. Despite the barriers, collaboration between clinicians/workers was valued.


Author(s):  
Atle Ødegård ◽  
Stål Bjørkly

AbstractThis chapter provides a novel framework for risk assessment and management by combining the Perception of Interprofessional Collaboration Model (PINCOM) and Historical-Clinical-Risk Management-20, Version 3 (HCR-20V3). PINCOM was developed to identify central aspects of interprofessional collaboration, whereas HCR-20V3 is the most used instrument in risk assessment of violence worldwide. The main scope of this chapter is to introduce and discuss the feasibility of combining the two tools to enhance collaboration between service providers in the mental health and criminal justice systems. First, we describe the HCR-20V3 and suggest how parts of it can be jointly used as a tool for concrete collaboration in the practice field. Next, we present the PINCOM tool, containing a conceptual model (PINCOM) and a research methodology (PINCOM-Q). It is suggested that the HCR-20V3 serves as a meeting point between different professionals for being concrete in joint casework. PINCOM can then be used within a larger social innovation framework and as a reflective tool during or after this structured professional assessment and acting as a catalyser for constructive collaboration.


Crisis ◽  
2007 ◽  
Vol 28 (3) ◽  
pp. 122-130 ◽  
Author(s):  
Marc S. Daigle ◽  
Anasseril E. Daniel ◽  
Greg E. Dear ◽  
Patrick Frottier ◽  
Lindsay M. Hayes ◽  
...  

Abstract. The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.


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