Personalizing Child Protection: The Value of Responsivity Factors

Personalization is an important strategy for enhancing the effectiveness of treatment that is aimed at reducing the risk of child maltreatment. In recent years, a growing body of research has appeared on how child protection can benefit from the principles of the Risk-Need-Responsivity model, but no attention has yet been paid to the implementation of the responsivity principle in child protection. Put simply, this principle states that treatment must be tailored to individual characteristics of clients to optimize its effectiveness. This study was the first to address how the responsivity principle can be of value in child protection. First, a systematic review of responsivity factors in forensic care was performed. Second, the relevance of applying each factor in child protection was examined through interviews with clinical professionals working in the field, who also provided suggestions on how treatment can be tailored to each of these factors. This resulted in an overview of seven responsivity factors all related to caregiver characteristics: problem denial, motivation to cooperate with treatment, psychological problems, cognitive abilities, cultural background, practical barriers such as financial problems and social support, and barriers to specific treatment types such as group therapy. Implications and recommendations for strengthening clinical practice are discussed.

Admissions to the Western Australian state forensic hospital from court on hospital orders over a 10-year period from 2007 to 2016

Objective: To investigate trends in admissions to the state forensic hospital (Western Australia (WA)) from court on hospital orders from 2007 to 2016. Method: A retrospective survey was undertaken. Demographic, clinical and legal data were obtained from hospital records. Hospital orders referred on less serious charges or without a primary diagnosis of major mental illness were identified as ‘non-forensic’. Results: There were 890 hospital orders representing 40% of total admissions. Eighty-one per cent were male and 50% had a diagnosis of schizophrenia; 22% were Indigenous; 421 (47%) were admitted on less serious (non-Schedule 1) charges; 199 (22%) did not have a primary diagnosis of a major mental illness recorded on the discharge summary; 82 (9%) had neither major mental illness nor serious charges. Overall, 539 hospital orders (60%) were identified as non-forensic; 243 (45%) of these were made with no input from the Court Liaison Service (CLS). Conclusions: Hospital orders make up a significant proportion of admissions to the forensic unit in WA. Many do not require secure forensic care. Developing alternative diversion pathways is essential.

Clinical supervision in a high secure hospital: a service evaluation

Few environments demand a higher level of emotional competences than forensic care settings, and the importance of clinical supervision to mitigate against the risks of such an environment cannot be underestimated. This paper explores the efficacy of clinical supervision provided to nursing staff within a high secure hospital using the Manchester Clinical Supervision Scale. Results indicated that the nursing workforce were overall very satisfied with their clinical supervision, specifically clinical team leaders are most likely to be very satisfied. Results also showed the significance of time: clinical supervision is more effective when it lasts between 30–60 minutes, but correspondingly, time is one of the key barriers to accessing clinical supervision.

The Forensic Symptoms Inventory—Youth Version—Revised: Development and Age Invariance Testing of a Broad-Spectrum Questionnaire for Forensic Assessment

Covering both individual and neuropsychological factors, the Forensic Symptom Inventory—Youth Version—Revised (FSI-YV-R) is the first broad spectrum questionnaire for adolescents in forensic care, measuring several deficits, such as executive dysfunctions, anger, and inadequate coping to enhance treatment goals and evaluate interventions. In this study, both the factor structure and the measurement and structural invariance of the FSI-YV-R were investigated. The sample consisted of 159 forensic juvenile outpatients (79.9% males and 20.1% females) aged 12 to 19 with a mean age of 16.07 ( SD = 1.57). Multi-Group Confirmatory Factor Analyses identified a second-order model (measuring executive functioning) and proved measurement and structural invariant across age groups (younger adolescents, 12–15 years and older adolescents, 16–18 years). Contrary to the expectations none of the FSI-YV-R subscales differentiated between younger adolescents (N = 74) and older adolescents (N = 85). These results and implications for both theory and practice are discussed.

Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years

Background Premature mortality among patients experiencing forensic care is high. This paper examines the morbidity and mortality of all Scottish high secure patients in 1992/1993 and followed up 20 years later through the context of recovery. Aims To explore morbidity and delineate which patients are at greatest risk of premature mortality. To assess the extent of suicide and unnatural deaths. To establish which factors, if any, appear protective. Method Health and mortality data were extracted from national data-sets and death categorised as premature or post-expected age. Standardised mortality ratios were calculated to explore natural, unnatural and suicide deaths with Cox regression conducted to explore baseline demographics and premature death. Results During a mean follow-up of 21.1 years, 36.9% (n = 89) died, at an average age of 55.6 years. Of these, 70.8% (n = 63) died prematurely. Men lost on average 14.9 years and women 24.1 years of potential life. Five lives (5.6%) were lost by suicide and three (3.4%) by unnatural means. Conclusions In contrast to other mainstream and forensic cohorts, high rates of suicide and accidental deaths were not apparent. Risk of premature mortality is high. A greater focus upon physical health by community and in-patient services is essential.