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ARMIDILO Building the bridge between risk

assessment and treatment for people with learning disabilities

Svein Øverland, Clinical psychologist

Sentral fagenhet, avd. Brøset, St. Olavs Hospital/

National unit for mandatory care

Three ill-defined problems

Intellectual deficiency Psychiatric disorder

Crime

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Target population

• Persons convicted to mandatory care

• Persons with ID or reduced cognitive skills and

a history of violence (included sexual violence)

• Persons with autism spectrum disorders with

a history of violence

• In prison, custody, or in local institutions

Our aim

• To protect the society from further severe violence

• To give persons convicted to mandatory care treatment for their behavioral problems

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På tide å bli enda bedre

The problem

TID

KONTROLL

1

2

3

Økt mistrivsel

Trawling

Grooming

Det er ikke farlig, lov å kikke

Overgrep

Seksuell fantasi

Livssituasjon

Hun tar ikke skade av det

TID

KONTROL

L

1

2

3

Dagdrømming, tråling

Kontakt, Grooming

”det er lov å kikke”

Overgrep

Seksuell fantasi

Frustrasjon

”hun har ikke vondt av det” 4

Stopp og tenk

Time out

Bruk venn/hjelper

Kom deg vekk

Løs problemet

1. Attitude toward and compliance with supervision Presence-2 to +2

RecentChange(+, 0, -)

CriticalItem?

2. Attitude toward and compliance with treatment

3. Sexual deviance

4. Inappropriate preoccupation

5. Victim selection and acquisition / grooming

6. Emotional coping ability

7. Self-Efficacy

8. Relationship skills

9. Substance abuse

10. Impulsivity

11. Use of violence or threats towards self or others

12. Mental health and other unique considerations

”The standard items”

Stable Dynamic Items (Environmental Factors) Presence-2 to +2

RecentChange(+, 0, -)

CriticalItem?

1. Attitude towards intellectually disabled individuals

2. Communication among supervisory staff

3. Client specific knowledge by supervisory staff

4. Consistency of supervision

5. Situational consistency

6. Unique considerations

TOTAL SUB-SECTION SCORE:

Risk assessment as process

• ARMIDILO leads to interventions in: Client factors – emotion and skills training Staff factors – dialogue and communication

ARMIDILO = KAOS + Dialogue

KAOS + Dialogue

• KAOS is given by the regular staff• The staff reinforces KAOS behaviour when

observed in the unit • Dialogue is observed by ”secret friends” is

reinforces when observed in meetings

KAOS in a nutshell KAOS is a cognitive behavioural therapy based on emotion- and skills training in a group setting where the staff both conduct the group

training and reinforce the new behaviour in the milleu and act as liaisons to both the

patients/clients/convicteds local authorities and family

Adapting the therapy

• We have to adapt the therapy to the patient• rather than expecting the patient adapting to

the therapist

The meny principle

• The participants chooses which of the themes they want to work with from the manual

• The first ones should be rather simple, the last ones must relate to their index crime(s)

The aim is to have less “bad feelings”

More of the “positive feelings”

• What can you do to make the good feelings come back again?

• What can you do to make good feelings stay that way?

• What can you do to make other people get good feelings?

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Environmental factors

• Sometimes it is simpler to change the patient through changing the environment

• Based upon the ARMIDILO scoring, interventions will include staff courses in general and specific knowledge of ID, autism, psychosis

• And assisting them to make better risk judgments based on learning of communication skills

Evaluation by the staff

• Staff reports that the participants make better use of social skills

• Non-participants as well• And even the staff