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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