![Page 1: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/1.jpg)
1
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
![Page 2: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/2.jpg)
Three ill-defined problems
Intellectual deficiency Psychiatric disorder
Crime
![Page 3: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/3.jpg)
3
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
![Page 4: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/4.jpg)
Our aim
• To protect the society from further severe violence
• To give persons convicted to mandatory care treatment for their behavioral problems
![Page 5: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/5.jpg)
5
På tide å bli enda bedre
![Page 6: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/6.jpg)
The problem
![Page 7: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/7.jpg)
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
![Page 8: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/8.jpg)
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
![Page 9: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/9.jpg)
![Page 10: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/10.jpg)
![Page 11: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/11.jpg)
![Page 12: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/12.jpg)
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”
![Page 13: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/13.jpg)
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:
![Page 14: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/14.jpg)
Risk assessment as process
• ARMIDILO leads to interventions in: Client factors – emotion and skills training Staff factors – dialogue and communication
![Page 15: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/15.jpg)
ARMIDILO = KAOS + Dialogue
![Page 16: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/16.jpg)
![Page 17: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/17.jpg)
![Page 18: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/18.jpg)
![Page 19: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/19.jpg)
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
![Page 20: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/20.jpg)
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
![Page 21: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/21.jpg)
Adapting the therapy
• We have to adapt the therapy to the patient• rather than expecting the patient adapting to
the therapist
![Page 22: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/22.jpg)
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)
![Page 23: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/23.jpg)
The aim is to have less “bad feelings”
![Page 24: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/24.jpg)
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?
![Page 25: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/25.jpg)
25
![Page 26: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/26.jpg)
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
![Page 27: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/27.jpg)
![Page 28: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/28.jpg)
![Page 29: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/29.jpg)
![Page 30: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/30.jpg)
Evaluation by the staff
• Staff reports that the participants make better use of social skills
• Non-participants as well• And even the staff
![Page 31: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/31.jpg)
![Page 32: Building the bridge between risk assessment and treatment](https://reader031.vdocuments.mx/reader031/viewer/2022030402/58749b191a28abfc5f8b5c35/html5/thumbnails/32.jpg)