greg swanborough - forensicare
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Safe and Secure HospitalsTRANSCRIPT
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The Forensic Clinical Specialist Program
A Strategy to Prevent Occupational Violence
Safe & Secure
Hospitals
Conference.Sydney Harbour Marriott
Greg Swanborough,
State-Wide Coordinator Forensic Clinical Specialist Program (Victoria)
Tuesday 21st October 2014 9:50 am – 10:20 am
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Presentation Outline
Forensic Clinical Specialist Program
• Overview• Why The Need ?• Aims• Practice – How is it achieved ?• The Result
Glossary:
AMHS – Area Mental Health Service MHCSS – Mental Health Community Support Services
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist Program
Overview
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist ProgramOverview:
• In the 2009-10 Victorian State Budget, the Victorian Government provided $1.39 million per annum to fund 10 positions for Forensic Clinical Specialists Program (FCSP).
• Initially a pilot initiative for 3 years, the Forensic Clinical Specialists program is now a permanent entity in the mental health landscape in Victoria.
• Currently not all AMHS & MHCSS have access to a Forensic Clinical Specialist Positions. (21 AMHS in Victoria)
Safe & Secure
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist ProgramOverview:
• The program consists of embedding Forensic Mental Health professionals into AMHS & parallel MHCSS.
• Mandate to build capacity of the workforce to better assess, treat and management individuals with a mental illness and co-existing risk of offending / re-offending or aggressive behaviour.
• Forensicare, the Victorian state-wide forensic mental health service, provides the FCSP clinician's with ongoing support, including specialised training and development.
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist ProgramStaffing:
• 10 X Forensic Clinical Specialists &
• 1 X Forensic Clinical Specialist Program Coordinator (Forensicare)
• Disciplines (Senior Mental Health Practitioners)
• Nursing
• Social work
• Psychology
• Occupational Therapy
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist ProgramStaffing:
• Skills Set:
• Trained in Offender Specific Risk Assessment (Structured Professional Judgement Assessment Tools)
• Violence• Inpatient• Medium & Long Term Community• Youth
• General Offending• Stalking & Stalking Violence• Sexual offending• Psychopathy
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Conference.Sydney Harbour Marriott
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Structured Professional Judgement Tools
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Conference.Sydney Harbour Marriott
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Structured Professional Judgement Tools
Structured Professional Judgement
3RD
Clinical Assessment
1ST
Actuarial Assessment
2ND
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist ProgramStaffing:
• Skills Set:
• Skills in provision of education to workforce• High level mental health practitioner• Knowledge / experience in Forensic Mental Health• Ability to liaise effectively at all levels of the
organisation• Ability to network / foster partnerships with multiple
services• Legislative knowledge – Sentencing Act, Crimes Act,
Mental Health Act, Crimes & Mental Impairment Act
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Forensic Clinical Specialist Program
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Conference.Sydney Harbour Marriott
Negotiator
Facilitator
Expert
Coordinator Interpreter
Advocate Educator
Risk/Safety
Champion
Clinician
Local Policy
Maker
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Forensic Clinical Specialist Program
Why?
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Violent Offending ProfileSafe & Secure
Hospitals
Conference.Sydney Harbour Marriott
Substance
Misuse
Personality
Disorder
Trauma
Relationship
Problems
Employment
Problems
Antisocial
Behaviours
Violent
Attitudes
Engagement
Difficulties
Past
Violence
Major Mental
Disorder
Douglas, Hart, Webster & Belfrage (2013)
Reduced
Income
Reduced
Education
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Major Mental Health DisordersSafe & Secure
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Conference.Sydney Harbour Marriott
Substance
Misuse
Personality
Disorder
Trauma
Relationship
Problems
Employment
Problems
Antisocial
Behaviours
Violent
Attitudes
Engagement
Difficulties
Major Mental
Disorder
Past
Violence
Reduced
Income
Reduced
Education
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Forensic Clinical Specialist ProgramWhy: (Client)
Secondary to their illness, more vulnerable to exposure to factors that increase risks for offending
More likely to be exposed to those who perpetrate offending and have pro-offending attitudes
More likely to be a victim of crime / offending themselves
Statistically more vulnerable to coming into contact with: Law enforcement Judicial system- Courts Corrections
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Forensic Clinical Specialist ProgramWhy: (Service)
• Recognition that some AMHS & MHCSS struggle to manage those with complex forensic and mental health problems
• Need for better communication and collaboration between justice and mental health
• Need for local expertise on relevant legislative requirements
• Need for practical and timely response
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Forensic Clinical Specialist Program
Aims
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist ProgramAIMS:
• Improved expertise and capacity of AMHS & MHCSS workforce to optimally assess and manage offending & aggressive behaviours.
• Improved clinical outcomes for clients.
• Clients involved in less incidents, particularly those of aggression and violence.
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist ProgramAIMS:
• Improved management of risk
• Improved coordination and referral pathways between specialist mental health services and correctional services including courts.
• Improved worker safety and reduced attrition via reduced violence and aggression in the workplace
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist Program
Practice
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Hospitals
Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist Program
Practice:
1. Advice & Consultation:
• Undertake joint risk assessments of patients with a forensic history or potential high risk of offending
• Work with AMHS & PDRSS in order to:• Identify & assess select clients with high risk & complex
behaviours• Develop comprehensive treatment and care plans for select
clients• Develop risk assessment & management plans
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Forensic Clinical Specialist Program
Practice:
• Deliver secondary consultation to the AMHS & MHCSS workforce
• Consultation/liaison service to AMHS & MHCSS staff on issues related to patients that have been found not guilty due to mental impairment and others considered at high risk of criminal and violent behaviours
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Forensic Clinical Specialist ProgramPractice:
• Liaison with services to reduce gaps in service provision, particularly during discharge or release
• Services include:• Corrections • Police• Courts• Prison based mental health services• Forensicare• AMHS & MHCSS
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Forensic Clinical Specialist ProgramPractice:
• Participate in the review of select clients (including case conferences) who may be:
• Presenting staff with challenges related to aggression & risk
• Nearing transfer/discharge/release and where there are concerns over risk
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Forensic Clinical Specialist ProgramPractice:
• Provide education and training to clinical and MHCSS on issues such as:
• The forensic clinical specialist program & benefits for clinicians & teams
• Crimes & Mental Impairment Act 1997 & legislative requirements
• Risk assessment & risk management
• Understanding & navigating the forensic system
• Understanding the role of mental health & offending
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Forensic Clinical Specialist ProgramPractice:
2. Quality Improvement & Organisational Commitments:
• Initiates and contributes to development of relevant policies, procedures & protocols
• Promotes service wide initiatives, increase use and development of evidence in working with clients with forensic issues.
• Data gathering & evaluation
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Forensic Clinical Specialist ProgramPractice:
• Enhancing management of processes such as risk management within organisation
• Lead and support development, implementation and evaluation of a robust risk framework within the organisation (AMHS & PDRSS) for patients with a forensic history/risk of offending
• Improvements in flow of information and communication processes between agencies working with clients
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Forensic Clinical Specialist ProgramPractice:
• Key contact point for justice, corrections and forensic referrers including, the courts, prisons, CCS, Forensicare’s inpatient & community service.
• Coordinate / contribute to operational review of incidents involving patients with a forensic/offending history.
• In exceptional circumstances the forensic clinical specialist may co-case manage a select client for a time limited period of time but should not be the primary or sole case manager for any client.
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist Program
The Result ?
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Conference.Sydney Harbour Marriott
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Forensic Clinical Specialist Program
2008/09 2009/10 2010/11 2011/12
AMHS with FCS 70% 66% 55% 44%
AMHS without FCS 30% 34% 45% 56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
% O
F R
EFER
RA
LS
Referrals from AMHS - with and without FCS
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Forensic Clinical Specialist Program
Result:
2013 Department of Health evaluation of the Forensic Clinical Specialist Program –
• Key Workforce & System Impacts Findings:
• A more systematic and evidence based approach to risk identification, assessment and risk management at the individual clinician level.
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Forensic Clinical Specialist ProgramKey Workforce & System Impacts Findings:
• Improved confidence and capability of staff to work with clients who present with forensic / violence risk:
• Higher quality risk assessments
• Improved capacity for client management
• Change in beliefs and attitudes among staff
• Cultural shift toward acceptance and understanding
• Services communicating more effectively around risk
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Forensic Clinical Specialist ProgramKey Workforce & System Impacts Findings:
• Improved continuum of care for clients
• Coordination and communication between a range of services, providing more holistic and coordinated treatment
• Strengthened referral pathways with the justice system
• Preliminary evidence also suggests improved management of forensic behaviours by AMHS and that AMHS staff are increasingly satisfied with the actions taken by their services
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Wisdom
“It ain’t what you don’t know that gets you into trouble. It’s
what you know for sure that just ain’t so.”
-- Mark Twain
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The Forensic Clinical Specialist Program
Questions ?
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Conference.Sydney Harbour Marriott