18 - Structured Risk Tools

Structured Risk Tools

© SPMM Course Stages in risk assessment According to Bouch & Marshall, the following stages are identified for risk assessment and management. A. Identifying the need for a full structured risk assessment (not everyone will need this) B. Assessing static, stable, dynamic and future risk factors and considering protective factors C. Individual formulation of risk applied to the context of current presentation D. Considering possible interventions and the level of support required E. Anticipating the impact of possible interventions F. Developing a management plan with specified short and long term implementations G. Reviewing and revising the management plan with variations in risk factors. Commonly used tools Structured Risk Tools HCR-20 (Webster): It is a popular structured clinical assessment tool for violence risk. HCR-20 (Historical, Clinical and Risk) shows good inter-rater reliability. It has  10 historical items (history of previous violence, PCLR score, etc.)  5 Clinical items (lack of insight, diagnosis of PD) and  5 risk management items (feasibility of plans, lack of support, etc.) It has been useful in predicting inpatient violence and community violence in discharged patients. Historical items Clinical items Risk items Previous violence history Negative attitudes to health services Management plan lacks feasibility Young age at first incident Active symptoms Exposure to destabilisers (e.g. alcohol) Unstable relationships Impulsivity Non-compliance Major mental illness Treatment unresponsiveness Stress Substance use Lack of insight Lack of personal support Psychopathy

Employment issues Personality disorder Early maladjustment Previous supervision failure