Greg Swanborough - Forensicare

The Forensic Clinical Specialist Program

A Strategy to Prevent Occupational Violence

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Conference.Sydney Harbour Marriott

Greg Swanborough,

State-Wide Coordinator Forensic Clinical Specialist Program (Victoria)

Tuesday 21st October 2014 9:50 am – 10:20 am

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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Overview

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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)

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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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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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• 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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Structured Professional Judgement Tools

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Structured Professional Judgement Tools

Structured Professional Judgement

3RD

Clinical Assessment

1ST

Actuarial Assessment

2ND

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• 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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Negotiator

Facilitator

Expert

Coordinator Interpreter

Advocate Educator

Risk/Safety

Champion

Clinician

Local Policy

Maker


Why?

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Violent Offending ProfileSafe & Secure

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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

Major Mental Health DisordersSafe & Secure

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Substance

Misuse

Personality

Disorder

Trauma

Relationship

Problems

Employment

Problems

Antisocial

Behaviours

Violent

Attitudes

Engagement

Difficulties

Major Mental

Disorder

Past

Violence

Reduced

Income

Reduced

Education

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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Aims

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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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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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Practice

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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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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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• 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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• 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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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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• 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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• 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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The Result ?

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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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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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Healthcare

Greg Swanborough - Forensicare