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Mitigating Forensic Risk for Practitioners
Abstract
Mental health and forensic settings experience the highest workplace violence incidents in the healthcare field (Harrell, 2011), yet graduate programs in psychology generally do not teach clinicians how to manage risk in these settings (Burl et al., 2012). To identify preventable risk factors in forensic settings seven subject matter experts employed in forensic settings completed a qualitative survey. Responses were combined into themes with the goal of representing both variety and prevalence of responses. Those sources of risk included: selfawareness, situational awareness, system checks, and de-escalation and offender knowledge. Some of their recommendations for addressing these issues included having staff identify and monitor their own needs and boundaries, with particular attention to sexual cues. Avoid becoming complacent with offenders, remain skeptical, and keep up to date on threats. Ensure facility staff are aware of your movements and schedule. Lastly, enlist interpersonal skills, de-escalation techniques, and adequately prepare for the setting, to effectively work with dangerous persons.
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This study examined differences between self-report and actual documentation of workplace violence (WPV) incidents in a cohort of health care workers. The study was conducted in an American hospital system with a central electronic database for reporting WPV events. In 2013, employees (n = 2010) were surveyed by mail about their experience of WPV in the previous year. Survey responses were compared with actual events entered into the electronic system. Of questionnaire respondents who self-reported a violent event in the past year, 88% had not documented an incident in the electronic system. However, more than 45% had reported violence informally, for example, to their supervisors. The researchers found that if employees were injured or lost time from work, they were more likely to formally report a violent event. Understanding the magnitude of underreporting and characteristics of health care workers who are less likely to report may assist hospitals in determining where to focus violence education and prevention efforts.
A survey of 300 independent practitioners revealed that 81 % experienced at least one incidentof patient physical attack, verbal abuse, or other harassment in private practice, at anotherjob, or both. Verbal abuse was the most frequently reported event. Physical attacks wereabout twice as common in hospitals and clinics as in independent practice. However, otherharassments, such as annoying phone calls and threats to sue, were more common in privatework than at other jobs. Because these types of incidents occur with some frequency, itseems advisable to discuss them and how to prevent or deal with them.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
De-escalation techniques are a highly recommended set of therapeutic interventions that are frequently used to prevent violence and aggression within mental health services. A thematic synthesis literature review identified 11 international papers. Seven themes emerged from the data synthesis. The first three related broadly to staff skills, including: characteristics of effective de-escalators, maintaining personal control, and verbal and non-verbal skills. The last four relate to the process of intervening and include: engaging with the patient, when to intervene, ensuring safe conditions for de-escalation, and strategies for de-escalation (including two sub-themes, autonomy confirming interventions, and limit-setting and authoritative interventions). De-escalation techniques are an example of a complex intervention, which has been overlooked by rigorous research, and it is often assumed that staff are able to perform these techniques in clinical practice.
This article explicates a systematic and structured conceptual model for crisis assessment and intervention that facilitates planning for effective brief treatment in outpatient psychiatric clinics, community mental health centers, counseling centers, or crisis intervention settings. Application of Roberts' seven-stage crisis intervention model can facilitate the clinician's effective intervening by emphasizing rapid assessment of the client's problem and resources, collaborating on goal selection and attainment, finding alternative coping methods, developing a working alliance, and building upon the client's strengths. Limitations on treatment time by insurance companies and managed care organizations have made evidence-based crisis intervention a critical necessity for millions of persons presenting to mental health clinics and hospital-based programs in the midst of acute crisis episodes. Having a crisis intervention protocol facilitates treatment planning and intervention. The authors clarify the distinct differences between disaster management and crisis intervention and when each is critically needed. Also, noted is the importance of built-in evaluations, outcome measures, and performance indicators for all crisis intervention services and programs. We are recommending that the Roberts' crisis intervention tool be used for time-limited response to persons in acute crisis.
Despite its clear importance, there have been very few empirical investigations of boundary violation propensity among mental health professionals. The present study explored the relationships between self‐reported propensity for boundary violations and predictors theorized to increase their likelihood. Australian mental health professionals (N = 275) completed an online questionnaire battery including demographics, the Sexual Boundary Violation Index, Boundaries In Practice Scale, Boundary Violations Propensity Questionnaire, Marlow‐Crowne Social Desirability Scale, Circumplex of Interpersonal Problems, Brief Inventory of Pathological Narcissism, Barratt Impulsiveness Scale Brief Version, Satisfaction With Life Scale, Brief Experiential Avoidance Questionnaire, Adverse Childhood Experiences Questionnaire and the Interpersonal Reactivity Index. Regression analysis was used to identify unique predictors. Boundary violation propensity was associated with nurturant interpersonal styles in females and dominant interpersonal styles in males. In regression analysis, unique predictors for male boundary violation propensity were grandiose narcissism, vulnerable narcissism, self‐centred interpersonal traits and low levels of empathic concern. For females, unique predictors were impulsivity, childhood adversity, self‐sacrificing interpersonal traits and vulnerable narcissism. In addition to informing theory about those at risk of perpetrating boundary violations, the identified predictors can inform those involved in selection for training programs and staff appointments and serve as markers for providing closer supervision.
An increasing number of graduate programs are available to students interested in the study of forensic psychology. The growth of forensic training opportunities is reflective of the wider development of forensic psychology as a discrete specialty area. An Internet-based survey was conducted to provide descriptive information to academic advisors of students interested in pursuing graduate-level training in forensic psychology. The goals of this survey were to identify forensic psychology graduate programs, categorize these programs by degree type, and examine their coursework content. The results of this survey will be useful to advisors seeking an understanding of the graduate training opportunities available in forensic psychology.
This paper reports on a survey of English-language police department websites, annual reports and other reports in order to identify key aspects of the status of women police internationally. Findings are reported for England and Wales, Scotland, Northern Ireland, Eire, the United States, Canada, Australia (eight departments), New Zealand, South Africa, Ghana, Nigeria, India, Pakistan, Hong Kong, Papua New Guinea, and Fiji. Data on the proportion of female officers were available from 18 of 23 locations, with a range between 5.1% and 28.8%. Recruit numbers were available for six locations, and ranged between 26.6% and 37.0%. Limited data on rank and deployment indicated overall improvements. Available longer-term trend data suggested that growth in female officers was slowing or levelling out. Overall, the study showed an urgent need to improve gender-based statistics in order to better inform strategies aimed at maximising the participation of women in policing.
It is clear that adequate academic and continuing education/training for correctional mental health professionals is imperative if their practice is to be effective. To help shape such training, the clinical and correctional knowledge ranked most meaningful and relevant by psychologists practicing in federal prisons is determined. Overall, results suggest nine core bodies of knowledge representing a mix of clinical (e.g., psychopathology, suicide prevention, psychopharmacology) and prison-based domains (e.g., interdepartmental communications, safety, confrontation avoidance) form the heart of their work. In terms of where such knowledge was obtained, graduate school is frequently endorsed for the more clinical domains, but the correctional domains are transmitted namely through on-the-job training. Recommendations for training psychologists to practice in corrections include the development of a two-tiered training strategy that offers a curriculum in basic psychological knowledge unique to corrections and an advanced curriculum that builds on foundational clinical knowledge obtained in graduate school.
This book focuses on taboos and uncomfortable topics that therapists and therapists-in-training often avoid and the damaging myths underlying this avoidance. Examples of the many topics include anger at patients; prayer with patients as part of therapy; fee disasters; therapists getting sick, growing old, and dying; confusion about disabilities; feelings of incompetence; therapists' fears; sexual orientation and self-disclosure; vulnerability; therapists' shame and guilt; silence about research data that are influential but faked; therapists' blunders; difficult aspects of race and ethnicity; the experience of being fired; confusion about what to do; and betrayal of ourselves, our profession, and our values to succeed or just survive. Providing opportunities for individuals, courses, and workshops to engage the topics directly, the book avoids imposing "right" answers and clinging to traditional "politically correct," or "psychologically correct" approaches. The book's model of learning encourages a mindful awareness of how we respond to the complex, messy situations that occur in real life and emphasizes the need for openness, honesty, courage, and constant questioning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Mass media, business, security, and government publications routinely highlight the incidents of workplace violence, yet little research has examined these incidents for gender similarities and differences. Using data from the 1992–1996 National Crime Victimization Survey, it is found that gender differences, more so than similarities, are characteristic of workplace violence. Specific types of jobs placed females more at risk of experiencing a violent incident than males in the same types of jobs: more robberies were committed against females employed at teaching institutions and in law enforcement and retail, and more simple assaults were committed against females in law enforcement and the transportation professions. In those incidents where an injury occurred, females lost more time from work. Several explanations for these results and directions for future research are offered.
Limited data exist analyzing the role of gender in workplace violence in health care settings. This study examined whether different types of threatening incidents with patients (physical, verbal, sexual, or posturing) were salient to male versus female staff across psychiatric settings (inpatient forensic, inpatient acute/chronic psychiatric, and outpatient psychiatric). Results indicated that although women disproportionately experienced sexualized threats, they were not more likely to report such incidents as salient and threatening. The study also assessed the extent to which situational variables contributed to staff's feelings of threat. Results showed that rapport with the patient, quality of relationships with coworkers, and presence of coworkers in the area were not significantly related to how threatened staff felt in a recent threatening incident. Findings are discussed within the context of staff training and organizational benefits.
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