An integrated case formulation approach in forensic practice: the contribution of Occupational Therapy to risk assessment and formulation

Abstract

Forensic services focus on risk reduction and extol the value of multidisciplinary working. Due to the complex relationship of personality disorder and risk, a multidisciplinary approach to risk assessment, formulation, management and reduction is essential. Occupational Therapists provide a unique perspective; however, current literature pertaining to the contribution of Occupational Therapy is negligible. This paper aims to initiate discussion of the value of Occupational Therapy contributions to risk assessment and formulation with personality disordered offenders. A new approach is described that integrates occupational adaptation and multiple sequential functional analysis to provide a structured framework for Occupational Therapy risk assessment and formulation. A single case report is presented to demonstrate the advantages of the approach for identifying offenders' strengths and difficulties, predicting risk of reoffending, identifying offence paralleling behaviour and informing and evaluating efficacy of intervention, thereby supporting the aims of forensic practice settings to assess, manage, treat and reduce risk.

Occupational adaptation – analyzing the maturity and understanding of the concept through concept analysis

“…Additionally, some authors ascribed the term to a simpler phenomenon of adapting occupations such as reducing the number of steps in the occupation or using modified equipment [32,[47][48][49][50][51]. Case studies were provided in several papers to facilitate understanding of the concept [52][53][54][55][56]. However, in some instances, authors failed to explicitly explain the process or delineate it from other phenomena in their work [36,[57][58][59][60][61][62], potentially compounding confusion around the concept.…”

Risk formulation in forensic practice: a review of the evidence

“…Less common factors related to risk formulation as assisting communication (Hopton et al , 2018), supporting the development of healthy relationships (Mannix and Bergin, 2016) and providing a space for reflection (Mannix and Bergin, 2016). There was no clear definition stated in three of the studies (Connell, 2015; Judge et al , 2014; Whitehead et al , 2007). One study (Belfrage, 2015) described the elements that should be included within a risk formulation: offence history, risk factors, scenario planning, risk management recommendations and risk relevant changes.…”

“…Data sources. Data used to inform the risk formulation process were gathered from a range of sources across the studies: file review (Connell, 2015; Judge et al , 2014; Kirkland and Baron, 2015; Mannix and Bergin, 2016); clinical interview (Connell, 2015; Judge et al , 2014; Whitehead et al , 2007); and assessment measures (Connell, 2015; Kirkland and Baron, 2015; Whitehead et al , 2007). Two studies documented collaboration with the service user when constructing the risk formulation (Kirkland and Baron, 2015; Shaw et al , 2017).…”

“…Mannix and Bergin (2016) discussed adhering to the Ramsden framework (problem, predisposing, protective, triggers and maintainers). Connell (2015) used multi-sequential functional analysis (identifying antecedents, behaviour and consequences). Duff and Willis (2006) used the Finkelhor (1984) [4] model, to identify factors that increase and decrease risk of sexual offending.…”

“…Quality measures. There was no evidence of quality measures for risk formulations for nine of the studies (Belfrage, 2015; Connell, 2015; Duff and Willis, 2006; Judge et al , 2014; Kirkland and Baron, 2015; Maltman and Turner, 2016; Mannix and Bergin, 2016; Shaw et al , 2017; Whitehead et al , 2007). Hopton et al (2018) used CFQC-R (Case Formulation Quality Checklist – Revised [5]) to assess the quality of the risk formulations, comparing those that had been completed within Version 2 of the HCR-20, with those that had been completed as part of Version 3.…”