Process Of Unstructured Clinical Judgement Health And Social Care Essay

Process Of Unstructured Clinical Judgement Health And Social C ar EssayHowever, there continues to be an increasing elicitandexpectationon originals from the public and the criminal justice system in regards to the potentialdangerposed byseriousoffendersbeing released grit into the society and the need for the offenders to be better managed, in orderto adequately protectthe public from dangerous individual(a)s (Doyle et el, 2002). As the appraisal of pretendis madeat mixed stages in the management extremity of the violent offender, it isextremelycrucial that noetic health professionals have a structured and consistent border on to find mind and valuation of violence. (Doyle et el, 2002).This paper will examine three models of risk assessment thatare usedto reduce potential danger to others, when integrating violent offenders back into the community. These three approaches are unstructured clinical apprehension, structured clinicaljudgementand actuarialassessment.It is not intended, in this paper, to explore the various instruments used in the assessment process for therespectiveactuarial and structured clinical approaches.Unstructured Clinical JudgementUnstructured clinical judgement is a process involving no particular(prenominal) guidelines, moreover relies on the individual cliniciansevaluationhaving regard to the clinicians experience and qualifications (Douglas et al, 2002).Doyle et el(2002, p650) refers toclinicaljudgement as first generation, and sees clinical judgement as allowing the cliniciancomplete kickshaw in intercourse to what information the clinician will or will not take notice of in their final determination of risk level. The unstructured clinicalinterviewhas been widely criticised because itis seenas inconsistent and inherently lacks structure and auniformapproachthat does not allow for canvass, retest reliability over time and amid clinicians (Lamont et al, 2009). Ithas been arguedthat this inconsistency inassessmentcan lead toincorrectassessment of offenders, as either high or low risk due to the subjective opinion inherent in the unstructured clinical assessmentapproach(Prentky et al, 2000). Even with these limitations discussed above the unstructured clinicalinterviewis still likely to be the most widely usedapproachin relation to the offenders violence risk assessment (Kropp, 2008).Kropp (2008), postulates that the continued use of the unstructured clinicalinterviewallows for idiographic analysis of the offendersbehaviour (Kropp, 2008, p205).Doyle et al (2002) postulates, that clinical studies have shown, that clinicians using the risk analysismethodof unstructured interview, is not asinaccurateaslooselybelieved.Perhaps this is due, largely to the level of experience andclinicalqualifications of those conducting the assessment. The unstructured clinicalassessmentmethodrelies heavily on verbal and non verbal cues and this has the potential of influencing individual clinicians assessment of risk, an d thus in turn has a high luck of over reliance in the assessment on the exhibited cues (Lamont et al, 2009).A major defacement with the unstructured clinical interview, is the apparent lack of structured standardized methodologybeing usedto modifyatestretest reliabilitymeasureantecedently mentioned.However, the lack of consistency in the assessment approach is asubstantialdisadvantage in the use of the unstructured clinical interview. The need for a more structuredprocessallowing forpredictabletest retest reliability wouldappearto be anecessarycomponent of some(prenominal) risk assessment in relation to violence.Actuarial AssessmentActuarialassessmentwas developedtoassessvarious risk factors that would improve on the probability of an offenders recidivism. However, Douglas et al (2002, p 625) cautions that the Actuarialapproachis not conducive to violence prevention. The Actuarial approach relies heavily on standardized instruments to assist the clinician in predicting violence, and the majority of these instrumentshas been developedto predict futureprobabilityof violence amongst offenders who have a history of mental illness and or criminal offending behaviours. (Grant et al, 2004)The use of actuarialassessmenthas increased in late(a) years as more non cliniciansare taskedwith the responsibility of management of violent offenders such as community corrections, correctional officers and probation officers. Actuarial risk assessment methods enable staff that do not have the experience,backgroundor necessaryclinicalqualifications toconducta standardised clinicalassessmentof offender risk. This actuarialassessmentmethodhas been foundto be extremelyhelpfulwhen having risk assessing offenders with mental health, substance abuse and violent offenders. (Byrne et al, 2006). However, Actuarial assessments have limitations in the unfitness of the instruments to provide any information in relation to the management of the offender, and strategies to prevent violence (Lamont et al, 2009).Whilst such instruments may provide transferabletestretest reliability, there is a need for caution when the instrumentsare usedwithin differing samples of thetestpopulationused as the validationsamplein developing thetest(Lamont et al, 2009). unversed anduntrainedstaffmay not be aware that testsare limitedby a range of variables that may limit the reliability of the test in use. The majority of actuarial toolswere validatedin North America (Maden, 2003). This hassignificantimplications when actuarial instrumentsare usedin the Australian context, especially when original cultural complexities are not taken into account. Doyle et al (2002) postulates that the actuarialapproachare focusedon prediction and that risk assessment in mental health has a much broaderfunctionand has to belinkclosely with management and prevention (Doyle et al, 2002, p 652). Actuarial instruments rely on measures of soundless risk factors e.g. history of violence, gender, psychopathy an d recorded social variables.Therefore, static risk factorsare takenas remaining constant.Hanson et al (2000) argues that where the results of unstructuredclinicalopinionareopento questions, the empirically based risk assessmentmethodcan significantly predict the risk of re offending.To relytotallyonstaticfactors thatare measuredin Actuarial instruments, and not incorporate dynamic risk factors has led to what Doyle et al (2002) has referred to as, Third Generation, or as more normally acknowledged as structured professional judgement.Structured Professional JudgmentProgression toward a structured professionalmodel, wouldappearto have followed a process of evolution since the 1990s.Thisprogressionhas developed throughacceptanceof the complexity of what risk assessment entails, and the pressures of the courts andpublicin developing an expectation of increased predictive true statement (Borum, 1996).Structured professional judgement brings together empirically validated risk factors, professional experience and contemporary knowledge of the patient (Lamont et al, 2009, p27).Structured professional judgement approach requires abroadassessmentcriteria covering both static and dynamic factors, and attempts to bridge the gap between the other approaches of unstructured clinical judgement, and actuarialapproach(Kropp, 2008).The incorporation of dynamic risk factors that are takingaccountof variable factors such as current emotionallevel(anger, depression, stress), social supports or lack of and willingness to participate in the treatment rehabilitation process.The structured professional approach incorporatesdynamicfactors, whichhave been found, to be also crucial in analysingriskof violence (Mandeville-Nordon, 2006).Campbell et al (2009) postulates that instruments thatexaminedynamic risk factors are moresensitivetorecentchanges that mayinfluencean increase or decrease in risk potential. Kropp (2008) reports that research has found that Structured Professional Judge ment measures alsocorrelatesubstantiallywith actuarial measures.ConclusionKroop, (2008) postulates that either a structured professional judgement approach, or an actuarial approach presents the most viable options for risk assessment of violence.The unstructuredclinicalapproachhas been widely criticised by researchers for lacking reliability, stiffness and accountability (Douglas et al, 2002). Kroop, (2008) also cautions that risk assessment requires the assessor to have an appropriate level of specialized knowledge and experience. This experience should be not only of offenders but also with victims.There wouldappearto be a valid argument that unless there is consistency intrainingof those conducting risk assessments the validity and reliability of any measure, either actuarial or structured professional judgement, will fail togivethelevelof predictability of violence thatis sought.Risk analysis of violence will perpetually be burdened by thelimitationwhich lies in the fact that exactanalyses are notpossible, andriskwill never be totally eradicated (Lamont et al, 2009, p 31.). Doyle et al (2002) postulates that a combination of structured clinical and actuarial approachesis warrantedto assist in risk assessment of violence. Further research appears to be warranted to improve the evaluation andoveralleffectiveness of risk management.