1. Risk Assessment in the Fife Forensic Learning Disability Service (FFLDS). Mike Doyle Forensic Psychologist, NHS Fife FFLDS: Supporting People to Build Good Lives

2. Fife Forensic Learning Disability Service 1.1999 – present ! 2.Multi-agency & multi- disciplinary. 3.Introduced ‘Significant Risk Advisory Group’ in Scotland

3. All management plans and decisions will be based on a risk assessment which is of the appropriate level to support such a decision or plan. The actions to be taken will be clearly documented and their rationale will link explicitly to risk assessment. The risk assessment and management processes will be dynamic, with the capacity to respond to changes in risk. Care will be taken to maintain the dynamic link between risk assessment and planning through ongoing assessment and review. The level and immediacy of any response to change will be proportionate to the significance and risk. Reductions and increases in restrictions or interventions will be justified and supported by a suitable reassessment of risk. FRAME: Framework for Risk Assessment Management and Evaluation – Risk Management Authority

4. Objectives:  Complete a ‘needs analysis’ to examine the numbers of risk assessments of different types that are likely to be required by the forensic service, and how often they would require to be updated.  October 2012 o 31 Community forensic LD cases  21 on Criminal/Civil orders underpinning community placement/treatment o 8 Fife Forensic In-patients – Levendale o 10 Regional Forensic In-patients - Daleview FFLDS Risk Assessment Review

5. Needs Assessment LocationNNew /yearUpdates Community18*216 Levendale817 Daleview1028 Mayfield**110 Total37631 * Counting only clients/pts on criminal/civil orders ** Assuming one pt per year from Assessment Unit -> FFLDS Assume 40 Hours per new risk assessment 6 * 40 = 240 Hours Assume 15 Hours per update 31 * 15 = 465 Hours Total 705 Hours Assume remaining 20 community clients require Level 1 or Level 2 risk assessment/risk management plans 20 @ 10 hours = 200 Hours905 Hours FFLDS Risk Assessment Review, July 2011

6. DisciplineN Hours/ Discipline / Year* Forensic/ Clinical Psychology 2480 Forensic Nursing 4480 Psychiatry2160 Total81120 * Assuming 4 hours per week per full-time post for 40 weeks per year Risk Assessment Demand

7. Initial decisions based on an awareness of the risk Case management with due attention to risk Risk management that is actively alert to risk FRAME: Framework for Risk Assessment Management and Evaluation – Risk Management Authority

8. Comprehensive File Review Current Clinical Assessments Client/Family/Practitioner Interviews Multi-agency Risk Management Planning Review of Available Files Recent Clinical Assessments Client/Family Interviews Multi-agency Input Referral Information Client/Family/Practitioner Interviews FFLDS Proposed Tiered Risk Assessment

9. FFLDS: Supporting People to Build Good Lives

10. Weekly multi- agency/disciplinary meetings Specialist Forensic Health/Social Work Practitioners Specialist Forensic Care Providers Information Gathering & Sharing Architecture of FFLDS

11. Risk Assessment & Risk Management Planning Case Formulation & Treatment Planning Enhanced Care Programme Approach Weekly multi- agency/disciplinary meetings Specialist Forensic Health/Social Work Practitioners Specialist Forensic Care Providers Analysis & Synthesis Architecture of FFLDS

12. Specialist Forensic Care Providers Specialist Forensic Health/Social Work Practitioners Risk Assessment & Risk Management Planning Enhanced Care Programme Approach Learning Disability Significant Risk Advisory Group LD-SRAG Weekly multi- agency/disciplinary meetings Governance & Scrutiny Case Formulation & Treatment Planning Social Work Senior Manager Architecture of FFLDS NHS Fife LD Service Learning Disability Management Team

13. Learning Disability Significant Risk Advisory Group The objectives of the Significant Risk Advisory Group are  To evaluate, oversee and endorse risk assessments and risk management proposals in respect ….of individuals, who pose a significant risk to the community. Endorsement will be undertaken by Health and Social Work Services managers.  To advise agencies/individual workers where individual care plans presented are deemed unsatisfactory and to refer back for appropriate amendment;  To act as a point of expert resource for workers seeking guidance in the support and management of individuals causing serious concerns.  LD-SRAG Constitution

14. Learning Disability Significant Risk Advisory Group The objectives of the Significant Risk Advisory Group are  To evaluate, oversee and endorse risk assessments and risk management proposals in respect ….of individuals, who pose a significant risk to the community. Endorsement will be undertaken by Health and Social Work Services managers.  To advise agencies/individual workers where individual care plans presented are deemed unsatisfactory and to refer back for appropriate amendment;  To act as a point of expert resource for workers seeking guidance in the support and management of individuals causing serious concerns.  LD-SRAG Constitution ‘I beseech you, in the bowels of Christ, think it possible you may be mistaken.” Cromwell

15. Learning Disability Significant Risk Advisory Group  Membership  Fife Council Social Work  Fife Council Criminal Justice Services  NHS Fife  Fife Constabulary (Offender Management Unit)  Fife Council Housing Dept.  Quorum  NHS General Manager or deputy  Service Manager Social Work Adult Service or deputy  Fife Constabulary Representative or deputy  Community Protection Team Representative or deputy  If an individual under review has a mental illness, a psychiatrist must be in attendance if decisions regarding risk management are necessary  Meetings 1 st Thursday each Month..

16. Specialist Forensic Care Providers Specialist Forensic Health/Social Work Practitioners Risk Assessment & Risk Management Planning Case Formulation & Treatment Planning Enhanced Care Programme Approach Learning Disability Significant Risk Advisory Group LD-SRAG MAPPA Weekly multi- agency/disciplinary meetings Health & Social Work Management Structures

17.  FFLDS Risk Assessment Review 2010 – 2011. Meeting demand for risk assessments  Completing and maintaining risk assessments on even only ‘high risk’ cases requires considerable resources and likely requires input from multiple disciplines.  A ‘tiered’ approach is required to match level of risk with rigour of risk assessment  Architecture of FFLDS as relates to risk assessment & risk management.  FFLDS structure provides forum for information sharing and agreeing protocols  Process of incident recording and ‘brief reviews’ provides firm basis for updating of risk assessments on regular bases  Role of Learning Disability Significant Risk Advisory Group; the LD-SRAG.  Provides independent scrutiny & check on risk management planning & organisational underwriting of risk management plans,  Works best when ‘serviced’ by a specialist forensic practitioners