The Forensic Clinical Specialist Program A Strategy to Prevent Occupational Violence Safe & Secure Hospitals Conference. Sydney Harbour Marriott Greg Swanborough, State-Wide Coordinator Forensic Clinical Specialist Program (Victoria) Tuesday 21 st October 2014 9:50 am – 10:20 am
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The Forensic Clinical Specialist Program
A Strategy to Prevent Occupational Violence
Safe & Secure
Hospitals
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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Conference.Sydney Harbour Marriott
Forensic Clinical Specialist Program
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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Forensic Clinical Specialist ProgramStaffing:
• 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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Forensic Clinical Specialist ProgramStaffing:
• 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
• 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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Forensic Clinical Specialist ProgramPractice:
• 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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Forensic Clinical Specialist ProgramPractice:
• Provide education and training to clinical and MHCSS on issues such as:
• The forensic clinical specialist program & benefits for clinicians & teams
• 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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Forensic Clinical Specialist ProgramPractice:
• 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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Forensic Clinical Specialist ProgramPractice:
• 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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Forensic Clinical Specialist Program
The Result ?
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Forensic Clinical Specialist Program
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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Forensic Clinical Specialist Program
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