{"id":7532,"date":"2018-09-05T12:02:05","date_gmt":"2018-09-05T12:02:05","guid":{"rendered":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/process-of-unstructured-clinical-judgement-health-and-social-care-essay\/"},"modified":"2018-09-05T12:02:05","modified_gmt":"2018-09-05T12:02:05","slug":"process-of-unstructured-clinical-judgement-health-and-social-care-essay","status":"publish","type":"post","link":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/process-of-unstructured-clinical-judgement-health-and-social-care-essay\/","title":{"rendered":"Process Of Unstructured Clinical Judgement Health And Social Care Essay"},"content":{"rendered":"
\n

However, there continues to be an increasing\u00a0interest\u00a0and\u00a0expectation\u00a0on professionals from the public and the criminal justice system in regards to the potential\u00a0danger\u00a0posed by\u00a0serious\u00a0offenders\u00a0being released\u00a0back into the community and the need for the offenders to be better managed, in order\u00a0to adequately protect\u00a0the public from dangerous individuals (Doyle et el, 2002). As the assessment of risk\u00a0is made\u00a0at various stages in the management process of the violent offender, it is\u00a0extremely\u00a0crucial that mental health professionals have a structured and consistent approach to risk assessment and evaluation of violence. (Doyle et el, 2002).<\/p>\n

This paper will examine three models of risk assessment that\u00a0are used\u00a0to reduce potential danger to others, when integrating violent offenders back into the community. These three approaches are unstructured clinical judgement, structured clinical\u00a0judgement\u00a0and actuarial\u00a0assessment.<\/p>\n

It is not intended, in this paper, to explore the various instruments used in the assessment process for the\u00a0respective\u00a0actuarial and structured clinical approaches.<\/p>\n

Unstructured Clinical Judgement<\/h2>\n

Unstructured clinical judgement is a process involving no specific guidelines, but relies on the individual clinician\u2019s\u00a0evaluation\u00a0having regard to the clinicians experience and qualifications (Douglas et al, 2002).\u00a0Doyle et el(2002, p650) refers to\u00a0clinical\u00a0judgement as \u201cfirst generation\u201d, and sees clinical judgement as allowing the clinician\u00a0complete\u00a0discretion in relation to what information the clinician will or will not take notice of in their final determination of risk level. The unstructured clinical\u00a0interview\u00a0has been widely criticised because it\u00a0is seen\u00a0as inconsistent and inherently lacks structure and a\u00a0uniform\u00a0approach\u00a0that does not allow for\u00a0test, retest reliability over time and between clinician\u2019s (Lamont et al, 2009). It\u00a0has been argued\u00a0that this inconsistency in\u00a0assessment\u00a0can lead to\u00a0incorrect\u00a0assessment of offenders, as either high or low risk due to the subjective opinion inherent in the unstructured clinical assessment\u00a0approach\u00a0(Prentky et al, 2000). Even with these limitations discussed above the unstructured clinical\u00a0interview\u00a0is still likely to be the most widely used\u00a0approach\u00a0in relation to the offender\u2019s violence risk assessment (Kropp, 2008).<\/p>\n

Kropp (2008), postulates that the continued use of the unstructured clinical\u00a0interview\u00a0allows for \u201cidiographic analysis of the offenders\u00a0behaviour\u201d (Kropp, 2008, p205).\u00a0Doyle et al (2002) postulates, that clinical studies have shown, that clinician\u2019s using the risk analysis\u00a0method\u00a0of unstructured interview, is not as\u00a0inaccurate\u00a0as\u00a0generally\u00a0believed.\u00a0Perhaps this is due, largely to the level of experience and\u00a0clinical\u00a0qualifications of those conducting the assessment. The unstructured clinical\u00a0assessment\u00a0method\u00a0relies heavily on verbal and non verbal cues and this has the potential of influencing individual clinician\u2019s assessment of risk, and thus in turn has a high probability of over reliance in the assessment on the exhibited cues (Lamont et al, 2009).\u00a0A major flaw with the unstructured clinical interview, is the apparent lack of structured standardized methodology\u00a0being used\u00a0to\u00a0enable\u00a0a\u00a0test\u00a0retest reliability\u00a0measure\u00a0previously mentioned.\u00a0However, the lack of consistency in the assessment approach is a\u00a0substantial\u00a0disadvantage in the use of the unstructured clinical interview.\u00a0 The need for a more structured\u00a0process\u00a0allowing for\u00a0predictable\u00a0test retest reliability would\u00a0appear\u00a0to be a\u00a0necessary\u00a0component of any risk assessment in relation to violence.<\/p>\n

Actuarial Assessment<\/h2>\n

Actuarial\u00a0assessment\u00a0was developed\u00a0to\u00a0assess\u00a0various risk factors that would improve on the probability of an offender\u2019s recidivism. However, Douglas et al (2002, p 625) cautions that the Actuarial\u00a0approach\u00a0is 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 instruments\u00a0has been developed\u00a0to predict future\u00a0probability\u00a0of violence amongst offenders who have a history of mental illness and or criminal offending behaviours. (Grant et al, 2004)<\/p>\n

The use of actuarial\u00a0assessment\u00a0has increased in recent years as more non clinicians\u00a0are tasked\u00a0with 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,\u00a0background\u00a0or necessary\u00a0clinical\u00a0qualifications to\u00a0conduct\u00a0a standardised clinical\u00a0assessment\u00a0of offender risk. This actuarial\u00a0assessment\u00a0method\u00a0has been found\u00a0to be extremely\u00a0helpful\u00a0when having risk assessing offenders with mental health, substance abuse and violent offenders. (Byrne et al, 2006). However, Actuarial assessments have limitations in the inability of the instruments to provide any information in relation to the management of the offender, and strategies to prevent violence (Lamont et al, 2009).\u00a0Whilst such instruments may provide transferable\u00a0test\u00a0retest reliability, there is a need for caution when the instruments\u00a0are used\u00a0within differing samples of the\u00a0test\u00a0population\u00a0used as the validation\u00a0sample\u00a0in developing the\u00a0test\u00a0(Lamont et al, 2009).\u00a0Inexperienced and\u00a0untrained\u00a0staff\u00a0may not be aware that tests\u00a0are limited\u00a0by a range of variables that may limit the reliability of the test in use. The majority of actuarial tools\u00a0were validated\u00a0in North America (Maden, 2003). This has\u00a0significant\u00a0implications when actuarial instruments\u00a0are used\u00a0in the Australian context, especially when indigenous cultural complexities are not taken into account. Doyle et al (2002) postulates that the actuarial\u00a0approach\u00a0are focused\u00a0on prediction and that risk assessment in mental health has a much broader\u00a0function\u00a0\u201cand has to be\u00a0link\u00a0closely with management and prevention\u201d (Doyle et al, 2002, p 652). Actuarial instruments rely on measures of static risk factors e.g. history of violence, gender, psychopathy and recorded social variables.\u00a0Therefore, static risk factors\u00a0are taken\u00a0as remaining constant.\u00a0Hanson et al (2000) argues that where the results of unstructured\u00a0clinical\u00a0opinion\u00a0are\u00a0open\u00a0to questions, the empirically based risk assessment\u00a0method\u00a0can significantly predict the risk of re offending.<\/p>\n

To rely\u00a0totally\u00a0on\u00a0static\u00a0factors that\u00a0are measured\u00a0in Actuarial instruments, and not incorporate dynamic risk factors has led to what Doyle et al (2002) has referred to as, \u201cThird Generation\u201d, or as more commonly acknowledged as structured professional judgement.<\/p>\n

Structured Professional Judgment<\/h2>\n

Progression toward a structured professional\u00a0model, would\u00a0appear\u00a0to have followed a process of evolution since the 1990s.\u00a0This\u00a0progression\u00a0has developed through\u00a0acceptance\u00a0of the complexity of what risk assessment entails, and the pressures of the courts and\u00a0public\u00a0in developing an expectation of increased predictive accuracy (Borum, 1996).\u00a0Structured professional judgement brings together \u201cempirically validated risk factors, professional experience and contemporary knowledge of the patient\u201d (Lamont et al, 2009, p27).\u00a0Structured professional judgement approach requires a\u00a0broad\u00a0assessment\u00a0criteria covering both static and dynamic factors, and attempts to bridge the gap between the other approaches of unstructured clinical judgement, and actuarial\u00a0approach\u00a0(Kropp, 2008).\u00a0The incorporation of dynamic risk factors that are taking\u00a0account\u00a0of variable factors such as current emotional\u00a0level\u00a0(anger, depression, stress), social supports or lack of and willingness to participate in the treatment rehabilitation process.\u00a0The structured professional approach incorporates\u00a0dynamic\u00a0factors, which\u00a0have been found, to be also crucial in analysing\u00a0risk\u00a0of violence (Mandeville-Nordon, 2006).\u00a0Campbell et al (2009) postulates that instruments that\u00a0examine\u00a0dynamic risk factors are more\u00a0sensitive\u00a0to\u00a0recent\u00a0changes that may\u00a0influence\u00a0an increase or decrease in risk potential. Kropp (2008) reports that research has found that Structured Professional Judgement measures also\u00a0correlate\u00a0substantially\u00a0with actuarial measures.<\/p>\n

Conclusion<\/h2>\n

Kroop, (2008) postulates that either a structured professional judgement approach, or an actuarial approach presents the most viable options for risk assessment of violence.\u00a0The unstructured\u00a0clinical\u00a0approach\u00a0has been widely criticised by researchers for lacking reliability, validity 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.\u00a0There would\u00a0appear\u00a0to be a valid argument that unless there is consistency in\u00a0training\u00a0of those conducting risk assessments the validity and reliability of any measure, either actuarial or structured professional judgement, will fail to\u00a0give\u00a0the\u00a0level\u00a0of predictability of violence that\u00a0is sought.\u00a0Risk analysis of violence will always be burdened by the\u00a0limitation\u00a0which \u201clies in the fact that\u00a0exact\u00a0analyses are not\u00a0possible, and\u00a0risk\u00a0will never be totally eradicated\u201d (Lamont et al, 2009, p 31.). Doyle et al (2002) postulates that a combination of structured clinical and actuarial approaches\u00a0is warranted\u00a0to assist in risk assessment of violence. Further research appears to be warranted to improve the evaluation and\u00a0overall\u00a0effectiveness of risk management.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

However, there continues to be an increasing\u00a0interest\u00a0and\u00a0expectation\u00a0on professionals from the public and the criminal justice system in regards to the potential\u00a0danger\u00a0posed by\u00a0serious\u00a0offenders\u00a0being released\u00a0back into the community and the […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"pagelayer_contact_templates":[],"_pagelayer_content":"","footnotes":""},"categories":[2805],"tags":[2819,2808,2807,2820],"class_list":["post-7532","post","type-post","status-publish","format-standard","hentry","category-us","tag-nursing-discussion-post-example-essay","tag-i-need-help-writing-a-nursing-essay","tag-help-with-nursing-discussion-board","tag-sample-social-care-research-papers"],"_links":{"self":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/posts\/7532","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/comments?post=7532"}],"version-history":[{"count":0,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/posts\/7532\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/media?parent=7532"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/categories?post=7532"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/tags?post=7532"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}