1. Re-imagining Mental Health Services: A Model of Tiered Service Delivery using Best Practice Principles in Risk Assessment, Formulation, Scenario Planning and Risk Management in Juvenile Justice. Dr Leanne Gregory, Principal Clinical Psychologist, IVY Re-imagining Youth Justice Conference HOWARD LEAGUE 2 April 2014 The King's Fund, 11-13 Cavendish Square, London W1G 0AN

3. IVY MultidisciplinaryTiered ApproachRisk Assessment Psychological Assessment

4. Why are we funded? Youth who perpetrate acts of serious violence are among the most marginalised and vulnerable in society. Backgrounds of adversity and abuse. Do not have equitable access to services equipped to assist them. At risk of poor outcomes and harm to others

5. The Model LEVEL ONE – CONSULTATION – IVY meet with involved professionals to discuss a young person. A SPJ risk assessment opinion incorporating risk factor ratings, a risk formulation, risk scenarios and recommendations for risk assessment/management LEVEL TWO – ASSESSMENT - Builds on the data available at level 1 but includes direct specialist assessments of mental health, psychological or offending needs necessary for a more complete formulation. LEVEL THREE – TREATMENT – Is offered where treatment needs are identified and cannot be met by local services. It is a formulation- led and eclectic approach to intervention.

6. Who is referring? 26 referrals 1 police 5 health 19 social work

7. Demographics – Age & Sex N= 25 Mean age = 15.5 Mode = 16 Range 12-17 Male = 19 Female = 6

8. Accommodation

9. Diagnosed or Suspected DifficultyNumber Anger7 Anxiety1 Autism Spectrum Disorder6 Attachment Disorder5 Attention Deficit Hyperactivity Disorder6 Communication Disorder1 Complex Post Traumatic Stress6 Deliberate Self-Harm7 Dissociation2 Eating Difficulties2 Emotional Dysregulation6 Learning Disability2 Low Mood2 Oppositional Defiant/Conduct Disorder2 Psychosis2 Sleep Difficulties2 Substance Misuse Difficulties (Alcohol/Drugs)7 Suicidal Ideation/Action6 Unusual perceptual experiences3 MEAN = 4.4

10. Domestic Violence

11. Other Maltreatment

12. PRIMARY RISK N = 17 Nature of Riskn = Primary Risk Fire-setting1 Interpersonal Violence 10 Self-harm/Suicidality3 Sexual offences (contact) 5 Sexual offences (non- contact) 1 Victimisation1 Violent Extremism1 Interpersonal Violence Suicide /DSH Firesetting Sexual offences non- contact Violent Extremism Victimisati on Sexual offence - contact

13. Nature of Riskn = Secondary Risk Fire-setting1 Interpersonal Violence 3 Self- harm/Suicidality 3 Sexual offences (contact) 0 Sexual offences (non-contact) 1 Victimisation5 Violent Extremism 0 SECONDARY RISK Victimisation Suicide /DSH Firesetting Sexual offences non- contact Interperson al violence

14. Comorbid Risks 64%

15. Level 2 10 offered 9 accepted Risk Assessment Learning Disability Personality Mental HealthDiagnostic Review

16. Emerging Themes TransitionLAACRejection ?Attachment Difficulties* ?ADHD ?Autistic Spectrum Vulnerability victimisation Unmet treatment need Difficulties with engagement*

17. FYI