1. Clare Neil Specialist Psychological Practitioner NHS Forth Valley/University of Edinburgh clare.neil@nhs.net

2. Overview Setting the scene Introducing PRISM PRISM evaluations Utility of PRISM

3. Why assess institutional violence - violence in NHS/SPS

4. Situational Risk Factors Current violence risk assessment tools typically focused at the individual level Behaviour also influenced by situational and environmental factors Comprehensive assessment of risk includes consideration of individual and situational factors

5. Development of PRISM Systematic literature review Qualitative research Field testing Focus on understanding situational risk factors and identifying risk management strategies Based on SPJ model Has been used in a variety of (closed) environments (including mental health and prisons) Special issue of International Journal of Forensic Mental Health (2010) http://www.gcu.ac.uk/prism/

8. Process Highlight areas of good practice and make recommendations for risk management Identify case priority Develop risk scenarios Rate each factor– problematic, needs improvement or satisfactory Collect and analyse information for each factor Establish and train multidisciplinary team

9. PRISM in Forth Valley

10. DomainSituational risk factors History of Institutional Violence Previous violence – needs improvement Diversity and change in complaints – satisfactory Escalation – not known Physical and Security Physical environment/resources – problematic Security measures – needs improvement Organisational All factors rated as problematic Staff Features Recruitment/retention – satisfactory All remaining factors rated as problematic Case Management Individualised risk assessment and interventions – problematic and critical items Population mix – problematic Quality of life experiences – needs improvement

11. PRISM in Forth Valley Confirmed what was already suspected 21 recommendations, high case priority Development of an Action Plan PRISM training as an ‘intervention’ in itself Contributed to a shift in how the ward was viewed and helped to secure required resources High levels of participation and well received

12. PRISM in The State Hospital

13. DomainSituational risk factors History of Institutional Violence Previous violence and change in complaints - needs improvement/satisfactory Diversity of violence – needs improvement Escalation of violence – satisfactory Physical and Security Physical environment/resources – problematic Security measures – needs improvement/satisfactory Organisational Adaptability to change – problematic Structure/style and responsivity – needs improvement Ethos; leadership; policies – satisfactory Staff Features Recruitment/retention; staff approach/style; and staff morale – needs improvement Staff training – satisfactory/needs improvement Staff levels – satisfactory Case Management Individualised risk assessment – needs improvement Population mix; interventions; quality of life - satisfactory

14. PRISM in The State Hospital Significant amount of information was available Interaction between situational risk factors 23 recommendations, low/routine case priority Some difficulties engaging ward-based staff in the process Further work into ward culture and how to measure the ‘functioning’ of the environment

15. Utility of PRISM Another helpful tool for the risk assessment kit? -PRISM training and process as a helpful framework -Comprehensive understanding -Cost-effective and efficient strategies -Full evaluations require resources