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Violent behaviour in adolescents: assessment and formulation using a structured risk assessment tool

Published online by Cambridge University Press:  10 October 2023

Gabrielle Pendlebury Open the ORCID record for Gabrielle Pendlebury [Opens in a new window] ,
Jane Anderson ,
Heidi Hales Open the ORCID record for Heidi Hales [Opens in a new window] ,
Duncan Harding  and
Alexandra Lewis
Gabrielle Pendlebury*
Affiliation:
Child and adolescent psychiatrist with adolescent forensic expertise working for Onebright psychiatry services, York, UK.
Jane Anderson
Affiliation:
Consultant adolescent forensic psychiatrist with Lambeth Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, London, UK.
Heidi Hales
Affiliation:
Consultant adolescent forensic psychiatrist with the North West London Forensic Child and Adolescent Mental Health Service, West London NHS Trust, London, UK.
Duncan Harding
Affiliation:
Consultant adolescent forensic psychiatrist with South London Community Forensic CAMHS, South London and Maudsley NHS Foundation Trust, London, UK.
Alexandra Lewis
Affiliation:
Consultant adolescent forensic psychiatrist with the Cambridge Lifespan Autism Spectrum Service, Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourne Hospital, Cambridge, UK.
*
Correspondence Gabrielle Pendlebury. Email: drgabriellependlebury@gmail.com
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Summary

Teenagers often present in crisis with risk issues, mainly risk to self but sometimes risk to others. Adolescent violence is commonplace and is not just the remit of adolescent forensic psychiatry. Clinicians may lack confidence assessing risk of violence and can neglect vital areas that are essential to reduce risk. Use of structured violence risk assessments enables the multi-agency professional network to formulate a young person's presentation and their violence in a holistic way and consequently develop targeted risk management plans addressing areas such as supervision, interventions and case management to reduce the risk of future violence. Of the several validated tools developed for young people, the Structured Assessment of Violence Risk – Youth (SAVRY™) is that most used by UK-based forensic adolescent clinicians. This article outlines the epidemiology, causes and purposes of violence among adolescents; discusses types of risk assessment tool; explores and deconstructs the SAVRY; and presents a fictitious risk formulation.

Keywords

Adolescencerisk assessmentviolencemultidisciplinaryrisk management
Type
Article
Information
BJPsych Advances , Volume 30 , Issue 3 , May 2024 , pp. 147 - 155
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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References

American Academy of Child & Adolescent Psychiatry (AACAP) (2017) Facts for Families: Violent Behavior in Children and Adolescents (https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Understanding-Violent-Behavior-In-Children-and-Adolescents-055.aspx).Google Scholar
Al-Attar, Z (2018) Development and Evaluation of Guidance to Aid Risk Assessments of Offenders with Autism (MA Dissertation). Sheffield Hallam University.Google Scholar
Ash, P (2019) Children are different: liability issues in working with suicidal and dangerous youths. Focus, 17: 355–9.CrossRefGoogle ScholarPubMed
Bartel, P, Borum, R, Forth, A (2002) Structured Assessment for Violence in Youth (SAVRY). University of South Florida.Google Scholar
Blumenthal, S, Wood, H, Williams, A (2018) Assessing Risk: A Relational Approach. Routledge.CrossRefGoogle Scholar
Borum, R (2000) Assessing violence risk among youth. Journal of Clinical Psychology, 56: 1263–88.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Chu, CM, Goh, ML, Chong, D (2016) The predictive validity of SAVRY ratings for assessing youth offenders in Singapore: a comparison with YLS/CMI ratings. Criminal Justice and Behavior, 43: 793–810.CrossRefGoogle Scholar
Desmarais, SL, Reeves, KA, Nicholls, TL, et al (2012) Prevalence of physical violence in intimate relationships, part 2: rates of male and female perpetration. Partner Abuse, 3: 170–98.CrossRefGoogle Scholar
Eells, TD (ed) (2007) Handbook of Psychotherapy Case Formulation (2nd edn). Guilford Press.Google Scholar
Fazel, S, Wolf, A (2017) Selecting a risk assessment tool to use in practice: a 10-point guide. Evidence Based Mental Health, 21: 41–3.CrossRefGoogle ScholarPubMed
Graham, P, Hughes, C (2005) So Young. So Sad. So Listen (2nd edn). RCPsych Publications.Google Scholar
Hales, H, Lewis, A (2022) CPD eLearning Module: Adolescent Forensic Psychiatry: Part 2 – Assessment and Treatment. Royal College of Psychiatrists.Google Scholar
Hart, SD, Douglas, KS, Guy, LS (2016) The structured professional judgment approach to violence risk assessment: origins, nature, and advances. In The Wiley Handbook on the Theories, Assessment, Treatment of Sexual Offending: Volume II. Assessment (eds Craig, L, Rettenberger, M): 643–66. Wiley-Blackwell.CrossRefGoogle Scholar
Hindley, N, Lengua, C, White, O (2017) Forensic mental health services for children and adolescents: rationale and development. BJPsych Advances, 23: 36–43.CrossRefGoogle Scholar
Koh, LL, Day, A, Klettke, B, et al (2020) The predictive validity of youth violence risk assessment tools: a systematic review. Psychology, Crime & Law, 26: 776–96.CrossRefGoogle Scholar
Lodewijks, HPB, Doreleijers, TAH, de Ruiter, C (2008) SAVRY risk assessment in violent Dutch adolescents: relation to sentencing and recidivism. Criminal Justice and Behavior, 35, 696–709.CrossRefGoogle Scholar
Loeber, R, Burke, JD, Lahey, BB, et al (2000) Oppositional defiant and conduct disorder: a review of the past 10 years, Part I. Journal of the American Academy of Child and Adolescent Psychiatry, 39: 1468–84.CrossRefGoogle ScholarPubMed
Malvaso, C, Day, A, Cale, J, et al (2022) Adverse Childhood Experiences and Trauma among Young People in the Youth Justice System (Trends & Issues in Crime and Criminal Justice no. 651). Australian Institute of Criminology.10.52922/ti78610CrossRefGoogle Scholar
McGowan, MR, Horn, RA, Mellott, RN (2011) The predictive validity of the Structured Assessment of Violence Risk in Youth in secondary education settings. Psychological Assessment, 23: 478–86.CrossRefGoogle Scholar
McNicholas, F, Moore, K (2022) Covid-19, child & adolescent mental health services (CAMHS) and crises. Irish Medical Journal, 115(1): 522.Google ScholarPubMed
Moffitt, TE (1993) Adolescence-limited and life-course-persistent antisocial behaviour: a developmental taxonomy. Psychological Review, 10094: 674–701.10.1037/0033-295X.100.4.674CrossRefGoogle Scholar
Moffitt, TE, Caspi, A, Rutter, M, et al (2001) Sex Differences in Antisocial Behaviour: Conduct Disorder, Delinquency, and Violence in the Dunedin Longitudinal Study. Cambridge University Press.CrossRefGoogle Scholar
Morgan, D, Ruszczynski, S (2007) Lectures on Violence, Perversion and Delinquency. Karnac Books.Google Scholar
Mroczkowski, MM, Walkup, JT, Appelbaum, PS (2021) Assessing violence risk in adolescents in the pediatric emergency department: systematic review and clinical guidance. Western Journal of Emergency Medicine, 22: 533–42.CrossRefGoogle ScholarPubMed
Muir, NM, Viljoen, JL, Shepherd, SM (2023) Violence risk assessment tools and indigenous peoples: colonialism as an underlying cause of risk ratings on the SAVRY. International Journal of Forensic Mental Health. Available from 10.1080/14999013.2023.2178554.CrossRefGoogle Scholar
Odgers, CL, Moretti, MM, Reppucci, ND (2005) Examining the science and practice of violence risk assessment with female adolescents. Law and Human Behavior, 29: 7–27.CrossRefGoogle ScholarPubMed
O'Shea, LE, Dickens, GL (2015) Contribution of protective factors assessment to risk prediction: systematic review and meta-analysis. European Psychiatry, 30(suppl 1): 211.CrossRefGoogle Scholar
Perrault, RT, Vincent, GM, Guy, LS (2017) Are risk assessments racially biased? Field study of the SAVRY and YLS/CMI in probation. Psychological Assessment, 29: 664–78.CrossRefGoogle ScholarPubMed
Rutter, M (1987) Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57: 316–31.CrossRefGoogle ScholarPubMed
Senior, M, Fanshawe, T, Fazel, M, et al (2021) Prediction models for child and adolescent mental health: a systematic review of methodology and reporting in recent research. JCPP Advances, 1(3): e12034.CrossRefGoogle ScholarPubMed
Shaffer, CS, Viljoen, JL, Douglas, KS (2022) Predictive validity of the SAVRY, YLS/CMI, and PCL:YV is poor for intimate partner violence perpetration among adolescent offenders. Law and Human Behavior, 46: 189–200.10.1037/lhb0000483CrossRefGoogle ScholarPubMed
Sturmey, P, McMurran, M (eds) (2011) Forensic Case Formulation. John Wiley & Sons.CrossRefGoogle Scholar
Teymoori, A, Cote, SM, Jones, BL, et al (2018) Risk factors associated with boys’ and girls’ developmental trajectories of physical aggression from early childhood through early adolescence. JAMA Network Open, 1(8): e186364.CrossRefGoogle ScholarPubMed
Tremblay, RE, Nagin, DS, Séguin, JR, et al (2004) Physical aggression during early childhood: trajectories and predictors. Pediatrics, 114: e43–50.CrossRefGoogle ScholarPubMed
Webb, EL, Morris, D, Hamer, A, et al (2022) Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs? Journal of Intellectual Disabilities and Offending Behaviour, 13: 32–44.CrossRefGoogle Scholar
Yakeley, J (2018) Psychodynamic advances to violence. BJPsych Advances, 24(1): 83–92.CrossRefGoogle Scholar
Zoccolillo, M, Pickles, A, Quinton, D, et al (1992) The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder. Psychological Medicine, 22: 971–86.CrossRefGoogle ScholarPubMed
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