Development and Implementation of the Northgate Offender Risk Assessment Package NORAP

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Development and Implementation of theNorthgate
Offender Risk Assessment Package (NORAP)

• Toni Brown, Psychology Associate
• Lee Anderson, RLN, Clinical Coordinator

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Northgate Hospital

• Largest specialist intellectual disability
  services in England, providing in-patient
  forensic services at a local, regional and
  national level.
• It provides medium-secure, low-secure and
  rehabilitation facilities for approximately 160
  patients, receiving referrals from health
  authorities, the courts, and prisons.

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Background to project at Northgate

• Need to develop a tool which could distinguish
  someones actual, transferable risk from their
  day to day risk
• NORAP has now been clinically rolled out across
  the hospital
• Aim for every patient to have a NORAP 6-9 months
  from admission, with updates every 2 years

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What is a NORAP?

• Joint Nursing/Psychology
• Violence, sexual offending, fire setting
  suicide/self-harm
• Research based
• Static and dynamic factors
• Collective Forensic Risk judgements
• Current and prospective risk
• Risk management recommendations and risk
  management plan

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Rationale

• NHS Executives guidance (DoH, 1994)
• Requires that risk assessment is component part
  of CPA
• DoH (2007) Best Practice in managing risk
• Risk management should be multidisciplinary
• Where suitable tools are available, should be
  based on assessment using the structured clinical
  judgement approach
• HCR-20 set as standard risk assessment tool

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4 Manuals

• HCR-20 (historical and clinical risk)
• SVR-20 (Sexual violence risk)
• Northgate Fire Setters Risk Assessment
• Northgate Self Harm Risk Assessment

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Factors considered in HCR-20

• 20 risk factors
• e.g. Previous violence

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Factors considered in SVR-20

• 20 risk factors
• e.g. Multiple sex offence types

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Northgate Fire setting Risk Assessment

• 11 risk factors
• e.g. Previous hoax calls to emergency services

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Northgate Self Harm Risk Assessment

• 16 risk factors
• e.g. Previous deliberate self harm

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Reliability and Validity of HCR-20 with offenders
with ID

• Study awaiting publication (Taylor et al)
• Implications from study the HCR-20 is a robust
  instrument for guiding structured clinical
  judgments concerning risk of violence amongst
  males with ID and forensic histories

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Risk Factors
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Completed NORAP

• NORAP Summary Report
• Statement of NORAP Limitations and use of NORAP
  Summary Report
• Overall Risk Judgments
• Priority Risk Behaviour Plan
• Supporting Evidence Collection Forms
• Coding sheets

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How is it done?

• Who is involved
• Procedure
• Timescale
• Final risk judgement
• Practicalities

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Procedure for administration

• Meet with relevant staff
• Evidence collection historical and clinical
• 3 way meeting to review scoring, consider final
  risk judgments, complete priority risk behaviour
  plan
• Write report
• Dissemination

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Training

• Collaborative nursing and psychology
• NORAP Liaison Nurse
• Joint training sessions
• ½ day session
• Group exercises
• Case study

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Evaluation of Staff Training
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Value of NORAP

• Feed into CPAs
• Mental Health Review Tribunals
• Inform treatment interventions
• Inform current and future support packages
• Previous information can be lost historically

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Implementation

• Clinical role out
• Villa by Villa rehab to acute
• Catch-up phase
• Programmatic approach
• New developments

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Implementation continued

• NORAP programme
• Steering group
• Resources across service
• Minimum standards 6 months from admission,
  updates every 2 years
• Waiting list
• Monthly plan (4 per month)

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Issues in Implementation

• Completion of NORAP
• Training
• Requests from MHRTs
• Dissemination of information

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Audit

• For 21 patients 67 recommendations were made at
  initial CPA meeting based on HCR-20/NORAP
  assessments
• Only 34 recommendations were discussed at
  subsequent CPA meetings
• Despite the NORAP being valued, still problems
  getting recommendations fed into treatment plans

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Future

• Evaluate process of incorporating recommendations
  into treatment plans

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References

• Boer, D., Hart, S., Kropp, P. Webster, C.D.
  (1997). Manual for the Sexual Violence Risk-20.
  Burnaby, British Columbia, Canada Simon Fraser
  University and British Columbia Forensic
  Psychiatric Services Commission
• Taylor et al (2009), Manual for using and scoring
  the Northgate Firesetting Risk Assessment and
  Northgate Self-Harm Risk Assessment
  (unpublished), NTW NHS Trust
• Taylor et al (2009), HCR-20 and Offenders with
  Disabilities (unpublished), NTW NHS Trust
• Webster, C.D., Eaves, D., Douglas, K.S.
  Wintrup, A. (1995). The HCR-20 The assessment of
  dangerousness and risk. Vancouver, Canada Simon
  Fraser University and British Columbia Forensic
  Psychiatric Services Commission