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The Comprehensive Assessment of Psychopathic Personality Symptom Rating Scale (CAPP SRS) is a relatively new measure of psychopathic personality disorder (PPD) based on the CAPP concept map of psychopathy. To investigate the CAPP SRS, we identified the most plausible formal test structure for the test using the framework proposed by Slaney and Maraun, identified an appropriate quantitative characterization of that test structure, and then statistically evaluated it based on analysis of CAPP SRS data collected from a multisite sample of 314 adult male correctional offenders and secure hospital patients in Scotland and England. Overall, the CAPP SRS survived falsification when observed test data were compared to expectations based on the unidimensional monotone latent variable or UMLV model of Holland and Rosenbaum. CAPP SRS composite scores calculated consistent with the UMLV model had good measurement precision and good external validity with respect to scores on an established test of PPD. The findings provide provisional support for the test validity of the CAPP SRS and highlight the importance of theory-driven evaluations of test validity.

This paper introduces a special issue of the Journal of Forensic Psychiatry and Psychology dedicated to violent extremism and mental health. We address three challenges faced by mental health pract...

In this chapter, the task of threat assessment is defined—and differentiated from the related task of risk assessment. Examples are given of police activities in which a threat assessment either provides or has the potential to provide a significant contribution to proceedings in order to illustrate both the task and the challenges faced by implementing such a psychologically informed activity in a law enforcement context. Key principles in the task, such as the necessity of linking threat assessment to threat management, will be described and discussed, as will be the strengths and weaknesses of some of the different approaches available to underpin and guide the threat assessment and management processes. This chapter will conclude with some comments about the evaluation of threat assessment and management activity in law enforcement because such an investment in time and resources can only be justified if it provides demonstrable benefits, which can be a challenge in services dedicated to harm prevention.

Introduction Quality improvement and implementation science practitioners identify relational issues as important obstacles to success. Relational interventions may be important for successful performance improvement and fostering Learning Health Systems. Methods This case report describes the experience and lessons learned from implementing a relational approach to organizational change, informed by Relational Coordination Theory, in a health system. Structured interviews were used to obtain qualitative participant feedback. Relational Coordination was measured serially using a validated seven‐item survey. Results An initial, relational intervention on one unit promoted increased participant engagement, self‐efficacy, and motivation that led to the spontaneous, emergent dissemination of relational change, and learning into other parts of the health system. Staff involved in the intervention reported increased systems thinking, enhanced focus on communication and relationships as key drivers for improvement and learning, and greater awareness of organizational change as something co‐created by staff and executives. Conclusions This experience supports the hypothesis that relational interventions are important for fostering the development of Learning Health Systems.

This chapter examines the task of preventing harmful behaviour motivated by a violent extremist ideology. It begins with a brief review of the history of practice in the field of risk assessment and management in order to highlight the latest learning and recommendations, which the violent extremism field would do well to follow. Risk and threat assessment and management practice is then compared and contrasted in order to highlight differences that account at least in part for the wide variety of guidance and expectations currently available. The final part of the chapter focuses on practical issues in the prevention of violent extremism through its assessment, formulation, and subsequent management. Specific key issues are addressed: (i) the application of the structured professional judgement approach in practice, from triage through to extended or live risk management; (ii) the challenge of establishing a violent extremist intent in a person who is the focus of concern, in order that the most appropriate guidance and management strategies are put against his or her harm potential; and (iii) the task of embedding and evaluating harm prevention into counter-terrorism practice. The chapter ends with concluding remarks and practice recommendations.

This two-part special issue of the International Journal of Forensic Mental Health is dedicated to the practice of forensic clinical interviewing, that is, the nature and application of specialist ...

PurposeThe task of assessing and managing risk of violence has evolved considerably in the last 25 years, and the field of violent extremism has the potential to stand on the shoulders of the giants of this time. Therefore, the objective of this study was to identify good practice in the risk field and to apply that to the specific area of risk in relation to violent extremism – in order that developments here accord to highest standards of practice achieved so far elsewhere.Method and ResultsWe begin by addressing the essential requirement to define the task of assessing and managing the risk of violent extremism – What is its purpose and parameters, who are its practitioners, in what contexts is this activity delivered, and how might any such context both facilitate and hinder the objectives of the task? Next, we map the terrain – What guidance is already available to assist practitioners in their work of understanding and managing the risk of violent extremism, and by what standards may we judge the quality of this and future guidance in the contexts in which is it applied? Finally, we explore options for the development of the field in terms of the empirical basis upon which the risks presented by individuals and the organizations to which they may affiliate are assessed, understood, and managed.ConclusionsRecommendations are proposed in relation to each of these three areas of concern with a view to supporting the rapid and credible advancement of this growing and vital area of endeavour.

Background Pressures are increasing for clinicians to provide high-quality, efficient care, leading to increased concerns about staff burnout. Purpose This study asks whether staff well-being can be achieved in ways that are also beneficial for the patient's experience of care. It explores whether relational coordination can contribute to both staff well-being and patient satisfaction in outpatient surgical clinics where time constraints paired with high needs for information transfer increase both the need for and the challenge of achieving timely and accurate communication. Methodology/approach We studied relational coordination among surgeons, nurses, residents, administrators, technicians, and secretaries in 11 outpatient surgical clinics. Data were combined from a staff and a patient survey to conduct a cross-sectional study. Data were analyzed using ordinary least squares and random effects regression models. Results Relational coordination among all workgroups was significantly associated with staff outcomes, including job satisfaction, work engagement, and burnout. Relational coordination was also significantly associated with patients' satisfaction with staff and their overall visit, though the association between relational coordination and patients' satisfaction with their providers did not reach statistical significance. Practice implications Even when patient-staff interactions are relatively brief, as in outpatient settings, high levels of relational coordination among interdependent workgroups contribute to positive outcomes for both staff and patients, and low levels tend to have the opposite effect. Clinical leaders can increase the expectation of positive outcomes for both staff and their patients by implementing interventions to strengthen relational coordination.

Working with women in secure services is an infrequent subject of research and discussion in the forensic mental health literature. There are several reasons for this, which will be considered in the introduction to this paper. However, a consequence of this situation is that there remains a lack of clarity in key areas of practice in relation to working with women in secure services, and working with women with personality disorder specifically: how women with personality disorder may present in secure services compared to men, therefore, the particular skills required of the practitioners who work with women and the main design features of the services within which they are managed. The body of this paper attempts to summarise important issues in each of these areas in order to inform future debate and developments in the field.

The behavioral effects of methamphetamine (METH) are mediated by the striatum, which is divided into the patch compartment, which mediates limbic and reward functions, and the matrix compartment, which mediates sensorimotor tasks. METH treatment results in repetitive behavior that is related to enhanced relative activation of the patch versus the matrix compartment. The patch, but not the matrix compartment contains a high density of µ opioid receptors, and localized blockade of patch-based µ opioid receptors attenuates METH-induced patch-enhanced activity and repetitive behaviors. Numerous studies have examined patch-enhanced activity and the contribution of patch-associated µ opioid receptors to METH-induced repetitive behavior, but it is not known whether patch-enhanced activity occurs during METH-mediated reward, nor is it known if patch-based µ opioid receptors contribute to METH reward. The goals of this study were to determine if blockade of patch-based µ opioid receptors alters METH-induced conditioned place preference (CPP), as well activation of the patch and matrix compartments following METH-mediated CPP. A biased conditioning paradigm was used to assess CPP, and conditioning occurred over an 8-day period. Animals were bilaterally infused in the striatum with the µ-specific antagonist CTAP or vehicle prior to conditioning. Animals were tested for preference 24h after the last day of conditioning, sacrificed and the brains processed for immunohistochemistry. Blockade of patch-based µ opioid receptors reduced METH-induced CPP, and reduced patch-enhanced c-Fos expression in the striatum following METH-mediated CPP. These data indicate that patch-enhanced activity is associated with METH-mediated reward and patch-based µ opioid receptors contribute to this phenomenon.

Work is increasingly complex, specialized, and interdependent, requiring coordination across roles, disciplines, organizations, and sectors to achieve desired outcomes. Relational coordination theory proposes that relationships of shared goals, shared knowledge, and mutual respect help to support frequent, timely, accurate, problem-solving communication, and vice versa, enabling stakeholders to effectively coordinate their work across boundaries. While the theory contends that cross-cutting structures can strengthen relational coordination, and that relational coordination promotes desired outcomes for multiple stakeholders, the empirical evidence supporting the theory has not previously been synthesized. In this article, we systematically review all empirical studies assessing the predictors and outcomes of relational coordination published from 1991 to 2019. We find evidence supporting the existing theory and discuss how that evidence supports expanding the theory from a linear structure–process–outcomes model to a dynamic model of change. An agenda for researchers and practitioners is proposed.

Welcome to this special edition of The Journal of Forensic Psychiatry & Psychology. We are delighted that researchers and practitioners from the fields of forensic and clinical psychology, psychiat...

Decisions about when to start or switch a therapy often depend on the frequency with which individuals are monitored or tested. For example, the optimal time to switch antiretroviral therapy depends on the frequency with which HIV-positive individuals have HIV RNA measured. This paper describes an approach to use observational data for the comparison of joint monitoring and treatment strategies and applies the method to a clinically relevant question in HIV research: when can monitoring frequency be decreased and when should individuals switch from a first-line treatment regimen to a new regimen? We outline the target trial that would compare the dynamic strategies of interest and then describe how to emulate it using data from HIV-positive individuals included in the HIV-CAUSAL Collaboration and the Centers for AIDS Research Network of Integrated Clinical Systems. When, as in our example, few individuals follow the dynamic strategies of interest over long periods of follow-up, we describe how to leverage an additional assumption: no direct effect of monitoring on the outcome of interest. We compare our results with and without the “no direct effect” assumption. We found little differences on survival and AIDS-free survival between strategies where monitoring frequency was decreased at a CD4 threshold of 350 cells/mu l compared with 500 cells/mu l and where treatment was switched at an HIV-RNA threshold of 1000 copies/ml compared with 200 copies/ml. The “no direct effect” assumption resulted in efficiency improvements for the risk difference estimates ranging from an 7- to 53-fold increase in the effective sample size.

Purpose – The implementation of the Offender Personality Disorder (OPD) strategy requires partnership between NHS providers and custodial and community-based practitioners in the National Offender Management Service (NOMS). What this partnership looks like is dependent on the nature and resources of involved services. However, what it is meant to achieve – reduced reoffending, a more knowledgeable workforce, and a more engaged client group – is clearer. It is fundamental to the OPD strategy that these outcomes are delivered through partnership so as to minimise harmful transitions between services, and to effectively share the expertise required for the holistic case management of personality disordered (PD) offenders. The paper aims to discuss these issues. Design/methodology/approach – The implementation of the OPD strategy is ongoing, and data will be forthcoming in due course that will allow for the empirical test of the hypothesis that working together is better than working separately. However, with the emphasis on public protection and workforce development, some of the crucial partnership issues may remain less well understood or explored. This paper overviews the services in which the authors are involved, describing their initiation and operation. Findings – The paper articulates how NHS/NOMS partnerships have been developed and experienced. Practical implications – The paper concludes with a discussion of a number of principles for partnership work in relation to the OPD strategy. Originality/value – This paper is intended to assist developing services to make the most of collaborative working across the PD pathway in England and Wales.

Purpose This paper examines the construct of psychopathy and the challenge of conceptualizing and operationalizing a personality disorder that is poorly described by standard diagnostic systems yet remains important within the forensic field. Methods We begin by reviewing what we know about the importance of psychopathy to crime and antisocial behavior - why psychopathy is a construct that is here to stay. We then consider the conceptualization of the construct - and from there to its measurement. Throughout, we focus on the model described as the Comprehensive Assessment of Psychopathic Personality (CAPP) (Cooke et al., 2012). The CAPP model can be assessed through the use of a semi-structured clinical interview and an informant rating form; the translation of the CAPP model into measurement and clinical practice is the focus here. Results We emphasise the use of the CAPP model to understand and explain both the nature and significance of psychopathic personality disorder as it presents in an individual: formulation provides the means to achieve this. Conclusions The final part of the paper describes the formulation process, and illustrates the utility of the CAPP approach for formulating two fictional clients both of who evince significant symptoms of psychopathy.

This chapter examines the formulation process and describes recent work in which it is being subject to close scrutiny. Formulation has been placed at the heart of the psychologically informed management of high-risk personality disordered offenders in prisons and probation services in England and Wales. The chapter describes in detail the work ongoing to support the development of good practice in formulation, which is as relevant to prison officers and probation staff as it is to mental health practitioners and their clients. It also discusses the purpose of formulation in forensic services and a description of what formulations could look like and why. The formulation process allows the opportunity to organize often quite disparate information about a client in order to expose the key elements of the case. Formulation plays a key role in the work of forensic services, that is, prisons, secure psychiatric hospitals, and community services for offenders, and has done for many years.

The term structured professional judgement (SPJ) refers to the discretionary application of evidence-based clinical guidelines for understanding complex problems in order to influence their comprehensive, positive and ongoing or continuous management. This chapter focuses on SPJ, that is, on the application of discretionary clinical guidelines that support the understanding and real time management of the threat of harmful behaviour in the clients of mental health, correctional and law enforcement services. This is because SPJ, more than any other approach to evaluating risk, incorporates both empirical and professional evidence about harmful behaviour, supports transparent and professionally accountable practice and guides pragmatic risk management in the services that endeavour to work collaboratively with their users. In practice, the SPJ approach is presented in the form of a manual containing guidance on navigating each step of the process of conceptualising, understanding and managing risk, where evidence of decision making at each step is recorded on a worksheet.

The third edition of the HCR-20 (HCR-20V3, Douglas, Hart, Webster, et al., 2013) consolidates essential recent thinking about risk assessment and management using the structured professional judgement approach. As with the preceding Risk for Sexual Violence Protocol (Hart, Kropp, Laws et al., 2003), risk factors for violence are now assessed for their relevance as well as presence, scenario planning has a central place in anticipating the nature, severity, imminence and likelihood of future harm, and risk management strategies must incorporate a combination of treatment, supervision, monitoring and victim safety planning interventions and recommendations. However, the key process now proposed for linking the assessment and overall management of risk is risk formulation—the act of understanding the underlying mechanism of an individual's harm potential in order to develop sensitive and proportionate hypotheses to facilitate change (embodied within the risk management plan). In this paper, the process of ri...

The aim of the present study was to investigate the inter-correlation between three different instruments for the assessment of psychopathic personality disorder. Eighty male inmates at Bergen prison (Norway) participated in the study. All the participants were assessed for psychopathy using the Psychopathy Checklist Revised (PCL-R; Hare, 1991), the Comprehensive Assessment of Psychopathic Personality – Institutional Rating Scale (CAPP-IRS; Cooke, Hart, & Logan, 2004), and the questionnaire Self-Report of Psychopathy Scale–III (SRP-III; Paulhus, Neumann, & Hare, in press). The correlational analysis revealed significant correlations between all the instruments, but substantial diverges were also found. CAPP-IRS and PCL-R showed high inter-correlations and, hence, seem to tap into the same underlying construct. The CAPP-IRS seems, however to have a higher affect focus in all its domains. Our finding of lower correlation between the SRP-III and the other two clinical tools may suggest a limitation in the in...

Psychopathic personality disorder (PPD) has important clinical and forensic implications. But much more effort has been devoted to assessing or diagnosing PPD than to explicating or defining it. In the first part of this paper, we describe the development of a conceptual model or “concept map” of PPD. Based on a systematic review of descriptions of PPD in the clinical and research literature, as well as consultation with subject matter experts, we identified key features of the disorder and translated them into 33 symptoms, presented as natural language (i.e., non-technical) trait descriptive adjectives or adjectival phrases. Each symptom in turn was defined by three synonymous adjectives or adjectival phrases. The 33 symptoms were grouped rationally to reflect six domains of personality functioning. In the second part of the paper, we discuss research completed and in progress intended to validate the CAPP conceptual model.

Assessing risk of violence in the short term is crucial for managing and preventing violence, especially in institutions such as psychiatric units and prisons. Despite a lack of consensus on the definition of "short term", a number of recent tools and guidelines have been developed to aid short-term clinical decision-making. Whereas the supporting evidence for the new tools is impressive, limitations remain in terms of the focus on prediction, limited consideration of strengths, and poor integration with formulation and risk management. The Short-Term Assessment of Risk and Treatability (START) is a brief clinical guide for the dynamic assessment of risks, strengths and treatability. It focuses on short-term risks and the characteristics of the individual that, if changed, might lead to an increase or decrease in risk. The START has the potential to operationalize the structured professional judgment (SPJ) approach in order to inform the evaluation of multiple risk domains relevant to everyday psychiatric clinical practice. However, explicit guidance on integrating risk assessment, formulation and management is limited in the START and this paper describes the SPJ approach, reviews recent developments in approaches to risk, and considers how the START can be used to inform SPJ approaches and link risk assessment, formulation, and management.

The Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2004) is a new personality-based model and clinical assessment of psychopathy. This study was the first to examine the content validity of the English-language CAPP. Content validation is a crucial part of the development and refinement of any new instrument. Prototypical analysis was used to evaluate the representativeness of CAPP symptoms to the psychopathy construct in adults. Symptoms were rated by international mental health professionals (N = 132). Findings support good content validity of the CAPP, with most symptoms rated as highly representative of psychopathy. Domains relating to interpersonal style were particularly prototypical. Confirmatory factor analyses further suggested that CAPP domains are highly unidimensional. However, some CAPP symptoms may be weaker items in the model and further refinement is needed.

The RSVP is a set of structured professional judgment guidelines for assessing risk of sexual violence. We investigated the interrater reliability (IRR) of judgments made using the RSVP in a multidisciplinary forensic-clinical context. Raters were 28 forensic mental health and intellectual disability professionals with diverse training and experience. They used the RSVP to evaluate six case vignettes that varied with respect to offense characteristics, clinical complexity, and level of risk. The IRR of ratings for individual risk factors was generally fair. There was a good level of interrater reliability on Summary Judgments and Supervision Recommendations. Interrater reliability was highest when used by professionals who were highly trained in forensic risk assessment. On average, professionals with lower levels of specialist training agreed less with their colleagues and experts, and provided higher estimations of sexual violence risk. Lower levels of agreement were found in cases with moderate levels of complexity and risk. The RSVP can be used to make judgments of risk with adequate levels of interrater reliability. However, this is dependent on the training and expertise of professionals who use the tool. Methodological strengths and limitations are considered, followed by a discussion of implications for training, practice, and future research.

PurposeLiterature and legend features many dangerous female characters. However, in fiction (and in film), it is the male psychopath who dominates. In the scientific literature, research into psychopathy in men also dominates. Studies of the nature and treatment of this severe personality disorder in women are sparse and little is known or agreed about its presentation in this group. Consequently, psychopathy is not routinely assessed in women and the harmful potential of some can be overlooked leading to failures in the management of risk, especially towards partners and children. The purpose of this paper is to explore how psychopathic women manifest the traits of their disorder compared to men.Design/methodology/approachThis paper focuses on the representation of women in fiction who appear to demonstrate psychopathic traits. Several relevant works of fiction will be identified but three texts are described in detail and their female characters and storylines explored.FindingsGender differences and practice implications are highlighted. Specifically, the paper explores the nuanced ways in which women execute their harmful conduct on others and their most likely relationships with the victims of their aggression; comparisons with men are drawn throughout. Further, comparisons are drawn between the psychopathic female characters created by men and women writers.Practical implicationsThe study of psychopathic women in fiction is an invaluable adjunct to empirical research as a way of understanding the phenomenology of psychopathy in this group.Originality/valueThis paper is the first to examine the representation of psychopathic women in fiction and to propose the value of fiction in the study of this particular group of clients.

Background Forensic mental health care in the UK has undergone a rapid expansion since the late 1990s. In medium secure units (MSUs), there is growing emphasis on developing care pathways without much theoretical underpinning. We developed a concept of ‘Milestones to Recovery’ (MTR) to measure progress through the MSU pathway. Aims Our aim was to validate the MTR framework. Our hypotheses were that patients scoring higher on the MTR Scale would be more likely to be aggressive to others in the following 6 months and resident in the acute areas of the unit and that those scoring lower would be more likely to be discharged within 6 months of the assessment. Methods An MTR scale was developed to enable the investigation of the validity of the MTR framework and evaluated with staff evaluations of 80 resident patients using a prospective, longitudinal and naturalistic design. Results The results suggest that the MTR framework is valid in discriminating between different stages on the MSU pathway. Therapeutic engagement was particularly important in terms of progress through the MSU, whereas current behaviour was important in predicting future aggression. Conclusions Further research is required to test the MTR framework across different levels of security, with larger samples and within different populations. Implications for practice Provides a framework to map progress through the service. Identifies key factors that influence recovery and rehabilitation. Potential to promote dialogue between patients and staff, and enhance motivation. Copyright © 2011 John Wiley & Sons, Ltd.

Formulation is the process or product of gathering and integrating diverse information to develop a concise account of the nature and etiology of the problems affecting a person's mental health to guide idiographic treatment design and other decision-making. Formulation is a core competency in mental health practice, including forensic mental health; however, there is no agreement concerning the details of how it should be done or how to evaluate it, either generally or more specifically with respect to forensic mental health. The purpose of this paper is to raise specific issues in the practice and evaluation of forensic case formulation, and so enhance the profile of this important area of work. In this paper, we (1) define case formulation and describe its key features, (2) specify criteria for evaluating case formulation, and (3) address challenges in forensic practice, with suggestions for advancing practice through research. We conclude with a proposed research agenda that we hope will encourage and...

Mentally disordered offenders who were psychopathic according to the Psychopathy Checklist-Revised (PCL-R) were divided into primary psychopath, secondary psychopath, controlled, and inhibited groups on the basis of a validated empirical classification, using the Antisocial Personality Questionnaire (APQ). They were compared on the factors and facets of the PCL-R, criminal history, Axis I and Axis II psychopathology, experience of child abuse, personality, interpersonal style, and clinical ratings of risk and treatability, to determine the utility of the APQ classification in identifying subtypes of psychopath. Significant differences between APQ primary and secondary psychopaths on several measures support the identification of these groups with the primary and secondary psychopaths hypothesized by Karpman (1948) and others. However, further differences suggest that the controlled and inhibited groups represent additional variants of primary and secondary psychopath, respectively. The results provide further evidence for the heterogeneity of psychopaths, and suggest that the PCL-R encompasses several distinct subtypes of abnormal personality.

The chapter will begin with a brief overview of the task of clinical risk assessment and management. As will become clear, the SPJ approach emphasizes the importance of understanding the risks posed by individual clients. Therefore, the chapter will go on to describe the SPJ approach to risk formulation, an essential process that links risk assessment with risk management via an understanding of the function or purpose of sexual violence for the individual. The structured professional judgment approach will then be illustrated through a description of the development and application of the Sexual Violence Risk-20 professional guidelines (SVR-20; Boer et al. (1997). Manual for the sexual violence risk-20: Professional guidelines for assessing risk of sexual violence. Vancouver, Canada: British Columbia Institute on Family Violence and the Mental Health, Law, and Policy Institute, Simon Fraser University) and the more recent structured professional guidelines known as the Risk for Sexual Violence Protocol (RSVP; Hart et al. (2003). The risk for sexual violence protocol: Structured professional guidelines for assessing risk of sexual violence. Vancouver, Canada: Mental Health, Law and Policy Institute, Simon Fraser University). A case study will be provided to illustrate the main features of the SPJ approach to working with sexual offenders. The chapter will end with a set of practice recommendations and suggestions for future research into sexual violence risk assessment and management using the SPJ approach.

This chapter focuses on the structured professional judgement (SPJ) approach to the clinical risk assessment and management of men and women whose sexual behaviour is harmful to others. The SPJ approach promotes the use of clinical guidelines—such as the Risk for Sexual Violence Protocol to help practitioners appraise the relevance of risk factors to the individual client and to create an understanding of that person’s risk potential, on the basis of which comprehensive and proportionate risk management plans can be prepared, implemented, evaluated, and repeatedly updated towards managed risk. This chapter makes the case that the most important part of the clinical risk assessment and management process using the SPJ approach is risk formulation—the process of generating an understanding of harmful behaviour that directly links assessment findings to management actions.