Risk assessment needs more focus on reducing actual risk. It is time we develop tools that combine scientific knowledge and clinical practice.

1. 1
ARMIDILO
Building the bridge between risk
assessment and treatment for people
with learning disabilities
Svein Øverland, Clinical psychologist
Sentral fagenhet, avd. Brøset, St. Olavs Hospital/
National unit for mandatory care

2. Three ill-defined problems
Intellectual deficiency Psychiatric disorder
Crime

3. 3
Target population
• Persons convicted to mandatory care
• Persons with ID or reduced cognitive skills and
a history of violence (included sexual violence)
• Persons with autism spectrum disorders with
a history of violence
• In prison, custody, or in local institutions

4. Our aim
• To protect the society from further severe
violence
• To give persons convicted to mandatory care
treatment for their behavioral problems

5. 5
På tide å bli enda bedre

6. The problem

7. TID
K
O
N
T
R
O
L
L
1
2
3
Økt mistrivsel
Trawling
Grooming
Det er ikke
farlig, lov å
kikke
Overgrep
Seksuell
fantasi
Livssituasjon
Hun tar
ikke
skade av
det

8. TID
K
O
N
T
R
O
L
L
1
2
3
Dagdrømming,
tråling
Kontakt,
Grooming
”det er lov
å kikke”
Overgrep
Seksuell
fantasi
Frustrasjon
”hun har
ikke
vondt av
det” 4
Stopp og tenk
Time out
Bruk
venn/hjelper
Kom deg vekk
Løs problemet

12. 1. Attitude toward and compliance with supervision Presence
-2 to +2
Recent
Change
(+, 0, -)
Critical
Item?
2. Attitude toward and compliance with treatment
3. Sexual deviance
4. Inappropriate preoccupation
5. Victim selection and acquisition / grooming
6. Emotional coping ability
7. Self-Efficacy
8. Relationship skills
9. Substance abuse
10. Impulsivity
11. Use of violence or threats towards self or others
12. Mental health and other unique considerations
”The standard items”

13. Stable Dynamic Items (Environmental Factors) Presenc
e
-2 to +2
Recent
Change
(+, 0, -)
Critical
Item?
1. Attitude towards intellectually disabled individuals
2. Communication among supervisory staff
3. Client specific knowledge by supervisory staff
4. Consistency of supervision
5. Situational consistency
6. Unique considerations
TOTAL SUB-SECTION SCORE:

14. Risk assessment as process
• ARMIDILO leads to interventions in:
 Client factors – emotion and skills training
 Staff factors – dialogue and communication

15. ARMIDILO = KAOS + Dialogue

19. KAOS + Dialogue
• KAOS is given by the regular staff
• The staff reinforces KAOS behaviour when
observed in the unit
• Dialogue is observed by ”secret friends” is
reinforces when observed in meetings

20. KAOS in a nutshell

KAOS is a cognitive behavioural therapy

based on emotion- and skills training

in a group setting

where the staff both conduct the group
training

and reinforce the new behaviour in the milleu

and act as liaisons to both the
patients/clients/convicteds local authorities
and family

21. Adapting the therapy
• We have to adapt the therapy to the patient
• rather than expecting the patient adapting to
the therapist

22. The meny principle
• The participants chooses which of the themes
they want to work with from the manual
• The first ones should be rather simple, the last
ones must relate to their index crime(s)

23. The aim is to have less “bad feelings”

24. More of the “positive feelings”
• What can you do to
make the good feelings
come back again?
• What can you do to
make good feelings stay
that way?
• What can you do to
make other people get
good feelings?

25. 25

26. Environmental factors
• Sometimes it is simpler to change the patient
through changing the environment
• Based upon the ARMIDILO scoring,
interventions will include staff courses in
general and specific knowledge of ID, autism,
psychosis
• And assisting them to make better risk
judgments based on learning of
communication skills

30. Evaluation by the staff
• Staff reports that the participants make better
use of social skills
• Non-participants as well
• And even the staff