IVY Formulation Workshop

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Transcript IVY Formulation Workshop

Interventions for Vulnerable Youth (IVY) Formulation in Risk Assessment – Principles and Practice


Clinical Psychologist and Project Manager


Consultant Social Worker (RMA)

CYCJ Annual Conference, Dundee, 2014

    Youth violence risk assessment, the context Case study outline  Formulation within risk assessment Formulation – definitions Formulation – Principles  The 4 Ps model   Formulation – process Formulation – outputs – group task and case example  Discussion and reflections


Youth Violence – the context

     The health, psychological, social, and financial burdens of crime – and violence in particular - are well established. Young people are most likely to be the victim of youth crime, however, victims can include peers, parents, siblings, strangers, professionals, intimate partners and vulnerable others. Youth homicides account for 41% of the formal figures and homicide is a leading cause of death among adolescents (World Health Organisation, 2011). can include serious and life threatening interpersonal violence, fire setting/arson, theft, vandalism and various behaviours considered to be antisocial. Indeed, adolescents account for a disproportionate amount of perpetrated rapes and child abuse (Radford et al, 2011; Vizard et al, 2007). In order to intervene with this population, it is essential to assess and understand the nature of the risk posed and the factors that contributed to the onset, development and maintenance of the problems. Contemporary practice guidelines advocate the use of

formalised risk assessment approaches


Risk Assessment Process

Identification Analysis Evaluation Communication

Framework for Risk Assessment Management and Evaluation (FRAME) http://www.rmascotland.gov.uk/standardsandguidelines/

Case Study

Case Study: Jamie

• • Jamie 17 years old • • • • • •

Case Study: Background Family Life Education Mental Health Substance Misuse Social History/Peer Association LAAC History

Case Study: Background

• • • • •

Sexual Behaviour

Age 11: Staff find kitchen implements in Jamie’s bedroom – suspected use for sexual purposes Age 11: Allegations of sodomy against an 9 year old boy in residential care. Age 13: Concerns of inappropriate sexual contact with his 4 year old cousin Age 15: Two claims of alleged rape against his then girlfriend who was deemed to be vulnerable to exploitation Currently: Relationships with a range of young women some of whom are known to be vulnerable • • • • • • •

Violent/Aggressive Behaviour

Violent behaviour reported at home and school from a young age Threats and actual violence towards staff in residential care, both male and female Fellow residents reported to be “petrified of him” Possession of weapons in both residential and community settings Victim and perpetrator of domestic violence in relationship with former partner Anger is targeted at individuals (usually staff) although he can remain calm with others who are present. Displays disproportionate responses to minor or inconsequential events

Case Study: Current Presentation

Avoidant of and aggressive towards staff Disengaging from support and supervision Whereabouts is frequently unknown Concern about peer associations/relationships Chaotic with poor self care

Formulation: Definitions

“…a process by which a set of hypotheses is generated about the etiology and factors that perpetuate a patient’s presenting problems and translates the diagnosis into specific, individualized treatment interventions.” ( Winters et al, 2007 ). “…Case formulation generally refers to an integrative process that synthesizes how one understands the complex, interacting factors implicated in development of a patient’s presenting problems. It is explicitly comprehensive and takes into account the child and family’s strengths and capacities that may help to identify potentially effective treatment approaches. The case formulation serves as a testable explanatory model that gives rise to ideas for intervention and eliminates some options that do not fit the model….” ( Winters et al 2007 )


“Formulation is the preparation of an evidence-based explanation of a person’s difficulties – their form, their origins, and their development and maintenance over time (Johnstone & Dallos, 2006; Tarrier, 2007).

Benefits of formulation

 Where theory and empirical knowledge merge with the understanding of an individual/family/system  Allow us to understand why a difficulty exists rather than simply describing a set of symptoms/problems  Fills the gap between describing and intervening  Guides intervention  Individually sensitive and specific  Allows us to understand complexity/comorbidity

Principles (Hart et al, 2011)


Make speculations about possible futures based on what is known, rather than quantitative forecasts. Provide explanations and justifications for speculations.

Action Oriented

Points to treatment targets and appropriate interventions, and consequently has value across the system. Offers a way to proceed with case.


Theory Driven

Theories from a range of perspectives allow us to identify salient features in large amounts of information.



What is happening for this particular person at this time, what might happen in the future, what might work best for this person. Supplementing theory with person centric information



Formulation defies quantification with numbers; it is a qualitative approach to understanding driven by theory and case specific information. The narrative should contain critical elements and have strucutre



The formulation should span time and containe information about the past the present and possible futures. In childhood it is important to understand the child’s age and stage of development at present, and the potential change associated with maturation.



As an explanatory theory, the formulation should be testable.



The formulation should generate new information and knowledge with the caveat that as an entity the formulation is not a certainty but a dynamic understanding subject to revision over time.


Formulation: 4 P’s Approach

 predisposing (i.e., factors in the individual’s past that may increase his proclivity or vulnerability to violence)  precipitating (i.e., events or circumstances that may trigger the behaviour or disinhibit usual behavioural controls); (motivators, disinhibitors)  perpetuating (i.e., factors that cause the risk to remain) (impeders, unresolved vulnerabilities)  protective factors (i.e., aspects of the offender’s functioning or circumstances that moderate the risk)

Formulation – Process

Problem Information Hypotheses Intervention Communicati on

• Identify the problem, can be complex.

• • Collect a range of information across time points and informants/ sources. Comprehensive.

• Make sense of the relationship between the 4 Ps. Make into a narrative and shared, sensible, formulation.

• Formulation will point to appropriate treatment targets and facilitate planning interventions. • Communicate, share and discuss formulation so that approach is coordinated.


Formulation Exercise

Formulation: Communication

 A story not a sum…  Consider the reader and use clear and meaningful terminology  Convey the key facts of the case  Provide a structure or plot to your story  Beginning, middle, end  Pattern, nature, seriousness, likelihood, imminence  Who, what, when, where, why, how  Theoretical framework

Reflections and Discussion