CSC REFERRAL MANUAL -...

CSC REFERRAL MANUAL

NOVEMBER 2003

Contents

1 Introduction - The Informed Referral .............................................................. 31.1 Overview Of Close Supervision Centres ....................................................... 3

The Aim of CSCs ................................................................................................... 3CSC Functions ....................................................................................................... 3CSC Phase II .......................................................................................................... 3CSC Phase III ......................................................................................................... 4

1.2 Identifying the Right Individuals ................................................................... 4What is Meant by Risk? ......................................................................................... 4Who is a Potential CSC Candidate? ....................................................................... 4

1.3 Mental Health Issues ...................................................................................... 5Mental Illness or Personality Disorder? ................................................................. 5

1.4 What is the Difference Between DSPDs and CSCs? ..................................... 52 CSC Process Overview and Time Scale ............................................................. 7

2.1 Key Stages ..................................................................................................... 7Stage 1 - CSC Initial Referral ............................................................................... 7Stage 2 - Multi-Disciplinary Mental Health Assessments .................................... 7Stage 3 - Local Assessment Case Conference ...................................................... 8Stage 4 - Independent Verification Process .......................................................... 9Stage 5 - Presentation to the CSC SC ................................................................... 9Stage 6 - Individual Care and Management Plan Transfer Case Conference ....... 9

2.2 Summary ...................................................................................................... 102.3 CSC Process Overview - Chart ................................................................... 11

3 Stage 1 - CSC Initial Referral .......................................................................... 123.1 Overview ...................................................................................................... 12

3.2 Initial Referral Report Completion Guidance .............................................. 13Governor Assessment .......................................................................................... 13Wing Management Assessment ........................................................................... 13Psychology Assessment ....................................................................................... 13Security Assessment ............................................................................................ 14Medical/Psychiatric Report .................................................................................. 14

4 Stage 2 - Multi-Disciplinary Health Assessments (Guidance for Operationaland Forensic Staff) ............................................................................................. 15

4.1 Overview ...................................................................................................... 154.2 General Guidance ......................................................................................... 154.3 Specific Guidance ........................................................................................ 17

Forensic Psychiatry .............................................................................................. 17Forensic Psychology ............................................................................................ 18Operational Managers .......................................................................................... 18

5 Stage 3 - Local Assessment Case Conference ................................................. 215.1 Overview ......................................................................................... '............. 215.2 Attendees at the Case Conference ................................................................ 215.3 Areas for Discussion at the Case Conference .............................................. 22

Observable Behaviour .......................................................................................... 22Mental and Physical Health ................................................................................. 22Personality Disorder ............................................................................................. 23Risk ...................................................................................................................... 24

6 Stage 4 - Independent Verification Process .................................................... 257 Stage 5 - Presentation to the CSC SC ............................................. . ................ 26

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Contents (continued)

8 Stage 6 - Individual Care and Management Plan Transfer Case Conference•.............................................................................................................................27

8.1 Overview ...................................................................................................... 278.2 Issues to Consider During the Transfer Case Conference ........................... 28

Appendix 1 - Glossary ............................................................................................... 29Appendix 2 - Contacts List ....................................................................................... 30Appendix 3 - Forensic Psychiatry Risk Assessment Report Guidelines .............. 31Appendix 4 - Forensic Psychology Risk Assessment Report Guidelines .............. 32

1 Introduction and advice on the assessment approach .......................................... 322 Guidelines for Administration ............................................................................. 333 Report Sections .................................................................................................... 334 Specific Assessments - Functional Analysis ....................................................... 355 Specific Assessments - PCL-R ............................................................................ 356 Specific Assessments -Violence Risk Scale (VRS) ........................................... 377 Specific Assessments - The HCR-20 Version 2.................................................. 398 Report Conclusions and Recommendations ........................................................ 429 Issues Raised in Disclosure .................................................................................. 43

Appendix 5 - Operational Manager Risk Assessment Report Guidelines ........... 44Overview .................................................................................................................. 44Custodial Behaviour ................................................................................................. 44Adjudications ........................................................................................................... 46Substance Abuse ...................................................................................................... 47

Disruptive or Challenging Behaviour Prior to Adult Imprisonment ....................... 47Relationship History ................................................................................................ 47Supplementary Information ..................................................................................... 48

Appendix 6 - CSC Diary Dates Form ...................................................................... 50Appendix 7 - CSC Initial Referral Form ................................................................ 52Appendix 8- CSC Referral Guide for Prisoners .................................................... 61Appendix 9 - CSC Informed Consent Form ........................................................... 63Appendix 10 - Local Assessment Case Conference Report Form ........................ 65Appendix 11 -CSC SC Assessment Summary Sheet ............................................. 69Appendix 12 - Care and Management Plan Form ................................................. 72

1 Introduction - The Informed Referral

This introductory section is designed to help guide you to an informed position aboutthe role of Close Supervision Centres (CSCs) within the Prison Service. It aims toinform you about the level of risk posed by the prisoner and thus enable you to makean informed decision about who is, and who is not, suitable for CSC referral. It givesbrief details of other High Security containment options for those prisoners who areunsuitable for CSCs, but about whom you may be concerned. It outlines the merits ofsubmitting the prisoner case you are considering and provides detailed guidance forstaff with regard to the referral process for CSCs.

The aim of the referral process is to identify the individual who is at high risk ofcausing problems to himself and to others now and in the future, and to identify anddocument this risk in detail.

1.1 Overview Of Close Supervision Centres

The Aim of CSCs

CSC units opened in February 1998, replacing Special Units. The aim of CSCs is toenable dangerous, disturbed, and disruptive prisoners to develop a settled andacceptable pattern of behaviour. CSCs are administered under a national managementstrategy, and they negate the need for the Continuous Assessment Scheme.

CSC Functions

The role of the CSC is to remove the most seriously disruptive prisoners from mainlocation prisons and contain them instead in small, highly-supervised units. CSCprisoners often have a range of complex and diverse psychological, psychiatric, andsecurity needs. CSCs provide the opportunity for individuals to address theirdisruptive behaviour, aiming to stabilise prisoners and prepare them for a return tomain location prisons. CSCs also provide long-term containment of those whocontinue to pose a serious threat.

CSC Phase II

Phase II comprises a more robust and systematic selection. Prisoners undergointegrated mental health assessments and develop individual plans. Plannedinterventions also occur where necessary.

Staff support and training strategies are also refined. There is a broader geographicalspread of CSCs at Phase II. This allows both for accommodating 'sub-types' ofprisoner and for focusing on individual needs.

CSC Phase III

Phase III involves a refinement of Phase II. Emphasis is placed on the furtherdevelopment of programmes and interventions. A multi-disciplinary style of workingis implemented. Prisoners undergo a move towards a more therapeutic milieu. Thereis also a change in emphasis regarding Non-Cooperation units.

1.2 Identifying the Right Individuals

What is Meant by Risk?

'Risk' refers to the chance or possibility of loss or bad consequence.

'Risk assessment' is a measure of that risk. It has been defined as 'a combination of

an estimate of the probability of a target behaviour occurring with a consideration ofthe consequences of such occurrences', 1i.e., it identifies both how likely something isto happen and the consequences of it happening. The target behaviour could beanything constituting a poor or bad outcome in relation to a positive goal, e.g.,smoking a cigarette when trying to stop is (bad) target behaviour in relation to the(positive) goal of quitting smoking.

Within the forensic setting, target behaviour often refers to violence, sexual offending,suicide, or self-harm, 2 whilst the goal is to live safely and in harmony with otherswhilst in custody.

Who is a Potential CSC Candidate?

A CSC candidate is a prisoner who is causing day-to-day management, safety, andcontrol problems for those who detain him and/or for those with whom he resides.Several attempts to manage him should have already been initiated before youconsider the CSC.

An individual who is suitable for placement in a CSC is currently demonstrating orthreatening to demonstrate behaviours that are dangerous to others (and in somecircumstances to himself), and he is no longer considered safe to be managed onnormal location or in a segregation environment.

Previously, he has demonstrated violence and/or control problems and has failed torespond to alternative methods of control such as segregation. In doing so, he hasfulfilled the movement requirements as listed in I.G.28/93.

If you doubt whether a CSC referral is the best way forward for any given individual,contact the CSC Operational Manager at Prison Service Headquarters (020 72176319) to discuss any concerns you have.

i Towl and Crighton, Psychology in Prisons, (1996), p.183.2 Mosson, Psychology in Prisons, p.129.

1.3 Mental Health Issues

Mental Illness or Personality Disorder?

Without professional training and the use of specific tests and diagnostic criteria, it isdifficult to differentiate between mental illness and personality disorder. However, itis not necessary for you to be able to make this distinction in order to make aneffective referral for any prisoner for whom you have a concern.

Some of the prisoners you encounter may exhibit behaviour that can be described asodd or bizarre. This can relate to something that a prisoner either does or says. Youmay witness an individual demonstrating complete disregard for his health or well-being, repeatedly self-harming using any implement he can find. He may appeardepressed and tearful, quiet and withdrawn, or aggressive and demonstrative. Takingthis into consideration with other information you possess about this individual, youmay regard him as a high risk to himself or to others and be considering a CSCreferral.

It is possible, however, that any one of these behaviours is a result of poor mentalhealth, indicating a larger underlying problem such as

• mental illness;

• inappropriate or insufficient medication as currently prescribed or refusal totake medication;

• a mental health problem that has yet to be identified; or• a personality disorder.

In any of the circumstances just described, there are places other than CSCs where theprisoner's health needs may be more appropriately monitored and managed. It isimportant that these avenues are explored and an appropriate referral made. However,exhibiting aggressive behaviours and having a mental health diagnosis that iscontrollable may reflect the need for movement to a CSC rather than high-securityhospital containment.

Any concerns about a prisoner's mental health should be discussed with the medicalstaff. Should a referral to the CSC system be made, the CSC Selection Committee(CSC SC) will request more detailed assessments from a forensic psychiatrist and aforensic psychologist in which these concerns are addressed.

1.4 What is the Difference Between DSPDs and CSCs?

An individual suitable for placement on a Dangerous and Severe Personality Disorder(DSPD) Unit is someone whose level of dangerousness is linked to his personalitydisorder and whose risk can be reduced to some extent by addressing his personalitydisorder prior tO or alongside his offending behaviour. It is currently considered bestpractice to assist the individual in identifying, exploring, and managing hispersonality disorder in order to reduce his level of dangerousness/risk and enable himto live a more manageable lifestyle upon release.

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The level of dangerousness of such an individual is reflected by his detainment in aHigh Security establishment. He does not present a danger to others on a daily basisand although a specialist environment is preferable, he does not require physicalsecurity over and above that provided on normal location. He may present a danger tohimself by displaying self-harming behaviours or suicidal tendencies. This behaviourmay be a direct result of his personality disorder and is often an initial indicator thathe suffers from such a disorder.

It is possible that an individual meets the criteria for both the DSPD and the CSC; hemay have a Severe Personality Disorder that is linked to his offending pattem, thusmaking him suitable for a DSPD referral, whilst also presenting a control problem inhis current environment and fulfilling the criteria as listed in I.G.28/93. Under thesecircumstances, it is necessary for this individual to be referred initially to theCSC system. Reference should be made to the behaviours that indicate referral toDSPD, as this can be used at later stages. Once the individual is no longer causingdaily control problems and can be sufficiently managed on normal location, a referralto the DSPD Service can be initiated.

The table below may help you to judge which referral is most appropriate for the caseyou are considering.

Behaviour DSPD CSC

Offending Behaviour Must be high risk May be high risk, but this isnot a pre-requisite

Personality Disorder Must be present and the May be present but this isprisoner must have a not a pre-requisite, nor mustclinically significant PCL-R the prisoner have a clinicallyscore.* significant PCL-R score. *

Institutional Behaviour Likely to have required a lot Must have displayed a rangeof management support that of disruptive behaviour ormay have resulted in a extreme violenceresultinginlengthy adjudication history, a further sentence or lengthybut this is not a pre-requisite, adjudication history.

Likely to be on normal Likely to be contained inlocation or within health care segregation at the time ofat the time of referral. May referral.have fluctuated between the

segregation and health care.

May have had several Will have had severaltransfers around the estate transfers around the estate.

but this is not a pre-requisite.

Is willing to undertake a Does not need to volunteerDSPD referral, to be considered for a CSC.

•Psychopathy Checklist (Revised): a tool used to assess psychopathic traits of personality

If you are unsure which type of referral is appropriate, contact either your CSCLiaison Officer or your DSPD Liaison Officer to discuss your concerns, giving detailsof the observations you have made.

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2 CSC Process Overview and Time Scale

The CSC process now follows six separate stages. This section is a quick referenceguide to the stages and the key activities they comprise. Each stage has a separatechapter allocated describing the key activities in more detail. Overall, theassessment process takes no longer than twelve weeks.

The CSC process is illustrated in a chart on page 11.

2.1 Key Stages

Stage 1 - CSC Initial Referral

There is no time limit on a new referral. The only event that affects the referralis the sitting of the CSC Selection Committee (CSC SC).

• The CSC SC sits once a month and is chaired by the Deputy Director General.

• The initial local referral can take place at any time as soon as concerns areraised about an individual prisoner. CSC SC support staff will advise of thenext CSC SC sitting at which an initial referral can be considered.

• The Initial Referral form is available in Appendix 7.

• Supplementary information is located at the back of this manual (Appendices3-5) to help you consider the key issues affecting CSC placement.

• If accepted by the CSC SC for further assessment, the CSC assessmentprocedures detailed below will be commissioned.

• If accepted by the CSC SC for further assessment, the prisoner will be notifiedin writing of this decision and informed about the assessment process. Oncethe assessments have been produced, the prisoner may apply to view them.

Stage 2 - Multi-Disciplinary Mental Health Assessments

Eight weeks are allocated for the completion of these assessments.

• Rule 46 Status is applied by the CSC SC to the case and the local CSCgoverns the process henceforth.

• Following the meeting of the CSC SC, the CSC Operational Manager atHeadquarters will write to the governor of the relevant establishment torequest specific reports from Forensic Psychiatry, Forensic Psychology, andOperational staff. The standardised set of assessments required from each ofthese groups is described in Appendices 3-5.

• Headquarters will set a provisional date for a local case conference. Thepurpose of the conference is to consider the three aforementioned reports andforward a collective recommendation to the CSC SC. The date of the case

conference will be stated in the commissioning letters.

• The prison needs to confirm with the CSC Operational Manager that thereports have been issued locally. Arrangement can be made withHeadquarters to offer further support where needed.

• The required reports should be written within eight weeks of the CSC SC'shaving commissioned them.

• Once the reports have been completed they should be forwarded in the form ofa dossier to the CSC Operational Manager no later than the eight weeks afterthe initial Commissioning letter.

• The CSC Operational Manager will forward this dossier to the IndependentVerification Panel as detailed in Stage 4 (below).

Stage 3 - Local Assessment Case Conference

This occurs ten weeks after the initial R46 confirmation.

• A local case conference, chaired by the CSC Operational Manager, will beconvened no later than ten weeks after the CSC SC's commissioning of theassessments.

• This case conference is designed to draw the three separate reports together inorder to present a single recommendation from the establishment for the CSCSC to consider.

• A case conference report format is available in Appendix 10.

• The author of each report should be available to attend this case conference.However, under some circumstances a representative of Health Care maypresent the psychiatrist's report. This person must be familiar with the reportcontents and issues. Other staff may attend where they have a direct bearingon the case. This may include Segregation staff, Probation, or other wing staffwho may be able to provide background for the report discussions.

Further assessments recommended at this stage that have a direct influence on themanagement of the prisoner should be noted and completed, where possible, eitherprior to the prisoner entering a CSC unit or as part of management plans where he isto remain in the mainstream high security estate.

Assessments required to clarify the existence of neurological damage affecting theprisoner's functioning may take longer to complete, and therefore need to be notedand investigated as soon as possible. Additional advice can be sought from the CSCPsychology or Psychiatry Advisor or your local Mental Health In-Reach Service.

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Stage 4 - Independent Verification Process

This occurs approximately eight to eleven weeks after the initial referral.

• This process will aim to provide an independent report within one month ofreceipt of the dossier. It is envisaged that this process will occur atapproximately the same time as the Local Assessment Case Conference.

• The specific remit of this panel is to consider the prisoner's mental healthdiagnosis and its implications for his risk management.

• Further assessment that directly affects the decision regarding the need forplacement in the CSC will be requested as a priority. This may effectivelydefer the case being considered by the CSC SC.

Stage 5 - Presentation to the CSC SC

The CSC SC aims to hear full assessment recommendations within twelve weeks

of approving Rule 46 on a prisoner

• The relevant information and decision made at the Local Assessment CaseConference should be recorded and submitted to the CSC SC for consideration

within eleven weeks of being commissioned.

• The Independent Verification Panel Report (Stage 4) will be available for theCSC SC's consideration, as will the Local Assessment Case Conferencerecommendation (Stage 3) andthe Reports Dossier (Stage 2).

• After consideration by the CSC SC, the Deputy Director General of the PrisonService will confirm the outcome of the case in writing. Should the prisonerbe selected into the CSC system, confirmation of this is given to the prisonerand the referring establishment, and placed on his CSC file at Headquarters.This documentation will state the reasons for his selection to the CSC system.

• All three contributing reports undertaken during this assessment will beavailable for disclosure to the prisoner and his legal representative uponrequest.

Stage 6 - Individual Care and Management Plan Transfer Case Conference

All cases accepted into a CSC unit should have an initial Care and ManagementPlan case conference within 4 weeks of arrival on the unit

• The designated receiving CSC unit will normally hold a case conference todevelop an initial Care and Management Plan for the new prisoner withinfour weeks of his arrival on the CSC unit (see Appendix 12).

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• Further assessments recommended at Stages 3 or 4 that have a direct influenceon the management of the prisoner should normally be completed prior to theTransfer Case Conference.

* Those prisoners whose assessments have resulted in their not beingrecommended for selection to the CSC may require the development of a localmanagement plan based around the assessment reports.

2.2 Summary

The dates generated by this guidance for each individual case should be calculatedand monitored by the local CSC Liaison Officer. The CSC Diary Dates form(Appendix 6) provides for this.

All staff should adhere to the generated dates wherever possible. Should youanticipate not being able to meet a deadline, please inform your CSC Liaison Officeras soon as possible to discuss alternative arrangements.

The CSC Operational Manager at Headquarters should be made aware of any slippageas a matter of urgency.

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2.3 CSC Process Overview-Chart

Significant behaviour

Initial assessment

Report to theCSC SC

I Rejected [ Accepted I

A Care and [ Becomes Rule 46 andManagement Plan may [ is referred for assessments.

be drawn up if necessary [ The prisoner is informed

[ Operational Manager,

[ Psychiatry, and Psychology/1 produce reports

/ I (no later than 8 weeks

i_"/-- [ after R46 applied)

Local Case Conference Independent verification I

(no later than 10 weeks (no later than 12 weeks

after R46 applied) after R46 applied)

CSC Selection Committee

(no later than 12 weeks

after R46 applied)

A(

A Care and Management Plan[ (no later than 7 daysmay be drawn up if necessary [ after the CSC SC)

(no later than 7 daysbefore the Transfer

Case Conference)

Transfer Case ConferenceAn individual Care and

Management Plan isdrawn up (no later than

4 weeks after the prisonerhas been accepted)

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3 Stage 1 - CSC Initial Referral

3.1 Overview

The dual purpose of the initial referral is to have an establishment agree locally that aprisoner requires an alternative placement, due to unmanageable and dangerousbehaviour, and to bring this prisoner to the attention of the CSC management team atHeadquarters for initial consideration.

I.G.28/93 still applies to these cases and should be adhered to.

Prisons making an initial referral are therefore required to do the following:

1. confirm that the individual has sufficiently exhausted all other optionswith regard to his management and control and that the CSC is the finalremaining option to reduce the level of risk he poses;

2. clearly document, using recent evidence, the extent of his dangerousbehaviour and risk towards himself, staff and/or other prisoners; and

3. clearly document, using recent evidence, how and why current•management and control strategies are insufficient to protect the individualand others from harm.

The initial referral is the basis upon which the case for a full CSC assessment is made.It therefore requires as much relevant information as possible to be submitted by thedepartments identified on the CSC Initial Referral form (Appendix 7).

In order for the CSC referral to be taken forward, it is necessary to demonstrate thatthe individual has met the above criteria. The CSC Initial Referral form must

demonstrate the following.

1. The individual has reached Stage 4 of the Management Strategy forDisruptive Inmates, as presented in I.G.28/93, by sufficiently exhaustingStages 1, 2, and 3 of that Strategy, namely:

Stage 1 internal action at the parent establishment;

Stage 2 temporary transfers from the parent establishment; and

Stage 3 centrally-managed transfers to training and local establishments

and meeting at least one of the following criteria:

Stage 4 • has been violent to staff and/or inmates;• has regularly incurred disciplinary reports;• has caused serious damage to property in prison;• has shown dangerous behaviour, such as rooftop

protests, hostage-taking, self-mutilation;• has a history of mental illness; and/or

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• has failed to respond to the earlier strategy measures toimprove control (see above, Stages 1-3).

2. The individual clearly exhibits, on the basis of past and recent evidence,unacceptable levels of dangerous behaviour and risk towards himself,staff, and/or other prisoners.

3. On the basis of past and recent evidence, current management andcontrol strategies are insufficient to protect the individual and othersfrom harm.

This information should be supplied through the reports submitted by WingManagement, Psychology, Psychiatric/Medical staff, and Security.

Where appropriate, other members of staff such as Landing/Segregation staff,Personal Officers, or Probation may also submit reports. Reports to court can also beincluded.

At least one report should document the incident or incidents that have led to thisinitial referral being made, supplying any background information leading up to theincident and details of any comments that were made before, during, or after theincident by all parties involved. If there is a string of incidents rather than a particularincident, this pattern of behaviour should be documented and commented upon by thePsychology Department and any other staff who wish to comment.

3.2 Initial Referral Report Completion Guidance

Governor Assessment

The Operational Governor responsible for Segregation should complete this section.It should include comments on the referral and a summary of his or her conclusions.

Wing Management Assessment

This briefly summarises the prisoner's current behaviour that has led to the referral.Reference should be made to his adjudication history and security issues (whererelevant), and IEP concerns should also be covered.

Psychology Assessment

This should be a brief report covering the nature, severity, and frequency of theproblem behaviour. Situational factors must be covered. Any links to the prisoner'soffending behaviour should be highlighted. Hypotheses about the triggering eventsshould be included. An interview with the prisoner, where safe and possible, mayprove useful. Any programmes undertaken by the prisoner must be noted, as shouldany assessments already on file. Full psychological testing is not necessary at thisstage.

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Security Assessment

Gang activities, involvement with drugs, relationships with significant peers, hostagethreats, and similar matters should be noted.

Medical/Psychiatric Report

The Medical Officer, visiting psychiatrist, or other relevant medical person shouldcomplete this report. There is no need for a full forensic psychiatric report at thisstage. This report comprises two sections, details as follows.

1. Previous BehaviourThis should include:

• a brief outline of the prisoner's psychiatric and medical history, withdetails of any treatment; and

• an outline of any referrals previously made to Special Hospitals, includingthe reasons why the referral was made and information regarding theprogress of the referral, such as the reasons for the prisoner's acceptance,refusal, or return to prison environment.

B. Current BehaviourIt is the role of the medical staff to provide information regarding the physical healthof the individual. It is important to state the following:

• whether the individual is currently being prescribed medication andthe extent to which the prisoner's health is stable; and

• whether any current medication remains appropriate and whether itis both necessary and feasible for this medication to continue underCSC conditions.

It would be useful for medical staff to comment on the following:

• any problems anticipated regarding medical issues in relation to a CSCplacement;

• any mood- or behaviour-related side-effects that can be anticipated from themedication;

• any difficulties the prisoner encounters regarding taking his medication, andany mood or behaviour changes that can be anticipated should he refuse totake his medication as required; and

• any insight into the prisoner's behaviour-triggers, such as involvement withalcohol or drugs;

Medical staff may also wish to comment on the following:

• evidence of learning difficulties;• evidence of neuropsychological difficulties;• presentation of the individual; and• any significant occurrences they may have encountered during their

interaction with the prisoner.

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4 Stage 2 - Multi-Disciplinary Health Assessments(Guidance for Operational and Forensic Staff)

4.1 Overview

This stage can commence only after a case has been accepted by the CSC SC and aset of reports commissioned. At this point, the prisoner has been designated Rule 46status. The prisoner will be notified in writing of this decision. He will also beinformed about the assessment process and should be provided with a copy of theCSC Referral Guide for Prisoners (see Appendix 8). Once the assessments have beenproduced, the prisoner may apply to view them.

The governor of the establishment will be required to generate reports from specificdepartments at the request of the CSC Operational Manager. These reports aredesigned to provide integrated multi-disciplinary risk assessments, including mentalhealth needs. This drive towards integrated risk assessment and risk managementderives from the conclusion of the HMCIP thematic review (August - September1999). Specifically, the management of disruptive prisoners should combine controland treatment, based on individual needs assessments.

Three departments, namely, Forensic Psychiatry, Forensic Psychology, andOperational, are obliged to present standard information regarding the prisoner inorder to produce a complete report dossier. Any other department or member of staffmay provide additional information where relevant.

General notes are provided immediately below to assist in the writing of reports;specific guidance for each department is given further below.

4.2 General Guidance

As a general guide all reports should indicate the following:

• your professional training and experience;• your role in relation to the prisoner;• the extent to which you have had contact with the prisoner;• the extent to which you have used other information for the report;• the extent to which you have had contact with other staff for the purpose of

writing the report; and• that the prisoner has undertaken informed consent prior to any assessment

being completed.

For example:

I have been a Segregation Officer for four years, two of which have been atHMP Belmarsh. I have known Mr X for two years whilst at Belmarsh, foreight months of which I have had almost daily contact with him as he has beenin the Segregation Unit. For the purpose of this report, 1 have used my

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general knowledge of Mr X and have interviewed him specifically for twohours on one occasion within the segregation interview room. I have read his

file documentation and adjudication sheets and discussed Mr X on twooccasions with the Senior Psychologist at Belmarsh for the purpose of this

report.

Or As a Security Office at HMP Belmarsh, I have not had contact with Mr X for

the purpose of writing this report. I have based my report on the security

information that is available at Belmarsh at the current time.

All reports should supply evidence for the information that they give. For example:

Mr X has a history of using weapons. He has three guilty adjudications for

weapons found in his cell (Frankland, 03.02.96; Belmarsh, 09.10.98;Belmarsh, 16.09.02). He has stated that he gains pleasure from the feelings of

power and control that he experiences when carrying a knife (Psychiatrist

Report, Belmarsh, 19. 04. 02).

All reports should be signed and dated by the author, and likewise note therole/profession of the author within the establishment. For example:

Signed .................................

Mr Smith, Consultant Psychiatrist

Date ....................................

All comments made citing information from other reports should be clearly

referenced as such, stating the report writer and the date of the report. For example:

It has been documented that Mr X derives personal enjoyment from violence

(Senior Psychologist, HMP Durham, 12.12. 02).

Or Mr X has stated that he 'enjoys being violent' (Higher Psychologist, HMPDurham, 12.12.02).

All reports must be written in accordance with open reporting conditions.Where security information is used, it should take the form of a gist and beapproved by the relevant manager.

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4.3 Specific Guidance

Forensic Psychiatry

This specification has been developed in conjunction with the Oxleas NHS Trust,which provides the Independent Panel Verification process. Additional guidance isprovided in Appendix 3.

Using the methods of data collection identified below and with reference to thePsychology Report, which is normally completed prior to the psychiatrist's reportbeing written, the psychiatrist is expected to explore issues and form conclusions inaccordance with those listed below.

Data Collection Methods

• Interviews with staff, e.g., prison officers involved.• Review of Inmate Medical Record (IMR).• Interview with the prisoner.• Other corroborative sources where appropriate

Issues to be Explored

• Family and personal history.• Sexual history.• Psychiatric history.• Drug and alcohol history.• Medical history.• History of offending.• Details of offence(s) resulting in custody.• Previous psychiatric reports.

Conclusions

The conclusions of the psychiatric evaluation should be organised in a suitablemanner and comment on the following:

• any previous Mental Health diagnoses under the Mental Health Act (1983);

• current diagnosis and formulation, considering especially mental illness andpersonality disorder. Comments on organic causes, learning difficulties, andneuropsychological problems will be of value;

• any implications for risk, to self and others, in relation to any diagnosticconcems;

• treatment and management considerations in relation to the above;

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• consideration of alternative placement, e.g., Special Hospital; and

• impact of placement in a CSC in relation to the above.

Forensic Psychology

This report should be completed by a Chartered Forensic Psychologist or, whereunavoidable, a Trainee Forensic Psychologist under the supervision of a CharteredForensic Psychologist.

It is essential that all psychologists undertaking CSC assessments follow theadvice and guidance in Appendix 4. Individuals should have undertaken thenecessary training to administer the relevant tests and had an appropriate levelof supervision. This report will be accessed by the prisoner, his legalrepresentative, an independent consultant forensic psychologist, and a consultantforensic psychiatrist, as well as the CSC Selection Committee.

A list of contacts offering support and guidance is available in Appendix 2.

The following structured risk assessments must be undertaken.

• A Functional Analysis.• A Psychopathy Checklist (Revised) (PCL-R) assessment.• An Historical, Clinical, and Risk factor checklist - 20 (HCR-20) assessment.• A Violence Risk Scale (VRS) assessment.

Where possible the prisoner should be interviewed, relevant staff consulted, and a fullrange of collateral material reviewed. A standardised Informed Consent form can befound in Appendix 9.

In some cases there may be insufficient collateral material to complete the necessaryassessments. This should be noted and the test guidance adhered to. Where aprisoner refuses to be interviewed, a report must draw upon all other available data.

In all cases every effort, including disclosure, should be undertaken to engage theprisoner in the process.

It is the purpose of this report to determine that the prisoner meets the criteria for theCSC and to clarify the implications for risk management drawn from the assessments.

Operational Managers

Whilst the initial referral report will have provided some evidence of the prisoner'sproblem behaviour, a fuller report is needed to support the more detailed multi-disciplinary assessments. Some of the information listed below can be provided bywing staff, probation staff, and segregation staff. It is helpful for this information tobe pulled together into one report using the relevant headings as listed below.

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Additional guidance on the information that would be helpful under each sectionheading is provided in Appendix 5.

Should the prisoner have a completed LSP (Life Sentence Plan), DCR(Discretionary Conditional Release) plan, or DIA (Dispersal InductionAssessment), please attach a copy/copies as an appendix to the report dossier.The following areas should be written up in the report and disclosed to the prisonerprior to the local case conference. Where information is drawn from security files itshould be gisted. Where this cannot be gisted or is critical to the referral, the reportmust comply with the Data Protection Act and be marked 'Not for Disclosure - DataProtection Act' (you must refer to the relevant section).

• Custodial Behaviour

This should constitute a detailed review of the prisoner's custodial behaviour,highlighting the events that led to the initial CSC referral. This must includedetails of poor as well as good behaviours and draw on locally-helddocumentation such as IEP records, observation sheets, and so forth.

• AdjudicationsAccount should be taken of:

• the quantity of adjudications (what proportion of the prisoner's behaviouris against the rules?);

• the frequency of the adjudications (how long is the prisoner able to abideby the rules?);

• the repetitiveness of adjudications across time (are there any patterns orescalations of behaviour?); and

• the range of adjudications (does the prisoner show a wide or narrow rangeof adjudication charges?).

• Substance abuse

Research suggests that people are more likely to commit acts of violencewhilst under the influence of alcohol. Recurring violence is also associatedwith substance abuse. Additionally, there is growing evidence to indicate thatviolent offenders who have a history of drug and/or alcohol abuse and alsosuffer from mental illness are more likely to commit serious violent offencesupon a wider range of victims and using more serious acts of violence, e.g.,employing weapons. It is therefore of particular importance to report what isknown or suspected about the prisoner's substance abuse history.

• Disruptive or challenging behaviour prior to adult imprisonmentAvailable social services and probation records are good material sources forthis review. This must include an account of the prisoner's familycircumstances, as well as pre-sentence court reports where available. Periodsof borstal, juvenile detention, and social services disposal must be described.Periods of stable as well as disruptive behaviour should be noted.

• Relationship historyThe prisoner's interaction with others is important. Points worth noting arewhether he has a very isolated or impersonal existence, whether he is amanipulator of vulnerable people (this may be evident in his offending), and

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whether he is aggressive much of the time either in general or towards specificgroups/individuals/genders.

Any additional material of relevance to your case that has not already been mentionedmay also be included in the Operational Manager's Report.

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5 Stage 3 - Local Assessment Case Conference

5.1 Overview

The purpose of this case conference is to draw the three independent assessmentstogether with the supporting material used as evidence and either

• confirm the suitability of the CSC placement; or

• make a recommendation for an alternative high security placement, toinclude options within the Directorate of High Security (DHS) or a referralto a High Security Hospital.

It is important to detail the following.

• The level and nature of the violence/disruption.• The presence of any physical and mental health issues, including neurological

disorders, learning difficulties, and personality disorder.• The current level of risk indicated by the prisoner, previously implemented

management strategies with their effect on his behaviour, and responses andbehaviours that may assist in the future management of the individual.

• The level of motivation the prisoner displayed throughout the CSC selectionprocess.

• Further recommended assessment required prior to selection or requiringconsideration as part of the prisoner's Care and Management Plan.

5.2 Attendees at the Case Conference

The case conference will take place locally but be chaired by the CSC OperationalManager. The main attendees must include the following.

• The report authors, namely, the Operational Manager, the ForensicPsychologist, and where possible, the Forensic Psychiatrist. Should the latterbe unavailable, the Health Care department must send a representative who isfamiliar with the report content and the issues arising from it.

• The CSC Operational Manager from Headquarters (the chair).

• Other attendees may include people who have contributed to the reports orwho have a working experience of the prisoner and can offer some contextualdetail, such as segregation staff, wing officers, security staff, and probationstaff.

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5.3 Areas for Discussion at the Case Conference

The case conference must discuss the following areas and complete a LocalAssessment Case Conference report (see Appendix 10) for the CSC SC to consider.

Observable Behaviour

Aim To identify the prisoner's behaviour that causes problems for himself orothers, and to identify any management style that has been attempted, withreference to its success in modifying dangerous behaviour. Details of theprisoner's behaviour and responses to initiatives from his Temporary Transfershould be included here. The following points must be considered.

• What specific behaviours are causing problems for prisoner himself or forothers?

• How has this behaviour been managed in the past with positive results?• How has this behaviour been managed in the past with negative results?• Have any further assessments been requested in order for the assessment

procedure to continue (give details)?• Have any further assessments been requested for the prisoner's Care and

Management Plan (give details)?

Mental and Physical Health

Mental Health

Aim To reach an informed judgement relating to the prisoner's current mentalhealth, to assess the impact of a CSC placement upon the prisoner's currentmental health, and to plan accordingly. The following points must beconsidered.

• Has the prisoner previously been identified as having active mental healthneeds and if so, what is his current mental state?

• Is the prisoner currently being medicated for reasons of mental health? Ifso:

o Is the medication currently being employed still appropriate?o Is it both necessary and feasible for the individual to continue with

this medication should he be selected for the CSC system?• Have any further assessments been requested in order for the assessment



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Physical HealthAim To reach an informed judgement relating to the prisoner's current mental and

physical health, to assess its impact on a CSC placement, and to planaccordingly. The following points must be considered.

• Has the prisoner previously been identified as having physical health needsand if so, what is his current state?

• Is the prisoner currently being medicated for reasons of physical health? Ifso:

o Is the medication currently being employed still appropriate?o Is it both necessary and feasible for the prisoner to continue with

this medication should he be selected for the CSC system?• Have any further assessments been requested in order for the assessment



Personality Disorder

Aim To identify any specific indications of personality disorder and to decide onthe most appropriate placement for the prisoner in the light of this information.Assessment for this may not have been undertaken. However, there may besome concerns that the prisoner is more suited to a DSPD than a CSC referral.Where this is the case, the appropriate DSPD referral must be undertaken.

If the individual is demonstrating day-to-day management problems thatrender him unsafe for his current environment, the CSC referral is appropriateto pursue. Details of his personality disorder should be included to assist withthe management of the individual, but these may need to be completed as apre-transfer assessment.

The following points must be considered.

• Has the Hare Psychopathy Checklist (1991) indicated any specific needsregarding psychopathic personality disorder?

• Have the other administered assessments indicated specific needsregarding personality disorder? If so:

o What were the outcomes of these assessments?

o Following consideration of these assessments, is it still appropriatefor the prisoner to continue to be assessed for the CSC system?

• Have any further assessments been requested in order for the assessmentprocedure to continue (give details)?

• Have any further assessments been requested for the prisoner's Care andManagement Plan (give details)?

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Risk

Aim To assess the prisoner's current level of risk and to discuss the level of successof previous risk management using the VRS and HCR-20. The followingmust be considered.

• Does the prisoner meet CSC criteria? If so, what is the main argument forhis selection to the CSC system?

• According to the assessments used, what are the identified levels of risk?• How motivated is the prisoner about addressing his levels of risk within a

CSC?

• Have any further assessments been requested in order for the assessmentprocedure to continue (give details)?

• Have any further assessments been requested for the prisoner's Care andManagement Plan (give details)?

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6 Stage 4- Independent Verification Process

The thematic review identified that a significant proportion of CSC prisoners hadpsychiatric needs. This has led to the introduction of the multi-disciplinary mentalhealth needs assessments and an independent mental health review process. Thelatter is undertaken by a Consultant Forensic Psychiatrist and a Consultant ForensicPsychologist external to the NHS authorities providing input into the main referringestablishments, i.e., the five dispersal prisons. These two consultants constitute theIndependent Verification Panel.

The main aim of the Independent Verification Panel is to evaluate the quality of themental health assessment commissioned by the CSC SC.

The verification process is used to evaluate the relevant information and conclusionsarrived at in the Stage 2 assessments undertaken by the psychiatrist and thepsychologist, taking into account what is known from all three reports. Specifically,the panel will look to verify whether the mental health concerns have been addressed.As part of this process the panel may recommend that other areas be explored eitherwhen the CSC SC is considering the case or after the prisoner has been through theCSC SC hearing.

The Independent Verification panel reports directly to the Chairman of the CSC SC inthe form of a written report certifying that the conclusions reached by the prisonpsychologist and psychiatrist are reasonable and relevant.

This process takes place approximately eight to eleven weeks after the initial referral,i.e., after receipt of the report dossier from Headquarters. The panel reports to thesame CSC SC meeting at which the referring establishment presents its own moredetailed case for assessment.

The panel may wish to consult with the authors of the reports or request access to rawdata underlying the report conclusions. Should the receiving establishment wish it,the panel is also available for advice on the prisoner's further assessment andmanagement options.

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7 Stage 5 - Presentation to the CSC SC

Appendix 11 contains a CSC SC Assessment Summary Sheet that should becompleted and submitted to the CSC SC for consideration. In completing it youcreate a checklist indicating that all necessary components of the process have beenconsidered. The CSC SC Assessment Summary Sheet will summarise importantinformation to be considered by the panel.

The CSC SC will consider in full the assessments submitted by the report authors.Matters for particular consideration are as follows.

• The referring establishment govemor will present the key findings of the threekey assessments. The report authors may also be present and make their owncontributions, highlighting the prisoner's key areas of risk, mental healthneeds, and management options.

• The CSC Operational Manager will summarise the findings of the local caseassessment conference and report the conclusions of the IndependentVerification panel.

• The committee will discuss all the report conclusions and consider the optionsfor CSC selection. Should the case meet the necessary criteria for CSCselection, the appropriate unit allocation will also be discussed along with anyimmediate priorities for the prisoner's management.

• Where a case is not considered suitable for selection into the CSC system,advice about alternative management plans will be discussed and actionedwhere possible.

The Deputy Director General will authorise written confirmation that the prisoner hasbeen accepted by the CSC SC to remain Rule 46 status and will transfer into one ofthe units. This confirmation will state the criteria under which the case was acceptedand will notify the prisoner of the future review procedures.

Where a case has been rejected, the dossier of evidence and assessments will be madeavailable to the holding establishment through the CSC Operational Manager.

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8 Stage 6- Individual Care and Management PlanTransfer Case Conference

8.1 Overview

Should the prisoner be successfully transferred into the CSC system, the receivingteam must devise an initial Care and Management Plan in collaboration with the Stage2 assessment staff within four weeks of receiving the prisoner. The receiving UnitManager will chair the Case Conference, inviting the prisoner and his legalrepresentative. Copies of this plan will be made available to the prisoner andprovided to the CSC SC in order to start the process of his regular reviews.

The initial Care and Management Plan will involve identifying the best practice forthe following:

• providing the prisoner's care;• managing the prisoner's daily behaviour; and

• encouraging the prisoner to reduce his risk of violent and/or disruptivebehaviour.

The Care and Management Plan must reflect a multi-disciplinary approach tomanaging and reducing violent and/or disruptive behaviour. The plan shouldencourage changes in behaviour to facilitate a return to the general prison population,where the prisoner can engage more fully in Sentence and Lifer Planning processesand thus address the main risk factors associated with his offending behaviour.

There are no time constraints regarding a prisoner's placement in the CSC and plansare therefore based on ongoing assessments, which are used to monitor individualprogress and risk reduction. These comprise a combination of daily behaviour ratingsheets and observation books completed by wing staff, an on-going use of the VRSand HCR-20 by the psychologists, and inputs from the other service providers such aseducation, PE, health care, and mental health teams.

The Care and Management Plan will be reviewed at three-monthly intervals at thelocal CSC unit and be submitted to the CSC SC regularly in order either to ensure theappropriateness of continued location in the CSC or to prompt for the prisoner to bemoved to an alternative location. Where appropriate and necessary, additionalassessments may be called upon.

Appendix 12 contains the Care and Management Plan report format.

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8.2 Issues to Consider During the Transfer CaseConference

• What is known about what works with regard to the prisoner's management?

• What has worked in the past? What has not worked in the past?

• What motivates the prisoner to do well? What encourages prisoner to dowell?

• What prevents the prisoner from behaving dangerously?

• What are the prisoner's areas of risk and what currently constitutes a high riskfor him?

• What further tests are necessary to confirm whether or not the prisoner hasfurther issues?

• What does the prisoner have in terms of motivators, successful managementstyles, goals, plans, personal support, and contacts with outside?

• What behaviours and thoughts may indicate deterioration and trigger a reviewof the prisoner's risk?

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Appendix 1 - Glossary

CSC Close Supervision Centre

CSC SC Close Supervision Centre Selection Committee

DHS Directorate of High Security

DSPD Dangerous and Severe Personality Disorder

FA Functional Analysis: a technique used to analyse an offence usingABCs, i.e., Antecedents, Behaviours, and Consequences

FPRAR Forensic Psychology Risk Assessment Report

HCR-20 Historical, Clinical, and Risk factor checklist - 20

I.G.28/93 Instruction to Governors, Number 28 of 1993

IMR Inmate Medical Record

NPD Non-Parole Date

PCL-R Psychopathy Checklist (Revised)

PED Parole Eligibility Date

SED Sentence Expiry Date

VRS Violence Risk Scale

WAIS-R Wechsler Adult Intelligence Scale (Revised)

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Appendix 2 - Contacts List

Headquarters

Role Name Location Telephone

Operations Manager John Dyne Room 632/635 020 7217 6319Directorate of Prison Service HQHigh Security Cleland House

Page StreetLondon SW1P 4LN

CSC Officer Jamie Marston Room 632/635 020 7217 6918

Directorate of Prison Service HQHigh Security (as above)

CSC Psychiatrist Dr Mark Morris The Tavistock and 020 7794 8262Directorate of Portman NHS TrustHigh Security The Portman Clinic

8 Fitzjohns AvenueLondon NW3 5NA

CSCs

Name Location Telephone

Dean Gardiner HMP Belmarsh 020 8331 4711Noel Young HMP Belmarsh 020 8331 4562

Drew Agnew HMP Durham 0191 332 3749Graeme Hogg HMP Durham 0191 332 3732Neil Pearson HMP Durham 0191 332 3690

Doug Graham HMP Frankland 0191 332 3131Tony Lamb HMP Frankland 0191 332 3231

Alfie Stockman HMP Full Sutton 01759 375327David Pearson HMP Full Sutton 01759 375040

Neil Tayles HMP Long Lartin 01386 835204

Bernie Lauff HMP Wakefield 01924 246008Howard Barker HMP Wakefield 01924 246038

Alan Setterington HMP Whitemoor 01354 602435

Margaret Adams HMP Woodhill 01908 722176Sean Reedman HMP Woodhill 01908 722131John Clark HMP Woodhill 01908 722166Anthony Wood HMP Woodhill 01908 722166

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Appendix 3 - Forensic Psychiatry Risk AssessmentReport Guidelines

It is expected that the psychiatric assessment should be include the following.

• Interviews with staff, e.g., prison officers involved.• Review of IMR.

• An interview with the prisoner.• Family and personal history.• Sexual history.• Psychiatric history.• Drug and alcohol history.• Medical history.• History of offending.• Details of offence resulting in custody.• Previous psychiatric reports.• Other corroborative sources where appropriate.

The conclusions of the psychiatric evaluation should be organised in a suitablemanner and comment on the following.

• Diagnosis, with special consideration given to mental illness and personalitydisorder.

• Implications of risk in relation to the diagnosis.

• Consideration of appropriate treatment.

• Consideration of alternative locations more appropriate for the prisoner, e.g., aSpecial Hospital.

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Appendix 4 - Forensic Psychology Risk AssessmentReport Guidelines

It is essential that all psychologists undertaking CSC assessments follow the adviceand guidance below. Individuals should have undertaken the necessary training toadminister the relevant tests and had an appropriate level of supervision. Thesereports will be accessed by the prisoner, his legal representative, an independentconsultant forensic psychologist and a consultant forensic psychiatrist, as well as theCSC Selection Committee.

For a list of contacts who can offer further support and guidance, see Appendix 2.

1 Introduction and advice on the assessment approach

1.1 The Forensic Psychology Risk Assessment Report (FPRAR) is commissionedby the Close Supervision Centre Selection Committee (CSC SC).

1.2 The purpose of the assessments is to establish a number of points.• Does the referral meet the selection criteria as outlined in I.G.28/93?

• What is the level and type of violence/disruption? Is this a function of theprisoner's current environment, or a core component of his lifestyle andoffending?

• Are related mental health symptoms present? If so, would alternative highsecure containment be more appropriate for the prisoner's mental healthneeds? If so, which establishment might be suitable to meet that need?

1.3 The FPRAR is one of three commissioned reports, the others being a forensicpsychiatric assessment and an operational/forensic history report.

1.4 These reports need to be completed within two months of receipt of thecommissioning letter.

1.5 You must ensure that you have attempted to gain full, informed consent fromthe prisoner when undertaking these assessments. Appendix 9 contains a copyof the Informed Consent form, which must be used on all CSC referrals.

1.6 A locally convened assessment case conference will be held at the end of thetwo-month period. You will be expected to attend this conference.

1.7 The report must be written as a fully discloseable document and should bedisclosed prior to attending the local assessment case conference. Should theprisoner be selected for the CSC system, the prisoner's solicitor will alsoreceive a copy of your report. If you require further guidance, you shoulddiscuss this with your supervisor.

1.8 If you have concerns about material that would comply with non-disclosure asstated in the Data Protection Act, you must clearly state your reasons for notdisclosing and mark the report 'Not for Disclosure - Data Protection Act' andstate the relevant section of the Act.

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1.9 The report will summarise the full assessment findings. However, detailedresults (e.g. PCL-R pro formas with evidence for item scoring, functionalanalysis etc.) will be required by the external validation panel only, and shouldbe stored in a confidential folder labelled 'CSC ASSESSMENTS (PCL-R;HCR-20; VRS)' and marked with dates.

1.10 See the overview of the assessment process (Chapter 2) for further detail ofthe CSC assessment and validation process.

1.11 If you require further assistance or information, you may wish to contact oneof the CSC sites (see Contacts List, Appendix 2).

2 Guidelines for Administration

2.1 Refer to the Structured Risk Assessment Guidance Manual to establishwhether you are competent to carry out the key assessments.

2.2 Refer to the Informed Consent form (Appendix 9) prior to commencing theassessments.

2.3 It is possible to use the combined structured interview schedule used forCSCP, but you must be aware of the need to supplement this with additionalPCL-R questions. This tool is currently being revised as it has some PCL-Ritems omitted from it. For further advice, contact Living Skills staff in OBPU.

2.4 Ensure that you refer to the guidance on Functional Analysis provided by CaraCunningham, Lucy Merrick, and Maggie Evans.

2.5 When scoring the different risk assessments, you must use the individual testmanuals.

3 Report Sections

3.1 Please consult the DHS Report Writing Guidelines for Psychologists &Supervisors for general guidance on report writing. The sections belowprovide additional details of what is specifically required for the CSC forensicrisk assessment report.

• Introduction

Outline your credentials.

The following paragraph can be used as part of the introduction tosummarise the purpose of the report and the tools used:

The purpose of this report is to summarise the main themes that have emergedfrom a recent assessment of Mr X using the HCR-20, the VRS, and the PCL-R.The main focus of the assessments is to determine the level of current violence,criminogenic need, and the risk of future violence. The assessment also

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includes a functional analysis of the individual's institutional behaviour andoffending history. The information contained in the report is based on bothinterview and file material

The introduction should also do the following.

• Provide a summary of the contact time with the prisoner.• Outline who will have access to the report (the prisoner and his solicitor,

case work team, CSC SC, personal officers, independent verificationpanel, etc).

• Specify which reports have been read and which individuals you haveconsulted with during the assessment (for example, you will need todiscuss the case with the commissioned psychiatrist).

• If you cite previous reports within the body of your own report, alwaysprovide the source of the citation.

• Co-operation and Presentation during Assessment

In this section you must establish that, prior to commencing theassessment schedule, you outline the disclosure and informed consentprocedures and limits of confidentiality. You should also comment onwhether the prisoner appeared to understand the above issues.

For those prisoners who indicate a willingness to comply fully with theassessment, you may wish to use the following paragraph:

Prior to commencing the assessment interviews, Mr X was informed of thenature and purpose of the assessments, the extent to which information will bedisclosed, and the possible outcomes of the assessment process. During thisdiscussion he was also informed of my requirement to pass on to relevantparties both security information and information relating to crimes for whichMr X had not been charged. Mr X appeared to comprehend fully these issuesand signed a consent form to indicate his willingness to participate in theassessment.

For those prisoners who do not fully comply you must still ensure that youcomment on informed consent. You should refer to the following.

• How you explained to the prisoner that the assessment would still beundertaken based on file information and observed behaviour.

• How you explained to the prisoner who assessment information will beshared with, namely, the authors of the psychiatric and operation reports,the independent validation panel, members of the CSC SC, the receivingestablishment, and those involved in sentence planning, currentsupervision, and release planning (where relevant).

• How you explained to the prisoner that he had the opportunity to re-engageat a later date should he so wish.

• What feedback you gave to the prisoner about the assessment outcome.

You should also comment on whether the prisoner appeared to understand theabove issues.

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• General guidance

In this section you should also do the following.

• Provide the dates on which the prisoner was interviewed.• Indicate the location of interviews (segregation unit, wing etc.) and any

implications of environmental constraints.

,, Note whether you have previously had contact with or knowledge ofprisoner.

• Comment on anything unusual about specific interviews, for example,environmental factors or recent incidents, sources of stress etc..

4 Specific Assessments - Functional Analysis

4.1 Guidelines for Administration

Using the guidelines for completing a Functional Analysis (FA), your aimwith this procedure should be to organise case material and/or analyse bothoffence-related and disruptive/violent custodial behaviour. An analysis ofboth these areas will enhance understanding of the prisoner as a whole andenable the exploration of links between institutional behaviour and offending.

4.2 As a guide it would be appropriate to conduct a FA on two or three occasionswhen the prisoner has been disruptive in custody and likewise on two or threeoccasions when he has not (if possible). Exploration of previous offendingwould also then be explored using this mechanism.

4.3 This process should only be completed if there is sufficient collateralinformation and if the prisoner is willing to see a psychologist and appears tobe engaged. The psychologist undertaking the assessment will need to make aclinical judgement as to whether or not to complete the FA.

4.4 Reporting the Information Gathered through the Functional AnalysisThe reporting on the outcome of this analysis should be incorporated into theoverarching structure of the report. Rather than detailing conclusions in aseparate section, the information elicited will inform and add detail to the risk

factors determined by the VRS and HCR-20 assessments, e.g., informing ofthe triggers to violence, levels of motivation, the violence cycle, and attitudestowards violent behaviour. This may also add further evidence to items of thePCL-R.

5 Specific Assessments - PCL-R

The PCL-R should only be used by those individuals who are trained todo so and who can specifically demonstrate IRR (themselves or theirsupervisor). Please refer to the Guidelines for Psychologists Administeringand Scoring the Psychopathy Checklist (Revised), HM Prison Service,March 2003.

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5.1 The specific PCL-R consent form does not need to be used, as the CSCInformed Consent form (Appendix 9) provides explicit PCL-R informedconsent. It is also advisable to provide the prisoner with a copy of the CSCReferral Guide for Prisoners (Appendix 8).


Where possible the PCL-R interviews should be videotaped, but alternativesmay need to be agreed with the prisoner if he or others are concerned aboutthe video (you or other unit staff may also be concerned about issues ofsafety). Audiotapes or a scribe may be acceptable alternatives. If either ofthese latter methods is being employed, it is important that all aspects of theinterview are recorded and not just the verbal responses, i.e., it is important tocapture examples of the prisoner's interpersonal style.

5.3 The collateral search should be completed prior to the interview. Where thereis a concern that there is insufficient collateral, a PCL-R should not becompleted. This will obviously affect the HCR-20 and VRS. If in doubt,consult your supervisor or a PCL-R trained trainer.

5.4 Guidelines for ScoringFollow the manual guidelines for scoring the 20-item assessment. Ensure thatyou source the evidence for future reference and supervision. Remember thatthe items are scored across a lifetime's functioning. Any concerns aboutcertain items being present only during extreme circumstantial events or aboutepisodes of acute mental health should be recorded but not given overdueconsideration when scoring. Ratings are to be completed on the basis oftypical functioning.

5.5 Guidance on re-assessment is contained within the HMPS Guidance Manual.

There may be additional concerns that there is no clear recording of informedconsent concerning the initial PCL-R assessment. Given the implications ofthis assessment, it may be advisable to repeat the process. This re-assessmentshould be "blind-scored", that is, done without sight of the original scores andfollowing clear recording of item evidence as stated above.

5.6 The PCL-R raw data and scoring sheets must be clearly labelled and storedsecurely. The Independent Verification Panel may wish to view the raw datashould there be a query. A Consent to Release form must be completed in theevent of this occurring.

5.7 Guidelines for reportingIn this section of the report it is important that strengths (or protective factors)as well as those items with a high score are reported. It is possible to reportaccording to the 3-Factor model if you are familiar with it, but be aware thatthe model accounts for only sixteen items. See Cooke, D.J., & Michie, C.,'Refining the Construct of Psychopathy towards a Hierarchical Model',Psychological Assessment, 13,2001, pp. 171-188.

5.8 Raw scores should not be reported but a description of percentile rankings forF1 (interpersonal style and effect) and F2 (behaviour) can be given in orderthat the ratings have some personal application to the prisoner. It is, however,

37

important to stress that these percentiles are derived from a North Americanadult male population, as UK norms have not yet been published.

5.9 The language used in this section should be specific to the prisoner rather thana direct copy of the item titles in the manual. For example, pathological lyingcan be described as follows:

Mr X often reports information that is not entirely honest and open. It istherefore advisable to check the validity of self-reported information withother file information and staff who manage Mr X closely on a regular basis.

5.10 The F1 items are, in the main, issues of responsivity and should be notedcarefully in terms of the prisoner's general and treatment management.Chapter 5 of the new HCR-20 Violence Risk Management Companion Guidecontains a useful table on conceptualising treatment responsivity across anumber of interpersonal style ratings. You can refer to this when reporting onthe F1 items.

5.11 The F2 items should inform treatment targets as well as management plans. Itis important to relate these factors back to the assessment purpose, in order tomake the evidence for the CSC containment (or not) clear. The issue oftreatment is not concerned with Offending Behaviour programmes beingunsuitable for the prisoner if he is a high scorer. Rather, the prisoner needs tobe made aware of the traits he displays and how these raise issues for hisongoing risk-monitoring. The reporting section in the HMPS PCL-RGuidance Manual offers a good example of how to word high scores and theimpact of such scores upon staff managing the prisoner's sentence.

6 Specific Assessments- Violence Risk Scale (VRS)

The VRS should only be used by those trained by the tool's authors,Wong and Gordon.

6.1 The VRS assesses the risk of violent recidivism. It uses six static and twentydynamic risk factors derived from an extensive review of risk assessment and

treatment literature that identified factors which are empirically ortheoretically linked to violence.

6.2 The factors are rated on a 4-point scale, reflecting the extent of the problemidentified by the factors.

6.3 The Stages of Change Model (Prochaska & DiClemente, 1986) is used withinthe VRS for factors that receive a score of 2 or 3 in order to assess readinessfor treatment. Following intervention, the stages of change can be re-assessedto determine progress.


You may use either the semi-structured interview in the manual or thecombined CSCP interview schedule (refer to earlier advice about thisinterview schedule). You should review file information for supportingcollateral.

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6.5 Rating the VRSRefer to the VRS Manual.

• Ratings should be based on the individual's lifetime functioning.

• Use collateral file information to support interview assessment.

• Each static factor is rated 0,1,2, or 3. With the exception of'Current Age',static factors cannot change to reflect a reduction in the risk of violence.

• Prior to rating each dynamic factor, read both the objective and the ratingdescriptions.

• Each dynamic factor is rated 0,1, 2, or 3. The higher the rating, the morethe factor is associated with violence in the prisoner's lifetime functioning.For example, a 0 rating should be given when the factor in question has noassociation with violence whereas a 3 rating would be given to indicatethat there is a consistent and significant association with violence.

• For the factors that you classify 2 or 3, rate the stage of change for eachfactor according to the instructions in the manual (see pp. 11-16).

• If you do not have enough information to score a factor, it should beomitted. In this case a pro-rated total score should be calculated (seemanual, p. 18).

• A clinical override is included in the VRS. The override allows the

assessor to capture extraordinary or unique situations relating to risk ofviolence that have not been covered by the individual VRS factors. Forexample, although indicated as low risk after a VRS rating, the offendermay have verbally expressed a serious intent to commit a violent act in thefuture. The override should also be used to indicate exceptional medical,psychological, or social conditions that may affect the offender's risk ofviolent recidivism, e.g., serious cognitive impairment, acute stressorswithin the offender's family etc..

6.6 Reporting VRS assessment results

(Additional advice is provided in the VRS training on report writing)

• The sum of the total static score and total dynamic score constitutes theindividual's assessed level of risk. It is useful to record this on your scoresheet for retention in the offender's psychology file (to contribute to UKnormative data), but it is not helpful to comment on scores in your report.

• In the report, comment in turn on each of the dynamic factors which youhave rated 2 or 3. Provide the evidence for each risk factor and, whereappropriate, draw this information from both offending behaviour andproxy behaviours demonstrated in prison. These factors are potentialtreatment targets.

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• Your Stages of Change rating for the identified treatment targets willenable you to comment on how motivated the offender is to address thisparticular factor. This may help you make recommendations about theprioritisation of treatment targets.

• If the offender is in the pre-contemplation/contemplation stage of changeon most of his high scoring dynamic factors, it is likely that he has noinsight into his problems and no intention of changing in the near future.As it is likely that many of the prisoners assessed for selection to the CSCsmay be in this category, recommendations in such cases will probablycentre on motivational enhancement strategies.

• Those factors on which the offender has rated 0 (and occasionally thoserated 1) can be commented on as areas of strength or protective factors.

6.7 Re-assessment

• If the offender has previously been assessed using the VRS, check the dateof administration. The assessment scores are valid for only two years.The scale should be re-administered after this length of time.

• If the offender has participated in treatment, with targets being based onthe highest scoring factors of the VRS, each factor and the associated stageon the Stages of Change model should be re-scored every six months.

7 Specific Assessments - The HCR-20 Version 2(Webster, C., Douglas, K., Eaves, D., and Hart, S., 1997)

Consult the manual published by the Mental Health, Law, and PolicyInstitute, Simon Fraser University, British Columbia, Canada, and reviewthe most up-to-date publications, e.g., Webster's new guide on how to usethe HCR-20 in developing risk management plans (this providesguidance on intervention and supervision strategies), HCR-20 ViolenceRisk Management Companion Guide (Douglas et al, 2001) etc..

7.1 The HCR-20 is a checklist of risk factors for violent behaviour. It consists of

twenty items comprising ten past 'historical' factors, five present 'clinical'variables, and five future 'risk management' issues. It was designed toprovide a view of future violent behaviour, to inform violence reduction andprevention strategies, and also to guide staff responsible for treating andmanaging risk reduction.

7.2 The authors define violence as 'actual, attempted, or threatened harm to aperson or persons'. Threats of harm are clear and unambiguous, rather thanvague statements of hostility. Behaviour that induces fear in the averageperson, such as stalking, is counted as violence. All sexual assaults areconsidered violent behaviour. (For more examples of acts considered violentand for those left out of the authors' definition, see pp.24-26 of the manual).

7.3 The historical section reviews the offender's index offence, his criminal,psychiatric, family, school, and vocational background, and other relevanthistorical information. The authors believe historical data should anchor risk

40

assessments. However, use of the term 'historical' does not imply all itemsare unchangeable. The clinical section entails a description of the offender'sstate of mind at the time of the incident or offence as well as current

diagnostic, symptomatological, and other clinical factors that have a bearingon risk. The risk section assesses the extent to which the offender's release

plans are robust and feasible and the degree to which the offender has engagedin previous release arrangements.

7.4 Administration of items

In using the HCR-20 to make decisions regarding the placement,treatment, or management of offender, you need to demonstrate a highlevel of expertise, as follows.

• Expertise in conducting individual assessments. You should havetraining and/or experience in interviewing, the administration andinterpretation of standardised tests, and the diagnosis of mental disorder.

• Expertise in the study of violence, You should be familiar with theprofessional and research literature on the nature, causes, and managementof violence.

• Expertise in factors related to mental disorder. Several historical items(5,6,7, and 9) and clinical item 3 assess factors directly related to mentaldisorder. Those who are not trained to conduct psycho-diagnosticassessments should not code these items, with the following exceptions:

o in consultation with or under the supervision of accreditedprofessionals;

o by referring to results of existing psycho-diagnostic assessments;o by provisionally coding the item and noting that the coding should

be confirmed by an accredited professional; oro by omitting the item and noting their omission may limit the final

judgment of risk.

Use multiple sources of information, and always source reports or consultationwith other professionals referred to in your judgments.

Carry out detailed interviews wherever possible (use the combined CSCPinterview schedule).

The interview(s) can be useful in assessing inconsistencies between what isknown about the prisoner and what he wants you to believe.

7.5 Item Coding

• Code items, using the 3-point scale provided on the HCR-20 coding sheet,according to the certainty that the risk factors are present.

• Ensure that you consider the context in which you are assessing the riskfor violence. In the majority of assessment reports requested by the CSCSC this will relate to institutional violence, but you may also need toconsider the risk for community violence where the prisoner is shortly duefor release.

41

• A score of 0 indicates the risk factor is absent or omitted (see section 7.6).

• A score of 1 indicates the risk factor is possibly or partially present.

• A score of 2 indicates the risk factor is definitely or clearly present.

7.6 Omitted Items

• If no information is available concerning a given item or if the informationis considered unreliable, the item may be omitted.

• If items are omitted, they should be given a score of 0 for clinicalassessment purposes, indicating that there is no information to suggest arisk factor is present.

• Omitted items may adversely affect the validity of the final risk judgment.You should therefore qualify your opinion, indicating how this mightchange if full information were available.

7.7 Final Risk JudgmentWhen all the items have been scored, make a final decision regarding the riskfor violence using the 3-point scale - low, moderate, or high - provided on thecoding sheet.

7.8 There is no specified method for reaching the final risk decision. The authorsargue that it makes little sense to sum the number of risk factors and usearbitrary cut-offs to classify individuals as low, moderate, or high risk, andthey urge caution about assuming that the relationship between the number ofrisk factors present and the risk for violence is linear.

7.9 Assessing risk is complex and likely to depend on the specific combination,and not just the number, of risk factors present. At times an individual may beassessed as a high risk for violence based on the presence of a single riskfactor. For example, the extreme psychopathic traits present in risk factor C3('active symptoms of major mental illness') where the prisoner has stated hisintent to commit a murder, or in risk factor H7 ('psychopathy'), may alonelead you to conclude that the offender is high risk.

7.10 Rate 'Low' if you believe the prisoner has no risk or very low risk forviolence. This would suggest that the prisoner is not in need of any specialintervention or supervision strategies designed to manage violence risk.

7.11 Rate 'Moderate' if you believe the individual has a somewhat elevated risk forviolence. This suggests a risk management plan should be developed whichshould include a mechanism for systematic re-assessment of risk.

7.12 A score of 'High' indicates that you believe the individual has a high or veryhigh risk of violence. This rating suggests that there is an urgent need for adetailed risk management plan which should typically include adviceconcerning staff, increasing levels of supervision (for example, as provided

42

within the CSC), and identifying possible treatment options, and an indicationof regular re-assessment timings.

7.13 Re-assessment

The risk for violence should be reassessed every six to twelve months orwhenever there is an important change in the circumstances and/orenvironment of the offender.

7.14 The HCR-20 may be useful to monitor progress in treatment and act as asystematic way of monitoring the risk progress of the relevant factors. (SeeDernevik et al, 2001, for further advice on the integration of this tool intotreatment and management).

7.15 Reporting the I-ICR-20The H items can be reported on in terms of risk management. The ViolenceRisk Management Companion Guide suggests splitting this section into two.The first group contains those items that have no predictive validity on theirown and are termed 'risk markers' (HI, H2, H8, and H10). Whilst essentiallystatic, they can change over time, as in the case of someone who commits afurther act of serious violence.

7.16 The second group contains factors (H3, H4, H5, H6, H7, and H9), which canbe viewed as 'risk markers' and may act as causal factors leading directly toviolence.

7.17 Whilst the first group can be viewed in an actuarial sense, i.e., the more theyare in evidence, the greater the risk, this is cautioned against this. The secondgroup should direct you towards more service-orientated provision for theseareas of need. Monitoring these areas as part of a management plan, whereservices are targeted, should inform as to the reduction (or not) of risk. It isalso possible to consider the worst and best functioning of these factors,looking at the levels of severity and stability.

7.18 The C and R items are truly dynamic factors upon which treatment andmanagement strategies should focus. The Violence Risk ManagementCompanion Guide provides a whole chapter dedicated to strategies that mayhelp to reduce risk in relation to C and R items. This is particularly relevant tothe R 'in' as well as the R 'out'. For the purpose of the CSC report, it is likelythat the prisoner is not approaching release. The focus of this section oughttherefore to be R 'in' and hence assist with the formulation of the Care and

Management plan targets.

8 Report Conclusions and Recommendations

8.1 The report must be clear about the prisoner's meeting (or not) the CSCcriteria. A summary of why he does or does not should draw together theassessment conclusions. Refer to the psychiatric assessment if an alternativeHigh Security health location referral would be more appropriate.

8.2 Where additional assessments will aid the development of the Care andManagement Plan, these should be noted along with reasons for their

43

suggested inclusion. If these are critical to decisions regarding CSC selection,they should be completed prior to the report being concluded.

8.3 If a referral is a borderline case, your assessments should offer alternativemanagement strategies within DHS locations by providing greater informationinto the presenting difficulties. This should be phrased in terms of whatsupport management methods may be helpful, rather than where these may beavailable.

8.4 You should clearly state the supervisor of this report and have him or her signit.

9 Issues Raised in Disclosure

9.1 Given that the report will have been disclosed to the prisoner, you shouldmake an entry about any concerns raised during this disclosure.

44

Appendix 5 - Operational Manager Risk AssessmentReport Guidelines

Overview

Whilst the initial referral report will have provided some evidence of the prisoner'sproblem behaviour, a fuller report is needed to support the more detailed multi-disciplinary assessments. Wing staff, probation staff, and segregation staff canprovide some of the information listed below. It is helpful for this to be pulledtogether into one report, using the headings stated below.

Should the prisoner have a completed LSP (Life Sentence Plan), DCR(Discretionary Conditional Release) plan, or DIA (Dispersal InductionAssessment), please attach a copy/copies as an appendix to the report dossier.

The following areas should be written up in the report and disclosed to the prisonerprior to the local case conference. Where information is drawn from security files, itshould be gisted. Where this cannot be gisted or is critical to the referral, the reportmust comply with the Data Protection Act and be marked 'Not for Disclosure - DataProtection Act' (you must refer to the relevant section).

Custodial Behaviour

You must provide a detailed review of the prisoner's custodial behaviour, highlightingthe events that led to the initial CSC referral. This needs to include poor and goodbehaviours alike, and should draw on locally-held documentation such as IEP records,observation sheets, and so forth.

Poor Behaviours

These behaviours demonstrate the individual is high risk and dangerous in his currentenvironment to staff, other prisoners, or himself. They need to be identified so thatbehaviour management plans can aim to reduce their frequency and levels of risk.

For the purpose of a CSC referral, poor behaviours specifically include any of thefollowing behaviours which the prisoner has actually carried out or has threatened tocarry out in your presence, or which the prisoner has been reported to have carried outwhilst in your responsibility, e.g., in the workshop, wing, class, etc..

• Threats, including intimidation/bullying.• Attacks or assaults.

• Other aggressive or hostile outbursts.• Impulsive acts.• Hostage taking• Attempted or actual murder.• Sexual behaviours comprising particularly sadistic acts.*• Serious and repeated disruption.

* See below for further information on this area.

45

Good Behaviours

Examples of good behaviour provide evidence that the prisoner is able to controlhimself in certain situations. These examples can be related back to the individual toindicate to him, in concrete terms, what kinds of behaviour are preferable where hishigh-risk behaviours are concerned. These behaviours should be included as they canbe fed into a care and management plan if the prisoner comes into the CSC, or mayeven offer further insight into management arrangements outside of the CSC.

Look for behaviours that contradict the high-risk behaviours for which the prisoner isbeing referred. For example, if he is often verbally aggressive, comment on occasionswhen he has demonstrated assertiveness and politeness. If he is often unsociable,highlight an example when he has socialised with others in an appropriate manner.These examples may be very small compared with ideal behaviours, but for thisindividual they may demonstrate significant improvements. There may have beenperiods of very settled behaviour that need to be explained.

Patterns of Behaviour

It is important to explore emerging pattems when reporting on the prisoner's custodialbehaviour. A pattern of behaviour is an identified link between several distinctbehaviours that have occurred across time. Identifying patterns of behaviour, ratherthan individual incidents, can provide insight into how and why a prisoner is triggeredinto behaving the way that he does and may help to predict how and when he mayreact in the future without intervention. Sometimes the trigger, or the management ofthe trigger, can be addressed, rather than the behaviour itself, in order for theunacceptable behaviour to be reduced or removed. For example, a prisoner who picksa fight on most Wednesday evenings may be receiving a telephone call from hispartner on that particular day each week. The prisoner may be unable to manage theemotions that this contact triggers and may channel his feelings into an aggressiveinteraction with others. This is not an excuse for his unacceptable behaviour, but itmay indicate a cause that can be addressed through behaviour management.

Staff who are in contact with the prisoners on a daily basis are therefore in an idealposition to identify these triggers and patterns. Some prisoners may be aware of theirtriggers to poor behaviour and able to verbalise them in conversation. However, otherprisoners may be unaware that they are responding to a situation or circumstance in arepetitive manner.

Examples of triggers are as follows.

• Anniversaries of events relating to family, offence etc..• Time of the day, week, month, or year.• Certain persons or activities.• Receiving mail.• Drugs or alcohol.• Responding badly to arguments or to losing (a game, etc.).

46

Historical Repetitions

• Patterns may emerge across a lengthy time span, either inside or outside theestablishment. There may or may not be a link to the offence.

Escalation

• The prisoner's behaviour may be escalating in seriousness and risk whenobserved across time: threats become actions, actions become moreaggressive, a weapon is carried, a weapon is used, life is threatened, andfinally life is taken. The best predictor of future behaviour is past behaviour,and an observed pattern of escalation across time may help to predict the typeand occasion of the next incident of high-risk behaviour.

Threats may have been made any length of time ago and later carried through,possibly indicating that a grudge has been held across time. Where this is the case,the pattern should be highlighted and any outstanding threats should be takenseriously and managed accordingly.

Repeatedly demonstrating poor attitudes towards others may indicate an underlyingproblem with that section of society, e.g., females, authority, specific types ofprisoners and/or offences.

Official records of the prisoner's behaviour that can be helpful sources include hisIEP records, daily history sheets, bullying reports, F2052 records, and SIRs. Securityinformation must be gisted.

Adjudications

Official records of behaviours that have broken the rules of the establishment are aclear and easy way to assess levels of risk.

Take account of the following.

• The quantity of the adjudications. What proportion of the prisoner'sbehaviour is against the rules?

• The frequency of the adjudications. How long is the prisoner able to abide bythe rules?

• The repetitiveness of adjudications across time. Are there any patterns orescalations of behaviour?

• The range of adjudications. Does the prisoner show a wide or narrow range ofadjudication charges?

Sometimes, general reports of the individual's behaviour suggest that he is suspectedof breaking the rules, e.g., trafficking, bullying, but no adjudications have been madeor have reached a guilty verdict. Where this is the case, comment on why this may beso. Does the prisoner appear to manipulate or to lie and to con? Does he bully othersinto carrying out unacceptable behaviours for him and not get involved himself?.

47

Substance Abuse

Research evidence supports the view that people are more likely to commit acts ofviolence whilst under the influence of alcohol. Recurring violence is also associatedwith substance abuse. There is even a growing body of evidence to indicate thatviolent offenders who have a history of drug and/or alcohol abuse and also sufferfrom mental illness are more likely to commit serious violent offences upon a widerrange of victims and using more serious acts of violence, e.g., employing weapons. Itis therefore of particular importance to report what is known or suspected about theprisoner's substance abuse history.

This history may have been evident in the prisoner's offending or it may, as is thecase with some prisoners, be an institutional problem. Associations with known drugusers and traffickers should be commented upon. Abuse of prescribed medicationmay also be linked to the prisoner's aggressive behaviour. Individuals with a historyof schizophrenia and substance abuse are more likely to commit acts of violence.Whilst such individuals may be following a course of medication, lapses may result inacts of aggression. Where the prisoner being assessed has a current diagnosis of amental illness, his willingness to adhere to his medication regime is worth reporting.

Disruptive or Challenging Behaviour Prior to AdultImprisonment

Available social services and probation history are good sources for evidence of aprisoner's disruptive behaviour prior to his adult imprisonment. Such reports mustinclude an account of the prisoner's family circumstances, and also pre-sentence courtreports where available. Periods of borstal, juvenile detention, or social servicesdisposal must be described. Periods of stable as well as disruptive behaviour shouldbe noted.

Where the prisoner has previously served periods of probation supervision or hasreceived similar privileges, such as those available within semi-secureaccommodation, it is helpful to note his responses. Key periods should be recordedand his behaviour under any such arrangement reported.

Relationship History

The prisoner's interaction with others is important. Points worth noting are whetherhe has a very isolated or impersonal existence, whether he is a manipulator ofvulnerable people (this may be evident in his offending), and whether he is aggressivemuch of the time either in general or towards specific groups/individuals/genders.

It is important to give an historical account of the prisoner's relationships as well as amore detailed account of his custodial relationships. The latter should includerelationships with other prisoners as well as staff. Staff groups should include bothwing staff and others with whom he has regular contact, such as instructional officers,PE, and education.

48

Supplementary Information

Attitudes/Beliefs

Strong beliefs and attitudes may be the driving force behind the prisoner's dangerousbehaviour. For example, he may believe that specific groups (females, sex offenders,anyone in a uniform) 'deserve all they get', or he may genuinely believe that weaponsare necessary for survival. He may believe that people who do him a perceivedinjustice should be repaid, and he may hold grudges for a long period of time before"repaying" them. Attitudes and beliefs are often entrenched in a person's lifestyle andit is part of the specialist's role to identify and comment upon them. However, dailycontact with the prisoner allows staff to witness the behavioural incidents that stemfrom these beliefs and attitudes, thus supporting the patterns identified by thespecialists. For example, you may have refused a request and feel that the prisonermay have held this against you for some time, or he may have told you that he prefersto carry a weapon outside of prison. These small behavioural incidents may beimportant parts of a much larger picture that can assist in measuring the prisoner'slevel of risk.

How might this be Presented?

You should provide any verbal evidence of beliefs or attitudes that may be linked tothe prisoner's level of risk, e.g.,

'All of you in uniform, you're all the same.'or 'An eye for an eye, a tooth for a tooth.'

You should describe any behavioural incidents or patterns of behaviour that may belinked to the prisoner's level of risk, e.g.,

bearing grudges;'supporting the use of weapons through his behaviour;supporting the use of violence through his behaviour; orattitude towards others verified by his socialising pattems

- aimed at sub-groups- aimed at targeted individuals.

Violent Sexual Fantasy

Deviant sexual interest has been found to be the strongest predictor of sexual re-offending (Hanson and Bussiere, 1998), yet individuals do not often report thissocially unacceptable behaviour (Pithers et al, 1989, Marshall et al, 1991). Althoughyou cannot see into a prisoner's mind, you may have reason to believe that he isshowing a particular interest in a specific individual, whether staff or prisoner.

You may be aware of the prisoner demonstrating pre-occupation with a certainprisoner or member of staff, and spending lots of time alone, seemingly daydreaming.Physical evidence would include any writing, artwork, or doodling which suggests

49

that the individual is pre-occupied with violent fantasies, sexual behaviour, or indeedwith any other activity, such as victimisation of others including death. Staff mayhave observed the prisoner engaging in acts of masturbation when watchingparticularly violent films or when certain staff are on duty. Staff may also havewitnessed the prisoner re-enacting his violent behaviour. His reading material mayalso be another good source of information.

50

Appendix 6- CSC Diary Dates Form

CSC Diary Dates Form

Referral

Name: Number:

Initial Assessment

Date of initial referral: Date initial referral accepted:

This is the Date of Commissioning

Initial Multi-Disciplinary Assessment

Date of submission of reports dossier:(This shouldbe no later than eight weeks after theDate of Commissioning(see above))

The dossier will be forwarded to the Independent Verification Panel immediately.

Local Assessment Case Conference

Date of Local Assessment Case Conference:(This shouldbe no later than ten weeks after the Date of Commissioning)

Independent Verification

Date of receipt of Independent Report:(This shouldbe no later thanone month afterthe IndependentVerificationPanel received the dossier,i.e., no later than twelve weeks after theDate of Commissioning)

Report to the CSC Selection Committee

Date of Local Recommendation provided to the CSC Selection Committee:(This shouldbe no later than twelve weeks after theDate of Commissioning)

Date on which the Outcome is confirmed:

If the case is accepted, this is the Date of Selection Approval(This shouldbe no later than seven days after the meetingof the CSC Selection Committee)

Date of Disclosure to the prisoner and legal representative:(This shouldbe no later than seven days before the TransferCase Conference(see below))

Transfer Case Conference/Individual Care and Management Plan

Date of Transfer Case Conference:(This shouldbe no later than four weeks after the Dateof SelectionApproval (see above))

52

Appendix 7 - CSC Initial Referral Form

REFERRAL TO THE CLOSE SUPERVISION CENTRESYSTEM

To: Room 632/635 From:CSC Unit

Directorate of High SecurityCleland House

Details of Prisoner being Referred

Prison Number: Full Name:

Date of Birth: Category:

NPD: LED: SED:

Sentence: Location: Main Offence:

Reason for Referral

Please tick (4 the ground(s) on which the prisoner is considered suitable forselection to the Close Supervision Centre system.Violence towards staff BarricadingViolence towards prisoners Self-mutilation

Repeated disciplinary offences Suicide attemptsDamage to property Other (please specify)Hostage taking

Please tick (_/_ the reports that have been submitted (reports must betypewritten)Wing Management PsychiatristSecurity Officer Other (please specify)Medical Officer

Psychologist (where appropriate)

Please tick (4 the current location of the prisonerCurrent Normal Hospital Segregation Temp. transfer

Location

To be completed at the CSC SC meetingDistributed at CSC SC meeting on:Considered at CSC SC meeting on:

[ I I

Segregation under Rule 45

Please list all the prisoner's periods of segregation within the last eighteenmonths

Date began Date finished G.O.O.D. Own I.G.28/93

Rule 45 Rule 45 protection

Disciplinary Record

Please list the number of each type of adjudication for the prisoner within thelast eighteen months

Assaults on staff

Assaults on prisoners

Damage to property

Detaining a person against his/herwill

Denial of access

Use of threatening, abusive, orinsulting words or behaviourTotal of other adjudications

Wing Management Report

Please include evidence substantiating the reason(s) for the referral.

Please type your report. You may use additional pages if necessary.

Name (Officer): Signature:

Grade: Date:

Name Signature:(countersigning Govemor)Grade: Date:

Security Officer's Report


1. Escape history and potential.

2. Please give full details of any special information relevant to thisreferral, e.g., names of prisoners with whom this prisoner should notassociate, involvement in drugs.

Name: Signature:

Grade: Date:

Medical Officer's Report

Please give a brief outline of the prisoner's medical history, details of anytreatment, and any medical restrictions that might affect the transfer.


Name: Signature:

Grade: Date:

Psychiatric Report

Please give a brief outline of the prisoner's current psychiatric condition anddetails of any current treatment.


Name: Signature:

Grade: Date:

Psychologist's Report


Name: Signature:

Grade: Date:

Monthly Review of Prisoners Awaiting Transfer to aClose Supervision Centre

Prisoner Details

Name: Number:

Prison: Location:

Date on which the prisoner was accepted:

Please give details of the prisoner's behaviour, e.g., significant alterations inbehaviour, significant events, adjudications.

Name: Signature:

Grade: Date:

61

Appendix 8- CSC Referral Guide for Prisoners

CSC Referral Guide for Prisoners

What is a CSC?

'CSC' stands for Close Supervision Centre. It is a location with extra staff to ensurethat no one, including yourself, is hurt by your behaviour.

Why am I being considered for a transfer to a CSC?

You are being considered for a CSC due to your behaviour in the immediate or recentpast. Staff at your current location are concerned that your behaviour has becomeunmanageable and that there is a higher-than-usual risk of you harming someone.

Who is responsible for this?

There are many people involved in the decision to move you. These include theGovernor, Wing Staff, Psychology, Psychiatry, Medical Staff, and Security, andpossibly people from your workshop, education, or PE departments. Staff at PrisonHeadquarters see all the reports that are being written to support your move, and theywork to ensure that this decision is right for you at this moment in time.

It is your behaviour alone that has triggered the decision to start CSC assessments.You can change that behaviour, with or without the help of the staff in the prison.

What happens now?

You will have been told in a letter that the CSC Selection Committee has assignedyou Rule 46 status on the basis of your behaviour. Now a series of assessments willbegin involving the local governor, psychology, and psychiatry.

The people responsible for preparing reports will interview you to complete theirassessments, and they will describe the type and format of each one. It is helpful foryou to participate in the assessments, as they allow you to share your own ideas onwhat should happen next to you.

If you choose not to be interviewed, the reports will be based on your file notes andon the recommendations of staff with whom you have had the most recent contact.

All the reports will be disclosed to you prior to the Selection Committee consideringthe report recommendations. You can also share these with your solicitor.

The reports will also be sent to an independent verification panel. The psychiatristand psychologist on this panel will complete a separate review of the information toensure that any mental health issues have been recognised and considered. They mayrecommend an alternative referral to a high security hospital or further assessments.

Within roughly three months the Selection Committee will decide upon whether totransfer you to a CSC unit or to an alternative location.

63

Appendix 9 - CSC Informed Consent Form

CSC Informed Consent Form

Prisoner Name: Number:

The above-named prisoner is undergoing assessment for his referral to the CloseSupervision Centre (CSC) system. One of the reports used to gather informationabout the prisoner is the Forensic Psychology Risk Assessment Report (FPRAR).

The purpose of the FPRAR is to show whether the prisoner meets the CSC selectioncriteria. The information gathered by the psychologist compiling this report will beshared with the authors of the psychiatric and operation reports, the independentvalidation panel, members of the CSC Selection Committee, the CSC casework teamat Prison Service Headquarters, the receiving establishment, and those involved insentence planning, current supervision, and release planning (where relevant). Theprisoner and his solicitor will also have access to the report.

It is beneficial for all parties concerned that the prisoner comply with and participatefully in the psychology assessment interview(s). This enables the psychologist toassess fully the prisoner's behaviour and needs first-hand. It also gives the prisonerthe opportunity to share his own ideas on what he would like to happen next.

If the prisoner decides not to comply with the psychologist, the psychologyassessment will still be undertaken based on file information and observed behaviour.

The prisoner will have the opportunity to re-engage with the psychology assessmentat a later date, should he wish to do so.

Whether or not the prisoner participates in the psychology assessment, he will receivefeedback as to the outcome of the assessment.

Prior to commencing the psychology assessment interview(s), the above-namedprisoner has been informed of the nature and purpose of the assessments, theextent to which information will be disclosed, and the possible outcomes of theassessment process. He has also been informed of the psychologist's requirementto pass on to relevant parties both any security information and informationrelating to crimes for which the above-named prisoner has not been charged.The above-named prisoner appears to comprehend fully these issues.

To be completed by the prisoner (please tick ONE of the following statements):

I agree to participate in the Forensic Psychology assessment []

I do not agree to participate in the Forensic Psychology assessment []

Prisoner's Signature:

Prisoner's Name: Date:

65

Appendix 10 - Local Assessment Case ConferenceReport Form

Local Assessment Case Conference Report Form

Prisoner Name: Prison Number:

Date of Local Assessment Case Conference:

Location of Local Assessment Case Conference:

Chair:

The purpose of the Local Assessment Case Conference (date and location as

above) is to assess the suitability of the above-named prisoner for referral to the

Close Supervision Centre Selection Committee. Please complete the followingsections (all comments should be typed).

Please provide full details of the prisoner's observable behaviour (additionalsheets may be used if necessary)

HM PRISONSERVICE



Please provide full details of the prisoner's mental and physical health needs(additional sheets may be used if necessary)

Please comment on whether the prisoner suffers from a specific personalitydisorder (additional sheets may be used if necessary)



Please provide details of the overall risk posed by the prisoner (additional sheets

may be used if necessary)

Please comment on a suitable location within the CSC system for the prisoner,should he be selected

Name: Signature:

Position: Date:

69

Appendix 11 -CSC SC Assessment Summary Sheet

CSC Selection Committee Assessment Summary Sheet


Date:

Reports Submitted (pleasetick;* indicatesobligatoryreport)

• Wing/Seg [] *Psychology [] *Psychiatry [] *Medical [] *Security []

Management

Governor [] Wing Staff [] Probation [] Education [] Workshop []

Visits [] Chaplaincy [] Other []

Is there a consensus that the prisoner's level of risk requires CSC conditions?

Yes [] No []

Is there a consensus that a CSC is the most suitable option available?

Yes [] No []

Physical Health (pleasetickandgivedetailswhererelevant)

Current Medication [] Medical Issues [] Other []

Is the prisoner physically fit? Yes [] No []

Will a CSC placement adversely affect his health? Yes [] No []

If the answer is 'Yes', please give details

............................ ,... ............ o.. .................. . ....................................

• .. ................................. .,. .............. .. .............. . ................ ,. ..............

Are any further tests or assessments requested? Yes [] No []

If the answer is 'Yes', please give details

CSC Selection Committee Assessment Summary Sheet(continued)


Date:

Mental/Neuropsychological Health (pleasetick andgive detailswhere relevant)

Is there evidence of the following?

Personality Disorder [] Mental Illness []

Neuropsychological Difficulties [] Learning Difficulties []

Are any further tests or assessments requested? Yes [] No []

If the answer is 'Yes', please give details........................................................................... o ................... °,° ....

..................................... ° ................................................................

,°° .............................. °°°°°°° ........................ °o°,°°°,° .................. °°° ........

......................................................................... ° ..... ° ................... °°.

Previous Allocation (Pleasetickandgive datesanddetailswhererelevant)

Has the prisoner previously been referred to a Special High Secure Hospital?

Yes [] No []

If the answer is 'Yes', please give details, including dates............................................... ° ............................................ ° .........

......... °°o°°°°° ..................... o°°°°° ...................... °°o°° .................. ° ............

........................... ° ................................................. , .................. , .....

Has the prisoner previously been allocated to a Special High Secure Hospital?

Yes [] No []

If the answer is 'Yes', please give details, including dates............................................. ° ........................................................

....................................... ° ........... o ........................... °° ............. ° .......

........................................ , .............................................................

The initial assessment is complete for submission to the CSC Committee

Name: Signature: Date:

Role:

72

Appendix 12- Care and Management Plan Form

Care and Management Plan

This plan contains assessments, specific to the prisoner named below, providedby the different departments involved in the care and management of prisonerswithin the CSC. The Care and Management Plan must be reviewed quarterlyfor the duration of the prisoner's being accommodated within a CSC.

When completing each section, please identify the sources of information onwhich the assessment is based and the degree of contact with the prisoner.

1. Prisoner Details

(To be completed by the CSC Administrator)

Prisoner Name:

Prisoner Number: Date of Birth: Category:

Index Offence: Sentence: Sentence Date:

PED: NPD: SED:

Location: CSC Selection Date:

Referring Establishment and Reason for Selection: .............................................................................................. o ........... , .......... . ..........................

Identified Risk Factors:................................... , ..................... ... .............

................................................. "........................

* ........................................... °...° ......... °°.°.°,.,°,°,°.

............................................ ° ................ ° ...........

Care Plan Objectives:................................................. , .......................

................................... , .....................................

............ ° ............................................................

.........................................................................

Initial Management Objectives.........................................................................

.........................................................................

.........................................................................

....................................... ,°,°, ........... °..,,..°° .........



2. Psychology

3. Probation

4. Healthcare/CPN



5. Education

6. PE Officer

7. Chaplaincy



8. Personal Officer

9. Adjudications

10. Prisoner's Comments

(This section provides an opportunity for the prisoner to make a personal

contribution to his Care and Management plan)



11. Summary of the Prisoner's Objectives for the Next Three Months

Objective Related Risk Area DesignatedFactor Caseworker

12. Names of Review Attendees



13. CSC Manager's Comments

14. Signatories

Prisoner: Date:

Wing Manager: Date:

Unit Manager: Date:

CSC Governor: Date:

CSC REFERRAL MANUAL -...

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Transcript of CSC REFERRAL MANUAL -...