CMH Risk Assessment – Violence


The patients violence risk state is [checkbox value="higher than|similar to|lower than"] their usual baseline of risk. 

The patients violence risk status is [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other patients in our service setting.

Foreseeable changes in violence risk: [textarea default="Nil"]

Documented incidents of violence: [textarea default="Nil. Yes."]

Resources available to the Pt: 

[textarea default="Help line numbers, Acute Care Team, PRN meds, Friends, Family, Counsellor, Community Mental Health Clinician, Disability Support Worker, NGO Caseworker, Distraction strategies"]

When asked, the patient [checkbox name="vicon" value="denied any current violent ideation or actions|disclosed current thoughts about violence|disclosed plans and / or intent to carry out acts of violence|admitted to recently committing an act of violence"][conditional field="vicon" condition="(vicon).is('disclosed current thoughts about violence')||(vicon).is('disclosed plans and / or intent to carry out acts of violence')||(vicon).is('admitted to recently committing an act of violence')"], because the patient felt: [checkbox value="current circumstances are unfair|mentally confused|tormented by thoughts|paranoid|righteous|outraged|not listened to|disrespected|impinged upon by others|current circumstances are out of their control|bullied|disrespected|wronged|the need for revenge|afraid for their safety|threatened|they have lost something of value|victimized by recent violence|excited by violence|their routine was disturbed|the need to assert toughness|forced to commit violence by peers|affected by substances|controlled by the behaviour of others."][textarea default=""][/conditional].

[checkbox name="violence" value="Known risk factors:"] [conditional field="violence" condition="(violence).is('Known risk factors:')"] [checkbox value="nil|documented violence towards others|Dx of conduct disorder|Dx of ASPD|Dx of ASD|attention deficits|hyperactivity|learning difficulties|an ABI|developmental delay|episodes of mania|poor theory of mind|impulse control difficulties|low frustration tolerance|low threshold for emotional reactivity|a history of early aggressive behaviour|low empathy|psychopathic traits|perspective-taking deficits|poor moral reasoning|drugs and/or alcohol misuse|intellectual difficulties|depression|poor behavioural control|excited by violence|fire-setting behaviours|deficits in social cognitions|sadistic traits|cruelty to animals|deficits in information-processing|documented incidents of dishonesty|attributes hostile intent to others|maternal alcohol abuse|is shame prone|paranoia|self-esteem is linked to violence|feels intense emotional distress|a psychotic illness|a history of treatment for emotional problems|antisocial beliefs and attitudes|an exposure to violence and conflict in the family|gang membership"][textarea default=""][/conditional].

[checkbox name="famfac" value="No known familial risk factors.|Familial risk factors:"] [conditional field="famfac" condition="(famfac).is('Familial risk factors:')"] [checkbox value="authoritarian childrearing attitudes|harsh, lax or inconsistent disciplinary practices|low parental involvement|low emotional attachment to parents or caregivers|low parental education|low parental income|parental substance abuse|parental criminality|poor family functioning|poor monitoring and supervision of children"][textarea default=""][/conditional].

[checkbox name="peerfac" value="No known peer risk factors.|Peer risk factors:"][conditional field="peerfac" condition="(peerfac).is('Peer risk factors:')"] [checkbox value="association with delinquent peers|involvement in gangs|feels socially rejected by peers|lacks involvement in conventional activities|academic underperformance|low commitment to education|school failure"][textarea default=""][/conditional].

[checkbox name="comfac" value="No known community risk factors.|Community risk factors:"][conditional field="comfac" condition="(comfac).is('Community risk factors:')"] [checkbox value="diminished economic opportunities|living in an area with a high concentration of underprivileged residents|has high levels of transiency|experiences high levels of family disruption|has low community participation|lives in a socially disorganised neighbourhood"][textarea default=""][/conditional]. 

[checkbox name="protfac" value="Protective factors:"][conditional field="protfac" condition="(protfac).is('Protective factors:')"] [checkbox value="an intolerant attitude towards deviant behaviour|a high IQ|good academic grades|a positive social orientation|highly developed social skills|plans ahead|realistic expectations for the future|religious|connected to family|connected to non-violent peers|fears violence and aggression|discusses problems with others|perceives parental disapproval for aggression|shares activities with family|supportive spouse|involved in pro-social activities|has positive role models|has affective relationships which are strong, close and prosocially oriented|is commited to education|is commited to work|has high needs for achievement|non-deviant peers|peer group rejects  antisocial behaviour|involvement in pro-social activities|early exposure to positive parenting practices"][textarea default=""][/conditional].

[textarea cols=90 rows=20 default="No additional information about violence risk known"].

The patients violence risk state is their usual baseline of risk.

The patients violence risk status is the general population, and other patients in our service setting.

Foreseeable changes in violence risk:

Documented incidents of violence:

Resources available to the Pt:

When asked, the patient .







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Sandbox Metrics: Structured Data Index 0.6, 31 form elements, 48 boilerplate words, 10 text areas, 15 checkboxes, 6 conditionals, 145 total clicks
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