CMH Risk Assessment – Violence
VIOLENCE RISK ASSESSMENT 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"].
There are 31 form elements.
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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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