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Queen's University
 

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Dynamic Risk Scale

Instructions

For each item below, you are asked to rate the client's behaviour on a variety of domains. There are two scale scores – one for predicting any incident, and one for predicting violent incidents. Two columns have been placed on the right, one for each scale score. Simply transfer the score for each item into the appropriate column(s) on the right. If the item does not count towards the total for a particular scale score, that cell is blacked out. If both cells are white, transfer that score to both cells.

For each item, choose the one number that best describes the client's presentation over the past MONTH and record it in the appropriate scoring column. If the problem does not apply to this client (i.e. medication non-compliance for a client who is not prescribed any medications), or if insufficient information is available to make a judgement, record “N/A” in the appropriate scoring column. If you are able to assert that the client has not had the particular problem at any time during the past month, record “0” for No Problem in the appropriate scoring column. If the problem has existed at any time in the past month, record “1”, “2”, “3”, or “4” in the appropriate scoring column.

The “Therapeutic alliance” items are set out somewhat differently, however, the scoring is the same. Select the number that best describes the client over the past MONTH, and place that number in the appropriate answer column(s).

Frontline Staff

No

Problem

Problem

Moderate

Problem

Problem Severe
Problem
N/A or
Unknown
Score
Any
Score
Violent

1. Previous violent acts ignored or passed over

0 1 2 3 4 N/A 0 0

2. Takes no responsibility for behavior

0 1 2 3 4 N/A 0 0

3. Anxiety, anger, or frustration

0 1 2 3 4 N/A 0 0

4. Shows no remorse

0 1 2 3 4 N/A 0 0

5. Unrealistic discharge plans

0 1 2 3 4 N/A 0 0

6. Escape or escape attempt

0 1 2 3 4 N/A 0 0

7. Unusual thought content

0 1 2 3 4 N/A 0 0

8. Complaints about staff

0 1 2 3 4 N/A 0 0

9. Shows no empathy and concern for others

0 1 2 3 4 N/A 0 0

10. Has antisocial attitudes and values

0 1 2 3 4 N/A 0 0

11. Poor compliance with current supervision restrictions

0 1 2 3 4 N/A 0 0

12. Exhibits few positive coping skills

0 1 2 3 4 N/A 0 0

13. Poor compliance with medications

0 1 2 3 4 N/A 0 0

14. Psychiatric symptoms are not in remission

0 1 2 3 4 N/A 0 0

15. Therapeutic Alliance

0 1 2 3 4 N/A 0 0

16. Denies all problems

Never

0

 

1

Occas.

2

 

3

Always

4

 

N/A

0 0

 

 

Clinical Staff

No

Problem

Problem

Moderate

Problem

Problem Severe
Problem
N/A or
Unknown
Score
Any
Score
Violent

17. Psychotic actions

0 1 2 3 4 N/A 0 0

18. Inactivity

0 1 2 3 4 N/A 0 0

19. Refusal to take part in non-medical therapy

0 1 2 3 4 N/A 0 0

20. Social withdrawal

0 1 2 3 4 N/A 0 0

21. Shallow affect

0 1 2 3 4 N/A 0 0

22. Lack of consideration for others

0 1 2 3 4 N/A 0 0

23. Mania

0 1 2 3 4 N/A 0 0

24. Anger

0 1 2 3 4 N/A 0 0

25. Inappropriate suspicion

0 1 2 3 4 N/A 0 0

26. Unconventional attitudes

0 1 2 3 4 N/A 0 0

27. Conceptual disorganization

0 1 2 3 4 N/A 0 0

28. Medication non-compliance

0 1 2 3 4 N/A 0 0

29. Therapeutic alliance

0 1 2 3 4 N/A 0 0

 

TOTAL

Any Violent

 

Item Descriptions – Frontline Staff

1. Previous violent acts ignored or passed over: Uncaring about violent acts he/she has perpetrated. Dismisses his/her violent acts as being unimportant.

2. Takes no responsibility for behavior: Tries to blame others or circumstances for his/her acts or problems. Sees him/herself, inappropriately, as a victim.

3. Anxiety, anger, or frustration

4. Shows no remorse: Does not feel responsible for index offense.  Is not sorry for what he/she has done to others.

5. Has unrealistic discharge plans: Include both unrealistic plans about being released and unrealistic plans about post-release activities.

6. Escape or escape attempt: Has actually escaped from supervised care or has tried to.

7. Unusual thought content: Thoughts seem unusual, bizarre, strange. Fixation on topics of no consequence.  Putting together ideas that obviously do not go together. This does not include silliness or feeble attempts at humor.

8. Complaints about staff: Any complaints against staff, justified or not.

9. Shows no empathy and concern for others.

10. Has antisocial attitudes and values.

11. Poor compliance with current supervision restrictions: Late returning from pass. Drifts from group if out on group activity. Does not report when required. Does not deal with stressful or upsetting events in a constructive way (i.e., is aggressive or self-defeating).

12. Exhibits few positive coping skills: Deals inappropriately with anger, i.e., reacts aggressively rather than assertively. Does not deal with stressful or upsetting events in a constructive way (i.e., is aggressive or self-defeating).

13. Poor compliance with psychiatric medication: Does not take medication or misses medication. If living in the community, use drug testing as evidence.

14. Psychiatric symptoms are not in remission.

15. Client denies all problems or just “goes through the motions”.

16. Therapeutic alliance: Code as follows:

  • "0"  Client is enthusiastically involved in treatment activities; recognizes and explores problem areas; seeks out staff assistance; makes realistic plans for the future.
  • "1"  Client is passively receptive to treatment efforts; attends programs as scheduled; participates when engaged directly; future plans are vague and poorly formulated. 
  • "2"  Client is variable in treatment; irregular attendance at programs; reluctant participant; difficult to engage in dialogue on problem areas. 
  • "3"  Client declines most treatments offered; sees no need for further hospitalization; passively waiting for discharge. 
  • "4"  Client actively refuses most treatments; sees no purpose to the hospital stay; denies all problems; constantly demanding discharge.


Item Descriptions – Clinical Staff

17. Psychotic actions: For example, stereotypes, bizarre mannerisms, facial grimaces, obviously inappropriate laughter, talking, or singing, or perseverative movements.  This does not include tics, spastic movements from a physical illness or disability, or movements that may be due to medications

18. Inactivity: Gets no physical exercise. Spends a great deal of time sleeping, or lying about.

19. Refusal to take part in non‑medical therapy: Includes psychological, social work, vocational, etc.

20. Social withdrawal: Avoids contact with others deliberately (as compared to others avoiding him).

21. Shallow affect, superficiality: General “so-what?” attitude.  Does not respond to normally emotional circumstances.

22. Lack of consideration for others: Callousness, little empathy - anything that shows an attitude of thinking only about his/her own concerns and never of the thoughts, feelings of, or consequences for, other clients or staff.

23. Mania: Hyperactivity. Worked up for no obvious reason. Not due to the effects of medication.

24. Anger: Inappropriate displays of losing temper. If the anger expressed is minor, then an isolated instance can be ignored.

25. Inappropriate suspicion: Must definitely be inappropriate (e.g., belief that food is poisoned, aliens are reading his thoughts, or “everyone is out to get him”. In some cases because of the nature of the client’s offense, his/her personality, or some physical abnormality, other clients may “pick on” him/her, and the client’s suspicions are possibly correct.)

26. Unconventional attitudes: Client is non-supportive of, rejects or denies validity or worth of conventional (anti-criminal) persons, activities or settings such as those associated with work, school or family. Shown by obvious contempt for, or a general cynical attitude about, such conventional persons, activities, or settings.

27. Conceptual disorganization: Thoughts seem confused, disconnected, disrupted. Inability to maintain a train of thought. This does not include silliness or feeble attempts at humor.

28. Medication non-compliance: This includes all types of medication, and either not taking medication or over-reliance on medication (e.g., requesting non-prescription medication for an extended period of time).  Also include evidence from drug-testing, especially if the client is living in the community.

29. Therapeutic alliance: Code as follows:

  • "0"  Client is enthusiastically involved in treatment activities; recognizes and explores problem areas; seeks out staff assistance; makes realistic plans for the future.
  • "1"  Client is passively receptive to treatment efforts; attends programs as scheduled; participates when engaged directly; future plans are vague and poorly formulated.
  • "2"  Client is variable in treatment; irregular attendance at programs; reluctant participant; difficult to engage in dialogue on problem areas.
  • "3"  Client declines most treatments offered; sees no need for further hospitalization; passively waiting for discharge.
  • "4"  Client actively refuses most treatments; sees no purpose to the hospital stay; denies all problems; constantly demanding discharge.


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