ABSTRACT
In contrast to low-risk behavioural excesses described in the previous chapter, behavioural excesses that are high risk (e.g. those involving violence to self or others) frequently raise significant concern amongst professionals, carers and members of the public. This should not mean that they are the only behaviours focused on although they may be the focus of initial targets. This is not just because they may have serious or lethal consequences but also because merely the possibility of their occurrence often means that such behaviours are focused on to the exclusion of the client’s other needs and life goals, with significant restrictions or barriers being likely to be put in place. Current practice, as we have noted in earlier chapters, focuses on the use of restrictions, medication, monitoring and supervision and individual cognitive-behavioural therapy (CBT). Working at the level of reinforcers or utilising punishment strategies is a further common approach, but is problematic since ideally efforts need to be focused on prevention. Our approach draws on utilising both a shared risk formulation and the Cognitive Approach to Risk Management (CARM) model. This functional-level understanding incorporates working at the level of both case-specific cognitive phenomenology, utilising behavioural methods, and a dynamic, acute process in the form of early warning signs of risk (EWS-R). We may also integrate other approaches to risk management such as de-escalation as required.
