Formulation can be defined as the process of constructing a hypothesis or “best guess” about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It provides a structure for thinking together with the client or service user about how to understand their experience(s) and how to move forward. The presentation of the case formulation will be conducted in accordance with the categories for consideration outlined in Weerasekara (1996) as follows: presenting issues; predisposing factors; precipitating factors; perpetuating factors and protective factors. These provide a clear comprehensive structure for reporting on the static, dynamic and contextual factors that may affect Tom’s behaviour and subsequent offending related judgements. The theoretical underpinning of the case formulation will be in accordance with the biopsychosocial model of psychological understanding. Metz (2005) provided a series of key recommendation(s) to the American Psychiatric Association (APA) commission on psychotherapy concerning the definition of the biopsychosocial model, which he comprehensively defined:
‘A biopsychosocial formulation is a tentative working hypothesis developed collaboratively with the child and family, which attempts to explain the biological, psychological and sociocultural factors which have combined to create and maintain the presenting clinical concern and which support the child’s best functioning… It will be changed, modified or amplified as the clinician and family learn more and more about the strengths and needs of the child and family’.
Table of Contents
Tom’s Presenting Issues:
Tom’s predisposing (background) factors:
Tom’s precipitating factors (triggers):
Tom’s perpetuating (maintaining) factors:
Tom’s protective factors (strengths):
Risk Assessment Instrument/Case Formulation:
Historical Risk Factors:
1. History of Violence:
2. History of Non-Violent Offending:
3. Early Initiation of Violence:
4. Past Supervision/Intervention Failures:
5. History of Self-Harm or Suicide Attempts:
6. Exposure to Violence in the Home:
7. Childhood History of Maltreatment:
8. Parental/Caregiver Criminality:
9. Early Caregiver Disruption:
10. Poor School Achievement:
Social/Contextual Risk Factors:
11. Peer Delinquency:
12. Peer Rejection:
13. Stress and Poor Coping:
14. Poor Parental Management:
15. Lack of Personal/Social Support:
16. Community Disorganisation:
Individual Risk Factors:
17. Negative Attitudes:
18. Risk Taking/Impulsivity:
19. Substance Use Difficulties:
20. Anger Management Problems:
21. Low/Empathy/Remorse:
22. Attention Deficit/Hyperactivity Difficulties:
23. Poor Compliance:
24. Low Interest/Commitment to School:
Protective Factors:
Risk Assessment Findings/ Future Intervention(s):
Objectives & Research Themes
This work aims to conduct a clinical case formulation for a 12-year-old youth named Tom, following a serious violent index offence, by applying the biopsychosocial model and the Structured Assessment of Violence Risk in Youth (SAVRY) to identify risk factors and determine appropriate future therapeutic interventions.
- Application of the biopsychosocial model in clinical case formulation.
- Risk assessment using the SAVRY instrument to evaluate recidivism potential.
- Analysis of developmental, familial, and environmental factors contributing to offending.
- Identification of protective factors to mitigate future risks.
- Development of recommendations for evidence-based interventions like trauma-focused CBT.
Excerpt from the Book
Tom’s Presenting Issues:
Tom has demonstrated shy and withdrawn behaviours towards peers and strangers; the only exception to this assertion is the relationship with his mum and sister. He appears to have developed a paternalistic attitude towards his mother and sister, with a desire to protect them from harm. Tom appears to dislike and resent Jack, there appears to be in the offence committed and the background report suggestions of an unresolved anger or hostility towards Jacks presence. He (Tom) has academically not been performing very well at secondary school, with truanting emerging during this time period – ongoing lack of engagement with educational services. He attributes his violent attack on Jack because of his fears that Jack will harm and kill his family members. This supports the paternalistic behaviour previously noted in his relationship with his mother and sister. The index offence suggests that positive offending attitudes have developed, where extreme violence has been justified to remove threats to him and his family. Furthermore there have been reports of two occurrences of bruising to his torso which has been attributed to falling off his pushbike. Bruising in this location can also constitute a risk factor/red flag for physical violence and child sex abuse (CSA) (Jensen, 2005); it has already been stated by Tracy that Jack appears to have a ‘nasty’ streak particularly when intoxicated, becoming violent with Tracy – with Tom it is reported that only lighter incidents of violence have occurred to date.
Summary of Chapters
Tom’s Presenting Issues: An overview of the subject's behavioral patterns, his relationship with family members, and the circumstances surrounding the violent index offense.
Tom’s predisposing (background) factors: An analysis of the chaotic family environment and early childhood trauma that may have contributed to the subject's attachment difficulties.
Tom’s precipitating factors (triggers): A discussion on the interpersonal conflicts that acted as immediate triggers for the subject's violent behavior.
Tom’s perpetuating (maintaining) factors: An examination of ongoing family dynamics and social withdrawal that sustain the subject's current psychological state and lack of engagement.
Tom’s protective factors (strengths): A review of the subject's prosocial traits and coping mechanisms that serve as positive resources for future intervention.
Risk Assessment Instrument/Case Formulation: An introduction to the SAVRY framework used to systematically assess violence risk and recidivism potential in this adolescent case.
Historical Risk Factors: A detailed breakdown of past behaviors, including violence, non-violent offenses, and early childhood maltreatment histories.
Social/Contextual Risk Factors: An assessment of environmental variables such as peer associations, parental management, and community stability.
Individual Risk Factors: An evaluation of personal attributes like impulsivity, substance use, and emotional regulation.
Protective Factors: A tabular summary of the subject's presence or absence of key protective assets.
Risk Assessment Findings/ Future Intervention(s): A synthesis of assessment scores and recommendations for trauma-focused therapeutic approaches.
Keywords
Case formulation, Biopsychosocial model, SAVRY, Adolescent violence, Risk assessment, Recidivism, Attachment theory, Trauma, Protective factors, Child maltreatment, Cognitive Behavioral Therapy, Forensic psychology, Behavioral analysis.
Frequently Asked Questions
What is the core focus of this publication?
The work focuses on the clinical case formulation and violence risk assessment of a 12-year-old male who committed a serious violent offense, utilizing established forensic instruments.
What are the central themes explored?
The central themes include developmental trauma, the impact of unstable family environments on attachment styles, and the application of standardized risk assessment tools in juvenile justice.
What is the primary objective of the case study?
The primary goal is to assess the subject's risk for future recidivism and identify evidence-based therapeutic interventions, such as trauma-focused CBT, to address his underlying psychological needs.
Which scientific methodology is utilized?
The study employs the Structured Assessment of Violence Risk in Youth (SAVRY) and the biopsychosocial model to organize clinical data and generate a holistic understanding of the subject.
What is addressed in the main part of the document?
The main part covers a comprehensive analysis of historical, social, and individual risk factors, concluding with findings that guide future clinical recommendations.
Which keywords best characterize this work?
The work is characterized by terms such as forensic case formulation, adolescent risk assessment, SAVRY, and trauma-informed clinical intervention.
How does the author interpret the subject's motive for violence?
The author interprets the subject's violence as a maladaptive, paternalistic "protector" response triggered by a perceived threat to his mother and sister, rather than pure unprovoked aggression.
Why is trauma-focused CBT recommended for the subject?
It is recommended because the assessment identified significant early childhood loss and insecure attachment, which are effectively addressed through trauma-focused interventions to improve emotional regulation.
- Citar trabajo
- Alexander Syder (Autor), 2018, Case Formulation. Forensic Child Psychology, Múnich, GRIN Verlag, https://www.grin.com/document/428872
