Higher Risk Of Violence Research Articles

A Pilot Study: Emergency Medical Services-Related Violence in the Out-of-Hospital Setting in Southeast Michigan.

Emergency Medical Services (EMS) personnel in the out-of-hospital setting continue to be at high risk for violence, in spite of continued research on a national scale. Our aim was to determine the prevalence and type of violence perpetrated against Southeast Michigan EMS personnel, and characteristics of victims in the out-of-hospital setting. EMS personnel from urban and suburban counties in Southeastern Michigan were surveyed online about their experience with violence, including description and outcomes, while working in the out-of-hospital setting within the previous 6months. Gift card incentive and recruitment scripts were provided and read to participants. This was a pilot study that was limited to 150 respondents and ran for 3months. Descriptive statistical analysis was done with an odds ratio, p value, and two-sample independent t-test analysis. There were 137 surveys respondents. Most respondents, 75 of 128 (58.6%) reported being a victim of violence within the previous 6months. Perpetrators were primarily patients and occasionally family members. Substance abuse or mental health issues were frequently associated with violence. Although not common, women reported violence perpetrated by a coworker more often than men (odds ratio 5.17; 95% confidence interval 1.67-16.0). Only 55 of 117 respondents (47.0%) felt that the training did an adequate job protecting them from violence. More than one-half of responding EMS personnel experienced work-related violence within the previous 6months in Southeast Michigan. This high rate of violence supports the need for additional research and policies that ensure the safety of EMS providers in this region.

Risk of violence and functional capacity of hospitalized elderly: a cross-sectional study.

To analyze the risk of violence associated to functional capacity and sociodemographic characteristics of hospitalized elderly. Quantitative, cross-sectional, multicenter study conducted with elderly receiving care at university hospitals of the municipalities of João Pessoa and Campina Grande, in the state of Paraíba, Brazil. The scales Katz and Hwalek-Sengstock Elder Abuse Screening Test were applied. The data was analyzed through descriptive and inferential statistics using Chi-squared Pearson test, Spearman correlation test, and multiple logistic regression. The participating elderly amounted to 323. The risk of violence was predominant among female elders aged 60 to 70 who are unable to read or write, live with someone, perform no labor activity, and whose income is higher than a minimum wage. Elders who were dependent for basic and instrumental activities presented a 2.11 score (Confidence Interval = 1.22-3.64; p = 0.000) and 1.70 (1.01-2.85; p = 0.044) and a higher risk of violence. Elders who depended on other people to perform both complex and basic activities are the most exposed to situations of violence.

The aporia of the European myth. How LGBTI+ migrants are stranded in the Italian reception system

Considering the increase of migrants and the development of a new type of reception system, oriented towards providing standardised, homogeneous assistance, this article questions the effects that the prevalence of "prima accoglienza" reception systems have on the identification and assistance of SOGI (sexual orientation and gender identity) migrants. Their approach, based on the supply of basic needs, tends to ignore the particular needs of SOGI migrants, as well as overlook the high risk of violence within the reception centres. Therefore, this article aims at evaluating the impact of this approach on the vulnerability of SOGI migrants.

Development, implementation and evaluation of a process to recognise and reduce aggression and violence in an Australian emergency department.

In 2018, we developed and implemented a novel approach to recognition and response to occupational violence and aggression (OVA). It included routine use of the Brøset Violence Checklist for all ED patients integrated with a score-based notification and response framework. The present study evaluated the impact of the new process on staff knowledge, perceptions and confidence regarding OVA in ED and the rate of security events related to OVA. The present study was conducted in a metropolitan hospital ED in Australia. Evaluation was by online before and after survey of nursing staff, point prevalence study of risk classification and comparison of OVA-related events involving security in the year before implementation and the year after the programme was embedded. One percent of patients were assessed as high violence risk with a further 4% at moderate risk. The introduction of the Brøset Violence Checklist increased documentation of violence risk assessment. It also improved staff perception of organisational support and awareness of behaviours associated with the risk of violence. There was a statistically significant reduction in unplanned OVA-related security responses (relative risk 0.75, 95% confidence interval 0.62-0.89). There was also a statistically significant shift to proactive management through early detection and intervention (relative risk 2.22, 95% confidence interval 1.85-2.66). A process including routine OVA risk assessment and a notification and response framework reduced unplanned security events due to OVA and increased staff confidence in recognition and management of OVA. This approach may be suitable for use more broadly in ED.

Factores asociados a la violencia contra los adolescentes dentro del hogar en el Perú

Background: Adolescence responds to a period of maturity and adjustment to the adult world; therefore, it is influenced by the social and family context, as well as by the previous stages of development. The objective of the present investigation was to determine the factors associated with violence against adolescents at home in Peru. Methods. A secondary analysis of the National Survey of Social Relations 2015 was carried out. The sample was of 1491 adolescents between 12 to 17 years old. Raw (PR) and adjusted (PRa) prevalence ratios using Poisson regression with robust variance were estimated. Results. It was found that adolescent women (PRa: 1.4; 95% CI: 1.17-1.68) and adolescents who live in homes where there are continuous fights or arguments between parents or adults who live there (PRa: 2.75; 95% CI: 2.11-3.57) have a higher risk of violence. Conclusions. Women and adolescents who live in families where there are continuous arguments between parents or adults have a high risk of domestic violence.

Psychiatric Patients with a Serious Mental Illness and a Recent History of Violent Behavior: An Exploration of Developmental, Clinical, Cognitive, and Demographic Characteristics

Background: Epidemiologic studies have shown that persons suffering from psychotic disorders are at increased risk of violent behavior. Several factors have been shown to predict violent behavior among persons with psychosis. However, prior research is limited in that these factors have not been explored simultaneously within the same study. Methods: The current study, therefore, aimed to determine which demographic, clinical, cognitive, and developmental characteristics were associated with an increased likelihood of violence among patients diagnosed with a psychotic disorder and which combination of these best predicted a history of violence. Participants (n=53) completed measures of demographics, violence risk, psychotic and personality symptoms, trauma, psychopathy and cognitive functioning. Results: Bivariate relationships were conducted to compare the history of violent behavior between all variables. Additionally, a binary logistic regression was run predicting participants’ history of violence. Several demographic, cognitive, clinical, and developmental factors were associated with increased odds of having a history of violence. The overall correct classification rate for the model was 92.2%, with 87.5% of participants without a history of violence and 91.4% with a history of violence being correctly classified. The model included antisocial personality traits, poor behavioral controls, head injury, not accepting responsibility, lacking goals, prior supervision failures, and HCR-20 total score. Conclusion: The binary logistic regression model showed good accuracy in predicting a history of violence in persons with psychosis. These findings are consistent with prior research and can inform efforts at risk assessment and identification of treatment targets for people with a psychotic disorder who are at highest risk of violence.

Asertividad una forma de prevención de riesgo de violencia en la Parroquia de Santa Rosa de la Provincia de Tungurahua

En los últimos años el nivel de violencia intrafamiliar en el Ecuador ha aumentado significativamente, pese a esta circunstancia las estrategias de prevención de riesgo de esta problemática no responden con la misma eficacia. En la ciudad de Ambato durante el 2017 el Hospital General Docente Ambato atendió hasta la fecha 1242 casos de violencia física y 165 de agresión sexual. El objetivo de la investigación es determinar el tipo de asertividad que presenta la población de estudio en relación con el nivel de riesgo de violencia generado dentro del entorno familiar en la Parroquia Santa Rosa de la Provincia de Tungurahua, la metodología aplicada fue descriptiva con corte transversal con diseño investigativo de acción participativa, la población de estudio fue de 1518 personas en las cuales se aplicó la escala multidimensional de asertividad (EMA) y la de valoración de riesgo en su acrónimo inglés Spouse Abuse Risk Assessment (SARA), se aplicó estadística descriptiva e inferencial utilizando métodos de asociación a través de Odd Ratio (OR). Los resultados se tiene que las personas que presentan mayor nivel de riesgo de sufrir violencia son quienes no son asertivos y tienen asertividad indirecta; mientras que aquellas personas que son asertivas corren menos riesgo de ser víctimas de violencia. Como conclusión se establece que la violencia aqueja a todo tipo de población, no estima ningún tipo de condición, pero es un elemento fundamental el componente sicológico de cada individuo, por lo que es necesario realizar un trabajo de concientización sobre el tema.

Aggressive behavior in psychiatric patients in relation to hormonal imbalance (Review).

Aggressive behavior is one of the main characteristics of different psychiatric disorders such as: personality disorders (antisocial personality disorder, borderline personality disorder), schizophrenia, intermittent explosive disorder, post-traumatic stress disorder, bipolar disorder, depression, alcohol/substance induced psychiatric disorders. Epidemiological evidence shows that always there is a higher risk of violence and aggressivity among patients with psychiatric disorders compared with general population. Researchers have tried many times to narrow the theories that can explain such a behavior, starting from models that involve a link between illness and aggression going up to external-environmental factors including the therapeutic relation in the hospital. Even if the majority of studies are centered on intoxications (with alcohol or other substances that potentiate the aggressive behavior) we will highlight another somatic dimension linked with this behavior. In the following review we summarize the hormonal imbalances that have been noted to accompany aggressive behavior in different psychiatric disorders. Several studies have been made starting even at the age of ten corelating hormone cortisol with increase aggression, but patients with psychiatric disorders have a higher sensitivity in linking hormonal imbalance with their behavior.

Judicial perspectives on mental health courts: The role of psychiatric disorder and violence risk

ObjectiveThe extent to which psychiatric diagnosis, treatment compliance, and violence risk influenced judges perceived benefits of Mental Health Court (“MHC”) for defendants with psychiatric disorders was examined. Method81 judges completed one vignette in which psychiatric diagnosis (Schizophrenia, Major Depressive Disorder, Posttraumatic Stress Disorder), treatment compliance (yes/no), and violence risk (high/low) were randomized. The online survey was distributed via email and following the vignette, judges answered a question about the appropriateness of MHC. ResultsJudges assessed defendants with severe psychiatric disorders (Schizophrenia and Major Depressive Disorder) – compared to defendants with PTSD – as more likely to benefit from MHCs. If deemed at low treatment compliance and/or high violence risk, judges were unlikely to appraise MHCs as beneficial, regardless of psychiatric diagnosis. ImplicationsJudges appear to consider relevant factors when determining whether MHC will benefit defendants with psychiatric disorders; however, future research should include more variables (e.g., addictions, history of violence) to examine the combined influence on judges' perception of MHC suitability.

Transcranial direct current stimulation (tDCS) as an intervention to improve empathic abilities and reduce violent behavior in forensic offenders: study protocol for a randomized controlled trial

BackgroundRecent studies show that changes in one of the brain areas related to empathic abilities (i.e. the ventromedial prefrontal cortex (vmPFC)) plays an important role in violent behavior in abusers of alcohol and cocaine. According to the models of James Blair, empathy is a potential inhibitor of violent behavior. Individuals with less empathic abilities may be less susceptible and motivated to inhibit violent behavior, which causes a higher risk of violence. Recent neuroscientific research shows that modulating (stimulation or inhibition) certain brain areas could be a promising new intervention for substance abuse and to reduce violent behavior, such as the neurostimulation technique transcranial direct current stimulation (tDCS). This study aims to investigate tDCS as an intervention to increase empathic abilities and reduce violent behavior in forensic substance use offenders.Methods/designA total sample of 50 male forensic substance abuse patients (25 active and 25 sham stimulation) will be tested in a double-blind placebo-controlled study, from which half of the patients will receive an active stimulation plus treatment as usual (TAU) and the other half will receive sham stimulation (placebo) plus TAU. The patients in the active condition will receive multichannel tDCS targeting the bilateral vmPFC two times a day for 20 min for five consecutive days. Before and after the stimulation period, the patients will complete self-report measurements, perform the Point Subtraction Aggression Paradigm (PSAP) and a passive viewing empathy task. Resting state electroencephalography (rsEEG) will be performed before and after the treatment period. A follow up will be conducted after 6 months. The primary outcome is to investigate multichannel tDCS as a new intervention to increase empathic abilities and reduce violent behavior in offenders with substance abuse problems. In addition, we will determine whether electrophysiological responses in the brain are affected by the tDCS intervention. Finally, the effects of tDCS on reducing craving will be investigated.DiscussionThis study is one of the first studies using multichannel tDCS targeting the vmPFC in a forensic sample. This study will explore the opportunities to introduce a new intervention to improve empathic abilities and reduce violence in forensic substance use offenders. Specifically, this study may give insight into how to implement the tDCS intervention in the setting of daily clinical practice in this complex, multiple-problem target group and with that contribute to reduction of recidivism.Trial registrationDutch Trial Register, NTR7701. Registered on 12 January 2019. Prospectively registered before the recruitment phase. https://www.trialregister.nl/trial/7459.Recruitment started on the 1st of February 2019 and will be finished approximately in the winter of 2019. Protocol version 1. 22 May 2019.

Freedom Restrictive Coercive Measures in Forensic Psychiatry.

Background: In Germany, people suffering from severe mental illness who have committed serious offenses and have considerably reduced or suspended criminal responsibility can be detained and treated in forensic psychiatric hospitals. In the German federal state of Baden-Wuerttemberg, all psychiatric hospitals including forensic psychiatric hospitals are obliged to record data on every coercive intervention and to submit them to a central registry. The objective of this study was to determine key measures for the use of seclusion and restraint and to compare them with data from the same registry on the use of coercion in general inpatient mental health care.Methods: Data on the main psychiatric diagnosis according to ICD-10, type and duration of each coercive measure and number of treated cases according to diagnoses, and cumulated number of days of treatment from all 8 forensic facilities in the state of Baden-Wuerttemberg covering a catchment area with about 11 million inhabitants were collected at the treated-case-level for 3 years.Results: 22.6% of the cases treated in 2017 in forensic psychiatric hospitals were subjected to seclusion, and 3.8% were subjected to mechanical restraint. The mean cumulated duration of seclusion episodes per affected case was 343.9 h and the mean cumulated duration of restraint episodes was 261.7 h. 13.2% of the treated cases were subjected to room confinement with a mean cumulated duration of 539.1 h per affected case. Involuntary medication was applied in 1.9% of the cases. In general psychiatry, 2.9% of the treated cases were subjected to seclusion, and 4.7% were subjected to mechanical restraint. The mean cumulated duration per affected case amounted to 32.2 h for seclusion episodes and to 37.6 h for restraint episodes. Involuntary medication was applied in 0.6% of cases.Conclusion: Compared to general psychiatry, mechanical restraint is used in forensic psychiatry substantially less frequently and seclusion substantially more frequently. Room confinement is used only in forensic psychiatric hospitals. Use of involuntary medication is rare. On the one hand, recorded involuntary medication comprises only clear actions against the patient's expressed will as defined by law. Psychological pressure to take medication to avoid other forms of coercion and to achieve higher levels of freedom within the facility is not recorded. On the other hand, the low numbers of clear involuntary medication probably reflect the high legal threshold for such interventions, and, consequently, efforts by staff to motivate voluntary acceptance. The long duration of freedom-restricting coercive measures in forensic psychiatry probably reflects the selection of patients at high risk of violence.

820 Transgender Patients with Assault by Burn

Abstract Introduction The transgender population is estimated at 25 million worldwide and 1 million in the United States. Transgender individuals or those experiencing gender dysphoria are at a higher risk of intimate partner violence and assault (60%) as well as suicide (40%), with reports of 18 transgender individuals killed this year alone in the United States. Trauma and burn care providers need to be aware of this population’s unique medical and surgical needs. To our knowledge, we describe the first reports of burn injuries in transgender patients. Methods We performed a retrospective review of all transgender or gender dysphoric patients admitted to a regional burn center from 2010 to 2019 with a major burn diagnosis (>20% total body surface area). Patients were identified by International Classification of Disease codes in addition to self-identification at time of admission. We describe the mechanism of injury, circumstances surrounding the incident, hospital course, disposition at discharge, and outcomes in clinic follow up. Results The cohort consisted of two patients who were transgender females (i.e. born biologic male and identified as female), aged 31 and 36. Both patients were homeless and had histories of substance abuse and mental health issues. The burn sizes were 20% and 80% and both were flame injuries. One was injured by her domestic partner. The other was injured in a tent fire from a camping stove. The 20% TBSA patient underwent 3 surgeries and was discharged to medical respite on PBD #55. The 80% TBSA patient underwent 9 surgeries and was discharged to inpatient rehabilitation on PBD #75. Regarding their transgender medical care, neither patient was actively being treated by a medical professional although they both reported taking estrogens. Neither patient had undergone transgender surgery. Hormone therapy was not continued during their hospital stay due to lack of information surrounding prior use and limited knowledge regarding the safety of hormonal therapy during burn treatment. Both patients were initially lost to follow up but subsequently reentered our health care system. Both patients have since been referred to our county transgender clinic and are now actively followed by a transgender provider. Conclusions Transgender patients are at high risk for violence and assault, which includes burn. These patients are more difficult to identify and may have inadequate transgender medical care. Burn providers of all levels should be aware of the unique needs of this population and involve transgender medical providers in the acute and rehabilitative care when feasible. Applicability of Research to Practice Raise public awareness regarding assault by burn in the transgender population.

Violent Crime Among Israeli Inmates: Does Gender Matter?

The purpose was to examine (a) gender differences in violent crime, (b) gender differences in the risk factors related to violent offending, and (c) the factors that moderate the relationship between gender and violent crime among 290 inmates. The findings indicated no gender differences in violent crimes. The findings revealed that violent crime is associated with family crime, exposure to interparental violence, child abuse and neglect (CAN), and mental health. Low–medium economic status and CAN were associated with higher risk of violence only among the women. The findings highlight the intersection of CAN with self-destructive behaviors which require simultaneous interventions.

Violence and Emergency Department Use among Community-Recruited Women Who Experience Homelessness and Housing Instability.

Women who experience housing instability are at high risk for violence and have disproportionately high rates of emergency department (ED) use. However, little has been done to characterize the violence they experience, or to understand how it may be related to ED use. We recruited homeless and unstably housed women from San Francisco shelters, free meal programs, and single room occupancy (SRO) hotels. We used generalized estimating equations to examine associations between violence and any ED use (i.e., an ED visit for any stated reason) every 6 months for 3 years. Among 300 participants, 44% were African-American, and the mean age was 48 years. The prevalence of violence experienced in the prior 6 months included psychological violence (87%), physical violence without a weapon (48%), physical violence with a weapon (18%), and sexual violence (18%). While most participants (85%) who experienced physical violence with a weapon or sexual violence in the prior 6 months had not visited an ED, these were the only two violence types significantly associated with ED use when all violence types were included in the same model (ORphysical/weapon = 1.83, 95% CI 1.02-3.28; ORsexual = 2.15, 95% CI 1.30-3.53). Only violence perpetrated by someone who was not a primary intimate partner was significantly associated with ED use when violence was categorized by perpetrator. The need to reduce violence in this population is urgent. In the context of health care delivery, policies to facilitate trauma-informed ED care and strategies that increase access to non-ED care, such as street-based medicine, could have substantial impact on the health of women who experience homelessness and housing instability.

Architecture of Back Propagation Neural Network Model for Early Detection of Tendency to Type B Personality Disorders

Personal disorder is a type of mental illness. People with personal disorder can not respond changes and demands of life in normal ways. Women with type B personal disorder tend to have high risk of violence. It is important to make early detetction of this personal disorder, so that it can be anticipated properly. This paper reports an architecture model of back propagation neural network (BPPN) for early detection of type B personal disorder. The back propagation process divided into two phases, i.e training and testing. The training process used 43 data and the testing process used 34 data. The output classified into 4 diagnosis category of type B personal disorder, I.e. anti social, borderline, histrionic, and narcissistics. The optimal parameters of BPPN model consist of maximum epoch of 1000, maximum mu of 10000000000, increase mu of 25, decrease mu of 0.1, and neuron hidden layer of 25. The MSE of training is 3.07E-14 and MSE of testing is 1.00E-03. The accuracy of training is 90.7%, while the accuracy of testing is 97.2%.

Factors and characteristics of physical violence among healthcare workers of a tertiary hospital in Enugu, Nigeria

Background: Healthcare workers (HCWs) especially those involved in patients’ care are at high risk of violence. The study is aimed at determining factors and characteristics of physical violence among HCWs in a tertiary hospital in Nigeria.Methods: The descriptive cross-sectional study was carried out among 412 HCWs from March to July, 2018. Data entry and analysis were done using Epi InfoTM 3.5.4 and Chi square and Fischer’s exact test where applicable were used to ascertain factors associated with physical workplace violence.Results: Respondents included 111 (26.9%) doctors and 301 (73.1%) nurses. Prevalence of physical violence was 12.6%. Of those who experienced workplace violence, the perpetrators were mainly patients’ relatives 37 (71.2%) and patients 8 (15.4%). In majority of cases, 28 (53.8%), no action was taken against the assailant. Prevalence of physical violence was significantly higher among nurses (15.3%) than doctors (5.4%) p=0.007. It is also higher among females (14.2%) than males (7.8%), although not significantly. Furthermore, HCWs who work in newborn units were most likely to experience physical violence.Conclusions: The study revealed that physical violence is prevalent among HCWs and violence prevention programs should be instituted to address it.

Researching violence against women and girls in South Sudan: ethical and safety considerations and strategies

BackgroundGlobally, it is estimated that at least one out of every three women experiences violence by an intimate partner and/or non-partner throughout their lifetime. Women and girls are at even higher risk of violence in conflict and humanitarian crises. Although effort has expanded to build rigorous evidence and research on violence against women and girls (VAWG) among conflict-affected populations, methodological and ethical challenges remain. Basic ethical research practices are more challenging in conflict-affected populations and therefore require supplementary protections. While it is important to follow international ethical guidelines, in practice it is sometimes difficult depending on the setting. The aim of this paper is to present the main ethical challenges that occur when conducting research on VAWG in conflict and humanitarian settings, as well as potential strategies to address these challenges, based on a recent study carried out in South Sudan in 2016.Case presentationThis paper provides an analysis utilizing the World Health Organization guidelines on doing research on VAWG and in conflict and humanitarian settings. The paper analyses four main components: the first component is a risk-benefit assessment, which includes identifying the research gap and evaluating feasibility with local stakeholders. The second component is a methodological and conceptual approach, which involves both local stakeholders and external experts in order to develop flexible methods that can be used in a volatile conflict setting. The third component is safety considerations, which emphasizes the importance of collaborating with a partner with strong local networks. The last component is analysis and research uptake. This component describes the importance of developing different research products, and disseminating them in a way to ensure they would be relevant and minimize any risks to the participants.ConclusionsThe study in South Sudan provided an excellent opportunity to put into practice the international ethical guidelines to carry out research on VAWG in conflict and humanitarian settings. The study enabled the research team to reflect on the guidelines and develop strategies to cope with new methodological and ethical challenges that arose in this complex setting, adapting the guidelines, as necessary. It demonstrated the necessity of developing a strong yet adaptable methodology with multiple alternative plans to solve any safety or ethical issues that occur throughout the entirety of the study. It also revealed the importance of collaborating with an implementing partner and gathering input from both local and international stakeholders on research design, analysis and uptake. Most importantly, the study in South Sudan emphasized that this type of complex research requires significant planning, in addition to substantial financial and human resources. Donor buy-in and flexibility is therefore essential.

Family, School, and Peer Support Are Associated With Rates of Violence Victimization and Self-Harm Among Gender Minority and Cisgender Youth

PurposeGender minority (GM) youth experience high rates of violence, and research on protective factors to reduce violence victimization and self-harm is lacking. The purpose of this study was to determine how family, school, peer, and community support influenced rates of violence victimization and self-harm among GM and cisgender adolescents. MethodsThis research uses data from the 2017 New Mexico Youth Risk and Resiliency Survey (N = 18,451). The main independent variable was gender, dichotomized into GM and cisgender, and the secondary independent variables were family, school, community, and peer support. Dependent variables were sexual and dating violence, suicide attempts, and nonsuicidal self-injury. Logistic regression models were built for the four dependent variables, including demographics, support scores, and interaction terms between gender and support. ResultsSix percent of high school students in New Mexico identified as GM are unsure of their gender. GM students experienced higher rates of violence and self-harm and lower levels of support than cisgender students. Among all students, family support was associated with lower odds of sexual violence and self-harm, while school support was associated with lower odds of dating violence and nonsuicidal self-injury. There were significant interactions between gender, violence, and support. The protective effects of support were less pronounced for GM students than for cisgender students. ConclusionsFamily and school support are associated with lower rates of some forms of violence and self-harm among adolescents. Additional support may be necessary to reduce harm among GM adolescents, who are at higher risk for violence and its sequelae.

The Violence Reduction Programme: An exploration of posttreatment risk reduction in a specialist medium-secure unit.

There is limited evidence for treatment programmes for offenders with a diagnosis of personality disorder deemed to be of high risk of violence towards others. This study sought to evaluate change in clinician-rated risk of violence in males among offenders accepted to a specialist medium-secure hospital providing treatment based on the Violence Reduction Programme (VRP). A retrospective, records-based cohort study design was used to explore change in risk of violence in a sample including five VRP cohorts composed of 33 offenders. Violence risk scale (VRS) score was the primary outcome measure. Correlates of treatment dropout were also explored. Twenty-seven men completed treatment. Paired pretreatment and posttreatment VRS scores were available for 19 men. Six men disengaged with treatment. There was a significant mean reduction in risk of violence score (d = 1.08). At the individual level, eleven (57%) participants in the VRP showed reliable reduction in risk of violence. No treatment completers with a complete rating pair demonstrated an increased risk of violence. Younger age and referral from prison were significantly associated with treatment dropout. VRP-based treatment appears to be a promising intervention for specialist services for offenders with a personality disorder diagnosis in the United Kingdom. Longer term follow-up to ascertain whether these apparent treatment gains are accompanied by actual reduction in violent recidivism is now required, and a full scale trial warranted.

Safer cash in conflict: Exploring protection risks and barriers in cash programming for internally displaced persons in Cameroon and Afghanistan

AbstractAs cash increasingly becomes an essential part of humanitarian assistance, it is critical that practitioners are aware of, and work to mitigate, exposure to protection risks among the most vulnerable recipients. This article presents findings from qualitative research exploring protection risks and barriers that arise in cash programming for internally displaced persons at high risk of violence and exploitation in Cameroon and Afghanistan. The authors conclude with recommendations for mainstreaming global protection principles into cash programmes, as well as key considerations for designing and implementing cash programmes in ways that minimize existing risks of harm and avoid creating new ones.