WARRN – a formulation-based risk assessment procedure for Child and Adolescent Mental Health Services (CAMHS): the view of clinicians
| Date | 11 November 2019 |
| DOI | https://doi.org/10.1108/JFP-06-2019-0025 |
| Published date | 11 November 2019 |
| Pages | 228-239 |
| Author | Nicola S. Gray,Jacqui Tiller,Robert J. Snowden |
| Subject Matter | Health & social care |
WARRN –a formulation-based risk
assessment procedure for Child and
Adolescent Mental Health Services
(CAMHS): the view of clinicians
Nicola S. Gray, Jacqui Tiller and Robert J. Snowden
Abstract
Purpose –Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the
assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health
services which has been adopted across most Child and Adolescent Mental Health Services (CAMHS)
across Wales. The paper aims to discuss this issue.
Design/methodology/approach –An online survey was disseminated to National Health Service clinicians
in CAMHS to evaluate their perceptions of the use and effectiveness of WARRN. Data from 88 clinicians were
analysed with both quantitative and qualitative methods.
Findings –Clinicians reported increased clinical skills, increased confidence in their assessment and
management of risk and in safety planning, the increased safety of service users and the general public, and a
belief that WARRN had saved lives. The qualitative data showed that clinicians thought a common risk
evaluation instrument across Wales and different agencies had created a common language and
understanding that improved communication.
Practical implications –WARRN appears well accepted in CAMHS services with the view that it is having a
very positive effect on service user well-being and safety and could be implemented in other services.
Originality/value –This is the first report of a formulation-based approach to the management of serious
problem behaviours in CAMHS services.
Keywords Self-harm, Violence, Risk management, Suicide, Homicide, Formulation, Safety planning
Paper type Research paper
Introduction
Child and Adolescent Mental Health Services (CAMHS) within the National Health Service (NHS)
provide assessment and treatment for children and young people with emotional, behavioural
and mental health difficulties. This project aimed to evaluate staff opinions of the usefulness
of the Wales Applied Risk Research Network (WARRN) programme for the identification and
management of serious risks across CAMHS in Wales. It aimed to identify whether staff believe
WARRN’s implementation has improved clinical skills and confidence in managing serious risks
presenting in children and young people, and whether they believe it has improved the safety of
service users and the public, leading to lives being saved.
Suicide and self-harm are major public health problems in adolescents, with suicide being the
second most common cause of death in young people (Hawton et al., 2012). There is a strong
association between attempting/completing suicide and poor mental health in this population
(Shaffer et al., 1996) and so the assessment and management of risk of suicide is a major part of
the work of CAMHS. Likewise, rates of violence are elevated in adolescents (Ellickson and
McGuigan, 2000) and the assessment of violent behaviour forms a key part of the role of CAMHS
(Firth et al., 2009; Tiffin and Kaplan, 2004; Daniel et al., 2013).
Received 19 June 2019
Revised 20 August 2019
Accepted 22 August 2019
Nicola S. Gray is based at
Swansea University, Swansea,
UK and Caswell Clinic,
Bridgend, UK.
Jacqui Tiller is based at
Swansea University, Swansea,
UK and Action for Children,
Cardiff, UK.
Robert J. Snowden is based at
Cardiff University, Cardiff, UK.
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JOURNAL OF FORENSIC PRACTICE
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VOL. 21 NO. 4 2019, pp. 228-239, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-06-2019-0025
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