RAMBO: The evaluation of an intervention program for UK mentally abnormal young offenders

• DOI: https://doi.org/10.1016/S0196-1152(05)12003-1
• Date: 08 August 2005
• Pages: 53-73
• Published date: 08 August 2005
• Author: Theodore I. Mutale

RAMBO: THE EVALUATION OF AN

INTERVENTION PROGRAM FOR

UK MENTALLY ABNORMAL

YOUNG OFFENDERS

Theodore I. Mutale

ABSTRACT

This chapter offers a prospective and naturalistic study of the impact of a

risk-assessment and risk-management program on mentally abnormal

young offenders admitted to a medium secure adolescent psychiatric in-

patient unit in the United Kingdom (U.K.) because of violent, dangerous

or self-harming behaviour. As a result of the risk assessment, there was a

reduction in their violent, dangerous or self-harming behaviour that was

significantly associated with a reduction in the number of risk factors.

About 80% were discharged directly back into the community.

Public concerns over the dangerous behaviour of some people with mental

disorder and the introduction of the Care Program Approach in the U.K.

has put risk assessment at the centre of public safety debates (HMSO, 1989;

Duggan, 1997). Risk assessment instruments and procedures that have been

developed in response to these public concerns are applicable mainly to

The Organizational Response to Persons with Mental Illness Involved with the Criminal Justice

System

Research in Social Problems and Public Policy, Volume 12, 53–73

Copyright r2005 by Elsevier Ltd.

All rights of reproduction in any form reserved

ISSN: 0196-1152/doi:10.1016/S0196-1152(05)12003-1

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adults. A further important development is that some investigators now

regard risk management as an integral part of a comprehensive risk assess-

ment (Heilbrun, 1997) because some do not regard a one-time risk predic-

tion as adequate (Steadman et al., 1993). With very few exceptions (Hoge &

Andrews, 1996) risk assessment linked to risk management in adolescents

has received less attention.

The aim of this study is to determine the impact of a structured risk

management program targeted at risk factors identified by an adolescent

risk-assessment checklist in a medium secure unit for mentally disordered

young offenders. The study was conducted in a U.K. national medium

secure or locked adolescent psychiatric inpatient unit that received patient

referrals from England, Wales, Scotland and Northern Ireland.

The risk-assessment checklist, RAMBO (Risk Assessment Multi-system

Behavioural Outcomes), is a questionnaire comprising of 63 risk and pro-

tective factors (18 static and 45 dynamic) for adolescent antisocial, offend-

ing, dangerous and self-harming behaviour derived from the literature

(Burgess, Hartman, & McCormack, 1987;Cornell, Peterson, & Richards,

1999;Hoge, Andrews, & Leschied, 1996;Mossman, 1994;Lynam, 1996;

Lewandowski & Westman, 1996;Rodham, Hawton, & Evans, 2004). The 63

items reflect risk and protective factors in the three subsystems to which

most young people belong to – family, school and peer group. In order to

ensure that there was a systematic inquiry of risk and protective factors,

operational definitions for most items were included in a manual that ac-

companies the checklist. Risk factors reflected childhood adversity, sub-

stance misuse, current and past antisocial or offending behaviour, current

and past self harm, individual characteristics such as empathy and impulse

control and psychopathology.

The definition and rating of optimal parenting is similar to that adopted

by the Parenting Bonding Instrument (Parker, Tupling, & Brown, 1979).

The definition of emotional abuse used in the checklist has previously been

described in the literature (Glaser, 1995). The definitions and rating of

anxiety, depression, suicidal thoughts, passivity and paranoid ideation

were similar to corresponding items in the Brief Psychiatric Rating Scale

(Ventura, Lukoff, & Nuechterlein, 1993). The definition and rating of the

symptoms of post-traumatic stress disorder was similar to the items in

the post-traumatic stress disorder scale of the Trauma Symptom Checklist

for Children (Briere, 1996). In all, the checklist was simply a structured and

systematic extension of history taking and determined the number of risk

factors present and was not meant to be a risk prediction schedule (see the

appendix).

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