Galatean Risk Screening Tool

1. Galatean Risk Screening Tool A Decision Support System for Mental-Health Risk Screening and Assessment Funded by the NHS New and Emerging Applications of Technology (NEAT) Programme £245,457.78

2. Structure of Seminar • Introduction to the research project • Background • Current position • GRiST knowledge representation • Knowledge representation tasks • Summary and conclusions

3. Project Aims/objectives • Develop & implement a pragmatic mental-health risk-screening tool: - • Representing the perspectives of all relevant clinical specialties and potential users of the tool • Based on the low-level data used by expert practitioners when making risk judgements • Usable by anyone required to make risk assessments in mental health, irrespective of training • Integrated into the CPA process • Administratively feasible • Build it into a computer Decision Support System

4. Present situation • GRiST: generates an information profile • to help the assessor identify those people who require further, more detailed risk assessments • Provide documented evidence of the decision making process in risk assessment and management New funding • Develop a computer decision support system

5. Decision Support System • Available over the world-wide web • A database of client cues and associated risk judgements • provided by practitioners as part of their clinical practice. • A suite of statistical and pattern recognition tools for analysing the database • A validated psychological model of risk assessment based on multi-disciplinary clinical expertise • provides a full analysis of how clinicians perceive the contribution cues make to different forms of mental-health risk.

6. Clinical outcomes • Better identification of people at risk • Reduction of inappropriate referrals • Earlier risk detection • Knowledge about risk-assessment expertise • Knowledge about mental-health risk • Education and training of mental-health practitioners • Better interdisciplinary communication of risk • Increased consumer awareness of mental-health risk and appropriate interventions

7. Galatean Risk Screening Tool A Computerised Decision Support System for Mental Health

8. Developing the tool • Understand expert mental-health risk assessment • Identify the information used • cues • relationships between them • Akin to development of expert systems • knowledge elicitation • traditionally from a single expert • recently, requirement for “representative” expertise • collective expertise

9. How to elicit the expert knowledge • Psychological model of knowledge and reasoning • cognitive model • What form? • experts don’t use rules • Classification • clinical decision making is classification • patients assigned to one of a number of categories • mental-health risk: classify clients into high and low risk for different categories • e.g. suicide; self-harm; self neglect; violence

10. Compare client with each galatea The Galatean ModelA perfect-prototype model of classification • Classes are High and Low Risk • Galatea representing perfect example of client with extreme risk in all areas • Galatea representing perfect example of client with no risk in any area Represents each class by the hypothetically perfect member

11. Eliciting galateas • Focus on memorable cases and cues • Hierarchical knowledge structure • concepts relating to risk • subcomponents eventually reduced to measurable cues • datum components • Example knowledge structure …see later

12. Eliciting galateas • Interviews with the experts • Generate a conceptual map of knowledge • amind map • Convert the mind map to a hierarchical knowledge structure • Validate and develop the hierarchy • to define all concepts and relevant risk data • Create a questionnaire to gather the data • Galatean Risk Screening Tool: GRiST • FIRST: The Mind Maps …

13. Behaviour Social context Suicide/self-harm Personal history MENTAL HEALTH Medication/ Therapy Depresssion Self neglect Violence/aggression

14. In home Who Access night day Cooking Shopping Desire Regularity Dehydration Use of time When Fluids Provisions Length Eating Personal hygiene Cooking Drinking Sleeping patterns housecare Alcohol Washing Living skills Bath Diet Balance Frequency Routine House care wandering behaviour motivation Substance Abuse Non-compliance Weight loss Medication/ Therapy SELF NEGLECT Dirty Unshaven Dry These concepts expanded elsewhere in overall mind map Strength/vitality Skin Dehydrated Body Financial Appearance Insight Smell Uncombed Hair Breath Intentionality General Services Dirty Day centre Clothes Access Unkempt Dishevelled Dirty shoes State Torn cleanliness

15. From mind map to hierarchical structure • Imagine picking up the central node • Thumb and forefinger • It all hangs loose …. like the branches of a tree

16. In home Who Access night day Cooking Shopping Desire Regularity Dehydration Use of time When Fluids Provisions Length Eating Personal hygiene Cooking Drinking Sleeping patterns housecare Alcohol Washing Living skills Bath Diet Balance Frequency Routine House care wandering behaviour motivation Substance Abuse Non-compliance Weight loss Medication/ Therapy SELF NEGLECT Dirty Unshaven Dry These concepts expanded elsewhere in overall mind map Strength/vitality Skin Dehydrated Body Financial Appearance Insight Smell Uncombed Hair Breath Intentionality General Services Dirty Day centre Clothes Access Unkempt Dishevelled Dirty shoes State Torn cleanliness From mind map ……..

17. hair dirty uncombed SELF NEGLECT wandering behaviour routine living skills finance insight services appearance substance abuse diet medication/ therapy intentionality sleeping house care motivation washing access day centre use of time clothes body compliance length regularity time cooking shopping housecare shoes state day night frequency balance unkempt/ dishevelled torn/ holes cleanliness Dirty scuffed eating provisions drinking alcohol weight loss unshaven access in home dehydration Strength/vitality smell skin dirty cooking desire who spotty dry flaky general fingernails general breath

18. Final hierarchical structure for self neglect after review SELF NEGLECT motivation recent weight change living skills sleeping patterns behaviour diet waking time: active/passive mental state substance misuse compliance access of services aimlessness History of eating disorders Loss/gain accidents change disorder frequency nature cause appearance cooking housecare shopping appetite healthy variety sufficient food drink clothes hygiene food fluids Condition: age, threadbare, torn, etc cleanliness hair: dirty, uncombed frequency of washing Body: smell, teeth, fingernails, etc

19. compliance medication/ treatment abscond/disengage contact Self-neglect hierarchy corresponding to the screening tool SELF NEGLECT access of services history of accidents/falls mental state recent weight change basic living skills diet sleeping problems misuse of alcohol or drugs aimlessness,lack of motivation personal hygiene food drink • All the bottom-level components are questions in the assessment tool • Mental state is itself a hierarchy with bottom-level questions …

20. Final tool: Section C for self-neglect

21. Relationship between the self-neglect hierarchy and the final version of GRiST compliance medication/ treatment abscond/disengage contact SELF NEGLECT access of services history of accidents/falls mental state recent weight change basic living skills diet sleeping problems misuse of alcohol or drugs aimlessness,lack of motivation personal hygiene food drink These are all directly asked in the self-neglect section Compliance and mental state questions are asked in the underlying factors

22. The Research Team Christopher Buckingham, Ian Nabney & Steve Brockie University of Aston Ann Adams, Gerald Kearns, & Christopher Mace University of Warwick Richard Picking North East Wales Institute Ann Davis University of Birmingham Tom Chan Surrey Hampshire Borders Trust Heather Gage University of Surrey Seamus Watson West Sussex Health and Social Care NHS Trust