J Psychiatr Pract. 2021 May 5;27(3):203-211. doi: 10.1097/PRA.0000000000000552.
Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting, and then documenting, other-directed violence (ODV) risk screening, assessment, and management. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving: clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of ODV ideation and behavior; and a personalized safety plan to mitigate/manage risk. In this fourth column of the series, we describe chain analysis as a critical tool for assessing and intervening on ODV ideation and behavior. We identify the pathways of reinforcement that can cause ODV to persist, and how to navigate potential barriers to completing ODV chains. Using a case example, we demonstrate how to apply chain analysis to ODV ideation and behavior and offer interventional strategies that can be used to disrupt the chain and ultimately reduce the risk for violence.
暴力风险评估是精神卫生治疗的必要组成部分。为了遵守护理标准以及伦理和法律要求，有必要制定一个合理的流程来进行和记录针对他人的暴力（ODV）风险筛查、评估和管理。在本系列的 5 部分中，我们描述了一种实现潜在暴力患者治疗性风险管理的模型，其中包含以下基本要素：临床访谈辅以结构化的筛查或评估工具；根据时间性和严重程度进行风险分层；链分析以干预 ODV 观念和行为的功能；以及个性化的安全计划以减轻/管理风险。在本系列的第四部分中，我们将描述链分析作为评估和干预 ODV 观念和行为的关键工具。我们确定了导致 ODV 持续存在的强化途径，以及如何克服完成 ODV 链的潜在障碍。我们将通过一个案例示例来演示如何将链分析应用于 ODV 观念和行为，并提供可以用来打断链条并最终降低暴力风险的干预策略。
