What is Nu-Rekall Mind Science?

Introduction

As a supporter of evidence-based treatment (EBT), and someone who endeavours to cite my sources and back up my claims wherever possible, I find the lack of science in some circles really frustrating. I recently stumbled upon an organization called International Suicide Prevention run by Matthew D. Dovel that makes very fantastic claims about the effectiveness of a treatment or set of treatments called “Nu-Rekall” on mental health and suicide, unmatched by any other treatment and without any peer reviewed studies to support their efficacy.

Naturally, my curiosity was piqued, but the Nu-Rekall treatment is vague and the proprietor, as I explain below, appears not to have the background necessary to treat mental health disorders. My hope with this article is to stimulate discussion on EBT, and to publicly challenge Mr. Dovel to bring his work in-line with established best practices.

All the quoted content below is used within the DMCA and 17 U.S.C. § 107 on Fair Use in the United States and § 29.1 of the Copyright Act of Canada.

Matthew D. Dovel

Matthew Dovel says on his website that he is a suicide prevention expert. He also says he is a scientist. Everyone has different criteria for that word, but I would define a scientist as someone who contributes to the body of knowledge in a field through academic scholarship, like publishing in a journal.

His academic education includes:

  • Charter College-Anchorage (2 years), took Computer Aided Drafting (CAD)
  • University of Nevada-Las Vegas (3 years), majored in Civil Engineering and minored in Psychology and Business. It’s unclear if Dovel earned a degree here.
  • Palomar College (2 years), he indicates mostly computer-related topics but may have taken a couple Psychology courses

In addition to these formal educational pursuits Dovel also notes PSI Seminars and other self-help workshops. There is no evidence that he has participated in any training or education related to Social Work, Psychology, Medicine or an allied field relevant to mental health, nor has he indicated any evidence-based training in suicide intervention like Applied Suicide Intervention Skills Training (ASIST), QPR, or others.

Since March 2015, Dovel has sat on the Editorial Board of the prestigious-sounding International Journal of Emergency Mental Health and Human Resilience which is published by OMICS Group. That someone can sit on an editorial board with no graduate study or published literature themselves is worrisome. That journal is not indexed by PubMed or other reputable warehouses for scientific data, like most of the OMICS Group journals.

His LinkedIn proclaims that “There is no one better than I am at preventing suicides!”, I have my doubts.

Dovel has written a book called “Life After Death” chronicling two Near Death Experiences (NDE). It appears to be these NDE, not his suicide prevention work, that led him to be profiled on Good Morning America (you can see that interview here), A&E and 20/20. This is clearly stated on his LinkedIn in the publications section, but is less clear in other areas, such as the about page of his organization ISP (detailed below) where he states under a column about partnerships with ISP “As seen on:CBS, NBC, ABC, FOX, ESPN, Coast to Coast, Good Morning America, 20/20,.” This is very misleading.

Some of his other (self) publications include:

Other potentially misleading items include an article titled “Psychology Today: Abstract – New Treatments that Cure Suicidal Ideation“. This article has no connection to the magazine Psychology Today but rather that is part of the article’s title.

International Suicide Prevention (ISP)

International Suicide Prevention is Dovel’s charity. It is a registered 501(c)(3) non-profit (EIN#20-4671131), though its Form 990 indicates less than $25,000 in revenue.

On the contact page, there is an opportunity to buy posters promoting ISP with their 24/7 helpline number (which Dovel claims he answered himself for 10 years.) There is no attribution indicating he has permission to use the intellectual property of Fox, which owns the rights to the Fry character from the TV series Futurama. Update: Dec-20-2016: This image has been removed, though other potentially infringing images may remain.

On the page for law enforcement targeted initiatives, Dovel notes that his Suicide Prevention Guide Booklet has been “endorsed by mental health professionals, doctors, and advanced behavioral studies experts as a viable solution to drastically reduce suicide rates.” Although he does list one endorsement by a Psychologist in the back of the handbook, the other individual listed is a neurolinguistic programming practitioner. There is insufficient evidence to support the efficacy of NLP (Sturt, et. al., 2012).

On an ISP page listing endorsements Dovel lists an orthopedic surgeon (Andrea E. Salvi) as endorsing his material. This surgeon is also a Board Member of an OMICS Group Journal, and appears to have has no professional experience in psychology or suicide. I can find no evidence to support Salvi’s assertion that he has performed any work for the US military.

Nu-Rekall

Nu-Rekall (trademarked) is the basis for the treatments that Dovel promotes. The website claims that “Nu-Rekall™ has self-help procedures that are completely autonomous removing suicidal ideation permanently.” Dovel does not link to any peer-reviewed studies evaluating his techniques. Dovel claims he helps over 200 individuals daily, but as this page suggests, he is likely counting every visitor to his website as a client he has delivered service to.

He charges nearly $5,000 on his website for training in his Nu-rekall methods.

4 Phase Model

Dovel does actually describe his 4 phase model on one page. I’ve paraphrased it here to the best of my ability.

  1. The client should ask themselves how long they’ve been suicidal and what occurred at the time those suicidal thoughts started?
  2. Next, because the treatment can cause amnesia, the client fills out a questionnaire about the event that triggered the suicidal thoughts and its emotional intensity
  3. Now the client imagines the event occurring again, but changes details about it (such as altering the weather)

No peer-reviewed studies are provided to explain why this movement technique is supposed to have any impact on one’s suicidality or emotional state, and ignores that for many people suicidal thoughts are not caused by a single distressing event but rather a constellation of risk factors, with no identifiable cause at all (see the Suicide Prevention Resource Centre’s list of suicide risk factors, the majority of which are not negative life events.)

Suicide Prevention Guide Booklet (SPGB)

This booklet (running 32 pages with wide margins and a large font) includes two ad spaces, both unused. Rather than go through the book line by line I’ve picked out some quotes for commentary.

“it takes fewer muscles to smile than to get angry according to Japanese’s” (this article confirms the origins of the concept that it takes fewer muscles to smile than to frown are uncertain; there’s no evidence suggesting they are Japanese.)

“Education has been shown to be the best method for reducing suicide rates.” Certainly, training gatekeepers is important. But educating clients themselves in methods of self-help has a limited contribution to the suicide rate when compared to broad community interventions that works on multiple levels, as Fountoulakis, Gonda, & Rihmer (2011) explain.

“According to scientific research humans have only two core emotions: love, and fear.” This is also incorrect. It used to be thought that there were 6 core emotions (anger, fear, surprise, disgust, happiness and sadness), although research from the University of Glasgow (Jack, Garrod & Schyns, 2014) suggests four (anger, fear, happiness, sadness.)

Russell (2003; 2009) conceptualizes “core affect” as the idea of feeling either good or bad – but there are no studies that I could find indicating two core emotions of love and fear.

“At the University of Berkley, California a study was done on a group of Manic Depressants with just the following self-therapy for one year. At the end of the year ALL were declassified as Manically Depressed.” Note the spelling errors and the use of the outdated term “manic depressive” (manic depression was replaced in the DSM-III in 1980 with “bipolar disorder”) while person-centered language would suggest calling the participants “people with bipolar disorder” instead. There’s is no citation listed and I would doubt if any such study ever existed.

“Top two reasons for a suicide attempt[:] The sudden change of status for an individual’s: romantic, and/or financial situation.” While there is support to the idea that relational changes commonly precede a suicide attempt (e.g. Yen et. al., 2005; Bagg, Glenn & Lee, 2013; Conner, et. al., 2012) that is because social support is an important buffer to suicide. (Gonçalves, et. al., 2014; Kleiman, Riskind, & Schaefer, 2014; Farrell, Bolland & Cockerham, 2014; Kleiman, et. al., 2012; Hirsch & Barton, 2011)

While Hempstead & Phillips (2015) notes that financial issues can lead to suicide, “mental illness, health problems, and other personal issues [and] access to lethal means also importantly affects suicide risk.” It appears that financial issues only commonly precede suicide in middle age.

Near the end is an “EMR” (Emotional Memory Removal) chart that requires an individual to think about a strong emotion while raising or lowering their hands (the chart indicates when to do which) and saying a number out loud, and then repeating the process but raising an arm and a leg. No sources are provided for why this would be effective.

Dovel’s Study

I reached out to Dovel for some clarification on the evidence-base for his work. He responded linking me to some of the sources that you see above. He also linked me to this suggested evaluation of his techniques.

The way the study appears to be constructed was that Dovel would have each participant rate their suicidal thoughts on a scale of 1-10. Then they would perform the Nu-Rekall procedures and receive a follow up call at 1 week, 1 month and 6 months to determine if the level of their intensity increased or decreased, and whether they had demonstrated any suicidal behaviour.

There are a number of methodological issues with this study that would prevent it from being accepted for peer review. Just a few that come to mind:

  • He indicates he had 500 volunteers (gender-matched exactly 50/50), but he only started with 60. Each month he surveyed other callers for a total of 500 surveys. If that’s the case, there is not 6 months of continuous data (as in a longitudinal design) for 500 people, there is 6 months of data for 60 people, severely limiting the usefulness of the large sample size.
  • There is a failure to define intensity (how do you verify a change if you’re not defining the variables?)
  • There is a failure to define suicidal behaviour or how he determined there was no recurrence in suicidal behaviour
  • There is a failure to control for the impact that emotional support from any helper would provide (a control group where someone received supportive check-ins without doing Nu-Rekall would have showed this)

Best Practices and Recommendations

I invite Dovel to follow some recommendations for himself, his website and the Nu-Rekall program. These include:

  • Taking a proper suicide intervention training like ASIST so that he can incorporate the evidence-base into his literature
  • Change references to the ISP helpline number to the National Suicide Prevention Lifeline (1-800-273-8255) until such time as Dovel has completed helpline training through an NSPL or AAS-accredited crisis line. This will ensure he is competent to perform suicide risk assessment
  • Consider completing the AAS Crisis Worker certification
  • Write up a proper proposal for a study of the Nu-Rekall techniques that includes repeatable methods, proper controls, and results and then having that study performed by an independent third party
  • Get that study peer-reviewed and published in a PubMed-indexed journal to open it to critique
  • Remove references to media like Good Morning America and 20/20 from the ISP websites so that visitors are not misled into thinking those appearances were related to suicide prevention work; make it clear those appearances were focused on near-death experiences
  • Provide citations for claims throughout existing pamphlets (like the UC Berkeley study noted above)

References

Bagge, C. L., Glenn, C. R., & Lee, H. (2013). Quantifying the impact of recent negative life events on suicide attempts. Journal Of Abnormal Psychology, 122(2), 359-368. doi:10.1037/a0030371

Conner, K. R., Houston, R. J., Swogger, M. T., Conwell, Y., You, S., He, H., & … Duberstein, P. R. (2012). Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type. Drug & Alcohol Dependence, 120(1-3), 155-161. doi:10.1016/j.drugalcdep.2011.07.013

Sturt, J., Ali, S., Robertson, W., Metcalfe, D., Grove, A., Bourne, C., & Bridle, C. (2012). Neurolinguistic programming: a systematic review of the effects on health outcomes. The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners, 62(604), e757-e764. doi:10.3399/bjgp12X658287

Farrell, C. T., Bolland, J. M., & Cockerham, W. C. (2014). Original article: The Role of Social Support and Social Context on the Incidence of Attempted Suicide Among Adolescents Living in Extremely Impoverished Communities. Journal Of Adolescent Health, doi:10.1016/j.jadohealth.2014.08.015

Fountoulakis, K. N., Gonda, X., & Rihmer, Z. (2011). Review: Suicide prevention programs through community intervention. Journal Of Affective Disorders, 13010-16. doi:10.1016/j.jad.2010.06.009

Gonçalves, A., Sequeira, C., Duarte, J., & Freitas, P. (2014). Suicide ideation in higher education students: influence of social support. Atencion Primaria, 46(Supplement 5), 88-91. doi:10.1016/S0212-6567(14)70072-1

Hempstead, K. A., & Phillips, J. A. (2015). Research Article: Rising Suicide Among Adults Aged 40–64 Years. The Role of Job and Financial Circumstances. American Journal Of Preventive Medicine, 48491-500. doi:10.1016/j.amepre.2014.11.006

Hirsch, J. K., & Barton, A. L. (2011). Positive Social Support, Negative Social Exchanges, and Suicidal Behavior in College Students. Journal Of American College Health, 59(5), 393-398. doi:10.1080/07448481.2010.515635

Jack, R. E., Garrod, O. G., & Schyns, P. G. (2014). Dynamic Facial Expressions of Emotion Transmit an Evolving Hierarchy of Signals over Time. Current Biology, (2), 187. doi:10.1016/j.cub.2013.11.064

Kleiman, E. M., Riskind, J. H., & Schaefer, K. E. (2014). Social Support and Positive Events as Suicide Resiliency Factors: Examination of Synergistic Buffering Effects. Archives Of Suicide Research, 18(2), 144-155. doi:10.1080/13811118.2013.826155

Kleiman, E. M., Riskind, J. H., Schaefer, K. E., & Weingarden, H. (2012). The moderating role of social support on the relationship between impulsivity and suicide risk. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 33(5), 273-279. doi:10.1027/0227-5910/a000136

Russell, J.A. (2003) Core Affect and the Psychological Construction of Emotion. Psychological Review. 110(1). 145-172. DOI: 10.1037/0033-295X.110.1.145

Russell, J. A. (2009). Emotion, core affect, and psychological construction. Cognition & Emotion, 23(7), 1259-1283. doi:10.1080/02699930902809375

Yen, S., Pagano, M. E., Shea, M. T., Grilo, C. M., Gunderson, J. G., Skodol, A. E., & … Zanarini, M. C. (2005). Recent Life Events Preceding Suicide Attempts in a Personality Disorder Sample: Findings From the Collaborative Longitudinal Personality Disorders Study. Journal Of Consulting And Clinical Psychology, 73(1), 99-105. doi:10.1037/0022-006X.73.1.99

Cite this article as: MacDonald, D.K., (2016), "What is Nu-Rekall Mind Science?," retrieved on November 23, 2017 from http://dustinkmacdonald.com/nu-rekall-mind-science/.

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PREPaRE Model for School Crisis Intervention

Introduction

When we normally think of crisis intervention, we think of adults responding to events in their personal life. Of course, people young and old can require crisis intervention, and not just from events in their personal life. School violence, natural disasters and other elements can require crisis intervention.

Werner (2015) noted that the tow most important activities school counsellors can do to prepare for crisis events are to develop a comprehensive crisis plan and to practice it regularly. The goal of the PREPaRE Curriculum is to train mental health worker, school psychologists and other administrators, educators and clinicians to develop such a crisis plan, to build a crisis team to execute that plan and to understand the tasks of crisis intervention in the aftermath of a crisis.

School Crisis Intervention

Most school counsellors receive little or no crisis intervention training and therefore enter the field feeling unprepared to handle tasks that become assigned to them in the aftermath of a crisis. (Allen, et. al., 2002) Training like the PREPaRE Model and other programs can help bridge this gap.

Knox & Roberts (2005) performed a comprehensive literature review on school crisis intervention and specifically crisis intervention teams. They found that there was a need for well-thought out crisis intervention programs and plans before crises occur, and that there were similarities in the literature about how experts believed response to a crisis should be structured.

They recommended school crisis intervention be split into three phases:

Primary Interventions

Primary prevention activities are those that are provided to all students in order to promote safety and health. These could be “conflict resolution, gun safety and safe driving courses, alcohol and drug awareness programs, teenage parenting resources, and suicide prevention programs.” (Knox & Roberts, 2005; p.94)

Secondary Interventions

Secondary prevention activities focus on individuals in the aftermath of a crisis in order to limit its impact. This can include physical measures like moving students, debriefing and immediate crisis intervention in the aftermath, and notifying parents and the media.

Tertiary Interventions

Tertiary interventions include long-term counselling and psychotherapy that extends after the crisis period ends and the school environment returns to normal.

PREPaRE Framework

  • Prevent and Prepare for psychological trauma
  • Reaffirm physical health, perceptions of security and safety
  • Evaluate psychological trauma risk
  • Provide interventions and Respond to psychological needs
  • Examine the effectiveness of crisis prevention and intervention

The PREPare Model is structured around two workshops. The first (1-day) workshop is provided for all school staff to teach them how the crisis team and crisis intervention works, while the second (2-day) workshop is designed specifically for crisis team members.

PREPaRE Curriculum

The following information comes from Nickerson et. al. (2014):

Crisis Prevention and Preparedness (1-day workshop for all staff)

  • Identify four characteristics of a crisis event.
  • Identify the key concepts associated with the PREPaRE acronym.
  • Describe the four activities of the school crisis team.
  • Understand the importance of hierarchical crisis team structure and response.
  • Identify the five major functions of the Incident Command System (ICS).
  • Identify strategies for communicating with school boards creating or sustaining teams.
  • Identify three concepts related to crime prevention through environmental design.
  • Identify guiding principles in crisis plan development.
  • Identify essential components of crisis plans.
  • Identify key concepts from the workshop that their crisis team needs to learn or address to be adequately prepared for crisis situations

Crisis Intervention and Recovery (2-day workshop for crisis intervention staff)

  • Report improved attitudes toward, and readiness to provide, school crisis intervention.
  • Identify the variables that determine the traumatizing potential of a crisis event.
  • Identify the range of school crisis interventions indicated by the PREPaRE acronym.
  • Indicate how school crisis interventions fit into the larger school crisis response.
  • Specify the critical factors in evaluating psychological trauma risk after a crisis event.
  • Match psychological trauma risk to a range of appropriate school crisis interventions.

Elements of a Crisis Team

A crisis team should be in place before a crisis occurs so that they can immediately get to work after a crisis occurs. Knox & Roberts (2005) recommend that the team be comprised of 4-8 multidisciplinary members (e.g. Principal, counsellor, nurse, etc.)

Responding to a Crisis

Brock (2006) indicates a variety of responses for each level of the framework that are available to the mental health professional facilitating a crisis intervention. These items assume that a crisis has already occurred.

Reaffirm physical health, perceptions of security and safety

  • Meet physical needs like shelter and water
  • Provide a sense of safety by removing individuals from the site of a crisis
  • Remove or restrict access to dangerous objects or crisis site (remove sharps, put up barriers, etc.)

Evaluate psychological trauma risk

  • Evaluate exposure to crisis and note reactions (physical, behavioural, cognitive)
  • Examine internal and external resources (within the school and local community agencies)
  • Refer clients to psychotherapy where possible

Provide interventions and Respond to psychological needs

  • Re-establish social support systems. This can involve
  • Provide psycho-education: Empower survivors and their caregivers
  • Provide immediate crisis intervention
  • Provide/Refer for longer term crisis intervention

Evaluation of the PREPaRE Curriculum

Brock et. al. (2011) performed the initial evaluation of the program and found that participants significantly improved on their skills related to crisis prevention, crisis intervention and displayed high general satisfaction with the workshops. When Nickerson et. al. (2014) evaluated the PREPaRE after making changes they found that these benefits continued to be demonstrated in follow-ups, proving the efficacy of the program.

Training in the PREPaRE Model

Brock (2006) publishes the content of the PREPaRE workshop online, where they can be accessed in order to help individuals build their crisis intervention skills. Additionally, workshops can be accessed through the National Association for School Psychologists (NASP).

References

Allen, M., Burt, K., Bryan, E., Carter, D., Orsi, R, & Durkan, L.(2002). School counselors’ preparation for and participation in crisis intervention. Professional School Counseling, 6, 96-102

Brock, S.E. (2006) “Crisis Intervention Training”, Workshop PDF. Accessed on November 19, 2016 from www.csus.edu/indiv/b/brocks/workshops/district/smfcsd.12.06.pdf

Brock, S. E., Nickerson, A. B., Reeves, M. A., Savage, T. A., & Woitaszewski, S. A. (2011). Development, Evaluation, and Future Directions of the PREPaRE School Crisis Prevention and Intervention Training Curriculum. Journal Of School Violence10(1), 34-52. doi:10.1080/15388220.2010.519268

Knox, K., & Roberts, A. (2005). Crisis intervention and crisis team models in schools. Children & Schools27(2), 93-100.

Nickerson, A. B., Serwacki, M. L., Brock, S. E., Savage, T. A., Woitaszewski, S. A., & Louvar Reeves, M. A. (2014). PROGRAM EVALUATION OF THE PREPaRE SCHOOL CRISIS PREVENTION AND INTERVENTION TRAINING CURRICULUM. Psychology In The Schools51(5), 466-479. doi:10.1002/pits.21757

Cite this article as: MacDonald, D.K., (2016), "PREPaRE Model for School Crisis Intervention," retrieved on November 23, 2017 from http://dustinkmacdonald.com/prepare-model-school-crisis-intervention/.
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Dynamic Appraisal of Situational Aggression (DASA)

Introduction

The Dynamic Appraisal of Situational Aggression (DASA) is a tool developed by Ogloff & Daffern (2006) to assess the likelihood that a patient or client will become aggressive within a psychiatric inpatient environment. The DASA is based on the Norwegian Brøset-Violence-Checklist (BVC).

DASA Items

  1. Irritability
  2. Impulsivity
  3. Unwillingness to follow instructions
  4. Sensitive to perceived provocation
  5. Easily angered when requests are denied
  6. Negative attitudes
  7. Verbal threats.

Scoring the DASA

Each of the items are scored 0 if absent or 1 if is present now or has been present in the last 24 hours. This means that if someone is not currently displaying easy anger upon denied requests, but was earlier, that item should be scored 1.

There is no typical cut-off score for the DASA, although Barry-Walsh et. al. (2009) note in their research that “for each increase in DASA total score, there was a 1.77 times increased likelihood that the patient would behave aggressively in the following 24 hours.”

In Ogloff & Daffern’s original 2006 study

  • 18% of aggressive patients scored 1 to 3
  • 15% of aggressive patients scored 4 or 5
  • 55% of aggressive patients scored 6 or 7

Kaunomäki (2013) used a cut-off score of 4 to identify high-risk individuals.

DASA Research

A study of the DASA by Griffith, Daffern & Godber (2013) the DASA allowed nurses to predict aggressive behaviour significantly better than unaided judgements. Lantta et. al. (2016) confirmed the same on mental health inpatient units.

Taylor & Large (2013) question the predictive validity of the DASA, noting that of 200+ patients identified as potentially becoming aggressive, only one actually will. (This “low base rate” problem is the same issue affecting violence risk assessment and suicide risk assessment.)

Daffern & Howells (2007) compared the DASA with the HCR-20 and noted moderate predictive validity.

Current Use

The DASA is currently used by a variety of mental hospitals around the world. Some DASA write-ups include:

Reference

Barry-Walsh, J., Daffern, M., Duncan, S., & Ogloff, J. (2009). The prediction of imminent aggression in patients with mental illness and/or intellectual disability using the Dynamic Appraisal of Situational Aggression instrument. Australasian Psychiatry, 17(6), 493-496. doi:10.1080/10398560903289975

Chan, O. (2014) The Assessment of Imminent Aggression in Forensic Setting A Validation Study of the Dynamic Appraisal of Situational Aggression (DASA) in Hong Kong. Non-Peer Reviewed. Retrieved on November 13, 2016 from http://www.hkcpsych.org.hk/index.php?option=com_docman&task=doc_view&gid=1338&Itemid=354&lang=en

Daffern, M., & Howells, K. (2007). The Prediction of Imminent Aggression and Self-Harm in Personality Disordered Patients of a High Security Hospital Using the HCR-20 Clinical Scale and the Dynamic Appraisal of Situational Aggression. International Journal Of Forensic Mental Health, 6(2), 137.

Griffith, J. J., Daffern, M., & Godber, T. (2013). Examination of the predictive validity of the Dynamic Appraisal of Situational Aggression in two mental health units. International Journal Of Mental Health Nursing, 22(6), 485-492. doi:10.1111/inm.12011

Kaunomäki, J. (2015) Patient interventions after the assessment of violence risk: Observational study in a Finnish psychiatric admission ward. Institute of Behavioral Sciences. Thesis. Retrieved on November 13, 2016 from https://helda.helsinki.fi/bitstream/handle/10138/156453/Pro%20Gradu%20Kaunomäki%202015.pdf?sequence=3

Lantta, T., Kontio, R., Daffern, M., Adams, C. E., & Välimäki, M. (2016). Using the Dynamic Appraisal of Situational Aggression with mental health inpatients: a feasibility study. Patient Preference & Adherence, 10691-701. doi:10.2147/PPA.S103840

Ogloff, J. P., & Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & The Law, 24(6), 799-813. doi:10.1002/bsl.741

Taylor, L., & Large, M. (2013). Dynamic Appraisal of Situational Aggression lacks utility. International Journal Of Mental Health Nursing, 22(6), 579. doi:10.1111/inm.12019

Cite this article as: MacDonald, D.K., (2016), "Dynamic Appraisal of Situational Aggression (DASA)," retrieved on November 23, 2017 from http://dustinkmacdonald.com/dynamic-appraisal-situational-aggression-dasa/.

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Bereavement Risk Assessment Tool (BRAT)

Introduction

Bereavement Risk Assessment Tool (BRAT) Sample
Bereavement Risk Assessment Tool (BRAT) Sample

From September 2012 to April 2013, I had the pleasure of completing an 400 hour field placement with Durham Hospice (now VON Durham Hospice). During the first 200 hours (my first semester), I completed the Fundamentals of Hospice Palliative Care Course, learned how to perform psychosocial assessments and assisted in the facilitation of a Day Hospice group.

My second semester and final 200 hours, I completed an 8-week Bereavement Volunteer Peer Support Program that focused on the fundamentals of providing individual and group peer support to grieving individuals. That’s where I learned about this tool, the Bereavement Risk Assessment Tool (BRAT).

The BRAT was developed by Victoria Hospice Society to help “communicate personal, interpersonal and situational factors that may place a caregiver or family member at greater risk for a significantly negative bereavement experience” (Victoria Hospice Society, n.d.)

The version of the BRAT I worked with is the 2008 version, though the 2013 manual is available for purchase on the Victoria Hospice website.

Bereavement Risk Assessment Tool (BRAT) Items

The BRAT is organized into 11 domains for a total of 40 items. Each is scored on a yes/no basis and a risk level (unmitigated and mitigated.) The “unmitigated risk” level is the raw score from the first 10 domains, while the “mitigated risk level” takes into account the 11th domain. The domains are listed below, though the items themselves are not, out of respect for the author’s copyright:

  1. Kinship
  2. Caregiver
  3. Mental Health
  4. Coping
  5. Spirituality/Religion
  6. Concurrent Stressors
  7. Previous Bereavements
  8. Supports & Relationships
  9. Children & Youth
  10. Circumstances Involving the Patient, the Care or the Death
  11. Protective Factors Supporting Positive Bereavement Outcomes

Scoring the Bereavement Risk Assessment Tool

The BRAT is scored using an Excel sheet that automatically calculates the correct score and prepares the document for printing. Documentation information includes the date, the assessor and client’s names, an ID number (e.g. case/file number) and the name of the deceased.

Five Levels of Risk

  • Risk Level 1: No Known Risk
  • Risk Level 2: Minimal Risk
  • Risk Level 3: Low Risk
  • Risk Level 4: Moderate Risk
  • Risk Level 5: High Risk

Research Support for the Bereavement Risk Assessment Tool

The BRAT has received some, though very minimal, research exploration. Rose et. al. (2011) explored the inter-rater reliability of the BRAT and found it adequate (inter-class correlation of 0.68.) Qualitative responses indicated it was a useful tool for assessment of bereavement risk.

The lack of other published work significantly limits the usability of these tool in a research environment. Other reviews (e.g. this presentation by Bill Palmer) fail to identify the BRAT in a list of bereavement assessment tools which suggests it may not be well-known outside of the Canadian Hospice environment.

Other Bereavement Risk Assessment Tools

These tool recommendations come from Bill Palmer’s presentation:

  • Adult Attitude to Grief Scale (AAG)
  • Core Bereavement Items (CBI)
  • Grief Evaluation Measure (GEM)
  • Inventory of Traumatic Grief (ITG)
  • Texas Revised Inventory of Grief (TRIG)

Other Resources

References

Rose, C., Wainwright, W., Downing, M., & Lesperance, M. (2011). Inter-rater reliability of the Bereavement Risk Assessment Tool. Palliative & Supportive Care, 9(2), 153-164. doi:10.1017/S1478951511000022

Victoria Hospice Society. (n.d.) “Clinical Tools | Victoria Hospice Society” Retrieved on October 17, 2016 from http://www.victoriahospice.org/health-professionals/clinical-tools

Cite this article as: MacDonald, D.K., (2016), "Bereavement Risk Assessment Tool (BRAT)," retrieved on November 23, 2017 from http://dustinkmacdonald.com/bereavement-risk-assessment-tool-brat/.
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