Using the Sex Offender Risk Appraisal Guide (SORAG)

Introduction

Following up on my article about how to use the Violence Risk Appraisal Guide (VRAG), this article reviews how to use a tool that is bundled with that tool, the Sex Offender Risk Appraisal Guide (SORAG). Like the VRAG, this is an actuarial tool that can be used to predict the risk of re-offending among sex offenders.

Before reading about the SORAG, it is helpful to review the VRAG post as many of the elements that are covered in that post are required before proceeding to the SORAG items. It is recommended that any completion of the SORAG be preceded by a completion of the VRAG as this will save you a significant amount of time.

Completing the SORAG

Like the VRAG, the first step is to complete the Childhood & Adolescent Taxon Scale (CATS) worksheet and the list of Conduct Disorder Symptoms.

Cormier-Lang Criminal History Scores

In order to answer item 5 on the SORAG, Criminal History Score for Non-Violent Offenses Prior to the Index Offense, it’s necessary to complete the Cormier-Lang Criminal History worksheet also provided on the SORAG. This worksheet is completed by filling out the number of non-violent offenses and applying the weight to them noted on the sheet.

Sex Offender Risk Appraisal Guide (SORAG) Items

The SORAG itself has 14 items that are similar to those found on the VRAG.

  1. Lived with both biological parents to age 16 (except for death of parent)
  2. Elementary School Maladjustment
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense)
  5. Criminal history score for nonviolent offenses (from Cormier-Lang system)
  6. Criminal history score for violent offenses (from Cormier-Lang system)
  7. Number of previous convictions for sexual offenses (pertains to convictions known from all available documentation to be sexual offenses prior to the index offense)
  8. History of sex offenses only against girls under 14 (including index offenses; if offender was less than 5 years older than victim, always score +4)
  9. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release)
  10. Age at index
  11. 11. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  12. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  13. Phallometric test results
  14. 14. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
    14. b. CATS score (from the CATS worksheet)
    14. WEIGHT (Use the highest circled weight from 12 a. or 12 b.)

You’ll note that many of these items are available from the VRAG. The tool indicates where there are overlaps in order to save you time filling out the worksheets and tools.

Determining Risk Level of Sex Offenders

After completing the tool, you must take the total score of the SORAG and compare it to the below levels.

  • A score of -17 to +2 indicates an individual is at Low risk for re-offending
  • A score of +3 to +19 indicates an individual is at Medium risk for re-offending
  • A score of +20 to +34 indicates an individual is at High risk for re-offending

An individual who is on the border between these two levels should have that indicated. For instance, someone who scores at +1 or +2 should be noted as “Low-Medium Risk” to highlight that they are at the edge of the established risk level.

Recidivism Rates using the SORAG

Rather than grouping an individual into low, medium or high risk categories, it is often more illuminating to examine the recidivism rates. These come from Violent Offenders as well.

Probability of Recidivism
SORAG score 7 years 10 years
< − 9 0.07 0.09
−9 to -4 0.15 0.12
-3 to +2 0.23 0.39
+3 to +8 0.39 0.59
+9 to +14 0.45 0.59
+15 to +19 0.58 0.76
+20 to +24 0.58 0.80
+25 to +30 0.75 0.89
> +31 1.00 1.00

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Cite this article as: MacDonald, D.K., (2017), "Using the Sex Offender Risk Appraisal Guide (SORAG)," retrieved on November 17, 2017 from http://dustinkmacdonald.com/using-sex-offender-risk-appraisal-guide-sorag/.
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Using the Violence Risk Appraisal Guide (VRAG)

Introduction

The Violence Risk Appraisal Guide (VRAG; Quinsey, Harris, Rice, & Cormier, 2006) is a tool that can be used to estimate statistically the risk of recidivism. It is comprised of 12 items that are associated with a risk of re-offending and is completed with all available information. You can download the full VRAG in PDF format. The Sexual Offender Risk Appraisal Guide (SORAG) is reviewed in another article.

The VRAG is an actuarial risk assessment, involving a mathematical technique applied to determines what factors were present in offenders who later went on to commit violent crimes. (Brown & Singh, 2014) This approach eliminates the bias found in unstructured judgement.

The VRAG has been examined in over 40 studies, and has been found effective even with individuals who have a lower IQ. (Camilleri & Quinsey, 2011)

Completing the VRAG

The first step to completing the VRAG is to complete the Childhood & Adolescent Taxon Scale. Below, where a request for information relates to an “index offense” that is the one that led to the individual entering the Criminal Justice system

Childhood & Adolescent Taxon Scale (CATS) Worksheet

This scale includes 8 items that are scored from 0 to 1, based on the coding guidelines provided. These items are:

  1. Elementary School Maladjustment
  2. Teenage Alcohol Problem
  3. Childhood Aggression Rating
  4. More Than 3 DSM Conduct Disorder Symptoms
  5. Ever suspended or expelled from school
  6. Arrested under the age of 16
  7. Lived with both biological parents to age 16 (except for death of parents)

Conduct Disorder Symptoms

Next, the assessor will complete the list of Conduct Disorder symptoms, circling those that occurred before age 16 except for items 13 and 15 which are before aged 16:

  • 1. Often bullied, threatened or intimidated others
  • 2. Often initiated physical fights
  • 3. Used a weapon that could cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  • 4. Was physically cruel to people
  • 5. Was physically cruel to animals
  • 6. Stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery)
  • 7. Forced someone into sexual activity
  • 8. Deliberately engaged in fire setting with the intention of causing serious damage
  • 9. Deliberately destroyed others’ property (other than by fire setting)
  • 10. Broken into someone else’s house, car, or building
  • 11. Often lied to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  • 12. Stolen items of nontrivial value without confronting a victim (like shoplifting, theft, or forgery)
  • 13. Before [age] 13, stayed out late at night, despite parental prohibitions
  • 14. Ran away from home overnight (or longer) at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  • 15. Before [age] 13, was often truant from school

Cormier-Lang Criminal History Scores for Non-Violent Offenses

This scoring form allows you to answer item number 5 below, the Criminal History Score for Non-Violent Offenses Prior to the Index Offense. This score is developed by counting the number of non-violent offenses and applying a weight to them. For instance, bank robbery is counted x7 while Indecent Exposure is counted x2. So an individual who has two instances of Indecent Exposure and 1 instance of Bank Robbery would have (2×2 = 4) + (1×7 = 7) = 4+7 = 11.

Violence Risk Appraisal Guide (VRAG) Items

Next are the 12 VRAG items. The tool provides detailed coding instructions for each of these:

  1. Lived with both biological parents to age 16 (except for death of parent):
  2. Elementary School Maladjustment:
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense):
  5. Criminal history score for nonviolent offenses prior to the index offense
  6. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release):
  7. Age at index offense
  8. Victim Injury (for index offense; the most serious is scored):
  9. Any female victim (for index offense)
  10. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  11. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  12. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
  13. (Technically 12b) bCATS score (from the CATS worksheet)

Scoring the VRAG

Determining Risk

Risk categories are provided in the VRAG manual. They are approximated here although more detail is available in the complete manual. For each score, if an individual is close to the next score you should list them as a combination of the two. For instance an individual whose score is -10, -9 or -8 would be listed as Low-Medium rather than just Low.

  • -24 to -8 is Low Risk
  • -7 to +13 is Medium Risk
  • +14 to +32 is High Risk

Determining Rate of Recidivism

The risk of recidivism is presented below, from the same manual (pages 283-286):

Probability of Recidivism
VRAG score 7 years 10 years
< −22 0.00 0.08
−21 to −15 0.08 0.10
−14 to −8 0.12 0.24
−7 to −1 0.17 0.31
0 to +6 0.35 0.48
+7 to +13 0.44 0.58
+14 to +20 0.55 0.64
+21 to +27 0.76 0.82
> +28 1.00 1.00

This is to be interpreted as a percentage. For instance a score of -10 is in the -14 to -8 category; therefore an individual would have a 7 year recidivism rate of 12% and a 10 year recidivism rate of 24%.

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Brown, J. & Singh, J.P. (2014) Forensic Risk Assessment: A Beginner’s Guide. Archives of Forensic Psychology. 1(1). 49-59. Retrieved on January 20, 2017 from http://www.archivesofforensicpsychology.com/web/wp-content/uploads/2015/01/Brown-and-Singh1.pdf

Camilleri, J.A. & Quinsey, V.L. (2011) Appraising the risk of sexual and violent recidivism among intellectually disabled offenders. Psychology, Crime & Law. 17(1) 59-74

Cite this article as: MacDonald, D.K., (2017), "Using the Violence Risk Appraisal Guide (VRAG)," retrieved on November 17, 2017 from http://dustinkmacdonald.com/using-violence-risk-appraisal-guide-vrag/.
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Referrals in Counselling

Introduction

When confronted with a crisis situation it’s important to be have the knowledge to tackle a crisis but also to have appropriate referrals for the client. In some roles, like that of 911 Operator, dispatching of police, fire and ambulance will be the sole “referral”, and while police or Victims Services may provide some referrals, the majority of the time this falls on to social services workers they come in contact with.

On services like Distress Centre Durham’s 24-hour helpline, referrals make up a small portion of our calls (between 5 and 10% each year), and more than half of these are to the local Mobile Crisis Team. On the Online Text and Chat Service (ONTX), the numbers are even smaller. Not all crisis roles will involve referrals but it good to be aware of them for times when client needs fall outside the boundaries of the service provided by your own agency.

Making Good Referrals

  • Initiate referrals or option exploration only when the client requests it or agency limits and boundaries (e.g. time limits, in-person vs. telephone service) require it
  • Obtain a copy of the United Way Blue Book, access to the 211.ca website/211 phone number for situations where referrals fall outside of your scope of knowledge
  • Ensure that any referral list is regularly updated to ensure individuals have correct contact information
  • If possible, conduct tours or bring in speakers from your most popular referrals so that you can confidently describe the intake and service delivery
  • Set a date for when the client will access the referrals and then follow up (if this is allowed as part of your agency procedures) to see if they were able to. If not – explore why. Long wait list? Bureaucracy? Client not sure how?
  • Review referral data regularly (at least on once a year) to determine what unmet needs exist in your community

Durham Region Referrals

The following are referrals that are regularly referred within Durham Region. These referrals should meet the Course Learning Outcome for CRIS 1342 “Describe and discuss various crises and suggest agency referrals.” All the below issues may be handled by Distress Centre Durham helpline workers or Online Text and Chat Responders, in addition to the specific external agencies listed.

These organizations are in no way comprehensive – there are many situations not covered here (e.g. motor vehicle accidents, issues involving children, pregnancy, relationships and so on) but this is a good start. 211 is your friend!

Addiction Referrals in Durham Region

  • Pinewood Centre – Pinewood is a full-service addiction treatment facility. They provide detox and withdrawal management, in addition to addictions counselling on both an inpatient and outpatient basis.

Counselling and Mental Health Referrals in Durham Region

  • Catholic Family Services of Durham Region – Catholic Family Services provides counselling (both on a walk-in basis and scheduled appointments) on a geared-to-income basis for a range of mental health issues. They provide service in both English and French and specialize in trauma but work with a wide variety of clients.
  • Durham Region Family Services – The Region of Durham also provides counselling with a team of trained counsellors.
  • Durham Mental Health Services – Durham Mental Health Services provides case management, counselling and emergency support (including Mobile Crisis and residential crisis beds) within Durham Region.

Financial and Employment Crisis Referrals in Durham Region

  • Community Development Council Durham (CDCD) – CDCD has programs for some areas of financial need like winter heating costs and housing stability.
  • John Howard of Durham Region – John Howard provides employment-based supports as well as counselling in the areas of anger management and intimate partner violence.
  • Ontario Works – For individuals who are in need of immediate assistance, Ontario Works can provide direct cash benefits to unemployed or underemployed individuals to help them pay their bills and remain homed and fed.

Homelessness Referrals in Durham Region

  • Bethesda House – Bethesda House is a shelter for women fleeing abuse located in Bowmanville.
  • Cornerstone Community Association – Cornerstone is the only men’s shelter in Durham Region. They provide transitional housing, and a residential shelter. Cornerstone will take single men over 16 years of age, single men with young children and couples with children. It is located in Oshawa.
  • Denise House – Denise House is a shelter for women feeling abuse located in Oshawa.
  • DYHSS (Durham Youth Housing and Support Services) – Also known as Joanne’s House, this is the only youth shelter in Durham Region, for youth 16 to 24, located in Ajax. Youth below 16 are required to be housed with Children’s Aid Society.
  • Herizon House – Herizon House is a shelter for women feeling abuse located in Ajax.
  • Muslim Welfare Home – The Muslim Welfare Home is a shelter for homeless women, whether or not they are fleeing abuse. It is located in Whitby.

Legal Referrals in Durham Region

  • Durham Community Legal Clinic – The Durham Community Legal Clinic provides general legal support to low-income individuals in the Durham Region who are in need of legal advice.
  • Durham Family Court Clinic – The Durham Family Court Clinic helps youth and families who have come into contact with the criminal justice system by providing assessment, counselling and support groups.
  • Luke’s Place – Luke’s Place provides women with emotional support and practical advice as they navigate the Family Court system with a trained advocate. For men as well as women who are survivors of intimate partner violence, Luke’s Place provides an adovcate that may accompany you to Court.

Physical and Sexual Health Referrals in Durham Region

  • Brain Injury Association of Durham – For those individuals who have experienced a traumatic brain injury, the Brain Injury Association provides peer support and support groups.
  • Durham Sexual Health Clinic – The sexual health clinic provides confidential and anonymous STI screening, contraception and referrals.
  • Oshawa Community Health Centre – The Oshawa Community Health Centre provides a full spectrum of physical and mental health services including general medicine, counselling, nutrition and other supports in one location.

Sexual Assault and Domestic (Intimate Partner) Violence Referrals in Durham Region

  • Durham Rape Crisis CentreFor women who have been victims/survivors of sexual assault, the Durham Rape Crisis Centre provides 24/7 emotional support and crisis intervention.
  • Lakeridge Health Domestic Violence and Sexual Assault Care Centre (DVSACC)For men or women who have experienced recent intimate partner violence or sexual violence (ideally within the previous 72 hours) you can be examined by a nurse for signs of injury, which can be documented without getting the police involved. This can help if you later decide to pursue a case against the person who injured you.
  • Support Services for Male Survivors of Sexual Abuse – Run by the Ministry of the Attorney General of Ontario, this toll-free service provides men access to information and referral. Like most lines of this nature run by the province (ConexOntario, the Mental Health and Addictions Helplines), I don’t believe they provide emotional support. This is a glaring absence

Sudden Loss or Grief Referrals in Durham Region

  • Bereaved Families of Ontario – Bereaved Families of Ontario has a Durham chapter that provides peer support through telephone, support groups and one-on-one sessions. Their programs tend to be focused on parents grieving the loss of their children but they provide other groups as needed.
  • Distress Centre Durham – Distress Centre provides two 8-week support groups, one for survivors of suicide (who have lost someone in their life to suicide) and a homicide survivor group, in addition to weekly “call outs” with a peer support survivor who has completed training. The Suicide Survivor group runs approximately 4 times a year while the homicide group runs once every 1-2 years based on availability.
  • Pregnancy and Infant Loss (PAIL) – The Pregnancy and Infant Loss Network provides support for women and men grieving the loss of a child, either during pregnancy (through miscarriage, illness, abortion, etc.) or in infancy.
  • VON Durham Hospice – Durham Hospice provides both palliative care support (resources for individuals with less than a year to live) and bereavement support (for those who have lost someone close to them.) Bereavement services are provided one-on-one in a peer support model, with groups available for teens/children, adults grieving the loss of their mothers and general grief support groups.
Cite this article as: MacDonald, D.K., (2016), "Referrals in Counselling," retrieved on November 17, 2017 from http://dustinkmacdonald.com/referrals-in-counselling/.
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LAPC Model of Crisis Intervention

The LAPC model was created by Cavaiola and Colford (2006) in their textbook Crisis Intervention Case Book. The advantage of the LAPC process is that it is easy to remember and apply, whether you are a degreed professional or a layman who has received a short amount of training. One of the difficulties of other crisis intervention models is that it can be difficult to recall the processes when they are needed most.

A client who is at high risk of danger will need a very directive approach where the crisis worker directs the intervention, a client at a moderate risk of danger will work best with a collaborative approach where control is shared, and a client at a low risk of danger should have a very non-directive approach where they lead.

The four steps of the LAPC Model are listed below:

LAPC Step 1. Listen

The first step in the crisis intervention process is to listen! This seems obvious but in a crisis it can be very easy to fall into the trap of hearing what we think is happening, rather than what is actually happening. If we fail to understand what the person in crisis is actually experiencing we will respond inappropriately.

Techniques used in the listening process include open-ended questions, paraphrasing and clarifying, and summarization. These are all primary counselling skills and are an inherent part of the active listening process.

In addition to hearing what a client is actually telling you, you should work carefully to avoid facial expressions or reactions which could be seen as judgemental. This is especially important when disturbing or scary content like suicidal or homicidal thoughts, sexual abuse or others are covered.

LAPC Step 2.Assess

Assessment is the next part of the process. This may be a structured and formal process (such as if you choose to use the CPR or DCIB Suicide Risk Assessments) or may be a much more informal process of synthesizing what you have learned in order to formulate an accurate picture of where needs are unmet or risk is present.

If you have failed to listen correctly, your assessment will not target the correct areas the client will not feel heard. Additionally, if you’ve missed signs of suicide or homicide risk (or in children, neglect or abuse) you may place the client or others at risk.

LAPC Step 3.Plan

The third step in the process is planning. In cases of suicide or homicide risk, safety planning will be the first order of business. For instance, someone who wants to overdose may give the pills to someone who can safeguard them, employ coping strategies to help ground themselves (watching their favourite movie or exercising for instance), or agreeing to call a crisis line if they can’t stay safe.

Once immediate safety concerns have been taken care of, other planning can take place. This may involve referrals to organizations (an article on this will be published June 6) for longer-term support (like counselling or case management), or otherwise performing the first steps to restoring equilibrium.

Planning should be a collaborative process between you and the client. If you simply take control and do everything for the client they will feel disempowered and dependency may result.

LAPC Step 4.Commit

Finally it’s important for the client to commit to the plan. If they have been involved in the process up until now, they should have little concern with committing. In some situations (like child welfare) there will be no option for them to “opt out” and they may be upset but getting them involved is still required.

Bibliography

Cavaiola, A. & Colford, J.E. (2010) Crisis Intervention Case Book. Nelson: Toronto, ON

Cite this article as: MacDonald, D.K., (2016), "LAPC Model of Crisis Intervention," retrieved on November 17, 2017 from http://dustinkmacdonald.com/lapc-model-crisis-intervention/.
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Basic Homicide Risk Assessment

Introduction to Homicide Risk Assessment

All mental health professionals in the US and Canada have an ethical duty to warn, the requirement to warn someone who is at risk of harm of that harm. This leads clinicians to conduct homicide risk assessments to determine the level of danger to others.

In therapy or crisis intervention, the clinician is required to breach a client’s confidentiality in order to make notifications for both homicide risk and suicide. The homicide notification was codified in Tarasoff v. Regents of the University of California (1976), a famous case where a psychologist was held liable after failure to take adequate steps to protect a woman that a client had confessed the desire to kill, when he did.

Borum & Reddy (2001) enumerated a variety of steps to performing a homicide risk assessment in a Tarasoff-style risk assessment, which is differentiated from a more long-term risk assessment by a focus on on clinical judgement than on an examination of actuarial risk factors. The ACTION steps below are used to perform the assessment.

To start, it’s important to clarify the difference between making a threat, and posing a threat. Someone who says they wish to hurt someone may not pose intent or take action that demonstrates an actual risk. Preparatory behaviours help guide the risk assessment, and include selecting a target, choosing the method, time and place of violence, acquiring means, and so on.

The goals of the Tarasoff homicide risk assessment will be:

  1. Is the client headed towards a violent act?
  2. How fast is the client moving towards that act, and do opportunities exist for intervention?

ACTION Steps for Tarasoff Homicide Risk Assessment

Attitudes in support of violence

Is the client demonstrating any antisocial attitudes or beliefs? If the client is at risk of harming their partner, do they hold misogynistic or patriarchal beliefs? The goal here is to determine whether the client believes that violence is a justified or normal response to this situation. The more justified the client believes he or she is, the higher the risk of violence.

Borum & Reddy also identify other factors to explore under attitudes:

  • Hostile attribution bias
  • Violent fantasies
  • Expectations about success of violence
  • Whether the client feels it will accomplish their goal

Capacity to carry out threat

Does the client have access to the means, and the intellectual capacity to carry out a criminal, violent act? They also need access to the target and opportunity. Stalking often precedes violent acts (Meloy, 2002) and this can lead to an individual learning about the target’s schedule and whereabouts.

Thresholds crossed in progression of behaviour

Any presence of lawbreaking indicates a “willingness and ability to engage in antisocial behavior to accomplish one’s objective.” Additionally, any kind of plan and preparatory behaviours to achieve this plan should be explored.

Intent to act vs. threats alone

It’s important to clarify the difference between an actual intent to act versus simple threats. On the distress line, we clarify with callers who make violent comments whether they actually intend to harm the person they’re speaking about, or whether their comments are a result of frustration.

Questioning the client helps suss out their intent, in addition to any preparatory behaviours, alternative plans to accomplish their aim (that may or may not involve violence.) A client who believes there is no other way to meet their goals are more likely to turn to violence.

Other’s knowledge of the client

Knowing how others respond to the client’s planned actions will help assess their potential for action. If many people around them respond negatively to their plan they may be less likely to follow through. On the opposite side, if their supports provide little resistance this can increase risk. The client’s self-report can also help inform their attitudes.

Non-compliance with strategies to reduce risk

Is the client willing and interested in reducing their chance of committing a violent act? If they have previously breached legal requirements like parole or court orders, or demonstrate a willingness to do so in the future, this raises their risk.

Appreciating the gravity of their mental health status and desire for treatment may also be important.

Further Reading

See the original article by Borum & Reddy for a more detailed review of the risk factors and additional items, or a book like Clinician’s Guide to Violence Risk Assessment by Mills, Kroner & Morgan.

Bibliography

Borum, R. & Reddy, M. (2001) Assessing violence risk in tarasoff situations: A fact-based model of inquiry. Behavioral Sciences and the Law. 19:375-385. doi: 10.1002/bsl.447

Meloy, J. (2002). “Stalking and violence.” In J. Boon and L. Sheridan (eds.) Stalking and psychosexual obsession: Psychological perspectives for prevention, polcing, and treatment. West Sussex, UK: John Wiley & Sons, Ltd

Tarasoff v. Regents of the University of California, 131 Cal. Rptr. 14 (Cal. 1976)

Cite this article as: MacDonald, D.K., (2016), "Basic Homicide Risk Assessment," retrieved on November 17, 2017 from http://dustinkmacdonald.com/basic-homicide-risk-assessment/.

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