Dynamic risk and violence in individuals with an intellectual disability: tool development and initial validation

Without a violence risk assessment designed for people with an intellectual disability (ID), assessors are reliant upon tools developed for mainstream offenders or develop their own tools. This study describes the early stages of development of the Current Risk of Violence (CuRV), an informant-reported measure of dynamic risk for aggression in adults with an ID. The pool of items was generated from a multitude of sources. Predictive accuracy for aggression was tested prospectively among 64 adults with an ID and history of aggression. The 34-item CuRV was found to be a brief, uncomplicated risk assessment. Initial findings revealed good predictive validity over a five-month period: area under the curve (AUC) range from .72, 95% CI [.59, .85] to .77, 95% CI [.66, .89]. These preliminary findings suggest that the CuRV may assist staff to perform assessments of risk in busy clinical settings. Future research effort is needed to fully explore the psychometric properties of the CuRV.     

The impact of sex offender’s interpersonal style,treatment readiness and the therapeutic alliance on treatment gain

The impact of internal responsivity factors and therapeutic process variables on intra-individual within-treatment gain in sex offenders has received little empirical attention. This study examined how (1) internal responsivity factors, including treatment readiness and interpersonal style, and (2) therapy process variables, including the therapeutic alliance and the presence of ruptures in the therapeutic relationship, impacted intra-individual within-treatment gain. Participants comprised 71 sex offenders who participated in group-based sex offender treatment programmes in prison or the community. Results showed that offender hostile-dominance and the affective and interpersonal characteristics of psychopathy, as measured by the Psychopathy Checklist: Screening Version Factor 1 score, negatively impacted treatment gain. Pre-treatment readiness, client ratings of the therapeutic alliance and whether or not there were ruptures in the therapeutic relationship had no association with within-treatment gain. The strength of the therapeutic alliance later in treatment did not moderate the relationship between offender interpersonal style, or psychopathy, and treatment gain.     

Transferring the burden of risk in private health care: medical indemnity insurance reform

This article provides an overview and critique of the recent medical indemnity insurance reforms implemented by the Commonwealth Government. The first part of the article sets out a number of the practical difficulties associated with the reforms whilst in the second part an analysis is given of the social philosophies and economic approaches that underlie them. The weaknesses and strengths of shifting the medical indemnity insurance market from a free-market approach to be more in line with the liberal-welfarist approach are considered, as is the need for each approach to be supplemented with a more comprehensive understanding of the human good.     

The defence of therapeutic privilege in Australia

Therapeutic privilege is a defence that excuses a medical practitioner or other health professional from complying with the requirements of full disclosure to a patient in circumstances where it is reasonably considered that such disclosure would be harmful to that patient's health or welfare. Although the concept originated in the United States, the defence has been applied in Australia, and was specifically endorsed as part of Australian law by the High Court in Rogers v Whitaker (1992) 175 CLR 479. However, there has been negligible application of the defence since that endorsement. This article examines the doctrine of therapeutic privilege in the present Australian medico-legal environment. After an examination of the concept and its three constituetent elements, the article canvasses the limited instances of judicial approval of the defence prior to Rogers v Whitaker. The author then analyses, by reference to reported and unreported case law, why the defence has been so narrowly interpreted since, such that it has come to occupy an almost untenable position in Australia's medical jurisprudence.     

‘Hold that Pose!’ Photography and kabuki in Kitano Takeshi's Kikujiro

This article examines Kitano Takeshi's film Kikujiro (Kikujirō no Natsu, 1999) from two directions: first, as an as an experiment in moving versus still photography, and second, as an exploration of time, memory and Japanese identity. I argue that it is in Kitano's cinematic use of elements from the kabuki drama that the two aspects come together. Kitano plays upon the conventions of both kabuki and film media to highlight the significance of the ‘still shot’ as it functions in human memory. By presenting moments of the story in the format of a child's photograph album, Kitano is able to explore ideas of ‘adult’ and ‘child’ as equally arbitrary constructions. Throughout Kikujiro, Kitano draws on a rich tradition of film, drama and television convention in order to explore the idea of where identity comes from – does it come from the past, the present, or do we make it up ourselves? Kitano places emphasis on the still mie pose to heighten emotion and draw attention to the present moment. By contrasting this method against that of photography, Kitano juxtaposes past and present modes of expression, enabling him to interrogate notions of time and the supposed timelessness of art. Finally, Kitano's critical use of the past locates identity not in some distant, unobtainable myth of the nation, but in the lived experience of each individual as a human being.