Forensic Disability Services with Dr Matt Frize

Our guest for this episode is Dr Matt Frize, Director of Forensic Disability Services, which sits within The Victorian State Government's Department of Families, Fairness and Housing (DFFH).

Co-host Karenza Louis-Smith and I were lucky to catch some time with Matt at the Complex Needs Conference earlier this year.

The sold out conference was co-hosted by ermha365 and ACSO Australia and funded by the Department of Families, Fairness and Housing.

We talk to Matt, a senior specialist psychologist, about how Forensic Disability Services addresses the needs of people with a cognitive impairment who come into contact with the criminal justice system in Victoria.

In this episode Matt mentions the ARMIDILO-S Assessment - the Assessment of Risk and manageability of Individuals with Developmental and Intellectual Limitations who Offend. More info at armidilo.net

ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.

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We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.

Chapters

• 0:00 Introduction to Get Real podcast
• 2:01 Challenges of marginalized individuals in justice system
• 5:42 The ripple effect of intervention
• 8:20 Criminal justice responses to complex behaviours
• 12:25 Why community understanding matters
• 15:15 Therapeutic communities and treatment approaches
• 19:36 The Armadillo risk assessment tool
• 22:14 Magic wand solutions and final thoughts

Transcript

Acknowledgment of Country

Get Real is recorded on the unceded lands of the Boonwurrung and Wurundjeri peoples of the Kulin Nation. We acknowledge and pay our respects to their elders, past and present. We also acknowledge that the First Peoples of Australia are the first storytellers, the first artists and the first creators of culture and we celebrate their enduring connections to country knowledge and stories, celebrate their enduring connections to country, knowledge and stories.

Introduction 

Welcome to Get Real talking. Mental health and disability brought to you by the team at ermha365. Join our hosts, Emily Webb and Karenza Louis-Smith, as we have frank and fearless conversations with special guests about all things mental health and complexity with special guests about all things mental health and complexity.

Acknowledgment of Lived Experience

We recognise people with lived experience of mental ill health and disability, as well as their families and 

carers. We recognise their strength, courage and unique perspective as a vital contribution to this podcast so we can learn, grow and achieve better outcomes together. 

 Emily Webb 

Welcome to Get Real talking mental health and disability. I'm Emily Webb. Our guest for this episode is Dr Matt Frize, Director of Forensic Disability Services, which sits within the Victorian State Government's Department of Families, Fairness and Housing. My co-host, Karenza Louis-Smith, and I were lucky to catch some time with Matt at the Complex Needs Conference earlier this year. The sold-out conference was co-hosted by erhma365 and ACSO Australia and funded by the department. So, let's get into the conversation with Matt about how the service he heads addresses the needs of people with a cognitive impairment who come into contact with the criminal justice system in Victoria.

 Karenza Louis-Smith 

Hi Matt. As the Director of Forensic Disability Services in Victoria now you manage support for individuals with cognitive impairments in contact with the criminal justice system. What kind of unique challenges do you think these individuals face and how does Forensic Disability Services address their needs? So big question. 

 Matt Frize 

That is a huge question. So, firstly, I think the clients we support are some of the most marginalised people in our community. They tend to be people who have had a really, really rough life and the reward they've got is by trying to do the best they can and adapt to their environment. Unfortunately, they've learnt some particular behaviours to achieve that they're doing the best they can and adapt to their environment. Unfortunately, they've learnt some particular behaviours to achieve that. They're doing the best they can and the reward they've got is involvement with the justice system. So for us, essentially, what we try and do and I think one thing we need to acknowledge is that position that they're coming from, whilst they have displayed significant behaviours and hurt a lot of people. These are generally people themselves who have been particularly hurt by our system and by others, and it's a real juggling act in that what we're trying to do is support people to get back out there into the community. You know you talk about rehabilitation. Often it's about habilitation. These aren't people who have engaged well in community. It's to be able to get them to live a full and fulfilling life and for them to achieve their goals, whilst also juggling the rights of others at the same time and keeping others safe. 

I'm very conscious. I've been in this space now for over 20 years and you know, one thing I'm very aware of is it's cyclical. What we do now impacts the next generation as well, and we need to have a very longitudinal approach to what we do here, because the ripple effects of what we do are massive, and I think it's one of the things that's I mean, I'm probably talking a bit beyond the the question here, but it's one of the brilliant things about what we do as a psychologist. You're not just affecting one person, but this service. By supporting one person to live a good life, what you're doing is you're having an enormous impact on a huge number of people, and so many people won't even be aware of that either, and it's intergenerational as well. 

Emily Webb 

Are we talking about the ripple effect? We're talking about those close to the person. You're supporting the community. What do we mean when we talk about these impacts with intervention and support can be really big. 

Matt Frize 

Often when we think about we're trying to change behaviour, but we forget that what we're trying to do is change behaviour to something positive. So obviously we're having an impact on the person. It's not just stopping a behaviour, it's promoting a person having a good life. But then what impact does that have on the person around them and their family? Then of course, we're thinking about the individuals who will not be victims, and it's one of the things I often remind our staff and say that anyone working in this area probably should be wearing our undies on the outside, because we're actually preventing victims. And then who does that affect as well? 

It's not just the victim, but then thinking about generationally especially when we're talking about things like sexual offending, which you know there is some evidence to say this particular population, this group of people. You know the higher prevalence of those sorts of issues. So it's not just the victim that doesn't happen, but also potentially their family and down the track as well. So that ripple effect I think is enormous and it can be a bit of a tsunami when really you think about it. 

Karenza Louis-Smith

So, Matt, we're obviously talking to you at the Complex Needs Conference. Live here and the bit I you know it's not a question on our list and it's one of the really big things we grapple with is why do we have a criminal justice response to complex and challenging behaviours, and is that the best response for people with disabilities? It's an interesting conversation. 

Matt Frize 

It's an interesting question and it's a really challenging one to answer. There are many functions of the criminal justice system. Obviously one is about keeping people safe. When we think about what are the functions of the criminal justice system, obviously one is about keeping people safe. When we think about what are the purposes of sentencing, you know there's individual deterrence, general deterrence, maintaining safety in the community. I don't necessarily think we should be throwing out a criminal justice system. It's about what are the pathways in that system understanding the individual. We don't talk enough about prognosis for an individual, what is possible of this person and therefore what's the best pathway forward. 

In Forensic Disability Services we have a range of pathways, ranging from secure residential treatment facilities right through to our community-based clinical services and disability justice coordination, where it's about supporting that person in the community just to find their way. 

And very much for those individuals it's about identifying those who might be destined for a pathway to custody, where we know it's actually likely to make their behaviour worse. 

But what can we do to get them into the community to reduce that long-term negative impact both for the person and therefore the community? But that's not to say that there aren't people where there is significant risk there. I don't think we can ignore that. But I think we can do a lot better at thinking about what's the right pathway, and I think it is incredibly rare that the right pathway is putting a person with disability who's vulnerable themselves in a jail setting, especially when the options for intervention and changing that behaviour are so limited. So I think you know services like we have, and I feel very fortunate and honoured to be responsible for a service where it's about getting the person out of custody, putting them in a secure environment and slowly and gradually transitioning them into the community, but being really focused about developing their skills on that pathway and also putting them in the driver's seat to do that as well. 

Emily Webb 

And we know that. Look the cohort of people that you work with, that everyone here at this conference works with. We know the possibilities and the opportunities and the challenges. Why is it so important that we don't give up? You know we need people outside of the profession to understand this is really important. So if a newspaper or radio announcer says you know why are we doing this, this, this is how much we're spending on this, why does the general community need to understand we've got to do this? 

Matt Frize

It's a great question because, at the end of the day, the community actually decides what we do. You know everything we do is directed politically and therefore you know those politicians make a decision around not just legislation, but where does funding go. And so for us to be able to create change, there needs to be recognition in the community about what works, what is evidence-based intervention, and to be able to then understand and inform our political parties and those who are in charge about where we go, what we fund and what we support. And I think you know, call out to you guys. 

I think it's fantastic that you've got a podcast like this Forensic Disability Services. We've got our pointy end, and then there's kind of community intervention, and I actually think what you guys are doing here in terms of a podcast is intervention and it's at the broadest community level, because what we do need to do is get the community generally to understand this, because, at the end of the day, any intervention, any resolution of this requires a community element to it. So I think, without people having an understanding of complex needs and I think it's brilliant that the term complex needs comes into it, because it is complex, it's some of the most complex things we deal with in community. An engineer has a formula that they can apply. You can't do that with people, and the people who work in this space need incredible skill and creativity to be able to achieve it. But again, they need the support of the community to be able to do that. 

Karenza Louis-Smith 

Yeah, that's really important, matt. The theme of the conference is what works. You know and like, I think, some of the things that you spoke a little bit about therapeutic models, residential environments that aren't necessarily jail or prisons Can you tell, like our listeners, about some of the, I guess, secret herbs and spices and things that you know your team is doing? That's seeing some of these things change and it's complex needs. We're not talking about people as being complex, but the needs and things that are happening in their lives and around them is where the complexity is. 

Matt Frize 

Yeah, sure, good question. Look, I guess, as a psychologist, as someone who's done research in this area and been responsible for services, I think we need to be real that the evidence base is not huge in this space. A lot of work needs to be done and the danger is, if there's rhetoric that we know what needs to be done, that we're not going to be challenging ourselves to try different things. There's a quote that creativity is intelligence having fun. It has been assigned to Einstein, but it wasn't. It was from a Harvard review. 

So what we're trying to do at the moment is explore a number of different avenues. So we've just completed an evaluation of our emotion regulation adapted DBT program. There's some really positive inroads there. We just gave a presentation on our therapeutic feedback model, which is a residential treatment model we apply in our residential treatment facilities and involves a therapeutic community component to it. We've got a couple of other things a motivational interviewing, evaluation going on, but I think increasingly what we're finding is it's not just about what you do with the individual, it's the supports around that person and that's where the interventions often need to be targeted. 

And I think there's a real problem with an us-them divide that the people we support are somehow different to us, that the people we support are somehow different to us, like if we think about changing our own behaviour. We don't get someone who writes a behaviour support plan where we never even see that plan and things are done. No, there needs to be clear motivation for that change, and often it's environmental factors that can have a big impact. If I've got a piece of chocolate cake in front of me, I don't care what therapeutic language is going on, I'm going to eat that. If it's not there, I'm probably not going to. So we need to be far more considerate of those environmental factors, including the supports around us, to be able to create those changes. 

And so that's a really big focus of what we're trying to do in forensic disability services. Think about not just CBT programs but those other pieces and how they all fit together. One of the other pieces of research we're doing at the moment is looking at the Armadillo risk assessment tools. It's a tool that looks both at the individual but also the environmental components. So you know, call out. I am an author of the tool, so obviously very passionate about it. But I think the great thing recognition in the disability space is the influence of the environment and it's not just about the person, and so increasingly we're putting a lot of our research and exploration into those components and what helps support behaviour change but also maintenance of that behaviour change. Again, it's easy to throw therapy at someone in a restrictive environment, but then the question is, how do you take that into the community and practice those skills and maintain that? And that's a completely different challenge. 

Emily Webb 

You mentioned therapeutic community and for people who may not know what that is, what is a therapeutic community? 

Matt Frize 

A therapeutic community is one where both staff and clients are responsible for therapeutic change. It recognises that it's not just about going in for a session each day. Every element of waking and sleeping life has an influence on behaviour change and the residents there work together to see change as well. So we have a number of components of that community which promote change. So I think one of the biggest things we've done is we have an incentive program for the clients. 

But it's not just about just having a good day. We need to be clear for each of those individuals. What are they trying to achieve through treatment and the staff being aware of that and being able to reward that? And the rewards are actually linked back to the client's underlying goals and also the underlying function for their offending. So often it's relational. So it's about what can we do to support this person to see that if they act in a positive way, they will get some of those relational elements as well. So the community is very much about recognising there's a whole number of people there to support that one person and I think in the few years that we've been applying we've seen more and more cohesion amongst the residents to support each other on their journeys through the program. 

Karenza Louis-Smith 

Comment from me. I just don't think we have enough therapeutic communities in Victoria. Wouldn't it be awesome to have some more? 

Matt Frize

Absolutely. I think again it comes back to that idea of intervention. It's not just the person in this void. There are so many elements to that and we need more research. We just presented on the number of changes we've done in the last few years. I often joke that we've got to remember that this is incremental. We're currently working with probably an iPhone 1. We were at a 3110, we're now at an iPhone 1. If we want an iPhone 15 in terms of a therapeutic community, we need to keep changing. But that requires research and being really transparent about what doesn't work. So I think you know there's a number of environments, not just disability, mental health. There should be a lot more opportunity, I think funding and training around this area, and you know we should be getting out there and talking about what does work, what doesn't work and then being prepared to go back to the drawing board. But I think there's a lot of anxiety from people about trying something different. 

Karenza Louis-Smith 

You also touched on people working together in those partnerships and I know you know the conference hosts here, ermha and Axo, work really really closely with your team across multiple services and you know it's that collaboration one person or one agency or one entity can't help solve all of these things. It takes a lot of us, I think, to kind of come together. What are your thoughts around that and that kind of collaboration piece, matt? 

Matt Frize 

It's one of the things I love actually about being in Victoria. 

Having spent a lot of my career in New South Wales and then coming to Victoria, I think there's a really strong positive cultural piece in Victoria in terms of the collaboration between government and NGOs Not to say that it doesn't happen in New South Wales, but I think there's a very strong network here in Victoria and there's a really strong respect amongst different organisations and how that collaboration works. 

So I think at the moment we're in a really exciting space and you know from the government side of things as well the recognition, just the Complex Needs project and about that integration and not working in silos. And I think what that's doing is often there's silos and the danger of silos is, in order for you to feel special, you kind of need to knock someone else down, but in that collaborative environment what you're doing is you're recognising the skills and experience of the range of parties and so you're all lifting each other up and you know working with a person on the ground you know Irma or Axo there is such skill that's required in those jobs and I don't think we do enough of a job of recognising that. But I think in some of these collaborative partnerships. At the moment we're getting better at being able to call some of that out. 

Emily Webb 

I want to track back to the armadillo that you mentioned, because now I've got an armadillo in my mind, which is quite cool. I love them, but you are the author of that. Can you explain the armadillo assessment that you created? 

Matt Frize 

I am one of a few authors of it, so the original one was driven by Jim Haven and Doug Bauer a number of years ago, particularly looking at sexual offending. So it looks at both risk and strength domains of an individual, but it looks at them and the environment and what's unique about it is, or what's really positive, is, that it's a purely dynamic tool. It only looks at factors that change over time, which means they can also be intervention targets. So there's been a number of evaluations now of the Armadillo here and overseas. So there's a couple of Scandinavian evaluations, there's one in the UK as well, and the Armadillo S has been shown to be an incredibly predictive tool over a couple of years in terms of recidivism. 

The tool I developed was an adaptation, which is a general tool looking broadly at offending. We did an evaluation in New South Wales with, I think, 126 offenders. It came out to be highly predictive over a three to six month period compared to other tools. So we're continuing to work on them at the moment and I think what's really helpful about it is it puts the person in a place and what we're actually finding and I'm talking about this tomorrow is when you combine it with static tools, so tools where factors don't change over time. I mean, they're very helpful in terms of being able to predict, but it doesn't tell you what to do. But we're actually finding that when you merge the two tools, the two types of tools together, you get a more of a picture of what risk is. So you're looking at it from different dynamics and, in actual fact, what we're finding is that to be able to predict whether someone goes on to offend or not, it varies depending on what timeframe. 

So these dynamic tools not surprisingly, if they're factors that change a lot for example, what's their engagement like with staff, what's their understanding of their offending behavior, what's substance use like that they're particularly predictive in a short period of time because those factors do change. But a static tool which looks at things like a person's age, their gender, ethnicity they don't change but, not surprisingly, they tend to be more predictive over a longer period of time Because when you think about it you don't know what those dynamic aspects are going to be like. But I think what's great about the Armadillo is it really informs what's likely in the immediate future, which then tells people supporting person what they need to do to try and address some of those risks. But again, for a person with a disability, by having the strengths component as well, it also means we're not throwing the baby out with the bathwater. We're not just looking at you as being a risk, but that person also has strengths that we need to be able to maintain and make sure we don't throw out when we intervene. 

Karenza Louis-Smith 

I think tools are actually really important and I think when we talk about those things that make a difference, I think what you know you're talking about helps guide practice, helps guide care teams, helps people understand I think perhaps the person more about what's happening, going on and what are the right things that we could do that could bring about change. 

Matt Frize 

Yeah, I think a really important element about tools is, if you look right back, danny Kahneman's kind of seen as the grandfather of this area and he talks about what we're trying to do is address bias. Everyone makes judgments every day. We look at someone we work with and we'll have an immediate idea about, maybe, what their risk is. But what tools try and do is identify some of those biases that we might have which are unfair for the person and bring us into a more objective perspective. So not only does it help with bias, but it also allows everyone to be talking the same language. 

Karenza Louis-Smith 

Matt, if people would like to find out more about the Armadillo, how can they do that? 

Matt Frize 

They can find that by going to armadillo dot net. Otherwise, if you just Google armadillo risk assessment, it does tend to pop up Awesome. 

Karenza Louis-Smith 

Thank you. 

Emily Webb 

And I was going to ask another question and it's a simple question, but I like doing it your magic wand solution. If there was a magic wand for you, mash what's the one thing you think could really really help in I don't know early intervention, changing understanding of people with forensic disability, like what would be great, or like just getting a ton of money from somewhere. 

Matt Frize 

I don't know what's one thing you think would be super useful, or a few maybe I think this area needs to be recognized for the complexity it is, and so, therefore, there needs to be a lot more pathways into how to get into this area and recognizing it as an expertise, which means training needs to be behind it, and we pay people for the jobs they do. I mean, I know you guys at Irma and Axo and the like the skill that's required to see a person change their life around and go in the right way. That is incredible, and so I think the community needs to acknowledge that. So if we're able to pay those people better and develop pathways, through unis and the like, to be able to build those skills, then I think we'd make a significant change. 

Emily Webb 

Have you got any final thoughts before we wrap up? And again, thank you so much for your time, because we know you are a person who has a lot of people who want to talk to you. 

Matt Frize 

I want to thank you for the opportunity to be able to speak today and what you're doing. You know, I think this is exactly where we need to be heading and I think this is an awesome initiative and I hope that you know we might be able to be involved again in the future. So, yeah, congratulations on what you're doing and also a fantastic conference as well. 

Outro

You've been listening to Get Real talking mental health and disability, brought to you by the team at Irma 365. Get Real is produced and presented by Emily Webb with Karenza Louis-Smith and special guests. Thanks for listening and we'll see you next time.