Clinicians were significantly more accurate than chance in prospectively predicting which male forensic patients would show assaultive behavior. However, some of the factors associated with clinical prediction, such as race, ability to follow ward routine, and arrest history, were not associated with actual assaultive behavior. In addition, clinicians failed to use dual diagnosis of schizophrenia and substance use disorder as a predictor.

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In New York State, patients who have been found not criminally responsible by reason of mental disease or defect, eventually become outpatients while still under the supervision of the courts. The treatment of these patients on outpatient orders of condition poses special problems. Treatment needs to center on the issues related to patient's potential for harmful/violent behavior. Therefore, outpatient clinicians need to conduct periodic risk assessments and must continuously monitor identified risk indicators. The author outlines steps for information gathering and evaluation necessary for risk assessment. Treatment of these patients is conceptualized as ongoing clinical risk identification and management. It is framed by a treatment contract that integrates mandates of the Orders of Conditions with information gathered through ongoing risk assessments and spells out legal and other consequences that may arise from non-compliance.

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