This research developed a model for forensic release decisions that in- INTRODUCTIONPrediction of successful outcome in the insanity acquittee population is crucial in facilitating patient release decisions. During the 1970s, there was heightened interest in the prediction of violent behavior due to the trend away from civil commitment based on a need for treatment and toward civil commitment based upon a standard of dangerousness to self or others (Monahan, 1984). By the end of the decade, however, a number of studies had suggested that mental health professionals possessed poor predictive abilities with regard to future violent acts (e.g., Cocozza & Steadman, 1976; Pfohl, 1978).One major problem in prediction literature has been the overprediction of violence, that is, high false positive prediction rates (Wenk & Emrich, 1982;Wenk, Robinson, & Smith, 1972). One reason for this, suggested by Monahan (1978) is that violence has a low rate of occurrence and can easily be overpredicted. In addition, violence can be unreliable as an event, and there is little consensus on the definition of violence or reliability in verifying its occurrence.A second problem in prediction research is to define what constitutes a successful outcome. Recidivism is frequently used as the sole criteria of outcome. However, its use has been criticized as overlooking the value of programs whose goals may be other than to alleviate an individual's proclivity toward criminality (Maltz, 1984;Gottfredson & Gottfredson, 1980). Further, there is little agreement among researchers as to a definition of recidivism. Maltz (1984) has identified nine different definitions of recidivism but advocates using rearrest rates as the most accurate, though limited, definition. In this research, we have chosen rearrest as our definition of recidivism as well.A third major problem in prediction literature is the lack of agreement about which independent variables are significant in a prediction model. Some studies have used standardized psychiatric interviews, mental status findings, and other clinical parameters (Strauss & Carpenter, 1977). However, attempts at predicting adjustment on parole have relied largely on actuarial tables and have been somewhat more successful (Gottfredson, Wilkins, & Hoffman, 1978;Hoffman & DeGostin, 1974;Glaser, 1962). The Salient Factor Scale, used by the U.S. Parole Board (Gottfredson, Hoffman, Sigler, & Wilkins, 1975) consists of nine items: prior convictions, prior incarcerations, age at first conviction, offense involved auto theft, history of drug abuse, employment prior to arrest, high school graduate, prior parole revocation, and release plan to live with spouse and/or children. While nearly all of the items in the Salient Factor Scale are based on an individual's actions prior to incarceration, Monahan (1978) has suggested the importance of additional postinstitutional factors, such as with whom the subject would be working and living, family support, and the type of environment to which an individual is released.Though...

It's been well documented that health care does not reliably transfer what we know from science into clinical practice. As a result, Americans do not always receive the care suggested by the scientific evidence. Despite the best intentions of a dedicated and skilled healthcare workforce, this can often lead to poor clinical outcomes. As research and technology rapidly advance, this gap between science and practice appears to be widening. There is an increasing public concern about a lack of access to appropriate treatment, pervasiveness of unsafe practices, and wasteful uses of precious health care resources leading to suboptimum treatment outcomes. Leadership has a critical role in creating and sustaining the environment that supports health services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Leadership has some responsibility to improve outcomes by insuring effective use of evidence-based treatment guidelines; measurement-based care; knowledge and skills management; care coordination; and information technologies. This paper addresses leadership issues in these components of a system's ability to improve treatment outcomes.

The results of the efforts to employ more women staff on secure wards in a forensic hospital are reported. These efforts were directed at creating equal employment opportunities as well as enhancing the resocialization of patients through more positive ward atmospheres. Ten ward atmosphere qualities identified by Moos were used as measures. The study concentrated on ratings of patients from two wards which had higher and lower concentrations of women staff. Patients in the ward having more women staff members rated their ward significantly higher on several relationship and systems maintenance dimensions but lower on the amount of aggression permitted.

This paper discusses issues in the community-based management of forensic patients. Community acceptance and safety demand a careful system of follow-up treatment for insanity acquittees. Many studies have examined the recidivism of this population, but few have dealt with administrative strategies to manage their care as outpatients. In this paper, we discuss our experiences in developing systems for follow-up care of insanity acquittees in the state of Maryland. Central to this work is the balancing of clinical, judicial and community concerns. The decision for outpatient care or movement of the patient to a non-forensic (regional) hospital is a significant turning point in the forensic patient's care. One of the major challenges faced by forensic mental health services is to develop consistency of practice throughout a state. A centralized system is easier to manage, but costly. A system embedded in community mental health centers is less duplicative, but requires major and ongoing educational support. A private practice model is flexible, but administratively challenging. The authors believe Maryland possesses well-developed approaches for the evaluation, treatment and conditional release of insanity acquittees. The state continues to study and redesign its systems toward increased effectiveness and efficiency.