Predictive validity of the <scp>HCR</scp>‐20 for inpatient aggression: the effect of intellectual disability on accuracy

O’Shea, Laura E.; Picchioni, Marco; McCarthy, Jane; Mason, Fiona; Dickens, Geoffrey L.

doi:10.1111/jir.12184

Cited by 20 publications

(11 citation statements)

References 38 publications

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“… 22 Similarly, a number of studies have reported elevated HCR-20 total and subscale scores among in-patients with intellectual disability, compared with those without. 5 , 6 , 17 , 23 Boer et al 24 outlined the principal items where people with intellectual disability may be likely to score higher on the HCR-20 than those without, such as relationship instability, employment problems and a lack of insight. However, regardless of the source of the problem relative to each item, each item is relevant to an accurate risk assessment of future violence.…”

Section: Discussionmentioning

confidence: 99%

“…The latter is important because of previous studies that reported that those with an intellectual disability within such services have higher rates of aggressive behaviour and higher scores on objective risk assessment tools. 5 , 6 Therefore, this study aimed to: (a) elucidate the characteristics and needs of patients with intellectual disability, who have been identified as ‘long stay’ within high and medium secure forensic psychiatric services, and (b) compare these with those who do not have a diagnosis of intellectual disability.…”

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confidence: 99%

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Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs

et al. 2018

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BackgroundIn recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability.AimsTo compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England.MethodFile reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported.ResultsOf the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores.ConclusionsIn spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs

et al. 2018

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“…Reports may also include near-incidents, where timely interventions prevented the incident from occurring. Incident reports of aggression in particular have shown to be related to clinical risk assessment for aggression (O'Shea et al 2015) and to be a helpful tool for care facilities to take measures towards guarding safety (Malda Castillo et al 2018).…”

mentioning

confidence: 99%

Impact of the initial response to COVID‐19 on long‐term care for people with intellectual disability: an interrupted time series analysis of incident reports

Schuengel

Tummers

Embregts

et al. 2020

J intellect Disabil Res

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Background The lockdown-measures in response to COVID-19 taken by long-term care organisations might have impacted problem behaviour and behavioural functioning of people with intellectual disability. This study tested changes in reported incidents, in particular regarding aggression, unexplained absence and, for contrast, medication errors. Methods Metadata on weekly incident and near-incident reports from 2016 to June 2020 involving over 14 000 clients with mild to serious intellectual disability of 's Heeren Loo, a long-term care organisation for people with intellectual disability, were subjected to interrupted time series analysis, comparing the COVID-19 with the pre-COVID-19 period. Results The imposition of lockdown-measures coincided with a significant drop in incidents (total, P < .001; aggression, P = .008; unexplained absences, P = .008; and medication errors, P < .001). Incidents in total (P = .001) and with aggression (P < .001) then climbed from this initial low level, while medication errors remained stably low (P = .94). Conclusion The rise in incidents involving aggression, against the background of generally lowered reporting, underlines the need for pandemic control measures that are suitable for people with intellectual disability in long-term care.

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“…Self-harm incidents as a service-level outcome indicator were reported in only two studies. 59,62 Neither of these studies reported change over time in self-harm as a result of intervention at the service level.…”

Section: Reoffending/'offending-like' Behaviour/incidentsmentioning

confidence: 98%

“…Most commonly, services used the structured clinical judgement tool the Historical, Clinical Risk 20 . 23,33,34,43,53,54,58,59 Other studies reported on static risk assessment measures such as the Violence Risk Appraisal Guide (VRAG), 23,53,54 Risk Matrix 2000, 53 Offender Group Reconviction Scale 22 and Static-99, 53 although these would not have utility as outcome measures as they would not be expected to change. The vast majority of these studies reported only cross-sectional data and not within-patient change in such measures over time.…”

Section: Risk Assessmentmentioning

confidence: 99%

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Morrissey

Geach

Alexander³

et al. 2017

Health Serv Deliv Res

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BackgroundInpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies was therefore undertaken.ObjectivesTo synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector.DesignThree linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.ResultsAt stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.ConclusionsTogether, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted.Future workThis would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.Study registrationThis study is registered as PROSPERO CRD42015016941.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Predictive validity of the HCR‐20 for inpatient aggression: the effect of intellectual disability on accuracy

Cited by 20 publications

References 38 publications

Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs

Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs

Impact of the initial response to COVID‐19 on long‐term care for people with intellectual disability: an interrupted time series analysis of incident reports

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

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