Routine violence risk assessment in community forensic mental healthcare

Abstract

We developed a method for periodic monitoring of violence risk, as part of routine community forensic mental healthcare. The feasibility of the method was tested, as well as its predictive validity for violent and risk enhancing behavior in the subsequent months. Participants were 83 clients who received forensic psychiatric home treatment, and six case managers. The method proved feasible and informative. Violent and risk enhancing behavior could be predicted to a reasonable extent (AUC ¼ .77, 95% CI ¼ .70-.85; respectively .76, .70-.82). Dynamic risk factors had an incremental predictive value over static factors in the prediction of violent behavior (OR ¼ 4.30, 1.72-10.73). The professional judgment of the case managers added further predictive power (OR ¼ 2.16, 1.40-3.33), corroborating the structured professional judgment approach. Finally, unmet needs for care of the client were associated with a reduced risk for violent and risk enhancing behavior (OR ¼ .80, and 0.84,). This latter finding suggests that in cases with unmet needs the case manager saw opportunities to do something about the risk. Currently we are testing whether using the method actually prevents violence.

Predictive Validity of the HKT-R Risk Assessment Tool: Two and 5-Year Violent Recidivism in a Nationwide Sample of Dutch Forensic Psychiatric Patients

“…Comparing these results with those found in other studies using the HKT-30 ( Canton et al, 2004 ; Hildebrand, Hesper, Spreen, & Nijman, 2005 ; Schönberger, Hildebrand, Spreen, & Bloem, 2008 ; van den Brink et al, 2010 ), the predictive validity of the Historical domain of the HKT-R has clearly improved; the predictive validity of the Clinical and Future domains have stayed stable. The predictive accuracy of the total score stayed stable and the FRJ after 5 years has somewhat decreased.…”

“…Patients convicted by the court to a TBS measure ( ter beschikkingstelling : involuntary admission by order of the state; de Ruiter & Trestman, 2007 ) have committed a crime caused by their problematic mental state during a period of insanity. The primary goal of a TBS order is the protection of society and the resocialization of the patients into society ( Brink, van den Hooijschuur, Os, van Savenije, & Wiersma, 2010 ; Van Marle, 2002 ). All forensic patients with a TBS order receive treatment to reduce the risk of future recidivism and to prepare them for reintegration into society ( Van der Veeken, Lucieer, & Bogaerts, 2016 ).…”

Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation

“…This must be done for various purposes, such as the adjustment or continuation of current treatments or the granting of leave modalities. Despite the positive impact of ROM [ 24 ] in general psychiatry and the use of ROM in decision making [ 25 ], we note that ROM in Dutch forensic psychiatry has only recently been introduced and that only a handful of empirical studies have been conducted in this field [ 26 , 20 , 21 ].…”

Predictive validity of the Short-Term Assessment of Risk and Treatability for violent behavior in outpatient forensic psychiatric patients.

“…It should be noted, however, that dynamic risk factors were not assessed with the START but with various other instruments (for details, see van den Brink et al, 2010). Regardless of this issue, the different findings Note.…”