Use and interpretation of routine outcome measures in forensic mental health

Shinkfield, Gregg; Ogloff, James R. P.

doi:10.1111/inm.12092

Cited by 14 publications

(14 citation statements)

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“…However, the D1 has been shown not to predict conditional discharge from a secure forensic hospital [ 15 ]—which would be the role of the DUNDRUM-3 and DUNDRUM-4 measures—and not to correlate with some risk assessment measures [ 16 ]. However, the D-1, when combined with the other scales of the DUNDRUM quartet, has been found to meet criteria for an acceptable routine outcome measurement in forensic mental health [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…A recent development in the assessment of need for therapeutic security has been the initial validation of the Dangerousness Understanding, Recovery And Urgency Manual (DUNDRUM Quartet; [ 9 ]), a suite of measures that aid the triaging of potential patients into all levels of therapeutic security, as well as the assessment of treatment completion and readiness for discharge. The DUNDRUM Quartet consists of four assessments of appropriateness of patients for admission to, and retention in, forensic mental health services and has seen increased adoption internationally since its publication [ 10 ]. The first assessment considers need for admission to forensic services, and has been validated by the authors [ 11 ]; the second considers urgency for admission [ 12 ]; and the third and fourth assessments assess, respectively, progress in treatment and recovery and have also received preliminary validation [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

et al. 2015

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BackgroundForensic medium secure services in the UK are a scarce but essential resource providing care for those in the criminal justice system with severe mental disorder. Appropriate allocation of beds to those most in need is essential to ensure efficient use of this resource. To improve decision-making processes in a UK forensic service, an admissions panel utilized the DUNDRUM 1&2 (D1 & D2) triage instruments.MethodsDemographic, diagnostic and clinical information on a prospective sample of referrals to a UK adult forensic service was gathered (n = 195). D1 and D2 measures were scored by a panel of clinical managers considering referral information and clinician opinion in reaching their ratings; those not admitted were also followed up.ResultsWithin the sample, D1 ratings were predictive of decisions to admit (AUC = .79) and also differentiated between levels of security (F(4) = 16.54, p < .001). Non-admission was not significantly associated with increased risk of offending at follow-up. Items relating to self-harm and institutional behaviour did not show a predictive relationship with the panel decision to admit.ConclusionsUse of a structured professional judgement tool showing good predictive validity has improved transparency of decisions and appears to be associated with more efficient use of resources, without increased risk to the public.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

et al. 2015

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“…Due to the nature of the patient population, their potential risk of recidivism and the restrictiveness of the system and facility, implementing recovery-oriented treatment in forensic psychiatry is complicated (7). Forensic psychiatric patients have mental health difficulties and functional impairment, but also present a history of criminal behavior, violent or sexual offending, a high prevalence of comorbid personality disorder, behavior disturbance, self-harm, and substance use (8). Treatment is thus related to a patient's clinical and psychopathological needs but should also take into account the balance between his/her needs and the needs for safety (9).…”

Section: Introductionmentioning

confidence: 99%

Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

Vorstenbosch

Castelletti

2020

Front. Psychiatry

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The Italian forensic psychiatric system underwent drastic reforms. The newly developed facilities are inspired by psychiatric community services, embracing a recovery-oriented approach. Needs and quality of life are broader concepts that consider the more rehabilitative and humanitarian aspects of treatment. In one of the new Italian forensic psychiatric services, this cross-sectional study aimed to investigate the needs and quality of life of forensic psychiatric patients. A second aim was to validate the Italian version of the Forensic inpatient Quality of Life questionnaire Short Version (FQL-SV). Overall, 42 forensic psychiatric patients were assessed using the Forensic version of the Camberwell Assessment of Need (CANFOR), the Historical-Clinical-Risk-Management-20 (HCR-20), the FQL-SV, and the World Health Organization Quality of Life (WHOQoL-Bref). Patients reported significantly fewer needs, whether met or unmet, than their treating clinicians. The general level of agreement between patients and clinicians on specific needs was low Kappa values were < .40 for 64% of the total needs and 46% of the unmet needs. Risk factors according to the HCR-20 mean scores were 13.1, 4.6, and 6.4 for the historical, clinical and risk management subscale. Quality of life was moderate to high for 74% of the patients. Our results showed that lower numbers of needs, whether reported by patients or clinicians, were associated with a better quality of life. The Italian FQL-SV had a Cronbach's alpha of 0.86 and correlated as expected with the WHOQoL-Bref. The FQL-SV is a valid and reliable tool, justifying its use for routinely assessing QoL in Italian forensic psychiatric services. This study enhances our understanding of needs and quality of life of forensic psychiatric patients and how their assessment could have an additional value for recoveryoriented treatment in forensic psychiatry. Although the detained status of forensic patients imposes real limits on the capacity for autonomy and choice, incorporating the patient's perspective on decision-making processes, in relation to aspects of treatment, care, and daily life, may have benefits such as a better treatment adherence or therapeutic alliance. Future research should clarify how routinely assessing needs and quality of life can contribute to the recovery of these forensic psychiatric patients.

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“…With regard to possible frequent cases of cognitive impairment and/or insufficient motivation to give sensible responses to CES-D questions, the patient-reported responses were collected from patients during one-on-one sessions with a nurse, who read a single CES-D item step-by-step, in case of need giving some necessary explanation and encouragement, and then listened to the patient's response and recorded it on the CES-D form. It should be emphasized that during a session, the nurse should properly document the course of interaction with a patient (Dijkstra, 2002;Shinkfield et al, 2015). The applied procedure created the best circumstances possible for the respondents to reflect and formulate proper answers to the questionnaire questions (Collins, 2003).…”

Section: Discussionmentioning

confidence: 99%

The Center for Epidemiologic Studies Depression Scale (CES-D): Is It Suitable for Use with Older Adults?

Górkiewicz

Chmiel

2015

Studies in Logic, Grammar and Rhetoric

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With the aim of verifying the suitability of the CES-D scale for use in long-term care institutions for older adults, the CES-D questionnaire was used to collect patient-reported assessments, and two well-known psychometric instruments – the Hospital Anxiety and Depression Scale (HADS) and the Barthel Index of Abilities of Daily Living – were used to collect nurse-reported assessments, based on observations of patients’ behaviours. With regard to possible frequent cases of cognitive impairment and/or insufficient motivation to give sensible responses to CES-D questions, the patient-reported responses were collected from patients during one-on-one sessions with a nurse. The reliability, concurrent validity, and the trustworthiness of the obtained data were supported with proper values of the Cronbach’s alpha coefficient, 0.70 < alpha < 0.85, with significant correlation between CES-D and HADS-Depression, R = 0.50, p < 0.001, and with significant correlation between scores of particular CES-D items vs. final CES-D evaluations of depression, proved by significance p < 0.001 for 18 of 20 CES-D items. These findings supported the effectiveness of the one-on-one session methodology in questionnaire surveys for older adults. The postulation that cases of self-reported depression included somewhat different information about the patient than nurse-reported depression concerning the same patient was supported with the evidence that, in spite of the significant correlation between the Barthel Index and HADS-Depression, R = −0.17, p = 0.016, and in spite of the significant correlation between CES-D and HADS-Depression, the correlation between the Barthel Index and CES-D, equal to R = −0.08 was insignificant at p = 0.244. The findings of this study, considered jointly, support the valuableness of the CES-D scale for use in one-on-one surveys for older adults.

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Use and interpretation of routine outcome measures in forensic mental health

Cited by 14 publications

References 20 publications

Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

The Center for Epidemiologic Studies Depression Scale (CES-D): Is It Suitable for Use with Older Adults?

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