Recent Submissions

  • Development of the FORUM: a new patient and clinician reported outcome measure for forensic mental health services

    Sales, Christian P. (2021)
    Forensic mental health services provide care to people in secure psychiatric hospitals and via specialised community teams. Such services are typically low volume and high cost, often highly restrictive and average duration of inpatient care prior to discharge is long. Measuring outcomes of care is important to safeguard patients and the public, monitor progress, inform treatment plans and assist in service evaluation and planning. We describe the development in England of a new outcome measure for forensic mental health services. Patient interviews and multi-stakeholder focus groups were held to elicit key concepts. Thematic analysis was used to develop an outcomes framework. Fifteen patients participated in the interviews and 48 stakeholders in the focus groups. Six domains were identified in thematic analysis: 'about me, my quality of life, my health, my safety and risk, my life skills and my progress'. Sixty-two stakeholders participated in the first round of the Delphi process, and 49 completed round two. Eight of the top fifteen outcomes were shared between patients/carers and professionals. Based on these results, a new outcome measure, the FORensic oUtcome Measure (FORUM), was developed including both a patient reported and clinician reported measure. Further assessment of the FORUM's use to track patients' progress over time, and facilitate shared decision-making and care planning, is required.
  • Violence risk formation: The move towards collaboratively produced, strengths-based safety planning

    Jones, Lawrence F. (2020)
    Case formulation has been increasingly recognized as critical to the tasks of intervention and risk assessment with people who have been violent. As a practice, however, formulation has little evidence as yet to support it; this is in no small measure due to the heterogeneity in approaches to creating formulations. This chapter highlights some of the problems with case formulation and suggested ways of addressing these concerns by testing reliability and validity. There are a number of different approaches to formulation with people who have been violent currently being used. The danger of premature closure in terms of the practitioners understanding of the causal factors involved in offending, is hopefully offset by the emphasis in the formulation process on revisiting the causal model and revising it if it does not stand up to testing. The chapter explores key competencies and skill sets that needs to be developed by practitioners engaged in formulation. These include causal reasoning skills, co-production skills, cultural competencies, self-monitoring and self-reflection skills, skills in acknowledging uncertainty and not knowing, as well as being able to make conjectures and hypotheses and an up-to-date knowledge of the literature on violent offending.
  • LIGATURE RECORD: improved capture of risk information in CAMHS PICU using a mnemonic-style documentation aid

    Anyameluhor, Fumnanya; El-Ahmar, Hana; Morley, Lucy (2021)
    Psychiatric risks associated with ligature-tying present significant management challenges for inpatient multidisciplinary teams (MDT). Accurate and detailed clinical information capture following incidents involving ligatures is necessary to inform future risk management. A documentation tool is presented which has been demonstrated to improve the accuracy of recording of clinical risk information following inpatient ligature incidents in the child and adolescent mental health service (CAMHS) psychiatric intensive care unit (PICU) setting. The LIGATURE RECORD tool provides a highly useable prompt for information capture of 14 important data elements identified as relevant to MDT risk formulation. The effectiveness of the LIGATURE RECORD tool was audited following its introduction in PICU in May 2020. Contemporaneous incident reports and progress note entries were examined with an improvement in the frequency of reporting of all 14 domains seen, with near-100% completeness where the prompt was used directly as a template. Particular improvements were seen in recording of non-narrative elements such as circumstantial information and important negative reports. Formal and informal feedback from clinical staff indicated good usability and high rates of adoption of the tool.
  • What is the health and well-being burden for patients living with a child with ADHD in the United Kingdom?

    Daley, David (2020)
    Objective: To explore the burden associated with childhood ADHD in a large observational study. Methods: We recruited familes with at least one child (6-18 years) with ADHD via 15 NHS trusts in the UK, and collected data from all family members. We made careful adjustments to ensure a like-for-like comparison with two different control groups, and explored the impact of controlling for a positive parental/carer ADHD screen, employment, and relationship status. Results: We found significant negative impacts of childhood ADHD on parents'/carers' hours and quality of sleep, satisfaction with leisure time, and health-related quality of life (measured by the EuroQol-5D [EQ-5D]). We found a decrement in life satisfaction, mental well-being (as measured by the Short-Warwick Edinburgh Mental Well-Being Scale [S-WEMWBS]), and satisfaction with intimate relationships, but this was not always robust across the different control groups. We did not find any decrement in satisfaction with health, self-reported health status, or satisfaction with income. Conclusion: The study quantifies the impact on the health and well-being of parents living with a child with ADHD using a survey of families attending ADHD clinics in the United Kingdom.
  • Standardizing the assessment of emotional development in adults with intellectual and developmental disability

    Hudson, Mark (2020)
    Objective The Scale of Emotional Development—Short (SED‐S) is an instrument to assess the level of emotional development (ED) in people with intellectual and developmental disability. Index cases are developed as a didactic tool to standardize the application of the scale. Method In a stepwise process, a European working group from six countries developed five index cases, one for each level of ED. All cases were first scored by 20 raters using the SED‐S and then rephrased to reduce inter‐rater variations (SD > 0.5). Results All five index cases yielded overall ratings that matched the intended level of ED. Across the range of ED, Regulating Affect needed rephrasing most to ensure a distinct description within each level of ED. Conclusions The tri‐lingual, cross‐cultural evolution of five index cases contributes to a standardized application of the SED‐S and can serve as training material to improve the inter‐rater reliability of the SED‐S across different cultures and languages. (PsycINFO Database Record (c) 2020 APA, all rights reserved) (Source: journal abstract)
  • FACT: a randomised controlled trial to assess the feasibility of QbTest in the assessment process of attention deficit hyperactivity disorder (ADHD) for young people in prison-a feasibility trial protocol

    Hall, Charlotte L.; Brown, Nikki (2020)
    INTRODUCTIONThe prevalence of attention deficit hyperactivity disorder (ADHD) within the Children and Young People Secure Estate (CYPSE) is much higher than seen in the general population. To make a diagnosis of ADHD, clinicians draw on information from multiple sources, including parents and teachers. However, obtaining these is particularly difficult for young people in the secure estate. There is increasing evidence in the community that QbTest is able to assist in the accurate and earlier diagnosis of ADHD. The objective of this study is to assess the feasibility and acceptability of QbTest in the assessment of ADHD within the CYPSE.METHODS AND ANALYSISA single-centre parallel group feasibility randomised controlled trial will be conducted. Sixty young people within the CYPSE identified as displaying possible symptoms of ADHD will be randomised to the intervention arm (n=30; QbTest plus usual care) or control arm (n=30; usual care). Primary analyses will be descriptive and a process evaluation will be conducted to assess the contexts involved in implementing the intervention. Interviews will be conducted to explore acceptability and thematic analysis will be used to analyse the data.ETHICS AND DISSEMINATIONThis study was approved by National Health Service Wales research ethics committee 3 (18/WA/0347) on 15 February 2019. The findings will be published in peer-reviewed journals, presented at relevant conferences and disseminated to the public via summaries cocreated with our patient and public involvement group.TRIAL REGISTRATION NUMBERISRCTN17402196.
  • Factor and reliability analysis of a brief scale to measure motivation to change lifestyle for dementia risk reduction in the UK: the MOCHAD-10

    de Oliveira, Deborah; Orrell, Martin (2019)
    BACKGROUND: Modifying lifestyle risk factors for dementia is a public health priority. Motivation for change is integral to the modification of health-related risk behaviours. This study investigates the psychometric properties of the previously validated tool entitled 'Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction Scale' (MCLHB-DRR) for use in the UK. METHODS: A sample of 3,948 individuals aged 50 and over completed the 27-item MCLHB-DRR online. The psychometric properties of the scale were explored via Exploratory Principal Axis Factoring (PAF) with Oblimin rotation. Confirmatory Factor Analysis (CFA) was used to confirm the factor structure using chi-square (chi2), the goodness-of-fit index (GFI), the comparative fit index (CFI), the root mean square error of approximation (RMSEA) and Root Mean Square Residual (RMR) as fit indices to evaluate the model fit. Internal consistency (Cronbach alpha) was measured for the final scale version. RESULTS: Exploratory Factor Analysis (EFA) resulted in a parsimonious 10-item, two-factor structure (5 items each, factor loadings > 0.3) that explained 52.83% of total variance. Based on the Pattern Matrix, Factor 1 was labelled "Positive Cues to Action" and Factor 2 was labelled "Negative Cues to Action". After addressing some errors in covariances, CFA showed a good fit where all fit indices were larger than 0.90 (GFI = 0.968, CFI = 0.938) and smaller than 0.08 (RMSEA = 0.072, RMR = 0.041). The standardized coefficients of Factor 1 and Factor 2 ranged from 0.30 to 0.73 and were all statistically significant (p < 0.001). The final scale showed moderate to high reliability scores (Factor 1 alpha = 0.809; Factor 2 alpha = 0.701; Overall alpha = 0.785). CONCLUSIONS: The new MOCHAD-10 (Motivation to Change Behaviour for Dementia Risk Reduction Scale) is a short, reliable and robust two-factor, 10-item clinical tool for use in preventative health care and research to evaluate motivation to change lifestyle for dementia risk reduction.
  • Electroconvulsive therapy for treatment-resistant schizophrenia

    Sinclair, Diarmid J. M.; Adams, Clive E. (2019)
    Background: Electroconvulsive therapy (ECT) involves the induction of a seizure by the administration of an electrical stimulus via electrodes usually placed bilaterally on the scalp and was introduced as a treatment for schizophrenia in 1938. However, ECT is a controversial treatment with concerns about long-term side effects such a memory loss. Therefore, it is important to determine its clinical efficacy and safety for people with schizophrenia who are not responding to their treatment. Objective(s): Our primary objective was to assess the effects (benefits and harms) of ECT for people with treatment-resistant schizophrenia. Our secondary objectives were to determine whether ECT produces a differential response in people: who are treated with unilateral compared to bilateral ECT; who have had a long (more than 12 sessions) or a short course of ECT; who are given continuation or maintenance ECT; who are diagnosed with well-defined treatment-resistant schizophrenia as opposed to less rigorously defined treatment-resistant schizophrenia (who would be expected to have a greater affective component to their illness). Search Method(s): We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including clinical trial registries on 9 September 2015 and 4 August 2017. There were no limitations on language, date, document type, or publication status for the inclusion of records in the register. We also inspected references of all the included records to identify further relevant studies. Selection criteria Randomised controlled trials investigating the effects of ECT in people with treatment-resistant schizophrenia. Data Collection and Analysis: Two review authors independently extracted data. For binary outcomes, we calculated the risk ratio (RR) and its 95% confidence intervals (CIs), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between the groups and its 95% CIs. We employed the fixed-effect model for all analyses. We assessed risk of bias for the included studies and created'Summary of findings' tables using the GRADE framework. Main Result(s): We included 15 studies involving 1285 participants (1264 completers with an average age of 18 to 46 years) with treatment-resistant schizophrenia. We rated most studies (14/15, 93.3%) as at high risk of bias due to issues related to the blinding of participants and personnel. Our main outcomes of interest were: (i) clinically important response to treatment; (ii) clinically important change in cognitive functioning; (iii) leaving the study early; (iv) clinically important change in general mental state; (v) clinically important change in general functioning; (vi) number hospitalised; and (vii) death. No trial reported data on death. The included trials reported useable data for four comparisons: ECT plus standard care compared with sham-ECT added to standard care; ECT plus standard care compared with antipsychotic added to standard care; ECT plus standard care compared with standard care; and ECT alone compared with antipsychotic alone. For the comparison ECT plus standard care versus sham-ECT plus standard care, only average endpoint BPRS (Brief Psychiatric Rating Scale) scores from one study were available for mental state; no clear difference between groups was observed (short term; MD 3.60, 95% CI -3.69 to 10.89; participants = 25; studies = 1; very low-quality evidence). One study reported data for service use, measured as number readmitted; there was a clear difference favouring the ECT group (short term; RR 0.29, 95% CI 0.10 to 0.85; participants = 25; studies = 1; low-quality evidence). When ECT plus standard care was compared with antipsychotics (clozapine) plus standard care, data from one study showed no clear difference for clinically important response to treatment (medium term; RR 1.23, 95% CI 0.95 to 1.58; participants = 162; studies = 1; low-quality evidence). Clinically important change in mental state data were not available, but average endpoint BPRS scores were reported. A positive effect for the ECT group was found (short-term BPRS; MD -5.20, 95% CI -7.93 to -2.47; participants = 162; studies = 1; very low-quality evidence). When ECT plus standard care was compared with standard care, more participants in the ECT group had a clinically important response (medium term; RR 2.06, 95% CI 1.75 to 2.42; participants = 819; studies = 9; moderate-quality evidence). Data on clinically important change in cognitive functioning were not available, but data for memory deterioration were reported. Results showed that adding ECT to standard care may increase the risk of memory deterioration (short term; RR 27.00, 95% CI 1.67 to 437.68; participants = 72; studies = 1; very low-quality evidence). There were no clear differences between groups in satisfaction and acceptability of treatment, measured as leaving the study early (medium term; RR 1.18, 95% CI 0.38 to 3.63; participants = 354; studies = 3; very low-quality evidence). Only average endpoint scale scores were available for mental state (BPRS) and general functioning (Global Assessment of Functioning). There were clear differences in scores, favouring ECT group for mental state (medium term; MD -11.18, 95% CI - 12.61 to -9.76; participants = 345; studies = 2; low-quality evidence) and general functioning (medium term; MD 10.66, 95% CI 6.98 to 14.34; participants = 97; studies = 2; very low-quality evidence). For the comparison ECT alone versus antipsychotics (flupenthixol) alone, only average endpoint scale scores were available for mental state and general functioning. Mental state scores were similar between groups (medium-term BPRS; MD -0.93, 95% CI -6.95 to 5.09; participants = 30; studies = 1; very low-quality evidence); general functioning scores were also similar between groups (medium-term Global Assessment of Functioning; MD -0.66, 95% CI -3.60 to 2.28; participants = 30; studies = 1; very low-quality evidence). Authors' conclusions: Moderate-quality evidence indicates that relative to standard care, ECT has a positive effect on medium-term clinical response for people with treatment-resistant schizophrenia. However, there is no clear and convincing advantage or disadvantage for adding ECT to standard care for other outcomes. The available evidence was also too weak to indicate whether adding ECT to standard care is superior or inferior to adding sham-ECT or other antipsychotics to standard care, and there was insufficient evidence to support or refute the use of ECT alone. More good-quality evidence is needed before firm conclusions can be made. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
  • Česká adaptace dotazníku CORE-OM: Vybrané psychometrické charakteristiky [Czech adaptation of the CORE-OM: Selected psychometric properties]

    Evans, Chris (2018)
    Objectives: The aim of the study was to adapt the CORE-OM measure to the Czech context and evaluate its psychometric properties. Sample and setting: CORE-OM, RSES, and SCL-90 were administered to 375 patients from four psychotherapy clinics (a clinical sample). Further, the first two measures were administered to 233 respondents from the general population (a non-clinical sample). Statistical analysis: The questionnaire structure was explored through an exploratory factor analysis, concurrent validity assessed using correlation with SCL-90 and RSES, and internal consistency using Cronbach’s alpha. The difference between the clinical and the non-clinical samples was determined by the Mann-Whitney test and sensitivity to change was assessed by the Wilcoxon signed-rank test. Results: The factor analysis revealed a two-factor structure. However, the factor solution for the clinical and the non-clinical samples differed. In the clinical sample, the internal consistency of the Total Score was α = 0,933, the Total Score correlated r s = 0,80 with GSI SCL- 90 and r s = -0,51 with RSES. The measure successfully differentiated between the clinical and the non-clinical samples. Using the Total Score, the clinical cutoff score had a value of c = 1,349 and the Reliable Change Index had a value of RCI = 0,445. The sensitivity to psychotherapy change was adequate ( r ~ -0,35 to -0,50 for individual clinics). Study limitation: The data was obtained through casual sampling and did not include outpatients or respondents with a psychotic disorder. Evaluation of sensitivity to change was based solely on self-report measures. (PsycINFO Database Record (c) 2018 APA, all rights reserved) (Source: journal abstract) Original language abstractCíle: Cílem této studie bylo adaptovat zahraniční dotazník CORE-OM do českého prostředí a ověřit jeho psychometrické vlastnosti. Soubor a metoda: Testovou baterii zahrnující CORE-OM, RSES a SCL-90 vyplnilo 375 pacientů ze čtyř klinických pracovišť (klinický vzorek). První dva nástroje vyplnilo také 233 respondentů z běžné populace (neklinický vzorek). Analýza: Struktura dotazníku byla zjišťována pomocí explorační faktorové analýzy, souběžná validita prostřednictvím korelace s nástroji SCL-90 a RSES a vnitřní konzistence pomocí Cronbachova koeficientu alfa. Rozdíl mezi klinickým a neklinickým výběrem byl testován Mann-Whitneyovým testem a citlivost ke změně pomocí Wilcoxonova znaménkového testu. Výsledky: Faktorová struktura dotazníku byla tvořena dvěma faktory, faktorová řešení pro klinický a neklinický výběr se však lišila. Pro klinický výběr dosahovala vnitřní konzistence celkového skóru hodnoty α = 0,933, korelace celkového skóru s GSI SCL-90 nabývala hodnoty r s = 0,80 a s RSES rs = -0,51. Dotazník dobře rozlišoval mezi klinickým a neklinickým výběrem. U celkového skóru dosahoval hraniční skór hodnoty c = 1,349 a index spolehlivé změny RCI = 0,445. Citlivost k terapeutické změně byla adekvátní (r ~ -0,35 až -0,50 pro různá klinická pracoviště). Limity studie: Data byla získána příležitostným výběrem a nezahrnovala klienty ambulantních pracovišť ani respondenty s psychotickým onemocněním. Testování citlivosti ke změně bylo založeno pouze na sebeposuzovacích metodách. (PsycINFO Database Record (c) 2018 APA, all rights reserved) (Source: journal abstract)
  • Risk assessment and suicide prevention in primary care

    Milton, John; Ferguson, Brian G. (1999)
    General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.
  • Forensic case formulation

    McMurran, Mary (2011)
    Addresses risk assessment and its implications for case formulation and treatment Covers a range of serious forensic problems such as violence, sexual offending, personality disorder, and substance misuse Offers guidance in training clinicians on ways to create useful formulations
  • Forensic case formulations: emerging issues

    McMurran, Mary (2011)
    In this concluding chapter, we will comment upon the previous chapters in this volume, review emerging issues in clinical case formulation generally and forensic case formulation specifically, and suggest directions for future research and practice in forensic case formulation. Many issues are common to all forms of case formulation. The issues of reliability and validity have haunted the literature on case formulation for over 30 years. The literature is full of vivid assessments of individual cases and sleight of hand translations of formulations into startling, innovative and counter-intuitive treatments. For example, Wolpe's (1986) assessment of an apparent height phobia revealed that, although the person was fearful when in her apartment in a tall building, her fear was not a fear of heights, but rather a fear of people thinking negatively about her which commonly happened when she was alone in her apartment. Hence, the counter intuitive treatment for this apparent height phobia was not exposure to heights – the clients already had such formulaic treatment and it had failed – rather, her treatment was based on exposure to imagining criticism from other people, a treatment that was highly effective. But such clinical scintillation should not blind us to the presence of the naked emperor in the room. In a series of reviews and empirical studies, Kuyken has repeatedly pointed out that despite the continuing interest in case formulation for many years, despite the recognition of case formulation as a core skill by many different professional organizations, despite over two decades of research into case formulation, the evidence supporting the use of case formulation remains sparse, incomplete and contradictory (Kuyken, 2006). The chapters by Mumma on reliability and Ghaderi on treatment validity show that this parlous state of affairs continues despite calls to action.
  • An individual case formulation approach to the assessment of motivation

    Jones, Lawrence F. (2002)
    This chapter contains section titled: Practice Algorithm Stage 1: Assessing Contextual and Situational Variables Stage 2: Initial Brief Assessment of Interest in Change Stage 3: Parallel Assessment and Intervention for Those who do not Wish to Engage Stage 4: Testing Veracity of Expressed Interest in Engagement Stage 5: Identifying Obstacles to Engagement Stage 6: Ongoing Assessment of Offence Paralleling Behaviour and Risk Conclusion Acknowledgements References
  • An electronic clinical decision support system for the assessment and management of suicidality in primary care: Protocol for a mixed-methods study

    Horrocks, Matthew; Aubeeluck, Aimee; Wright, Nicola; Morriss, Richard K. (2018)
    Background: Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management is an area that many General Practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalise and assess suicide risk which subsequently has an impact on clinical decision making. Clinical Decision Support systems (CDSS) have been widely implemented across different healthcare settings, including primary care to support practitioners in clinical decision making. CDSS may reduce inconsistencies in the identification, assessment and management of suicide risk by GPs by guiding them through the consultation and generating a risk assessment plan that can be shared with a service user or with specialised mental health services. Objective: To co-develop and test with end users (e.g. GPs, primary care attendees, mental health professionals) an e-CDSS to support GPs in the identification, assessment and management of suicidality in primary care. Methods: An ongoing embedded mixed methods study with four phases: 1) Qualitative interviews with GPs to explore their views on the content, format and use of the e-CDSS; consultation with two service user advisory groups (people aged ≤ 25 and people aged ≥25) to inform the content of the e-CDSS including phrasing of items and clarity; 2) Participatory co-production workshops with GPs, service users and clinical experts in suicidality to determine the content and format of the e-CDDS; gain consensus of the relevance of items; establish content validity (CVI) and identify pathways to implementation, using the Consolidated Framework for Implementation Research; 3) Building the e-CDSS so that it guides the GP through a consultation and 4) Usability testing of the e-CDSS with GPs and service users in one primary care practice involving a non-live and a live stage. Results: This is an ongoing study. The findings will enable us to evaluate the feasibility, acceptability and usability of a suicide specific electronic guided decision support system in primary care. Conclusions: This study will be the first to explore the feasibility, acceptability and usability of electronic guided decision support system for use in primary care consultations for the improved assessment and management of suicidality.
  • Electroconvulsive therapy for treatment-resistant schizophrenia

    Sinclair, Diarmid J. M.; Adams, Clive E. (2015)
    This is the protocol for a review and there is no abstract. The objectives are as follows: Our primary objective is to assess the effects (benefits and harms) of ECT for people with treatment-resistant schizophrenia. Our secondary objectives are to determine whether ECT produces a differential response in people: who are treated with unilateral compared to bilateral ECT; who have had a long course of ECT (more than 12 sessions) or short course of ECT; who are given continuation or maintenance ECT; who are diagnosed with well defined treatment resistant schizophrenia as opposed to less rigorously defined treatment-resistant schizophrenia (who would be expected to have a greater affective component to their illness). Copyright © 2015 The Cochrane Collaboration.
  • On mental health

    Taylor, Jeremy (2005)
  • Professionals' perceptions of the Mental Health Recovery Star

    Tickle, Anna C.; Walker, Clare A. (2013)
    Purpose: The Mental Health Recovery Star (MHRS) has received focus at a national policy level in consideration of outcome measurement within mental health services. The purpose of this paper is to seek the views of mental health professionals about its use within clinical practice. Design/methodology/approach: The paper employed a qualitative, exploratory design to interview 12 participants. Thematic analysis was used. Findings: Four main themes were identified: "the utility of the Recovery Star"; "not for everybody"; "service user involvement"; and "the status of the Recovery Star within the Trust". A range of factors was found to influence participants' use of the tool with service users. Research limitations/implications: The paper involved a small number of participants due to a low response rate. Future research could include larger studies and more detailed exploration of factors identified as limiting the use of the MHRS. Practical implications: The MHRS is a potentially useful tool but its limitations and the influence of organisational context must be considered as part of any plan to systematically implement its use within services. Originality/value: To the authors' knowledge, this is the first study of the views of mental health professionals about the MHRS. As it is professionals who are likely to determine whether and how the tool is used, the paper is seen as a valuable initial investigation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
  • Is everything in the garden rosy? An integrated care pathway for acute inpatient mental health care, from development to evaluation: Part 2

    Hall, Julie E. (2005)
    This is the second paper of two, which considers the development, use and evaluation of an integrated care pathway (ICP) for acute inpatient mental health care. This paper reports an evaluation that was carried out to measure the impact of an ICP (described in Part 1) on the interventions it was designed to guide. The methodology used was pre- and post-ICP comparison of activities/care recorded in health-care records using delineating measures. Data were gathered from the notes of 23 service-users who had two inpatient stays within a year, one pre-ICP and one post-ICP. The findings suggested an overall improved provision of interventions, although as the ICP progressed the likelihood of receiving interventions fell. Three specific aspects were not affected by the ICP, these were giving information about observation levels to service-users, care planning and medical interventions. These issues are discussed and the conclusion raise implications for further ICP development and implementation. © The Royal Society of Medicine Press 2005.
  • Forensic risk assessment in mental health practice: Part 2

    Woodcock, Ray (2011)
    In the last 20 years, risk assessment has expanded to mean much more than a simple determination of how dangerous an individual is. Risk formulations now encapsulate the assessment process more generally, and provide the basis for the identification of treatment needs, the development of supervision and risk reduction plans. In the first part of this series, the fluid nature of violence risk was emphasized. Further to this, it was pointed out that violence risk often changes over time and is heavily dependent on context. Part 2 expands on some of these ideas by considering some basic principles of forensic risk assessment and identifying some key issues which touch on the risk assessment and management processes.
  • EssenCES, a short questionnaire for assessing the social climate of forensic psychiatric wards

    Collins, Mick; Stacey, Jacqueline; Howells, Kevin (2008)
    Background: A supportive ward atmosphere is considered by many to be a precondition for successful treatment in forensic psychiatry, but there is a clear need for a valid and economic climate evaluation instrument. Aims: To validate a short questionnaire, designed for assessing forensic psychiatric wards. Climate dimensions measured with the 'Essen Climate Evaluation Schema' (EssenCES) are 'Therapeutic Hold', 'Patients' Cohesion and Mutual Support' and 'Safety' (versus threat of aggression and violence). Method: In 17 forensic mental hospitals in Germany, patients and staff completed the EssenCES and other questionnaires. Problematic events were recorded over a period of 3 weeks on each ward. Results: The anticipated three factor structure of the instrument was confirmed. The pattern of correlations also provided support for the validity of the subscales. Conclusions: The climate questionnaire is an economic and valid instrument for assessing the ward atmosphere in forensic psychiatry. Findings from a pilot study in England give confidence to the structural validity of the English version too. Copyright © 2008 John Wiley & Sons, Ltd.

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