• Goal attainment scaling: Usefulness of a tool to measure risk in violent mentally disordered offenders

      Izycky, Amy; Braham, Louise G.; Williams, Lisa; Hogue, Todd E. (2010)
      Measures of risk employed in mental health settings in the last 20 years have consisted of clinical scales that comprise both historical and clinical factors. Examples of such tools include the widely used HCR-20, SVR-20 and VRS. Such tools are time-intensive and, in the main, completed by an independent rater. At present there is a lack of systems to guide teams to investigate salient risk factors related to mental state and violent offending that inform treatment effectiveness, change and, ultimately, risk assessment decisions. This paper describes the application of such a system. The Standard Goal Attainment Scaling for Sex Offenders (GAS-S) has been modified for use with violent offenders and is presented herewith. Application of the tool to the Violent Offender Treatment Programme (VOTP) is discussed, alongside its potential usefulness in informing risk assessment and the effectiveness of treatment intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • History of the offence paralleling behaviour construct and related concepts

      Jones, Lawrence F. (2010)
      Constructs related to offence paralleling behaviour (OPB) have been around in the literature for many years. Obviously, some forms of assessment involve direct observation of the phenomenon being studied. In the study and assessment of offending behaviour and the risk of offending, however, the context of assessment and intervention is generally significantly different from the context of the behaviour being examined. This difference between the context of assessment and the context of offending is a central problem for most assessments undertaken by forensic practitioners. It is a curious phenomenon in the history of risk assessment and interventions targeting risk that intervention-based models of risk differ significantly from the models of risk used in the context of assessment. Most interventions targeting risk of reoffending use a combination of motivation, skill development, insight development and relapse prevention associated with developing approach goals. The causal models of risk-related behaviour in this context differ significantly from the models implicit in risk assessments. Indeed, often the reasons for including variables in a risk assessment instrument are atheoretical and based on data-dredging exercises or meta-analyses of predictors of reoffending/reconviction. This lack of coherence between the two models of risk is puzzling. In this chapter the model of offence processes implicit in relapse prevention and related interventions will also be explored as they have much in common with the OPB construct. Types of risk assessment and offence analysis are first explored before the OPB construct is described and analysed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
    • How reliable are case formulations? A systematic literature review

      Flinn, Lucinda C.; Braham, Louise G. (2015)
      Objectives: This systematic literature review investigated the inter-rater and test-retest reliability of case formulations. We considered the reliability of case formulations across a range of theoretical modalities and the general quality of the primary research studies.; Methods: A systematic search of five electronic databases was conducted in addition to reference list trawling to find studies that assessed the reliability of case formulation. This yielded 18 studies for review. A methodological quality assessment tool was developed to assess the quality of studies, which informed interpretation of the findings.; Results: Results indicated inter-rater reliability mainly ranging from slight (.1-.4) to substantial (.81-1.0). Some studies highlighted that training and increased experience led to higher levels of agreement. In general, psychodynamic formulations appeared to generate somewhat increased levels of reliability than cognitive or behavioural formulations; however, these studies also included methods that may have served to inflate reliability, for example, pooling the scores of judges. Only one study investigated the test-retest reliability of case formulations yielding support for the stability of formulations over a 3-month period.; Conclusions: Reliability of case formulations is varied across a range of theoretical modalities, but can be improved; however, further research is required to strengthen our conclusions.; Practitioner Points: Clinical implications: The findings from the review evidence some support for case formulation being congruent with the scientist-practitioner approach. The reliability of case formulation is likely to be improved through training and clinical experience. Limitations: The broad inclusion criteria may have introduced heterogeneity into the sample, which may have affected the results. Studies reviewed were limited to peer-reviewed journal articles written in the English language, which may represent a source of publication and selection bias.; © 2014 The British Psychological Society.
    • Identifying British Army infantry recruit population characteristics using biographical data

      Repper, Julie (2016)
      Background: The infantry accounts for more than a quarter of the British Army but there is a lack of data about the social and educational background of its recruits.; Aims: To provide an insight into British Army infantry recruits' personal, social and educational background prior to enlistment.; Methods: The study sample consisted of infantry recruits who enlisted into the British Army School of Infantry. Each recruit completed a 95-item biographical questionnaire. Descriptive statistics were used to describe the sample in terms of demographic, physical, personal, social and educational attributes.; Results: The study sample consisted of 1000 male recruits. Over half of the recruits were consuming alcohol at a hazardous or harmful level prior to enlistment and 60% of recruits had used cannabis prior to joining the Army. Academic attainment was low, with the majority of recruits achieving GCSE grade C and below in most subjects, with 15% not taking any examinations. Over half the recruits had been in trouble with the police and either been suspended or expelled from school.; Conclusions: Substance misuse and poor behaviour are highly prevalent among recruits prior to enlistment. Taken alongside existing evidence that some of these problems are commonplace among personnel in regular service, the assumption that the British Army infantry is, in itself, a cause of these behaviours should be questioned.; © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    • Implementing routine outcome measures in child and adolescent mental health services: From present to future practice

      Moldavsky, Maria; Marriott, Michael (2013)
      Background: Routine outcome measurement (ROM) in CAMHS is supported by U.K. Government policy. However, little is known about how measures are used in practice. Method: Data describing use of ROM, knowledge and attitudes regarding implementation were collected using a regional case-note audit, online survey and stakeholder workshop. Results: While the principle of ROM was supported by stakeholders, baseline and follow-up outcome measurement occurred in less than a fifth of cases. Barriers to implementation included lack of training and resources, clinicians' perceptions of the limitations of existing measures and lack of regular feedback of outcome data. Conclusions: Implementation of ROM may be facilitated by session-by-session measures with immediate feedback to clinicians and patients.
    • In their own words: A narrative-based classification of clients' problems on an idiographic outcome measure for talking therapy in primary care

      Evans, Chris (2006)
      The perspective of users has become a crucial component of healthcare planning, delivery and evaluation but, within mental healthcare, clients' views of their problem, in their own words, rarely form the basis for measuring the outcome of talking therapy. A new outcome measure, 'PSYCHLOPS' (Psychological Outcome Profiles), invites the client to write down 'the problem that troubles you most', 'another problem' and to 'choose one thing that is hard to do because of your problem'. Responses to these three items enabled us to explore how clients conceptualise their most troubling problem and the consequences of this problem and to provide a typology of these responses. A narrative-based approach was used to analyse PSYCHLOPS data from 235 users of primary care mental health services recruited through four therapists working in southeast England. Seven thematic categories emerged from the analysis of clients' responses to the domain 'problem': interpersonal; past event; state of mind; somatic; self-evaluation; competence/performance; material issues. Responses to the domain, 'consequences of the problem', were categorised under one of six themes: competence/performance; interpersonal; frame of mind; resolution and progression; self-evaluation; somatic. Users of mental health services in primary care offer a rich diversity of narratives, and these represent clients' voices that frame problems within the personal and social contexts in which they are experienced. © 2006 Radcliffe Publishing.
    • Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children

      Smailagic, Nadja; Huband, Nick (2011)
      Background Parenting programmes are a potentially important means of supporting teenage parents and improving outcomes for their children, and parenting support is a priority across most Western countries. This review updates the previous version published in 2001. Objectives To examine the effectiveness of parenting programmes in improving psychosocial outcomes for teenage parents and developmental outcomes in their children. Search strategy We searched to find new studies for this updated review in January 2008 and May 2010 in CENTRAL, MEDLINE, EMBASE, ASSIA, CINAHL, DARE, ERIC, PsycINFO, Sociological Abstracts and Social Science Citation Index. The National Research Register (NRR) was last searched in May 2005 and UK Clinical Research Network Portfolio Database in May 2010. Selection criteria Randomised controlled trials assessing short-term parenting interventions aimed specifically at teenage parents and a control group (no-treatment, waiting list or treatment-as-usual). Data collection and analysis We assessed the risk of bias in each study. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. Main results We included eight studies with 513 participants, providing a total of 47 comparisons of outcome between intervention and control conditions. Nineteen comparisons were statistically significant, all favouring the intervention group. We conducted nine meta-analyses using data from four studies in total (each meta-analysis included data from two studies). Four meta-analyses showed statistically significant findings favouring the intervention group for the following outcomes: parent responsiveness to the child post-intervention (SMD-0.91, 95% CI-1.52 to -0.30, P = 0.04); infant responsiveness to mother at follow-up (SMD-0.65, 95% CI-1.25 to -0.06, P = 0.03); and an overall measure of parent-child interactions post-intervention (SMD-0.71, 95% CI-1.31 to -0.11, P = 0.02), and at follow-up (SMD-0.90, 95% CI-1.51 to -0.30, P = 0.004). The results of the remaining five meta-analyses were inconclusive. Authors' conclusions Variation in the measures used, the included populations and interventions, and the risk of bias within the included studies limit the conclusions that can be reached. The findings provide some evidence to suggest that parenting programmes may be effective in improving a number of aspects of parent-child interaction both in the short-and long-term, but further research is now needed.
    • Information and evaluation in violence risk assessments

      Woodcock, Ray (2011)
      Parts one and two of this series focused on the process and principles of violence risk assessments in forensic mental health practice. Building on these substantive issues, part three considers the difficult issue of sourcing information, putting the pieces of the risk jigsaw together and evaluating risk. It also considers confidentiality and disclosure, as they are important aspects of the clinical duty of care and are directly related to the risk assessment and the management process.
    • Innovations in practice: Piloting electronic session-by-session monitoring in Child and Adolescent Mental Health Services: a preliminary study

      Hall, Charlotte L.; Moldavsky, Maria; Taylor, John A.; Marriott, Michael (2015)
      Background: Recent UK initiatives have advocated the use of session-by-session outcome measurement in CAMHS. However, little is known about the feasibility of this approach. Method: The PROMPT study (Patient Reported Outcome Monitoring Progress Tracker) piloted an iPad administered brief session-by-session measure (S × S) related to the Strengths and Difficulties Questionnaire impact supplement in three CAMHS teams. We report adherence to electronic S × S monitoring and a preliminary analysis of sensitivity to change. Results: Adherence to S × S was 57%, which is higher than the completion rates for the standard set of outcome measures usually completed by clinicians and young people. S × S showed some sensitivity to change. Conclusions: Session-by-session monitoring in CAMHS is worthy of further pursuit.
    • 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.
    • 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.
    • Lost in translation? Psychometric properties and construct validity of the English Essen Climate Evaluation Schema (EssenCES) social climate questionnaire

      Howells, Kevin; Ferguson, Eamonn (2012)
      The social climate of correctional (forensic) settings is likely to have a significant impact on the outcome of treatment and the overall functioning of these units. The Essen Climate Evaluation Schema (EssenCES) provides an objective way of measuring social climate that overcomes the content, length, and psychometric limitations of other measures. But the English translation of the EssenCES has yet to be sufficiently validated for use in forensic settings in the United Kingdom. The current study presents psychometric properties (factor structure and internal consistency) and an examination of construct validity with the English EssenCES. Satisfactory internal consistency was found for all EssenCES scales, and the expected three-factor structure was confirmed with both staff and residents and in prison and secure hospital settings using confirmatory factor analysis. Evidence to support construct validity was established using multilevel models, which showed statistically significant associations between scores on the EssenCES and scores on the Working Environment Scale, institutional aggression, and site security. Future validation work and potential practical applications of the EssenCES are discussed. © 2011 American Psychological Association.
    • Managing uncertainty in the clinical prediction of risk of harm: Bringing a Bayesian approach to forensic mental health

      Duggan, Conor (2017)
      Predicting the likelihood of harm posed by mentally disordered offenders remains controversial. It is proposed that a Bayesian approach may help quantify the uncertainty surrounding such prediction. An example of this approach quantifying the risk of breast cancer in the event of a positive mammogram is provided. Copyright (c) 2017 John Wiley & Sons, Ltd.
    • Measurement of needs

      Slade, Mike (2016)
      The assessments of needs for health care and needs for mental health care services have been relatively recently developed. As yet, the issue of how service users participate in defining need is largely unexplored territory. Just as formidable is the question—what are the consequences of conducting proper needs assessment? In assessing need, we are likely to confront previously inconspicuous layers of psychiatric morbidity and disability. This leads to two further questions: how shall we prioritise services, and is the pursuit of quality of life a reasonable proxy where staff are not able to provide a complete cure for mental disorders? Finally, it is sometimes helpful to step back from the detail of how to measure needs for healthcare and to ask why measure needs? Do needs reduce due to external factors, such as economic austerity leading to fewer available resources? In our view, an approach to health services that is fundamentally based upon need is in essence a moral choice. It is a view that attaches importance to the relief of suffering, whatever the circumstances of the person who is unwell, and which claims that a civilised society will offer services in proportion to the needs of those who may benefit from services. This sentiment has been more poetically expressed by Isabel Allende, when she wrote 'They also forced me to eat. They divided up the servings with the strictest sense of justice, each according to her need.' (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: chapter)
    • Measuring mental health outcomes in primary care: The psychometric properties of a new patient-generated outcome measure, 'PSYCHLOPS' ('psychological outcome profiles')

      Evans, Chris (2005)
      Background: Patient-generated outcome measures are rarely used in evaluating talking therapies in primary care but in other contexts they show high sensitivity to change. We have devised a novel patient-generated measure called 'PSYCHLOPS' ('Psychological Outcome Profiles'). This paper describes the psychometric properties of PSYCHLOPS. Method: Standardised responses to PSYCHLOPS, pre- and post-therapy, were compared with responses to an established measure, CORE-OM. Results: Data were obtained from 110 patients. The effect size, a measure of sensitivity to change, was -1.53 for PSYCHLOPS and -1.06 for CORE-OM (t = 5.10, P < 0.001). Pre-therapy alpha scores were 0.79 and 0.94, respectively. Change scores of both instruments correlated strongly (Spearman's rho = 0.61; P < 0.001). Detailed validity testing is reported. Conclusion: PSYCHLOPS is a sensitive measure of change after therapy. Alpha scores suggest satisfactory internal reliability. Evidence of convergent, concurrent and construct validity has been obtained. Further work is required to establish test-retest reliability. © 2005 Radcliffe Publishing.
    • Needs and risks of patients in a state-wide inpatient forensic mental health population

      Daffern, Michael (2010)
      Routine needs assessments have become mandated requirements for public mental health services. However, the appropriateness of these generic health needs assessments to specialist populations remains questionable. This study sought to assess individual needs assessed using a widely used clinician rated assessment (Health of the Nation Outcome Scales-Secure; HoNOS-Secure), a subjective needs assessment that considers both staff and patient perspectives (Camberwell Assessment of Need-Forensic version; CANFOR), and a measure of risk for general criminal recidivism (Level of Service Inventory: Screening Version; LSI:SV) in a secure forensic mental health service. Results revealed significant positive correlations between staff ratings on HoNOS-Secure, CANFOR total needs, and CANFOR met needs scores, but no significant association between CANFOR ratings or HoNOS-Secure ratings and LSI:SV scores. Although patients and staff reported the same number of needs overall according to CANFOR (7.2 vs. 7.5, P > 0.05), patients reported that more of these needs were unmet (3.1 vs. 2.3, P < 0.05). Differences between staff and patient ratings of need suggest that needs assessments should include patient perspectives to facilitate more collaborative and comprehensive care planning. Divergent perspectives between patients and staff may impair patient engagement in treatment and therefore negatively impact on outcome. Service planning issues and opportunities for future research are discussed.
    • New directions in assessing risk for sexual offenders

      Hogue, Todd E. (2004)
      Risk assessment is the cornerstone of effective offender management. The identification of the risks posed by offender and the factors associated with recidivism are crucial to the identification of appropriate and effective interventions designed to reduce the risk of recidivism. While it is generally accepted that the predictive accuracy of actuarial methods outperforms clinical judgement, critics of the actuarial approach argue that the limitations of actuarial risk assessments are such that experts have yet to reach consensus on the best risk factors for predictive accuracy and methods for combining these risk factors into an overall evaluation. This paper considers a number of important conceptual issues associated with the assessment of risk for sexual offenders and offers an alternative approach to risk appraisal. The Multiaxial Risk Appraisal (MARA) model encourages a more global approach to the assessment of risk and examines 'nomothetic' (actuarial scales and psychometric assessments of psychopathology and psychosexual characteristics) and 'idiographic' (empirically guided clinical assessment and dynamic changes in risk) approaches. One of the advantages of using the MARA model is that the resultant assessment considers the theoretical possibility that there are different aetiological pathways impacting on an offender's risk of recidivism and allows for the inclusion of dynamic risk-related information. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Offence Paralleling Behaviour (OPB) as a framework for assessment and interventions with offenders

      Jones, Lawrence F. (2004)
      Forensic psychologists, perhaps more than any other group of applied psychologists, need to work with various types of historical narrative, often describing the same set of events. Unfortunately, most methods for analysing behaviour in the psychological literature (e.g. functional analysis) focus on discrete episodes. With the notable exception, perhaps, of Gresswell and Hollin's (1992) 'multiple sequential functional analysis' paradigm, there is a general paucity of literature that attempts to grapple with the complexity of behaviour as a diachronic process. This problem comes, I believe, out of the more fundamental methodological problem of finding ways of modelling and operationalizing hypotheses about offences as processes as opposed to events. The concept of an 'offence' is not defined scientifically, it is a particular, socially defined value-driven way of describing certain types of behaviour. This chapter attempts to open up some of the questions about why and how, as forensic psychologists, we need to look at behaviour as a sequential development. In addition, it explores the ways in which viewing behaviour in this way enables practitioners to work with a broader range of psychological and behavioural processes that are helpful to the tasks of risk assessment and addressing offending behaviour. (PsycINFO Database Record (c) 2016 APA, all rights reserved)