• 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)
    • Offence paralleling behaviour: A case formulation approach to offender assessment and intervention

      Daffern, Michael; Jones, Lawrence F. (2011)
      New to the Wiley Series in Forensic Clinical Psychology, Offence Paralleling Behaviour presents an original framework of individualised assessment and treatment methods for clinicians working in the forensic environment. Provides a framework that helps practitioners to identify and work with offence-relevant behaviour and evidence pro-social change. Describes how Offence Paralleling Behaviour (OPB) can be successfully identified and used in risk assessment and treatment planning. Brings together leading academics and frontline clinicians, including psychiatric nurses, psychologists, psychiatrists, occupational therapists, drug and alcohol specialists, and correctional officers, as well as featuring the views of prisoners on OPB. Presents methods which allow staff to identify and use OPB in clinical practice. © 2010 John Wiley & Sons, Ltd.
    • Offenders with 'personality disorder' diagnosis

      Jones, Lawrence F.; Willmot, Phil (2017)
      This chapter provides an overview of issues involved in the assessment of offenders with personality disorders and references for further reading. Prior to developing an initial case formulation, it can be useful to use psychometric measures to provide an overview of problems, needs and symptoms which can later be addressed in the case formulation. Typically, standardized batteries for offenders with personality disorders assess both features of personality disorder and criminogenic factors. In order to improve the validity of an assessment it is useful to measure the construct in a number of different ways. This is particularly true in the forensic context where there are a number of factors that are likely make it difficult for an individual to be open and honest in their responses to psychometric measures. It is always useful to contrast self-report with observational assessment.
    • On mental health

      Taylor, Jeremy (2005)
    • Personal aspirations and concerns inventory for offenders: Developments in the measurement of offenders' motivation

      McMurran, Mary (2010)
      Background: It is important to attend to offenders' motivation for treatment and behavior change, either as a treatment selection criterion or a pre-treatment need. One measure of motivation that has been used with forensic populations is the Personal Concerns Inventory (PCI) and a PCI-Offender Adaptation (PCI-OA). As well as demonstrating promise in measuring offenders' motivation, the administration of the PCI and PCI-OA shows potential as a motivation enhancer. However, a number of potentially useful changes to the PCI-OA that may maximize its potential have been identified. These are described here. Method: The rationale and process of abridgement and further development of the PCI-OA into the Personal Aspirations and Concerns Inventory for Offenders (PACI-O) are described. Results of a pilot study with 22 prisoners are reported. The pilot study aimed to assess the acceptability of the PACI-O with an offender population. Results: Findings demonstrated that the interview took less time, although similar concerns were still identified, consistent with the previous PCI-OA. Conclusion: Consistency with previous evidence, together with positive feedback, suggests that the PACI-O was acceptable with an offender population. Future research is required to assess the psychometric properties of the PACI-O, and to evaluate its potential as an assessment of offender motivation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Practice-based evidence: Benchmarking NHS primary care counselling services at national and local levels

      Evans, Chris (2003)
      There are a number of problems for evidence-based practice (EBP) including limited generalizability of efficacy research results, the consequent lack of confidence in the relevance of such research, and the conceptual distance of most practitioners from the research process. The result is that EBP, although sound in principle, often fails to achieve its aim of improving practice. Practice-based evidence (PBE) provides a complementary bridge for the gap between research and practice to offset some of these problems, promoting collaboration between mental health services and academic institutions. This paper presents the initial results of such a collaboration via three phases: (1) the development of a referential database for primary care counselling services, (2) 'practitioner-friendly' feedback on grouped data to services, and (3) the combination of the two to build an evidence base for work with ethnic minorities-an area in which research trials are not well adapted to provide much evidence. Copyright (C) 2003 John Wily Sons, Ltd.
    • Prediction of institutional aggression among personality disordered forensic patients using actuarial and structured clinical risk assessment tools: Prospective evaluation of the HCR-20, VRS, Static-99, and Risk Matrix 2000

      Langton, Calvin M.; Hogue, Todd E.; Daffern, Michael; Mannion, Aisling; Howells, Kevin (2009)
      Entry to the Dangerous and Severe Personality Disorder (DSPD) service in England and Wales is heavily determined by risk status, and therefore requires valid procedures for monitoring changes in risk over time in order to make risk management decisions and determine patients' suitability for transfer to lower security settings. Yet little is known about the validity of current risk assessment tools with the new DSPD population. This study reports a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 consecutive admissions to the DSPD unit at a high secure forensic psychiatric hospital. Thirty eight per cent of the sample exhibited interpersonal physical aggression (IPA) on one or more instances over an average 1.5 year period following admission, and a similar percentage caused damage to property (DTP) on one or more occasions over the same period. All tools predicted DTP. HCR-20 Total and scale scores predicted IPA with structured final risk judgements also predicting repetitive (2+incidents of) IPA. HCR-20 Risk Management scores were significantly associated with imminence of IPA. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients.
    • Predictors of clinical and social outcomes following involuntary hospital admission: A prospective observational study

      Morriss, Richard K. (2011)
      The Study aimed to assess clinical and social outcomes following involuntary admissions over 1 year and identify socio-demographic and clinical patient characteristics associated with more or less favourable outcomes. Seven hundred and seventy-eight involuntary patients admitted to one of 22 hospitals in England were assessed within the first week after admission and at 1 month, 3 month and 12 month follow-ups. Outcome criteria were symptom levels, global functioning, objective social outcomes, and subjective quality of life (SQOL). Baseline characteristics and patients' initial experience were tested as predictors. Symptom levels and global functioning improved moderately. Objective social outcomes showed a small, but statistically significant deterioration, and SQOL a small, but significant improvement at 1 year. In multivariable analyses, admission due to risk to oneself and receiving benefits predicted poorer symptom outcomes. Female gender and higher perceived coercion were associated with better objective social outcomes, whilst higher initial satisfaction with treatment predicted more positive SQOL at follow-ups. Over a 1-year period following involuntary hospital admission, patients on average showed only limited health and social gains. Different types of outcomes are associated with different predictor variables. Patients' initial experience of treatment, in the form of perceived coercion or satisfaction with treatment, has predictive value for up to a year following the admission. © 2010 Springer-Verlag.
    • 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)
    • Rationale and development of a general population well-being measure: Psychometric status of the GP-CORE in a student sample

      Evans, Chris (2005)
      This paper presents the rationale, development, and psychometric status of a non-clinical self-report measure for the general population (GP)--including students--derived from the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and hence termed the GP-CORE. In contrast to the CORE-OM, the GP-CORE does not comprise items denoting high-intensity of presenting problems or risk and thereby increases its acceptability in a non-clinical population. Uniquely, over half the items in the GP-CORE are positively keyed. Analyses showed the GP-CORE to have good reliability, to distinguish between clinical and non-clinical populations, and have convergent validity against the full version. Norms for student populations are presented. It is suggested that the GP-CORE has considerable utility as a means of tapping the psychological well being of students and can then interface with counseling and mental health services using the CORE-OM. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • Relationships among risk, and communication and social skills in a high security forensic setting

      Collins, Mick (2004)
      The Behavioural Status Index was developed for risk assessment within forensic care. This paper reports data analysis for the Behavioural Status Index and its subscales. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 individual patients in two high security mental health hospitals in the UK. Results are reported for inter-item correlations, factor analysis, and differences among independent groups of patients, categorized by Mental Health Act 1983 classification, patient ward dependency, and patient gender. Data trends are indicative of clinically interesting relationships. A distinct factorial structure emerged suggesting groupings of behaviours.
    • 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.
    • Risk assessment in offenders with intellectual disability: A comparison across three levels of security

      Mooney, Paul; Johnston, Susan J. (2008)
      In mainstream offender samples, several risk assessments have been evaluated for predictive validity. This study extends this work to male offenders with intellectual disabilities. Participants from high-, medium-, and low-security settings, as well as community settings, were compared on a range of risk assessments. The Violence Risk Appraisal Guide, HCR-20-Historical Scale, the Risk Matrix 2000-C (combined risk), and the Emotional Problems Scales-Internalising discriminated between groups, with participants from high security having higher scores than those in medium security, who had higher scores than those in the community. The Violence Risk Appraisal Guide, all HCR-20 scales, the Short Dynamic Risk Scale, and the Emotional Problems Scales (Internalising and Externalising) showed significant areas under the curve for the prediction of violence. The Static-99 showed a significant area under the curve for the prediction of sexual incidents. The discussion reviews the value of these various scales to intellectual disability services. © 2008 Sage Publications.