Measurement-based care in forensic psychiatry
مراقبت مبتنی بر اندازه گیری در روانپزشکی قانونی-2020
Measurement-based care (MBC) is the systematic evaluation of a patient’s symptoms or factors before or during an encounter. It is used to inform treatment and behavioral health interventions. This article argues that MBC is the natural consequence flowing from evidence-based practice. In this article, MBC is defined and explained IN detail. Barriers to the implementation of MBC are presented and methods of selecting a measurement tool are evaluated. The article describes areas where MBC can be applied in forensic settings, and specific risk assessment tools are presented and evaluated, including the HCR-20v3, DASA-IV, DUNDRUM, and CGI–C. The article emphasizes how imperative it is that physicians use MBC and discusses why forensic practice is ideally suited to MBC. Measurement-based care in forensic psychiatry often say that when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be. (Lord Kelvin, 1889).
Keywords: Measurement-based care | Evidence-based practice | Forensic psychiatry | Risk assessment
Violence risk assessment for young adults receiving treatment for early psychosis
ارزیابی خطر خشونت برای بزرگسالان جوانی که درمان برای روان پریشی اولیه دریافت می کنند-2020
Aim: Although the absolute risk of violence is small for individuals with mental illnesses, a specific subgroup of individuals who appear to be at increased risk for violence includes young people experiencing emerging or early psychosis. Prior research has identified risk factors for violence in this population, though no prior studies using a formal risk assessment tool have been identified. This study used the Historical Clinical Risk Management-20, version 3 (HCR-20) to identify risk of future violence among a sample of young adults with early psychosis and relevant predictors of risk unique to this population.
Methods: The HCR-20 was administered to a sample of young adults with early psychosis (N = 53) enrolled at oneOnTrackNY site, part of a statewide program providing early intervention services to young adults presenting with a first episode of non-affective psychosis. A Confirmatory Factor Analysis (CFA) was conducted to explore the relative importance of the HCR-20 items for this population.
Results: The average age of participants was 21.9 years (SD 3.6 years) and most were male (69.8%, n = 37). Mostpatients were assessed to be at low risk for future violence based on the Case Prioritization summary risk rating (67.9%, n = 36). The CFA identified 4 items that were not of relative predictive value in identifying the risk of violence in this sample: history of substance use (item H5), history of major mental disorder (item H6), livingsituation (item R2), and personal support (item R3).
Conclusion: This study presents a formal approach to assessing violence risk in a population at elevated risk of violence, demonstrates the feasibility of using a standardized risk assessment tool in early intervention services, and identifies factors of particular importance associated with predicting violence in this population. Future research should implement violence risk assessment with a structured tool such as the HCR-20 and assess its accuracy in predicting future violent behavior in this setting.
Keywords: Early intervention | First-episode psychosis | Violence risk assessment
The empirical evidence base for the use of the HCR-20: A narrative review of study designs and transferability of results to clinical practice
پایه شواهد تجربی برای استفاده از HCR-20: مروری روایتی از طرح های مطالعه و قابلیت انتقال نتایج به عمل بالینی-2020
The HCR-20, a widely used method of assessing and managing risk, relies on the structured professional judgement approach. This paper reports a narrative literature review of the HCR-20 studies to explore the applicability of the study results to the use of the HCR-20 in clinical practice. From a literature search using terms “HCR-20” and “HCR 20”, 206 papers were included. Of studies using the HCR-20 version 2 (n = 191), 92% (n =176) relied on variables based on scores derived by adding item scores, and 50% (n = 95) tested the HCR-20using predictive validity methodology. Of the HCR-20 version 3 studies (n = 21), the “presence of risk fac- tors” step was the most commonly examined (n = 18, 86%), but 2 of the 7 steps (“scenario planning” and “management”) were not examined at all. Amongst those studies whose primary focus was on the HCR-20, 67% (n = 64/95) did so by assessing the predictive validity of the tool. Only one employed a design to test whether the use of the HCR-20 affected violence rates. The predominant study design provides support for the use of the HCR-20 as an actuarial tool, and there is limited empirical evidence in support of its effectiveness as a structured professional judgement approach to the assessment and management of the risk of violence.
Keywords: Risk assessment | risk management | HCR-20 | structured professional judgement | actuarial | predictive validity | threat assessment