Assessment of living skills and violence risk in forensic psychiatric patients is a priority for clinicians. Suitably fine-grained instruments are rare. The goal of this study was to compare a norm-based psychometric assessment battery (the Behavioural Status [BEST] Index) with known valid instruments. Parallel cohort studies were undertaken in four European countries. Inpatients from 24 forensic psychiatric clinics were assessed three times using five instruments measuring living skills, psychological symptoms, aggression, and violence risk. Positive clinical changes were noted in insight, empathy, and some behaviors related to communication and living skills, with little change in violence risk, which was low to medium for most patients. Clinical congruence was observed between logically cognate items of the BEST Index and comparison instruments. Evidence for the scientific and clinical utility of the BEST Index as an effective tool for forensic psychiatric practice is discussed.
‘Educational supervisor’ is the term now used by the General Medical Council for a consultant who has junior doctors working with him/her, whether employed by the National Health Service or a university. This paper represents our views of the role of the educational supervisor, rather than official College policy.
The role of daily living skills in forensic psychiatric patients in relation to psychotherapeutic progress and the potential reduction of dangerous behaviour has been neglected in the scientific discussion about clinical instruments for the evaluation of dangerousness and recidivism. This is mainly due to the lack of adequate observationally based instruments allowing for valid and reliable therapeutic assessments. Therefore, a new means of assessment focusing on daily living skills and social risk (the BEST-Index [Behavioural Status Index] was applied to n = 86 German forensic psychiatric patients. Two widely known actuarial instruments tapping violence risk were administered for cross validation (Psychopathy Checklist Revised [PCL-R], HCR-20). Within intervals of nine months, all instruments were applied three times. Sufficient inter rater reliability and good convergent validity of the sub-scales in relation to the actuarial instruments (HCR-20, PCL-R) could be demonstrated; supported by empirical data, clinicians working with the BEST-Index may use it to monitor behavioural change over long treatment periods. It is suggested that treatment planning and evaluation of mentally ill offenders might profit from its use.
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