BackgroundThe assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity.MethodsAll those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100).ResultsThe 11 item scale had good internal consistency (Cronbach's alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant for all 11 items.ConclusionsThe DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement. This provides fertile ground for future research as well as practical assistance in assessing unmet need, auditing case mix and planning care pathways.

BackgroundA mental health needs assessment in the Irish prison population confirmed findings from other jurisdictions showing high prevalence of severe mental illness, including psychosis amongst those newly committed. We implemented a participatory action research approach in order to provide an integrated mental health prison in-reach and court liaison service for this population.ResultsFollowing extensive consultation, a two stage screening process was developed which was supplemented by an inter-agency referral management system. During the six years 2006–2011, all 20,084 new remands to the main remand prison serving 58% of the national population were screened. Following the first stage screen, 3,195 received a comprehensive psychiatric assessment. Of these 561 (2.8%) had symptoms of psychosis – corresponding to the prior research finding – and 572 were diverted from the criminal justice system to mental health services (89 to a secure forensic hospital, 164 to community mental health hospitals and 319 to other community mental health services).ConclusionsWe have shown that it is possible to match research findings in clinical practice by systematic screening, to sustain this over a long period and to achieve consistent levels of diversion from the criminal justice system to appropriate mental health services. The sustained and consistent performance of the model used is likely to reflect the use of participatory action research both to find the most effective model and to achieve wide ownership and cooperation with the model of care.

Background and Context: School principals and school guidance counsellors can be very influential in deciding what subjects are offered on the curriculum, how they are promoted and who they are targeted to. For that reason, exploring their views of Computer Science (CS) as a subject can help unearth potential barriers that may hinder the wider uptake of the subject in schools.Objective: This study aimed to explore school principals and school guidance counsellors' views of CS as a subject at upper second level education in Ireland as part of the launch of a new subject. Method: Using one-to-one semi-structured interviews, the study sought the views of a sample pf 10 school principals and 10 school guidance counsellors from secondary schools in Ireland that had recently introduced the subject of CS on the curriculum. Findings: The study found contradictory views expressed, where the participants emphasised the value of the subject for all students, while at the same time presenting it as more suitable for certain types of students -highlight the tensions between the espoused values and the actual reality of practice.