A Clinical Feasibility Study of the Forensic Psychiatry and Violence Oxford (FoVOx) Tool

Cornish, Robert; Lewis, Alexandra; Parry, Owen Curwell; Ciobanasu, Oana; Mallett, Susan; Fazel, Seena

doi:10.3389/fpsyt.2019.00901

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Future research into the OxMIS tool will need to further address the feasibility of clinical implementation, this will likely involve incorporation into EHRs using structured data fields rather than natural language processing-the clinician may be asked to record the tool variables within the EHR as a routine part of clinical care. To fully evaluate feasibility it will be important to compare the OxMIS tool to current clinical practice and evaluate its acceptability and utility for clinicians, as has previously been done for similar risk assessment tools in forensic psychiatry (43). In addition, the effects of tool use on clinical care should ultimately be evaluated prospectively, as has been proposed for tools assessing psychosis risk (44).…”

Section: Strengths Limitations and Future Researchmentioning

confidence: 99%

Identifying Predictors of Suicide in Severe Mental Illness: A Feasibility Study of a Clinical Prediction Rule (Oxford Mental Illness and Suicide Tool or OxMIS)

Senior

Burghart

et al. 2020

Front. Psychiatry

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Background: Oxford Mental Illness and Suicide tool (OxMIS) is a brief, scalable, freely available, structured risk assessment tool to assess suicide risk in patients with severe mental illness (schizophrenia-spectrum disorders or bipolar disorder). OxMIS requires further external validation, but a lack of large-scale cohorts with relevant variables makes this challenging. Electronic health records provide possible data sources for external validation of risk prediction tools. However, they contain large amounts of information within free-text that is not readily extractable. In this study, we examined the feasibility of identifying suicide predictors needed to validate OxMIS in routinely collected electronic health records. Methods: In study 1, we manually reviewed electronic health records of 57 patients with severe mental illness to calculate OxMIS risk scores. In study 2, we examined the feasibility of using natural language processing to scale up this process. We used anonymized freetext documents from the Clinical Record Interactive Search database to train a named entity recognition model, a machine learning technique which recognizes concepts in freetext. The model identified eight concepts relevant for suicide risk assessment: medication (antidepressant/antipsychotic treatment), violence, education, self-harm, benefits receipt, drug/alcohol use disorder, suicide, and psychiatric admission. We assessed model performance in terms of precision (similar to positive predictive value), recall (similar to sensitivity) and F1 statistic (an overall performance measure). Results: In study 1, we estimated suicide risk for all patients using the OxMIS calculator, giving a range of 12 month risk estimates from 0.1-3.4%. For 13 out of 17 predictors, there was no missing information in electronic health records. For the remaining 4 predictors missingness ranged from 7-26%; to account for these missing variables, it was possible for OxMIS to estimate suicide risk using a range of scores. In study 2, the named entity recognition model had an overall precision of 0.77, recall of 0.90 and F1 score of 0.83. The concept with the best precision and recall was medication (precision

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Section: Strengths Limitations and Future Researchmentioning

confidence: 99%

Identifying Predictors of Suicide in Severe Mental Illness: A Feasibility Study of a Clinical Prediction Rule (Oxford Mental Illness and Suicide Tool or OxMIS)

Senior

Burghart

et al. 2020

Front. Psychiatry

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“…Future work could assess the feasibility of using two separate tools (or combining them) including testing whether the inclusion of new factors would incrementally improve the performance of FoVOx, and its acceptability among clinicians. Previous work has noted that adding certain clinical factors, such as the poor adherence, and psychosocial factors, such as community supervision, may increase the tool’s acceptability to clinicians [ 12 , 14 ]. Apart from FoxWeb, the Structured Outcome Assessment and Community Risk Monitoring (SORM) was an attempt to continuously measure around 30 modifiable factors among forensic psychiatric patients and developed in Sweden.…”

Section: Discussionmentioning

confidence: 99%

Integrating static and modifiable risk factors in violence risk assessment for forensic psychiatric patients: a feasibility study of FoVOx

Forsman

Cornish

Fazel

2022

Nordic Journal of Psychiatry

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Introduction Risk assessment is integral to forensic psychiatry. Previous work has highlighted the benefits of using scalable and evidence-based actuarial risk tools developed within forensic populations, such as the online Forensic Psychiatry and Violence Oxford (FoVOx) violence risk assessment tool. We examined the feasibility of using FoVOx in a Swedish forensic cohort and tested whether adding modifiable (dynamic) factors would increase its useability to clinicians. Methods We completed FoVOx assessments on all patients discharged from forensic psychiatric hospitals in Stockholm County, Sweden, between 2012 and 2017 and investigated recidivism rates. In addition, interviews were conducted with the clinicians responsible for each patient on the perceived accuracy, usefulness, and impact of FoVOx, which was examined using thematic analysis. Results Ninety-five discharges from forensic psychiatric hospitals were followed up. The median FoVOx score was a 7% likelihood of violent reoffending in two years after discharge. Six discharged patients (6%) were confirmed as violent recidivists using official records with a similar distribution of FoVOx risk categories as the rest of the sample. FoVOx was considered accurate by clinicians in more than half of cases, who suggested that modifiable risk factors could be added to increase acceptability. All clinicians thought that FoVOx was useful, and in 20% of discharges, it would have materially altered patient care. Overall, FoVOx was thought to impact decision-making and risk management, was practical to use, and could be completed without reference to written case material. Conclusion Completing FoVOx in forensic psychiatric hospitals can complement current approaches to clinical decision-making on violence risk assessment and management.

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“…Following this, clinicians were asked to complete semi-structured interviews by means of two questionnaires (one for each tool) to evaluate the utility and acceptability of the tools. These standardized questionnaires were developed and previously used to evaluate the feasibility of implementing OxMIS and another risk assessment tool FoVOx (Forensic Psychiatry and Violence Oxford) in clinical settings ( 31 , 36 ). The OxMIV semi-structured interview questionnaire for clinicians was designed prior to the OxMIS one, and thus some items differ between the two questionnaires.…”

Section: Methodsmentioning

confidence: 99%

Evaluating the Risk of Suicide and Violence in Severe Mental Illness: A Feasibility Study of Two Risk Assessment Tools (OxMIS and OxMIV) in General Psychiatric Settings

Beaudry

Canal‐Rivero

Ou³

et al. 2022

Front. Psychiatry

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BackgroundTwo OxRisk risk assessment tools, the Oxford Mental Illness and Suicide (OxMIS) and the Oxford Mental Illness and Violence (OxMIV), were developed and validated using national linked registries in Sweden, to assess suicide and violence risk in individuals with severe mental illness (schizophrenia-spectrum disorders and bipolar disorders). In this study, we aim to examine the feasibility and acceptability of the tools in three different clinical services.MethodWe employed a two-step mixed-methods approach, by combining quantitative analyses of risk scores of 147 individual patients, and thematic analyses of qualitative data. First, 38 clinicians were asked to use OxMIS and OxMIV when conducting their routine risk assessments in patients with severe mental illness. The risk scores for each patient (which provide a probability of the outcome over 12 months) were then compared to the unstructured clinical risk assessment made by the treating clinician. Second, we carried out semi-structured interviews with the clinicians on the acceptability and utility of the tools. Thematic analysis was conducted on the qualitative data to identify common themes, in terms of the utility, accuracy, and acceptability of the tools. The investigations were undertaken in three general adult psychiatric clinics located in the cities of Barcelona and Sevilla (Spain), and Changsha (China).ResultsMedian risk probabilities over 12 months for OxMIS were 1.0% in the Spanish patient sample and 1.9% in the Chinese sample. For OxMIV, they were 0.7% (Spanish) and 0.8% (Chinese). In the thematic analysis, clinicians described the tools as easy to use, and thought that the risk score improved risk management. Potential additions to predictors were suggested, including family history and the patient's support network. Concordance rates of risk estimates between the tools and clinicians was high for violence (94.4%; 68/72) and moderate for suicide (50.0%; 36/72).ConclusionBoth OxMIS and OxMIV are feasible and practical in different general adult psychiatric settings. Clinicians interviewed found that both tools provide a useful structured approach to estimate the risk of suicide and violence. Risk scores from OxMIS and OxMIV can also be used to assist clinical decision-making for future management.

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A Clinical Feasibility Study of the Forensic Psychiatry and Violence Oxford (FoVOx) Tool

Cited by 7 publications

References 17 publications

Identifying Predictors of Suicide in Severe Mental Illness: A Feasibility Study of a Clinical Prediction Rule (Oxford Mental Illness and Suicide Tool or OxMIS)

Identifying Predictors of Suicide in Severe Mental Illness: A Feasibility Study of a Clinical Prediction Rule (Oxford Mental Illness and Suicide Tool or OxMIS)

Integrating static and modifiable risk factors in violence risk assessment for forensic psychiatric patients: a feasibility study of FoVOx

Evaluating the Risk of Suicide and Violence in Severe Mental Illness: A Feasibility Study of Two Risk Assessment Tools (OxMIS and OxMIV) in General Psychiatric Settings

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