Assessing living skills in forensic mental health care with the behavioural status index: A European network study

Abstract

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.

A multi-site survey of forensic nursing assessment

“…Results do have to be viewed with caution due to the small effect sizes. One of the six sub scales (empathy) highlighted deterioration rather than improvement, in keeping with findings from the original research study (Ross et al, 2008). One possible explanation for this may be a result of patients having to spend prolonged periods of time in the company of others (not through choice) who present with challenging behaviours periodically.…”

“…The versatility of a tool was deemed essential as was the necessity to generate robust data that could be used to plan care with individual patients. The wider multidisciplinary assessment tool routinely used is the Historical Clinical Risk assessment (HCR-20 V3; Douglas et al, 2014) which uses current and historical behaviour to examine the patient against a range of pathological indexes (Chakhassi et al, 2010); earlier research identified a close correlation between BEST-Index and the dynamic factors of the HCR-20 (Ross et al, 2008). The HCR-20 V3 (Douglas et al, 2014) is currently in use across all Scottish forensic services.…”

“…BEST-Index has been subject to psychometric testing to assess its validity and reliability over the past few decades (Woods, Reed and Collins, 2003;Ross et al, 2008;Chakhssi, de Ruiter and Bernstein, 2010;Ross et al, 2012). Despite use in the research context, there is limited evidence of BEST-Index being actively applied and tested in routine clinical practice, and few reports of patients or staff views of the tool other than Sukkoo et al (2007).…”

“…Box 1: BEST-Index sub-scales Communication and social skillsitems illustrate adaptive social behaviours and processes by which interpersonal relationships are established Insightexamines the individual's cognitive constructs of reality, drawing on psychodynamic, cognitivebehavioural and phenomenological perspectives Work and recreational activitiesitems cover a range of constructive activities, not necessarily paid work Self and Family Careassess daily socially important areas such as personal hygiene, cooking, other aspects of self-care and care for other family or group members Empathyassesses ability to conceptualise others' worlds through identified behaviours Riskthis scale is an addendum designed for use in forensic populations behaviour to examine the patient against a range of pathological indexes (Chakhssi et al, 2010); earlier research identified a close correlation between BEST-Index and the dynamic factors of the HCR-20 (Ross et al, 2008). The HCR-20 V3 (Douglas et al, 2014) is currently in use across all Scottish forensic services.…”

Different yet similar? Prisoners versus psychiatric patients – A comparison of their mental health

“…Most of the data of these forensic patients were gathered in the context of an EU project called “Developing Community Living Skills in Offender Groups” (project acronym: DCLSOG2, additional acronym: COMSKILLS; study number: QLG5-CT-2001-01045) in forensic psychiatric hospitals in Weissenau, Reichenau, Langenfeld, Viersen, and Lippstadt/Eickelborn [28–30]. In addition, data of forensic patients were gathered in a forensic psychiatric hospital in Ueckermünde (Mecklenburg-Vorpommern) [31].…”