Determining when to conduct a violence risk assessment: Development and initial validation of the Fordham Risk Screening Tool (FRST).

Abstract

Techniques to assess violence risk are increasingly common, but no systematic approach exists to help clinicians decide which psychiatric patients are most in need of a violence risk assessment. The Fordham Risk Screening Tool (FRST) was designed to fill this void, providing a structured, systematic approach to screening psychiatric patients and determining the need for further, more thorough violence risk assessment. The FRST was administered to a sample of 210 consecutive admissions to the civil psychiatric units of an urban medical center, 159 of whom were subsequently evaluated using the Historical Clinical Risk Management-20, version 3, to determine violence risk. The FRST showed a high degree of sensitivity (93%) in identifying patients subsequently deemed to be at high risk for violence (based on the Case Prioritization risk rating). The FRST also identified all of the patients (100%) rated high in potential for severe violence (based on the Serious Physical Harm Historical Clinical Risk Management-20, version 3, summary risk rating). Sensitivity was more modest when individuals rated as moderate risk were included as the criterion (rather than only those identified as high risk). Specificity was also moderate, screening out approximately half of all participants as not needing further risk assessment. A systematic approach to risk screening is clearly needed to prioritize psychiatric admissions for thorough risk assessment, and the FRST appears to be a potentially valuable step in that process. (PsycINFO Database Record

Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: a systematic review and meta-analysis

“…However, other clinical contexts will exist where longer-term instruments may be more relevant or appropriate; the high sensitivity (0.75) and moderate PPV (0.55) suggest these instruments may have a role for some patients. Considering the brevity of the BVC and DASA, they could act as a screen before a longer term tool is used considering the expense involved in administering time-consuming and resource-intensive instruments [ 44 ].…”

“…Future research on violence risk assessment in forensic inpatient settings should focus more on imminent instruments as this meta-analysis found a smaller proportion of the research literature based on these instruments. Another useful direction for research would be further exploration of whether there should be a screen before longer-term instruments are used [ 44 ]. As the two imminent tools in this study rely predominantly on dynamic variables, research could investigate the role of novel dynamic variables to improve risk prediction, and whether adding static variables can add incremental performance.…”

The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review

“…The Fordham Risk Screening Tool (FRST) was developed by Rosenfeld et al () to provide a structured screening approach for the assessment of psychiatric patients. Two studies, Rosenfeld et al () and Rotter and Rosenfeld () examined this tool, which is used to determine whether a more comprehensive violence risk assessment using a validated, existing risk assessment instrument (e.g. the HCR‐20), is required for a particular service user.…”

Tertiary concerns: Campus threat assessment and management in an Australian university.

“…A number of tools exist to aid decision-making regarding when and if a full risk assessment should be conducted. Given that risk assessment involves the outlay of considerable time and resources, triage is crucial in determining which cases require a more comprehensive response (Rosenfeld et al, 2017). One well supported triage tool is the Fordham Risk Screening Tool (FRST), developed by Rosenfeld et al (2017).…”

“…Given that risk assessment involves the outlay of considerable time and resources, triage is crucial in determining which cases require a more comprehensive response (Rosenfeld et al, 2017). One well supported triage tool is the Fordham Risk Screening Tool (FRST), developed by Rosenfeld et al (2017). This tool has demonstrated a high degree of sensitivity in identifying psychiatric patients who present a high risk of violent behavior.…”