Longitudinal HCR‐20 scores in a high‐secure psychiatric hospital

Morrissey, Catrin; Beeley, Chris; Milton, John

doi:10.1002/cbm.1893

Cited by 16 publications

(21 citation statements)

References 11 publications

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“…Olsson et al (), for example, found reductions in scores on some items from the clinical and risk management scales after 9 months and on all but two risk items after a mean of 43 months. Morrissey et al () found that the mutable – clinical and risk management items – showed improvement over a 5‐year period in a high security hospital. These findings together suggest that the HCR‐20 is sensitive to change but over a longer period than the 6‐month and 12‐month period we adopted.…”

Section: Discussionmentioning

confidence: 99%

“…These reviews highlighted the utility and promise for including risk assessment tools, such as the Historical Clinical Risk‐20 (HCR‐20) (Webster et al, ), as an outcome measure as well as a tool for assisting assessment of risk of harm. A small, but significant, change in HCR‐20 scores over time on Clinical and Risk Management subscales and total scores has been shown in an English high security hospital sample (Morrissey et al, ) and in individual items on these subscales with level of security need as measured on a 9‐point scale (Müller‐Isberner et al, ).…”

Section: Introductionmentioning

confidence: 97%

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Patient characteristics and outcome measurement in a low secure forensic hospital

Longdon

Edworthy

Resnick³

et al. 2017

Criminal Behav Ment Health

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Patient characteristics and outcome measurement in a low secure forensic hospital

Longdon

Edworthy

Resnick³

et al. 2017

Criminal Behav Ment Health

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“…Longer treatment times have been found to be associated with reduced scores on the clinical and risk-management scales (10,11) and mean scores reduce between the first and second HCR-20 assessments (12). Morrissey and colleagues (13) also found statistically significant reductions in dynamic items each year. However, across studies, average changes were small with total clinical scores reducing by 0.19 to 0.32 points and risk-management scores reducing by 0.14 to 0.31 points per iteration (12,13).…”

Section: Introductionmentioning

confidence: 95%

The HCR-20 as a measure of reliable and clinically significant change in violence risk among secure psychiatric inpatients

O’Shea

Dickens

2015

Comprehensive Psychiatry

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“…Most commonly, services used the structured clinical judgement tool the Historical, Clinical Risk 20 . 23,33,34,43,53,54,58,59 Other studies reported on static risk assessment measures such as the Violence Risk Appraisal Guide (VRAG), 23,53,54 Risk Matrix 2000, 53 Offender Group Reconviction Scale 22 and Static-99, 53 although these would not have utility as outcome measures as they would not be expected to change. The vast majority of these studies reported only cross-sectional data and not within-patient change in such measures over time.…”

Section: Risk Assessmentmentioning

confidence: 99%

“…The vast majority of these studies reported only cross-sectional data and not within-patient change in such measures over time. Indeed, only one study reported change in scores over 5 years on the clinical risk items of the HCR-20 as an outcome indicator in a FIDD service, 33 despite the large number of services that are required to collect routine data on this measure.…”

Section: Risk Assessmentmentioning

confidence: 99%

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Morrissey

Geach

Alexander³

et al. 2017

Health Serv Deliv Res

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BackgroundInpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies was therefore undertaken.ObjectivesTo synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector.DesignThree linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.ResultsAt stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.ConclusionsTogether, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted.Future workThis would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.Study registrationThis study is registered as PROSPERO CRD42015016941.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Longitudinal HCR‐20 scores in a high‐secure psychiatric hospital

Cited by 16 publications

References 11 publications

Patient characteristics and outcome measurement in a low secure forensic hospital

Patient characteristics and outcome measurement in a low secure forensic hospital

The HCR-20 as a measure of reliable and clinically significant change in violence risk among secure psychiatric inpatients

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

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