Predictive validity of the START for unauthorised leave and substance abuse in a secure mental health setting: A pseudo-prospective cohort study

O’Shea, Laura E.; Dickens, Geoffrey L.

doi:10.1016/j.ijnurstu.2015.02.007

Cited by 12 publications

(6 citation statements)

References 38 publications

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“…No previous studies are known to the authors to have studied the predictive validity of dynamic risk and protective factors for leave approvals or positive treatment outcomes, other than discharge. Previous studies have focused mainly on violations during leave or unauthorized leave [ 36 ]. De Vries and Spreen [ 11 ] mentioned that ‘the factors on which therapists base their decisions are now barely studied.’ When they studied decision-making with the risk assessment tool HKT-30, they found a higher value of social skills, self-reliance, hostility, impulsivity and coping skills in patients who violated rules during leave, and a predictive value of (AUC = .71) for the combination of substance use, impulsivity and a lack of empathy for violation of rules during leave [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation

2016

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BackgroundRehabilitation in forensic psychiatry is achieved gradually with different leave modules, in line with the Risk Need Responsivity model. A forensic routine outcome monitoring tool should measure treatment progress based on the rehabilitation theory, and it should be predictive of important treatment outcomes in order to be usable in decision-making. Therefore, this study assesses the predictive validity for both positive (i.e., leave) and negative (i.e., inpatient incidents) treatment outcomes with the Instrument for Forensic Treatment Evaluation (IFTE).MethodsTwo-hundred and twenty-four patients were included in this study. ROC analyses were conducted with the IFTE factors and items for three leave modules: guided, unguided and transmural leave for the whole group of patients. Predictive validity of the IFTE for aggression in general, physical aggression specifically, and urine drug screening (UDS) violations was assessed for patients with the main diagnoses in Dutch forensic psychiatry, patients with personality disorders and the most frequently occurring co-morbid disorders: those with combined personality and substance use disorders.Results and ConclusionsResults tentatively imply that the IFTE has a reasonable to good predictive validity for inpatient aggression and a marginal to reasonable predictive value for leave approvals and UDS violations. The IFTE can be used for information purposes in treatment decision-making, but reports should be interpreted with care and acknowledge patients’ personal risk factors, strengths and other information sources.

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Section: Discussionmentioning

confidence: 99%

Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation

2016

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“…Physical Violence START vulnerability score, strength score, and specific risk estimates all showed significant and high predictive validity for physical violence in the 6-month follow-up period. Past studies have consistently found that START was predictive of physical violence in 3-12 months (12,(27)(28)(29)(30)(31)(32). START risk/vulnerability items for judging physical violence risk may thus also be generalizable to MDOs in Japan.…”

Section: Predictive Validitymentioning

confidence: 90%

Validity of Short-Term Assessment of Risk and Treatability in the Japanese Forensic Probation Service

et al. 2021

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This study aimed to evaluate the predictive validity and reliability of the Short-Term Assessment of Risk and Treatability (START) in the context of the Japanese forensic probation service. START is a structured professional judgement guide for risk domains concerning negative behaviors such as violence, self-harm, suicide, substance abuse, unauthorized leave, victimization, and self-neglect. In this study, rehabilitation coordinators evaluated community-dwelling patients who were treated under the Medical Treatment and Supervision Act at baseline and followed-up for 6 months. The results revealed that START vulnerability scores significantly predicted self-harm, suicide, physical aggression, substance abuse, and self-neglect. START strength scores predicted physical violence and unauthorized leave. Specific risk estimates predicted physical violence and self-neglect. Risk judgement for future substance use may require adjustments for cultural differences, because of the lower prevalence in Japan. These results suggest that START offers a feasible and valid tool that allows clinicians to plan treatment and promote recovery of forensic patients in Japan.

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“…Also, there is scant evidence that recovery‐focused care could reduce violence and aggression (Lim et al., 2017) as well as a structured behavioural plan (Bisconer et al, 2006). There are also a few interventions that seek to assess the risk of violence to reduce escalation, like START (O’Shea & Dickens, 2015) or DASA (Maguire et al., 2019). Based on the results of this study and previous research, we suggest that the use of de‐escalation interventions should be implemented and evaluated systematically in psychiatric outpatient settings as well.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of workplace violence and the psychological consequences of it among nurses working in psychiatric outpatient settings

Konttila

Holopainen²,

Pesonen

et al. 2020

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? There is a scarcity of studies concerning violence in psychiatric outpatient settings in the 2010s in spite of the deinstitutionalization of psychiatric services. Previous research on violence in psychiatric outpatient settings has failed to consider the association between the psychological consequences of violence, exposures to violence and background factors. What the paper adds to existing knowledge? It has been known for some time that exposures to violence are harmful for psychiatric inpatient nurses; the paper demonstrates that psychiatric outpatient nurses are also at risk. The psychological consequences of exposure to violence are highly individualized and influenced by background factors. Nurses who face harassment have a greater risk of suffering psychological symptoms. What are the implications for practice? De‐escalation interventions should be implemented in psychiatric outpatient settings. Organizations should consider the possibility of internal violence occurring when planning preventive interventions to manage and reduce workplace violence. Education targeted at violence prevention, management and debriefing should be organized systematically in psychiatric outpatient units and be taken into consideration in the mental health nursing curriculum. Abstract IntroductionThere is a scarcity of studies concerning violence and its consequences in psychiatric outpatient setting. AimThis study aimed to explore the occurrence of workplace violence and the psychological consequences of exposure to violence among nurses working in psychiatric outpatient settings. MethodResearch followed a cross‐sectional survey design. Data were collected with the VIA‐Q instrument. ResultsDuring the 12 months prior to the study, nurses (n = 181) had most often experienced psychological violence, with fatigue being the most common consequence. Harassment most often caused feelings of violated integrity, whereas physical violence most often caused insomnia. Significant relationships between exposure to violence and psychological consequences were identified. DiscussionWorkplace violence can manifest in a broad array of psychological symptoms and be harmful for nurses in psychiatric outpatient settings. It is important to discuss the subject of workplace violence and its place in the nursing curriculum and to reflect on how nurses are educated and trained to face violence in psychiatric nursing. Implications for PracticeDe‐escalation interventions should be implemented in psychiatric outpatient settings. Organizations should take steps to abolish internal violence. Nurses need appropriate education in order to prepare them to manage workplace violence.

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Predictive validity of the START for unauthorised leave and substance abuse in a secure mental health setting: A pseudo-prospective cohort study

Cited by 12 publications

References 38 publications

Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation

Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation

Validity of Short-Term Assessment of Risk and Treatability in the Japanese Forensic Probation Service

Occurrence of workplace violence and the psychological consequences of it among nurses working in psychiatric outpatient settings

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