Risk assessment by client and case manager for shared decision making in outpatient forensic psychiatry

Abstract

BackgroundIn outpatient forensic psychiatry, assessment of re-offending risk and treatment needs by case managers may be hampered by an incomplete view of client functioning. The client’s appreciation of his own problem behaviour is not systematically used for these purposes. The current study tests whether using a new client self-appraisal risk assessment instrument, based on the Short Term Assessment of Risk and Treatability (START), improves the assessment of re-offending risk and can support shared decision making in care planning.MethodsIn a sample of 201 outpatient forensic psychiatric clients, feasibility of client risk assessment, concordance with clinician assessment, and predictive validity of both assessments for violent or criminal behaviour were studied.ResultsAlmost all clients (98 %) were able to fill in the instrument. Agreement between client and case manager on the key risk and protective factors of the client was poor (mean kappa for selection as key factor was 0.15 and 0.09, respectively, and mean correlation on scoring −0.18 and 0.20). The optimal prediction model for violent or criminal behaviour consisted of the case manager’s structured professional risk estimate for violence in combination with the client’s self-appraisal on key risk and protective factors (AUC = 0.70; 95%CI: 0.60–0.80).ConclusionsIn outpatient forensic psychiatry, self-assessment of risk by the client is feasible and improves the prediction of re-offending. Clients and their case managers differ in their appraisal of key risk and protective factors. These differences should be addressed in shared care planning. The new Client Self-Appraisal based on START (CSA) risk assessment instrument can be a useful tool to facilitate such shared care planning in forensic psychiatry.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0500-3) contains supplementary material, which is available to authorized users.

Recovery and forensic care: Recent advances and future directions

“…Similar results were found byvan den Brink et al (2015) who sampled 201 outpatient forensic mental health service users and their case managers and assessed patient-staff concordance on key risk and protective factors appearing on the Short Term Assessment of Risk and Treatability (START;Webster, Martin, Brink, Nicholls, & Desmarais, 2009). While agreement was good at the service user and staff group levels, the level of concordance between individual patient and case manager pairs was poor.…”

“…Perhaps the most significant advance in this respect has been the promotion of shared decision-making (SDM) models (e.g., Barker, 2012;van den Brink et al, 2015). Although these models have been advanced primarily in general psychiatry (Drake, Cimpean, & Torrey, 2009;Hamann, Leucht, & Kissling, 2003) and in relation to medical treatment decisions (Joosten et al, 2008), their applicability to risk assessments in forensic mental health is increasingly recognised (Barnao, Ward, & Robertson, 2016;Coffey, 2012;Dixon, 2012;Sullivan, 2005).…”

Single-item predictive validity of the Short-Term Assessment of Risk and Treatability (START) for violent behaviour in outpatient forensic psychiatry

“…Whether this is specific for clinicians working in an outpatient setting remains to be tested. Inviting clients to assess their own risk and protective factors for violence and to select their own 'key' factors may be helpful here, both to involve them in shared care planning and to improve the predictive value of violence risk assessment (van den Brink et al, 2015).…”

“…Nonetheless, these features may have therapeutic significance, such as drawing attention to positive aspects of client functioning and fostering the therapeutic alliance and patient motivation for treatment, which are without a doubt worthwhile considerations in the clinical application of risk assessment. However, these therapeutic claims require testing Troquete et al, 2013;van den Brink et al, 2015).…”

Usability and Workflow Evaluation of “RhEumAtic Disease activitY” (READY)

“…Shared decision making for care planning has demonstrated that it improves risk management and patient satisfaction in outpatient settings [32][33][34]. As READY creates a shared platform by integrating data from both patients and physicians, the influence of technology on physician and patient interactions may become either an obstacle or the enabler of physicians' use of technology [35].…”