The DUNDRUM Quartet: validation of structured professional judgement instruments DUNDRUM-3 assessment of programme completion and DUNDRUM-4 assessment of recovery in forensic mental health services

O’Dwyer, Sarah T; Davoren, Mary; Abidin, Zareena; Doyle, Elaine; McDonnell, Kim; Kennedy, Harry G

doi:10.1186/1756-0500-4-229

Cited by 41 publications

(59 citation statements)

References 18 publications

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“…The location at baseline (for eight locations from the most to least secure) predicted harm to others (AUC = 0.812, 95% confidence interval 0.677 to 0.948, p < 0.001) as expected, since we have previously shown that location is a proxy for measures of risk [32] and recovery [23,24]. Length of stay at the beginning of the observation period did not predict harm to others (AUC = 0.504, 95% CI 0.343-0.665, p = 0.963).…”

Section: Resultssupporting

confidence: 67%

“…The patients were grouped according to their location in the hospital as this has been established as a proxy for risk levels [23,24,32,33]. Adverse events were further subdivided into violence and self-harm, as outcome measures for the prospective study.…”

Section: Methodsmentioning

confidence: 99%

“…The DUNDRUM-3 programme completion scale and DUNDRUM-4 recovery scale [22,23] are two structured professional judgement instruments designed for use as measures of progress along the recovery pathway for those detained in secure forensic psychiatric services. These have been shown to predict moves from more secure to less secure places, along with measures of risk [24] and they have been shown to predict conditional discharge from hospital to the community [25].…”

Section: Introductionmentioning

confidence: 99%

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Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

et al. 2013

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BackgroundThe START and SAPROF are newly developed fourth generation structured professional judgement instruments assessing strengths and protective factors. The DUNDRUM-3 and DUNDRUM-4 also measure positive factors, programme completion and recovery in forensic settings.MethodsWe compared these instruments with other validated risk instruments (HCR-20, S-RAMM), a measure of psychopathology (PANSS) and global function (GAF). We prospectively tested whether any of these instruments predict violence or self harm in a secure hospital setting (n = 98) and whether they had true protective effects, interacting with and off-setting risk measures.ResultsSAPROF and START-strengths had strong inverse (negative) correlations with the HCR-20 and S-RAMM. SAPROF correlated strongly with GAF (r = 0.745). In the prospective in-patient study, SAPROF predicted absence of violence, AUC = 0.847 and absence of self-harm AUC = 0.766. START-strengths predicted absence of violence AUC = 0.776, but did not predict absence of self-harm AUC = 0.644. The DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales also predicted in-patient violence (AUC 0.832 and 0.728 respectively), and both predicted in-patient self-harm (AUC 0.750 and 0.713 respectively). When adjusted for the HCR-20 total score however, SAPROF, START-S, DUNDRUM-3 and DUNDRUM-4 scores were not significantly different for those who were violent or for those who self harmed. The SAPROF had a significant interactive effect with the HCR-dynamic score. Item to outcome studies often showed a range of strengths of association with outcomes, which may be specific to the in-patient setting and patient group studied.ConclusionsThe START and SAPROF, DUNDRUM-3 and DUNDRUM-4 can be used to assess both reduced and increased risk of violence and self-harm in mentally ill in-patients in a secure setting. They were not consistently better than the GAF, HCR-20, S-RAMM, or PANSS when predicting adverse events. Only the SAPROF had an interactive effect with the HCR-20 risk assessment indicating a true protective effect but as structured professional judgement instruments all have additional content (items) complementary to existing risk assessments, useful for planning treatment and risk management.

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Section: Resultssupporting

confidence: 67%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

et al. 2013

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“…Validation studies have shown good psychometric qualities (Flynn, O'Neill, McInerney, & Kennedy, 2011;Freestone et al, 2015;O'Dwyer et al, 2011) and indicated that the DUNDRUM-1 items can predict the level of therapeutic security needed (Flynn et al, 2011;Freestone et al, 2015) and LOS (Davoren et al, 2015) while the DUNDRUM-3 and DUNDRUM-4 can predict moves between levels of therapeutic security (Davoren et al, 2012) and discharge (Davoren et al, 2013).…”

Section: Dangerousness Understanding Recovery and Urgency Manual (Thmentioning

confidence: 99%

Patient characteristics related to length of stay in Dutch forensic psychiatric care

Eckert¹,

Schel²,

Kennedy

et al. 2017

The Journal of Forensic Psychiatry & Psychology

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Create an overview of characteristics of patients in long-term forensic psychiatric care (LFPC) with a higher length of stay (LOS) care compared to patients in regular forensic psychiatric care (RFPC) with a shorter LOS. Data were collected from 139 patient records. This study examined whether patients in LFPC differ from patients in RFPC on sociodemographic data, legal data and clinical data and whether those characteristics are able to predict LOS. Patients in LFPC were more often born in a Dutch Caribbean country, less often had a substance abuse disorder, were more often emotionally neglected during childhood, had a higher HCR-20 risk item score, a higher security needs score, a higher (less successful) recovery score, were more often recidivist and had absconded more often than RFPC patients. Certain characteristics were able to distinguish the longer LOS group which might be useful to establish sequel services and enhance treatment efficiency.

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“…The same scale had predominantly static rather than dynamic characteristics and measured the clinical need for therapeutic security and specialist interventions that is distinct from measures of risk [3]. The assessment of need for therapeutic security can be understood as determining who would benefit from admission to a forensic mental health service or to various levels of therapeutic security.…”

Section: Introductionmentioning

confidence: 99%

DUNDRUM-2: Prospective validation of a structured professional judgment instrument assessing priority for admission from the waiting list for a forensic mental health hospital

2011

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BackgroundThe criteria for deciding who should be admitted first from a waiting list to a forensic secure hospital are not necessarily the same as those for assessing need. Criteria were drafted qualitatively and tested in a prospective 'real life' observational study over a 6-month period.MethodsA researcher rated all those presented at the weekly referrals meeting using the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale. The key outcome measure was whether or not the individual was admitted.ResultsInter-rater reliability and internal consistency for the DUNDRUM-2 were acceptable. The DUNDRUM-1 triage security score and the DUNDRUM-2 triage urgency score correlated r = 0.663. At the time of admission, after a mean of 23.9 (SD35.9) days on the waiting list, those admitted had higher scores on the DUNDRUM-2 triage urgency scale than those not admitted, with no significant difference between locations (remand or sentenced prisoners, less secure hospitals) at the time of admission. Those admitted also had higher DUNDRUM-1 triage security scores. At baseline the receiver operating characteristic area under the curve for a combined score was the best predictor of admission while at the time of admission the DUNDRUM-2 triage urgency score had the largest AUC (0.912, 95% CI 0.838 to 0.986).ConclusionsThe triage urgency items and scale add predictive power to the decision to admit. This is particularly true in maintaining equitability between those referred from different locations.

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The DUNDRUM Quartet: validation of structured professional judgement instruments DUNDRUM-3 assessment of programme completion and DUNDRUM-4 assessment of recovery in forensic mental health services

Cited by 41 publications

References 18 publications

Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

Patient characteristics related to length of stay in Dutch forensic psychiatric care

DUNDRUM-2: Prospective validation of a structured professional judgment instrument assessing priority for admission from the waiting list for a forensic mental health hospital

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