scholarly journals Outcome measures of risk and recovery in Broadmoor High Secure Forensic Hospital: stratification of care pathways and moves to medium secure hospitals

BJPsych Open ◽  
2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Samantha McCullough ◽  
Carolyn Stanley ◽  
Helen Smith ◽  
Molly Scott ◽  
Minesh Karia ◽  
...  
Keyword(s):  
Care Pathway ◽  
Violence Risk ◽  
Global Assessment Of Functioning ◽  
Dynamic Risk ◽  
Forensic Hospital ◽  
Secure Care ◽  
Therapeutic Programme ◽  
Measures Of Risk ◽  
Overall Functioning ◽  
Different Levels

Background Placements within high secure forensic hospitals consist of wards providing various different levels of relational security. They should form a coherent pathway through secure care, based on individual patient risks and needs. Moves to less secure wards within high secure forensic hospitals and moves on to lower secure hospital settings have rarely been systematically studied. Aims The aim of this study was to ascertain if placements within Broadmoor High Secure Hospital and moves from Broadmoor to medium secure hospitals corresponded to measures of violence risk, programme completion and recovery. Method A 13-month prospective cohort study was completed. Patients (n = 142) were rated at baseline for violence risk (Historical, Clinical and Risk – 20), therapeutic programme completion and recovery (DUNDRUM tool) and overall functioning (Global Assessment of Functioning). Placements on the care pathway and moves on to medium secure hospitals were observed. Results Placements on the care pathway within the high secure hospital were associated with dynamic violence risk (F = 16.324, P<0.001), therapeutic programme completion (F = 4.167, P = 0.003), recovery (F = 2.440, P = 0.050) with better scores on these measures being found in the rehabilitation wards and the poorest scores on the highest levels of dependency. Moves to medium secure hospitals were associated with better scores on dynamic risk of violence (F = 33.199, P<0.001), therapeutic programme completion (F = 9.237 P<0.001), recovery (F = 6.863, P = 0.001). Conclusions Placements within Broadmoor Hospital formed a coherent pathway through high secure care. Moves to less secure places were influenced by more than reduction in violence risk. Therapeutic programme completion and recovery in a broad sense were also important.

scholarly journals Factors predicting citizens’ risk tolerance regarding earthquakes

2021 ◽  
Author(s):  
◽  
Liv Henrich
Keyword(s):  
Risk Perception ◽  
Psychometric Properties ◽  
Nuclear Power ◽  
Risk Mitigation ◽  
Risk Tolerance ◽  
Risk Characteristics ◽  
Tolerance Study ◽  
Measures Of Risk ◽  
The Government ◽  
Different Levels

<p>People tolerate different levels of risk from different hazards in their day-to-day life. Perceptions of risks and the amount of risk mitigation people desire for different hazards vary. Previous research shows that the psychometric properties of different hazards predict the level of risk people tolerate for various hazards, but not for earthquakes. Risk tolerance is likely to also be affected by factors other than the psychometric properties of hazards. This research tested how earthquakes score on psychometric risk properties compared to five other hazards, and aimed to replicate previous research on the risk factors predicting risk tolerance. Secondly, the research aimed to test if other factors, namely framing effects, risk perception and fatalistic thinking predict risk tolerance for earthquakes. In Study 1, participants from Wellington, New Zealand (N = 139) rated six different hazards (nuclear power, smoking, alcohol, driving, flying and earthquakes) on several risk characteristics and measures of risk tolerance. The results showed that the different hazards were perceived differently in terms of risk tolerance and that participants thought different risk mitigation actions were appropriate for the six hazards. Factor analysis showed that factors derived from risk characteristics did not predict risk tolerance. Study 2 (N = 173) assessed the effects of framing messages, risk perception and fatalism on risk tolerance (judgments about the firmness of the legislation; willingness to pay tax) and judgments about who should pay. The frames had an effect on participants’ concern about the risk, but did not affect the other measures. Generally participants thought that the Government should pay for strengthening buildings, however, those participants who perceived damage as preventable (fatalism measure) thought that private owners should pay for strengthening.</p>

scholarly journals Changes in J-SOAP-II and SAVRY Scores Over the Course of Residential, Cognitive-Behavioral Treatment for Adolescent Sexual Offending

Sexual Abuse ◽  
2015 ◽  
Vol 29 (4) ◽  
pp. 342-374 ◽  
Author(s):  
Jodi L. Viljoen ◽  
Andrew L. Gray ◽  
Catherine Shaffer ◽  
Natasha E. Latzman ◽  
Mario J. Scalora ◽  
...  
Keyword(s):  
Behavioral Treatment ◽  
Sex Offender ◽  
Sexual Offending ◽  
Cognitive Behavioral ◽  
Violence Risk ◽  
Cognitive Behavioral Treatment ◽  
Assessment Protocol ◽  
Dynamic Risk ◽  
Modifiable Factors ◽  
Offender Assessment

Although the Juvenile Sex Offender Assessment Protocol–II (J-SOAP-II) and the Structured Assessment of Violence Risk in Youth (SAVRY) include an emphasis on dynamic, or modifiable factors, there has been little research on dynamic changes on these tools. To help address this gap, we compared admission and discharge scores of 163 adolescents who attended a residential, cognitive-behavioral treatment program for sexual offending. Based on reliable change indices, one half of youth showed a reliable decrease on the J-SOAP-II Dynamic Risk Total Score and one third of youth showed a reliable decrease on the SAVRY Dynamic Risk Total Score. Contrary to expectations, decreases in risk factors and increases in protective factors did not predict reduced sexual, violent nonsexual, or any reoffending. In addition, no associations were found between scores on the Psychopathy Checklist:Youth Version and levels of change. Overall, the J-SOAP-II and the SAVRY hold promise in measuring change, but further research is needed.

The Short- to Medium-Term Predictive Accuracy of Static and Dynamic Risk Assessment Measures in a Secure Forensic Hospital

Assessment ◽  
2011 ◽  
Vol 20 (2) ◽  
pp. 230-241 ◽  
Author(s):  
Chi Meng Chu ◽  
Stuart D. M. Thomas ◽  
James R. P. Ogloff ◽  
Michael Daffern
Keyword(s):  
Risk Assessment ◽  
Predictive Accuracy ◽  
Medium Term ◽  
Dynamic Risk ◽  
Forensic Hospital ◽  
Dynamic Risk Assessment ◽  
Assessment Measures

Long-stay in high and medium secure forensic psychiatric care – Prevalence, patient characteristics and pathways in England

2016 ◽  
Vol 33 (S1) ◽  
pp. S180-S180 ◽  
Author(s):  
R. Edworthy ◽  
B. Vollm
Keyword(s):  
Patient Group ◽  
Service Provision ◽  
Psychiatric Care ◽  
Care Pathway ◽  
Patient Characteristics ◽  
Care Pathways ◽  
Cross Sectional ◽  
Case File ◽  
Secure Care ◽  
Forensic Psychiatric

IntroductionForensic psychiatric services are costly and highly restrictive for patients. Clinical experience and the limited research available indicate some patients stay for too long in these settings. A proportion of patients may, however, require long-term (potentially life-long) secure forensic psychiatric care but their needs may not be met by existing service provision designed for faster throughput.ObjectivesWe conducted a national, multi-centre, cross sectional study exploring the prevalence of long-stay and characteristics of long-stayers in high and medium secure forensic psychiatric care in England.Aims(1) Estimate the prevalence of long-stay in secure settings in England (length of stay over 5 years in medium secure care or 10 years in high secure care); (2) describe the characteristics, needs and care pathways of long-stay patients. Develop recommendations following the exploration of international models for this patient group.MethodsWe employed a mixed-methods approach including the analysis of administrative data, case file reviews, patient interviews, consultant questionnaires, interviews with clinicians and commissioners and a Delphi survey.ResultsTwenty-five percent (n = 401) of our sample were experiencing long-stay. This patient group has a heterogeneous set of characteristics and needs relating to their diagnosis, offending history, risk and therapeutic need and have experienced a variety of care pathways through secure care.ConclusionsWe found a greater number of long-stay patients than originally estimated with a set of characteristics and needs that are arguably different to that of the general forensic population, therefore calling for a specific care pathway and service provision for this patient group with a greater focus on autonomy and quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model

2021 ◽  
pp. 1-7
Author(s):  
Seena Fazel ◽  
Mark Toynbee ◽  
Howard Ryland ◽  
Maria Vazquez-Montes ◽  
Hasanen Al-Taiar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Interpersonal Violence ◽  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
Psychiatric Inpatients ◽  
Inpatient Setting ◽  
Violence Risk ◽  
Dynamic Risk ◽  
Schizophrenia Spectrum ◽  
Modifiable Factors

Abstract Background Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions. Methods Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1–4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded. Results We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18) female. Common diagnoses were schizophrenia-spectrum disorders (70%, n = 62) and personality disorders (20%, n = 18). There were 93 violent incidents. Factors contributing to violence risk were a total dynamic score of ⩾1 (OR 3.39, 95% CI 1.25–9.20), 10-year increase in age (OR 0.67, 0.47–0.96), and female sex (OR 2.78, 1.04–7.40). Non-significant associations with schizophrenia-spectrum disorder were found (OR 0.50, 0.20–1.21). In a fixed-effect model using all covariates, AUC was 0.77 (0.72–0.82) and 0.75 (0.70–0.80) when the dynamic score was excluded. Conclusions In predicting violence risk in individuals with psychiatric disorders, modifiable factors added little incremental value beyond static ones in a psychiatric inpatient setting. Future work should make a clear distinction between risk factors that assist in prediction and those linked to needs.

scholarly journals Factors predicting citizens’ risk tolerance regarding earthquakes

2021 ◽  
Author(s):  
◽  
Liv Henrich
Keyword(s):  
Risk Perception ◽  
Psychometric Properties ◽  
Nuclear Power ◽  
Risk Mitigation ◽  
Risk Tolerance ◽  
Risk Characteristics ◽  
Tolerance Study ◽  
Measures Of Risk ◽  
The Government ◽  
Different Levels

<p>People tolerate different levels of risk from different hazards in their day-to-day life. Perceptions of risks and the amount of risk mitigation people desire for different hazards vary. Previous research shows that the psychometric properties of different hazards predict the level of risk people tolerate for various hazards, but not for earthquakes. Risk tolerance is likely to also be affected by factors other than the psychometric properties of hazards. This research tested how earthquakes score on psychometric risk properties compared to five other hazards, and aimed to replicate previous research on the risk factors predicting risk tolerance. Secondly, the research aimed to test if other factors, namely framing effects, risk perception and fatalistic thinking predict risk tolerance for earthquakes. In Study 1, participants from Wellington, New Zealand (N = 139) rated six different hazards (nuclear power, smoking, alcohol, driving, flying and earthquakes) on several risk characteristics and measures of risk tolerance. The results showed that the different hazards were perceived differently in terms of risk tolerance and that participants thought different risk mitigation actions were appropriate for the six hazards. Factor analysis showed that factors derived from risk characteristics did not predict risk tolerance. Study 2 (N = 173) assessed the effects of framing messages, risk perception and fatalism on risk tolerance (judgments about the firmness of the legislation; willingness to pay tax) and judgments about who should pay. The frames had an effect on participants’ concern about the risk, but did not affect the other measures. Generally participants thought that the Government should pay for strengthening buildings, however, those participants who perceived damage as preventable (fatalism measure) thought that private owners should pay for strengthening.</p>

scholarly journals Forensic application of static and dynamic risk factors: Is it the right time?

2021 ◽  
Vol 16 ◽  
Author(s):  
Brian Abbott
Keyword(s):  
Risk Factors ◽  
Sexual Violence ◽  
Sexual Offender ◽  
Risk Assessments ◽  
Future Research ◽  
Offender Treatment ◽  
Violence Risk ◽  
Dynamic Risk Factors ◽  
Dynamic Risk ◽  
Forensic Practice

It is common, accepted clinical practice to conduct risk assessments of individuals who commit sexual offenses using the combination of sexual violence risk actuarial measures and dynamic risk factors. This assessment approach has utility when identifying treatment targets, assessing progress in sexual offender treatment, and forming risk management plans. Little research has examined this method in forensic contexts such as deciding whether individuals who suffer from mental disorders are likely to engage in sexually dangerous behavior as defined by sexually violent predator or persons (“SVP”) involuntary civil confinement laws in the USA. In particular, it is uncertain whether the combination of sexual violence risk actuarial measures and dynamic risk factors (DRF) produces sufficiently reliable, relevant, and probative evidence for the trier of fact to properly evaluate the SVP legally defined likelihood of sexual dangerousness. This article explores the efficacy of combining actuarial measures of sexual violence risk and dynamic risk factors as applied in SVP risk assessments based on some commonly observed forensic practices among evaluators. Based on the analysis, recommendations for forensic practice and future research are offered.

scholarly journals Dynamic sexual offense risk assessment using the VRS-SO with indeterminate sentenced men

2021 ◽  
Vol 16 ◽  
Author(s):  
Mark E. Olver
Keyword(s):  
Risk Assessment ◽  
Sexual Violence ◽  
Sexual Offending ◽  
Dynamic Assessment ◽  
Sexual Offense ◽  
Violence Risk ◽  
High Stakes ◽  
Dynamic Risk ◽  
Assessment And Treatment ◽  
Dynamic Risk Assessment

Indeterminate detention (ID) is a high stakes sanction reserved for exceptionally high risk-high need (HRHN) persons who are deemed to pose an undue risk to public safety. It is one of the most extreme measures that is routinely taken by justice systems to manage sexual violence risk and prevent sexual and violent recidivism. Naturally, risk assessment is most frequently employed as a mechanism to keep dangerous people in custody; but seldom is risk assessment viewed as a possible ticket out for men with an ID designation who have made substantive risk changes and whose risk can be safely managed in the community. This article features applications of a dynamic sexual violence risk assessment and treatment planning tool, the Violence Risk Scale-Sexual Offense version (VRS-SO), with ID individuals and other HRHN men, to assess risk in a dynamic manner to inform risk management efforts and release decisions. VRS-SO data on an ID sample are presented along with clinical illustrations of dynamic risk assessment. Several propositions are made with supporting data from VRS-SO normative research with treated sexual offending samples regarding the use of dynamic tools with ID men and the perils and pitfalls of relying solely on static measures. Ultimately, dynamic risk instruments can be used to track progress and monitor risk change over multiple assessments to inform release and reintegration decisions with ID persons. In this regard, dynamic assessment has the potential to help, rather than hinder, reintegration of ID sentenced persons and can inform safe, fair, and humane decisions.

scholarly journals Explaining Chinese Reactions to COVID-19 During the Outbreak: A Systematic Illustration

2021 ◽  
Vol 9 ◽  
Author(s):  
Meng Yuan
Keyword(s):  
Risk Perceptions ◽  
Central Government ◽  
Provincial Government ◽  
Trust In Government ◽  
Public Attention ◽  
Subjective Knowledge ◽  
Measures Of Risk ◽  
Risk Judgments ◽  
Linear Regressions ◽  
Different Levels

Objective: This research attempts to explore systematically factors that influence public reactions during COVID-19 pandemic, including different measures of risk perceptions, public trust in different levels of governments, and attention to news.Methods: This research uses a national stratified random sample of Chinese population and multiple linear regressions to explore the potential predictors of public reactions to coronavirus disease-2019 (COVID-19).Results: This research found that the effects of attentions to news, provincial experience, trust in government, demographics, and political cultures on risk perceptions depend on measures of risk perceptions, risk judgments vs. cognitive vs. affective risk perceptions. Moreover, the effect of culture on trust in government is consistent across different levels of government, trust in local, provincial, and central governments; living in the epicenter of COVID-19 in China decreases trust in local/provincial government but not trust in central government; public attention to news can bring both positive (trust in government) and negative (negative affect) outcomes. Finally, it confirmed positive associations among risk perception, subjective knowledge, and attention to news.Conclusion: The findings suggest challenges for risk communication.

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