Structured Risk Assessment Tools Research Articles

Pressure injury risk assessment and prescription of preventative interventions using a structured tool versus clinical judgement: An interrater agreement study.

To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement. Interrater agreement study. Data were collected from November 2019 to December 2022. Paired nurse-assessors were allocated randomly to independently assess pressure injury risk using a structured tool (incorporating the Waterlow Score), or clinical judgement; then prescribe preventative interventions. Assessments were conducted on 150 acute patient participants in a general tertiary hospital. Agreement of risk level was analysed using absolute agreement proportions, weighted kappa and prevalence-adjusted and bias-adjusted kappa. Ninety-four nurse assessors participated. Absolute agreement of not-at-risk versus at-risk-any-level was substantial, but absolute agreement of risk-level was only fair. Clinical judgement assessors tended to underestimate risk. Where risk level was agreed, prescribed intervention frequencies were similar, although structured tool assessors prescribed more interventions mandated by standard care, while clinical judgement assessors prescribed more additional/optional interventions. Structured tool assessors prescribed more interventions targeted at lower-risk patients, whereas assessors using clinical judgement prescribed more interventions targeted at higher-risk patients. There were clear differences in pressure injury risk-level assessment between nurses using the two methods, with important differences in intervention prescription frequencies found. Further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk, with emphasis on the impact of risk assessments on subsequent preventative intervention implementation. The results of this study are important for clinical practice as they demonstrate the influence of using a structured pressure injury risk assessment tool compared to clinical judgement. Whilst further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk and prescribe interventions, our findings do not support a change in practice that would exclude the use of a structured pressure injury risk assessment tool. This study adhered to the GRRAS reporting guideline. No patient or public involvement in this study. Educators and researchers can use the findings to guide teaching about pressure injury risk assessment and preventative intervention and to direct future studies. For clinical nurses and patients, a change in clinical practice that would exclude the use of a structured risk assessment tool is not recommended and further work is needed to validate the role of clinical judgement to assess risk and its impact on preventative intervention.

Evidence-based sentencing and scientific evidence.

Evidence-based sentencing (EBS) is a new name for an aspiration that has deep roots in criminal law: to apply the sentence most appropriate to each offender's risk of reoffending, in order to reduce that risk as far as possible. This modern version of the traditional sentencing goals of rehabilitation and incapacitation fits into the broader approach of so-called "evidence-based public policy." It takes the view that the best existing evidence for reducing reoffending are modern structured risk assessment tools and claims to be able to achieve several goals at once: reducing reoffending, maintaining high levels of public safety, making more efficient use of public resources, and moving criminal policy away from ideological battles by basing it on the objective knowledge provided by the best available scientific evidence. However, despite the success of this approach in recent years, it is not clear to what extent it succeeds in correctly assessing the risk of individual offenders, nor whether it achieves its intended effect of reducing recidivism. This paper aims to critically examine these two issues: the quality of the scientific evidence on which EBS is based, and the available data on the extent to which it achieves (or does not achieve) its intended goals.

Violent behaviour in adolescents: assessment and formulation using a structured risk assessment tool

SUMMARYTeenagers often present in crisis with risk issues, mainly risk to self but sometimes risk to others. Adolescent violence is commonplace and is not just the remit of adolescent forensic psychiatry. Clinicians may lack confidence assessing risk of violence and can neglect vital areas that are essential to reduce risk. Use of structured violence risk assessments enables the multi-agency professional network to formulate a young person's presentation and their violence in a holistic way and consequently develop targeted risk management plans addressing areas such as supervision, interventions and case management to reduce the risk of future violence. Of the several validated tools developed for young people, the Structured Assessment of Violence Risk – Youth (SAVRY™) is that most used by UK-based forensic adolescent clinicians. This article outlines the epidemiology, causes and purposes of violence among adolescents; discusses types of risk assessment tool; explores and deconstructs the SAVRY; and presents a fictitious risk formulation.

The Structured Assessment of Protective Factors for violence risk (SAPROF): A meta-analysis of its predictive and incremental validity.

Although the inclusion of protective factors in risk assessment is believed to improve prediction, most risk assessment tools emphasize risk factors. In response, the Structured Assessment of Protective Factors for violence risk (SAPROF) has been developed, which focuses exclusively on protective factors and is used in conjunction with a structured risk assessment tool. It has received increasing attention from both researchers and forensic mental health practitioners, and additional versions have been developed for use with adolescents (SAPROF-YV) and sex offenders (SAPROF-SO). To assess their psychometric performance, we conducted a meta-analysis of validation studies. Our final sample included 39 articles with 5,434 subjects from 16 countries. Overall, the SAPROF(-YV/-SO) showed good interrater reliability and moderate-to-good predictive performance for the absence of recidivism and institutional misconduct. All three instruments exhibited incremental validity when used in conjunction with a risk-focused assessment tool. Our meta-analysis additionally showed that changes on the SAPROF are associated with decreased violent and general recidivism after controlling for baseline risk. We also uncovered several shortcomings in current research with the SAPROF(-YV/-SO). Studies did not report calibration indices and most studies were retrospective and limited to male offenders. The present findings provide support for the relevance of protective factors in risk assessment, but future research should focus on their hypothesized role in treatment and risk management. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Risk assessment of recidivism in Latin America: assessing the reliability and validity of the Self-Appraisal Questionnaire

ABSTRACT Structured risk assessment tools are widely used across the criminal justice systems in western countries. However, little research has been conducted to validate these tools in low and middle-income societies. The aim of this study was to validate a cost-efficient risk assessment tool, the Self-Appraisal Questionnaire (SAQ) in Uruguay, Latin America. The SAQ was administered to a sample of 333 adult male inmates in combination with data from the case file information at the Prison System and self-report. Results showed significant evidence of SAQ’s score reliability (Cronbach α = .91) and concurrent validity with the Self-Report Psychopathy Scale Short Form (r = .62, p < .001). Furthermore, the SAQ showed satisfactory concurrent validity with official data and self-report data for recidivism (AUC = .71 and .75) and for violent recidivism (AUC = .76 and .77). Implications for future research in low and middle-income countries are discussed.

Procena rizika kod adolescentnih seksualnih prestupnika - prikaz slučaja

One of the most important roles of mental health professionals in the forensic evaluation of the adolescent sex offenders is to assess the risk of future delinquent behavior. A psychiatric and psychological expertise of a 17-year-old male adolescent, who was accused of rape, was conducted at court's request in order to determine the maturity of the juvenile, the risk of reoffending and the need for treatment. The current case report demonstrates risk assessment based on the structured professional evaluation. This approach integrates clinical with empirical knowledge and it has been proven highly useful in risk assessment of sexual recidivism in adolescent sex offenders. The assessment was based on the integration of that data obtained from the structured risk assessment tool Juvenile Sex Offender Assessment Protocol-II (JSOAP-II, Prentky and Righthand, 2003) and data based on standard professional expertise by forensic clinicians. The aim of the present case report was to show the advantages of a structured approach to risk assessment in adolescent sex offenders, as well as to assess the practical implications related to appropriate case management and the need for treatment.

Identifying Predictors of Suicide in Severe Mental Illness: A Feasibility Study of a Clinical Prediction Rule (Oxford Mental Illness and Suicide Tool or OxMIS).

BackgroundOxford Mental Illness and Suicide tool (OxMIS) is a brief, scalable, freely available, structured risk assessment tool to assess suicide risk in patients with severe mental illness (schizophrenia-spectrum disorders or bipolar disorder). OxMIS requires further external validation, but a lack of large-scale cohorts with relevant variables makes this challenging. Electronic health records provide possible data sources for external validation of risk prediction tools. However, they contain large amounts of information within free-text that is not readily extractable. In this study, we examined the feasibility of identifying suicide predictors needed to validate OxMIS in routinely collected electronic health records.MethodsIn study 1, we manually reviewed electronic health records of 57 patients with severe mental illness to calculate OxMIS risk scores. In study 2, we examined the feasibility of using natural language processing to scale up this process. We used anonymized free-text documents from the Clinical Record Interactive Search database to train a named entity recognition model, a machine learning technique which recognizes concepts in free-text. The model identified eight concepts relevant for suicide risk assessment: medication (antidepressant/antipsychotic treatment), violence, education, self-harm, benefits receipt, drug/alcohol use disorder, suicide, and psychiatric admission. We assessed model performance in terms of precision (similar to positive predictive value), recall (similar to sensitivity) and F1 statistic (an overall performance measure).ResultsIn study 1, we estimated suicide risk for all patients using the OxMIS calculator, giving a range of 12 month risk estimates from 0.1-3.4%. For 13 out of 17 predictors, there was no missing information in electronic health records. For the remaining 4 predictors missingness ranged from 7-26%; to account for these missing variables, it was possible for OxMIS to estimate suicide risk using a range of scores. In study 2, the named entity recognition model had an overall precision of 0.77, recall of 0.90 and F1 score of 0.83. The concept with the best precision and recall was medication (precision 0.84, recall 0.96) and the weakest were suicide (precision 0.37), and drug/alcohol use disorder (recall 0.61).ConclusionsIt is feasible to estimate suicide risk with the OxMIS tool using predictors identified in routine clinical records. Predictors could be extracted using natural language processing. However, electronic health records differ from other data sources, particularly for family history variables, which creates methodological challenges.

The Predictive Properties of Psychiatric Diagnoses, Dynamic Risk and Dynamic Risk Change Assessed by the VRS-SO in Forensically Admitted and Released Sexual Offenders.

Psychiatric diagnoses, static risk factors, and criminogenic needs at time of admission and release were examined in a mentally ill sample of psychiatrically detained sexual offenders. Although clinically found to be at low or even very low risk at discharge, 12% reoffended sexually over an average follow-up of 7 years. Psychotic disorders were present in only 5% of offenders, whereas 93% had a personality disorder diagnosis and 76% a paraphilic disorder diagnosis. Only exhibitionism and alcohol misuse were associated with relapse. Static risk factors captured by the Static-99 also did not significantly predict recidivism; however, the VRS-SO—a structured risk assessment tool that assesses criminogenic needs and changes in risk from treatment or other change agents, rated retrospectively on the present sample—predicted sexual recidivism as well as any new imprisonment or psychiatric placement. In particular, the sexual deviance factor of the VRS-SO had large in magnitude predictive associations with sexual reoffending, while treatment related changes assessed on this factor were significantly related to non-reoffending. Findings corroborate the advantages of structured risk assessment and structured change monitoring, particularly for complex clientele such as mentally ill sexual offenders.

A clinimetric analysis of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool: PURPOSE-T.

The assessment of patients' risk for developing pressure ulcers is a routine and fundamental nursing process undertaken to prevent avoidable harm to patients in all care settings. Many risk assessment tools are currently used in clinical practice, however no individual tool is recommended by advisory bodies such as the National Institute for Health and Care Excellence or the European Pressure Ulcer Advisory Panel. The evidence base on the value of structured risk assessment tools in reducing the incidence or severity of pressure ulcers is poor. This purpose of this article is to provide a clinimetric analysis of the recently developed Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) and identify areas for future research to improve the utility of structured risk assessment in identifying patients at risk of developing pressure ulcers.

Risk assessment tools for the prevention of pressure ulcers.

Risk assessment tools for the prevention of pressure ulcers.

Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: a systematic review and meta-analysis

Background and AimsViolent behaviour by forensic psychiatric inpatients is common. We aimed to systematically review the performance of structured risk assessment tools for violence in these settings. MethodsThe nine most commonly used violence risk assessment instruments used in psychiatric hospitals were examined. A systematic search of five databases (CINAHL, Embase, Global Health, PsycINFO and PubMed) was conducted to identify studies examining the predictive accuracy of these tools in forensic psychiatric inpatient settings. Risk assessment instruments were separated into those designed for imminent (within 24 hours) violence prediction and those designed for longer-term prediction. A range of accuracy measures and descriptive variables were extracted. A quality assessment was performed for each eligible study using the QUADAS-2. Summary performance measures (sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, and area under the curve value) and HSROC curves were produced. In addition, meta-regression analyses investigated study and sample effects on tool performance. ResultsFifty-two eligible publications were identified, of which 43 provided information on tool accuracy in the form of AUC statistics. These provided data on 78 individual samples, with information on 6,840 patients. Of these, 35 samples (3,306 patients from 19 publications) provided data on all performance measures. The median AUC value for the wider group of 78 samples was higher for imminent tools (AUC 0.83; IQR: 0.71–0.85) compared with longer-term tools (AUC 0.68; IQR: 0.62-0.75). Other performance measures indicated variable accuracy for imminent and longer-term tools. Meta-regression indicated that no study or sample-related characteristics were associated with between-study differences in AUCs. InterpretationThe performance of current tools in predicting risk of violence beyond the first few days is variable, and the selection of which tool to use in clinical practice should consider accuracy estimates. For more imminent violence, however, there is evidence in support of brief scalable assessment tools.

Policing people with sexual convictions using strengths-based approaches

PurposeEffective risk management planning ought to include strategies that help control and mitigate risk, as well as develop and strengthen client’s protective factors. The active risk management system (ARMS) is a structured risk assessment and management planning tool designed to assess both dynamic factors known to be related to sexual recidivism, along with protective factors that might support the desistance process. The tool was recently implemented across all police forces in England and Wales. The purpose of this paper is to examine police practitioner’s experience of the tool, their attitudes towards risk assessment, risk management planning, interviewing clients for the assessment and their perspective on strengths-based approaches in general.Design/methodology/approachA mixed method approach is adopted including one attitudinal measure: community attitudes towards sexual offender-revised (CATSO-R); and four focus groups, analysed using interpretive phenomenological analysis (IPA).FindingsCATSO-R results indicate that when compared to other populations, police officers appear to perceive sex offenders as dangerous, requiring severe punishment. These findings are supported in the IPA analysis where three themes highlight the following: principles and practices of the ARMS tool are incongruent with traditional policing; the negative values officers hold conflicts with a role that supports a process of reintegration and Training and supervision is insufficient to equip management of sexual offenders and violent offender’s with the skills and knowledge needed.Originality/valueOnly one study exists in which ARMS training and its pilot test were examined, this is the first empirical examination of its application in practice. Findings are therefore, of relevance to practitioners and academics alike.

Spousal Assaulters in Outpatient Mental Health Care: The Relevance of Structured Risk Assessment.

This study examined whether a typology of perpetrators of intimate partner violence (IPV) could be replicated in a Dutch sample ( N = 154) of self-referred IPV perpetrators using a structured risk assessment tool for relational violence (Brief Spousal Assault Form for the Evaluation of Risk [B-SAFER]). Our findings support the previous IPV perpetrator subtypes: low-level antisocial (LLA), family only (FO), psychopathology (PP), and generally violent/antisocial (GVA). The subtypes differed on the descriptive dimensions general criminality, substance use, and mental health problems. The prevalence rates for each subtype were roughly comparable with those in previous studies. Contrary to expectation, the prevalence of the GVA subtype was relatively high in our self-referred sample compared with court-referred samples. Our findings suggest that structured risk assessment should be an integral part of the intake procedure for IPV perpetrators entering treatment, to assess their level of risk and to arrive at a tailored risk management strategy, regardless of setting or referral source.

Understanding Clinicians' Use of Cues When Assessing the Future Risk of Violence: A Clinical Judgement Analysis in the Psychiatric Setting.

Research is sparse on how clinicians' judgement informs their violence risk assessments. Yet, determining preferences for which risk factors are used, and how they are weighted and combined, is important to understanding such assessments. This study investigated clinicians' use of static and dynamic cues when assessing risk in individual patients and for dynamic cues considered in the recent and distant past. Clinicians provided three violence risk assessments for 41 separate hypothetical cases of hospitalized patients, each defined by eight cues (e.g., psychopathy and past violence severity/frequency). A clinical judgement analysis, using regression analysis of judgements for multiple cases, created linear models reflecting the major influences on each individual clinician's judgement. Risk assessments could be successfully predicted by between one and four cues, and there was close agreement between different clinicians' models regarding which cues were relevant for a given assessment. However, which cues were used varied between assessments: history of recent violence predicted assessments of in-hospital risk, whereas violence in the distant past predicted the assessed risk in the community. Crucially, several factors included in actuarial/structured risk assessment tools had little influence on clinicians' assessments. Our findings point to the adaptivity in clinicians' violence risk assessments, with a preference for relying on information consistent with the setting for which the assessment applies. The implication is that clinicians are open to using different structured assessment tools for different kinds of risk assessment, although they may seek greater flexibility in their assessments than some structured risk assessment tools afford (e.g., discounting static risk factors). Across three separate violence risk assessments, clinicians' risk assessments were more strongly influenced by dynamic cues that can vary over time (e.g., level of violence) than by static cues that are fixed for a given individual (e.g., a diagnosis of psychopathy). The variation in the factors affecting risk assessments for different settings (i.e., in hospital versus in the community) was greater than the variability between clinicians for such judgements. The findings imply a preference for risk assessment strategies that offer flexibility: either using different risk assessment tools for different purposes and settings or employing a single tool that allows for different inputs into the risk assessment depending upon the nature of the assessment. The appropriateness of these clinical intuitions about violence risk that are implied by our findings warrants further investigation.

Failure analysis in the identification of synergies between cleaning monitoring methods

The 4 monitoring methods used to manage the quality assurance of cleaning outcomes within health care settings are visual inspection, microbial recovery, fluorescent marker assessment, and rapid ATP bioluminometry. These methods each generate different types of information, presenting a challenge to the successful integration of monitoring results. A systematic approach to safety and quality control can be used to interrogate the known qualities of cleaning monitoring methods and provide a prospective management tool for infection control professionals. We investigated the use of failure mode and effects analysis (FMEA) for measuring failure risk arising through each cleaning monitoring method. FMEA uses existing data in a structured risk assessment tool that identifies weaknesses in products or processes. Our FMEA approach used the literature and a small experienced team to construct a series of analyses to investigate the cleaning monitoring methods in a way that minimized identified failure risks. FMEA applied to each of the cleaning monitoring methods revealed failure modes for each. The combined use of cleaning monitoring methods in sequence is preferable to their use in isolation. When these 4 cleaning monitoring methods are used in combination in a logical sequence, the failure modes noted for any 1 can be complemented by the strengths of the alternatives, thereby circumventing the risk of failure of any individual cleaning monitoring method.

Psychopathy in Offenders with Intellectual Disabilities: A Comparison of the PCL-R and PCL:SV

Psychopathy is one of the strongest predictors of future offending and is often included as an important item in structured risk assessment tools. Recent research recognizes the importance of psychopathy in offenders with intellectual disabilities (OIDs). This study presents data on the clinical utility of the Psychopathy Checklist–Revised (PCL–R) and the Psychopathy Checklist: Screening Version (PCL:SV) among OIDs. The psychometric properties of both instruments were similar, although the PCL:SV might have some minor advantages. First because of the absence of the PCL–R item marital relationships, which appeared difficult to score. Second, the PCL:SV is less time-consuming than its extended counterpart. Future research confirming these results with larger cohorts is recommended.

Risk assessment tools for the prevention of pressure ulcers

Use of pressure ulcer risk assessment tools or scales is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. Indeed, use of a risk assessment tool is recommended by many international pressure ulcer prevention guidelines, however it is not known whether using a risk assessment tool makes a difference to patient outcomes. We conducted a review to provide a summary of the evidence pertaining to pressure ulcer risk assessment in clinical practice. To determine whether using structured, systematic pressure ulcer risk assessment tools, in any health care setting, reduces the incidence of pressure ulcers. In December 2013, for this second update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid EMBASE; and EBSCO CINAHL. Randomised controlled trials (RCTs) comparing the use of structured, systematic, pressure ulcer risk assessment tools with no structured pressure ulcer risk assessment, or with unaided clinical judgement, or RCTs comparing the use of different structured pressure ulcer risk assessment tools. Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for eligibility, obtained full versions of potentially relevant studies and screened these against the inclusion criteria. We included two studies in this review. One small, cluster randomised study found no statistical difference in pressure ulcer incidence in patients who were assessed by nurses using the Braden risk assessment tool (n=74) compared with patients assessed by nurses who had receiving training and then used unstructured risk assessment (n=76) (RR 0.97, 95% CI 0.53 to 1.77) and those patients assessed by nurses using unstructured risk assessment alone (n=106) (RR 1.43, 95% CI 0.77 to 2.68). The second study was a large single blind randomised controlled study which compared the effect of risk assessment on pressure ulcer incidence using the Waterlow risk assessment tool (n=411), the Ramstadius risk screening tool (n=420) and no formal risk assessment (n=420). There was no statistical difference in pressure ulcer incidence between the three groups (Waterlow 7.5% (n=31); Ramstadius 5.4% (n=22); clinical judgement 6.8% (n=28) (RR 1.10, 95% CI 0.68 to 1.81; Waterlow vs no formal risk assessment), (RR 0.79, 95% CI 0.46 to 1.35; Ramstadius vs no formal risk assessment), (RR 1.44, 95% CI 0.85 to 2.44; Waterlow vs Ramstadius). Two studies were identified which evaluated the effect of risk assessment on patient outcomes; In one study, there was no statistically significant difference in pressure ulcer incidence between people who were assessed using the Braden risk assessment tool compared with those receiving unstructured risk assessment. Methodological limitations of this study prevent firm conclusions being drawn. However, a further high quality RCT identified no statistical differences in pressure ulcer incidence when people were assessed using either the Waterlow risk assessment tool, the Ramstadius risk assessment tool, or using clinical judgement alone. There is no reliable evidence to suggest that the use of structured, systematic pressure ulcer risk assessment tools reduces the incidence of pressure ulcers.

Risk Assessment of Mentally Ill Patients are Urgently Needed in China

It is one of the main tasks of forensic psychiatry to reduce risk behaviors in mentally ill patients through risk assessment and management. Because of the subjectivity of mental disorders diagnosis and the complexity of disease itself, how to assess dangerous behavior or risk in patients with mental disorder is critically important. Relevant successful experience shows that the risk of violence in mentally ill patients can be predicted relatively accurately and controlled to some extent. Violence risk assessment has been put into mental disorders treatment guidelines by American Psychiatric Association and the British National Institute for Health and Clinical optimization [5,6]. Structured risk assessment tools such as HCR-20 have been regularly used for assisting in violence risk assessment of patients (and offenders) in some developed countries, and are often used to justify the long periods of detention [7-9]. Many patients are discharged if they at low level of risks, but much of these instruments are based on static or unchangeable risk factors, which mean that their level of risk will not materially change with treatment. Nevertheless, these tools provide some means to assist forensic psychiatrists to make these difficult decisions regarding detention and discharge. The Chinese violence risk assessment is still in its infancy and lack of systematic research and evidence based risk assessment tools for mentally ill patients. Bin Xie, etc. introduced MOAS (Modified Overt Aggression Scale) and conducted the rater consistency to the Chinese version of MOAS [10]. My research team brought in HCR-20 (The Historical Clinical Risk Management) and carried out a preliminary study of the reliability and validity about it [11]. Xueli Zhang, et al. revised violence Risk Scale (VRS) for assessing violence risk and risk change, and examined the reliability of this modified Violence Risk Scale in Chinese version (VRS-C) [12]. However, because such assessment tools need specialized training and take long time to finish the evaluation, they are still in the research stage. No debate on the actuarial vs. structured professional judgment has been found so far. The Disease Prevention and Control Center in Chinese Health Ministry issued a Severe mental disorders management norms in 2009 and classified the violence risk of severe mental disorders into 6 levels from light to heavy. But no validity and reliability data was provided in Chinese patients. Therefore, it is an urgent task currently to establish a relatively objective, quantifiable, operational assessment model or tool based on evidence. The model of the tool can be used for accurate assessment and prediction the risk of mentally ill patients. The Chinese forensic psychiatry experts mostly adopt unstructured clinical assessment to estimate violent risk of mentally ill patients based on investigation, history taking and clinical examination. This method advantage is to make individual assessment and the disadvantage is not very objective and less systematic. Different institution even different experts in the same institution may obtain different conclusions by the unstructured clinical assessment, which means the psychiatrists make the judgments based on their own clinical experience and makes it difficult to compare the assessment opinions. A few scholars specializing in forensic psychiatry or psychologists advocate the actuarial assessment or structured professional judgment. Therefore, it is necessary to develop a shared risk assessment model or tool for Chinese forensic psychiatry experts to reach a coincident opinion in one case as much as possible. But there are enormous complicated variables involved in risk assessment such as biological and psychological characteristics, environmental influence from family and society, types of violence, incentives, illness situation, etc. [13]. It is very difficult task to design a shared assessment model or tool with considering so many factors in so urgent time to promote better implementation of China Mental Health Act and the amended Criminal Procedure Law. While it is a reasonable way to develop a risk assessment checklist, particularly focusing on modifiable risk factors based on previous research. Katrina Witt, etc. found that those four factors had a high correlation with violence risk including the conduct of hostilities, the recent substance abuse and alcohol abuse history, treatment non adherence, history of crime and violence. And they also found that the four factors could predict violence risk through a systematic literature review of 110 studies and meta-analysis [14]. At the same time, set up a database for severe mental illness patients in China and then revise the shared risk assessment checklist. Eventually China will develop a management protocol for mental illness patients based on their different level of risk and will have a profound risk assessment tool or model to promote reasonable and effective disposal, prevention and surveillance services for the mentally ill patients. Language: en

EPA-0442 – All things being equal? predictive validity of the hcr-20 among heterogenous groups of secure psychiatric inpatients

Introduction The HCR-20 is the most widely used structured violence risk assessment tool in medium secure units in England and has good predictive validity for inpatient violence. However little is known about whether its predictive validity varies between different clinical and demographic groups. Objectives 1) collect HCR-20 risk assessment and three month follow-up data for all eligible inpatients 2) examine the ability of the HCR-20 to predict various indices of inpatient aggression using receiver operating characteristics (ROC), and 3) compare AUC values derived from different groups (i.e. men vs. women) Aim determine if the HCR-20 performs equally across different clinical and demographic groups. Methods This study was conducted amongst inpatients at St Andrew's (N=505). Demographic (age, ethnicity, gender), clinical (diagnosis) and routinely collected risk assessment data (HCR-20) were collated. Incidents of aggression were coded using the OAS for the three months following assessment. Results ROC analysis revealed that the HCR-20 total, Clinical scale and Risk Management scale were predictive of all types of aggression; the Historical scale was a significant predictor of verbal aggression and physical aggression towards objects but not physical aggression towards people. The predictive efficacy of the HCR-20 differed according to gender and diagnosis, with superior performance obtained with women and those with a diagnosis of personality disorder. Conclusions This study reveals differences in the HCR-20's efficacy between groups. Further development and optimisation of the HCR-20 may be required. Alternatively, interventions to prevent aggression may be more effective among some groups. Future research should address these issues.

Measuring and Interpreting the Predictive Validity of Violence Risk Assessments: An Overview of the Special Issue

Mental health professionals are routinely called upon to assess and testify concerning the violence risk of their patients. Expert opinion on risk assessment continues to influence decisions resulting in the long-term denial of civil liberty or even death in the case of capital proceedings. Today, many clinicians use structured risk assessment tools to assist in these tasks. Although few would claim that violence can be predicted without error, all but the most skeptical would concede that our knowledge and ability to assess violence risk far exceeds that of three decades ago. This said, whether current practices are empirically, ethically, or legally valid remains a question of great importance given the consequences that may follow erroneous assessments. And while 30 years ago there was a broad (albeit often overstated) consensus that expert opinion on this topic was inherently suspect, today the field appears to operate on a broad (albeit often overstated) consensus that practices have improved to a sufficient extent to warrant the sizeable impact that violence risk assessments often have on individual liberty, levels of service, and resource allocation.