scholarly journals Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shaoling Zhong ◽  
◽  
Rongqin Yu ◽  
Robert Cornish ◽  
Xiaoping Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Psychiatric Patients ◽  
Clinical Decision ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Risk Categories

Abstract Background Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service. Methods We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool. Results The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1–40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians’ assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future. Conclusions Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.

Can violence risk assessment really assist in clinical decision-making?

2013 ◽  
Vol 48 (3) ◽  
pp. 286-288 ◽  
Author(s):  
Matthew M Large ◽  
Christopher J Ryan ◽  
Sascha Callaghan ◽  
Michael B Paton ◽  
Swaran P Singh
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Violence Risk ◽  
Violence Risk Assessment

scholarly journals Probability and loss: two sides of the risk assessment coin

2011 ◽  
Vol 35 (11) ◽  
pp. 413-418 ◽  
Author(s):  
Matthew M. Large ◽  
Olav B. Nielssen
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Current Form ◽  
Mental Health Settings ◽  
Future Harm ◽  
Two Sides

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.

scholarly journals Developing a clinically useful actuarial tool for assessing violence risk

2000 ◽  
Vol 176 (4) ◽  
pp. 312-319 ◽  
Author(s):  
John Monahan ◽  
Henry J. Steadman ◽  
Pamela C. Robbins ◽  
Eric Silver ◽  
Paul S. Appelbaum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Clinical Utility ◽  
Psychiatric Patients ◽  
Classification Tree ◽  
Base Rate ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
High Degree ◽  
Actuarial Method

BackgroundA new actuarial method for violence risk assessment – the Iterative Classification Tree (ICT) – has become available. It has a high degree of accuracy but can be time and resource intensive to administer.AimsTo increase the clinical utility of the ICT method by restricting the risk factors used to generate the actuarial tool to those commonly available in hospital records or capable of being routinely assessed in clinical practice.MethodA total of 939 male and female civil psychiatric patients between 18 and 40 years old were assessed on 106 risk factors in the hospital and monitored for violence to others during the first 20 weeks after discharge.ResultsThe ICT classified 72.6% of the sample as either low risk (less than half of the sample's base rate of violence) or high risk (more than twice the sample's base rate of violence).ConclusionsA clinically useful actuarial method exists to assist in violence risk assessment.

Risk Assessment

Criminology ◽  
2014 ◽  
Author(s):  
Ashley A. Pritchard ◽  
Adam J. E. Blanchard ◽  
Kevin S. Douglas
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Psychiatric Patients ◽  
Poor Performance ◽  
Professional Judgment ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Dynamic Risk Factors ◽  
Forensic Patients ◽  
Empirically Supported

Violence risk assessment is the process of identifying the level of risk for future violence posed by offenders, forensic patients, and civil psychiatric patients. In each such context, whether persons are detained or released into the community is a decision governed by law. The field of violence risk assessment has witnessed tremendous growth over the past several decades. With few exceptions, its use in numerous legal settings has been upheld by courts, and in some cases professionals have positive duties to conduct risk assessments and protect potential victims. After early research findings suggesting very poor performance of clinicians in predicting violence, a great deal of research has focused on improving risk assessment. Several hundred studies have now been conducted on structured approaches to risk assessment (e.g., actuarial prediction, structured professional judgment). Similarly, a great amount of scientific attention has been paid to identifying empirically supported violence risk factors. More recently, scholars have been focusing on identifying so-called dynamic risk factors, or those that are changeable and of most relevance to intervention. Current themes in risk assessment include focusing on how risk assessment can inform risk management and risk reduction and how best to integrate risk assessment technology into actual practice.

scholarly journals Correction to: Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Briana S. Last ◽  
Simone H. Schriger ◽  
Carter E. Timon ◽  
Hannah E. Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Qualitative Study ◽  
Clinical Decision Making ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Mental Health Settings

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Biomechanical Rupture Risk Assessment

Aorta ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 42-60 ◽  
Author(s):  
T. Christian Gasser
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Validation Studies ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Treatment ◽  
Maximum Diameter ◽  
Individual Risk ◽  
Rupture Risk ◽  
Aneurysm Wall

AbstractAbdominal aortic aneurysm (AAA) rupture is a local event in the aneurysm wall that naturally demands tools to assess the risk for local wall rupture. Consequently, global parameters like the maximum diameter and its expansion over time can only give very rough risk indications; therefore, they frequently fail to predict individual risk for AAA rupture. In contrast, the Biomechanical Rupture Risk Assessment (BRRA) method investigates the wall’s risk for local rupture by quantitatively integrating many known AAA rupture risk factors like female sex, large relative expansion, intraluminal thrombus-related wall weakening, and high blood pressure. The BRRA method is almost 20 years old and has progressed considerably in recent years, it can now potentially enrich the diameter indication for AAA repair. The present paper reviews the current state of the BRRA method by summarizing its key underlying concepts (i.e., geometry modeling, biomechanical simulation, and result interpretation). Specifically, the validity of the underlying model assumptions is critically disused in relation to the intended simulation objective (i.e., a clinical AAA rupture risk assessment). Next, reported clinical BRRA validation studies are summarized, and their clinical relevance is reviewed. The BRRA method is a generic, biomechanics-based approach that provides several interfaces to incorporate information from different research disciplines. As an example, the final section of this review suggests integrating growth aspects to (potentially) further improve BRRA sensitivity and specificity. Despite the fact that no prospective validation studies are reported, a significant and still growing body of validation evidence suggests integrating the BRRA method into the clinical decision-making process (i.e., enriching diameter-based decision-making in AAA patient treatment).

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