The Forensic Supplement to the interRAI Mental Health Assessment Instrument: Evaluation and Validation of the Problem Behavior Scale

Background: Numerous validation studies support the use of the interRAI Mental Health (MH) assessment system for inpatient mental health assessment, triage, treatment planning, and outcome measurement. However, there have been suggestions that the interRAI MH does not include sufficient content relevant to forensic mental health. We address this potential deficiency through the development of a Forensic Supplement (FS) to the interRAI MH system. Using three forensic risk assessment instruments (PCL-R; HCR-20; VRAG) that had a record of independent cross validation in the forensic literature, we identified forensic content domains that were missing in the interRAI MH. We then independently developed items to provide forensic coverage. The resulting FS is a single-page, 19-item supplementary document that can be scored along with the interRAI MH, adding approximately 10–15 min to administration time.We constructed the Problem Behavior Scale (PBS) using 11 items from the interRAI MH and FS. The Developmental Sample, 168 forensic mental health inpatients from two large mental health specialty hospitals, was assessed with both an earlier version of the interRAI MH and FS. This sample also provided us access to scores on the PCL-R, the HCR-20 and the VRAG. To validate our initial findings, we sought additional samples where scoring of the interRAI MH and the FS had been done. The first, the Forensic Sample (N = 587), consisted of forensic inpatients in other mental health units/hospitals. The second, the Correctional Sample (N = 618) was a random, representative sample of inmates in prisons, and the third, the Youth Sample (N = 90) comprised a group of youth in police custody.Results: The PBS ranged from 0 to 11, was positively skewed with most scores below 3, and had good internal consistency (Cronbach's Alpha = 0.80). In a test of concurrent validity, correlations between PBS scores and forensic risk scores were moderate to high (i.e., r with PCL-R Factor two of 0.317; with HCR-20 Clinical of 0.46; and with HCR-20 Risk of 0.39). In a test of convergent validity, we used Binary Logistic Regression to demonstrate that the PBS was related to three negative patient experiences (recent verbal abuse, use of a seclusion room, and failure to attain an unaccompanied leave). For each of these three samples, we conducted the same convergent validity statistical analyses as we had for the Developmental Sample and the earlier findings were replicated. Finally, we examined the relationship between PBS scores and care planning triggers, part of the interRAI systems Clinical Assessment Protocols (CAPs). In all three validity samples, the PBS was significantly related to the following CAPs being triggered: Harm to Others, Interpersonal Conflict, Traumatic Life Events, and Control Interventions. These additional validations generalize our findings across age groups (adult, youth) and across health care and correctional settings.Conclusions: The FS improves the interRAI MH's ability to identify risk for negative patient experiences and assess clinical needs in hospitalized/incarcerated forensic patients. These results generalize across age groups and across health care and correctional settings.

Evaluation of forensic therapies using FOTRES

Forensic therapies are sometimes subject to great fluctuations in terms of their continuity of implementation, their quality, as well as their school of thought. Additionally, they are not adequately measured or evaluated. In many cases, their documentation is insufficiently structured and often incomplete. In this context, the change processes of the client are not well documented and important long-term goals are sometimes lost in the process (Melton et al., 2007). However, well-founded findings are available as to which procedures have proven themselves both empirically and in practice in forensic risk assessments. This article offers an overview of the current forensic assessment process with a particular focus on the Forensic Operationalized Therapy/Risk Evaluation System (FOTRES).

Protective Factor Assessments: What Are We Measuring?—An Investigation of the Internal Validity of the Structured Assessment of Protective Factors for Violence Risk

The use of instruments measuring protective factors is on the rise in risk evaluation, management, and treatment planning. Although assessment tools must have good internal validity to be generalizable and reproducible, little is known about the internal validity of protective factor instruments. The present study evaluated the factor structure of the Structured Assessment of Protective Factors for Violence Risk (SAPROF) via confirmatory and exploratory factor analyses of forensic risk assessments of 143 individuals convicted of violent and sexual violent offenses in Switzerland. The SAPROF did not show any differences by type of offenses. Although our confirmatory factor analysis did not confirm the classic SAPROF scale’s structure, the results of the exploratory analysis were in line with previous theoretical research as it revealed a four-factor model comprising Resilience, Reintegration, Treatability, and Living Conditions. These results have implications for the use of the SAPROF in forensic risk assessments and treatment management plans.