Table 1

Review of Studies on Shared Risk Formulation in Forensic Population

StudyLocationSettingSample SizeTools EmployedStudy DesignOutcomes
Bjorkly9NorwayMedium secure forensic psychiatry unit1 case reportProgression ladder; criterion-based, stepwise intervention to reduce riskLiterature review and a case illustrationThe case illustrated a successful progression toward self-management of violence and personal growth.
Fluttert et al.8NorwayMaximum secure forensic psychiatry unit189 eligible men; 168 were involved in the interventionStaff Observation Aggression Scale–Revised (SOAS-R)
Early Recognition Method (ERM)
Naturalistic, one-way, case-crossover design; cases were their own controlsA significant decline in the number of seclusions and lower severity of violence were observed after intervention.
Rana Abou-Sinna and Leubbers10AustraliaSecure forensic psychiatry unit72 (66 men, 6 women)Camberwell Assessment of Needs–Forensic (CANFOR-S)
Health of Nations Outcome Scale–Secure (HoNOS-S)
Historical Clinical Risk-20 (HCR-20)
CANFOR-S nurse and patient ratings of total needs positively correlated with HoNOS-S clinical and security scales, as well as HCR-20 clinical and risk assessment scales.
Troquete et al.12The NetherlandsThree outpatient forensic psychiatry clinics310 patients (201 in intervention group), 58 case managersShort-Term Assessment of Risk and Treatability (START)
Client Self-Appraisal (CSA) based on START
Cluster randomized controlled trialThe primary outcome consisted of the proportion of clients with one or more violent or criminal incidents in the 6 months before the end of follow-up. No difference was found between treatment as usual and the START/CSA group.
Van den Brink et al.13The NetherlandsOutpatient forensic psychiatry clinic196 patientsShort-Term Assessment of Risk and Treatability (START)
Client Self-Appraisal (CSA) based on START
Naturalistic outcome study using the intervention group from Troquete et al.12CSA critical vulnerabilities and key strengths were significant univariate predictors of recidivism. The best predictive model involved both the case managers' rating from START and the CSA measure of risk and protective factors. (AUC 0.70, 95% CI, 0.60–0.80).
Daroven et al.11IrelandSecure forensic psychiatry unit58 menDUNDRUM 3+4 completed separately by staff and patientsProspective, naturalistic, observational cohort study, single-blind designPatients rated themselves more optimistically than the clinicians.
Clinicians' scores predicted more accurately the move between levels of security.
Higher concordance between staff and patient scores correlated with lower levels of security and further progress.
  • AUC = area under the curve; CI = confidence interval.