Article Figures & Data
Figures
- Figure 1.
Summary of study selection and exclusion (flow diagram).
Tables
Study Location Setting Sample Size Tools Employed Study Design Outcomes Bjorkly9 Norway Medium secure forensic psychiatry unit 1 case report Progression ladder; criterion-based, stepwise intervention to reduce risk Literature review and a case illustration The case illustrated a successful progression toward self-management of violence and personal growth. Fluttert et al.8 Norway Maximum secure forensic psychiatry unit 189 eligible men; 168 were involved in the intervention Staff Observation Aggression Scale–Revised (SOAS-R) Early Recognition Method (ERM) Naturalistic, one-way, case-crossover design; cases were their own controls A significant decline in the number of seclusions and lower severity of violence were observed after intervention. Rana Abou-Sinna and Leubbers10 Australia Secure forensic psychiatry unit 72 (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.12 The Netherlands Three outpatient forensic psychiatry clinics 310 patients (201 in intervention group), 58 case managers Short-Term Assessment of Risk and Treatability (START)
Client Self-Appraisal (CSA) based on STARTCluster randomized controlled trial The 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.13 The Netherlands Outpatient forensic psychiatry clinic 196 patients Short-Term Assessment of Risk and Treatability (START)
Client Self-Appraisal (CSA) based on STARTNaturalistic outcome study using the intervention group from Troquete et al.12 CSA 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.11 Ireland Secure forensic psychiatry unit 58 men DUNDRUM 3+4 completed separately by staff and patients Prospective, naturalistic, observational cohort study, single-blind design Patients 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.
