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Conducting Patient Oriented Research (POR) in a Forensic Psychiatric Facility: A Case Study of Patient Involvement 在法医精神病学设施中进行以患者为导向的研究(POR):患者参与的案例研究
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-05-29 DOI: 10.1080/14999013.2022.2080305
C. Dell, L. Williamson, H. McKenzie, M. Mela, D. Akça, M. Cruz, T. Ramsum, S. Sultana, N. Camacho Soto, A. Kamal
Abstract Patient oriented research (POR) is new to the healthcare research landscape in Canada and has not yet been applied to the forensic field. This review begins by introducing POR, the POR Level of Engagement Tool, and complimentary approaches used in research with forensic patients. Next, the potential key challenges, paradoxes, and benefits of applying POR to a forensic mental health setting are presented. Drawing on this understanding, a review of our team’s experiences applying the POR Level of Engagement Tool at the Regional Psychiatric Center, a Canadian forensic psychiatric facility, is presented as a case study. The research question supported by our patient advisors and addressed with patients and facility staff was: “What topics do you think we need to know more about to benefit patients at the Regional Psychiatric Center?” We conclude this review article with recommendations on how to meaningfully, and practically, involve forensic psychiatric patients diagnosed with mental disorders in POR when initiating a project. Forensic psychiatric patients can provide insightful knowledge based on their experiences of mental illness to improve the prison health care system and practices.
摘要以患者为导向的研究(POR)是加拿大医疗保健研究领域的一个新领域,尚未应用于法医学领域。本综述首先介绍POR,POR参与水平工具,以及用于法医患者研究的补充方法。接下来,介绍了将POR应用于法医心理健康环境的潜在关键挑战、悖论和好处。基于这一理解,我们的团队在加拿大法医精神病机构区域精神病中心应用POR参与水平工具的经验作为案例研究进行了回顾。由我们的患者顾问支持并与患者和机构工作人员讨论的研究问题是:“你认为我们需要了解更多关于哪些主题才能使区域精神病中心的患者受益?”,在启动项目时,涉及被诊断为POR精神障碍的法医精神病患者。法医精神病患者可以根据他们的精神疾病经历提供有见地的知识,以改善监狱的医疗保健系统和做法。
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引用次数: 0
How Should the Risk of Absconding Be Assessed? Existing Approaches within Forensic Mental Health Systems and Examination of a New Scale 如何评估潜逃风险?法医心理健康系统的现有方法与新尺度的检验
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-05-29 DOI: 10.1080/14999013.2022.2078909
Stephanie R. Penney, Treena Wilkie, A. Simpson
Abstract At present, there are few validated tools to assist clinicians in assessing absconding risk and formulating viable risk management plans. In this article, we review existing literature on instrument validity and reliability in relation to absconding among patients in forensic care. We examine the predictive validity of a new risk assessment scale for absconding, the Waypoint Elopement Risk Scale-Historical (WERS-H), and assess its incremental utility against a general violence risk assessment instrument (HCR-20V3). Results from all active inpatients in our service (N = 139) revealed 73 individuals who were responsible for 261 absconding events from 2014 to 2020, representing a similar event frequency from a previous census conducted in 2012, but also reflecting considerable annual fluctuations in rate. Confirming results of earlier studies, the presence of substance use and lengthy durations of forensic supervision emerged as key variables associated with absconding. The WERS-H was found to be a significant predictor of future absconding events (incident rate ratio = 1.21, 95% CI [1.07, 1.38], p = .002) and contributed incrementally over the HCR-20V3 Historical scale, suggesting that the use of an absconding-specific risk tool may yield better predictive accuracy compared to assessment instruments in the domain of general violence or offending.
目前,很少有有效的工具来帮助临床医生评估潜逃风险并制定可行的风险管理计划。在这篇文章中,我们回顾了现有的文献关于仪器效度和信度在法医护理患者中潜逃。我们检验了一种新的潜逃风险评估量表,即路径点私奔风险量表-历史(WERS-H)的预测有效性,并评估了其相对于一般暴力风险评估工具(HCR-20V3)的增量效用。我们服务的所有活跃住院患者(N = 139)的结果显示,从2014年到2020年,73人对261起潜逃事件负责,这与2012年进行的前一次人口普查的事件频率相似,但也反映了相当大的年度波动。证实早期研究的结果,药物使用的存在和长时间的法医监督成为与潜逃相关的关键变量。研究发现,WERS-H是未来潜逃事件的重要预测因子(发生率比= 1.21,95% CI [1.07, 1.38], p = .002),并且在HCR-20V3历史量表上的贡献逐渐增加,这表明与一般暴力或犯罪领域的评估工具相比,使用潜逃特定风险工具可能产生更好的预测准确性。
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引用次数: 3
Evaluating an Expedited Process to Assess Fitness to Stand Trial in Canada 评估一个快速的过程,以评估是否适合在加拿大受审
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-05-26 DOI: 10.1080/14999013.2022.2078908
David Hill, Sabrina Demetrioff
Abstract In this study, we investigated the potential benefits of using an alternative approach for completing court ordered fitness to stand trial assessments in a Canadian forensic mental health service. Using file information, court databases, and an economic analysis, we compared a hospital-based model of evaluation to a court clinic model in a sample of 96 accused persons from 2013 to 2017. Results revealed a significantly shorter time period for forensic report completion in the court clinic group, but no difference in criminal case processing time between groups. There was a higher rate of accused persons opined to be unfit to stand trial in the court clinic group (25.9%) compared to the hospital-based model (7.7%). Report quality varied somewhat between groups, with forensic assessment reports citing mental disorder and relevant case law more often in the court clinic model. Economic analyses indicated there was a marked cost savings associated with completing assessments at court instead of hospital. Our findings suggest there are several benefits for forensic mental health systems in utilizing community-based models of forensic evaluation.
在这项研究中,我们调查了在加拿大法医心理健康服务中使用替代方法完成法院命令的出庭评估的潜在益处。利用档案信息、法院数据库和经济分析,我们在2013年至2017年的96名被告样本中比较了基于医院的评估模型和法院诊所模型。结果显示,法院门诊组法医报告完成时间明显缩短,但在刑事案件处理时间上各组间无差异。与以医院为基础的模式(7.7%)相比,法院诊所组被认为不适合接受审判的被告比例(25.9%)更高。报告质量在各组之间有所不同,法医评估报告在法庭诊所模式中更多地引用精神障碍和相关判例法。经济分析表明,在法庭而不是医院完成评估可显著节省费用。我们的研究结果表明,利用基于社区的法医评估模型,法医精神卫生系统有几个好处。
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引用次数: 0
Systems and Processes that Enable Progress for Older Forensic Mental Health Patients 使老年法医心理健康患者取得进展的系统和过程
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-05-26 DOI: 10.1080/14999013.2022.2080304
Kate Walker, V. Furtado, J. Yates, T. Dening, B. Völlm, Chris Griffiths
Abstract Older forensic mental health patients have complex needs and requirements; service provision is required to address mental health, offending risk and issues associated with aging (geriatric care). This study aimed to identify the systems and processes that enable valued progress (in terms of quality of life, health, wellbeing, recovery and reduced risk) for older forensic mental health patients. Interviews were conducted with 48 members of staff working with these patients in secure hospitals or the community. Thematic analysis was used to analyze the data. Four overarching themes were identified regarding what facilitated or acted as a barrier in relation to quality of life, health, wellbeing and recovery. Multidisciplinary input, an individualized approach and implementing holistic and needs-led care was found to facilitate progress. However, lack of resources, excluding the patients in care planning, gaps in expertise and knowledge, and a lack of specialized units that could address mental health, forensic and elderly needs were found to be barriers. Extensive, multilevel and wide-ranging support is required specifically for older forensic mental health patients. Joint working is required between older adult and forensic mental health services incorporating geriatric medicine expertise in order to implement co-produced care and treatment plans.
老年法医精神卫生患者有复杂的需求和要求;需要提供服务,以解决心理健康、犯罪风险和与老龄化有关的问题(老年保健)。本研究旨在确定能够为老年法医精神健康患者带来有价值的进步(在生活质量、健康、福祉、康复和降低风险方面)的系统和过程。在安全的医院或社区与这些病人打交道的48名工作人员进行了访谈。采用主题分析法对数据进行分析。在生活质量、健康、福祉和康复方面,确定了四个总体主题,说明了是什么促成了或成为了什么障碍。发现多学科投入、个性化方法和实施整体和需求导向的护理有助于促进进展。然而,缺乏资源(不包括护理计划中的病人)、专业知识和知识方面的差距以及缺乏能够满足心理健康、法医和老年人需求的专门单位,被认为是障碍。需要特别为老年法医精神健康患者提供广泛、多层次和广泛的支持。老年人和法医精神卫生服务机构需要联合开展工作,纳入老年医学专业知识,以便执行共同制定的护理和治疗计划。
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引用次数: 0
The Impact of a Short-Term Mental Health Intervention Delivered in an Australian Prison: A Multi-Cultural Comparison 澳大利亚监狱短期心理健康干预的影响:一种多文化比较
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-05-11 DOI: 10.1080/14999013.2022.2041772
J. Ogloff, Arran Rose, Denny Meyer, S. Benson, S. Shepherd, J. Pfeifer, Stephanie Louise, J. Trounson, J. Skues, M. Daffern
Abstract The Australian prison population is increasingly diverse, yet there is limited research assessing the impact of mental health interventions across culturally diverse groups. This study aimed to evaluate the impact of a short-term psycho-educational program on psychological distress, symptoms of mental illness, coping processes, cognitive fusion (i.e., attachment to patterns of thinking or specific thoughts) and somatic issues for 124 people in prison. Cross-cultural comparisons for intervention effects were made for three cultural groups: culturally and linguistically diverse (CALD; N = 45), Indigenous Australian (N = 24) and English-speaking background (ESB; N = 55). Several differences in intervention outcomes were observed across the cultural groups. Following completion of the program, ESB participants reported significantly reduced levels of depressive symptoms, avoidance coping, cognitive fusion and somatic issues. CALD participants reported significantly reduced somatic issues post-intervention. No significant differences were found in the Indigenous Australian group. These findings indicate that cultural background may influence the effectiveness of mental health interventions delivered within prisons. As such, prisons should aim to offer specialized culturally appropriate mental health services to meet diverse needs.
澳大利亚监狱人口日益多样化,但评估不同文化群体心理健康干预影响的研究有限。本研究旨在评估短期心理教育计划对124名在押人员心理困扰、精神疾病症状、应对过程、认知融合(即对思维模式或特定想法的依恋)和躯体问题的影响。对三个文化群体进行了干预效果的跨文化比较:文化和语言多样性(CALD);N = 45)、澳大利亚土著(N = 24)和英语背景(ESB;n = 55)。在不同的文化群体中观察到干预结果的一些差异。项目完成后,ESB参与者报告抑郁症状、逃避应对、认知融合和躯体问题的水平显著降低。CALD参与者报告干预后躯体问题显著减少。在澳大利亚土著人群中没有发现显著差异。这些发现表明,文化背景可能影响监狱内提供的心理健康干预措施的有效性。因此,监狱应致力于提供在文化上适当的专门心理健康服务,以满足各种需求。
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引用次数: 1
“If I Didn’t Have Them, I’m Not Sure How I Would Have Coped with Everything Myself”: Empowering and Supporting Parents/Carers of High-Risk Young People Assisted by Community Forensic CAMHS “如果我没有他们,我不确定我会如何应对自己的一切”:在社区法医CAMHS的协助下,赋予和支持高危年轻人的父母/看护人权力
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-04-11 DOI: 10.1080/14999013.2022.2060382
J. Jacob, R. Lane, Sophie D’Souza, L. Cracknell, O. White, J. Edbrooke‐Childs
Abstract Parent/carer involvement in their child’s support for mental health difficulties is a critical component of effective care. 13 Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) across England were developed to provide specialist support to young people at high risk of harm to self and in particular others, and their families. The aim of this study is to explore parent/carer experiences of Community F:CAMHS. Thematic analysis of interviews (N = 18, from 5 sites) was conducted. Superordinate themes generated focused on 1) facilitators; and 2) barriers to support. Subthemes generated relate primarily to facilitators, particularly empowering parents/carers through the co-production of strategies to help, “holding” cases (taking ownership), and acting on behalf of and supporting parents/carers. Managing clear, joined-up communication across multi-agencies is also of key importance. Barriers to effective support are a lack of joined-up communication at the beginning of the implementation of the services, awareness of Community F:CAMHS, and limited contact. Implications, including the need to further embed the Community F:CAMHS offering in the overall provision of support for this population are discussed. Areas for future research are identified, including the exploration of how young people's characteristics and outcomes may impact parents/carers’ experiences of interacting with services.
父母/照顾者参与对儿童心理健康困难的支持是有效照顾的关键组成部分。13 .在英格兰各地建立了社区法医儿童和青少年心理健康服务(F:CAMHS),向自我伤害风险高的年轻人,特别是对他人及其家人提供专家支持。本研究的目的是探讨社区F:CAMHS的父母/照顾者体验。对访谈(N = 18,来自5个站点)进行专题分析。产生的高级主题集中在1)促进者;2)支持的障碍。所产生的子主题主要与促进者有关,特别是通过共同制定帮助策略、“持有”案例(取得所有权)以及代表和支持父母/照顾者采取行动来赋予父母/照顾者权力。管理跨多个机构的清晰、连贯的沟通也至关重要。有效支持的障碍是在服务实施之初缺乏联合沟通、对社区F:CAMHS的认识以及接触有限。讨论了影响,包括需要进一步将社区F:CAMHS纳入对这一人群的总体支持提供。确定了未来研究的领域,包括探索年轻人的特征和结果如何影响父母/照顾者与服务互动的体验。
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引用次数: 1
Sexual and Violent Recidivism of Empirically-Typed Individuals Convicted of Rape 经验型强奸犯的性与暴力累犯
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-04-07 DOI: 10.1080/14999013.2022.2052999
Laura Freudenthaler, U. Tran, R. Eher
Abstract Men convicted of rape are a heterogenous group among individuals with sexual offending history. This may contribute to the difficulty of establishing adequate treatment during institutionalization and preventing recidivism after release. Therefore, we aimed to identify an empirical typology of individuals convicted of rape based on (a) common criminological variables (age at first offense, number of prior convictions, relation to the victim), (b) offense behavior (alcoholization during the offense) and (c) clinical diagnoses (substance abuse and dependence, psychopathy, sexual sadism, Cluster B personality disorders, paraphilias, paraphilia-related disorders) associated with the risk of sexual offending. Data of N = 575 adult males with raping history were analyzed. We found four types with different profiles in the described variables: an antisocial impulsive, a sexualized, a highly violent and a non-criminal situational type. The types significantly varied in prognostic validity for violent, but not sexual, recidivism. Also, the typology exhibited a slightly higher predictive validity for violent recidivism than Static-99 scores. In contrast to Static-99, the typology failed to significantly predict sexual recidivism. Although the types explained more variance of violent recidivism than Static-99 scores, the value of applying a broad set of risk factors in contrast to combining only few are discussed.
摘要在有性侵犯史的个体中,被判犯有强奸罪的男性是一个异质性群体。这可能会导致在收容期间建立适当治疗和防止释放后再犯的困难。因此,我们的目的是根据(a)常见的犯罪学变量(初犯年龄、前科数量、与受害者的关系)、(b)犯罪行为(犯罪期间酗酒)和(c)与性犯罪风险相关的临床诊断(药物滥用和依赖、精神病、性施虐、b类人格障碍、性反常、性反常相关障碍)来确定被判强奸的个体的经验类型。对575名有强奸史的成年男性进行数据分析。我们在描述的变量中发现了四种不同类型的人:反社会冲动型、性化型、高度暴力型和非犯罪情景型。这些类型在暴力累犯的预测有效性上有显著差异,而不是性累犯。此外,该类型对暴力再犯的预测效度略高于静态-99分数。与Static-99相比,该类型不能显著预测性再犯。尽管与Static-99分数相比,这些类型解释了更多的暴力累犯的差异,但与仅结合少数风险因素相比,应用广泛的风险因素的价值得到了讨论。
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引用次数: 2
Cross-Cultural Violence Risk Assessment: Adapting the HCR-20V3 for Incarcerated Offenders in Mexico 跨文化暴力风险评估:墨西哥被监禁罪犯适用HCR-20V3
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-03-31 DOI: 10.1080/14999013.2022.2053000
Alicia Nijdam-Jones, Eric García-López, Libertad Merchan Rojas, Aura Ruiz Guarneros, B. Rosenfeld
Abstract This prospective study investigated the predictive validity of a culturally adapted version of the Historical-Clinical-Risk Management-20 (HCR-20V3) with a sample of 114 incarcerated males in a medium-security prison in Mexico City. The goal was to integrate a culturally responsive approach to violence risk assessment by incorporating culturally relevant risk factors identified by forensic mental health professionals in Latin America who conduct violence risk assessments. These risk factors related to problematic family and peer relationships, machismo, normalization of violence, and economic disadvantage. Data collection for HCR-20V3 ratings involved clinical interviews and a review of institutional documents; data on aggressive incidents were collected through document review, self-report follow-up interviews, and guard reports. Participants who engaged in institutional violence during the 3-month follow-up period were given significantly higher scores on several culturally relevant risk factors than those who did not engage in institutional violence. Although the culturally adapted HCR-20V3 items did not provide incremental validity to the original HCR-20V3 items, the culturally adapted HCR-20V3 total score produced an area under the ROC curve of .73-.74. The findings provide evidence that the culturally adapted HCR-20V3 has strong predictive validity and the utility of adapting culturally relevant risk factors for the assessment of violence risk.
摘要:本前瞻性研究调查了历史-临床-风险管理-20 (HCR-20V3)文化适应性版本的预测有效性,样本为114名在墨西哥城中等安全监狱服刑的男性。目标是通过纳入拉丁美洲进行暴力风险评估的法医心理健康专业人员确定的与文化相关的风险因素,将一种符合文化特点的方法纳入暴力风险评估。这些风险因素与有问题的家庭和同伴关系、大男子主义、暴力正常化和经济劣势有关。HCR-20V3评分的数据收集包括临床访谈和机构文件的审查;攻击性事件的数据通过文件审查、自我报告随访访谈和警卫报告收集。在三个月的随访期间,参与机构暴力的参与者在几个与文化相关的风险因素上的得分明显高于没有参与机构暴力的参与者。虽然文化适应后的HCR-20V3量表的效度并没有比原HCR-20V3量表的效度增加,但文化适应后的HCR-20V3总分在ROC曲线下产生了0.73 - 0.74的面积。研究结果证明,适应文化的HCR-20V3具有很强的预测有效性,并且适应文化相关风险因素对暴力风险评估具有实用性。
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引用次数: 2
Understanding Current Staff Experiences, Practices and Needs in Supporting Young People with Neurodevelopmental Disorders in the Queensland Youth Justice System 了解目前工作人员的经验,实践和需求,支持青少年神经发育障碍在昆士兰青年司法系统
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-01-30 DOI: 10.1080/14999013.2021.2019854
Alanna Heanue, M. Gullo, N. Hayes, Hayley M Passmore, N. Reid
Abstract Young people with neurodevelopmental disorders are overrepresented in the youth justice system and face many disadvantages due to their impairments. The current study investigated what factors predict and contribute to the behavior of youth justice professionals working in the Queensland (QLD) youth justice system, utilizing a behavior change wheel framework. Eighty-one youth justice professionals participated in an online survey assessing capability, opportunity and motivation and additional open-ended questions capturing their recommendations for improvement. Results demonstrated that training frequency, capability, opportunity and motivation significantly predicted behaviors to identify and support young people with neurodevelopmental disorders (i.e., target behaviors). Capability (p = <.001) and motivation (p = .02) were significant independent predictors of the target behaviors. Examination of open-ended responses provided by the youth justice professionals identified several key areas, consistent with existing literature, which were in need of modifications to further support young people with neurodevelopmental disorders. These included: use of language, availability of resources, increased liaison with stakeholders, and knowledge and understanding of neurodevelopmental disorders. Overall, the current results provide helpful directions in terms of future targets for implementation strategies and interventions to better support young people with neurodevelopmental conditions who are involved with the QLD youth justice system.
摘要患有神经发育障碍的年轻人在青年司法系统中的比例过高,由于他们的残疾,他们面临着许多不利因素。目前的研究利用行为改变轮框架,调查了哪些因素可以预测和促进昆士兰青年司法系统青年司法专业人员的行为。81名青年司法专业人员参加了一项在线调查,评估了能力、机会和动机,并提出了一些额外的开放式问题,提出了改进建议。结果表明,训练频率、能力、机会和动机显著预测了识别和支持患有神经发育障碍的年轻人的行为(即目标行为)。能力(p=<.001)和动机(p=.02)是目标行为的显著独立预测因素。对青年司法专业人员提供的开放式答复的审查确定了几个关键领域,与现有文献一致,这些领域需要修改,以进一步支持患有神经发育障碍的年轻人。其中包括:语言的使用、资源的可用性、加强与利益相关者的联系,以及对神经发育障碍的了解和理解。总的来说,目前的结果为实施战略和干预措施的未来目标提供了有益的指导,以更好地支持参与昆士兰青年司法系统的患有神经发育疾病的年轻人。
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引用次数: 0
Community-Based Remediation of Juvenile Competence to Stand Trial: A National Survey 基于社区的青少年受审能力补救:一项全国性调查
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2022-01-27 DOI: 10.1080/14999013.2021.2007431
I. Kruh, Neil Gowensmith, Amanda Alkema, Kristin M. Swenson, D. Platt
Abstract Youth found incompetent to stand trial in U.S. juvenile courts may be ordered to attend Juvenile Competence Remediation Services to assist them in becoming competent to proceed with their case. Representatives from 19 community-based JCRS programs were surveyed about current norms and practices. The results suggest that programs routinely meet some emerging best practices (e.g., dyadic service delivery; developmentally sensitive services), but not others (e.g., providing case management services; services guided by outcome data). The results also reveal a lack of consistency across programs in a variety of areas (e.g., training and experience of providers; educational curricula used by providers).
摘要无法在美国少年法庭受审的青少年可能会被命令参加青少年能力补救服务,以帮助他们有能力继续审理案件。来自19个社区JCRS项目的代表接受了关于当前规范和实践的调查。结果表明,项目通常符合一些新兴的最佳实践(例如,二元服务提供;对发展敏感的服务),但不符合其他最佳实践(如,提供病例管理服务;以结果数据为指导的服务)。研究结果还表明,各项目在各个领域缺乏一致性(例如,提供者的培训和经验;提供者使用的教育课程)。
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引用次数: 0
期刊
International Journal of Forensic Mental Health
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