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Current Practices in Incorporating Culture into Forensic Mental Health Assessment: A Survey of Practitioners 将文化纳入法医心理健康评估的现行做法:对从业人员的调查
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-09-13 DOI: 10.1080/14999013.2021.1952355
Amanda M. Fanniff, Taylor M. York, Alexandra L. Montena, Kenzie Bohnsack
Abstract Forensic evaluators conduct assessments of individuals with a wide range of sociocultural identities. Although recommendations regarding how to incorporate cultural considerations in forensic evaluations have been published over the past decade, there is no clear consensus on best practices nor is it clear how evaluators interpret and apply the available recommendations. The current survey represents a replication and extension of a previous survey regarding self-reported culturally-informed practices among forensic evaluators. Subjects were forensic mental health professionals (n = 258; 64.7% women, 69.4% PhD or PsyD) recruited through listservs and training events to complete a survey online or by hard copy. Evaluators reported significant challenges in conducting culturally-informed evaluations, including lack of appropriate tests for their examinees, lack of guidelines for their evaluations, lack of colleagues from diverse backgrounds, and lack of relevant research. Evaluators reported engaging in a wide range of culturally-informed practices across all domains, some being nearly universal (e.g., considered cultural context when forming diagnosis). In contrast, other practices were relatively uncommon (e.g., referred the evaluation to another professional with more knowledge/experience regarding examinees with particular identities). Results indicate a need for more research, more practice guidelines, and diversification of the forensic mental health workforce.
司法鉴定人员对具有广泛社会文化身份的个体进行评估。虽然在过去十年中发表了关于如何将文化因素纳入法医评估的建议,但对最佳做法没有明确的共识,评估人员如何解释和应用现有建议也不清楚。目前的调查是先前关于法医评估人员自我报告的文化知情做法的调查的复制和扩展。研究对象为法医精神卫生专业人员(n = 258;64.7%的女性,69.4%的博士或心理学博士)通过列表服务和培训活动被招募来完成在线或纸质的调查。评估人员报告说,在进行了解文化的评估方面面临重大挑战,包括缺乏对考生的适当测试、缺乏评估指南、缺乏来自不同背景的同事以及缺乏相关研究。评估人员报告说,他们在所有领域都参与了广泛的文化知情实践,其中一些几乎是普遍的(例如,在形成诊断时考虑文化背景)。相比之下,其他做法相对少见(例如,将具有特定身份的考生的评估转介给具有更多知识/经验的其他专业人员)。结果表明,需要更多的研究,更多的实践指南,以及法医精神卫生工作人员的多样化。
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引用次数: 0
Beyond Window Dressing: Does Moving to a New Building Really Shape the Perception of, and Actual Safety on Forensic Inpatient Programs? 超越橱窗装饰:搬到新建筑真的塑造了对法医住院项目的认知和实际安全吗?
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-08-27 DOI: 10.1080/14999013.2021.1973153
Jonathan Bridekirk, E. Ham, Laura C. Ball, Barna Konkolÿ Thege
Abstract Waypoint Centre for Mental Health Care expanded its facility in 2014 to include a new state-of-the-art forensic hospital building, called the Atrium. Prior to moving Waypoint’s forensic programs into the Atrium, the Therapeutic Climate Study (TCS) was launched in order to monitor changes in perceived and objective safety indicators among forensic staff and patients. The present study consisted of a 5-year cross-sectional sequential design, consisting of both survey and hospital administrative data. Across all years of data collection, inpatients ( = 256) reported higher perceived safety when compared to staff ( = 932). However, changes in perceived safety were not linear and only slightly improved for staff over time. Sociodemographic characteristics and perceived recovery measures predicted perceived safety for staff and inpatients, regardless of the move. Male staff reported higher perceived quality of patient-service provider relationships and lower perceived safety, whereas female staff reported higher perceived patient cohesion and higher perceived safety. Both staff and inpatients who perceived the hospital’s principles and practices as more recovery-oriented reported higher perceived safety. Inpatients who have been at the hospital longer reported lower perceived safety, regardless of the move. Hospital administrative data showed the number of incidents in a centralized emergency response system spiked right after the move but eventually tapered off, whereas the rates of violent incidents had increased and remained higher since moving to the new building. Results from this study suggest that staffs’ and inpatients’ sense of safety is determined by multiple factors, of which physical environment seems to play a less central role.
Waypoint精神卫生保健中心于2014年扩建了其设施,包括一座新的最先进的法医医院大楼,名为中庭。在将Waypoint的法医项目转移到中庭之前,启动了治疗气候研究(TCS),以监测法医工作人员和患者感知和客观安全指标的变化。本研究包括一个5年的横断面序列设计,包括调查和医院管理数据。在所有年份的数据收集中,住院患者(=256)报告的安全感高于工作人员(=932)。然而,员工感知安全的变化并不是线性的,只是随着时间的推移略有改善。社会形态特征和感知恢复措施预测了工作人员和住院患者的感知安全,无论他们采取何种行动。男性工作人员报告称,患者服务提供者关系的感知质量较高,感知安全性较低,而女性工作人员则报告称,感知患者凝聚力较高,感知安全性较高。认为医院的原则和做法更注重康复的工作人员和住院患者都报告了更高的安全感。住院时间较长的患者报告称,无论采取何种行动,他们的安全感都较低。医院行政数据显示,集中应急系统中的事件数量在搬迁后立即激增,但最终逐渐减少,而暴力事件的发生率有所上升,自搬迁到新大楼以来一直居高不下。研究结果表明,工作人员和住院患者的安全感是由多种因素决定的,其中物理环境似乎不太重要。
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引用次数: 0
Intersection between Justice-Involved Youth Personality Profiles and Criminal Risk-Need Patterns 涉司法青少年人格特征与犯罪风险-需求模式的交集
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-08-23 DOI: 10.1080/14999013.2021.1972061
Y. Kotelnikova, C. D. Lefebvre, M. Campbell, D. Canales, Catherine Stewart
Abstract To purpose of the current study was to inform system level decision-making about the value of integrating clinically relevant personality information with criminogenic need risk appraisal in justice-involved youth. Using a Canadian sample of youth referred for court-ordered psychological assessments (N = 201, M age=15.62 years; 70% male), we examined the patterns of association and differentiation between youths’ Youth Level of Service/Case Management Inventory (YLS/CMI) criminogenic need/risk profiles with personality profiles derived from the personality scales of the Millon Adolescent Clinical Inventory (MACI, Millon, Millon adolescent clinical inventory. National Computer Systems, 1993). Specifically, latent profile analysis identified four MACI based personality profiles: externalizing, internalizing, dependent/followers, and complex dysregulated personality profiles. These groups varied significantly on YLS/CMI risk-need profiles. Although both externalizing and complex dysregulated sub-types represented higher criminal risk, their intervention needs diverged meaningfully. These results provide insight into the heterogeneity of justice-involved youth and point to the need for system resources that allow for appropriate intervention matching to maximize the goal of recidivism risk reduction in youth.
摘要本研究的目的是为系统级决策提供信息,了解将临床相关人格信息与司法参与青年的犯罪需求风险评估相结合的价值。使用加拿大青少年样本进行法庭命令的心理评估(N = 201,M年龄=15.62 年;70%为男性),我们研究了青少年服务水平/病例管理量表(YLS/CMI)的犯罪需求/风险特征与Millon青少年临床量表(MACI,Millon,Millon青春期临床量表,国家计算机系统,1993)的个性特征之间的关联和差异模式。具体而言,潜在特征分析确定了四种基于MACI的人格特征:外化、内化、依赖/追随者和复杂的失调人格特征。这些组在YLS/CMI风险需求档案上存在显著差异。尽管外化和复杂的失调亚型都代表着更高的犯罪风险,但它们的干预需求存在显著差异。这些结果深入了解了涉及司法的青年的异质性,并指出需要系统资源,以便进行适当的干预匹配,最大限度地实现降低青年累犯风险的目标。
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引用次数: 1
Knowledge and Opinions of Fitness to Stand Trial Elements in Australia 澳大利亚适格审判要件的认识与看法
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-08-09 DOI: 10.1080/14999013.2021.1966140
Grant Alan Blake, J. Ogloff, R. Fullam
Abstract Fitness to stand trial (equivalent to competency to stand trial) requires that defendants have a basic understanding of the purpose of the trial and the trial procedures. Little is known, however, about what constitutes a basic factual understanding of the matters. This study developed a legal knowledge survey in which participants were asked to define legal concepts and respond to legal scenarios. They then rated the importance of each component of the fitness to stand trial test to achieving a fair trial. Participants (N = 393; females 69.7%) aged between 18 and 66-years (M = 31.26-years, SD = 11.48-years) from each Australian state and territory completed the online survey. Legal knowledge was high (86.5% correct) and there was no difference between participants on any clinical (e.g., current or past mental illness, neurological conditions), criminological (e.g., criminal history), or demographic variable (e.g., gender, employment, education), except age (curvilinear R2 = .12). Participants under 30-years old used significantly more Americanisms on difficult items compared with participants over 30-years old. On average, participants rated almost every component of the legal test as “extremely important” to a fair trial. The legal knowledge survey had good psychometric properties (Cronbach’s α = .86, interrater reliability ĸ > .80 on most variables, single solution factor analysis). Overall, the results support the presumption underpinning the Australian test for fitness, which is that people possess a basic factual understanding of a trial and trial procedures. Further research should focus on testing knowledge in special populations (e.g., mental illness, dementia, intellectual disability).
出庭适格(相当于出庭适格)要求被告对审判目的和审判程序有基本的认识。然而,对于什么构成了对这些问题的基本事实理解,人们知之甚少。本研究开发了一项法律知识调查,要求参与者定义法律概念并对法律场景做出反应。然后,他们评估了接受审判测试的每个组成部分对实现公平审判的重要性。参与者(N = 393;来自澳大利亚各州和领地的年龄在18至66岁之间(M = 31.26岁,SD = 11.48岁)的女性69.7%完成了在线调查。法律知识很高(正确率为86.5%),除年龄外,参与者在任何临床(如当前或过去的精神疾病、神经系统疾病)、犯罪学(如犯罪史)或人口统计学变量(如性别、就业、教育)上均无差异(曲线R2 = .12)。与30岁以上的参与者相比,30岁以下的参与者在困难问题上使用的美国语明显更多。平均而言,参与者认为法律测试的几乎每一个组成部分对公平审判都“极其重要”。法律知识调查具有良好的心理测量性质(Cronbach 's α = 0.86,大部分变量的互信度为0.80,单解因子分析)。总的来说,研究结果支持了澳大利亚健康测试的假设,即人们对试验和试验程序有基本的事实性理解。进一步的研究应侧重于在特殊人群(如精神疾病、痴呆、智力残疾)中测试知识。
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引用次数: 1
Patient Participation in Pro Re Nata Medication in Forensic Psychiatric Care: Interview Study with Patients and Nurses 患者参与司法精神病护理中的康复药物:对患者和护士的访谈研究
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-08-07 DOI: 10.1080/14999013.2021.1965267
K. Hipp, M. Kangasniemi
Abstract Pro re nata (PRN, as-needed) medication is commonly used in forensic psychiatric inpatient care, but little is known about the participation of patients in its prescription and administration. This study describes patient participation in PRN medication treatment in forensic psychiatric inpatient care. Data were collected during interviews with 34 inpatients and 19 registered nurses in a Finnish forensic psychiatric hospital. The data underwent inductive content analysis. We found that patient participation in PRN was related to patients’ individual needs and health conditions, and the use of PRN involved private decisions made in the social context of the ward. PRN was an integrated part of daily care, and it involved three stakeholders, namely patients, nurses, and physicians; however, the role of patients in this collaboration was undefined. The administration events for PRN were multiform, and depended on the level of agreement between patients and nurses on the need for PRN. In the future, more attention should be paid to how to motivate patients and provide them with equal opportunities to be involved in the planning of PRN, and to optimize shared decision making so that the expertise of both patients and nurses is utilized in the administration and evaluation of PRN.
摘要Pro-renata(PRN,根据需要)药物通常用于法医精神病住院治疗,但对患者参与其处方和管理知之甚少。本研究描述了在法医精神病住院治疗中患者参与PRN药物治疗的情况。数据是在采访芬兰一家法医精神病医院的34名住院患者和19名注册护士时收集的。数据经过归纳内容分析。我们发现,患者参与PRN与患者的个人需求和健康状况有关,PRN的使用涉及病房社会背景下的私人决策。PRN是日常护理的一个组成部分,它涉及三个利益相关者,即患者、护士和医生;然而,患者在此次合作中的作用尚不明确。PRN的给药事件是多种形式的,取决于患者和护士对PRN需求的一致程度。未来,应更多地关注如何激励患者,为他们提供参与PRN规划的平等机会,并优化共享决策,以便将患者和护士的专业知识用于PRN的管理和评估。
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引用次数: 4
Unidimensionality of the Strengths and Vulnerabilities Scales in the Short-Term Assessment of Risk and Treatability (START) 风险和可治疗性短期评估(START)中优势和脆弱性量表的不确定性
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-08-02 DOI: 10.1080/14999013.2021.1953193
R. Whittington, C. Pollak, Alice Keski-Valkama, Andrew Brown, Alina Haines-Delmont, J. Bak, J. Hvidhjelm, R. Almvik, T. Palmstierna
Abstract The Short-Term Assessment of Risk and Treatability (START) is a 20-item structured professional judgment instrument for assessing dynamic risk in mental health services. Much of the START research literature examines the relationship between Strengths and Vulnerabilities sub-scale total scores and various adverse outcomes including violence. This assumes that the two sub-scales have the psychometric property of unidimensionality i.e. all the items cluster together as a measure of a single construct. Such assumed unidimensionality is a necessary condition for any analyses based on scale “total score” and the widespread use of scores summated in this way in research studies may obscure more specific clusters of items within each sub-scale. This multinational study examined START assessments (n = 685) conducted in four forensic services in Scandinavia and the UK using principal component analysis. It was found that all but three Strengths items (Substance Use, Social Support and Material Resources) and all but four Vulnerabilities items (Substance Use, Social Support, Material Resources and Self care) loaded >0.5 on the expected component. This indicates a unidimensional structure underlying the START and provides empirical support from a large multinational sample for the widespread use of summated Strengths and Vulnerabilities scores in forensic psychiatric risk research.
摘要风险和可治疗性短期评估(START)是一种20项结构的专业判断工具,用于评估心理健康服务中的动态风险。START的许多研究文献考察了优势和脆弱性子量表总分与包括暴力在内的各种不良结果之间的关系。这假设两个子尺度具有单维度的心理测量特性,即所有项目都聚集在一起,作为单个结构的度量。这种假设的单维度是任何基于量表“总分”的分析的必要条件,在研究中广泛使用这种方式汇总的分数可能会模糊每个子量表中更具体的项目集群。这项多国研究考察了START评估(n = 685)在斯堪的纳维亚和英国的四个法医服务中使用主成分分析进行。研究发现,除三个优势项目(物质使用、社会支持和物质资源)外,所有优势项目和除四个弱势项目(物质用途、社会支持、物质资源和自我护理)外,预期成分的负荷均大于0.5。这表明了START背后的一维结构,并为在法医精神病风险研究中广泛使用综合优势和脆弱性评分提供了来自大型跨国样本的经验支持。
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引用次数: 2
The Meaningfulness of Grandiose and Vulnerable Narcissism in Forensic Mental Health Rehabilitation Practice: A Systematic Review 浮夸型和脆弱型自恋在法医心理健康康复实践中的意义:系统回顾
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-07-31 DOI: 10.1080/14999013.2021.1963016
Lobke H. Keune, V. de Vogel, M. Eisenberg, H. V. van Marle
Abstract Narcissism is a personality construct with grandiose, and vulnerable aspects, that are interconnected through antagonistic characteristics. While antagonism is strongly related to antisocial behavior, the role of narcissism remains underexplored in offender rehabilitation practice. Research in non-forensic samples has already shown promising results in the differential associations for grandiose and vulnerable narcissism in relation to violent and antisocial behavior and treatment responsiveness that could be relevant for offender rehabilitation. To research the meaningfulness of both narcissism aspects for forensic offender rehabilitation practice, we systematically reviewed the electronic literature databases CINAHL EBSCOhost, Cochrane CENTRAL, EMBASE, Medline All Ovid, PsycINFO Ovid, and Web of Science Core Collection. Subsequently, we synthesized the outcome into meaningful data classifications related to the risk of violence in offender populations and treatment responsivity. In total, 14 publications on forensic samples were included. Overall, the findings suggest that grandiose narcissism was strongly related to proactive violence and a low treatment responsiveness. Vulnerable narcissism was associated with reactive aggression, mediated by impulsivity and negative emotions, and with a moderate responsivity level. As such, both narcissism aspects seem relevant for the development of structured and focused treatment plans in offender rehabilitation practice. The implications for offender rehabilitation practice are provided.
摘要自恋是一种具有宏大和脆弱方面的人格建构,这些方面通过对立的特征相互联系。虽然对抗性与反社会行为密切相关,但自恋在罪犯康复实践中的作用仍未得到充分探索。对非法医样本的研究已经表明,在与暴力和反社会行为以及可能与罪犯康复相关的治疗反应相关的浮夸和脆弱自恋之间的差异关联方面,取得了有希望的结果。为了研究自恋两个方面对法医罪犯康复实践的意义,我们系统地回顾了电子文献数据库CINAHL EBSCOhost、Cochrane CENTRAL、EMBASE、Medline All Ovid、PsycINFO Ovid和Web of Science Core Collection。随后,我们将结果合成了与罪犯群体暴力风险和治疗反应性相关的有意义的数据分类。总共收录了14份关于法医样本的出版物。总体而言,研究结果表明,浮夸的自恋与积极的暴力和低治疗反应性密切相关。易受伤害的自恋与反应性攻击有关,由冲动和负面情绪介导,并具有中等的反应水平。因此,自恋的两个方面似乎都与罪犯康复实践中结构化和重点治疗计划的制定有关。提供了对罪犯康复实践的影响。
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引用次数: 2
Predictors of Weight Gain and Metabolic Indexes among Men Admitted to Forensic Psychiatric Hospital 法医精神病院男性住院患者体重增加和代谢指标的预测因素
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-07-19 DOI: 10.1080/14999013.2021.1952356
N. Hilton, E. Ham, S. Hill, Talia Emmanuel, Barna Konkolÿ Thege
Abstract People with mental health disorders face elevated risk of metabolic syndrome (MetS), which increases the risk of serious health problems and premature mortality. Obesity is prevalent among those hospitalized in forensic psychiatric units, and substantial weight gains during hospitalization have been reported. We examined International Diabetes Federation (IDF) criteria and proxy MetS indexes (body mass index [BMI], blood pressure, and waist circumference) in the medical records of 527 men admitted to a forensic hospital, and tested predictors of weight gain during their first year or less in hospital. IDF indexes were documented for 22% of men whereas proxy indexes were documented for 46%. Both suggested similar MetS prevalence: 16% IDF, 17% proxy. Weight gain averaged 1.72 kg per month; BMI, being a smoker, and length of stay were independent predictors. Interventions focusing on these risk factors are advisable in order to support both mental and physical health among individuals admitted to forensic psychiatric services. The proxy MetS indexes offer a rapid screening measure and a promising tool for research studies and clinical practice in the absence of blood test results.
摘要患有精神健康障碍的人面临代谢综合征(MetS)的风险增加,这增加了严重健康问题和过早死亡的风险。肥胖在法医精神科住院患者中很普遍,据报道,住院期间体重大幅增加。我们在527名入住法医医院的男性的医疗记录中检查了国际糖尿病联合会(IDF)的标准和代理MetS指数(体重指数[BMI]、血压和腰围),并测试了他们住院第一年或更短时间内体重增加的预测因素。22%的男性记录了IDF指数,而46%记录了代理指数。两者都表明MetS的患病率相似:IDF为16%,代理为17%。平均体重增加1.72 千克/月;BMI、吸烟者和住院时间是独立的预测因素。以这些风险因素为重点的干预措施是可取的,以支持接受法医精神病服务的个人的心理和身体健康。在没有血液检测结果的情况下,MetS代理指数为研究和临床实践提供了一种快速筛查手段和一种很有前途的工具。
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引用次数: 4
Tū Tahanga: A Qualitative Descriptive Study of a Culturally Adapted Violence Prevention Programme in a Forensic Mental Health Service TúTahanga:法医心理健康服务中适应文化的暴力预防计划的定性描述性研究
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-07-15 DOI: 10.1080/14999013.2021.1953194
Francis Florencio, D. Healee, Te Ratahi, N. Wiki, B. McKenna
Abstract There is growing evidence that culturally adapted, evidence-based, violence prevention programmes can have benefits for people in correctional and forensic mental health services. Adding to this evidence is crucial, given the over-representation of Indigenous people and ethnic minorities in such services. This qualitative descriptive study describes Tū Tahanga, which combines the ManAlive violence prevention programme, with Māori (Indigenous people of Aotearoa/New Zealand) cultural concepts. This was developed for Māori service users in a forensic mental health service. Content analysis was undertaken through interviews with participants in the group (N = 11). Core aspects of ManAlive were maintained. These aspects coexist with cultural concepts of a specific healing space, a holistic Māori model of health, and the creation of family like supportive relationships reinforced by living in the same facility. This description lays a platform for future evaluative research to determine the impact of the programme on reducing violent offending.
摘要越来越多的证据表明,适应文化、循证的暴力预防方案可以为惩教和法医心理健康服务人员带来好处。鉴于土著人民和少数民族在此类服务中的代表性过高,补充这一证据至关重要。这项定性描述性研究描述了TúTahanga,它将ManAlive暴力预防方案与毛利人(新西兰奥特亚土著人)的文化概念相结合。这是为法医心理健康服务中的毛利人服务用户开发的。内容分析是通过对小组参与者的访谈进行的(N = 11) 。ManAlive的核心方面得以保留。这些方面与特定的治疗空间、整体的毛利人健康模式以及通过生活在同一设施中加强的家庭式支持关系的文化概念共存。这一描述为未来的评估研究奠定了平台,以确定该方案对减少暴力犯罪的影响。
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引用次数: 3
The Physical Health and Activity of Patients under Forensic Psychiatric Care: A Scoping Review 法医精神病护理下患者的身体健康和活动:范围界定综述
IF 1.4 4区 医学 Q2 Nursing Pub Date : 2021-07-05 DOI: 10.1080/14999013.2021.1943570
K. Moss, C. Meurk, M. Steele, E. Heffernan
Abstract We completed a scoping review to map current knowledge and identify research gaps relating to the physical health and activity of patients under forensic psychiatric care, and interventions to improve physical health and activity. Twenty-four articles comprising 22 studies were included in the review. There was a high prevalence of overweight and obesity among forensic patients and weight gain often occurred following admission. Interventions showed some health benefits, but there is insufficient evidence. Future research could benefit from adapting approaches evaluated in general mental health services. Future interventions should consider co-design and assess implementation factors and cost-effectiveness.
摘要我们完成了一项范围界定审查,以绘制当前知识图谱,并确定与接受法医精神病护理的患者的身体健康和活动以及改善身体健康和行为的干预措施有关的研究空白。该综述共收录了24篇文章,包括22项研究。法医患者中超重和肥胖的患病率很高,入院后体重经常增加。干预措施显示出一些健康益处,但证据不足。未来的研究可能受益于调整在一般心理健康服务中评估的方法。未来的干预措施应考虑共同设计和评估执行因素和成本效益。
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引用次数: 2
期刊
International Journal of Forensic Mental Health
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