Effectiveness of Nonsuicidal Self-Injury Interventions among Incarcerated Women in Correctional Facilities and Secure Settings: An Integrative Review.

Nonsuicidal self-injury (NSSI) is prevalent among incarcerated women in correctional facilities. This poses a challenge in selecting appropriate intervention. This integrative review aimed to identify effective interventions for managing NSSI among incarcerated women. Whittemore and Knafl's framework for integrative reviews was used, and eight databases were searched with 11 papers meeting the inclusion criteria. Six interventions for NSSI for incarcerated women were identified as promising in reducing the rate of NSSI. Data did not support the effectiveness of gender-specific interventions for incarcerated women. There is a need for further research to identify appropriate interventions to target NSSI among incarcerated women.

Too risky to use, or too risky not to? Lessons learned from over 30 years of research on forensic risk assessment with Indigenous persons.

Indigenous peoples are overrepresented in correctional systems internationally, reflecting a history of systemic racism and colonial oppression, and the practice of risk assessment with this population has been a focus of legal and sociopolitical controversy. We conducted a systematic review and meta-analysis of the risk assessment literature comparing Indigenous and non-Indigenous (White majority) groups. We retrieved 91 studies featuring 22 risk tools and 15 risk/need/cultural domains (N = 59,693, Indigenous; N = 237,729, non-Indigenous/White) and four documents identifying culturally relevant factors. Most measures demonstrated moderate predictive validity but often had significant ethnoracial differences, particularly for static measures. The Service Planning Instrument/Youth Assessment Screening Inventory, Level of Service Inventory youth variants, Psychopathy Checklist-Revised and Youth Version, and the Violence Risk Scale and its Sexual Offense version had the strongest predictive validity and least ethnoracial discrepancy. The Static Factors Assessment and Dynamic Factors Identification and Analysis-Revised had the weakest predictive validity. For Indigenous persons, the strongest individual predictors of recidivism were low education/employment, substance abuse, antisocial pattern, and poor community functioning, while mitigating factors that predicted decreased recidivism were measures of risk change (i.e., from culturally integrated programs combining mainstream and traditional healing approaches), cultural engagement/connectedness, and protective factors. In practice, static measures need to be supplemented with dynamic ones, and assessors should select measures with at least moderate predictive validity and ideally the least ethnoracial bias. These conclusions are tempered by the quantity and quality of the literature coupled with the circumstance that some study authors have coauthored tools in this review. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Short-term risk assessment in the long term: A scoping review and meta-analysis of the Brøset Violence Checklist.

WHAT IS KNOWN ON THE SUBJECT?: The Brøset Violence Checklist (BVC) has been widely translated and implemented in diverse mental healthcare settings to improve prevention of violence. It is valued as a brief but effective tool in clinical practice. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review is the largest and most comprehensive international review of the BVC conducted in the 25+ years since the inception of the instrument in 1995. It integrates findings from existing studies and establishes that the tool has many impressive strengths considering the brief time investment required for completion. The review reveals that the tool has been used in more than 20 different countries around the world in a variety of mental health and other settings as both a risk assessment tool to guide clinical practice and as a formally structured intervention to minimize violence. There is much variation in how the tool is implemented and scored in different services. This variation questions its applicability as a resource and consistency and its use needs attention. This variation in use also limits the conclusions regarding best practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The review supports the use of the BVC as one part of the package for mental health services committed to preventive action aimed at reducing violence and coercion. The review identified that the patient perspective was often absent when completing the BVC, and so this should be considered as an option by services as part of a collaborative philosophy of care. ABSTRACT: INTRODUCTION: Existing literature on the Brøset Violence Checklist (BVC) is examined in the context of usability, implementation and validity to provide evidence-based recommendations on its application and identify opportunities for future development. AIM/QUESTION: To identify current knowledge on the BVC and guide clinicians and researchers toward the next steps in using this tool in clinical practice to prevent violence in healthcare settings. METHOD: A scoping review approach with a meta-analysis supplement was adopted to broadly identify and map available evidence on the BVC and provide specific estimates of predictive validity in different contexts. RESULTS: Sixty-two studies conducted in 23 countries addressed the implementation of the BVC across various settings. Many studies adapted the original BVC, and the clinical utility was noted as an important feature. A meta-analysis of the original BVC format estimated a pooled area under the curve at 0.83 (95% CI 0.78-0.87) in a subset of 15 studies. DISCUSSION: The BVC combines high predictive validity and good clinical utility across a wide range of settings and cultures. It should continue to be incorporated into routine practice in mental health services focused on preventing violence and coercion. IMPLICATIONS FOR PRACTICE: Development of collaborative approaches with service users involved in assessing their own risk of future violence.

Correctional nursing in Canada's Prairie provinces: Roles, responsibilities, and learning needs.

BACKGROUND: Nurses represent the largest group of health care professionals working with incarcerated persons, yet there is limited understanding of their learning needs, or their roles and responsibilities; and what is known is poorly disseminated. PURPOSE: The goal of this research was to describe the roles, responsibilities, and learning needs of correctional nurses practicing in provincial correctional facilities in Alberta and Manitoba, and to add these data to the existing data set from Saskatchewan. METHODS: Three hundred and forty nurses working in provincial correctional facilities in western Canada were invited to complete a self-administered online survey consisting of a Learning Needs Assessment questionnaire (demographic information, knowledge and learning needs, and professional development); and the Staff Questionnaire (which targeted specific skill sets relevant to clinical practice in secure environments). Eighty-two nurses completed the online survey (overall response rate 24%). RESULTS: Overall, those who participated were experienced in nursing and correctional nursing. The learning needs they identified aligned with their correctional nursing roles and unique practice settings. In particular, issues related to the care of incarcerated persons with mental health disorders and related care were paramount (self-harming behaviours, suicide, mental health assessments in general). In response to the five comprehensive skill sets assessed in the Staff Questionnaire, respondents rated their involvement and importance of the individual skills as important to varying degrees. CONCLUSIONS: The results of this survey shed light on contemporary developments in correctional nursing within provincial correctional facilities in western Canada and provide a foundation for continuing professional education and development, practice, and future research initiatives.

Saskatchewan Provincial Correctional Nurses: Roles, Responsibilities, and Learning Needs.

Nurses represent the largest group of health care professionals working with incarcerated persons. Using a self-administered online questionnaire, this study surveyed a group of provincial correctional nurses to gain insight into their roles, responsibilities, and learning needs in relation to this complex area of practice. Specific aims included describing who they are, what they do, what they need, and what factors influence their practice. A total of 33 responses were received and analyzed, representing a response rate of 34.7%. Many areas of need were identified by the respondents related to their roles and practice. These findings will provide a foundation for continuing education, practice, and future research.

Exploring the Delivery of Healthcare in the Police Detention Center Through Remote Presence Technology.

INTRODUCTION: There is overwhelming evidence to support the delivery of high-quality health service at a lower cost with the use of advanced technologies. Implementing remote presence technology to expand clinical care has been fraught with barriers that limit interprofessional collaboration and optimal client outcomes. In Canada, government ministries responsible for correctional services, policing, and health are well positioned to link federal, provincial, and regional services to enhance service delivery at the point of care for individuals detained within the justice system. Using remote presence technology to link the detention center with relevant health services such as the emergency room has the potential to open up a new care pathway. RESEARCH QUESTION: The key research question was how a new intervention pathway for individuals detained in police service detention centers could be implemented. RESEARCH DESIGN: Utilizing an exploratory qualitative research design, interviews were undertaken with 12 police service and six healthcare participants. Data were transcribed and thematically analyzed. FINDINGS: Four main themes emerged and included role conflict, risk management, resource management, and access to services. A number of collaborative learning partnerships were identified by the participants. IMPLICATIONS: These themes reveal important facilitators and barriers to attending to the health needs of detainees within the police detention center through the utilization of remote presence.

Piloting violence and incident reporting measures on one acute mental health inpatient unit.

During May, 2006, on one acute mental health inpatient unit, nursing staff evaluated each patient three times a day (i.e., once each nursing shift) using the Broset Violence Checklist (BVC). Associated data were collected using the Staff Observation and Aggression Scale-Revised (SOAS-R) if an adverse incident occurred. At the end of the data collection period, the nursing staff were asked to complete a short questionnaire anonymously to evaluate how useful they had found the instruments. N = 93 patients were admitted to the unit during the month of study. Seven incidents were reported using the SOAS-R. A slight trend was noted for higher BVC score in aggressive patients. A potential high occurrence of underreporting on incidents was observed. There was limited feedback data from nursing staff at the end of the study, but the responses received were encouraging for continued use of the instruments in practice. The pilot study fulfilled its purpose in two ways. First, it allowed staff on the unit to experience using structured instruments to support their practice. Second, it allowed an opportunity to raise awareness of potential underreporting and tolerance of aggression on the unit.

Assessing living skills in forensic mental health care with the behavioural status index: a European network study.

Assessment of living skills and violence risk in forensic psychiatric patients is a priority for clinicians. Suitably fine-grained instruments are rare. The goal of this study was to compare a norm-based psychometric assessment battery (the Behavioural Status [BEST] Index) with known valid instruments. Parallel cohort studies were undertaken in four European countries. Inpatients from 24 forensic psychiatric clinics were assessed three times using five instruments measuring living skills, psychological symptoms, aggression, and violence risk. Positive clinical changes were noted in insight, empathy, and some behaviors related to communication and living skills, with little change in violence risk, which was low to medium for most patients. Clinical congruence was observed between logically cognate items of the BEST Index and comparison instruments. Evidence for the scientific and clinical utility of the BEST Index as an effective tool for forensic psychiatric practice is discussed.

Barriers to research utilisation among forensic mental health nurses.

This study used a cross-sectional, descriptive design to identify barriers to research utilisation among forensic mental health nurses. A postal questionnaire was sent to the total population of 88 registered nurses working in a forensic mental health hospital in the UK. Forty-seven responded representing a response rate of 53%. Results showed that the greatest barriers to research utilisation were those related to the characteristics of the setting in which nurses work or the personal characteristics of nurses themselves, which seems to be consistent with previous studies undertaken in the area. However, the nurses reported it especially difficult to trust what research shows because they feel that it is not always possible to apply those findings to their particular work environment. The main implications for policy are a need for an increase in support from management, programmes of advanced education to provide nurses with research skills, an improvement in accessibility and availability of research reports and an increase in time available to read and implement research. The main suggestions for future research are that qualitative studies should be carried out to attain a better understanding of mental health nurses' attitudes towards research utilisation.

Risk prediction: a review of the literature.

This review of risk assessment and prediction literature briefly describes the historical and philosophical influences on the construct of dangerousness; chronicles the advances in research associated with the reconceptualization of dangerousness as risk; and describes current practice and research related to risk assessment, with particular attention to commonly used risk assessment tools and to existing issues and controversies. This cannot be considered a systematic review of the literature but a reflection of some of the key issues found in the literature.

Assessing risk for imminent violence in the elderly: the Brøset Violence Checklist.

OBJECTIVE: The Brøset Violence Checklist (BVC) assesses confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects as either present or absent. It is hypothesised that an individual displaying two or more of these behaviours is more likely to be violent in the next twenty-four hour period. This study aims to test the validity of the instrument in geriatric settings and to report on the predictive value of an easy-to-use risk assessment instrument. METHOD: Eight thousand eight hundred and thirty-five BVC observations were completed in two psychogeriatric wards (n = 42 patients) and two special care units for patients with dementia (n = 40 residents). To measure violent incidents the study group was monitored using the Staff Observation Aggression Scale-Revised (SOAS-R). RESULTS: This study disclosed that patients in geriatric wards and residents in nursing homes who are aggressive have higher BVC scores than the non-violent subjects indicating that the BVC does predict violent episodes in these settings. CONCLUSION: From a clinical perspective, it is most important that a prediction aid has good sensitivity, so that most cases are detected and have a high negative predictive value so that most non-cases on the measure are indeed non-cases. Our results indicate that the BVC was able to achieve this goal.

Challenging behaviour in the elderly-monitoring violent incidents.

OBJECTIVE: To explore the frequency and nature of violent incidents in psychogeriatric wards and nursing homes in terms of type and severity of incidents, what provoked the incidents, and what kind of measure was needed to stop the aggression. MATERIAL AND METHODS: Aggressive behaviour of the study group was monitored using the Staff Observation Aggression Scale-Revised (SOAS-R( in two Norwegian nursing homes and two geriatric psychiatric wards for a period of three months. Severity of incidents were monitored with the built-in severity scoring system in SOAS-R. RESULTS: During the study period 32 out of the 82 patients were reported to be violent. The majority of the incidents were generated by a minority of the patients. Physical injury to the staff as a consequence of the aggression was extremely rare. Situations where the client was denied something were the most provocative ones and a substantial number of incidents occurred at bath/shower times. Talking to the patient was the most frequent measure used to stop the aggression, but more intrusive measures were also used. CONCLUSIONS: A substantial proportion of the incidents were associated with personal care tasks, suggesting a crucial role for communication difficulties and a focus for staff training. We suggest that personal care situations should be added to the variable list in future research.

The Behavioural Status Index: testing a social risk assessment model in a high security forensic setting.

The Behavioural Status Index model suggests that 'social risk' tends to vary inversely with an individual's insight and capacity to perform key communication and social skills. The aim of this study was to describe emergent trends in data related to the risk, insight, and communication and social skills subscales used in the model. Data were collected from 503 patients in two high security mental health hospitals. Although a distinct factorial structure emerged suggesting groupings of behaviours, results provide little support for the overall model proposed.

Effectiveness of nursing interventions in people with personality disorders.

BACKGROUND: Nurses usually provide care for people with personality disorders on a day-to-day basis. Consequently, it is important to establish how effective nursing interventions are for those with personality disorders, both in terms of general management and more specific therapeutic approaches. These are also issues of current political and professional debate. The crucial question, however, for planners, providers and commissioners of services is, What research evidence is there about effectiveness? There is also a need to determine what further research is necessary to evaluate programmes for managing or modifying behaviours. AIM: The aim of this paper is to report on a systematic review of the literature on the effectiveness of nursing interventions in people with personality disorders, whether delivered by nurses alone or in combination with other health care professionals. METHOD: The review was conducted according to the United Kingdom National Health Service Centre for Reviews and Dissemination guidelines. Literature was identified from electronic database searching, footnote chasing, hand searching of journals and contact with authors of studies. Narrative synthesis was undertaken in relation to study design, participants, and type of intervention. FINDINGS: Eighteen separate studies were included in the review: four randomized controlled trials, four non-randomized controlled trials, seven before-and-after studies and three case studies. CONCLUSIONS: There is a weak evidence-base for what constitutes effective nursing intervention with people with personality disorders. There is stronger evidence from mixed disciplines intervention studies than from nursing only intervention studies. Studies of interventions based on psychological approaches show greater improvements in outcomes than nursing management studies.

The Brøset violence checklist (BVC).

OBJECTIVE: The Brøset violence checklist (BVC) is a short-term violence prediction instrument assessing confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects as either present or absent. The aim of this paper is to describe the evolution and usefulness of the BVC. METHOD: This paper reviews studies on the BVC and discusses implications for further research. RESULTS: Empirical research has shown that it has moderate sensitivity and high specificity with an adequate inter-rater reliability. CONCLUSION: The BVC is a useful instrument for predicting inpatient violence within the next 24-h period. The psychometric properties of the instrument are satisfactory. Results from ongoing studies will give important information on cultural differences, the validity of the BVC in less well staffed wards, the clinical use of the checklist and its ability to predict violence throughout all the hospital stay.

Relationships among risk, and communication and social skills in a high security forensic setting.

The Behavioural Status Index was developed for risk assessment within forensic care. This paper reports data analysis for the Behavioural Status Index and its subscales. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 individual patients in two high security mental health hospitals in the UK. Results are reported for inter-item correlations, factor analysis, and differences among independent groups of patients, categorized by Mental Health Act 1983 classification, patient ward dependency, and patient gender. Data trends are indicative of clinically interesting relationships. A distinct factorial structure emerged suggesting groupings of behaviours.