Utilization of the Fordham Risk Screening Tool for violence risk assessment in an emergency department.

BACKGROUND: Violence is a critical problem in the emergency department (ED) and patients experiencing mental health crises are at greater violence risk; however, tools appropriate for assessing violence risk in the ED are limited. Our goal was to evaluate the utility of the Fordham Risk Screening Tool (FRST) in reliability assessing violence risk in adult ED patients with acute mental health crises through evaluation of test characteristics compared to a reference standard. METHODS: We evaluated performance of the FRST when used with a convenience sample of ED patients undergoing acute psychiatric evaluation. Participants underwent assessment with the FRST and an established reference standard, the Historical Clinical Risk Management-20, Version 3 (HCR-20 V3). Diagnostic performance was assessed through evaluation of test characteristics and area under the receiver operating characteristic curve (AUROC). Psychometric assessments examined the measurement properties of the FRST. RESULTS: A total of 105 participants were enrolled. In comparison to the reference standard, the AUROC for the predictive ability of the FRST was 0.88 (standard error 0.39, 95% confidence interval [CI] 0.81-0.96). Sensitivity was 84% (95% CI 69%-94%) while specificity was 93% (95% CI 83%-98%). The positive predictive value was 87% (95% CI 73%-94%) and negative predictive value was 91% (95% CI 83%-86%). Psychometric analyses provided reliability and validity evidence for the FRST when used in the ED setting. CONCLUSIONS: These findings support the potential utility of the FRST when used to assess violence risk in adult ED patients experiencing a mental health crisis. Future research with more diverse populations and ED settings is warranted.

Multifamily group psychoeducation and cognitive remediation for first-episode psychosis: a randomized controlled trial.

BACKGROUND: Multifamily group psychoeducation (MFG) has been shown to reduce relapse rates among individuals with first-episode psychosis. However, given the cognitive demands associated with participating in this intervention (e.g., learning and applying a structured problem-solving activity), the cognitive deficits that accompany psychotic disorders may limit the ability of certain individuals to benefit from this intervention. Thus, the goal of this study is to examine whether individuals with first-episode psychosis who participate simultaneously in MFG and cognitive remediation--an intervention shown to improve cognitive functioning among individuals with psychotic disorders--will be less likely to experience a relapse than individuals who participate in MFG alone. METHODS/DESIGN: Forty individuals with first-episode psychosis and their caregiving relative will be recruited to participate in this study. Individuals with first-episode psychosis will be randomized to one of two conditions: (i) MFG with concurrent participation in cognitive remediation or (ii) MFG alone. The primary outcome for this study is relapse of psychotic symptoms. We will also examine secondary outcomes among both individuals with first-episode psychosis (i.e., social and vocational functioning, health-related quality of life, service utilization, independent living status, and cognitive functioning) and their caregiving relatives (i.e., caregiver burden, anxiety, and depression) DISCUSSION: Cognitive remediation offers the possibility of ameliorating a specific deficit (i.e., deficits in cognitive functioning) that often accompanies psychotic symptoms and may restrict the magnitude of the clinical benefits derived from MFG. TRIAL REGISTRATION: ClinicalTrials (NCT): NCT01196286.

Suicide prevention skills, confidence and training: Results from the Zero Suicide Workforce Survey of behavioral health care professionals.

INTRODUCTION: In behavioral health care settings, a workforce well trained in suicide prevention is critically important for behavioral health care professionals across different disciplines and service sectors who are likely to have considerable exposure to patients at risk for suicidal behavior. This study examined the types of training behavioral health care professionals received, their self-reported skills, comfort level and confidence related to suicide prevention, the association of types and length of training with skills, comfort level and confidence, and areas in which participants would like more training. METHODS: The Zero Suicide Workforce Survey was administered electronically to behavioral health care professionals at six behavioral health treatment centers with both inpatient and ambulatory programs in Connecticut, USA. Item numbers and percentages were calculated for 847 respondents with behavioral health care roles. The chi-square tests were performed to determine the statistical significance of group differences. Non-parametric sign tests were performed to determine the statistical significance of the collective differences in direction among items between groups. RESULTS: Suicide prevention training is associated with increased levels of behavioral health care professionals' skills and confidence, but one-third of behavioral health care professionals in the sample received no formal training in suicide prevention/intervention. Even brief training appears to have a positive impact on behavioral health care professionals' assessment of their skills and confidence. Prominent topics for additional training include suicide-specific treatment approaches, suicide prevention and awareness, and identification of risk factors and warning signs. CONCLUSION: Although behavioral health care professionals may often encounter patients at risk for suicide, many have not obtained any relevant training. The findings highlight the need to strengthen suicide identification, assessment and treatment within behavioral health care treatment settings as part of an effort to prevent suicide.