Exploring a new structured professional judgment measure (impulsivity measure related to violence) after an average follow-up of 10 years: A study of Finnish offenders.

BACKGROUND: Identification of the risk factors underlying impulsivity related to violent acts is an essential component of risk assessment and management to reduce violent offending. AIMS: Our aim was to develop a clinically useful measure for assessing impulsivity related to violence. Our research questions were which items in the newly developed measure are associated with later violent recidivism and what is the measure's predictive validity? METHODS: A new scale, the impulsivity measure related to violence (IMP-V), was studied by completing the scale, blind to outcome, from information in the forensic psychiatric examination reports of 63 of a 1-year referral cohort of 181 Finnish offenders. Data on reoffending for up to 15 years after release were collected from official criminal records. RESULTS: The predictive accuracy of the IMP-V continuous ratings was 78% and for the categorical summary risk ratings 77%. Univariate analyses of categorical summary risk ratings of the risk factors revealed that, with two exceptions, each additional score on the IMP-V was associated with a significant increase in violence recidivism. CONCLUSIONS: These preliminary results indicate that the IMP-V is a promising decision-enhancing guide for assessing the risk of violence in impulsive people and that the measure is worth developing for use with impulsivity-prone offenders and forensic psychiatric patients. The IMP-V organises information on the nature of impulsivity in violence-prone persons and thus also creates opportunities for more effective risk management.

Structured professional judgement and sequential redirections.

BACKGROUND: Findings from violence risk assessment prediction-outcome studies suggest that there is no overall 'standout' scheme. AIM: This paper aims to highlight that even greater attention is now required on intervention-focused research. METHODS: Recent advances in the development of structured professional judgement schemes, such as the Historical, Clinical, Risk Management-20 (Version 3), are considered when applied to the tasks of refining individual case formulation and risk management planning. The paper also considers social science research relevant to improving interventions aimed at preventing violence and related risks. RESULTS: A sequential redirection treatment model is proposed on the basis of our limited understanding of how interventions 'work' when applied to mentally disordered offenders. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Future developments in violence-reduction interventions will require improved integration between the worlds of research and clinical practice.

The Short-Term Assessment of Risk and Treatability (START): a prospective validation study in a forensic psychiatric sample.

A new assessment scheme--the Short-Term Assessment of Risk and Treatability (START)--presents a workable method for assessing risks to self and others encountered in mentally and personality disordered clients. This study aimed to demonstrate (a) prevalence and severity of risk behaviors measured by the START, (b) psychometric properties of START, (c) similarities and differences in START scores across different mental health professionals, and (d) concurrent validity of START with diverse negative outcomes. Treatment team members completed the 20-item, dynamically focused START for 137 forensic psychiatric inpatients. Prevalence and severity of START risk domains were measured for 51 patients detained in the hospital for 1 year. Results revealed high rates of generally low-level adverse events. With some exceptions, START scores were meaningfully associated with outcomes measured by a modified Overt Aggression Scale.

Short-Term Assessment of Risk and Treatability (START): The case for a new structured professional judgment scheme.

The Short-Term Assessment of Risk and Treatability (START) is a new structured professional judgment scheme intended to inform multiple risk domains relevant to everyday psychiatric clinical practice (e.g. risk to others, suicide, self-harm, self-neglect, substance abuse, unauthorized leave, and victimization). The article describes the processes involved in establishing an interdisciplinary approach to risk assessment and management. The authors present a review of the rationale for START, including the value of dynamic variables, the importance of strengths, and the extent to which clinicians must be attentive to multiple risk domains, reflecting theoretical and scientific evidence of the overlap among risks. Using the development, validation, and implementation of START as an example, the authors describe the processes by which other researchers, clinicians, and administrators could adapt existing assessment schemes or create new ones to bridge some remaining gaps in the risk assessment and management continuum.

Unavailable essential archival data: a major limitation in the conduct of clinical practice and research in violence risk assessment.

Numerous studies have identified various historical factors strongly associated with violent behaviour in psychiatric patients. We comment herein on some practical reasons for difficulty in obtaining the background documentation necessary for risk assessment.