Short-term clinical risk assessment and management: Comparing the Brockville Risk Checklist and Hamilton Anatomy of Risk Management.

The current article aims to examine the performance of two brief, dynamic risk measures - the Brockville Risk Checklist (BRC4) and one of two versions of the Hamilton Anatomy of Risk Management [HARM-FV and electronic HARM-FV (eHARM-FV)] - scored at regular clinical case conferences for forensic psychiatric patients in two different settings. The eHARM represents a first-in-class dynamic risk assessment tool using data analytics. Two studies are presented from two forensic psychiatric hospitals in Ontario, Canada. The first study compared the HARM-FV, scored by trained research staff, with the BRC4, scored concurrently by clinical teams, on 36 forensic inpatients. In the second study, trained research staff scored both the BRC4 and the eHARM-FV on 55 forensic inpatients. Both studies demonstrated that the BRC4 and both HARM-FV tools were moderately and positively correlated with each other, with higher agreement for similar domains and items. In both samples, the risk measures performed better at identifying individuals who engaged in repeated or more serious problematic behavior. The HARM-FV and eHARM-FV produced higher area under the curve values for subsequent behavior compared with the BRC4. All three tools were effective at detecting future aggression and adverse incidents. We did not directly compare the HARM-FV and eHARM-FV.

The psychometric properties of the Forensic Stigma Scale (FSS).

Three studies examined the psychometric properties of a new scale, the Forensic Stigma Scale (FSS), designed to measure public stigma of forensic patients. In Study 1, the initial item pool was derived to measure three components of stigma (stereotypes, prejudice, discrimination). An EFA (n = 218) identified a two-factor model with 12 items. In Study 2, this two-factor solution was confirmed using CFA with a separate sample (n = 326) which had good-excellent fit indices. All 12 items loaded (> 0.40) on the two latent factors (Dangerousness/Unpredictability [7 items] and Responsibility/Blame [5 items]) identified in the EFA. In Study 3, using the combined samples from the previous two studies, the 12-item FSS showed promising internal consistency reliability (0.75-0.80) and demonstrated satisfactory-good criterion validity; the scale was moderately correlated with a similar construct and was able to differentiate individuals who did and did not have specific education on forensic psychology. IRT analyses demonstrated that both subscales had discrimination parameters in the moderate-high range (α = 1.03 to 2.54), though the threshold parameters (bi) on the Dangerousness/Unpredictability subscale showed better distribution across trait levels. Overall, the 12-item FSS demonstrates strong psychometric properties, especially the Dangerousness/Unpredictability subscale. The scale may provide clinical and empirical uses for measuring public stigma of forensic patients.

Legally Mandated, Formally Pressured, or Voluntary Anger Treatment: Associations With Treatment Recommendations, Refusal, and Completion.

Legally mandated treatment is common in the criminal justice system, for example, for anger management, substance misuse, and intimate partner violence. Past studies have compared voluntary and legally mandated treatment participants but have not distinguished a third, in-between group that is formally pressured to participate in treatment, but not mandated by the criminal justice system. The current study aimed to assess differences on individual characteristics (e.g., sociodemographic and psychiatric) and baseline measures of psychopathology (e.g., anger, aggression, and depression) across three levels of voluntariness and to determine whether voluntariness was associated with treatment recommendation, refusal, and completion at an outpatient anger treatment clinic. Data were retrospectively gathered from the clinical charts of 405 participants. Referrals were classified as voluntary (e.g., self-referred, 61%), formally pressured (e.g., required by work, 14%), or legally mandated (e.g., court order, 25%). Legally mandated participants were younger, more likely to have substance use disorder, less likely to be women, to have a high school education, or to be on psychiatric medications compared to the other two groups. Voluntary participants scored higher on measures of self-reported anger, depression, and stress than the legally mandated participants. Legally mandated participants in particular presented with non-clinical levels of anger and aggression. Level of voluntariness did not affect the decision to recommend individual or group therapy after an intake assessment, but legally mandated participants were significantly more likely (OR = 2.30) than voluntary participants to refuse recommended treatment. Level of voluntariness did not have a significant association with treatment completion. Findings support our distinction between legally mandated and formally pressured participants, but do not support previous research that suggests legally mandated individuals have lower attrition rates in similar treatment programs. The study has implications for the criminal justice system and for anger treatment programs who admit participants with varying levels of voluntariness.

Validation of the Booth Evaluation of Absconding Tool for Assessment of Absconding Risk.

Although absconsion from secure forensic settings is uncommon, it can have serious consequences for the patient, the hospital, and the public. To assess risk of absconding in this population, using empirically based literature and clinical expertise, the authors designed a 28-item structured professional judgment measure, the Booth Evaluation of Absconding Tool (BEAT). To evaluate the psychometric properties of the BEAT, we completed a blinded, case-matched, retrospective study of absconders (n = 57) and non-absconders (n = 26) between 2009 and 2017. Together, the absconders accounted for 120 absconding incidents over the study period. The incidents had similar characteristics as previously published descriptive studies of absconding behavior. The BEAT demonstrated solid internal consistency (α = 0.78), promising inter-rater reliability across many items, and good accuracy in differentiating absconders from controls (area under the curve = 0.77). Considering the limitations associated with a retrospective chart review study, these results show promising reliability and validity for the BEAT and suggest that the BEAT could be a useful tool in assessing and managing absconding in forensic patients.