Barriers and facilitators to structured professional Risk Assessment in Forensic Services

Watts, Rebecca (2024). Barriers and facilitators to structured professional Risk Assessment in Forensic Services. University of Birmingham. Clin.Psy.D.

Preview

Watts2024ClinPsyD_Redacted.pdf
Text - Redacted Version
Available under License All rights reserved.
Download (2MB) | Preview

Abstract

Abstract
Background
Addressing violence and aggression in psychiatric inpatient settings is of significant concern (Spencer et al. 2013). NHS England has mandated the use of the HCR-20 to assess aggressive risk for forensic populations (Coid et al., 2011). Previous research has demonstrated that HCR-20 risk items demonstrate varying predictive validity for institutional violence (Douglas & Shaffer, 2021). O’Shea et al. (2013) conducted a meta-analysis, finding that the HCR-20 showed adequate predictive validity for the HCR20 total scale, C5, and R5 scales. They also found the HCR-20 overall predicted violence better in samples with a higher proportion of males, those with a diagnosis of schizophrenia and with higher proportions of Caucasians in the sample.
Aim
The present meta-analysis examines variations in efficacy concerning the HCR-20’s predictive validity with regard to aggression types, HCR-20 scales, and how these variations can be moderated by clinical and demographic variables.
Method
A systematic search of the literature was carried out using the Ovid MEDLINE(R), EMBASE, and PsycINFO databases.
Results
The predictive validity of the H10 scale did not reach acceptable thresholds for all types of aggression. The HCR-20, C5 and R5 all show adequate predictive validity for the ‘any aggression’ outcome. The reported AUC coefficient for the HCR20, C5 and the R5 was greater in samples containing higher proportions of males and those with a diagnosis of schizophrenia, whereas no statistically reliable association was observed for the relationship between the proportion of Caucasians and predictive validity for any of the HCR20, C5, and R5 subscales.
Conclusion
The HCR 20 subscale was able to adequately predict ‘any aggression’, ‘physical aggression’, ‘verbal aggression’ and ‘physical-other’. The HCR-20 subscale struggled to predict physical aggression with the use of objects and ‘self-harm’.

Introduction:
Forensic services work with individuals that have engaged in criminal behaviour. As such conducting risk assessments (RA) is an integral part of forensic work (Olsson & Kristiansen, 2017). Historically RA focused on predicting future violence, over time this has evolved to adopting an approach encompassing risk management (McEwan et al., 2011). However, professionals’ perceptions about the meaningfulness of RA are under researched (Hurducas et al., 2014). In other settings, professionals have discussed the time-consuming nature of RA, (Derblom et al., 2021) and the need for team working (Raven & Rix., 1999).
This study aimed to explore professionals' understanding of barriers and facilitators to the completion of SPJ tools within forensic services.
Method:
Online semi-structured interviews were conducted with seven participants. Reflexive Thematic Analysis (RTA) was used to analyse the data.
Results:
Three main themes were identified which included ‘Forensic World,’ ‘Barriers to Risk Assessment,’ and ‘Facilitative Elements of Risk Assessment’. Participants discussed that RA could feel divorced from clinical practice, that they are time consuming, and can be used as part of defensible practice. On the other hand, RA’s value was enhanced by team working to communicate multiple perspectives, appropriate formulation, and risk management plans.

Discussion:
The findings from this research indicate that clinicians’ experiences of forensic RA are multi-dimensional, encompassing various aspects that can be influenced by working in this complex context. Organisations and stakeholders may wish to consider strategies such as: training and education, encouraging reflective practice, implementing regular case discussions and supervision in addition to reviewing the accessibility of the RA paperwork.

Type of Work:

Thesis (Doctorates > Clin.Psy.D.)

Award Type:

Doctorates > Clin.Psy.D.

Supervisor(s):