START-ing Risk Assessment and Shared Care Planning in Out-patient Forensic Psychiatry: Results from a cluster randomized controlled trial

Nadine Troquete

START-ing Risk Assessment and Shared Care Planning in Out-patient Forensic Psychiatry: Results from a cluster randomized controlled trial

Vertaalde titel van de bijdrage: START-en met Risico Taxatie en Samen Beslissen in de Ambulante Forensische Psychiatrie: Resultaten van een Cluster Gerandomiseerd Gecontroleerd Onderzoek

Nadine Troquete

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Het hoofddoel van forensisch psychiatrische behandeling is het voorkómen van toekomstig gewelddadig gedrag. Het is gebruikelijk om risicotaxatie instrumenten te gebruiken om te bepalen welke cliënten het hoogste risico en dus de meeste behoefte aan behandeling en/of supervisie hebben. De evidentie voor het gebruik van deze instrumenten om geweld teh voorkómen is echter beperkt en dit is zorgwekkend. Het opbouwen en onderhouden van cliënt motivatie voor behandeling is een extra uitdaging in de forensische psychiatrie. Zowel theorieën als onderzoek in andere zorgsectoren suggereren dat Shared Decision Making (SDM) hiervoor een nuttig hulpmiddel kan zijn. Daarom onderzoekt deze dissertatie het effect van de combinatie van gestructureerde risicotaxatie en SDM op recidivisme en cliënt functioneren en welbevinden. De Risk Assessment and Care Evaluation (RACE) studie werd uitgevoerd in de ambulante forensische psychiatrie. Cliënten verbeterden significant: recidivisme nam af en welbevinden en functioneren namen toe. Maar, geen van deze verbeteringen konden worden toegeschreven aan de interventie. Momenteel is er dus beperkte ondersteuning voor het gebruik van risicotaxatie instrumenten als een methode voor het voorkómen van gewelddadig gedrag en dus voor het veranderen van behandelprotocollen door het invoeren van het systematisch gebruik van gestructureerde risicotaxatie instrumenten in de klinische zorg. De evidentie is echter beperkt tot 4 onderzoeken, waaronder deze dissertatie. Meer onderzoek is dan ook nodig. Specifiek naar de voordelen van het gebruik van risicotaxatie instrumenten en hoe zij kunnen bijdragen aan effectievere behandelingen, gemeten in verminderingen van crimineel en gewelddadig gedrag, en manieren waarop cliënten meer betrokken kunnen worden in hun behandeling.

Vertaalde titel van de bijdrage	START-en met Risico Taxatie en Samen Beslissen in de Ambulante Forensische Psychiatrie: Resultaten van een Cluster Gerandomiseerd Gecontroleerd Onderzoek
Originele taal-2	English
Kwalificatie	Doctor of Philosophy
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	Wiersma, Durk, Supervisor Schoevers, Robert, Supervisor van den Brink, Rob, Co-supervisor
Datum van toekenning	12-nov.-2014
Plaats van publicatie	[S.l.]
Uitgever	[S.n.]
Gedrukte ISBN's	978-90-367-7414-7
Elektronische ISBN's	978-90-367-7415-4
Status	Published - 2014

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Title and contents Final publisher's version, 77,1 KB
Chapter 1 Final publisher's version, 643 KB
Chapter 2 Final publisher's version, 797 KB
Chapter 3 Final publisher's version, 941 KB
Chapter 4 Final publisher's version, 821 KB
Chapter 5 Final publisher's version, 990 KB
Chapter 6 Final publisher's version, 727 KB
Chapter 7 Final publisher's version, 671 KB
Appendices Final publisher's version, 2,1 MB
Complete dissertationFinal publisher's version, 4,14 MB
PropositionsFinal publisher's version, 18,4 KB

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title = "START-ing Risk Assessment and Shared Care Planning in Out-patient Forensic Psychiatry: Results from a cluster randomized controlled trial",

abstract = "The prevention of future violent behaviour is the main aim of forensic psychiatric treatment. Structured risk assessment instruments are commonly used to determine which clients are in need of which treatment and/or supervision. However, there is very limited support for their use as a method for violence prevention. Establishing and maintaining client motivation for treatment is and additional challenge in forensic psychiatry. Both theories and research in other settings suggest that Shared Decision Making (SDM) could be helpful in this respect. Therefore, this thesis examines the effect of an intervention combining structured risk assessment with SDM on levels of recidivism and client functioning and well-being. The Risk Assessment and Care Evaluation (RACE) study was conducted in out-patient forensic psychiatry. Clients improved significantly over time, both in levels of recidivism (which went down) and in well-being and functioning (which went up). However, none of the improvements could be attributed to the intervention. Thus there is currently very limited support for the use of risk assessment instruments as a way of violence prevention. Nor can the changing of treatment policies by introducing the systematic use of structured risk assessment in clinical care be either advocated or opposed at this time. However, the evidence base is limited to 4 studies, including this one. Therefore, investigations of the benefits of risk assessment instruments and their contribution to more effective treatment interventions in terms of reduction of criminal and violent behaviour and ways in which to involve clients more in their treatment are necessary.",

author = "Nadine Troquete",

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T2 - Results from a cluster randomized controlled trial

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N2 - The prevention of future violent behaviour is the main aim of forensic psychiatric treatment. Structured risk assessment instruments are commonly used to determine which clients are in need of which treatment and/or supervision. However, there is very limited support for their use as a method for violence prevention. Establishing and maintaining client motivation for treatment is and additional challenge in forensic psychiatry. Both theories and research in other settings suggest that Shared Decision Making (SDM) could be helpful in this respect. Therefore, this thesis examines the effect of an intervention combining structured risk assessment with SDM on levels of recidivism and client functioning and well-being. The Risk Assessment and Care Evaluation (RACE) study was conducted in out-patient forensic psychiatry. Clients improved significantly over time, both in levels of recidivism (which went down) and in well-being and functioning (which went up). However, none of the improvements could be attributed to the intervention. Thus there is currently very limited support for the use of risk assessment instruments as a way of violence prevention. Nor can the changing of treatment policies by introducing the systematic use of structured risk assessment in clinical care be either advocated or opposed at this time. However, the evidence base is limited to 4 studies, including this one. Therefore, investigations of the benefits of risk assessment instruments and their contribution to more effective treatment interventions in terms of reduction of criminal and violent behaviour and ways in which to involve clients more in their treatment are necessary.

AB - The prevention of future violent behaviour is the main aim of forensic psychiatric treatment. Structured risk assessment instruments are commonly used to determine which clients are in need of which treatment and/or supervision. However, there is very limited support for their use as a method for violence prevention. Establishing and maintaining client motivation for treatment is and additional challenge in forensic psychiatry. Both theories and research in other settings suggest that Shared Decision Making (SDM) could be helpful in this respect. Therefore, this thesis examines the effect of an intervention combining structured risk assessment with SDM on levels of recidivism and client functioning and well-being. The Risk Assessment and Care Evaluation (RACE) study was conducted in out-patient forensic psychiatry. Clients improved significantly over time, both in levels of recidivism (which went down) and in well-being and functioning (which went up). However, none of the improvements could be attributed to the intervention. Thus there is currently very limited support for the use of risk assessment instruments as a way of violence prevention. Nor can the changing of treatment policies by introducing the systematic use of structured risk assessment in clinical care be either advocated or opposed at this time. However, the evidence base is limited to 4 studies, including this one. Therefore, investigations of the benefits of risk assessment instruments and their contribution to more effective treatment interventions in terms of reduction of criminal and violent behaviour and ways in which to involve clients more in their treatment are necessary.

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CY - [S.l.]

ER -

START-ing Risk Assessment and Shared Care Planning in Out-patient Forensic Psychiatry: Results from a cluster randomized controlled trial

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