The practice of violence risk assessment in Spain

Background. Violence risk assessment is a key requirement in professional decision making involving prevention, intervention or reporting on human behavior. The use of structured tools for violence risk assessment has shown to improve the accuracy of assessments based exclusively on clinical judgment or expertise in psychiatric, correctional and legal settings. Objectives. This study presents results of the first survey about professional practices associated with tools for violence risk assessment in Spain. Materials and methods. The information was collected by administering an online-based survey that was distributed by e-mail to members of professional organizations around the country. Results. As in professional contexts worldwide, the Robert Hare’s psychopathy scales (Psychopathy Checklist-Revised and Psychopathy Checklist: Screening Version) and the Historical-Clinical-Risk Management-20 topped the list of the most used tools both by professional choice and institutional requirement. Conclusions. We provide novel data on the prevalence of use and the perceived utility of specific tools, as well as on other issues related to the professional practice of violence risk assessment in Spain, which can guide professional in the health care, correctional and forensic settings, as well as those responsible for decisions in institutions about choosing which tool to implement.Facultad de Ciencias Médica

The practice of violence risk assessment in Spain

Background. Violence risk assessment is a key requirement in professional decision making involving prevention, intervention or reporting on human behavior. The use of structured tools for violence risk assessment has shown to improve the accuracy of assessments based exclusively on clinical judgment or expertise in psychiatric, correctional and legal settings. Objectives. This study presents results of the first survey about professional practices associated with tools for violence risk assessment in Spain. Materials and methods. The information was collected by administering an online-based survey that was distributed by e-mail to members of professional organizations around the country. Results. As in professional contexts worldwide, the Robert Hare’s psychopathy scales (Psychopathy Checklist-Revised and Psychopathy Checklist: Screening Version) and the Historical-Clinical-Risk Management-20 topped the list of the most used tools both by professional choice and institutional requirement. Conclusions. We provide novel data on the prevalence of use and the perceived utility of specific tools, as well as on other issues related to the professional practice of violence risk assessment in Spain, which can guide professional in the health care, correctional and forensic settings, as well as those responsible for decisions in institutions about choosing which tool to implement.Facultad de Ciencias Médica

The practice of violence risk assessment in Spain

Background. Violence risk assessment is a key requirement in professional decision making involving prevention, intervention or reporting on human behavior. The use of structured tools for violence risk assessment has shown to improve the accuracy of assessments based exclusively on clinical judgment or expertise in psychiatric, correctional and legal settings. Objectives. This study presents results of the first survey about professional practices associated with tools for violence risk assessment in Spain. Materials and methods. The information was collected by administering an online-based survey that was distributed by e-mail to members of professional organizations around the country. Results. As in professional contexts worldwide, the Robert Hare’s psychopathy scales (Psychopathy Checklist-Revised and Psychopathy Checklist: Screening Version) and the Historical-Clinical-Risk Management-20 topped the list of the most used tools both by professional choice and institutional requirement. Conclusions. We provide novel data on the prevalence of use and the perceived utility of specific tools, as well as on other issues related to the professional practice of violence risk assessment in Spain, which can guide professional in the health care, correctional and forensic settings, as well as those responsible for decisions in institutions about choosing which tool to implement.Facultad de Ciencias Médica

La práctica de la evaluación del riesgo de violencia en España

La valoraci?n del riesgo de violencia es un requisito fundamental en la toma de decisiones profesionales que implican prevenir, intervenir o informar sobre la conducta de las personas. El uso de herramientas estructuradas mejora la precisi?n de las evaluaciones basadas en el juicio cl?nico en contextos psiqui?tricos, penitenciarios y jur?dicos. Este estudio presenta resultados de la primera encuesta sobre el uso de herramientas de evaluaci?n del riesgo de violencia y sobre su utilidad percibida en Espa?a. Las escalas de psicopat?a (PCL-R y PCL:SV) y el HCR-20 encabezaron la lista de las herramientas m?s usadas tanto por elecci?n personal como por requisito institucional. Se ofrecen datos novedosos sobre las pr?cticas profesionales de evaluaci?n del riesgo de violencia que pueden orientar a los profesionales que desempe?an su tarea en contextos sanitarios, correccionales y forenses, donde los instrumentos estructurados son frecuentemente usados para asistirlos en la toma de decisiones

International Perspectives on the practical application of violence risk assessment : a global survey of 44 countries

Mental health professionals are routinely called upon to assess the risk of violence presented by their patients. Prior surveys of risk assessment methods have been largely circumscribed to individual countries and have not compared the practices of different professional disciplines. Therefore, a Web-based survey was developed to examine methods of violence risk assessment across six continents, and to compare the perceived utility of these methods by psychologists, psychiatrists, and nurses. The survey was translated into nine languages and distributed to members of 59 national and international organizations. Surveys were completed by 2135 respondents from 44 countries. Respondents in all six continents reported using instruments to assess, manage, and monitor violence risk, with over half of risk assessments in the past 12 months conducted using such an instrument. Respondents in Asia and South America reported conducting fewer structured assessments, and psychologists reported using instruments more than psychiatrists or nurses. Feedback regarding outcomes was not common: respondents who conducted structured risk assessments reported receiving feedback on accuracy in under 40% of cases, and those who used instruments to develop management plans reported feedback on whether plans were implemented in under 50% of cases. When information on the latter was obtained, risk management plans were not implemented in over a third of cases. Results suggest that violence risk assessment is a global phenomenon, as is the use of instruments to assist in this task. Improved feedback following risk assessments and the development of risk management plans could improve the efficacy of health services

Het gebruik van risicotaxatie instrumenten onder SPV-en

Ons onderzoek laat zien dat gebruik van gestructureerde risicotaxatie instrumenten nog niet zo veel voorkomt onder sociaal psychiatrisch verpleegkundigen. Dit kan voor een belangrijk deel veroorzaakt zijn door het feit dat de verpleegkundigen in onze steekproef maar voor een beperkt percentage in forensische settings werkten. Binnen de algemene GGZ is gebruik van gestructureerde risicotaxatie instrumenten nog geen gemeengoed. Toch zouden deze instrumenten ook hier een belangrijke rol kunnen vervullen als methode om risico's van patiënten voor zichzelf en anderen in kaart te brengen. Vooral de START ('t Lam et al., 2009) lijkt hiervoor geschikt, omdat met dit instrument niet alleen het risico voor anderen, maar ook het risico op victimisatie, risico op zelfbeschadigend gedrag, suïcidegevaar, ongeoorloofde afwezigheid, middelenmisbruik en zelfverwaarlozing vastgesteld kan worden. Een nauwkeurige risicotaxatie leidt tot een doelgerichte behandelaanpak, zodat negatieve uitkomsten voor de psychiatrische patiënt zelf, en voor zijn omgeving, voorkomen kunnen worden

International Survey of Violence Risk Assessment Practices: Presentation of Belgian data

Objective Mental health professionals are routinely called upon to assess the violence risk presented by their patients, frequently aided by structured instruments. Though surveys of risk assessment and management have been conducted, these efforts have been largely circumscribed to individual countries and have not compared the practices of members of different professional disciplines. Method A web-based survey was developed to examine the international use of structured instruments in the violence risk assessment process across five continents and to compare the perceived utility of such instruments by psychologists, psychiatrists, and nurses. The survey was translated into nine languages and distributed to members of 59 national and international organizations following the Dillman total Survey Design method. Belgium results The Belgium sample was composed of 86 mental health professionals (69 psychologists, 12 psychiatrists, 1 nurse and 4 other professionals). Respondents had an average age of 43.93 years and 10.85 years of which was spend in practice. Over half of their time in the past 12 months was spent on clinical activities, most often in forensic hospitals followed by private practice and correctional institutions. Additional responsibilities over the past 12 months included administrative duties, teaching with comparatively little time being spent on research pursuits. Respondents reported having conducted an average of 211.68 violence risk assessment in their lifetimes, over half of which with the aid of a structured instrument. In the past 12 months, respondents conducted an average of 40.76 violence risk assessments, again over half of which using a structured instrument. Over both their lifetimes and the past 12 months, respondents reported that the instrument most commonly using in the violence risk assessment process were the: PCL-R (Psychopathy Checklist Revised; Hare 1991, 2003), the HCR-20 (Historical Clinical Risk; Webster, Douglas, Eaves, et Hart, 1997), the VRAG (Violence Risk Appraisal Guide; Quinsey, Harris, Rice et Cormier, 2006) and the SAPROF (Structured Assessment of PROtective Factors for violence risk; de Vogel, de Ruiter, Bouman, & de Vries Robbé, 2011). The PCL-R and the HCR-20 are the most used instruments. As for the perceived usefulness of these instruments by respondents, the utility for risk assessment was described as “quite useful” and “useful” for the PCL-R, HCR-20 and the SAPROF. The usefulness of the VRAG was more nuanced. To develop a violence risk management plan or implement violence risk management plan, the instruments were used less frequently, however, the HCR-20 was the instrument found most useful, followed by PCL-R and SAPROF.Les professionnels de la santé mentale sont amenés à évaluer le risque de violence présenté par leurs patients. De nombreuses méthodes d’évaluation ont été développées et implémentées dans différents pays. Toutefois, les pratiques des professionnels n’ont à ce jour pas encore été comparées. Cette enquête a été développée au plan international, afin d’identifier les méthodes d’évaluation du risque de violence et de comparer leur utilité perçue par les psychologues, psychiatres et infirmiers psychiatriques. L’enquête a été complétée par 2135 répondants provenant de 44 pays répartis dans cinq continents. Cette étude se focalise spécifiquement sur les pratiques des professionnels en Belgique concernant l’évaluation du risque de violence. Les répondants ont déclaré utiliser les instruments afin d’évaluer, gérer et superviser les risques de violence. Plus de la moitié des évaluations se fait via l’utilisation d’un instrument structuré. L’évaluation du risque de violence constitue un enjeu mondial, tout comme l’utilisation d’instruments structurés. Les 86 professionnels belges répondants ne se distinguent pas particulièrement des professionnels des autres pays