Using expert interviews and evaluations of clinical reports for developing a structured clinical assessment instrument for forensic psychiatric patients

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Over decades, a growing number of offenders have been institutionalised in forensic mental hospitals. Patients prospects of discharge into the community are largely dependent on the perceived risk of reoffending outside the institution. There is a variety of risk assessment instruments available, but it has not been investigated which aspects of a patients condition and behaviour are crucial for the therapists appreciations. Also, most established risk assessment instruments are not very helpful in capturing subtle progress and change in patients problem behaviour. In the project suggested, an economic structured assessment instrument shall be developed, grasping the criteria most relevant in the view of experienced therapists. For that purpose, 100 interviews with staff in forensic hospitals shall be conducted. Interviews shall focus facets of patients conditions, behaviour and attitudes which appear prognostically relevant to the therapists. Also, each therapist will be asked to provide one anonymised report written for the court which is finally deciding about a patients discharge. Based on the content analysis of interviews and reports, a list of around 100 statements shall be drafted as a basis of the instrument to be developed. Interview partners are asked to review the preliminary list of statements and to mark items appearing inadequate. The edited item list will be used for a first assessment of 200 patients, one hundred of them in forensic mental hospitals (Art 63 of the penal code), one hundred in forensic addiction treatment units (Art 64 of the penal code). Each interview partner will be asked to assess two patients, and each patient shall be assessed by another staff member familiar with the patient. Thus, a total number of 200 patients will be assessed independently by two staff members. Assessors will also be asked to rate the patients general prospect of discharge and the risk of subsequent offences on simple rating scales.Explorative factor analysis will be used to identify the latent content structure of the preliminary assessment instrument and scale analysis for additional item selection. Analyses will be computed in the total sample as well as in subsamples. A shortened version of the assessment instrument shall be used for another assessment of the same group of 200 patients 6 to 9 months later. The mentioned statistical procedures are applied again.The dimensions of the resulting assessment instrument will be critically discussed with regard to the base of knowledge about factors predicting relapse vs. social integration. A considerable gap between this knowledge base and the instruments dimensionality may indicate problems of patients assessments in clinical practice. A good fit may confirm the questionnaire as a useful additional rating instrument, adequate for an economic dimensional assessment of prognostically relevant criteria.