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

几十年来，越来越多的罪犯被送进法医精神病院。患者出院进入社区的前景在很大程度上取决于在机构外再次犯罪的感知风险。有各种各样的风险评估工具可用，但还没有调查患者病情和行为的哪些方面对治疗师的评价至关重要。此外，大多数已建立的风险评估工具在捕捉患者问题行为的细微进展和变化方面帮助不大。在建议的项目中，应开发一种经济结构化评估工具，掌握经验丰富的治疗师认为最相关的标准。为此，应对法医医院的工作人员进行100次面谈。面谈应集中于与治疗师有关的患者状况、行为和态度的各个方面。此外，每位治疗师将被要求提供一份匿名报告，供最终决定患者出院的法院使用。在对访谈和报告进行内容分析的基础上，应起草一份约100项声明的清单，作为拟定文书的基础。面试伙伴被要求审查初步陈述清单，并在似乎不充分的项目上打上记号。编辑后的项目清单将用于对200名患者的首次评估，其中100人在法医精神病院(刑法第63条)，100人在法医戒毒所(刑法条)。每个面谈伙伴将被要求评估两名患者，每个患者应由另一名熟悉患者的工作人员评估。因此，总共200名患者将由两名工作人员独立评估。评审员亦会被要求以简单的评分表对病人的一般出院前景和再犯法的风险进行评分，并会使用探索性因素分析来确定初步评估工具的潜在内容结构，并会使用量表分析以选择额外的项目。分析将在总样本和子样本中计算。在6至9个月后，对同一组200名患者进行另一次评估时，应使用简化版评估工具。将再次应用上述统计程序。将根据预测复发与社会融合的因素的知识基础，批判性地讨论所产生的评估工具的维度。这一知识基础和工具维度之间的相当大的差距可能表明临床实践中患者评估的问题。一个很好的匹配可能会确认问卷是一个有用的额外评级工具，足以对预测相关标准进行经济层面的评估。

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.