Implementing a Violence Risk Screening Protocol in a Civil Psychiatric Setting: Preliminary Results and Clinical Policy Implications
- 345 Downloads
Comprehensive violence risk assessment can require substantial time and resources, which may be challenging for an already strapped public mental health system. Herein, we describe a naturalistic study of the Fordham Risk Screening Tool (“FRST”), a violence risk screening instrument designed to quickly identify individuals for whom thorough violence risk assessment would be advisable. All patients admitted to one of three state hospitals during the study period received FRST screening and HCR-20V3 risk assessment. The FRST reliably and accurately identified individuals deemed high risk by the HCR-20V3. The implications of these findings, and the broader clinical policy choices are reviewed.
KeywordsViolence Risk assessment Screening Triage
Compliance with Ethical Standards
Conflict of interest
Neither author has a financial or non-financial conflict of interest to disclose.
Because this study was implemented as a pilot project to improve the accuracy and quality of violence risk assessments, all data were extracted from the electronic medical record, without any identifying information. The study was reviewed and approved by the Institutional Review Board of the New York State Office of Mental Health/Nathan Kline Institute.
The study was granted a waiver of informed consent by the IRB.
- Bjørkly, S., Hartvig, P., Heggen, F. A., Brauer, H., & Moger, T. A. (2009). Development of a brief screen for violence risk (V-RISK-10) in acute and general psychiatry: An introduction with emphasis on findings from a naturalistic test of interrater reliability. European Psychiatry, 24(6), 388–394.CrossRefPubMedGoogle Scholar
- Douglas, K. S., Hart, S. D., Webster, C. D., & Belfrage, H. (2013). HCR-20 V3: Assessing risk for violence: user guide. Burnaby: Mental Health, Law, and Policy Institute, Simon Fraser University.Google Scholar
- New York State/New York City Mental Health-Criminal Justice Panel Report and Recommendations. (2008). Retrieved from http://www.criminaljustice.ny.gov/pio/mh-cjreport.pdf.
- Pinals, D., & Mossman, D. (2012). Evaluation for civil commitment. Oxford: Oxford University Press.Google Scholar
- Rosenfeld, B., Foellmi, M., Howe, J., & Rotter, M. (2013). Development and validation of the Bronx Risk Screening Tool (BRST). In Paper presented at the 12th annual meeting of the International Association of Forensic Mental Health Services, Maastricht, Netherlands.Google Scholar
- Rosenfeld, B., Foellmi, M., Khadivi, A., Wijetunga, C., Howe, J., Nijdam-Jones, A., … Rotter, M. (2017). Determining when to conduct a violence risk assessment: development and initial validation of the Fordham Risk Screening Tool (FRST). Law and Human Behavior, 41(4), 325.CrossRefPubMedGoogle Scholar
- Soulier, M. F., Maislen, A., & Beck, J. C. (2009). Status of the psychiatric duty to protect, circa 2006. The Journal of the American Academy of Psychiatry and the Law, 38(4), 457–473.Google Scholar
- Steadman, H. J., Mulvey, E. P., Monahan, J., Robbins, P. C., Appelbaum, P. S., Grisso, T., … Silver, E. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 55(5), 393–401.CrossRefPubMedGoogle Scholar
- Testa, M., & West, S. G. (2010). Civil commitment in the United States. Psychiatry (Edgmont), 7(10), 30.Google Scholar
- Torrey, E. F., Kennard, A. D., Eslinger, D., Lamb, R., & Pavle, J. (2010). More mentally ill persons are in jails and prisons than hospitals: A survey of the states. Arlington, VA: Treatment Adv.Google Scholar